36C10G18R0208-1-0010001.pdf

36C10G18R0208-1 Amendment 0010

524114

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF PAGES

UNDER DPAS (15 CFR 700)

2. CONTRACT NUMBER 3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED 6. REQUISITION/PURCHASE NUMBER

SEALED BID (IFB)

NEGOTIATED (RFP)

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

NOTE: In sealed bid solicitations "offer" and "Offeror" mean "bid" and "bidder".

9. Sealed offers in original and _____________________________ copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in until local time _______________________ (Hour) (Date)

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All Offers are subject to all terms and conditions contained in this solicitation.

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

AREA CODE NUMBER EXTENSION

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

A SOLICITATION/CONTRACT FORM I CONTRACT CLAUSES

B SUPPLIES OR SERVICES AND PRICES/COSTS PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

C DESCRIPTION/SPECS./WORK STATEMENT J LIST OF ATTACHMENTS

D PACKAGING AND MARKING PART IV - REPRESENTATIONS AND INSTRUCTIONS

E INSPECTION AND ACCEPTANCE

F DELIVERIES OR PERFORMANCE

G CONTRACT ADMINISTRATION DATA L INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

H SPECIAL CONTRACT REQUIREMENTS M EVALUATION FACTORS FOR AWARD

K REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ________ calendar days (60 calendar days unless a different period is inserted by the Offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT 10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%) (See Section I, Clause No. 52-232-8)

14. ACKNOWLEDGEMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The Offeror acknowledges receipt of amendments to the SOLICITATION for Offerors and related documents numbered and dated):

DUNS: DUNS+4: CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER 15A. NAME AND

ADDRESS OF

OFFEROR

(Type or print)

15B. TELEPHONE NUMBER 17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXTENSION 15C. CHECK IF REMITTANCE ADDRESS IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS IN SCHEDULE.

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM (4 copies unless otherwise specified)

10 U.S.C. 2304(c) 41 U.S.C. 3304(a) ( )

24. ADMINISTERED BY (If other than Item 7) 25. PAYMENT WILL BE MADE BY CODE

PHONE: FAX:

26. NAME OF CONTRACTING OFFICER (Type or print) 27. UNITED STATES OF AMERICA 28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

(Signature of Contracting Officer)

(REV. 6/2014)

10. NAICS

11. TABLE OF CONTENTS

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 33

Previous edition is unusable Prescribed by GSA-FAR (48 CFR) 53.214(c)

SOLICITATION, OFFER AND AWARD

SOLICITATION

OFFER (Must be fully completed by Offeror)

AWARD (To be completed by Government)

1 252 N/A

36C10G18R0208-1

X

36C10G

U.S. Department of Veterans Affairs OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

U.S. Department of Veterans Affairs OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

See Section L

13:00 Eastern 11-09-2018

Lori A Smith Contracting Officer

540-479-8450 Ext. 214 Lori.Smith3@va.gov

See Attached Table of Contents

X 1

X 8

X 43

X 130

X 131

X 132

X 148

X 166

X 167

X 191

X 193

X 217

X 243

U.S. Department of Veterans Affairs OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

VAFSC

U.S. Department of Veterans Affairs Financial Services Center

PO BOX 149971

(see Section G.15 invoicing/payment) Austin TX 78714-8917

1 (877) 489-6135

Table of Contents

SECTION B- SUPPLIES OR SERVICES AND PRICE/COSTS

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

1.0 GENERAL INFORMATION

1.1 Introduction

1.2 Background

1.3 Scope of Services

2.0 PROJECT MANAGEMENT

2.1 Post Award Meeting

2.1.1 Kickoff Meeting

2.2 Project Management Plan (Project Plan)

2.2.1 Implementation Strategy

2.2.2 CCN Deployment Plan

2.3 Risk Management Plan

2.4 Operational Quality and Reporting Requirements

2.4.1 Quality Assurance Plan

2.4.2 Supplemental Project Management Reporting Requirements

2.5 CCN Communications Plan

2.6 Accreditation

2.7 Service Organization Control Reporting (SSAE 18)

2.7.1 Service Organization Control Reporting Generally

2.7.2 Service Organization Control Reporting Specifications and Deliverables SOC 1 and SOC 2 Reporting Specifications and Deliverables

