36C10G18R0208-1-0019005.xlsx

XLSX spreadsheet 752 KB Posted Jun 3, 2019

Attached to: Customer Care Network Region 4
Solicitation number: 36C10G18R02081
Issued by: Department of Veterans Affairs Strategic Acquisition Center Frederick

About this file

Written by GovTribe AI · Dec 30, 2023

This solicitation requests proposals for a Customer Care Network contract in Region 4 to provide durable medical equipment, medical devices, orthotics, and prosthetics to veterans. The contract will have a one-year base period and four one-year options periods. The Department of Veterans Affairs Strategic Acquisition Center Frederick will evaluate proposals and award the contract. Offerors must submit proposals through the Federal Business Opportunities website by September 28, 2018. The solicitation document provides instructions on where to fax or mail item prescriptions for processing under the contract once awarded.

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36C10G18R0208-1 0019 CCN Reg4 CLIN X002 Pricing Template v2.xlsx

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File	Type	Posted
36C10G18R0208-1-0019004.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0019000.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0019003.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0019001.xlsx	XLSX spreadsheet	Jun 3, 2019
36C10G18R0208-1-0019002.pdf	PDF	Jun 3, 2019
36C10G18R0208-1-0018000.pdf	PDF	May 30, 2019
36C10G18R0208-1-0017000.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017004.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017001.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017008.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017002.pdf	PDF	May 23, 2019
36C10G18R0208-1-0017005.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017007.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017006.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0017003.xlsx	XLSX spreadsheet	May 23, 2019
36C10G18R0208-1-0016005.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016007.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016008.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016009.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016006.pdf	PDF	Apr 12, 2019
36C10G18R0208-1-0016003.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016004.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016002.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016000.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0016001.pdf	PDF	Apr 11, 2019
36C10G18R0208-1-0015000.pdf	PDF	Apr 8, 2019
36C10G18R0208-1-0015001.pdf	PDF	Apr 8, 2019
36C10G18R0208-1-0014001.pdf	PDF	Apr 6, 2019
36C10G18R0208-1-0014000.pdf	PDF	Apr 6, 2019
36C10G18R0208-1-0013002.pdf	PDF	Apr 5, 2019
36C10G18R0208-1-0013003.xlsx	XLSX spreadsheet	Apr 5, 2019
36C10G18R0208-1-0013005.xlsx	XLSX spreadsheet	Apr 5, 2019
36C10G18R0208-1-0013001.pdf	PDF	Apr 5, 2019
36C10G18R0208-1-0013004.xlsx	XLSX spreadsheet	Apr 5, 2019
36C10G18R0208-1-0013000.pdf	PDF	Apr 5, 2019
36C10G18R0208-1-0012001.pdf	PDF	Feb 27, 2019
36C10G18R0208-1-0012000.pdf	PDF	Feb 27, 2019
36C10G18R0208-1-0011007.pdf	PDF	Feb 26, 2019
36C10G18R0208-1-0011008.pdf	PDF	Feb 26, 2019
36C10G18R0208-1-0011006.pdf	PDF	Feb 26, 2019
36C10G18R0208-1-0010001.pdf	PDF	Nov 7, 2018
36C10G18R0208-1-0010000.pdf	PDF	Nov 7, 2018
36C10G18R0208-1-0009002.xlsx	XLSX spreadsheet	Nov 6, 2018
36C10G18R0208-1-0009001.pdf	PDF	Nov 6, 2018
36C10G18R0208-1-0009000.pdf	PDF	Nov 6, 2018
36C10G18R0208-1-0008000.pdf	PDF	Nov 1, 2018
36C10G18R0208-1-0008001.pdf	PDF	Nov 1, 2018
36C10G18R0208-1-0007001.pdf	PDF	Oct 27, 2018
36C10G18R0208-1-0007003.pdf	PDF	Oct 27, 2018
36C10G18R0208-1-0007002.pdf	PDF	Oct 27, 2018

