6. Schedule of Services updated 31924.pdf
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- Solicitation number
- 15BFA024R00000009
About this file
This document appears to be a Schedule of Services that outlines the pricing and service categories for a potential federal contract for Comprehensive Medical Services for Adult Incarcerated Individuals in Residential Reentry Centers and on Home Confinement.
The document lists various inpatient and outpatient facility and professional services, as well as medical supplies, DME, laboratory services, and pharmaceuticals, with pricing structured around discounts or premiums to Medicare Part A, Part B, and actual billed charges. It provides pricing for a Base Period and two Option Periods, as well as a 6-month extension period. Key service categories include inpatient, outpatient, physician, therapy, dialysis, laboratory, DME, and pharmacy services. The document does not provide a full Statement of Work or Objectives, but rather outlines the high-level scope of required medical services and the pricing framework for those services.
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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
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 Out of Network (OON)
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)
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
___Discount or +___ Premium to Actual Billed
Charges by Medical Provider OR negotiated lesser amount
___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 ____________
Price Per Glasses ____________
Pricing Category 10
Price Per Day ____________
Pricing Category 11
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
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
Pricing Category 6
Out of Network (OON) ___Discount or +___ Premium Medicare
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
___Discount or +___ Premium to Actual Billed
Charges by Medical Provider OR negotiated lesser amount
___Discount or +___ Premium to Medicare
Part B
Pricing Category 3
Pharmaceuticals (Generic) ___Discount or +___ Premium to Average
Pricing Category 4
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 6
Out of Network (OON) ___Discount or +___ Premium Medicare
Pricing Category 7
___Discount or +___ Premium to Actual Billed
Charges by Medical Provider OR negotiated lesser amount
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
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)
___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)
Price Per Day ____________
Pricing Category 11
Price Per Claim Processed ________
Schedule of Services Optional 6 Month Extension Pricing Category 1
Pricing Category 8
Price Per Glasses ____________
Pricing Category 9
Price Per Glasses ____________
Pricing Category 10
___Discount or +___ Premium to Actual Billed
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
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
Charges by Medical Provider OR negotiated lesser amountOptometry Services
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