FILE | Q | nursing home - Attachment

FBO DAILY ISSUE OF JUNE 08, 2011 FBO #3483
DOCUMENT

Q -- nursing home - Attachment

Notice Date: 6/6/2011
Notice Type: Attachment
NAICS: 423450 — Medical, Dental, and Hospital Equipment and Supplies Merchant Wholesalers
Contracting Office: Department of Veterans Affairs;Lebanon VAMC;Acquisitions (Bldg 99);1700 South Lincoln Ave;Lebanon PA 17042-7529
ZIP Code: 17042-7529
Solicitation Number: VA24411RQ0328
Response Due: 6/20/2011
Archive Date: 8/19/2011
Point of Contact: Michael Bermes
E-Mail Address: 8-6018<br
Small Business Set-Aside: N/A
Description: Table of Contents SECTION A - STANDARD FORM (SF) 14491 A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS1 SECTION B - CONTINUATION OF SF 1449 BLOCKS3 B.1 CONTRACT ADMINISTRATION DATA3 B.2 RATE DETERMINATION4 B.3 ORAL MEDICATIONS5 B.4 PRICE SCHEDULE5 B.5 DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK6 SECTION C - CONTRACT CLAUSES10 C.1 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (FEB 2007)10 C.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)14 C.3 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)14 C.4 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)15 C.5 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008)15 C.6 ACCEPTABLE SAFETY AND SANITATION PRACTICES15 C.7 MEDICARE/MEDICAID STANDARDS15 C.8 ECONOMIC PRICE ADJUSTMENT16 C.9 TERMINATION OF SERVICES16 C.10 PAYMENTS17 C.11 MINIMUM QUANTITIES17 C.12 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)17 C.13 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (JUN 2008)17 C.14 ELECTRONIC INVOICE SUBMISSION22 SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS19 D.1 DEPARTMENT OF VETERANS AFFAIRS (VA) COMMUNITY NURSING HOME PROGRAM LEVEL OF CARE - DESCRIPTIONS19 SECTION B - CONTINUATION OF SF 1449 BLOCKS B.1 CONTRACT ADMINISTRATION DATA 1. Contract Administration: All contract administration matters will be handled by the following individuals: a. CONTRACTOR: b. GOVERNMENT: Contracting Officer 00595 Department of Veterans Affairs Lebanon VA Medical Center, Mail Code 505 1700 South Lincoln Ave, Lebanon PA 17042 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X]52.232-34, Payment by Electronic Funds Transfer - Other than Central Contractor Registration, or []52.232-36, Payment by Third Party 3. INVOICES: Invoices shall be submitted in arrears: a. Quarterly[] b. Semi-Annually[] c. Other[monthly] 4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address: Department of Veterans Affairs Lebanon VA Medical Center, Mail Code 505 1700 South Lincoln Ave, Lebanon PA 17042 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows: AMENDMENT NO DATE ______________________________ _____________ ______________________________ _____________ ______________________________ _____________ This is a basic ordering agreement for the period from 08/01/2011 to 07/31/2012, in accordance with FAR 16.7. A contract is formed, in accordance with the terms and conditions of this agreement, when VA agrees to place a patient into the nursing home which is currently listed on CCR.GOV, and the nursing home agrees to accept the patient. Upon acceptance by the contractor of beneficiaries of Department of Veterans Affairs (VA), all terms and conditions of this agreement shall apply during such time as a VA patient remains in that nursing home at the expense of VA. Upon acceptance of a VA patient by the nursing home, if and when requested by the Contracting Officer or authorized representative, the contractor shall furnish all supplies and services herein described, at the per diem rates for the levels of care specified below. VA levels of care are defined in Section D of this agreement. VA is obligated only to the extent authorized placements of patients are made under this agreement. B.2 RATE DETERMINATION 1.The per diem rate is established by the current Medicaid rate for Medicaid approved nursing homes plus a fair market amount (percentage) to cover the cost of supplies, services, and equipment above that provided under Medicaid established by the local state Medicaid agency (SMA). Rates established after the effective date of this contract will constitute a modification to the contract. Rates may be changed once during the annual continuation of the contract upon the receipt of updated Medicaid rates. Rate changes will not be paid retroactively. 2.VA will use Medicaid rates for semi-private room, board, and routine nursing care. 3.A percentage is added onto the current Medicaid rate for payment of all levels of nursing care and routine ancillary services/supplies, such as drugs, nursing supplies, oxygen (occasional use), x-ray, ECGs, Restorative Nursing Program, laboratory, physician visits, and rental equipment. No additional fees will be paid for routine care. Routine care will be provided to Veterans the same as it is provided to other Medicaid residents. 4.Special equipment, (e.g. Clinitron bed), is not considered routine ancillary services, and may be provided by the VA under a Prosthetics Consult which may be requested through the CNH RN Case Manager. 5.Monthly 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 will be reimbursed by the VA. 6.Hospice Care and Dialysis are not included in the rate. VA or other payors may be used for Hospice and Dialysis, as determined by the veteran with VA approval. 7.Therapy must be intended to improve functioning, not to maintain functioning. Rehabilitation therapies will be provided as a distinct level of care for an authorized and limited amount of time as long as the Veteran is showing progress. 8.The Rehabilitation Rate will be paid for the first seven days of a Veteran's admission in order to prevent a delay in care. Thereafter, prior to the initiation of any therapy, the CNH must provide the VA Community Specialty Services Nurse Manager with: 8.1 A complete initial assessment for each therapy which is to be performed at the CNH. The initial assessment for each therapy must be performed by a licensed therapist and may not be charged to the VA. 8.2The initial assessment for each therapy must include a list of goals expected to be accomplished by that therapy, the specific plan of therapy, and an estimate of the expected time frame needed to accomplish the goals of therapy. 