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Arizona

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

Arizona

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

Volume Unit

Actual Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

Outpatient Proposed % of Medicare

Inpatient Proposed % of Medicare

OUTPATIENT/PHYSICIAN SERVICES

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	15,668	$244	699	$252	14,136	$260	17,574	$268	18,259	$277	18,971	$285	19,711	$295	20,480	$304	20,392	$314	3,685	$324	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	227	$0	4,593	$0	5,711	$0	5,933	$0	6,165
	Colonoscopy	proced	1,953	$686	87	$708	1,762	$731	2,191	$754	2,276	$779	2,365	$803	2,457	$829	2,553	$856	2,542	$883	459	$911	68%	0%	68%	0%	68%	0%	68%	0%	68%	0%	68%	0%	68%	0%	68%	0%	68%	0%	59	$0	1,193	$0	1,484	$0	1,542	$0	1,602
	Dermatology Services and Diagnostic Exams	proced	732	$124	33	$128	660	$132	821	$136	853	$140	886	$145	921	$149	957	$154	953	$159	172	$164	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	2	$0	30	$0	38	$0	39	$0	41
	Hearing/Speech Exams	exams	792	$87	35	$90	714	$93	888	$96	923	$99	959	$102	996	$106	1,035	$109	1,031	$112	186	$116	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	35	$0	714	$0	888	$0	923	$0	959
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	173	$233	8	$240	156	$248	194	$256	202	$264	209	$272	218	$281	226	$290	225	$299	41	$309	73%	0%	73%	0%	73%	0%	73%	0%	73%	0%	73%	0%	73%	0%	73%	0%	73%	0%	6	$0	114	$0	142	$0	148	$0	154
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	123	$355	5	$366	111	$378	138	$390	143	$403	149	$416	155	$429	161	$443	160	$457	29	$471	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	2	$0	43	$0	53	$0	55	$0	58
	MM - General Services	proced	1,612	$546	72	$564	1,454	$582	1,808	$601	1,879	$620	1,952	$640	2,028	$660	2,107	$681	2,098	$703	379	$726	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	28	$0	567	$0	704	$0	732	$0	760
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	7,483	$383	334	$395	6,751	$408	8,393	$421	8,720	$435	9,060	$448	9,413	$463	9,780	$478	9,738	$493	1,760	$509	59%	0%	59%	0%	59%	0%	59%	0%	59%	0%	59%	0%	59%	0%	59%	0%	59%	0%	197	$0	3,974	$0	4,940	$0	5,133	$0	5,333
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	436	$82	19	$85	393	$88	489	$90	508	$93	528	$96	549	$99	570	$103	567	$106	103	$109	18%	0%	18%	0%	18%	0%	18%	0%	18%	0%	18%	0%	18%	0%	18%	0%	18%	0%	4	$0	72	$0	90	$0	93	$0	97
	MM - Vestibular Function Tests	proced	276	$77	12	$79	249	$82	310	$84	322	$87	334	$90	347	$93	361	$96	359	$99	65	$102	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	7	$0	151	$0	188	$0	195	$0	203
	Non-Invasive Vascular Studies	proced	1,798	$187	80	$193	1,622	$200	2,017	$206	2,095	$213	2,177	$219	2,262	$226	2,350	$234	2,340	$241	423	$249	47%	0%	47%	0%	47%	0%	47%	0%	47%	0%	47%	0%	47%	0%	47%	0%	47%	0%	38	$0	762	$0	948	$0	985	$0	1,023
	Ophthalmology Services and Diagnostic Exams	proced	26,740	$50	1,193	$52	24,125	$54	29,992	$55	31,162	$57	32,377	$59	33,640	$61	34,952	$63	34,802	$65	6,289	$67	49%	0%	49%	0%	49%	0%	49%	0%	49%	0%	49%	0%	49%	0%	49%	0%	49%	0%	587	$0	11,871	$0	14,758	$0	15,334	$0	15,932
	Pathology	proced	148,099	$16	6,608	$16	133,614	$17	166,111	$17	172,589	$18	179,320	$18	186,314	$19	193,580	$20	192,749	$20	34,829	$21	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	1,242	$0	25,116	$0	31,224	$0	32,442	$0	33,707
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	6,992	$66	312	$68	6,308	$70	7,842	$72	8,148	$75	8,466	$77	8,796	$80	9,139	$82	9,100	$85	1,644	$88	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	101	$0	2,052	$0	2,551	$0	2,650	$0	2,753
	Radiology - CT	proced	15,953	$153	712	$158	14,393	$163	17,893	$168	18,591	$173	19,316	$179	20,069	$184	20,852	$190	20,763	$196	3,752	$203	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	181	$0	3,664	$0	4,555	$0	4,733	$0	4,918
	Radiology - General	proced	19,251	$51	859	$52	17,368	$54	21,592	$56	22,434	$57	23,309	$59	24,218	$61	25,163	$63	25,055	$65	4,527	$67	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	219	$0	4,422	$0	5,497	$0	5,712	$0	5,934
	Radiology - Mammography Diagnostic	proced	170	$152	8	$157	153	$162	191	$167	198	$173	206	$178	214	$184	222	$190	221	$196	40	$202	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	2	$0	39	$0	49	$0	50	$0	52
	Radiology - Mammography Screening	proced	551	$117	25	$121	497	$125	618	$129	642	$133	667	$137	693	$142	720	$146	717	$151	130	$156	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	6	$0	127	$0	157	$0	163	$0	170
	Radiology - MRI	proced	6,571	$306	293	$315	5,928	$325	7,370	$336	7,658	$347	7,956	$358	8,267	$369	8,589	$381	8,552	$393	1,545	$406	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	75	$0	1,509	$0	1,876	$0	1,950	$0	2,026
	Radiology - Nuclear Medicine	proced	956	$700	43	$722	863	$745	1,072	$769	1,114	$794	1,158	$819	1,203	$845	1,250	$872	1,244	$900	225	$929	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	11	$0	220	$0	273	$0	284	$0	295
	Radiology - PET & PET/CT	proced	394	$1,508	18	$1,556	355	$1,606	441	$1,657	459	$1,710	476	$1,765	495	$1,821	514	$1,880	512	$1,940	93	$2,002	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	4	$0	90	$0	112	$0	117	$0	121
	Radiology - Radiation Oncology	proced	31,209	$355	1,392	$367	28,157	$378	35,005	$390	36,370	$403	37,788	$416	39,262	$429	40,793	$443	40,618	$457	7,340	$472	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	354	$0	7,168	$0	8,912	$0	9,259	$0	9,621
	Radiology - Ultrasound	proced	5,630	$81	251	$84	5,079	$87	6,315	$89	6,561	$92	6,817	$95	7,083	$98	7,359	$101	7,327	$105	1,324	$108	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	25%	0%	64	$0	1,293	$0	1,608	$0	1,670	$0	1,736
	Vision Exams	exams	22,085	$151	985	$156	19,925	$161	24,771	$166	25,737	$172	26,741	$177	27,784	$183	28,867	$189	28,744	$195	5,194	$201	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	985	$0	19,925	$0	24,771	$0	25,737	$0	26,741

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	90,273	$97	4,028	$101	81,444	$104	101,252	$107	105,201	$111	109,304	$114	113,567	$118	117,996	$122	117,490	$125	21,230	$129	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	1,692	$0	34,219	$0	42,541	$0	44,200	$0	45,924

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	1,164	$766	52	$791	1,050	$816	1,306	$842	1,357	$869	1,410	$897	1,465	$926	1,522	$955	1,515	$986	274	$1,018	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	0	$0	7	$0	9	$0	9	$0	9
	Ambulatory Surgery - ASC Setting	proced	15,368	$240	686	$248	13,865	$256	17,237	$264	17,909	$273	18,608	$281	19,334	$290	20,088	$300	20,001	$309	3,614	$319	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	254	$0	5,131	$0	6,379	$0	6,627	$0	6,886
	Ambulatory Surgery - Office Setting	proced	28,572	$173	1,275	$179	25,778	$185	32,047	$191	33,297	$197	34,595	$203	35,945	$210	37,346	$216	37,186	$223	6,719	$230	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	472	$0	9,539	$0	11,859	$0	12,322	$0	12,802
	Ambulatory Surgery - Outpatient Setting	proced	10,920	$1,721	487	$1,776	9,852	$1,833	12,249	$1,892	12,726	$1,952	13,223	$2,015	13,738	$2,079	14,274	$2,146	14,213	$2,215	2,568	$2,286	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	180	$0	3,646	$0	4,533	$0	4,709	$0	4,893
	Emergency Room Visits	visits	7,823	$728	349	$751	7,058	$775	8,774	$800	9,117	$825	9,472	$852	9,842	$879	10,225	$907	10,182	$936	1,840	$966	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	17	$0	334	$0	415	$0	431	$0	448
	Maternity	proced	411	$425	18	$438	371	$452	461	$467	479	$482	498	$497	517	$513	537	$529	535	$546	97	$564	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	2	$0	37	$0	46	$0	48	$0	50
	Nutritional Counseling	visits	79	$68	4	$70	71	$72	88	$75	92	$77	95	$80	99	$82	103	$85	103	$87	19	$90	50%	0%	50%	0%	50%	0%	50%	0%	50%	0%	50%	0%	50%	0%	50%	0%	50%	0%	2	$0	36	$0	44	$0	46	$0	48
	Observation Care	visits	2,654	$145	118	$149	2,394	$154	2,977	$159	3,093	$164	3,214	$169	3,339	$175	3,469	$180	3,454	$186	624	$192	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	29	$0	584	$0	726	$0	754	$0	784
	Prosthetic and Orthotic Services	visits	60	$49	3	$51	54	$52	67	$54	70	$56	73	$58	75	$60	78	$61	78	$63	14	$65	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	3	$0	54	$0	67	$0	70	$0	73

