Revised Attach 1 - Contr Pricing and SCC.pdf

Attachment 1: Contract Pricing & Sub-Contract Certification

MCC San Diego - Comprehensive Medical Services

RFP15B61021R00000001

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

Except for session-priced items, 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) 41740 San Diego-Chula Vista-Carlsbad, CA. 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)

Long-Term Care Facility Services: The Medicare benchmark utilized for long-term care hospital services covered by Medicare Part A shall be the most current MS-LTC-DRG payment amount (i.e., Adjusted LTCH PPS Standard Prospective Payment) established for CBSA 41740, San Diego-Carlsbad, CA.

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 72, San Diego-Chula Vista-Carlsbad, CA. 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- 41740 San Diego-Chula Vista- Carlsbad, CA. Offerors may propose a discount from or a premium to the benchmark charges.

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

MCC San Diego

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

Inpatient Days: 750 days (estimated) Outpatient Visits: 310 visits (estimated) Inpatient Psychiatric Days: 220 days (estimated) Long Term Care Days: 135 days (estimated)

Option Year 1 - Thirteen (13) months through twenty-four (24) months from EDOA.

Inpatient Days: 750 days (estimated) Outpatient Visits: 310 visits (estimated) Inpatient Psychiatric Days: 220 days (estimated) Long Term Care Days: 135 days (estimated)

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

Inpatient Days: 750 days (estimated) Outpatient Visits: 310 visits (estimated) Inpatient Psychiatric Days: 220 days (estimated) Long Term Care Days: 135 days (estimated)

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

Inpatient Days: 750 days (estimated) Outpatient Visits: 310 visits (estimated) Inpatient Psychiatric Days: 220 days (estimated) Long Term Care Days: 135 days (estimated)

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

Inpatient Days: 750 days (estimated) Outpatient Visits: 310 visits (estimated) Inpatient Psychiatric Days: 220 days (estimated) Long Term Care Days: 135 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. Optometrist services shall be paid based upon the provision of defined session.

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

Cardiologist: Visit duration 8 hrs. (approximately) Visit quantity 12 per contract year

Endocrinologist: Visit duration 8 hrs. (approximately) Visit quantity 12 per contract year

Infectious Disease: Visit duration 8 hrs. (approximately) Visit quantity 12 per contract year

OB/GYN: Visit duration 8 hrs. (approximately) Visit quantity 24 per contract year

Optometrist: Session duration 4 hrs. (approximately) Session quantity 24 per contract year (estimated)

Orthopedic Surgeon: Visit duration 8 hrs. (approximately) Visit quantity 12 per contract year

Psychiatrist: Visit duration 8 hrs. (approximately) Visit quantity 48 per contract year

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.

Base Year – MCC San Diego

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. Inpatient Psychiatric Facility Srvcs: - Discount or + Premium to Medicare Part A 1d. Long Term Care Facility Services: - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - Discount or + Premium to Medicare Part B 2c2. Optometrist: $_______ Per 4 hr. Session

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

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

Option Year 1 – MCC San Diego

Thirteen (13) months through twenty-four (24) 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. Inpatient Psychiatric Facility Srvcs: - Discount or + Premium to Medicare Part A 1d. Long Term Care Facility Services: - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - Discount or + Premium to Medicare Part B 2c2. Optometrist: $_______ Per 4 hr. Session

Option Year 2 – MCC San Diego

Twenty-five (25) months through thirty-six (36) 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. Inpatient Psychiatric Facility Srvcs: - Discount or + Premium to Medicare Part A 1d. Long Term Care Facility Services: - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - Discount or + Premium to Medicare Part B 2c2. Optometrist: $_______ Per 4 hr. Session

Option Year 3 – MCC San Diego

Thirty-seven (37) months through forty-eight (48) 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. Inpatient Psychiatric Facility Srvcs: - Discount or + Premium to Medicare Part A 1d. Long Term Care Facility Services: - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - Discount or + Premium to Medicare Part B 2c2. Optometrist: $_______ Per 4 hr. Session

Option Year 4 – MCC San Diego

Forty-nine (49) months through sixty (60) 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. Inpatient Psychiatric Facility Srvcs: - Discount or + Premium to Medicare Part A 1d. Long Term Care Facility Services: - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - Discount or + Premium to Medicare Part B 2c2. Optometrist: $_______ Per 4 hr. Session

Option to Extend Services as Authorized by FAR 52.217-8 – MCC San Diego

1a. Inpatient Facility Services: - Discount or + Premium to Medicare Part A 1b. Outpatient Facility Services: - __ Discount or + Premium to Medicare Part B 1c. Inpatient Psychiatric Facility Srvcs: - Discount or + Premium to Medicare Part A 1d. Long Term Care Facility Services: - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - Discount or + Premium to Medicare Part B 2c2. Optometrist: $_______ Per 4 hr. Session

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

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

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.

Sub-Contract Certification

This contract does ______ does not ______ provide for subcontracting possibilities.

If answer is in the affirmative, Offeror will submit _________ a sub-contracting plan in accordance with the requirements of FAR 52.219-9.