2.8 Transition

2.8.1 Reserved

2.8.2 Transition Out

3.0 HIGH PERFORMING NETWORK

3.1 Network Establishment and Maintenance

3.2 Provider Networks

3.2.1 CCN Healthcare Services Network

3.2.2 CCN Complementary and Integrative Healthcare Services Network

3.3 Out-of-Network Providers

3.4 Identification of High-Performing Providers

3.4.1 Institutional Providers

3.4.2 Group Practice Providers

3.4.3 Individual Providers - CCN

3.5 CCN Region

3.6 Network Adequacy Management

3.7 Credentialing

3.7.1 Credentialing Requirements

4.0 CCN HEALTH BENEFIT PACKAGE

4.1 CCN Healthcare Services

4.1.1 CCN Healthcare Service Exceptions

4.2 CCN Complementary and Integrative Healthcare Services

4.3 Excluded CCN Healthcare Services

4.4 CCN Assisted Reproductive Technology Services

5.0 ELIGIBILITY

6.0 CUSTOMER SERVICE

6.1 Contractor VA Support Call Center Functions

6.2 CCN Provider Call Center Function

6.3 Reserved

6.4 Contractor Customer Service Technology

6.5 Veteran Complaints and Grievances and Customer Service Procedure

6.6 Congressional and VA Inquiries

6.7 CCN Provider Satisfaction Surveys

6.8 Call Center Operations and Customer Service Technology Performance Requirements and Metrics

7.0 REFERRALS AND PRIOR AUTHORIZATION

7.1 Notification of Emergent, or Behavioral Health Care

7.2 Referrals from VA to CCN Provider

7.3 Referrals Requested from a CCN Provider for VA Provided Care or Another CCN Provider

7.4 Prior Authorizations

8.0 SCHEDULING OF APPOINTMENTS

9.0 MEDICAL DOCUMENTATION

9.1 Medical Documentation Submission Process

9.2 Medical Documentation Data Elements

9.3 Medical Documentation Submission Timeframes

9.4 Medical Documentation Submission Format

9.5 Reserved

9.6 Critical Findings

9.7 Identification and Documentation of Transplant Candidates

9.8 Medical Documentation and Audit

10.0 TRAINING – CONTRACTOR PROCESSES, SYSTEMS, AND INTERFACES

10.1 Training Plan

10.1.1 Training Program for Contractor CCN Providers, Contractor Personnel, and VA Staff Training Program

10.1.2 Contractor CCN Provider and Contractor Personnel Outreach and Education Program

10.1.2.1 Provider Only Training

10.1.3 Contractor-Provided VA Staff Training Sessions

10.2 Contractor Training Materials

10.3 VA Provided Training

11.0 OPTIONAL TASK: MEDICAL ADMINISTRATIVE MANAGEMENT

11.1 Optional Task: Appointment Scheduling and Comprehensive Care Coordination

11.1.1 Contractor Schedules

11.1.2 Veteran Self-Schedules

11.1.3 Comprehensive Care Coordination

11.1.4 Daily Appointment Scheduling and Comprehensive Care Coordination Reporting

11.2 Optional Task: Care Coordination Follow-up

11.3 Optional Task: Comprehensive Case Management Program Administration

11.4 Optional Task: Comprehensive Disease Management Program Administration 91

12.0 CLAIMS PROCESSING AND ADJUDICATION FOR CCN HEALTHCARE SERVICES

RENDERED

12.1 Claims Processing System Functions

12.1.1 Claims Adjudication and Payment Rules

12.2 Paper Claims

12.3 Signature Requirements

12.3.1 Signature on File Procedure

12.3.2 Network Provider Signature on Claims

12.4 Claims Submission and Processing Timeframes

12.5 Issuance of EOB

12.6 Issuance of Remittance Advice

12.7 Coordination of Benefits

12.7.1 VA Designation of Primary or Secondary Payer of Healthcare Services

12.7.2 Other Health Insurance

12.8 Claims for Services Rendered to Veterans Assigned to Other CCN Region

12.9 Claims Auditing

12.10 Reserved

12.11 Reserved

12.12 Claims Reporting

12.13 Federal Codes and Regulations

12.14 Improper Payments Elimination and Recovery Improvement Act

12.14.1 Payment Accuracy

12.14.2 Accounting and Access to Records

12.14.3 Agreed-Upon-Procedures

12.14.4 Error Determination Rebuttals

12.14.5 Additional Reviews

12.14.6 Recoveries

12.14.7 Reduction of improper payment performance goals

13.0 VETERAN CLAIM APPEALS AND PROVIDER RECONSIDERATIONS

13.1 Veteran Appeals

13.2 Practitioner and Provider Reconsiderations

14.0 CLINICAL QUALITY AND PATIENT SAFETY MONITORING

14.1 Clinical Quality Monitoring Plan (CQMP)

14.1.1 Reserve

14.1.2 Clinical Quality and Patient Safety Improvement Component of the CQMP 108

14.2 Clinical Quality and Patient Safety Issues Identification

15.0 PHARMACY

15.1 Urgent/Emergent Prescriptions

15.2 Urgent/Emergent Prescription Network Adequacy

15.2.1 Urgent/Emergent Prescription Performance Metrics

15.3 Routine/Maintenance Prescriptions

15.4 Contingency Plan for Disaster Response

15.5 Walk-In Prescriptions

16.0 DURABLE MEDICAL EQUIPMENT

16.1 Urgent/Emergent Prescriptions for DME and Medical Devices

16.2 Routine Prescriptions for DME and Medical Devices

16.3 Reserved

16.4 Oral Appliance Therapy (OAT) for Obstructive Sleep Apnea (OSA)

17.0 DENTAL

17.1 Dental Network Adequacy

17.2 Dental Network Provider Credentialing

17.3 Dental Network Compliance

17.4 Dental Care Referrals and Prior Authorization

17.5 Return of Dental Records

17.6 Dental Clinical Quality Management

18.0 TECHNOLOGY

18.1 Contractor Software Configuration Management Requirements

18.2 Continuity of Operations

18.3 Contractor System Access

18.4 VA System Integration Requirements

18.5 Veteran Demographic and Administrative Data

18.6 IT Customer Service

18.7 VA Community Care Provider Portal

18.8 Contractor Self Service Website

18.9 Contractor Reporting and Data Submission

18.10 Email Communication

18.11 Reserved

18.12 Submission of EDI Transactions

18.13 Submission of Medical Documentation

18.14 Submission of OHI

18.15 Provider Data Transfer

18.15.1 Contractor Provider Data

18.15.2 VA Provider Data

18.16 Section 508 – Electronic and Information Technology Standards

18.16.1 Equivalent Facilitation

18.16.2 Compatibility with Assistive Technology

18.16.3 Acceptance and Acceptance Testing

19.0 DATA ANALYTICS

19.1 Data Specification

19.2 Data Repository and Data Repository Relational Database Schema

19.3 Reserved

19.4 Data Transmissions

19.5 Data Integrity

SECTION D - PACKAGING AND MARKING

SECTION E - INSPECTION AND ACCEPTANCE

SECTION F - DELIVERIES OR PERFORMANCE

Schedule of Deliverables

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 CONTRACT ADMINISTRATION DATA

