Attachment 1-Contract Pricing and Subcontract Certification Rev_LOS.pdf

Solicitation Attachment 1: Contract Pricing & Subcontract Certification MDC Los Angeles - Comprehensive Medical Services

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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 the Schedule of Items and Subcontract Certification.

Pricing Methodology

Except for services based on session rate, 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, excluding Inpatient Psychiatric Services (IPF), 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) 31084, Los Angeles - Long Beach - Glendale, California. 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 1 of this solicitation)

Medicare Part A IPF Services. The Medicare benchmark to be utilized for IPF services covered by Medicare Part A shall be the most current federal per diem payment rate established for CBSA 31084, Los Angeles - Long Beach - Glendale, California. The Federal per diem payment rate calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Offerors may propose a discount from or a premium to Federal per diem payment rate.

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, 18-Los Angeles-Long Beach-Anaheim, CA, all counties. 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 – 31084, Los Angeles-Long Beach-Glendale, 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

MDC Los Angeles

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

Inpatient Days: 997 days (estimated) Inpatient Psychiatric: 385 days (estimated) Outpatient Visits: 518 visits (estimated)

Option Year 1 Inpatient Days: 997 days (estimated) Inpatient Psychiatric: 385 days (estimated) Outpatient Visits: 518 visits (estimated)

Option Year 2 Inpatient Days: 997 days (estimated) Inpatient Psychiatric: 385 days (estimated) Outpatient Visits: 518 visits (estimated)

Option Year 3 Inpatient Days: 997 days (estimated) Inpatient Psychiatric: 385 days (estimated) Outpatient Visits: 518 visits (estimated)

Option Year 4 Inpatient Days: 997 days (estimated) Inpatient Psychiatric: 385 days (estimated) Outpatient Visits: 518 visits (estimated)

Optional 6-month extension Inpatient Days: 499 days (estimated) Inpatient Psychiatric: 193 days (estimated) Outpatient Visits: 259 visits (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. Session based services shall be paid based upon the provision of defined sessions.

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

Other Physicians:

Gastroenterologist: Visit duration: 6 hours Visit quantity: 12 per contract year

Orthopedic Surgeon: Visit duration: 6 hours Visit quantity: 12 per contract year

Podiatrist: Visit duration: 6 hours Visit quantity: 12 per contract year

Session Based Services:

Optometrist: Session duration 6 hrs. (approximately)

Session quantity 12 per contract year (estimated)

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

Base Year

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

1a. Inpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part A 1b. Inpatient Psychiatric Services: - __ Discount or + ___ Premium to Medicare Part A 1c. Outpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part B 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 six (6) hour session

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

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

Option Year 1

1a. Inpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part A 1b. Inpatient Psychiatric Services: - __ Discount or + ___ Premium to Medicare Part A 1c. Outpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part B 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 six (6) hour session

Option Year 2

1b. Inpatient Psychiatric Services: - __ Discount or + ___ Premium to Medicare Part A 1c. Outpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part B 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 six (6) hour session

Option Year 3

1b. Inpatient Psychiatric Services: - __ Discount or + ___ Premium to Medicare Part A 1c. Outpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part B 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 six (6) hour session

Option Year 4

1b. Inpatient Psychiatric Services: - __ Discount or + ___ Premium to Medicare Part A 1c. Outpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part B 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 six (6) hour session

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

Option to Extend Services as Authorized by FAR 52.217-8

1b. Inpatient Psychiatric Services: - __ Discount or + ___ Premium to Medicare Part A 1c. Outpatient Facility Services: - __ Discount or + ___ Premium to Medicare Part B 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 six (6) hour session

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

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

All offerors are hereby advised 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 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 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 a proposal in response to the solicitation.

Subcontract Certification

This contract { } does or { } does not, provide for subcontracting possibilities.

If answer is in the affirmative, offeror { }will, submit a subcontracting plan in accordance with the requirements of FAR 52.219-9.

Offerors are strongly encouraged to consult the following link to obtain assistance with subcontracting opportunities: https://www.sba.gov/federal-contracting/counseling-help/commercial-market-representatives