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	4,703	$36	210	$37	4,243	$39	5,275	$40	5,481	$41	5,694	$42	5,917	$44	6,147	$45	6,121	$47	1,106	$48	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	19	$0	376	$0	467	$0	485	$0	504
	Allergy Testing	proced	437	$275	19	$284	394	$293	490	$302	509	$312	529	$322	550	$332	571	$342	569	$353	103	$365	48%	0%	48%	0%	48%	0%	48%	0%	48%	0%	48%	0%	48%	0%	48%	0%	48%	0%	9	$0	188	$0	234	$0	243	$0	252
	Chiropractic	visits	19,555	$43	872	$44	17,642	$46	21,933	$47	22,788	$49	23,677	$50	24,600	$52	25,560	$53	25,450	$55	4,599	$57	13%	0%	13%	0%	13%	0%	13%	0%	13%	0%	13%	0%	13%	0%	13%	0%	13%	0%	117	$0	2,362	$0	2,936	$0	3,051	$0	3,170
	Dialysis and Related Services	proced	48,732	$278	2,174	$287	43,966	$296	54,659	$306	56,791	$315	59,006	$325	61,307	$336	63,698	$347	63,425	$358	11,461	$369	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	11	$0	225	$0	280	$0	291	$0	302
	Immunizations	proced	2,109	$44	94	$45	1,903	$47	2,366	$48	2,458	$50	2,554	$52	2,653	$53	2,757	$55	2,745	$57	496	$58	31%	0%	31%	0%	31%	0%	31%	0%	31%	0%	31%	0%	31%	0%	31%	0%	31%	0%	29	$0	583	$0	725	$0	753	$0	783
	Nephrology – ESRD Services	months	2,488	$257	111	$266	2,245	$274	2,791	$283	2,900	$292	3,013	$301	3,130	$311	3,252	$321	3,238	$331	585	$342	3%	0%	3%	0%	3%	0%	3%	0%	3%	0%	3%	0%	3%	0%	3%	0%	3%	0%	3	$0	71	$0	88	$0	91	$0	95
	Office Administered Drugs	proced	52,703	$266	2,351	$275	47,548	$284	59,113	$293	61,418	$302	63,814	$312	66,302	$322	68,888	$332	68,592	$343	12,394	$354	15%	0%	15%	0%	15%	0%	15%	0%	15%	0%	15%	0%	15%	0%	15%	0%	15%	0%	364	$0	7,361	$0	9,151	$0	9,508	$0	9,878
	PT/OT/SLP	visits	92,197	$90	4,113	$93	83,180	$96	103,410	$99	107,443	$102	111,633	$105	115,987	$109	120,510	$112	119,993	$116	21,682	$119	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	1,312	$0	26,537	$0	32,991	$0	34,278	$0	35,615

MH & HOMELESS - AMBULATORY
	Outpatient Mental Health	visits	1,238	$143	55	$147	1,117	$152	1,389	$157	1,443	$162	1,499	$167	1,557	$172	1,618	$178	1,611	$184	291	$189	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0	$0	6	$0	7	$0	7	$0	7
	Outpatient Substance Abuse	visits	83	$123	4	$127	75	$131	93	$135	97	$139	100	$144	104	$148	108	$153	108	$158	20	$163	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	0	$0	0	$0	1	$0	1	$0	1
	Psychotherapy (Ind. 45+ min / Group)	visits	8,984	$125	401	$129	8,105	$133	10,077	$137	10,470	$142	10,878	$146	11,302	$151	11,743	$156	11,693	$161	2,113	$166	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	39	$0	787	$0	978	$0	1,016	$0	1,056

INPATIENT PROFESSIONAL SERVICES various 60,614 $133 2,704 $137 54,686 $141 67,986 $146 70,638 $150 73,393 $155 76,255 $160 79,229 $165 78,889 $171 14,255 $176 4% 0% 4% 0% 4% 0% 4% 0% 4% 0% 4% 0% 4% 0% 4% 0% 4% 0% 96 $0 1,946 $0 2,419 $0 2,514 $0 2,612 $0 2,714 $0 2,820 $0 2,807 $0 507 $0 $0

INPATIENT FACILITY SERVICES

INPATIENT MEDICINE AND SURGERY
	IP Acute Medical	days	12,993	$1,875	580	$1,935	11,722	$1,997	14,573	$2,061	15,142	$2,127	15,732	$2,195	16,346	$2,265	16,983	$2,337	16,910	$2,412	3,056	$2,489	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	9	$0	173	$0	215	$0	224	$0	232
	IP Acute Surgical	days	11,176	$3,875	499	$3,999	10,083	$4,127	12,535	$4,259	13,024	$4,395	13,532	$4,536	14,060	$4,681	14,608	$4,831	14,545	$4,985	2,628	$5,145	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	31	$0	617	$0	767	$0	797	$0	828
	IP Maternity Deliveries	days	290	$2,096	13	$2,163	262	$2,232	325	$2,304	338	$2,377	351	$2,454	365	$2,532	379	$2,613	377	$2,697	68	$2,783	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	1	$0	12	$0	15	$0	16	$0	16
	IP Maternity Non-Deliveries	days	34	$2,531	2	$2,612	31	$2,696	38	$2,782	40	$2,871	41	$2,963	43	$3,058	44	$3,155	44	$3,256	8	$3,361	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	0	$0	2	$0	2	$0	3	$0	3

MH & HOMELESS - INPATIENT
	IP Acute Mental Health	days	2,556	$905	114	$934	2,306	$964	2,867	$995	2,979	$1,026	3,095	$1,059	3,216	$1,093	3,341	$1,128	3,327	$1,164	601	$1,201	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	1	$0	12	$0	14	$0	15	$0	15
	IP Acute Mental Health Extended Stays	days	1,188	$195	53	$201	1,072	$208	1,332	$214	1,384	$221	1,438	$228	1,495	$236	1,553	$243	1,546	$251	279	$259	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0	$0	5	$0	7	$0	7	$0	7
	IP Acute Substance Abuse	days	2,442	$662	109	$683	2,203	$705	2,739	$728	2,846	$751	2,957	$775	3,072	$800	3,192	$826	3,178	$852	574	$879	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1	$0	14	$0	17	$0	18	$0	18

&"Times New Roman,Regular"&8&F &A &D &T &"Times New Roman,Bold"Milliman &"Times New Roman,Regular"Page &P of &N

*FY18 historical data is the basis of the FY19-FY27 projections. The projected state-wide Community Care volumes and enrollment/patient summary data are adjusted to reflect contractual period of performance considerations in FY19, FY20, and FY27 (e.g., SHCD). The volumes and enrollment/patient summary data also reflect anticipated growth in the Veteran population over the life of the contract. The Medicare Allowable Unit Price includes inflationary impacts over the Period Of Performance.