8.3The initial assessment for therapy provided by the CNH will be reviewed by VA personnel and a decision regarding authorization will be made. If authorized in writing, each therapy may not exceed 4 weeks of therapy, must be provided for no less than 5 times a week, and for no less than 65 minutes per therapy session, or for a total of 325 minutes per week. 8.4 Once therapy has been authorized in writing by the VA and initiated, the CNH must provide Therapy Progress Notes. These should summarize the therapy provided, and the progress, or lack of progress, made towards the stated goals. 8.4This information shall accompany the CNH's monthly billing invoice. Without this information the additional Rehabilitation Therapy per diem rates shall not be paid. B.3 MEDICATIONS 1.Medications, which comprise more than 8.5% of the per diem rate on a monthly basis, are excluded from the per diem rate and will be reimbursed by the VA. High medication costs will be determined or priced using the Average Wholesale Price (AWP) of the medications plus a transaction fee of 3% per month. All calculations will be made on a monthly basis. 2.When a high cost drug is identified, VA staff must be advised promptly in order to establish an appropriate course of action, which may include the provision of the high cost drug by the VA. 3.All Pharmacy costs for every VA beneficiary shall be attached to the invoice when submitted. Pharmacy costs are not to be added to the monthly per diem rate total. Failure to provide information in this manner shall result in delayed payments. 4.The most recent Medication list for each Veteran will be provided to the VA in June and December when invoices are submitted. B.4 PRICE SCHEDULE STATE APPROVED MEDICAID RATE: VA APPROVED BASIC RATE: Descriptions of Care/Per Diem Rates: Reduced Physical Functioning Group: These residents have care needs primarily of activities of daily living and general supervision. RUG II Scores 12 & 13 RUG III Scores: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1 Basic, Hospice, Impaired Cognition, Behavior Problems Group: These residents have moderate ADL deficiencies, have cognitive impairment in decision-making, recall and short-term memory; hospice care. RUG II Scores: 5, 6, 9, 10, 11, 14, 15, 16 RUG III Scores: IA2, IA1, IB2, IB1, BA2, BA1, BB2, BB1 Clinically Complex Group: These residents receive complex clinical care or have conditions requiring skilled nursing management and interventions for conditions and treatments such as burns, coma, septicemia, pneumonia, foot infections or wounds, internal bleeding, dehydration, tube feeding, oxygen, transfusions, hemiplegia RUG II Scores: 7, 8 RUG III Scores: CC2, CC1, CB2, CB1, CA2, CA1 Special Care Group: These residents are moderately or highly disabled in ADLs, receive complex clinical care or have serious medical conditions such as: MS, ALS, quadriplegia, Stage III or IV pressure ulcers, radiation therapy, surgical wounds or open lesions, tube feeding and aphasia RUG II Scores: 3, 4 RUG III Scores: SE3, SE2, SE1, SSC, SSB, SSA Rehabilitation Group: These residents receive physical, speech, or occupational therapy for an authorized and limited length of time. Therapy must be pre-approved by written signature of VA Provider after submission of: 1.The most recent MDS indicating a change in level of care needs 2. An initial therapy assessment performed by a licensed therapist 3.Approval for therapy will be for a period not to exceed four weeks 4.Therapy will be provided for a minimum of 325 minutes per week 5.A copy of the summarized therapy notes and updated MDS will be sent to the VA at the end of the four weeks in order for the higher per diem rate to be paid. RUG II Scores: 1, 2 RUG III Scores: RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB, RHA, RMC, RMB, RMA, RLB, RLA B.5 DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK 1.The nursing home shall ensure that care meets the health needs and promotes the maximum well being of VA patients. Nursing Home care will be furnished to ensure that the total medical, nursing, and psycho-social needs of VA beneficiaries are met. Routine Physician visits, laboratory, x-rays, ECGs, and other services for VA beneficiaries will be at the same frequency as those provided to other Medicaid patients at the nursing home receiving the same or comparable level of care. In addition, the care provided will include semi-private room, meals, nursing care, and other services or supplies commensurate with the VA authorized level of care, without extra charge. The per diem rate(s) established in this contract will include the cost of medical care, routine ancillary services and supplies, such as drugs, nursing supplies, oxygen for occasional use, x-ray, ECGs, laboratory, physician visits, restorative nursing care, and rental equipment unless otherwise specifically excepted. 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. 3.Veterans receiving care under this agreement, who require hospital care, will be admitted 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-VA facility may be accomplished provided VA authorization is obtained. This VA authorization must be obtained as soon as possible and shall not exceed 4 hours of admission to the non-VA facility. It is further agreed that admission to a VA facility shall be accomplished as soon as the patient's condition is sufficiently stabilized to permit transfer for admission to a VA facility. 4.If a Veteran receiving care under this agreement is hospitalized from the nursing home, the nursing home and VA facility will arrange to hold a bed in reserve, when such a decision is in the best interest of the Veteran and the VA. The number of covered bed hold days shall be determined by VA on a case-by-case basis, but shall not exceed the number of bed hold days allowed by state Medicaid regulations, which is 15 days. Payment shall follow state Medicaid regulations, which is 1/3 of the Basic per diem rate. The VA facility shall include payment for these "bed hold" days only when the VA receives notification of the admission within 4 hours of the event, as noted above. 