6. Schedule of Services Revised.pdf
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- Solicitation number
- 15BFA024R00000009
About this file
This document outlines a solicitation for comprehensive medical services. The Bureau of Prisons is seeking a contractor to provide healthcare delivery to adult federal inmates housed in Residential Reentry Centers and on Home Confinement, including those monitored under the Federal Location Monitoring program. Services will include inpatient and outpatient medical, dental, and behavioral health services. Pricing will be based on discounts or premiums to Medicare rates, actual billed charges, or average wholesale prices for pharmaceuticals. Questions regarding this solicitation must be submitted by February 14, 2024, with proposals due at a later unspecified date. The selected contractor will provide services nationwide under the oversight of the Department of Justice Bureau of Prisons Central Office.
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Inpatient Facility Services Inpatient Rehabilitation Facility (IRF) Services Home Health and Hospice Inpatient Psychiatric Services Long Term Care Skilled Nursing Facility Services (SNF) Inpatient Dialysis Services
Outpatient Facility Services (includes Outpatient Hospital and Ambulatory Surgical Centers)
Inpatient Physician Services Outpatient Physician Services Ambulance Services Clinical Laboratory Services Durable Medical Equipment (DME), Prosthetics/Orthotics, and Supplies Federal Qualified Health Center (FQHC) Outpatient Dialysis Services Occupational Therapy (OT), Speech Therapy (ST), and Physical Therapy (PT)
Non-Medicare Dental Services and Services with “D” Codes
Pricing Category 5
___Discount or +___ Premium to Actual Billed Charges by Medical Provider OR negotiated lesser amountOptometry Services
___Discount or +___ Premium to Average Whole Price (AWP)
Pricing Category 4
Pharmaceuticals (Generic)
Pharmaceuticals (Non-Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Schedule of Services Base Period Pricing Category 1
___Discount or +___ Premium to Medicare Part A
Pricing Category 2
___Discount or +___ Premium to Medicare Part B
Pricing Category 3
Pricing Category 6
___Discount or +___ Premium Medicare OR Actual Billed Charges by the Provider
Out of Network (OON)
Out of Network (OON)
Non-Medicare Medical Supplies
Prescription Eye Glasses Single Lens
Prescription Eye Glasses Bi-Focal
Extended Stay Per Diem
Billing services for medical care rendered to RRMB inmates housed with state and local government entities
Inpatient Facility Services Inpatient Rehabilitation Facility (IRF) Services Home Health and Hospice Inpatient Psychiatric Services Long Term Care Skilled Nursing Facility Services (SNF) Inpatient Dialysis Services
Outpatient Facility Services (includes Outpatient Hospital and Ambulatory Surgical Centers)
Inpatient Physician Services Outpatient Physician Services Ambulance Services Clinical Laboratory Services Durable Medical Equipment (DME), Prosthetics/Orthotics, and Supplies Federal Qualified Health Center (FQHC) Outpatient Dialysis Services
Price Per Glasses ____________
Pricing Category 10 Price Per Day ____________
Pricing Category 11
___Discount or +___ Premium to Medicare Part B
Schedule of Services Option Period 1 Pricing Category 1
___Discount or +___ Premium to Medicare Part A
Pricing Category 2
Price Per Claim Processed ________
___Discount or +___ Premium to Actual Billed Charges by Medical Supplier OR negotiated lesser amount
Pricing Category 7
Pricing Category 8
Pricing Category 9
Price Per Glasses ____________
___Discount or +___ Premium to Actual Billed Charges by Medical Provider OR negotiated lesser amount
Occupational Therapy (OT), Speech Therapy (ST), and Physical Therapy (PT)
Non-Medicare Dental Services and Services with “D” Codes
Out of Network (OON)
Non-Medicare Medical Supplies
Prescription Eye Glasses Single Lens
Prescription Eye Glasses Bi-Focal
Extended Stay Per Diem
Billing services for medical care rendered to RRMB inmates housed with state and local government entities
Pricing Category 3
Pharmaceuticals (Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Pricing Category 4
Pricing Category 6
Out of Network (OON) ___Discount or +___ Premium Medicare OR Actual
Billed Charges by the Provider