California

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

California

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

Volume Unit

Actual Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

CLIN X002 Total Evaluated Price

Outpatient Proposed % of Medicare

Inpatient Proposed % of Medicare

OUTPATIENT/PHYSICIAN SERVICES

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	23,550	$139	1,051	$143	21,247	$148	26,414	$153	27,444	$158	28,515	$163	29,627	$168	30,782	$173	30,650	$179	5,538	$185	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	164	$0	3,313	$0	4,118	$0	4,279	$0	4,446
	Colonoscopy	proced	1,984	$587	89	$605	1,790	$625	2,225	$645	2,312	$665	2,402	$687	2,496	$709	2,593	$731	2,582	$755	467	$779	53%	0%	53%	0%	53%	0%	53%	0%	53%	0%	53%	0%	53%	0%	53%	0%	53%	0%	47	$0	956	$0	1,189	$0	1,235	$0	1,283
	Dermatology Services and Diagnostic Exams	proced	2,110	$110	94	$114	1,904	$118	2,367	$121	2,459	$125	2,555	$129	2,654	$133	2,758	$138	2,746	$142	496	$147	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6	$0	119	$0	148	$0	153	$0	159
	Hearing/Speech Exams	exams	1,780	$80	79	$83	1,606	$85	1,997	$88	2,075	$91	2,156	$94	2,240	$97	2,327	$100	2,317	$103	419	$106	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	79	$0	1,606	$0	1,997	$0	2,075	$0	2,156
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	432	$152	19	$157	390	$162	485	$167	503	$172	523	$178	543	$184	565	$189	562	$195	102	$202	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	8	$0	152	$0	189	$0	196	$0	204
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	220	$284	10	$293	198	$302	247	$312	256	$322	266	$332	277	$343	288	$354	286	$365	52	$377	41%	0%	41%	0%	41%	0%	41%	0%	41%	0%	41%	0%	41%	0%	41%	0%	41%	0%	4	$0	80	$0	100	$0	104	$0	108
	MM - General Services	proced	4,926	$410	220	$423	4,444	$437	5,525	$451	5,741	$465	5,964	$480	6,197	$496	6,439	$511	6,411	$528	1,158	$545	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	52	$0	1,052	$0	1,307	$0	1,358	$0	1,411
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	5,966	$390	266	$403	5,383	$416	6,692	$429	6,953	$443	7,224	$457	7,505	$472	7,798	$487	7,765	$502	1,403	$518	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	148	$0	2,989	$0	3,716	$0	3,861	$0	4,011
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	480	$90	21	$93	433	$96	538	$99	559	$102	581	$105	604	$108	627	$112	625	$116	113	$119	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	6	$0	124	$0	154	$0	160	$0	166
	MM - Vestibular Function Tests	proced	79	$72	4	$74	71	$76	89	$79	92	$81	96	$84	99	$87	103	$89	103	$92	19	$95	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	33%	0%	1	$0	24	$0	30	$0	31	$0	32
	Non-Invasive Vascular Studies	proced	2,065	$225	92	$232	1,863	$239	2,316	$247	2,406	$255	2,500	$263	2,598	$271	2,699	$280	2,688	$289	486	$298	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	30	$0	604	$0	751	$0	780	$0	810
	Ophthalmology Services and Diagnostic Exams	proced	16,166	$56	721	$58	14,585	$60	18,132	$62	18,839	$64	19,574	$66	20,337	$68	21,131	$70	21,040	$72	3,802	$75	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	407	$0	8,232	$0	10,235	$0	10,634	$0	11,048
	Pathology	proced	256,948	$13	11,464	$13	231,818	$14	288,199	$14	299,438	$14	311,116	$15	323,250	$15	335,857	$16	334,415	$16	60,427	$17	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	825	$0	16,679	$0	20,735	$0	21,544	$0	22,384
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	7,878	$62	351	$63	7,108	$66	8,836	$68	9,181	$70	9,539	$72	9,911	$74	10,297	$77	10,253	$79	1,853	$82	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	79	$0	1,604	$0	1,994	$0	2,071	$0	2,152
	Radiology - CT	proced	19,073	$192	851	$198	17,208	$205	21,393	$211	22,227	$218	23,094	$225	23,995	$232	24,930	$239	24,823	$247	4,485	$255	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	142	$0	2,876	$0	3,576	$0	3,715	$0	3,860
	Radiology - General	proced	30,781	$52	1,373	$54	27,771	$56	34,525	$57	35,871	$59	37,270	$61	38,724	$63	40,234	$65	40,061	$67	7,239	$69	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	230	$0	4,642	$0	5,771	$0	5,996	$0	6,229
	Radiology - Mammography Diagnostic	proced	621	$151	28	$156	560	$161	697	$166	724	$172	752	$177	781	$183	812	$189	808	$195	146	$201	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	5	$0	94	$0	116	$0	121	$0	126
	Radiology - Mammography Screening	proced	1,517	$138	68	$143	1,369	$147	1,702	$152	1,768	$157	1,837	$162	1,908	$167	1,983	$173	1,974	$178	357	$184	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	11	$0	229	$0	284	$0	295	$0	307
	Radiology - MRI	proced	5,410	$356	241	$367	4,881	$379	6,068	$391	6,305	$403	6,551	$416	6,806	$429	7,071	$443	7,041	$457	1,272	$472	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	40	$0	816	$0	1,014	$0	1,054	$0	1,095
	Radiology - Nuclear Medicine	proced	896	$1,010	40	$1,042	808	$1,076	1,005	$1,110	1,044	$1,146	1,085	$1,182	1,127	$1,220	1,171	$1,259	1,166	$1,299	211	$1,341	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	7	$0	135	$0	168	$0	175	$0	181
	Radiology - PET & PET/CT	proced	101	$1,721	5	$1,776	91	$1,833	113	$1,892	118	$1,952	122	$2,015	127	$2,079	132	$2,146	131	$2,214	24	$2,285	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	1	$0	15	$0	19	$0	20	$0	20
	Radiology - Radiation Oncology	proced	50,987	$429	2,275	$443	46,000	$457	57,188	$472	59,418	$487	61,735	$502	64,143	$518	66,644	$535	66,358	$552	11,991	$570	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	380	$0	7,688	$0	9,558	$0	9,931	$0	10,319
	Radiology - Ultrasound	proced	8,092	$115	361	$118	7,301	$122	9,076	$126	9,430	$130	9,798	$134	10,180	$139	10,577	$143	10,532	$148	1,903	$152	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	60	$0	1,220	$0	1,517	$0	1,576	$0	1,638
	Vision Exams	exams	12,436	$199	555	$205	11,220	$211	13,949	$218	14,493	$225	15,058	$232	15,645	$240	16,255	$248	16,186	$255	2,925	$264	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	555	$0	11,220	$0	13,949	$0	14,493	$0	15,058