5.The VA facility will approve Therapeutic Leave days for long-term placements. The leave must be part of a written therapeutic plan of care and pre-approved by VA staff. Leave days at VA expense are limited to 6 days per calendar year. Payment will follow state Medicaid regulations, which is 100% of basic per diem rate. Exceptions may be approved by the VA facility Community Specialty Services Nurse Manager. 6.In the event a VA beneficiary receiving nursing home care under this contract dies, the nursing home will promptly notify the VA office that authorized the admission and immediately assemble, inventory, and safeguard the patient's personal effects pending further guidance by VA or the Veteran's family. Upon death of the Veteran, medical records will be retained by the nursing home for a period of at least three years following termination of care. 7.It is agreed that VA will have the right to on-site reviews of the nursing home 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 Veteran is rendered. 8.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 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. 9.Contracted Community Nursing Homes will provide the VA annually with their current and specific admission and exclusion criteria. 10.It is agreed that duly authorized representatives of VA will provide follow up supervision visits to Veterans placed to assure the continuity of care and to assist in the veteran's transition back to the community. It is understood that these visits do not substitute for, nor relieve, the nursing home in any way of the responsibility for the daily care and medical treatment of the Veteran. 11.All medical records concerning the Veteran's care in the nursing home will be readily accessible to VA. Upon discharge of the Veteran, medical records will be retained by the nursing home for a period of at least three years following termination of care. 12.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: 12.1. Admission identification record. 12.2. VA Form 10 1204, Referral for Community Nursing Home Care, or State-approved referral form. 12.3. Admitting evaluation (including diagnosis by nursing home physician). 12.4. Physician orders. 12.5. Progress notes. The physician orders/notes shall be charted immediately after patient is seen. 12.6. Special reports (laboratory, x ray, activity, etc.). 12.7. SMA Patient Assessment Form. 12.8. Minimum Data Set (MDS) information. 13.The VA beneficiary will be provided nursing home care at the expense of VA for a period not in excess of that stated in the referral form, unless an extension of the authorization is provided in writing by the placing VA facility. 14.The authorization agreement, VA Form 10-7078, for the affected Veteran will terminate whenever a VA beneficiary is 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 Veteran returns and is readmitted to the CNH. 15.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: 15.1. The VA beneficiary is discharged and subsequently qualifies for a new MDS admission assessment. 15.2 The nursing home submits a new MDS assessment that documents a change in the level of care classification. The CNH RN Case Manager will also provide documentation regarding the level of care required by the Veteran and both assessments will be considered prior to a per diem rate change. 15.3 The initial MDS will be provided to the VA upon the admission of a VA beneficiary and the er diem rate will be based upon that rating, the exception being the Rehabilitation ratings which are subject to VA written authorizations and time limitations. 15.4The most recent MDS Section Z will be submitted monthly along with the invoices. 16.VA beneficiaries admitted under contract for Respite Care will be weighed upon admission and again upon discharge. This information will be included with the invoice when submitted. 17.The VA, at its sole option, will monitor the professional care and administrative management of services provided to VA beneficiaries under this agreement, through one or any combination of the following methods; reviews of state agencies reports, on-site review of the Nursing Home by VA staff, and/or on-site monitoring of VA patients. It is agreed that the Nursing Home shall provide VA with copies of all state agency reports when requested, and cooperate fully with VA's quality improvement-quality assurance program functions relating to this agreement, including VA's on-site review and monitoring. The VA Contracting Officer, (CO), along with the Contracting Officer's Technical Representative, (COTR), shall make all final determinations as to the contractor's reasonable cooperation with VA and compliance with these requirements. It is understood that certain internal quality indicator/quality assurance information is not available for VA review. Current quality measures and current individual MDS information will be made available. 18.The CNH is responsible for complying with all the rules, policies and regulations expressed by the state in which they operate, (Pennsylvania), as they relate to nursing facilities providing 24 hours per day protective oversight to their residents. Therefore, if a Veteran is sent to an outpatient clinic appointment at the VA, (or admission exam in the VA Emergency Department), the CNH must assure that adequate oversight is provided during the trip to the VA and while the Veteran remains on the VA campus as an outpatient. This oversight may be provided by a family member, clergy person, volunteer or any other person who, in the judgment of the CNH, can responsibly and capably provide the Veteran with the necessary oversight and assistance with personal care needs. In the absence of any other person, the nursing facility shall send a staff member to assure protective oversight and assistance. When the Veteran is an outpatient on the VA campus, he is still considered a resident of the nursing facility and the nursing facility is thereby responsible to provide physical assistance and protective oversight. 