Attachment 1 FCI Three Rivers Contract Pricing and Sub-Contract Certification 1.pdf

Attachment 1: Contract Pricing & Sub-Contract Certification FCI Three Rivers -Comprehensive Medical Service

15B51620R00000001

Blocks 19 through 24 – Contract Pricing and Sub-Contract Certification

Overview

Services are required to be provided in accordance with the Performance Work Statement included in this solicitation/contract. Offerors are required to submit, as a part of their business proposal, a completed copy of Schedule of Items and Sub-Contract Certification.

Pricing Methodology

Price proposals will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of service to be provided, Offerors will be allowed to propose a variance from the benchmark Medicare rate in the form of a discount from or a premium to Medicare rates established by the Centers for Medicare and Medicaid Services.

The rates established in the resulting contract shall not be construed as participation in the Medicare program; contract rates will merely be equated to Medicare rates of reimbursement without reductions for deductibles, copayments, or coinsurance. When appropriate, outlier payments calculated in accordance with Medicare reimbursement methodologies shall be made in recognition of extremely costly stays. The outlier payment shall be calculated based upon the defined benchmark and will consist of the operating portion only. This structuring of the pricing methodology is not intended to be restrictive of any Offeror; Offerors need only to propose that percentage discount from or premium to the Medicare benchmark rate which will reflect the desired level of payment for the category of services rendered. If during contract performance, it is determined that a necessary contract deliverable is not covered by Medicare reimbursement methodologies, a separate rate shall be negotiated for such deliverable(s).

Medicare Part A. The Medicare benchmark to be utilized for all services covered by

Medicare Part A shall be the most current Basic MS-DRG Payment (i.e., Operating Federal Rate) established for Core Based Statistical Area (CBSA) 13850 Corpus Christie, Texas.

The Basic MS-DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Offerors may propose a discount from or a premium to Basic MS-DRG rates. (Refer to Attachment 5 of this solicitation)

Medicare Part B Physician Services and Non-physician Services. The

Medicare benchmark to be utilized for all physician and non-physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 99. The benchmark charges shall be those established for participating providers. Offerors may propose a discount from or a premium to the benchmark charges.

Medicare Part B Facility Services (including hospital outpatient services and ambulatory surgical centers).

The Medicare benchmark to be utilized for all facility services covered by Medicare Part B shall be the most current APC and ASC rates calculated for CBSA 13850 Corpus Christie, Texas. Offerors may propose a discount from or a premium to the benchmark charges.

Long Term Care Facility Services:

The Medicare benchmark utilized for long-term care hospital services covered by Medical Part A shall be the most current MS-LTC-DRG payment amount (i.e.

Adjusted LTCH PPS Standard Prospective Payment) established for CBSA 13850 Corpus Christie, Texas.

Estimated Quantities

Estimated quantities for the base year and all option years are detailed below.

The estimated quantities provided are not a representation to the Offeror/Contractor that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normal.

Inpatient and Outpatient Facility and Physician Services

Base Year – Effective Date of Award (EDOA) through twelve (12) months from EDOA.

Inpatient Days: 110 days (estimated) Outpatient Days: 225 visits (estimated) LTAC Days: 45 days Option Year 1 - Thirteen (13) months through twenty-four (24) months from EDOA.

Inpatient Days: 110days (estimated) Outpatient Days: 225 visits (estimated) LTAC Days: 45 days (estimated)

Option Year 2 - Twenty-five (25) months through thirty-six (36) months from EDOA.

Inpatient Days: 110 days (estimated) Outpatient Days: 225 visits (estimated) LTAC Days: 45 days (estimated)

Option Year 3 - Thirty-seven (37) months through forty-eight (48) months from EDOA.

Inpatient Days: 110 days (estimated) Outpatient Days: 225 visits (estimated) LTAC Days: 45 days (estimated)

Option Year 4 - Forty-nine (49) months through sixty (60) months from EDOA.

Inpatient Days: 110 days (estimated) Outpatient Days: 225 visits (estimated) LTAC Days: 45 days (estimated)

Outpatient Institution Services

Estimated quantities shall remain constant for the base year and all option years. For Medicare-based services, duration of visits is listed for informational purposes only, as contracted rates will be based upon the Medicare allowable per procedure performed. Mobile MRI, Mobile Ultrasound, and Optometrist shall be paid based upon the provision of defined sessions.

Note: Session priced items which exceed the established session or are less than full session shall be pro-rated to the nearest quarter hour.