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	159,783	$127	7,129	$132	144,156	$136	179,216	$140	186,206	$145	193,468	$149	201,013	$154	208,852	$159	207,956	$164	37,577	$169	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	2,128	$0	43,030	$0	53,496	$0	55,582	$0	57,750

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	4,628	$602	206	$622	4,176	$641	5,191	$662	5,394	$683	5,604	$705	5,823	$728	6,050	$751	6,024	$775	1,088	$800	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1	$0	23	$0	28	$0	29	$0	30
	Ambulatory Surgery - ASC Setting	proced	9,191	$261	410	$270	8,292	$278	10,308	$287	10,710	$297	11,128	$306	11,562	$316	12,013	$326	11,962	$336	2,161	$347	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	183	$0	3,709	$0	4,611	$0	4,791	$0	4,978
	Ambulatory Surgery - Office Setting	proced	29,818	$185	1,330	$191	26,902	$197	33,445	$203	34,749	$210	36,104	$217	37,512	$224	38,975	$231	38,808	$238	7,012	$246	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	595	$0	12,034	$0	14,961	$0	15,545	$0	16,151
	Ambulatory Surgery - Outpatient Setting	proced	12,327	$1,458	550	$1,505	11,121	$1,553	13,826	$1,603	14,365	$1,654	14,926	$1,707	15,508	$1,762	16,113	$1,818	16,043	$1,876	2,899	$1,936	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	45%	0%	246	$0	4,975	$0	6,185	$0	6,426	$0	6,677
	Emergency Room Visits	visits	22,020	$553	982	$571	19,866	$589	24,698	$608	25,661	$627	26,662	$647	27,702	$668	28,782	$689	28,659	$711	5,179	$734	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	16	$0	320	$0	398	$0	414	$0	430
	Maternity	proced	1,285	$541	57	$559	1,159	$577	1,441	$595	1,497	$614	1,556	$634	1,617	$654	1,680	$675	1,672	$697	302	$719	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	23%	0%	13	$0	261	$0	325	$0	337	$0	350
	Nutritional Counseling	visits	322	$110	14	$114	291	$117	361	$121	375	$125	390	$129	405	$133	421	$137	419	$142	76	$146	52%	0%	52%	0%	52%	0%	52%	0%	52%	0%	52%	0%	52%	0%	52%	0%	52%	0%	7	$0	151	$0	188	$0	195	$0	203
	Observation Care	visits	1,753	$146	78	$151	1,582	$156	1,966	$161	2,043	$166	2,123	$171	2,205	$177	2,291	$183	2,282	$188	412	$194	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	78	$0	1,582	$0	1,966	$0	2,043	$0	2,123
	Prosthetic and Orthotic Services	visits	273	$56	12	$58	246	$59	306	$61	318	$63	331	$65	343	$67	357	$70	355	$72	64	$74	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	56%	0%	7	$0	137	$0	171	$0	178	$0	184

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	5,172	$79	231	$82	4,666	$84	5,801	$87	6,027	$90	6,262	$92	6,507	$95	6,760	$98	6,731	$102	1,216	$105	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	27	$0	555	$0	690	$0	717	$0	744
	Allergy Testing	proced	978	$272	44	$281	882	$290	1,097	$299	1,140	$309	1,184	$319	1,230	$329	1,278	$340	1,273	$350	230	$362	63%	0%	63%	0%	63%	0%	63%	0%	63%	0%	63%	0%	63%	0%	63%	0%	63%	0%	28	$0	560	$0	696	$0	724	$0	752
	Chiropractic	visits	53,695	$47	2,396	$48	48,444	$50	60,226	$51	62,574	$53	65,015	$55	67,550	$56	70,185	$58	69,884	$60	12,628	$62	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	344	$0	6,951	$0	8,642	$0	8,979	$0	9,329
	Dialysis and Related Services	proced	153,287	$351	6,839	$362	138,295	$374	171,930	$385	178,635	$398	185,602	$411	192,840	$424	200,361	$437	199,501	$451	36,049	$466	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	35	$0	713	$0	887	$0	921	$0	957
	Immunizations	proced	2,832	$44	126	$46	2,555	$47	3,176	$49	3,300	$50	3,429	$52	3,563	$53	3,702	$55	3,686	$57	666	$59	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	20	$0	397	$0	494	$0	513	$0	533
	Nephrology – ESRD Services	months	7,462	$284	333	$293	6,732	$302	8,369	$312	8,696	$322	9,035	$332	9,387	$343	9,753	$354	9,711	$365	1,755	$377	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	12	$0	246	$0	305	$0	317	$0	330
	Office Administered Drugs	proced	68,255	$230	3,045	$238	61,579	$245	76,556	$253	79,542	$261	82,644	$270	85,867	$278	89,216	$287	88,833	$297	16,052	$306	11%	0%	11%	0%	11%	0%	11%	0%	11%	0%	11%	0%	11%	0%	11%	0%	11%	0%	325	$0	6,580	$0	8,180	$0	8,499	$0	8,831
	PT/OT/SLP	visits	262,304	$92	11,703	$95	236,650	$98	294,206	$101	305,680	$104	317,601	$108	329,988	$111	342,857	$115	341,386	$118	61,687	$122	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	32%	0%	3,752	$0	75,876	$0	94,330	$0	98,009	$0	101,831

MH & HOMELESS - AMBULATORY
	Outpatient Mental Health	visits	10,252	$123	457	$126	9,250	$131	11,499	$135	11,948	$139	12,414	$143	12,898	$148	13,401	$153	13,343	$158	2,411	$163	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	3	$0	59	$0	74	$0	77	$0	80
	Outpatient Substance Abuse	visits	1,015	$164	45	$170	916	$175	1,139	$181	1,183	$186	1,230	$192	1,278	$199	1,327	$205	1,322	$211	239	$218	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	1	$0	14	$0	17	$0	18	$0	19
	Psychotherapy (Ind. 45+ min / Group)	visits	93,980	$129	4,193	$133	84,788	$137	105,410	$142	109,521	$146	113,792	$151	118,230	$156	122,841	$161	122,314	$166	22,102	$171	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	503	$0	10,163	$0	12,635	$0	13,128	$0	13,640

