Inactive

This is not a solicitation announcement. This is a sources sought notice only. The purpose of this synopsis is to gain knowledge of potential qualified sources and their size classification (HUBZone, ... This is not a solicitation announcement. This is a sources sought notice only. The purpose of this synopsis is to gain knowledge of potential qualified sources and their size classification (HUBZone, 8(a), small business, small disadvantage, veteran owned, women owned or service- disabled veteran owned small business relative to NACIS 623110 - Nursing Care Facilities (Skilled Nursing Facilities) $34 Million, PSC: Q402 Medical- Nursing Home Care Contracts. Responses to this notice will be used by the Government to make appropriate acquisition decisions. After review of the responses to this sources sought notice, a solicitation announcement may be published in Contracting Opportunities website. Responses to this source sought notice are not considered adequate responses to the solicitation announcement. All interested offerors must respond to the solicitation announcement in addition to responding to this sources sought notice. The Veterans Affairs, Network Contracting Office, is seeking sources to provide the following service for VA Greater Los Angeles Healthcare System (VAGLAHS) , VA Long Beach Healthcare System (VALBHS), VA Loma Linda Healthcare System (LALLHS) and VA San Diego Healthcare System (VASDHS). If you are interested, and capable of providing the required services, please provide the requested information as indicated below. Response to this notice should include company name, address, phone number, Unique Entity ID (UEI), point of contact, size of business pursuant to the following questions: (1) Is your business small (2) If small, does your firm qualify as a small, emerging business, or small disadvantaged business? (3) If disadvantaged, specify under which disadvantaged group and if your firm is certified under Section (8(a) of the Small Business Act? (4) Is your firm a certified HubZone firm? (5) Is your firm a woman-owned or operated business? (6) Is your firm a certified service-disabled veteran owned small or veteran owned small business? (7) Capability statement that addresses the organization s qualifications and ability to perform as a contractor specifically for the work described in the attached DRAFT excerpt of the Performance Work Statement (PWS). Respondents are also encouraged to provide specific examples (e.g. contract number, point of contact information) of the Contractor s experience providing the same or similar services to that described in the attached DRAFT PWS. Capability statement shall specify the following item: Have you been a Prime Contractor in providing Nursing home facilities in the Community Nursing Home (CNH) program described in in the Draft PWS below?  If so, please provide detailed information describing the services you provided, where these services were provided. If these services were provided under contract, identify the organization for whom you provided these services and provide the contact information for someone from that organization who can verify your contract with that organization. Responses to this notice shall be e-mailed to the attention of Ben Bayoneta at: benjumar.bayoneta@va.gov. Telephone responses will not be accepted. Responses must be received in writing no later than 12:00PM PST on Thursday August 24, 2023. This notice is to assist the VA in determining sources only. A solicitation is not currently available. If a solicitation is issued it will be announced later, and all interested parties must respond to that solicitation announcement separately from the responses to this announcement. Responses to this sources sought is not a request to be added to a prospective bidders list or to receive a copy of the solicitation. PLEASE see below DRAFT Performance Work Statement (PWS) for details. 1. INTRODUCTION 1.1 The Community Nursing Home (CNH) program is a key component of the Veterans Health Administration (VHA) continuum of care under authority 38 U.S. Code § 1720. The Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs, California Veterans Administration Health Care System, in the following approximate geographic areas: Southern California 1.2 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. 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. 1.3 The contractor is required to follow Medicare/Medicaid standards for all VA placements. Medicare and Medicaid clinical and program standards are found in 42 CFR Part 483 2. SCOPE 2.1 Nursing home care will be furnished to ensure the total medical, nursing, and psycho-social needs of VA beneficiaries. The nursing home shall ensure that care meets the health needs and promotes the maximum well-being of VA patients. Physician visits, laboratory, x-ray, and other special services for VA patients will be at the same frequency as that provided to other patients at the nursing home receiving the same or comparable level of care. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA authorized level of care, without extra charge. All therapy services will be provided by a licensed professional staff and follow the Medicare regulation and procedures of progress toward identified goals. The per diem rate(s) established in this contract will include the cost of primary medical care, geriatric psychiatric consultation, drugs and routine supplies, laboratory, x ray, basic durable medical equipment and other special services authorized by VA, unless otherwise specifically accepted. 