G.2 RESERVED

G.3 IT CONTRACT SECURITY

G.4 DATA RIGHTS

G.5 SMALL BUSINESS SUBCONTRACTING OPPORTUNITIES

G.6 LIMITATIONS ON SUBCONTRACTING – MONITORING AND COMPLIANCE (JUN

2011) 151

G.7 SUBCONTRACTING COMMITMENTS – MONITORING AND COMPLIANCE (JUN

2011) 151

G.8 SUBCONTRACTING PLAN – MONITORING AND COMPLIANCE (JUNE 2011) 152

G.9 TERM OF CONTRACT

G.10 PERIOD OF PERFORMANCE

G.11 KEY PERSONNEL AND TEMPORARY EMERGENCY SUBSTITUTIONS

G.12 PLACE OF PERFORMANCE

G.13 PERFORMANCE INCENTIVE PLAN

G.14 ORDERING PROCEDURES

G.15 INVOICES: ADDENDUM TO 52.212-4

SECTION H - SPECIAL CONTRACT REQUIREMENTS

SECTION I - CONTRACT CLAUSES

I.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017) 168

I.3 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

ALTERNATE II (NOV 2017)

I.4 RESERVED

I.5 52.216-18 ORDERING (OCT 1995)

I.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

I.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

I.8 52.217-7 OPTION FOR INCREASED QUANTITY—SEPARATELY PRICED LINE

ITEM (MAR 1989)

I.9 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

I.10 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ... 184

I.11 52.222-35 EQUAL OPPORTUNITY FOR VETERANS (OCT 2015)

I.12 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES (JUL

2014) 185

I.13 52.232-18 AVAILABILITY OF FUNDS (APR 1984)

I.14 52.244-2 SUBCONTRACTS (OCT 2010)

I.15 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016) (DEVIATION)

I.16 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

I.17 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (DEC 2009)

I.18 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012) 189

I.19 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

I.20 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN

2008) 190

I.21 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO

BENEFICIARIES (JAN 2008)

I.22 MANDATORY WRITTEN DISCLOSURES

I.23 52.216-1 TYPE OF CONTRACT…………………………………… ………………192

I.24 52.233-2 SERVICE OF PROTEST ………………………………………………………192

SECTION J - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

LIST OF ATTACHMENTS

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF

OFFERORS

K.1 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THATREQUIRE

CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS OR STATEMENTS—

REPRESENTATION (JAN 2017)

K.2 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015)

K.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JULY 2013)

K.4 52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT

TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

K.5 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (NOV 2017)

K.6 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

SECTION M - EVALUATION FACTORS FOR AWARD

36C10G18R0208-1 Amendment 0009

SECTION B- SUPPLIES OR SERVICES AND PRICE/COSTS

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

Item Number Description Comment

Contract Period

0001 Healthcare Services Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to these services are inclusive of all authorized healthcare services identified in PWS Section 4.1, “CCN Healthcare Services” and Complementary and Integrative Health Services identified in PWS Section 4.2, “CCN Complementary and Integrative Health Services” covered by the applicable Medicare Prospective Payment System (PPS).

Base

0002 Reimbursement for Highly Rural Care Areas with Scarce Medical Services

Maximum % of the locality adjusted Medicare rate for each state for each year of the PoP. This CLIN only applies if the Contractor must execute a specific agreement in a highly rural care area at a rate that exceeds Medicare as required to maintain network adequacy. Adequate documentation must be provided to the Contracting Officer for review and disposition to support a request for higher than Medicare rates. The Contractor may, in highly rural care areas, exceed Medicare, but shall not exceed the maximum rate initially proposed for each state.

Base

0002AA Highly Rural Care provided in Arizona

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AB Highly Rural Care provided in California

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AC Highly Rural Care provided in Colorado

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AD Highly Rural Care provided in Hawaii

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AE Highly Rural Care provided in Idaho

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AF Highly Rural Care provided in Montana

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AG Highly Rural Care provided in New Mexico

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AH Highly Rural Care provided in Nevada

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AI Highly Rural Care provided in Oregon

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AJ Highly Rural Care provided in Texas

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AK Highly Rural Care provided in Utah

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AL Highly Rural Care provided in Washington

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0002AM Highly Rural Care provided in Wyoming

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Base

0003 Urgent/Emergent Durable Medical Equipment (DME), Medical Devices, Orthotics, and Prosthetic items

Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to these services for purchases against this CLIN that are not bundled under other healthcare services provided pursuant to the contract (e.g. hardware used in orthopedic surgery, prosthetic valves in cardiac surgery, implantable devices), pricing will be equal to the Medicare rates for the products against this CLIN.

Base

0004 Home Health Care Summary CLIN, not separately priced (NSP) Base 0004AA Skilled Home Health Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to Skilled Home Health services are that contract pricing for this CLIN is equal to the Medicare rate for the services being performed.

