Inactive

Community nursing home facility for veterans. Looking in the Northern California catchment area. Rehabilitation Criteria. All therapy provided under this IDIQ will be individual therapy, rather than g... Community nursing home facility for veterans. Looking in the Northern California catchment area. Rehabilitation Criteria. All therapy provided under this IDIQ will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy will require pre-approval by VA before services are provided. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria. Retroactive claims will not be approved – NO EXCEPTIONS. Please consult with any member of your VA CNH Team for authorization submission instructions. Description of Rehabilitative Therapy. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment. Covered therapy services shall be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist. Nursing Home’s Responsibility for Patient Care: Duly authorized representatives of VA will provide quality oversight visits to veterans placed to assure continuity of care and to assist in the veterans’ transition back into the community. These visits do not substitute nor relieve the CNH in anyway of the responsibility for the daily care and medical/psycho-social treatment of the veteran. This care includes times when VA beneficiaries are transported away from the nursing home to necessary medical appointments. Adequate supervision, care and treatment supplies (i.e. portable oxygen, dressing supplies, etc.) must be provided by the nursing home when a veteran is transported away from the nursing home to a medical appointment. This applies to clinical appointments at the VA Medical Center and Clinics (CBOCs) as well as medical appointments in the local community. See section 17, e if prior authorization is clinically required to cover the cost of staff or contracted providers to accompany/escort the veteran to his VA or VA-authorized appointment. For ventilator-dependent veterans who are receiving care in sub-acute faculties a RN must always accompany them when leaving the facility for appointments; the RN must be able to maintain the veteran’s airway and provide for a safe experience while away from the sub-acute facility. Private Room: Beneficiaries or their representatives may elect to pay separately for a private room. If a private room is requested, the VA beneficiary shall be obligated to pay the difference between the standard rate and the private room rate. This agreement should be in writing between the facility and the beneficiary or their legal representative, with a copy to the COR. If the contractor elects to place a VA beneficiary in a private room without a formal request, then the VA is only obligated to pay the rate for the beneficiary’s current level of care under the terms of this contract. Termination of Services. VA reserves the right to remove any or all VA patients from the CNH at any time when it is determined to be in the best interest of VA or the patients without additional costs to the Government or the Veteran. VA Authorizations. Authorization for nursing home care will be provided to the CNH and it will list the CNH’s DBA name, dates authorized (please note the end date is the date of discharge and non-payable) and the CNH’s Tax-ID. Authorization for nursing home care will be provided to the CNH on VA Form 10-7080. Each authorization validity period will be noted on the VA Form 10-7080 with a beginning and end date. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7080 and must be received prior to services being rendered. Primary Medical Coverage. The assigned CNH provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders as soon as the veteran arrives at the CNH. The CNH provider is responsible for general medical care, urgent evaluation and intervention. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines. The assigned nursing home provider will provide timely care following the most current CMS guidelines; arranging 24/7 access for patient care; arranging easy access to VA staff for consultation; providing timely response to calls and arranging for timely provider back-up according to OBRA guidelines (42 CFR 483.40, OBRA Guidelines). Provider visits: As indicated in Section C, 1 above - Primary care physician visits are required to take place at a minimum of one (1) per month. These visits are included as part of the per diem reimbursement rate, and in no case, are to be billed separately or billed to the patient or his/her family/representative. If a patient’s condition requires specialty medical evaluation and treatment (i.e., Infectious Disease) that specialty care can be provided by the VA via submitting a request to the CNH program. The CNH program will review the request and enter a consult for the requested specialty care. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices shall be observed throughout the facility. The CNH will address employee and patient safety practices through staff orientation, training and adherence to related policy or procedures to provide a safe and clean environment. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran’s Belongings or Personal Effects. VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility, as determined and authorized by VA. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA notification must be performed within 72 hours of admission of the patient to a non-Federal facility and notice of any veteran death within 24 hours or immediately on the first business day after a weekend or holiday by faxing the approved form to the fiscally responsible VA Medical Center. Hospitalizations: If the CNH facility is requesting bed hold reimbursement the request must be submitted immediately, but no later than 48 hours after the patient left the facility. Requests submitted after 48 hours may not be approved. Hospitalization Bed Holds are approved at five (5) days maximum per episode and can be renewed up to 15-days maximum when in the best interest of the Veteran and the VA. Bed hold extensions beyond 15-days are considered on a case by case basis. The patient must present with significant clinical acuity along with limited placement options to be considered for review. Additional review by the NCHCS GEC Associate Chief of Staff may be warranted but not required. Therapeutic Leave/Home Visits: Bed holds for Therapeutic Leave/Home Visits may be authorized by the CNH Program Coordinator based on individual patient needs and safety. They are generally limited to two (2) times per month, four (4) days total per month and must be pre-approved. Please note the word generally, as it is not exact and there is flexibility; discuss with CNH Program Coordinator. Retroactive requests for Therapeutic Leave/Home Visits authorizations will be denied. Background. Introduction. The Community Nursing Home (CNH) program is a key component of the Veterans Health Administration (VHA) continuum of care. The Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs Northern California Health Care System, in Yuba City, California at the prices specified in the section titled Schedule of Items of this IDIQ. Nursing home facilities in the CNH program shall cooperate with VA staff in referral of appropriate veterans for care and accept veterans of which they have the capability/capacity to care. The term, “facilities,” shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas where patient medical/psycho-social care and well-being is provided for. VA shall have the right to inspect the CNH and all appurtenances by authorized VA representative(s) to ensure that acceptable standards are maintained and that the necessary care to maintain the well-being of the patient is rendered. CNH Hospice Coverage: Reimbursement for inpatient CNH hospice care requires pre-authorization. Approval will only be considered for established VA patients who meet hospice clinical criteria, are enrolled in hospice services, and in conjunction with VA provider review and concurrence. This level of coverage is limited to a 6-month period of time after which additional VA Provider review and re-certification will be required for additional coverage approval. It is the responsibility of the CNH facility to request coverage extensions beyond the initial 6-months. It is also the responsibility of the CNH facility to notify the designated VA official of any patient hospice care disenrollment. A grace period of up to 30-days maximum will be provided for patients who no longer desire hospice care or meet hospice criteria to aid in their transition home or to apply for additional/alternative coverage. Rehabilitation therapy or other ancillary services for restorative purposes will not be approved while patient is under hospice coverage. VA Health Care System Consultation/Resources. Pre-Authorizations: All pre-authorization requests should be faxed to 916-640-8094, the VA Northern California Health Care System Community Nursing Home Program. If the Veteran being considered for admission is enrolled at a different VA Health Care System, the CNH will need to receive pre-auth from that VA Health Care System. Telephone Care Communications Systems (TCCS): For urgent, same-day, outpatient, specialty care or for non-urgent scheduled clinic appointments/consultations, phone (800) 382-8387. between 7 a.m. and 7 p.m. Monday through Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible. After hours, weekends and holidays: Registered nurses are available to provide enrolled veterans with free, confidential health questions 24 hours a day, 7 days a week through our toll-free telephone care program, at (800) 382-8387. Transportation: Medically necessary transportation to and from VA medical appointments will be authorized by the paying VA Healthcare System. Travel can only be arranged for authorized CNH patients and only when requested by the CNH facility with at least 72 business hours advanced notice. For initial transportation requests, contact the CNH Program Registered Nurse. Charitable Contributions. The CNH will not solicit contributions, donations, or gifts from patients or family members. Note: Established charitable fundraising activities of a CNH fall outside the scope of this language. CNH Billing. Invoices for IDIQ care and ancillary services shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. Items not pre-authorized will not be processed. The CNH will promptly notify the VA CNH Program Coordinator regarding any change in Veteran status: discharge, transfer, against medical advice (AMA), hospitalization, death (use form titled Nursing Home Notification of Discharge or Death and fax to CNH Program) and/or any changes in payer source and any inability to complete timely billing. All invoices must include the full name and address of the CNH and shall reflect the patient’s name, social security number, number of days billed, and agreed upon rate (s). Failure to include this information may result in delayed payment. The current CNH Billing Cover Sheet can be obtained from the VA Fee Basis/Purchased Care Department. Pre-approves services billed by CMS procedures or CPT codes: All VA pre-approved services, which are provided in addition to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes. The CNH will be reimbursed based on local guidelines and VA pricing schedules as authorized by the VA. High cost drugs: Medications, which comprise more than 8.5% of the monthly per diem rate, will be reimbursed to the CNH at the Average Wholesale Price (AWP) of each drug. The VA Health Care System Community Nursing Home Program COR will request the VA Pharmacy department provide the AWP for each drug, based on the National Drug Code (NDC) and the CNH will be reimbursed at the AWP or be reimbursed at what the CNH bills, whichever is less. Supplies used in conjunction with the administering of medications will be authorized, if clinically appropriate. All calculations will be made monthly. When a high cost drug patient is identified, VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medication by the VA. It is recommended that the accepting CNH request sufficient quantities of medication from the institution that the patient is being transferred from for the convenience and the ease of transition of the patient. Invoice Correction: Corrected invoices must be submitted for additional payment of any VA pre- authorized ancillary costs or changes to the original billing. Items not pre-authorized will not be processed. All corrected invoices must include all items that are affected by the change. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this IDIQ. No obligation will be incurred by VA under this IDIQ, until authorizations are issued for nursing home care of specific beneficiaries. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the CNH as outlined in this IDIQ. VA will make payment for the day a recipient enters the CNH but not the day the recipient leaves a CNH unless entrance and departure are on the same day, then payment will be made for one (1) day.