2.2 Full attention shall be given to motivating and educating patients to achieve and maintain independence in the activities of daily living, to the maximum extent possible. Every effort shall be made to keep patients ambulatory and to achieve an optimal level of self-care. 2.3 The nursing home shall accept referral of and shall provide all services specified in this contract for any person determined eligible by the VA Under Secretary for Health or his/her designee, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. In addition, the nursing home warrants that subcontracting will not be resorted to as a means of circumventing this provision. Additionally, the nursing home shall not maintain nor provide dual or segregated patient facilities which are segregated on the basis of race, creed, color, or national origin. The nursing home shall neither require such segregated use by written or oral policies, nor tolerate such use by local custom. The term facilities shall include but not be limited to rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas. 3. PERIOD OF PERFORMANCE: In accordance with FAR 16.504, This is an Indefinite Delivery Indefinite Quantity (IDIQ) contract for a five (5) year period. 4. REQUIREMENTS 4.1 Level of Care: The contractor shall provide one or more specific levels of care defined in the following paragraphs. Level of care determinations are based on the VA Resource Utilization Groups (RUGS-IV) case-mix, the industry standard. See 42 CFR Parts 411 and 489. A case-mix system categorizes patients into groups according to their level of care needs. RUGS-IV, like other case-mix systems, defines patients for clinical and reimbursement purposes. 4.2 Respite Care: This level of care is designed to provide short term, not to exceed 30 days per calendar year, services for veterans with chronic illness not in need of acute care services and who are not better accounted for in the RUG case mix. This is designed to provide temporary relief to the primary care giver to help the veteran to continue residing in their primary residence. It is designed to accommodate referrals with minimum care needs. Respite will be reimbursed based on RUG case-mix system; in the event a RUG is not completed by the contractor the lowest RUG will be reimbursed: Reduced Physical Function. 4.3Reduced Physical Function: Residents whose needs are primarily for support with activities of daily living and general supervision. Calculations identify residents who are receiving restorative nursing services as recorded on the MDS and include: urinary and/or bowel training program, passive and/or active range of motion, amputation/prosthesis, training, splint, or brace assistance, dressing or grooming training, eating, or swallowing training, transfer training, bed mobility and/or walking training, communication training. For this contract we require an ADL dependency of 3 or more. 4.4 Behavioral Symptoms and Cognitive Performance: Residents satisfying the following two conditions: Having a maximum ADL dependency score of 5 or less. Having behavioral or cognitive performance symptoms, involving any of the following: difficulty in repeating words, temporal orientation, or recall (score on the Brief Interview for Mental Status <=9), difficulty in making self-understood, short term memory, or decision making (score on the Cognitive Performance Scale >=3), hallucinations, delusions, physical behavioral symptoms toward others, verbal behavioral symptoms toward others, other behavioral symptoms, rejection of care, or wandering. 4.5 Clinically Complex: Residents receiving complex clinical care or have conditions requiring skilled nursing management, interventions or treatments involving any of the following: pneumonia, hemiplegia with ADL dependency score of 5 or more, surgical wounds or open lesions with treatment, burns, chemotherapy while a resident, continuous flow oxygen therapy while a resident, IV medications while a resident, or transfusions while a resident. 4.6 Special Care High: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 3 or more, exceptions based on clinical need and review. Receiving complex clinical care or have serious medical conditions involving any one of the following: comatose, septicemia, diabetes with insulin injections and insulin order changes, quadriplegia with a higher minimum ADL dependence criterion (ADL score of 5 or more), chronic obstructive pulmonary disease (COPD) with shortness of breath when lying flat, fever with pneumonia, vomiting, weight loss, or tube feeding meeting intake requirement, or respiratory therapy. 4.7 Extensive Services: Residents satisfying the following two conditions: Having a minimum ADL dependency score of 3 or more, exceptions based on clinical need and review. While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation. 4.8 Rehabilitation: Residents receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. Therapy must be ordered by a licensed physician or designee for a specific period of time, not to exceed one month or as clinically indicated. Therapy extensions may be approved by a designated VA Contract Nursing Home team member, Veteran will need to participate in enough rehab minutes to qualify for a category 2 rehabilitation RUG. Rehabilitation services will not be reimbursed without a rehab approval. 4.9 Rehabilitation Plus Extensive Services: Residents satisfying all the following three conditions: Having a minimum activity of daily living (ADL) dependency score of 3 or more, exceptions based on clinical need and review. Receiving physical therapy, occupational therapy, and/or speech-language pathology services while a resident. Therapy extensions may be approved by a designated Contract Nursing Home team member, Veteran will need to participate in enough rehab minutes to qualify for a category 2 rehabilitation RUG. Rehabilitation services will not be reimbursed without a VA rehab approval. While a resident, receiving complex clinical care and have needs involving tracheostomy care, ventilator/respirator, and/or infection isolation. Rehabilitation services will not be reimbursed without a rehab approval. 