Pricing Category 7 ___Discount or +___ Premium to Actual Billed
Pharmaceuticals (Non-Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Pricing Category 5
___Discount or +___ Premium to Actual Billed Charges by Medical Provider OR negotiated lesser amountOptometry Services
Price Per Day ____________
Pricing Category 11
Price Per Claim Processed ________
Schedule of Services Option Period 2 Pricing Category 1
Pricing Category 8 Price Per Glasses ____________
Pricing Category 9 Price Per Glasses ____________
Pricing Category 10
___Discount or +___ Premium to Actual Billed
Inpatient Facility Services Inpatient Rehabilitation Facility (IRF) Services Home Health and Hospice Inpatient Psychiatric Services Long Term Care Skilled Nursing Facility Services (SNF) Inpatient Dialysis Services
Outpatient Facility Services (includes Outpatient Hospital and Ambulatory Surgical Centers)
Inpatient Physician Services Outpatient Physician Services Ambulance Services Clinical Laboratory Services Durable Medical Equipment (DME), Prosthetics/Orthotics, and Supplies Federal Qualified Health Center (FQHC) Outpatient Dialysis Services Occupational Therapy (OT), Speech Therapy (ST), and Physical Therapy (PT)
Non-Medicare Dental Services and Services with “D” Codes
Out of Network (OON)
Pricing Category 4
Pharmaceuticals (Non-Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Pricing Category 5
___Discount or +___ Premium to Actual Billed Charges by Medical Provider OR negotiated lesser amountOptometry Services
___Discount or +___ Premium to Medicare Part A
Pricing Category 2
___Discount or +___ Premium to Medicare Part B
Pricing Category 3
Pharmaceuticals (Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Pricing Category 6
Out of Network (OON) ___Discount or +___ Premium Medicare OR Actual
Billed Charges by the Provider
Pricing Category 7
___Discount or +___ Premium to Actual Billed
Non-Medicare Medical Supplies
Prescription Eye Glasses Single Lens
Prescription Eye Glasses Bi-Focal
Extended Stay Per Diem
Billing services for medical care rendered to RRMB inmates housed with state and local government entities
Inpatient Facility Services Inpatient Rehabilitation Facility (IRF) Services Home Health and Hospice Inpatient Psychiatric Services Long Term Care Skilled Nursing Facility Services (SNF) Inpatient Dialysis Services
Outpatient Facility Services (includes Outpatient Hospital and Ambulatory Surgical Centers)
Inpatient Physician Services Outpatient Physician Services Ambulance Services Clinical Laboratory Services Durable Medical Equipment (DME), Prosthetics/Orthotics, and Supplies Federal Qualified Health Center (FQHC) Outpatient Dialysis Services Occupational Therapy (OT), Speech Therapy (ST), and Physical Therapy (PT)
Pricing Category 8 Price Per Glasses ____________
Pricing Category 9 Price Per Glasses ____________
Pricing Category 10
___Discount or +___ Premium to Actual Billed
Pricing Category 2
___Discount or +___ Premium to Medicare Part B
Pricing Category 3
Pharmaceuticals (Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Price Per Day ____________
Pricing Category 11
Price Per Claim Processed ________
Schedule of Services Optional 6 Month Extension Pricing Category 1
___Discount or +___ Premium to Medicare Part A
Non-Medicare Dental Services and Services with “D” Codes
Out of Network (OON)
Non-Medicare Medical Supplies
Prescription Eye Glasses Single Lens
Prescription Eye Glasses Bi-Focal
Extended Stay Per Diem
Billing services for medical care rendered to RRMB inmates housed with state and local government entities
Price Per Day ____________
Pricing Category 11
Price Per Claim Processed ________
___Discount or +___ Premium to Actual Billed Charges by Medical Provider OR negotiated lesser amount
Pricing Category 8 Price Per Glasses ____________
Pricing Category 9 Price Per Glasses ____________
Pricing Category 10
Pricing Category 6
Out of Network (OON) ___Discount or +___ Premium Medicare OR Actual
Billed Charges by the Provider
Pricing Category 7 ___Discount or +___ Premium to Actual Billed
Pricing Category 4
Pharmaceuticals (Non-Generic) ___Discount or +___ Premium to Average
Whole Price (AWP)
Pricing Category 5
___Discount or +___ Premium to Actual Billed amountOptometry Services
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