Base

0004AB Unskilled Home Health Price Not Required. Contract pricing is up to the VA Fee Schedule.

Assumptions/considerations related to these Unskilled Home Health services includes assistance with all daily living activities such as house cleaning, food preparation, grocery shopping, laundry, accompanying Veteran to medical appointments (e.g.

Homemaker/Home Health Aide).

Base

Number Description Comment

Contract Period

0005 Seasonal Influenza Vaccination

Dollar price for each year of the POP. This CLIN is for the administration and dispensing fees for the influenza vaccine (trivalent, quadrivalent and high dosage). VA will pay the negotiated price for each vaccination.

Base

0006 Non-Medicare Healthcare Services, VA Fee Schedule

Price Not Required. Contract pricing is up to the VA Fee Schedule.

Assumptions/considerations related to the non-Medicare Healthcare Services, VA Fee Schedule - When a given medical procedure is not payable under Medicare rules or is payable under Medicare rules but does not have established pricing at the local level, such medical procedures will be paid based on the applicable VA Fee Schedule.

Outpatient services performed by Inpatient Prospective Payment System (IPPS) -exempt facilities are also included under this CLIN.

Base

0007 Non-Medicare, Non-VA Fee Schedule - Medical and Surgical Healthcare Services

Price Not Required. Assumptions/considerations - when a given medical procedure is not payable under Medicare rules, or is payable under Medicare rules but does not have established pricing at the local level, and is not included in the VA Fee Schedule, VA will reimburse the healthcare claims pursuant to 38 CFR 17.55 or 38 CFR 17.56, including any subsequent changes to include but not limited to payment based on a percentage of billed charges.

Base

0008 Home Infusion Therapy Offeror prices only required for those items where a standard Medicare or VA rate does not already exist. Home infusion drugs billed at CLIN X009 rates.

Base

0009 Urgent and Emergent Medication

VA will pay the Contractor for brand name medication at a Fixed Price based on Average Wholesale Price (AWP) plus/minus percent, plus a dollar amount for dispensing fee.; and generic medication at a Fixed Price based on AWP plus/minus percent, plus a dollar amount for dispensing fee.

Base

0009AA Brand Name Medication Fixed Price based on Percent of Average Wholesale Price for each year of the PoP Base 0009AB Generic Medication Fixed Price based on Percent of Average Wholesale Price for each year of the PoP Base 0009AC Dispensing Fee Dollar price for each dispensing activity for each year of the PoP Base 0010 Dental Services Provide price for each of the 28 codes being evaluated for each year of the PoP.

Dental services will be reimbursed based on the negotiated rates per American Dental Association (ADA) Current Dental Terminology (CDT) code listing for the region where the service is provided. VA will pay the Contractor using health care CLINs (X001, X002, X006 etc.) if the dental procedure is performed in conjunction with a medical service.

Base

0011 Administrative Services Administrative Services based on a per member per month (PMPM) model. The PMPM covers the Contractors charges for all administrative services for managing the services purchased under this contract. The PMPM charge is to be invoiced in accordance with the total number of Active Veterans per month. The PMPM fee is tiered to accommodate for low volumes and to encourage price reductions at higher volumes.

Base

0011A Administrative Services for Healthcare Services

Summary CLIN, NSP. Dollar price for each Active Veteran per month in each of the three tiers for the PoP.

Base

0011AA Administrative Services for Healthcare Services - Tier 1

Each Active Veteran Per Month Tier 1 (0-94,999) Base

0011AB Administrative Services for Healthcare Services - Tier 2

Each Active Veteran Per Month Tier 2 (95,000-144,999) Base

0011AC Administrative Services for Healthcare Services - Tier 3

Each Active Veteran Per Month Tier 3 (145,000 and greater) Base

0011B Administrative Services for Dental

Summary CLIN, NSP. Dollar price for each Active Veteran per month in each of the three tiers for the PoP.

Base

0011BA Administrative Services for Dental - Tier 1

Each Active Veteran Per Month Tier 1 (0-5,799) Base

0011BB Administrative Services for Dental - Tier 2

Each Active Veteran Per Month Tier 2 (5,800-6,599) Base

0011BC Administrative Services for Dental - Tier 3

Each Active Veteran Per Month Tier 3 (6,600 and greater) Base

0011CA Administrative Services for Pharmacy Benefit Management (PBM)

Dollar price for each Active Veteran per month for each year of the PoP. Administrative Fee for Pharmacy Benefits Management (PBM) is to be invoiced based on when an urgent /emergent pharmacy claim is paid for an Active Veteran during that billing month.

Base

0011DA Administrative Services for Assisted Reproductive Technology services

(ART)

Dollar price for each Collateral of Veteran per month for each year of the PoP. Base

0012 Implementation and Transition Out

Summary CLIN, NSP Base

0012AA Implementation Lump sum $ price based on # of milestones completed in year Base 0012BA Transition Out Price Not Required. Base 0013 Data Price Not Required. Assumptions/considerations for this CLIN includes all services associated with delivery of data throughout performance and at the end of the contract.

Base

Contract Period

0014 Agreed Upon Procedures Provide the price of the audit. The audit must meet Government requirements. Base 0015 Healthcare Services

Approved Under the Veterans Millennium Health Care Act

(MILLBILL)

Price Not Required. Assumptions/consideration for this CLIN refers to PWS Section 7.1 which directs the Contractor to pend claims for emergent or urgent care and submit a Referral Request in order to obtain an Approved Referral from VA. VA will review and determine if authority exists to return an Approved Referral. Care authorized by VA under the authority of 38 U.S.C. 1725, will be annotated by VA as such and paid by the Contractor at the 70th percentile of CMS rates.

