36C10G18R0208-1-0016007.pdf
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- Customer Care Network Region 4
- Solicitation number
- 36C10G18R02081
About this file
This is a solicitation for a Customer Care Network Region 4 contract. The solicitation seeks healthcare and administrative services to support Veterans in Region 4, including healthcare services paid at 100% of Medicare rates, reimbursement for services provided in highly rural areas above Medicare rates, urgent durable medical equipment and medications, dental and pharmacy services, and administrative fees on a per member per month basis. The contractor will also provide optional tasks such as appointment scheduling, care coordination, and disease management programs. The period of performance is base year plus four option years. Pricing is included for evaluation purposes for the base period, and the contractor must provide pricing for the option periods.
36C10G18R0208-1 0016 Conformed SF 33 RFP 36C10G18R0208-1 041019.pdf
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36C10G18R0208-1 Amendment 0016
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)
1 270 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
10:00 AM EDT
04-15-2019
Lori A Smith Contracting Officer
540-479-8450 Ext. 214 Lori.Smith3@va.gov
See Attached Table of Contents
X 1
X 8
X 57
X 144
X 145
X 146
X 162
X 180
X 181
X 206
X 208
X 230
X 256
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
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
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 122
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)
G.7 SUBCONTRACTING COMMITMENTS – MONITORING AND COMPLIANCE
(JUN 2011)
G.8 SUBCONTRACTING PLAN – MONITORING AND COMPLIANCE (JUNE 2011)
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) 182
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.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) .. 197
I.11 52.222-35 EQUAL OPPORTUNITY FOR VETERANS (OCT 2015)
I.12 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES (JUL
2014) 198
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) 202
I.19 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)
I.20 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN
2008) 203
I.21 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO
BENEFICIARIES (JAN 2008)
I.22 MANDATORY WRITTEN DISCLOSURES
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) 208
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) 211
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
SECTION B- SUPPLIES OR SERVICES AND PRICE
Item Number Description Comment Contract Period
0001 Healthcare Services
Price Not Required. This CLIN is priced at 100 % of Medicare for evaluation purposes. 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
Reimbursement for Highly Rural Care Areas with Scarce Medical Services
Price Required. This CLIN is to be priced as a percentage of Medicare.
The contractor may propose a percentage rate equal to or greater than the Medicare rate. See Attachment L, “Region 4 Authorizations & Unique Counts by Rurality FY15-FY18”. The Contracting Officer will only authorize pricing to be paid for this CLIN when Contractor submits documentation for the rate proposed in a Highly Rural Care Area or for Scarce Medical Services.
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
Urgent/Emergent Durable Medical Equipment (DME), Medical Devices, Orthotics, and Prosthetic items
Price Not Required. This CLIN is priced at 100% of 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 at 100% of 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 at 100% of 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
0005 Seasonal Influenza Vaccination
Dollar price for each year of the POP derived from offeror’s unit price per vaccination time volume data. This CLIN is for the administration and dispensing fees for the influenza vaccine (trivalent, quadrivalent and high dosage). VA will pay the proposed price for each vaccination and administration.
Base
0006 Non-Medicare Healthcare Services, VA Fee Schedule
Price Not Required. Contract pricing is equal to the VA Fee Schedule.
Assumptions/considerations related to the non-Medicare Healthcare Services, VA Fee Schedule - When a given medical procedure, to include Home Infusion Therapy, 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
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 based on a percentage of billed charges for services.
0008 Home Infusion Therapy (HIT)
Price required: Offeror will provide a single fixed percentage rate for future HCPCS or CPT billing applications that do not have an associated/established Medicare or VA Fee reimbursement rate at time of service. The VA will not reimburse in excess of proposed (%) of billed charges for HIT services. The Contracting Officer will only authorize payment for this CLIN when accompanied by adequate documentation and will be reimbursed at the percent proposed as reflected in the Offerors Price Proposal. Home infusion drugs billed at CLIN X009 rates.
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. Base
0014 Agreed Upon Procedures Provide the price of the audit. The audit must meet Government requirements. Base
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
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
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 Program Administration - Tier 2
Price Not Required Base
0018BC
Optional: Comprehensive Case Management Program Administration - Tier 3
Price Not Required Base
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 equal 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
Reimbursement for Highly Rural Care Areas with Scarce Medical Services
Price Required. This CLIN is to be priced as a percentage of Medicare.
The contractor may propose a percentage rate equal to or greater than the Medicare rate. See Attachment L, “Region 4 Authorizations & Unique Counts by Rurality FY15-FY18”. The Contracting Officer will only authorize pricing to be paid for this CLIN when Contractor submits
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
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
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
Urgent/Emergent Durable Medical Equipment (DME), Medical Devices, Orthotics, and Prosthetic items
Price Not Required. This CLIN is priced at 100% of 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 at 100% of 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 at 100% of 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 derived from offeror’s unit price per vaccination time volume data. This CLIN is for the administration and dispensing fees for the influenza vaccine (trivalent, quadrivalent and high dosage). VA will pay the proposed price for each vaccination and administration.
Option 1
1006 Non-Medicare Healthcare Services, VA Fee Schedule
Price Not Required. Contract pricing is equal 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.
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 or based upon usual and customary prices for services..
Option 1
1008 Home Infusion Therapy
Price required: Offeror will provide a single fixed percentage rate for future HCPCS or CPT billing applications that do not have an associated/established Medicare or VA Fee reimbursement rate at time of service. The VA will not reimburse in excess of proposed (%) of billed charges for HIT services. The Contracting Officer will only authorize payment for this CLIN when accompanied by adequate documentation and will be reimbursed at the percent proposed as reflected in the Offerors Price Proposal. 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
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
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
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
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
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.
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
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 equal 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
Reimbursement for Highly Rural the Medicare rate. See Attachment L, “Region 4 Authorizations & Unique Counts by Rurality FY15-FY18”. The Contracting Officer will only authorize pricing to be paid for this CLIN when Contractor submits documentation for the rate proposed in a Highly Rural Care Area or for Scarce Medical Services.
Option 2
2002AA Highly Rural Care provided in Arizona
Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP Option 2
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
2002AM Highly Rural Care provided in Wyoming
Maximum % of the locality adjusted Medicare rate for this state for each year of the PoP Option 2
Urgent/Emergent Durable Medical Equipment (DME), Medical Devices, Orthotics, and Prosthetic items
Price Not Required. This CLIN is priced at 100% of 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 at 100% of 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 at 100% of 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).
2005 Seasonal Influenza Vaccination
Dollar price for each year of the POP derived from offeror’s unit price per vaccination time volume data. This CLIN is for the administration and dispensing fees for the influenza vaccine (trivalent, quadrivalent and high dosage). VA will pay the proposed price for each vaccination and administration.
Option 2
2006 Non-Medicare Healthcare Services, VA Fee Schedule
Price Not Required. Contract pricing is equal 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
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 or based upon usual and customary prices for services.
Option 2
2008 Home Infusion Therapy
Price required: Offeror will provide a single fixed percentage rate for future HCPCS or CPT billing applications that do not have an associated/established Medicare or VA Fee reimbursement rate at time of service. The VA will not reimburse in excess of proposed (%) of billed charges for HIT services. The Contracting Officer will only authorize payment for this CLIN when accompanied by adequate documentation and will be reimbursed at the percent proposed as reflected in the Offerors Price Proposal. 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 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…
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