19.Power of Attorney written consent must be obtained by the CNH prior to certain treatments in order for the VA to provide such treatment for VA beneficiaries deemed incompetent to provide informed consent. 20.VA reserves the right to send the Veteran back to the CNH without being seen if an escort is not provided, or a signed consent for treatment is needed and is not provided. 21.Expenses, (such as transportation costs), incurred by failure to comply will be deducted from the subsequent invoice. SECTION C - CONTRACT CLAUSES C.1 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (FEB 2007) (a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights- (1) Within a reasonable time after the defect was discovered or should have been discovered; and (2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item. (b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Government wide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract. (c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties. (d) Disputes. This contract is subject to the Contract Disputes Act of 1978, as amended (41 U.S.C. 601-613). Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract. (e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference. (f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence. (g) Invoice. (1) The Contractor shall submit an original invoice and three copies(or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include- (i) Name and address of the Contractor; (ii) Invoice date and number; (iii) Contract number, contract line item number and, if applicable, the order number; (iv) Description, quantity, unit of measure, unit price and extended price of the items delivered; (v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading; (vi) Terms of any discount for prompt payment offered; (vii) Name and address of official to whom payment is to be sent; (viii) Name, title, and phone number of person to notify in event of defective invoice; and (ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract. (x) Electronic funds transfer (EFT) banking information. (A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract. (B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer-- Central Contractor Registration, or 52.232-34, Payment by Electronic Funds Transfer--Other Than Central Contractor Registration), or applicable agency procedures. (C) EFT banking information is not required if the Government waived the requirement to pay by EFT. (2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315. (h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings. (i) Payment.- (1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract. (2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315. (3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause. (4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made. (5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall immediately notify the Contracting Officer and request instructions for disposition of the overpayment. (j) Risk of loss. Unless the contract specifically provides otherwise, risk of loss or damage to the supplies provided under this contract shall remain with the Contractor until, and shall pass to the Government upon: (1) Delivery of the supplies to a carrier, if transportation is f.o.b. origin; or (2) Delivery of the supplies to the Government at the destination specified in the contract, if transportation is f.o.b. destination. (k) Taxes. The contract price includes all applicable Federal, State, and local taxes and duties. (l) Termination for the Government's convenience. The Government reserves the right to terminate this contract, or any part hereof, for its sole convenience. In the event of such termination, the Contractor shall immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subcontractors to cease work. Subject to the terms of this contract, the Contractor shall be paid a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges the Contractor can demonstrate to the satisfaction of the Government using its standard record keeping system, have resulted from the termination. The Contractor shall not be required to comply with the cost accounting standards or contract cost principles for this purpose. This paragraph does not give the Government any right to audit the Contractor's records. The Contractor shall not be paid for any work performed or costs incurred which reasonably could have been avoided. (m) Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the Contractor, or if the Contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the Contractor for any amount for supplies or services not accepted, and the Contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience. (n) Title. Unless specified elsewhere in this contract, title to items furnished under this contract shall pass to the Government upon acceptance, regardless of when or where the Government takes physical possession. (o) Warranty. The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract. (p) Limitation of liability. Except as otherwise provided by an express warranty, the Contractor will not be liable to the Government for consequential damages resulting from any defect or deficiencies in accepted items. (q) Other compliances. The Contractor shall comply with all applicable Federal, State and local laws, executive orders, rules and regulations applicable to its performance under this contract. (r) Compliance with laws unique to Government contracts. The Contractor agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of appropriated funds to influence certain Federal contracts; 18 U.S.C. 431 relating to officials not to benefit; 40 U.S.C 3701, et seq., Contract Work Hours and Safety Standards Act; 41 U.S.C. 51-58, Anti-Kickback Act of 1986; 41 U.S.C. 265 and 10 U.S.C. 2409 relating to whistle blower protections; 49 U.S.C 40118, Fly American; and 41 U.S.C.423 relating to procurement integrity. (s) Order of precedence. Any inconsistencies in this solicitation or contract shall be resolved by giving precedence in the following order: (1) The schedule of supplies/services. (2) The Assignments, Disputes, Payments, Invoice, Other Compliances, and Compliance with Laws Unique to Government Contracts