5. RATE DETERMINATION: 5.1 The per diem rate is established by the current Medicare rate for Medicare approved nursing homes to cover the cost of supplies, services, and equipment above that provided under Medicare established by the local state Medicare agency (CMS). Rates established after the effective date of this contract will constitute a modification to the contract. 5.2 VA will use the Medicare rates for semiprivate room, board, and routine nursing care. 5.3 For all levels of nursing care, the negotiated per diem rate includes routine ancillary services/ supplies, such as drugs, nursing supplies, oxygen (occasional use), x-ray, laboratory, physician visits, geriatric psychiatric consultations, and basic medical equipment rental. 5.4 Special equipment, e.g., clinitron bed and wound vac are not considered routine ancillary services (and may be provided by the VA or pre-approved by the VA as a line item for rental on invoice). 5.5 High drug costs which comprise more than eight and one-half percent (8.5%) of the per diem rate are generally not considered routine ancillary supplies (and may be provided by the VA or preapproved by the VA as a line item). When a high-cost drug patient is identified the nursing home staff are responsible for notifying the VA and requesting a line-item reimbursement for high dollar medication via 30 day cost out. VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medications by VA. 5.6 Rehabilitation therapies will be provided as a distinct level of care. Rehabilitation visits will be authorized by VA based on actual services provided and typically in 30 day increments or as clinically indicated pre-approved increments. Therapy extensions may be approved by a designated VA Contract Nursing home team member, Veteran will need to participate in enough rehab minutes to qualify for a category 2 rehabilitation RUG. Rehabilitation services will not be reimbursed without a rehab approval. 5.7 Hospice Care and Dialysis are not included in the rate. VA or other payers may be used for Hospice and Dialysis, as determined by the veteran with VA approval. Hospice and Dialysis services are billed and authorized separately. 5.8 The per diem rate(s) will apply throughout the term of this agreement, including extension period(s). The rate(s) may be adjusted upon review. 6. Economic Rate Adjustments: 6.1 Rate adjustments may be requested by either the VA or the Contractor s authorized Community Nursing Home (CNH) representative during the term of this IDC. Adjustments will occur no more frequently than those issued by the CMS. Normally, this will be in conjunction with the annual Option renewal review. 6.2 Request for Rate adjustments must be accompanied by a justification for consideration by the Contracting Officer. No adjustments will be made until the Contracting Officer receives a CMS authenticated copy of the new rate, signed, and dated in a conspicuous area at the top right of the document by the authorized nursing home official. 6.3 If approved, the contract must be modified and signed by both the Contractor and the VA Contracting Officer. The effective date of the rate adjustment will be the actual Effective Date as indicated on the IDC or the modification. 6.4 Level of Care Classification Effective Records: The level of care classification and associated per diem rate will remain in effect for each placement until and unless one of the following events takes place: 6.4.1 Veteran triggers a significant clinical change, which includes but is not limited to: start or stop of therapy, increased clinical needs such as oxygen, injectables or increased activity of daily living assistance. 6.4.2 The recipient is discharged and subsequently qualifies for a new admission assessment. 7. ANCILLARY COSTS: Ancillary costs are pre-approved costs for supplies or services not identified as included in the all-inclusive rate or any other pre- authorized rate or schedule or payment for items or services provided under this agreement. Ancillary costs such as high dollar medications, and special equipment, may not be added to any invoice without written permission of the VA medical center placing the veteran, it is the responsibility of the contracted nursing facility to notify the CNH program an ancillary cost has been identified. If permission is received, the nursing home must also submit the physician's order for the medication/supply, the dispensing log, the supplier, and the cost charged by the supplier to the nursing home, and what the nursing home is charging the VA. 8. MEDICATIONS: High dollar medications, which comprise more than 8.5% of the per diem rate on a monthly basis, are excluded from that rate. High drug costs will be determined or priced using the Average Wholesale Price (AWP) of the drugs or the nursing home contracted pharmacy, plus a transaction fee, not to exceed 3% per month, to cover providers actual cost. All calculations will be made monthly and reviewed by the VA to confirm cost, level of care, and dates of admission. When a high-cost drug patient is identified the nursing home staff are responsible for notifying the VA and completing a high dollar request form requesting a line-item reimbursement for high dollar medication. VA staff must be advised promptly to establish an appropriate course of action, which may include the provision of the medications by VA. 9. Specialized Prosthetics Equipment (e.g., special bed and/or bariatric equipment: Veterans may be eligible for specialized equipment when clinically indicated. The contracted nursing facility is responsible for notifying the CNH program when specialized equipment is clinically indicated. Pre-approval required by VA. 10. 