INPATIENT PROFESSIONAL SERVICES various 88,884 $156 3,966 $161 80,191 $167 99,695 $172 103,583 $177 107,622 $183 111,820 $189 116,181 $195 115,682 $201 20,903 $208 2% 0% 2% 0% 2% 0% 2% 0% 2% 0% 2% 0% 2% 0% 2% 0% 2% 0% 99 $0 2,004 $0 2,492 $0 2,589 $0 2,690 $0 2,795 $0 2,904 $0 2,891 $0 522 $0 $0

INPATIENT FACILITY SERVICES

INPATIENT MEDICINE AND SURGERY
	IP Acute Medical	days	27,872	$2,730	1,244	$2,818	25,146	$2,908	31,262	$3,001	32,481	$3,097	33,748	$3,196	35,064	$3,298	36,431	$3,404	36,275	$3,513	6,555	$3,625	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	19	$0	386	$0	479	$0	498	$0	517
	IP Acute Surgical	days	16,065	$5,558	717	$5,736	14,494	$5,920	18,019	$6,109	18,722	$6,305	19,452	$6,506	20,210	$6,715	20,999	$6,929	20,908	$7,151	3,778	$7,380	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	25	$0	508	$0	632	$0	656	$0	682
	IP Maternity Deliveries	days	535	$3,522	24	$3,634	483	$3,751	600	$3,871	623	$3,994	648	$4,122	673	$4,254	699	$4,390	696	$4,531	126	$4,676	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	6	$0	115	$0	143	$0	149	$0	155
	IP Maternity Non-Deliveries	days	91	$2,329	4	$2,403	82	$2,480	102	$2,560	106	$2,642	110	$2,726	114	$2,813	119	$2,903	118	$2,996	21	$3,092	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	0	$0	9	$0	11	$0	11	$0	11

MH & HOMELESS - INPATIENT
	IP Acute Mental Health	days	4,786	$1,565	214	$1,615	4,318	$1,667	5,368	$1,720	5,577	$1,775	5,795	$1,832	6,021	$1,891	6,256	$1,951	6,229	$2,014	1,126	$2,078	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1	$0	28	$0	34	$0	36	$0	37
	IP Acute Mental Health Extended Stays	days	1,798	$186	80	$192	1,622	$198	2,017	$204	2,095	$211	2,177	$217	2,262	$224	2,350	$231	2,340	$239	423	$247	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1	$0	10	$0	13	$0	13	$0	14
	IP Acute Substance Abuse	days	4,920	$1,456	220	$1,503	4,439	$1,551	5,518	$1,600	5,734	$1,652	5,957	$1,704	6,190	$1,759	6,431	$1,815	6,403	$1,873	1,157	$1,933	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	2%	0%	3	$0	68	$0	84	$0	88	$0	91

&D &T &"Times New Roman,Bold"Milliman &"Times New Roman,Regular"Page &P of &N

Colorado

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

Colorado

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

Volume Unit

Actual Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

Projected Community Care Volume

Medicare Allowable Unit Price

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

VA Estimated Service Distribution for Highly Rural & Scarce Medical

Proposed % of Medicare

CLIN X002 Volume

CLIN X002 Total Evaluated Price

CLIN X002 Volume

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CLIN X002 Total Evaluated Price

CLIN X002 Volume

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CLIN X002 Total Evaluated Price