Base

0016 Optional: Appointment Scheduling & Comprehensive Care Coordination

Summary CLIN, NSP Base

0016AA Optional: Implementation for Appointment Scheduling and Comprehensive Care Coordination

Price Not Required Base

0016BA Optional: Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor’s site

Price Not Required Base

0016C Optional: Appointment Scheduling and Comprehensive Care Coordination

Summary CLIN, NSP. Dollar price per Unique Approved Referral for each of the tiers of unique approved referrals for a period of performance.

Base

0016CA Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 1

Price Not Required Base

0016CB Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 2

Price Not Required Base

0016CC Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 3

Price Not Required Base

0016CD Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 4

Price Not Required Base

0016CE Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 5

Price Not Required Base

0017 Optional: Care Coordination Follow-Up

Summary CLIN, NSP Base

0017AA Optional: Implementation for Care Coordination Follow-Up

Price Not Required Base

0017BA Optional: Care Coordination Follow-Up Administration

Price Not Required Base

0018 Optional: Comprehensive Case Management Program Administration

Summary CLIN, NSP Base

0018AA Optional: Implementation for Comprehensive Case Management Program

Price Not Required Base

0018B Optional: Comprehensive Case Management Program Administration

Summary CLIN, NSP. Dollar price per Unique Approved Referral for each of the tiers for each year of the PoP.

Base

0018BA Optional: Comprehensive Case Management Program Administration - Tier 1

Price Not Required Base

0018BB Optional: Comprehensive Case Management

Price Not Required Base

Contract Period

Program Administration - Tier 2

0018BC Optional: Comprehensive Case Management Program Administration - Tier 3

Price Not Required Base

0019 Optional: Comprehensive Disease Management Administration

Summary CLIN, NSP Base

0019AA Optional: Implementation for Comprehensive Disease Management

Price Not Required Base

0019B Optional: Comprehensive Disease Management Program Administration

Summary CLIN, NSP. Dollar price per Unique Approved Referral for each of the tiers for each year of the PoP.

Base

0019BA Optional: Comprehensive Disease Management Program Administration - Tier 1

Price Not Required Base

0019BB Optional: Comprehensive Disease Management Program Administration - Tier 2

Price Not Required Base

0019BC Optional: Comprehensive Disease Management Program Administration - Tier 3

Price Not Required Base

0020 Assisted Reproductive Technology (ART) Services

The CLIN is to be used for all health care and providers associated with the VA authorization type ART. Provide unit price for each of price codes in the pricing template.

Base

1001 Healthcare Services Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to these services are inclusive of all authorized healthcare services identified in PWS Section 4.1, “CCN Healthcare Services” and Complementary and Integrative Health Services identified in PWS Section 4.2, “CCN Complementary and Integrative Health Services” covered by the applicable Medicare Prospective Payment System (PPS).

Option 1

1002 Reimbursement for Highly Rural Care Areas with Scarce Medical Services

Maximum % of the locality adjusted Medicare rate for each state for each year of the PoP. This CLIN only applies if the Contractor must execute a specific agreement in a highly rural care area at a rate that exceeds Medicare as required to maintain network adequacy. Adequate documentation must be provided to the Contracting Officer for review and disposition to support a request for higher than Medicare rates. The Contractor may, in highly rural care areas, exceed Medicare, but shall not exceed the maximum rate initially proposed for each state.

Option 1

1002AA Highly Rural Care provided in Arizona

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AB Highly Rural Care provided in California

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AC Highly Rural Care provided in Colorado

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AD Highly Rural Care provided in Hawaii

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AE Highly Rural Care provided in Idaho

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AF Highly Rural Care provided in Montana

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AG Highly Rural Care provided in New Mexico

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AH Highly Rural Care provided in Nevada

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AI Highly Rural Care provided in Oregon

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AJ Highly Rural Care provided in Texas

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AK Highly Rural Care provided in Utah

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1002AL Highly Rural Care provided in Washington

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

Contract Period

1002AM Highly Rural Care provided in Wyoming

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 1

1003 Urgent/Emergent Durable Medical Equipment (DME), Medical Devices, Orthotics, and Prosthetic items

Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to these services for purchases against this CLIN that are not bundled under other healthcare services provided pursuant to the contract (e.g. hardware used in orthopedic surgery, prosthetic valves in cardiac surgery, implantable devices), pricing will be equal to the Medicare rates for the products against this CLIN.

Option 1

1004 Home Health Care Summary CLIN, NSP Option 1 1004AA Skilled Home Health Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to Skilled Home Health services are that contract pricing for this CLIN is equal to the Medicare rate for the services being performed.

Option 1

1004AB Unskilled Home Health Price Not Required. Contract pricing is up to the VA Fee Schedule.

Assumptions/considerations related to these Unskilled Home Health services includes assistance with all daily living activities such as house cleaning, food preparation, grocery shopping, laundry, accompanying Veteran to medical appointments (e.g.

Homemaker/Home Health Aide).

Option 1

1005 Seasonal Influenza Vaccination

Dollar price for each year of the PoP. This CLIN is for the administration and dispensing fees for the influenza vaccine (trivalent, quadrivalent and high dosage). VA will pay the negotiated price for each vaccination.