Orthopedic Surgeon: Visit duration-8 hours (approximate) Visit quantity-4 per contract year (approximate)

Gastroenterology: Visit duration-8 hours (approximate) Visit quantity-4 per contract year (approximate)

General Surgeon: Visit duration-8 hours (approximate) Visit quantity-4 per contract year (approximate)

Optometrist: Session duration 8 hours. (approximate)

Session quantity 36 per contract year (estimated)

Mobile MRI: Session duration 8 hours. (approximate) Session quantity 4 Per contract year (estimated)

Mobile Ultrasound: Session duration 8 hours (approximate) Session quantity 4 Per contract year (estimated)

Schedule of Items

Offerors shall complete the following Schedule of Items. All proposed pricing and participation targets will be evaluated in accordance with Federal Acquisition Regulation (FAR) 52.212-2, Evaluation - Commercial Items, and Attachment 4, Submission and Evaluation of Proposals, of this solicitation.

Effective Date of Award (EDOA) through twelve (12) months from EDOA.

1a. Inpatient Facility Services: -__Discount or +___ Premium to Medicare Part A 1b. Outpatient Facility Services:-__ Discount or +__ Premium to Medicare Part B 1c. Long Term Acute Care Facility:-__ Discount or +__ Premium to Medicare Part B 2a. Inpatient/Outpatient Physician Services:-__ Discount or +__Premium to Medicare Part B 2b. Outpatient Institution Services: -Other Physicians -_ Discount or +__Premium to Medicare Part B 2c. Optometrist _______per session 2c1 Mobile MRI ______ per session 2c2.Mobile Ultrasound ____ per session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE

"-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Thirteen (13) months through twenty-four (24) months from EDOA.

1b. Outpatient Facility Services:-__ Discount or +__ Premium to Medicare Part B 1c. Long Term Acute Care Facility:-__ Discount or +__ Premium to Medicare Part B 2a. Inpatient/Outpatient Physician Services:-__ Discount or +__Premium to Medicare Part B 2b. Outpatient Institution Services: -Other Physicians: -__Discount or +__Premium to Medicare Part B 2c. Optometrist _______per session 2c1.Mobile MRI ______ per session 2c2.Mobile Ultrasound ____ per session

Twenty-five (25) months through thirty-six (36) months from EDOA.

1b. Outpatient Facility Services:-__ Discount or +__ Premium to Medicare Part B 1c. Long Term Acute Care Facility:-__ Discount or +__ Premium to Medicare Part B 2a. Inpatient/Outpatient Physician Services:-__ Discount or +__Premium to Medicare Part B 2b. Outpatient Physician Services:-_ Discount or +__Premium to Medicare Part B 2c. Optometrist _______per session 2c1.Mobile MRI ______ per session 2c2.Mobile Ultrasound ____ per session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Thirty-seven (37) months through forty-eight (48) months from EDOA.

1b. Outpatient Facility Services:-__ Discount or +__ Premium to Medicare Part B 1c. Long Term Acute Care Facility:-__ Discount or +__ Premium to Medicare Part B

Base Year

Option Year 1

Option Year 2

Option Year 3

2a. Inpatient/Outpatient Physician Services:-__ Discount or +__Premium to Medicare Part B 2b. Outpatient Institution Services: -Other Physicians: -__Discount or +__Premium to Medicare Part B 2c. Optometrist _______per session 2c1. Mobile MRI ______ per session 2c2. Mobile Ultrasound ____ per session

Forty-nine (49) months through sixty (60) months from EDOA.

1b. Outpatient Facility Services:-__ Discount or +__ Premium to Medicare Part B 1c. Long Term Acute Care Facility:-__ Discount or +__ Premium to Medicare Part B 2a. Inpatient/Outpatient Physician Services:-__ Discount or +__Premium to Medicare Part B 2b. Outpatient Institution Services: -Other Physicians: -__Discount or +__Premium to Medicare Part B 2c. Optometrist _______per session 2c1. Mobile MRI ______ per session 2c2. Mobile Ultrasound ____ per session

Sixty one (61) months through sixty (66) months from EDOA.

1b. Outpatient Facility Services:-__ Discount or +__ Premium to Medicare Part B 1c. Long Term Acute Care Facility:-__ Discount or +__ Premium to Medicare Part B 2a. Inpatient/Outpatient Physician Services:-__ Discount or +__Premium to Medicare Part B 2b. Outpatient Institution Services: -Other Physicians: -__Discount or +__Premium to Medicare Part B 2c. Optometrist _______per session 2c1. Mobile MRI ______ per session 2c2. Mobile Ultrasound ____ per session

All Offerors are hereby advised that the successful Offeror's unit pricing (to include discount percentage from or premium percentage to the benchmark Medicare rate) for the base year and all option years is public information, in accordance with Federal Acquisition Regulation (FAR) 15.503(b)(1)(iv).

Accordingly, all successful unit pricing will be released to unsuccessful Offerors with the notification of award as well as to the general public when requested. Any party who objects to the release of their own unit pricing information, should they be awarded a contract in response to this solicitation, should not submit proposal in response to the solicitation.

This contract does _ does not___ provide for subcontracting possibilities. If answer is in the affirmative, Offeror will submit sub-contracting plan in accordance with the requirements of FAR 52.219-9.

Option Year 4

Option to Extend Services as Authorized by FAR 52.217-8

Sub-Contract Certification