Outpatient Proposed % of Medicare

Inpatient Proposed % of Medicare

OUTPATIENT/PHYSICIAN SERVICES

AMB PC & SC - DIAGNOSTICS
	Cardiovascular	proced	10,166	$124	454	$128	9,172	$132	11,402	$136	11,847	$141	12,309	$145	12,789	$150	13,288	$155	13,231	$159	2,391	$165	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	14%	0%	62	$0	1,248	$0	1,552	$0	1,613	$0	1,676
	Colonoscopy	proced	944	$494	42	$510	852	$526	1,059	$543	1,100	$560	1,143	$578	1,188	$597	1,234	$616	1,229	$636	222	$656	60%	0%	60%	0%	60%	0%	60%	0%	60%	0%	60%	0%	60%	0%	60%	0%	60%	0%	25	$0	514	$0	639	$0	664	$0	690
	Dermatology Services and Diagnostic Exams	proced	396	$112	18	$115	357	$119	444	$123	461	$127	479	$131	498	$135	518	$139	515	$144	93	$148	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	1	$0	21	$0	26	$0	27	$0	28
	Hearing/Speech Exams	exams	642	$67	29	$69	579	$71	720	$73	748	$76	777	$78	808	$80	839	$83	836	$86	151	$88	81%	0%	81%	0%	81%	0%	81%	0%	81%	0%	81%	0%	81%	0%	81%	0%	81%	0%	23	$0	468	$0	581	$0	604	$0	627
	MM - Central Nervous System Psychological Testing, Neuropsych. Exams	proced	111	$270	5	$278	100	$287	125	$296	129	$306	134	$316	140	$326	145	$336	144	$347	26	$358	22%	0%	22%	0%	22%	0%	22%	0%	22%	0%	22%	0%	22%	0%	22%	0%	22%	0%	1	$0	22	$0	28	$0	29	$0	30
	MM - Gastroenterology Diagnostic Studies excluding endoscopies, radiology	proced	101	$407	5	$420	91	$433	113	$447	118	$461	122	$476	127	$491	132	$507	131	$523	24	$540	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	30%	0%	1	$0	28	$0	34	$0	36	$0	37
	MM - General Services	proced	967	$1,075	43	$1,109	872	$1,145	1,085	$1,181	1,127	$1,219	1,171	$1,258	1,217	$1,299	1,264	$1,340	1,259	$1,383	227	$1,427	35%	0%	35%	0%	35%	0%	35%	0%	35%	0%	35%	0%	35%	0%	35%	0%	35%	0%	15	$0	307	$0	381	$0	396	$0	411
	MM - Neurology Diagnostic Exams, Sleep Tests, EEG, EMG	proced	2,491	$309	111	$319	2,247	$329	2,794	$340	2,903	$351	3,016	$362	3,134	$374	3,256	$385	3,242	$398	586	$411	27%	0%	27%	0%	27%	0%	27%	0%	27%	0%	27%	0%	27%	0%	27%	0%	27%	0%	30	$0	609	$0	758	$0	787	$0	818
	MM - Otorhinolaryngology Therapies and Diagnostic Exams	proced	227	$82	10	$85	205	$88	255	$90	265	$93	275	$96	286	$99	297	$103	295	$106	53	$109	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	19%	0%	2	$0	40	$0	50	$0	51	$0	53
	MM - Vestibular Function Tests	proced	69	$88	3	$91	62	$94	77	$97	80	$100	84	$103	87	$106	90	$110	90	$113	16	$117	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	1	$0	23	$0	28	$0	30	$0	31
	Non-Invasive Vascular Studies	proced	1,393	$190	62	$196	1,257	$203	1,562	$209	1,623	$216	1,687	$223	1,752	$230	1,821	$237	1,813	$245	328	$253	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	24%	0%	15	$0	303	$0	377	$0	392	$0	407
	Ophthalmology Services and Diagnostic Exams	proced	11,017	$53	492	$55	9,940	$57	12,357	$59	12,839	$60	13,340	$62	13,860	$64	14,400	$66	14,339	$68	2,591	$71	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	42%	0%	207	$0	4,184	$0	5,201	$0	5,404	$0	5,615
	Pathology	proced	109,414	$14	4,882	$14	98,713	$15	122,721	$15	127,507	$16	132,480	$16	137,647	$17	143,015	$17	142,401	$18	25,731	$18	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	12%	0%	595	$0	12,029	$0	14,955	$0	15,538	$0	16,144
	Pulmonology Svcs, Diag Exams, Ventilator Mgmt	proced	4,983	$45	222	$46	4,496	$48	5,589	$49	5,807	$51	6,033	$53	6,269	$54	6,513	$56	6,485	$58	1,172	$60	8%	0%	8%	0%	8%	0%	8%	0%	8%	0%	8%	0%	8%	0%	8%	0%	8%	0%	19	$0	382	$0	474	$0	493	$0	512
	Radiology - CT	proced	10,721	$156	478	$161	9,672	$166	12,025	$172	12,494	$177	12,981	$183	13,487	$189	14,013	$195	13,953	$201	2,521	$207	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	79	$0	1,605	$0	1,995	$0	2,073	$0	2,154
	Radiology - General	proced	13,688	$61	611	$63	12,349	$65	15,353	$67	15,952	$69	16,574	$71	17,220	$73	17,892	$76	17,815	$78	3,219	$81	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	101	$0	2,049	$0	2,547	$0	2,646	$0	2,750
	Radiology - Mammography Diagnostic	proced	782	$158	35	$163	706	$168	877	$173	911	$179	947	$185	984	$191	1,022	$197	1,018	$203	184	$209	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	6	$0	117	$0	146	$0	151	$0	157
	Radiology - Mammography Screening	proced	2,284	$130	102	$134	2,061	$138	2,562	$142	2,662	$147	2,766	$152	2,873	$157	2,985	$162	2,973	$167	537	$172	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17	$0	342	$0	425	$0	442	$0	459
	Radiology - MRI	proced	3,894	$334	174	$344	3,513	$355	4,368	$367	4,538	$378	4,715	$390	4,899	$403	5,090	$416	5,068	$429	916	$443	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	29	$0	583	$0	725	$0	753	$0	782
	Radiology - Nuclear Medicine	proced	798	$762	36	$786	720	$811	895	$837	930	$864	966	$891	1,004	$920	1,043	$949	1,039	$980	188	$1,011	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	6	$0	119	$0	148	$0	154	$0	160
	Radiology - PET & PET/CT	proced	512	$1,625	23	$1,677	461	$1,731	574	$1,786	596	$1,844	619	$1,903	643	$1,964	669	$2,026	666	$2,091	120	$2,158	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	4	$0	77	$0	95	$0	99	$0	103
	Radiology - Radiation Oncology	proced	18,779	$371	838	$383	16,942	$395	21,062	$408	21,884	$421	22,737	$434	23,624	$448	24,545	$462	24,440	$477	4,416	$492	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	139	$0	2,811	$0	3,494	$0	3,631	$0	3,772
	Radiology - Ultrasound	proced	4,129	$91	184	$94	3,725	$97	4,631	$100	4,812	$103	4,999	$106	5,194	$110	5,397	$113	5,374	$117	971	$121	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	31	$0	618	$0	768	$0	798	$0	829
	Vision Exams	exams	11,190	$206	499	$213	10,095	$220	12,550	$227	13,040	$234	13,548	$242	14,077	$249	14,626	$257	14,563	$265	2,631	$274	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	499	$0	10,095	$0	12,550	$0	13,040	$0	13,548

AMB PC & SC - E&M SVCS
	Office Visits/Urgent Care/Physical Exams - Non MH	visits	38,531	$102	1,719	$105	34,762	$109	43,217	$112	44,903	$116	46,654	$120	48,473	$123	50,364	$127	50,148	$131	9,061	$136	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	37%	0%	638	$0	12,906	$0	16,044	$0	16,670	$0	17,320

AMB PC & SC - PROF SVCS AND PROCS
	Ambulance	runs	2,476	$552	110	$570	2,234	$588	2,777	$607	2,885	$626	2,998	$646	3,115	$667	3,236	$688	3,222	$710	582	$733	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4%	0%	4	$0	82	$0	102	$0	106	$0	111
	Ambulatory Surgery - ASC Setting	proced	8,773	$254	391	$262	7,915	$270	9,840	$279	10,224	$288	10,622	$297	11,037	$307	11,467	$317	11,418	$327	2,063	$337	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	114	$0	2,298	$0	2,857	$0	2,969	$0	3,084
	Ambulatory Surgery - Office Setting	proced	12,941	$169	577	$175	11,675	$180	14,515	$186	15,081	$192	15,669	$198	16,280	$204	16,915	$211	16,843	$218	3,043	$225	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	168	$0	3,390	$0	4,215	$0	4,379	$0	4,550
	Ambulatory Surgery - Outpatient Setting	proced	9,501	$1,203	424	$1,241	8,572	$1,281	10,657	$1,322	11,073	$1,364	11,505	$1,408	11,953	$1,453	12,419	$1,500	12,366	$1,548	2,235	$1,597	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	29%	0%	123	$0	2,489	$0	3,095	$0	3,215	$0	3,341
	Emergency Room Visits	visits	10,438	$585	466	$604	9,417	$623	11,707	$643	12,164	$664	12,638	$685	13,131	$707	13,644	$729	13,585	$753	2,455	$777	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	24	$0	495	$0	615	$0	639	$0	664
	Maternity	proced	300	$523	13	$540	271	$557	336	$575	350	$593	363	$612	377	$632	392	$652	390	$673	71	$694	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	16%	0%	2	$0	42	$0	52	$0	54	$0	56
	Nutritional Counseling	visits	100	$98	4	$101	90	$104	112	$108	117	$111	121	$115	126	$118	131	$122	130	$126	24	$130	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	0	$0	8	$0	10	$0	10	$0	10
	Observation Care	visits	1,576	$150	70	$154	1,422	$159	1,768	$164	1,837	$170	1,909	$175	1,983	$181	2,061	$187	2,052	$193	371	$199	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	61%	0%	43	$0	861	$0	1,070	$0	1,112	$0	1,155
	Prosthetic and Orthotic Services	visits	27	$48	1	$49	24	$51	30	$53	31	$54	33	$56	34	$58	35	$60	35	$61	6	$63	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	100%	0%	1	$0	24	$0	30	$0	31	$0	33