paragraphs of this clause. (3) The clause at 52.212-5. (4) Addenda to this solicitation or contract, including any license agreements for computer software. (5) Solicitation provisions if this is a solicitation. (6) Other paragraphs of this clause. (7) The Standard Form 1449. (8) Other documents, exhibits, and attachments (9) The specification. (t) Central Contractor Registration (CCR). (1) Unless exempted by an addendum to this contract, the Contractor is responsible during performance and through final payment of any contract for the accuracy and completeness of the data within the CCR database, and for any liability resulting from the Government's reliance on inaccurate or incomplete data. To remain registered in the CCR database after the initial registration, the Contractor is required to review and update on an annual basis from the date of initial registration or subsequent updates its information in the CCR database to ensure it is current, accurate and complete. Updating information in the CCR does not alter the terms and conditions of this contract and is not a substitute for a properly executed contractual document. (2)(i) If a Contractor has legally changed its business name, "doing business as" name, or division name (whichever is shown on the contract), or has transferred the assets used in performing the contract, but has not completed the necessary requirements regarding novation and change-of-name agreements in FAR subpart 42.12, the Contractor shall provide the responsible Contracting Officer a minimum of one business day's written notification of its intention to (A) change the name in the CCR database; (B) comply with the requirements of subpart 42.12; and (C) agree in writing to the timeline and procedures specified by the responsible Contracting Officer. The Contractor must provide with the notification sufficient documentation to support the legally changed name. (ii) If the Contractor fails to comply with the requirements of paragraph (t)(2)(i) of this clause, or fails to perform the agreement at paragraph (t)(2)(i)(C) of this clause, and, in the absence of a properly executed novation or change-of-name agreement, the CCR information that shows the Contractor to be other than the Contractor indicated in the contract will be considered to be incorrect information within the meaning of the "Suspension of Payment" paragraph of the electronic funds transfer (EFT) clause of this contract. (3) The Contractor shall not change the name or address for EFT payments or manual payments, as appropriate, in the CCR record to reflect an assignee for the purpose of assignment of claims (see Subpart 32.8, Assignment of Claims). Assignees shall be separately registered in the CCR database. Information provided to the Contractor's CCR record that indicates payments, including those made by EFT, to an ultimate recipient other than that Contractor will be considered to be incorrect information within the meaning of the "Suspension of payment" paragraph of the EFT clause of this contract. (4) Offerors and Contractors may obtain information on registration and annual confirmation requirements via the internet at http://www.ccr.gov or by calling 1-888-227-2423 or 269-961-5757. ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The following clauses are incorporated into 52.212-4 as an addendum to this contract: C.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 60 days. C.3 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) (a) The Government may extend the term of this contract by written notice to the Contractor within 60 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension. (b) If the Government exercises this option, the extended contract shall be considered to include this option clause. (c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed five (5) years. C.4 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) The bidder or offeror agrees that if a contract is awarded to him/her, as a result of this solicitation, he/she will not advertise the award of the contract in his/her commercial advertising in such a manner as to state or imply that the Department of Veterans Affairs endorses a product, project or commercial line of endeavor. C.5 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008) (a) It is expressly agreed and understood that this is a non- personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor or its health-care providers are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided but retains no control over professional aspects of the services rendered, including by example, the Contractor's or its health-care providers' professional medical judgment, diagnosis, or specific medical treatments. The Contractor and its health-care providers shall be liable for their liability-producing acts or omissions. The Contractor shall maintain or require all health-care providers performing under this contract to maintain, during the term of this contract, professional liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: $ 2,000,000.00_. However, if the Contractor is an entity or a subdivision of a State that either provides for self-insurance or limits the liability or the amount of insurance purchased by State entities, then the insurance requirement of this contract shall be fulfilled by incorporating the provisions of the applicable State law. (b) An apparently successful offeror, upon request of the Contracting Officer, shall, prior to contract award, furnish evidence of the insurability of the offeror and/or of all health- care providers who will perform under this contract. The submission shall provide evidence of insurability concerning the medical liability insurance required by paragraph (a) of this clause or the provisions of State law as to self-insurance, or limitations on liability or insurance. (c) The Contractor shall, prior to commencement of services under the contract, provide to the Contracting Officer Certificates of Insurance or insurance policies evidencing the required insurance coverage and an endorsement stating that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. Certificates or policies shall be provided