Option 1

1006 Non-Medicare Healthcare Services, VA Fee Schedule

Price Not Required. Contract pricing is up to the VA Fee Schedule.

Assumptions/considerations related to the non-Medicare Healthcare Services, VA Fee Schedule - When a given medical procedure is not payable under Medicare rules or is payable under Medicare rules but does not have established pricing at the local level, such medical procedures will be paid based on the applicable VA Fee Schedule.

Outpatient services performed by Inpatient Prospective Payment System (IPPS) -exempt facilities are also included under this CLIN.

Option 1

1007 Non-Medicare, Non-VA Fee Schedule - Medical and Surgical Healthcare Services

Price Not Required. Assumptions/considerations - when a given medical procedure is not payable under Medicare rules, or is payable under Medicare rules but does not have established pricing at the local level, and is not included in the VA Fee Schedule, VA will reimburse the healthcare claims pursuant to 38 CFR 17.55 or 38 CFR 17.56, including any subsequent changes to include but not limited to payment based on a percentage of billed charges.

Option 1

1008 Home Infusion Therapy Offeror prices only required for those items where a standard Medicare or VA rate does not already exist. Home infusion drugs billed at CLIN X009 rates.

Option 1

1009 Urgent and Emergent Medication

VA will pay the Contractor for brand name medication at a Fixed Price based on Average Wholesale Price (AWP) plus/minus percent, plus a dollar amount for dispensing fee.; and generic medication at a Fixed Price based on AWP plus/minus percent, plus a dollar amount for dispensing fee.

Option 1

1009AA Brand Name Medication Fixed Price based on Percent of Average Wholesale Price for each year of the PoP Option 1 1009AB Generic Medication Fixed Price based on Percent of Average Wholesale Price for each year of the PoP Option 1 1009AC Dispensing Fee Dollar price for each dispensing activity for each year of the PoP Option 1 1010 Dental Services Provide price for each of the 28 codes being evaluated for each year of the PoP.

Dental services will be reimbursed based on the negotiated rates per American Dental Association (ADA) Current Dental Terminology (CDT) code listing for the region where the service is provided. VA will pay the Contractor using health care CLINs (X001, X002, X006 etc.) if the dental procedure is performed in conjunction with a medical service.

Option 1

1011 Administrative Services Administrative Services based on a per member per month (PMPM) model. The PMPM covers the Contractors charges for all administrative services for managing the services purchased under this contract. The PMPM charge is to be invoiced in accordance with the total number of Active Veterans per month. The PMPM fee is tiered to accommodate for low volumes and to encourage price reductions at higher volumes.

Option 1

1011A Administrative Services for Healthcare Services

Summary CLIN, NSP. Dollar price for each Active Veteran per month in each of the three tiers for the PoP.

Option 1

1011AA Administrative Services for Healthcare Services - Tier 1

Each Active Veteran Per Month Tier 1 (0-94,999) Option 1

1011AB Administrative Services for Healthcare Services - Tier 2

Each Active Veteran Per Month Tier 2 (95,000-144,999) Option 1

1011AC Administrative Services for Healthcare Services - Tier 3

Each Active Veteran Per Month Tier 3 (145,000 and greater) Option 1

1011B Administrative Services for Dental

Summary CLIN, NSP. Dollar price for each Active Veteran per month in each of the three tiers for the PoP.

Option 1

1011BA Administrative Services for Dental - Tier 1

Each Active Veteran Per Month Tier 1 (0-5,799) Option 1

Contract Period

1011BB Administrative Services for Dental - Tier 2

Each Active Veteran Per Month Tier 2 (5,800-6,599) Option 1

1011BC Administrative Services for Dental - Tier 3

Each Active Veteran Per Month Tier 3 (6,600 and greater) Option 1

1011CA Administrative Services for Pharmacy Benefit Management (PBM)

Dollar price for each Active Veteran per month for each year of the PoP. Administrative Fee for Pharmacy Benefits Management (PBM) is to be invoiced based on when an urgent /emergent pharmacy claim is paid for an Active Veteran during that billing month.

Option 1

1011DA Administrative Services for Assisted Reproductive Technology services

(ART)

Dollar price for each Collateral of Veteran per month for each year of the PoP. Option 1

1012 Implementation and Transition Out

Summary CLIN, NSP Option 1

1012AA Implementation Price Optional Option 1 1012BA Transition Out Lump sum $ price for total incremental cost to transition out above and beyond the status quo, applicable if Transition Out services exercised by VA in this Option Year.

PoP goes from the time that the CO notifies the Contractor of a planned transition out start date to the later of either 6 months or completion of all processing and finalization of all open healthcare claims inventories or as mutually agreed to by the CO and Contractor.

Option 1

1013 Data Price Not Required. Assumptions/considerations for this CLIN includes all services associated with delivery of data throughout performance and at the end of the contract.

Option 1

1014 Agreed Upon Procedures Provide the price of the audit. The audit must meet Government requirements. Option 1 1015 Healthcare Services

Approved Under the Veterans Millennium Health Care Act

(MILLBILL)

Price Not Required. Assumptions/consideration for this CLIN refers to PWS Section 7.1 which directs the Contractor to pend claims for emergent or urgent care and submit a Referral Request in order to obtain an Approved Referral from VA. VA will review and determine if authority exists to return an Approved Referral. Care authorized by VA under the authority of 38 U.S.C. 1725, will be annotated by VA as such and paid by the Contractor at the 70th percentile of CMS rates.