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). The provider must be an active licensed independent practitioner. 11. Rehabilitation Criteria. All therapy provided will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility. Therapy may require pre-approval by VA before services are provided, Veterans receiving therapy will need to generate enough therapy minutes to generate a category 2 rehab RUG. 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. 12. 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 (recipient must participate in enough therapy minutes to trigger a category 2 rehabilitation RUG) unless they meet the criteria for maintenance therapy requiring the skills of a therapist. 13. Evaluations/re-evaluations should consider the following: Establishment of treatment goals specific to the patient s disability or dysfunction and designed to specifically address each problem identified in the evaluation; design of a plan of care addressing the patient s disorder, including establishment of procedures to obtain goals, determining the frequency and intensity of treatment; continued assessment and analysis during implementation of the services at regular intervals; instruction leading to establishment of compensatory skills; selection of devices to replace or augment a function (e.g., for use as an alternative communication system and short-term training on use of the device or system); and patient and family training to augment rehabilitative treatment or establish a maintenance program. Education of staff and family should be ongoing. 14. Transportation: 14.1 The VA can provide transportation on a as needed basis for VA appointments only, notification needs to be timely by the contract nursing home. Those patients who have family or others capable of transporting and providing supervision to the veteran in the outpatient area at the VA are encouraged to do so if indicated appropriate by contract nursing home provider. 14.2 If a veteran is sent to an outpatient appointment at the VA (or admission exam where admission is not a certainty) the nursing home must make a judgment as to whether the veteran needs physical assistance due to disability or oversight due to confusion. Some Veterans will be predesignated as needing an escort, the Nursing Home are responsible for knowing which patients require an escort. The nursing home must assure that adequate oversight is provided during the trip to the VA or while in the outpatient clinic. VA does not provide escorts. Should a Veteran require an escort, please arrange with family member or via private pay with the Veteran. Please see below for Oversight. 15. Oversight 15.1 The nursing home is responsible for complying with all the rules, policies and regulations expressed by the state in which they operate as they relate to nursing facilities providing 24 hours per day protective oversight to their residents. 15.2 Oversight can be provided by a family member, clergy person, volunteer, contracted agency or any other person who, in the judgment of the nursing home can responsibly and capably provide the necessary oversight. However, someone from the facility or a family member or volunteer must be with a resident who evidences any mental confusion or who would have a problem negotiating his/her way through the outpatient clinic process. 15.3 In the absence of any other person, the nursing facility should arrange for an escort via Veteran private pay assure protective oversight. This judgment is made by the nursing home and does not preclude dropping off a mentally alert and physically capable resident for a medical appointment or some other activity, to be picked up at a later time. 15.4 When the veteran is in the outpatient clinic at the VA, s/he still is considered a resident of the nursing facility that is thereby responsible to provide physical assistance and protective oversight. The VA s responsibility in the outpatient clinic is for treatment only. If the contracted nursing home is unable to staff protective oversight the contract nursing home is responsible for rescheduling outpatient clinic appointment to accommodate staffing. 16. Re-admission to the VA Hospital and Emergency Care; Notification of Death of Veterans; CNH Responsibility to Veteran s Belongings or Personal Effects. 16.1 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. 16.2 Veterans receiving care under this contract, who begin to require acute hospital care, will be readmitted to an appropriate VA facility, as determined, and authorized by the VA. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. VA authorization must be obtained as soon as possible and not to exceed 72 hours of admission to the non-Federal facility. If hospitalization of a non-emergency nature is required, it is agreed that readmission to a VA facility will be accomplished as soon as the patient's condition is sufficiently stabilized to permit admission to VA. 16.3 If a veteran is re-hospitalized from the nursing home, the nursing home and VA facility will arrange for a bed hold. Bed holds will not exceed 7 calendar days per episode of care to be reimbursed at the reduced physical RUG rate. Family or other responsible party must be informed of this and verification of intent to pay privately for bed holds that exceed 7 days per episode of care. 16.4 VA payment amounts for bed hold days will be lowest rate, or reduced physical rate of care. 17. Therapeutic passes: The VA may authorize a therapeutic overnight pass for long term care placements on a case-by-case situation with prior authorization from the VA. Requests need to be submitted in writing by CNH facility MD to the local authorizing VA CNH Program designee. Any excessive overnight stays will be reviewed to determine if the Veteran could live in a less restrictive setting. In the event a Veteran is allowed on an overnight pass without approval from the local authorizing VA CNH program, the CNH facility will not be paid for those days. 18. Admissions and Discharges 18.1 Patients receiving care under this contract, 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 admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained. If hospitalization of a non-emergency nature is required, it is agreed that readmission to a VA Medical Center will be accomplished as soon as the patient's condition is sufficiently stabilized to permit admission to VA. 18.2 In the event a VA beneficiary receiving nursing home care under this contract dies, the nursing home will promptly notify the VA Contract Nursing Home team. 19. VETERANS VOLUNTARILY ABSENCE 19.1 In the event a VA beneficiary receiving nursing home care under this contract decides to leave the facility, as soon as possible the nursing home will, but not to exceed 48 hours, notify the VA that the VA beneficiary has voluntarily left the facility. 19.2 In the event a VA beneficiary receiving nursing home care under this contract desires to leave the facility for 24 hours or more [excludes scheduled appointment and off-site medical treatment] on a pass, the nursing home must obtain approval from the facility provider and VA office authorizing admission BEFORE the VA beneficiary is granted a pass and allowed to leave the facility. 19.3 The nursing home is responsible for supervising VA beneficiaries housed at their facility whether the beneficiary is at the facility or has been transported to a clinic or other treatment facility, to the doctor, of the VAMC. 19.3.1 The nursing home is responsible for complying with all the rules, policies and regulations expressed by the state in which they operate as they relate to nursing facilities providing 24 hours per day protective oversight to their residents. 19.3.2 If a veteran is sent to an outpatient appointment at the VA (or admission exam where admission is not a certainty) the nursing home must make a judgment as to whether the veteran needs physical assistance due to disability or oversight due to confusion. The nursing home must assure that adequate oversight is provided during the trip to the VA or while in the outpatient clinic. 20. MEDICAL RECORDS 20.1 All medical records concerning the veteran's care in the nursing home will be readily accessible to VA. Upon discharge or death of the patient, medical records will be retained by the nursing home for a period of at least three years following termination of care. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C. 552a). A medical record shall be maintained for each patient that includes at least the following: Admission identification records Admitting evaluation (including diagnosis by nursing home physician). Physician orders. Progress notes. The physician orders/notes shall be charted immediately after patient is seen. Special reports (laboratory, x ray, activity, etc.). Minimum Data Set (MDS) information, provided to VA upon admission and every six months thereafter 21. TERMINATION OF SERVICES 21.1 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. 21.2 The authorization agreement for the affected patient will terminate whenever a VA patient is re-hospitalized for 15 calendar days or more, whether in a VA or in a non-Federal facility. A new authorization agreement will be required at the time the patient returns. 22. PAYMENTS Payments made by VA under this contract constitute the total cost of nursing home care. No additional charges will be billed to Medicare Part B, the beneficiary or his/her family, either by the nursing home or any third part furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement. The contractor will not solicit contributions, donations, or gifts from patients or family members. VA will make payment for the day a recipient enters the facility but not the day the recipient leaves a facility unless entrance and departure are on the same day then payment will be made for one day. The contractor is responsible for confirming VA approval for admission and services rendered such as but not limited to therapy and high dollar oral medications. 23. INVOICES Invoices shall be submitted promptly to the authorizing facility by the 10th calendar day following the end of the month in which services were rendered. All invoices must include the full name and address of the nursing home and shall reflect the patient's name, social security number, number of days billed, level of care category, and per diem rate. Failure to include this information and incorrect information may result in delayed payments. 24. GOVERNMENT INVOICE ADDRESS All Invoices from the contractor shall be submitted to the Contract Nursing home team designee. UB04 may be submitted electronically or via secure fax to the Contract Nursing Home designee for processing. This process is subject to change. 25. REGULATIONS 25.1 HIPAA Compliance. HIPAA compliance is required. The Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA, but VACO has recognized CNH Facilities as an entity that does not require a BAA as long as they are conducting health care ...