for the Contractor and/or each health- care provider who will perform under this contract. (d) The Contractor shall notify the Contracting Officer if it, or any of the health-care providers performing under this contract, change insurance providers during the performance period of this contract. The notification shall provide evidence that the Contractor and/or health-care providers will meet all the requirements of this clause, including those concerning liability insurance and endorsements. These requirements may be met either under the new policy, or a combination of old and new policies, if applicable. (e) The Contractor shall insert the substance of this clause, including this paragraph (e), in all subcontracts for health-care services under this contract. The Contractor shall be responsible for compliance by any subcontractor or lower-tier subcontractor with the provisions set forth in paragraph (a) of this clause. * Amounts from paragraph (a) above: C.6 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) The contractor shall obtain all necessary licenses and/or permits required to perform this work. He/she shall take all reasonable precautions necessary to protect persons and property from injury or damage during the performance of this contract. He/ she shall be responsible for any injury to himself/herself, his/her employees, as well as for any damage to personal or public property that occurs during the performance of this contract that is caused by his/her employees fault or negligence, and shall maintain personal liability and property damage insurance having coverage for a limit as required by the laws of the State of Pennsylvania. Further, it is agreed that any negligence of the Government, its officers, agents, servants and employees, shall not be the responsibility of the contractor hereunder with the regard to any claims, loss, damage, injury, and liability resulting there from. C.7 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008) The contractor agrees to provide all services specified in this contract for any person determined eligible by the Department of Veterans Affairs, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. The contractor further warrants that he/she will not resort to subcontracting as a means of circumventing this provision. C.8 ACCEPTABLE SAFETY AND SANITATION PRACTICES Acceptable safety and sanitation practices shall be observed throughout the facility. The building shall conform to the standards of the Life Safety Code (National Fire Protection Association Standard #101) in effect on the date of contract award. C.9 MEDICARE/MEDICAID STANDARDS The contractor is required to follow Medicare/Medicaid standards for all VA placements, except Life Safety. Medicare and Medicaid clinical and program standards are found in 42 CFR 483 C.10 ECONOMIC PRICE ADJUSTMENT This provision does not apply to ancillary services that may be added or deleted from the agreement. The per diem rate(s) will apply throughout the term of this contract, including extension period(s). The rate(s) may be adjusted only to reflect a change in a Medicaid rate as authorized by the SMA. Normally, this will be on an annual basis. The negotiated percentage above the Medicaid rate, to cover the all inclusive nature of the contract, will not be renegotiated; but will be applied and added to the new Medicaid rate for the adjusted per diem rate for each level of care item. This clause does not apply to rates for non Medicaid nursing homes. In this regard, new rates will be negotiated requiring a modification to the contract. Each per diem price adjustment under this clause is subject to the following limitations: Any adjustment shall be limited to the effect of increases or decreases in the approved SMA's patient care components within the affected Medicaid groups. Adjustments will occur no more frequently than those issued by the SMA. No adjustments will be made until the Contracting Officer receives an SMA 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. Within ten days after this occurs, the Contracting Officer will execute an approval signature and date at the approximate location of the nursing home official's signature, the action of which will serve as the effective date of the adjusted rate. A copy of the fully executed document will be sent to the nursing home official for record keeping purposes. C.11 TERMINATION OF SERVICES VA reserves the right to remove any or all VA patients from the nursing home at any time, when it is determined to be in the best interest of VA or the patients. C.12 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. Neither the VA nor the Veteran can be held liable to pay the nursing home or any third party furnishing services or supplies if the parties are on the List of Excluded Individuals/Entities (LEIE) or Excluded Parties List System (EPLS) lists. C.13 MINIMUM QUANTITIES It is impossible to determine the exact or estimated amount which will be expended under this contract. No obligation will be incurred by VA under this contract 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 nursing home as outlined in Section E of this contract. 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. C.14 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (JUN 2009) (a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (1) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)). Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104 (g)). (2) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553). (3) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Pub. L. 108-77, 108-78) (b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 253g and 10 U.S.C. 2402). [] (2) 52.203-13, Contractor Code of Business Ethics and Conduct (DEC 2008)(Pub. L. 110-252, Title VI, Chapter 1 (41 U.S.C. 251 note)). [] (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (MAR 2009) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.) [] (4) 52.204-11, American Recovery and Reinvestment Act-Reporting Requirements (MAR 2009) (Pub. L. 111-5). [] (5) 52.219-3, Notice of Total HUBZone Set-Aside (Jan 1999) (15 U.S.C. 657a). [] (6) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (July 2005) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a). [] (7) [Reserved] [] (8)(i) 52.219-6, Notice of Total Small Business Set-Aside (June 2003) (15 U.S.C. 644). [] (ii) Alternate I (Oct 1995) of 52.219-6. [] (iii) Alternate II (Mar 2004) of 52.219-6. [] (9)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644). [] (ii) Alternate I (Oct 1995) of 52.219-7. [] (iii) Alternate II (Mar 2004) of 52.219-7. [] (10) 52.219-8, Utilization of Small Business Concerns (May 2004) (15 U.S.C. 637(d)(2) and (3)). [] (11)(i) 52.219-9, Small Business Subcontracting Plan (APR 2008) (15 U.S.C. 637(d)(4)). [] (ii) Alternate I (Oct 2001) of 52.219-9. [] (iii) Alternate II (Oct 2001) of 52.219-9. [] (12) 52.219-14, Limitations on Subcontracting (Dec 1996) (15 U.S.C. 637(a)(14)). [] (13) 52.219-16, Liquidated Damages--Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)). [] (14)(i) 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns (OCT 2008) (10 U.S.C. 2323) (if the offeror elects to waive the adjustment, it shall so indicate in its offer.) [] (ii) Alternate I (June 2003) of 52.219-23. [] (15) 52.219-25, Small Disadvantaged Business Participation Program--Disadvantaged Status and Reporting (APR 2008) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323). [] (16) 52.219-26, Small Disadvantaged Business Participation Program--Incentive Subcontracting (Oct 2000) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323). [] (17) 52.219-27, Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside (May 2004) (15 U.S.C. 657 f). [X] (18) 52.219-28, Post Award Small Business Program Rerepresentation (APR 2009) (15 U.S.C 632(a)(2)). [X] (19) 52.222-3, Convict Labor (June 2003) (E.O. 11755). [] (20) 52.222-19, Child Labor--Cooperation with Authorities and Remedies (FEB 2008) (E.O. 13126). [X] (21) 52.222-21, Prohibition of Segregated Facilities (Feb 1999). [X] (22) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246). [X] (23) 52.222-35, Equal Opportunity for Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans (Sept 2006) (38 U.S.C. 4212). [X] (24) 52.222-36, Affirmative Action for Workers with Disabilities (Jun 1998) (29 U.S.C. 793). [X] (25) 52.222-37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans (Sept 2006) (38 U.S.C. 4212). [] (26) 52.222-39, Notification of Employee Rights Concerning Payment of Union Dues or Fees (Dec 2004) (E.O. 13201). [] (27) 52.222-54, Employment Eligibility Verification (Jan 2009). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.) [] (28)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items (May 2008) (42 U.S.C.6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (ii) Alternate I (MAY 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (29) 52.223-15, Energy Efficiency in Energy-Consuming Products (DEC 2007)(42 U.S.C. 8259b). [] (30)(i) 52.223-16, IEEE 1680 Standard for the Environmental Assessment of Personal Computer Products (DEC 2007) (E.O. 13423). [] (ii) Alternate I (DEC 2007) of 52.223-16. [] (31) 52.225-1, Buy American Act--Supplies (FEB 2009) (41 U.S.C. 10a-10d). [] (32)(i) 52.225-3, Buy American Act--Free Trade Agreements-- Israeli Trade Act (JUN 2009) (41 U.S.C. 10a-10d, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C 3805 note, Pub. L. 108-77, 108-78, 108-286, 108-302, 109-53 and 109-169, 109-283, and 110-138). [] (ii) Alternate I (Jan 2004) of 52.225-3. [] (iii) Alternate II (Jan 2004) of 52.225-3. [] (33) 52.225-5, Trade Agreements (JUN 2009) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note). [X] (34) 52.225-13, Restrictions on Certain Foreign Purchases (JUN 2008) (E.O.'s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury). [] (35) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150). [] (36) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C. 5150). [] (37) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)). [] (38) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)). [] (39) 52.232-33, Payment by Electronic Funds Transfer--Central Contractor Registration (Oct 2003) (31 U.S.C. 3332). [X] (40) 52.232-34, Payment by Electronic Funds Transfer--Other than Central Contractor Registration (May 1999) (31 U.S.C. 3332). [] (41) 52.232-36, Payment by Third Party (May 1999) (31 U.S.C. 3332). [] (42) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a). [] (43)(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). [] (ii) Alternate I (Apr 2003) of 52.247-64. (c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.). [X] (2) 52.222-42, Statement of Equivalent Rates for Federal Hires (May 1989) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). Employee Class Monetary Wage-Fringe Benefits [X] (3) 52.222-43, Fair Labor Standards Act and Service Contract Act--Price Adjustment (Multiple Year and Option Contracts) (Nov 2006) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). [] (4) 52.222-44, Fair Labor Standards Act and Service Contract Act--Price Adjustment (Feb 2002) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). [] (5) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (Nov 2007) (41 U.S.C. 351, et seq.). [] (6) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services--Requirements (FEB 2009) (41 U.S.C. 351, et seq.). [] (7) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (MAR 2009)(Pub. L. 110-247) [] (8) 52.237-11, Accepting and Dispensing of $1 Coin (SEP 2008) (31 U.S.C. 5112(p)(1)). (d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records--Negotiation. (1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract. (2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved. (3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law. (e)(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause-- (i) 52.203-13, Contractor Code of Business Ethics and Conduct (DEC 2008) (Pub. L. 110-252, Title VI, Chapter 1 (41 U.S.C. 251 note)). (ii) 52.219-8, Utilization of Small Business Concerns (May 2004) (15 U.S.C. 637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. If the subcontract (except subcontracts to small business concerns) exceeds $550,000 ($1,000,000 for construction of any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that offer subcontracting opportunities. (iii) [Reserved] (iv) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246). (v) 52.222-35, Equal Opportunity for Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans (Sept 2006) (38 U.S.C. 4212). (vi) 52.222-36, Affirmative Action for Workers with Disabilities (June 1998) (29 U.S.C. 793). (vii) 52.222-39, Notification of Employee Rights Concerning Payment of Union Dues or Fees (Dec 2004) (E.O. 13201). (viii) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.). (ix) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)). Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104(g)). (x) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements "(Nov 2007)" (41 U.S.C. 351, et seq.). (xi) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services-Requirements (FEB 2009)(41 U.S.C. 351, et seq.). (xii) 52.222-54, Employee Eligibility Verification (JAN 2009) (xiii) 52.226-6, Promoting Excess Food Donataion to Nonprofit Organizations. (MAR 2009)(Pub. L. 110-247). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6. (xiv) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64. (2) While not required, the contractor may include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations. SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS Attachment 1: Definitions of VA Levels of Care, Resource Utilization Groups (RUGS-II), VA Manual, M-1, Part I, Chapter 31 Attachment 2: Authorization and Invoice for Medical and Hospital Attachment 3: Referral for Community Nursing Home Care Attachment 4: Application for furnishing long term care services to beneficiaries Attachment 5: Register of Wage Determination D.1 DEPARTMENT OF VETERANS AFFAIRS (VA) COMMUNITY NURSING HOME PROGRAM LEVEL OF CARE - DESCRIPTIONS Level of Care determinations are based on the VA Resource Utilization Groups (RUGS-II/ RUGS-III) case-mix, the industry standard. A case-mix system categorizes patients into groups according to their level of care needs. RUGS-II/ RUGS-III, like other case-mix systems, defines patients for clinical and reimbursement purposes. Additional information on RUGS-II/ RUGS-III use for VA purposes can be acquired from the Contracting Officer in concert with the appropriate VA community health official. Contracting Officer should apply the rates associated with the following VA levels of care when using comparable local state levels of care. Rates for private care nursing homes should be approved in accordance with M 5, Part II, Chapter 3, paragraph 3.16. Reduced Physical Functioning Group: These residents have care needs primarily of activities of daily living and general supervision. RUG II Scores 12 & 13 RUG III Scores: PE2, PE1, PD2, PD1, PC2, PC1, PB2, PB1, PA2, PA1 Basic, Hospice, Impaired Cognition, Behavior Problems Group: These residents have moderate ADL deficiencies, have cognitive impairment in decision-making, recall and short-term memory; hospice care. RUG II Scores: 5, 6, 9, 10, 11, 14, 15, 16 RUG III Scores: IA2, IA1, IB2, IB1, BA2, BA1, BB2, BB1 Clinically Complex Group: These residents receive complex clinical care or have conditions requiring skilled nursing management and interventions for conditions and treatments such as burns, coma, septicemia, pneumonia, foot infections or wounds, internal bleeding, dehydration, tube feeding, oxygen, transfusions, hemiplegia RUG II Scores: 7, 8 RUG III Scores: CC2, CC1, CB2, CB1, CA2, CA1 Special Care Group: These residents are moderately or highly disabled in ADLs, receive complex clinical care or have serious medical conditions such as: MS, ALS, quadriplegia, Stage III or IV pressure ulcers, radiation therapy, surgical wounds or open lesions, tube feeding and aphasia RUG II Scores: 3, 4 RUG III Scores: SE3, SE2, SE1, SSC, SSB, SSA Rehabilitation Group: These residents receive physical, speech, or occupational therapy for an authorized and limited length of time. Therapy must be pre-approved by written signature of VA Provider after submission of : 1.The most recent MDS indicating a change in level of care needs 2. An initial therapy assessment performed by a licensed therapist 3.Approval for therapy will be for a period not to exceed four weeks 4.Therapy will be provided for a minimum of 325 minutes per week 5.A copy of the summarized therapy notes and updated MDS will be sent to the VA at the end of the four weeks in order for the higher per diem rate to be paid. RUG II Scores: 1, 2 RUG III Scores: RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB, RHA, RMC, RMB, RMA, RLB, RLA INVOICES: 1.Invoices shall be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered. 2.All invoices must include the full name and address of the nursing home and shall reflect the patient's name, social security number, the specific calendar days billed per each level of care category, and the per diem or bed hold rate. All billing information shall be submitted on one page. 3.All Pharmacy costs for every VA beneficiary shall be attached to the invoice when submitted. Pharmacy costs are not to be added to the monthly per diem rate total. Failure to provide information in this manner shall result in delayed payments. 4.The most recent MDS Section Z shall be submitted with monthly invoices. 5.Authorizations for nursing home care will be accomplished on VA Form 10-7078, Authorization and Invoice for Medical and Hospital Services. Each authorization validity period will be from the initial effective date to disposition. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078. 6.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 medications, and special equipment or services may not be added to any invoice without written permission of the VA Medical Center placing the veteran. 7.If such ancillary costs are anticipated, the CNH RN Case Manager must be notified so the VA may decide how and by whom the ancillary supplies and services will be provided. 8.If VA authorization is received, the nursing home must also submit the physician's order for the medication/supply/service, the dispensing log, the supplier and the cost charged by the supplier to the nursing home.
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