AMB PC & SC - THERAPIES
	Allergy Immunotherapy	visits	1,528	$48	68	$49	1,379	$51	1,714	$52	1,781	$54	1,850	$56	1,922	$58	1,997	$60	1,989	$61	359	$63	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	5%	0%	4	$0	72	$0	89	$0	93	$0	96
	Allergy Testing	proced	286	$253	13	$261	258	$269	321	$278	333	$286	346	$296	360	$305	374	$315	372	$325	67	$335	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	17%	0%	2	$0	43	$0	53	$0	55	$0	57
	Chiropractic	visits	7,164	$44	320	$46	6,463	$47	8,035	$49	8,349	$50	8,674	$52	9,013	$53	9,364	$55	9,324	$57	1,685	$59	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	28	$0	558	$0	694	$0	721	$0	749
	Dialysis and Related Services	proced	34,655	$284	1,546	$293	31,265	$303	38,869	$313	40,385	$323	41,960	$333	43,597	$343	45,297	$354	45,102	$366	8,150	$378	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	8	$0	161	$0	200	$0	208	$0	216
	Immunizations	proced	1,643	$37	73	$39	1,482	$40	1,843	$41	1,915	$42	1,989	$44	2,067	$45	2,148	$47	2,138	$48	386	$50	38%	0%	38%	0%	38%	0%	38%	0%	38%	0%	38%	0%	38%	0%	38%	0%	38%	0%	28	$0	561	$0	698	$0	725	$0	753
	Nephrology – ESRD Services	months	2,291	$265	102	$274	2,067	$283	2,570	$292	2,670	$301	2,774	$311	2,882	$321	2,995	$331	2,982	$341	539	$352	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1	$0	26	$0	32	$0	33	$0	34
	Office Administered Drugs	proced	42,583	$280	1,900	$289	38,418	$299	47,761	$308	49,624	$318	51,560	$328	53,570	$339	55,660	$349	55,421	$361	10,014	$372	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	6%	0%	122	$0	2,459	$0	3,057	$0	3,177	$0	3,301
	PT/OT/SLP	visits	70,086	$87	3,127	$90	63,231	$93	78,610	$96	81,675	$99	84,861	$102	88,170	$106	91,609	$109	91,216	$112	16,482	$116	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	39%	0%	1,211	$0	24,496	$0	30,454	$0	31,641	$0	32,875

MH & HOMELESS - AMBULATORY
	Outpatient Mental Health	visits	1,903	$137	85	$141	1,717	$146	2,135	$151	2,218	$155	2,305	$160	2,395	$166	2,488	$171	2,477	$176	448	$182	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	0	$0	10	$0	12	$0	13	$0	13
	Outpatient Substance Abuse	visits	749	$91	33	$94	676	$97	840	$100	873	$103	907	$107	943	$110	979	$114	975	$117	176	$121	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	0	$0	7	$0	9	$0	9	$0	10
	Psychotherapy (Ind. 45+ min / Group)	visits	14,757	$127	658	$131	13,314	$135	16,552	$139	17,197	$144	17,868	$148	18,565	$153	19,289	$158	19,206	$163	3,470	$168	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	10%	0%	69	$0	1,395	$0	1,734	$0	1,801	$0	1,872

INPATIENT PROFESSIONAL SERVICES various 38,193 $140 1,704 $144 34,458 $149 42,839 $154 44,509 $159 46,245 $164 48,049 $169 49,923 $174 49,708 $180 8,982 $186 3% 0% 3% 0% 3% 0% 3% 0% 3% 0% 3% 0% 3% 0% 3% 0% 3% 0% 46 $0 923 $0 1,147 $0 1,192 $0 1,239 $0 1,287 $0 1,337 $0 1,331 $0 241 $0 $0

INPATIENT FACILITY SERVICES

INPATIENT MEDICINE AND SURGERY
	IP Acute Medical	days	7,830	$2,174	349	$2,244	7,064	$2,315	8,782	$2,390	9,125	$2,466	9,481	$2,545	9,850	$2,626	10,235	$2,710	10,191	$2,797	1,841	$2,887	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	5	$0	91	$0	113	$0	118	$0	122
	IP Acute Surgical	days	6,382	$4,130	285	$4,262	5,758	$4,399	7,158	$4,539	7,437	$4,685	7,727	$4,835	8,029	$4,989	8,342	$5,149	8,306	$5,314	1,501	$5,484	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	7%	0%	21	$0	417	$0	518	$0	538	$0	559
	IP Maternity Deliveries	days	267	$2,849	12	$2,940	241	$3,034	299	$3,131	311	$3,231	323	$3,335	336	$3,441	349	$3,551	347	$3,665	63	$3,782	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	9%	0%	1	$0	22	$0	27	$0	28	$0	29
	IP Maternity Non-Deliveries	days	58	$893	3	$922	52	$951	65	$982	68	$1,013	70	$1,045	73	$1,079	76	$1,113	75	$1,149	14	$1,186	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0%	0	$0	0	$0	0	$0	0	$0	0

MH & HOMELESS - INPATIENT
	IP Acute Mental Health	days	3,589	$1,246	160	$1,286	3,238	$1,327	4,026	$1,369	4,182	$1,413	4,346	$1,458	4,515	$1,505	4,691	$1,553	4,671	$1,603	844	$1,654	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1	$0	19	$0	23	$0	24	$0	25
	IP Acute Mental Health Extended Stays	days	934	$126	42	$130	843	$134	1,048	$138	1,088	$143	1,131	$147	1,175	$152	1,221	$157	1,216	$162	220	$167	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	0	$0	5	$0	6	$0	6	$0	7
	IP Acute Substance Abuse	days	682	$1,475	30	$1,522	615	$1,571	765	$1,621	795	$1,673	826	$1,727	858	$1,782	891	$1,839	888	$1,898	160	$1,958	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	1%	0%	0	$0	7	$0	8	$0	8	$0	9

&D &T &"Times New Roman,Bold"Milliman &"Times New Roman,Regular"Page &P of &N

Hawaii

Department of Veterans Affairs

Community Care Network Contract, Region 4

CLIN X002 Pricing Template

Hawaii

FY18 Historical Data*

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

FY24/OY5

FY25/OY6

FY26/OY7

FY27/EXT

FY19/ Base

FY20/OY1

FY21/OY2

FY22/OY3

FY23/OY4

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