Option 1

1016 Optional: Appointment Scheduling & Comprehensive Care Coordination

Summary CLIN, NSP Option 1

1016AA Optional: Implementation for Appointment Scheduling and Comprehensive Care Coordination

Implementation price per VA Facility at Government site for a PoP. VA will pay the negotiated fixed price for each VA Facility that orders Appointment Scheduling and Comprehensive Care Coordination. The Contractor can earn only one implementation payment per VA Facility during the entire contract.

Option 1

1016BA Optional: Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor’s site

Implementation price per VA Facility at Contractor's site for a PoP. VA will pay the negotiated fixed price. The Contractor can earn only one implementation payment during the entire contract.

Option 1

1016C Optional: Appointment Scheduling and Comprehensive Care Coordination

Summary CLIN, NSP. Dollar price per Unique Approved Referral for each of the tiers of unique approved referrals for a period of performance.

Option 1

1016CA Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 1

Unique Approved Referral Tier 1 (0-331,400) Option 1

1016CB Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 2

Each Unique Approved Referral Tier 2 (331,401-773,300) Option 1

1016CC Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 3

Each Unique Approved Referral Tier 3 (773,301-1,215,200) Option 1

1016CD Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 4

Each Unique Approved Referral Tier 4 (1,215,201-1,657,000) Option 1

1016CE Optional: Appointment Scheduling and Comprehensive Care Coordination - Tier 5

Each Unique Approved Referral Tier 5 (1,657,001-2,540,600) Option 1

Contract Period

1017 Optional: Care Coordination Follow-Up

Summary CLIN, NSP Option 1

1017AA Optional: Implementation for Care Coordination Follow-Up

One-time lump sum $ in the year the option is exercised. Dollar amount reflects the total lump sum for implementation services for each year of the PoP; these implementation services shall be excluded from other Contractor Administrative Service Fees.

Option 1

1017BA Optional: Care Coordination Follow-Up Administration

VA will pay the contractor the monthly $ firm fixed price per Veteran that receives Care Coordination Follow Up Services.

Option 1

1018 Optional: Comprehensive Case Management Program Administration

Summary CLIN, NSP Option 1

1018AA Optional: Implementation for Comprehensive Case Management Program

One-time lump sum $ in the year the option is exercised. This CLIN reflects the total lump sum for implementation services; these implementation services shall be excluded from other Contractor Administrative Service Fees.

Option 1

1018B Optional: Comprehensive Case Management Program Administration

Summary CLIN, NSP Option 1

1018BA Optional: Comprehensive Case Management Program Administration - Tier 1

Each Unique Approved Referral Tier 1 (0-41,000). Option 1

1018BB Optional: Comprehensive Case Management Program Administration - Tier 2

Each Unique Approved Referral Tier 2 (41,001-82,000). Option 1

1018BC Optional: Comprehensive Case Management Program Administration - Tier 3

Each Unique Approved Referral Tier 3 (82,001 and greater). Option 1

1019 Optional: Comprehensive Disease Management Administration

Summary CLIN, NSP Option 1

1019AA Optional: Implementation for Comprehensive Disease Management

One-time lump sum $ in the year the option is exercised. Pricing for this CLIN reflects the total lump sum of implementation services. These implementation services shall be excluded from other Contractor Administrative Service Fees.

Option 1

1019B Optional: Comprehensive Disease Management Program Administration

Summary CLIN, NSP. Dollar price per Unique Approved Referral for each of the tiers for each year of the PoP.

Option 1

1019BA Optional: Comprehensive Disease Management Program Administration - Tier 1

Each Unique Approved Referral Tier 1 (0-41,000). Option 1

1019BB Optional: Comprehensive Disease Management Program Administration - Tier 2

Each Unique Approved Referral Tier 2 (41,001-82,000). Option 1

1019BC Optional: Comprehensive Disease Management Program Administration - Tier 3

Each Unique Approved Referral Tier 3 (82,001 and greater). Option 1

1020 Assisted Reproductive Technology (ART) Services

The CLIN is to be used for all health care and providers associated with the VA authorization type ART. Provide unit price for each of price codes in the pricing template.

Option 1

2001 Healthcare Services Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to these services are inclusive of all authorized healthcare services identified in PWS Section 4.1, “CCN Healthcare Services” and Complementary and Integrative Health Services identified in PWS Section 4.2, “CCN Complementary and Integrative Health Services” covered by the applicable Medicare Prospective Payment System (PPS).

Option 2

2002 Reimbursement for Highly Rural Care Areas with Scarce Medical Services

Maximum % of the locality adjusted Medicare rate for each state for each year of the PoP. This CLIN only applies if the Contractor must execute a specific agreement in a highly rural care area at a rate that exceeds Medicare as required to maintain network adequacy. Adequate documentation must be provided to the Contracting Officer for review and disposition to support a request for higher than Medicare rates. The Contractor may, in highly rural care areas, exceed Medicare, but shall not exceed the maximum rate initially proposed for each state.

Option 2

2002AA Highly Rural Care provided in Arizona

Maximum % of the locality adjusted Medicare rate for this state for each year of the

Option 2

Contract Period

2002AB Highly Rural Care provided in California

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AC Highly Rural Care provided in Colorado

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AD Highly Rural Care provided in Hawaii

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AE Highly Rural Care provided in Idaho

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AF Highly Rural Care provided in Montana

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AG Highly Rural Care provided in New Mexico

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AH Highly Rural Care provided in Nevada

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AI Highly Rural Care provided in Oregon

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AJ Highly Rural Care provided in Texas

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AK Highly Rural Care provided in Utah

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2002AL Highly Rural Care provided in Washington

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

1002AM Highly Rural Care provided in Wyoming

Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP

Option 2

2003 Urgent/Emergent Durable Medical Equipment (DME), Medical Devices, Orthotics, and Prosthetic items

Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to these services for purchases against this CLIN that are not bundled under other healthcare services provided pursuant to the contract (e.g. hardware used in orthopedic surgery, prosthetic valves in cardiac surgery, implantable devices), pricing will be equal to the Medicare rates for the products against this CLIN.

Option 2

2004 Home Health Care Summary CLIN, NSP Option 2 2004AA Skilled Home Health Price Not Required. This CLIN is priced up to 100% Medicare.

Assumptions/considerations related to Skilled Home Health services are that contract pricing for this CLIN is equal to the Medicare rate for the services being performed.

Option 2

2004AB Unskilled Home Health Price Not Required. Contract pricing is up to the VA Fee Schedule.

Assumptions/considerations related to these Unskilled Home Health services includes assistance with all daily living activities such as house cleaning, food preparation, grocery shopping, laundry, accompanying Veteran to medical appointments (e.g.

Homemaker/Home Health Aide).

Option 2

2005 Seasonal Influenza Vaccination

Dollar price for each year of the PoP. This CLIN is for the administration and dispensing fees for the influenza vaccine (trivalent, quadrivalent and high dosage). VA will pay the negotiated price for each vaccination.

Option 2

2006 Non-Medicare Healthcare Services, VA Fee Schedule

Price Not Required. Contract pricing is up to the VA Fee Schedule.

Assumptions/considerations related to the non-Medicare Healthcare Services, VA Fee Schedule - When a given medical procedure is not payable under Medicare rules or is payable under Medicare rules but does not have established pricing at the local level, such medical procedures will be paid based on the applicable VA Fee Schedule.

Outpatient services performed by Inpatient Prospective Payment System (IPPS) -exempt facilities are also included under this CLIN.

Option 2

2007 Non-Medicare, Non-VA Fee Schedule - Medical and Surgical Healthcare Services

Price Not Required. Assumptions/considerations - when a given medical procedure is not payable under Medicare rules, or is payable under Medicare rules but does not have established pricing at the local level, and is not included in the VA Fee Schedule, VA will reimburse the healthcare claims pursuant to 38 CFR 17.55 or 38 CFR 17.56, including any subsequent changes to include but not limited to payment based on a percentage of billed charges.

Option 2

2008 Home Infusion Therapy Offeror prices only required for those items where a standard Medicare or VA rate does not already exist. Home infusion drugs billed at CLIN X009 rates.

Option 2

2009 Urgent and Emergent Medication

VA will pay the Contractor for brand name medication at a Fixed Price based on Average Wholesale Price (AWP) plus/minus percent, plus a dollar amount for dispensing fee.; and generic medication at a Fixed Price based on AWP plus/minus percent, plus a dollar amount for dispensing fee.

Option 2

2009AA Brand Name Medication Fixed Price based on Percent of Average Wholesale Price for each year of the PoP Option 2 2009AB Generic Medication Fixed Price based on Percent of Average Wholesale Price for each year of the PoP Option 2 2009AC Dispensing Fee Dollar price for each dispensing activity for each year of the PoP Option 2 2010 Dental Services Provide price for each of the 28 codes being evaluated for each year of the PoP.

Dental services will be reimbursed based on the negotiated rates per American Dental Association (ADA) Current Dental Terminology (CDT) code listing for the region where

Contract Period the service is provided. VA will pay the Contractor using health care CLINs (X001, X002, X006 etc.) if the dental procedure is performed in conjunction with a medical service.

2011 Administrative Services Administrative Services based on a per member per month (PMPM) model. The PMPM covers the Contractors charges for all administrative services for managing the services purchased under this contract. The PMPM charge is to be invoiced in accordance with the total number of Active Veterans per month. The PMPM fee is tiered to accommodate for low volumes and to encourage price reductions at higher volumes.

Option 2

2011A Administrative Services for Healthcare Services

Summary CLIN, NSP. Dollar price for each Active Veteran per month in each of the three tiers for the PoP.

Option 2

2011AA Administrative Services for Healthcare Services - Tier 1

Each Active Veteran Per Month Tier 1 (0-94,999) Option 2

2011AB Administrative Services for Healthcare Services - Tier 2

Each Active Veteran Per Month Tier 2 (95,000-144,999) Option 2

2011AC Administrative Services for Healthcare Services - Tier 3

Each Active Veteran Per Month Tier 3 (145,000 and greater) Option 2

2011B Administrative Services for Dental

Summary CLIN, NSP. Dollar price for each Active Veteran per month in each of the three tiers for the PoP.

Option 2

2011BA Administrative Services for Dental - Tier 1

Each Active Veteran Per Month Tier 1 (0-5,799) Option 2

2011BB Administrative Services for Dental - Tier 2

Each Active Veteran Per Month Tier 2 (5,800-6,599) Option 2

2011BC Administrative Services for Dental - Tier 3

Each Active Veteran Per Month Tier 3 (6,600 and greater) Option 2

2011CA Administrative Services for Pharmacy Benefit…