CCN Next Gen - Medical TOPR West 36C10G26R0003 0002-13 Amendment.pdf

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5. PROJECT NUMBER (if applicable)

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2. AMENDMENT/MODIFICATION NUMBER

CODE

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8. NAME AND ADDRESS OF CONTRACTOR

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PAGE OF PAGES

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Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

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is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

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Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

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Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

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(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

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(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

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ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 40

0002-13 4-17-2026

36C10G

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

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

36C10G

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

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

To all Offerors/Bidders

36C10G26R0003

12-15-2025

X x X

X

The purpose of this amendment (0002-13) is to:

1. Revise administrative errors from amendment 0002-12 Block 14.

2. Update RFP language and revise CLIN language in Section B and E.

3. Provide updated Attachment C.

4. Publish and provide CCN Next Gen Medical - West TOPR 0002 Conformed Copy 04172026

See continuation page for further details. All Other Terms and Conditions Remain the Same.

Jessica Portillo Contracting Officer

CONTINUATION PAGE 36C10G26R0003 0002-13

This amendment provides a conformed copy of the CCN Next Gen Medical - West TOPR 0002 Conformed Copy, noticed with RFP 36C10G26R0003 as CCN Next Gen Medical – West TOPR 0002. The following revisions have been incorporated into the updated conformed copy and are detailed below for your reference.

Note: The words struck out in the “From” sections of each change denote the language that will be removed in each revision. The words in red font in the “To” sections of each change denote the new language to be added in each version.

Change 1:

Revise administrative errors from amendment 0002-12 TOPR West, Block 14 dated 4/10/2026 to read as follows:

FROM:

2. Update Attachment 1: CCN Next Gen - Medical TOPR PWS_East_04_09_26 v5

3. Establish Attachment 8 – Medical Network Waiver Data as an attachment for Medical TOPR East.

TO:

2. Update Attachment 1: CCN Next Gen - Medical TOPR PWS_West_04_09_26 v5

3. Establish Attachment 8 – Medical Network Waiver Data as an attachment for Medical TOPR West.

Change 2:

Section B.2.1 TASK ORDER PROCEDURES is hereby revised as follows:

FROM:

Contractors under CCN Next Gen - Medical shall provide services as requirements are identified throughout the ordering period. Each requirement will specify details as they relate to deliverables, performance, and other technical items. The Government anticipates the task orders to have a Period of Performance (PoP) consisting of one (1) three (3) year base period and two (2), 12 month option periods.

In accordance with FAR 17.2, the Government may contemplate the use of options in each task order. Inclusion of options at the task order level will be properly documented and approved in accordance with FAR and agency procedures and will be clearly stated in the TOPR. FAR 52.217-9 will be included in any task orders that include options. TOs may also include FAR 52.217-8, Option to Extend Service.

TO:

Contractors under CCN Next Gen – Medical, shall provide services as requirements are identified throughout the ordering period. Each requirement will specify details as they relate to deliverables, performance, and other technical items. The Government anticipates the task orders to have a Period of Performance (PoP) consisting of one (1) three (3) year base period and two (2), 12-month option periods.

The Government anticipates that the IDIQ award date will commence on or about January 2027. This anticipated award date is provided for planning purposes only and may be revised at the CO's discretion due to programmatic or operational needs.

Offerors should be prepared to initiate performance in accordance with the requirements and timeliness specified in each task order.

In accordance with FAR 17.2, the Government may contemplate the use of options in each task order. Inclusion of options at the task order level will be properly documented and approved in accordance with FAR and agency procedures and will be clearly stated in the TOPR. FAR 52.217-9 will be included in any task orders that include options. TOs may also include FAR 52.217-8, Option to Extend Service.

Change 3:

The following language in section B.4 Medical CLIN Structure is hereby changed as follows:

FROM:

CLIN X001, Healthcare Services:

CLIN X001, Healthcare Services, VA will pay the Contractor for all authorized medical services provided under this contract. The Contractor shall reimburse network providers at the lessor of the billed charges or the maximum allowable rate specified by Medicare.

The lesser of the billed charges means that if the amount billed by the network provider is lower than the maximum allowable Medicare rate, the Contractor shall reimburse the provider based on the billed amount rather than the Medicare rate.

Sub CLIN X001AA, Standard Medicare Rate Healthcare Services:

Sub CLIN X001AA, Standard Medicare Rate Healthcare Services: VA will pay the Contractor for authorized medical services at the locality adjusted Medicare Rates.

Sub CLIN X001AB, PPS Exempt Healthcare Services:

Sub CLIN X001AB, PPS Exempt Healthcare Services, VA will pay the Contractor for authorized medical services that are excluded from IPPS and OPPS based on CMS issued payment rules. This includes services delivered at All Payer Model Agreement Hospitals that are included in rate orders and unit rates approved by the State, unless there is a VA CO approved rate that sets an alternate rate for such services.

CLIN X002, Waivers of Payment Rates:

CLIN X002, Waiver of Payment Rates, VA will pay the Contractor for authorized services in highly rural areas and/or regions with scarce medical resources by allowing payment at a percentage above the locality-adjusted Medicare rate, the VA Fee Schedule rate, or the Alaska Fee Schedule rate. Upon VA approval and execution of a waiver request, the Contractor shall reimburse providers at the lesser of the approved rate or the billed charges for the specified services. The lesser of the billed charges means that if the provider's billed amount is lower than the rate approved through the waiver request, the Contractor will reimburse the provider based on the billed amount rather than the higher approved waiver rate.

CLIN X003, Seasonal Vaccinations and Adult Immunizations:

CLIN X003, Seasonal Vaccinations, VA will pay the Contractor for administrating the influenza (trivalent, quadrivalent and high dosage), COVID-19 vaccines, and VA approved adult immunizations at retail pharmacies. Pricing for this CLIN is determined by the Medicare rates and methodology for each vaccination. CLIN X003 includes the administration.. See attachment P.a for VA approved adult immunizations.

CLIN X004, Fee Schedules:

CLIN X004, VA Fee Schedule, covers all authorized non-Medicare medical services. VA will pay the Contractor the Fee Schedule rates 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.

Sub CLIN X004AA, VA Fee Schedule:

Sub CLIN X004AA, VA Fee Schedule, VA will pay the Contractor the VA Fee Schedule rate 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 there is an established VA Fee Schedule rate.

Sub CLIN X004AB, Alaska Fee Schedule:

Sub CLIN X004AB, Alaska Fee Schedule, covers all authorized non-Medicare medical services in the state of Alaska. VA will pay the Alaska Fee Schedule rate for services furnished in Alaksa using the Alaska Fee Schedule and the Alaska

Professional Fee Schedule, unless there is a VA CO approved rate that sets an alternate rate for such services.

CLIN X005, Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services:

CLIN X005, Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services, VA will pay the Contractor for authorized healthcare services when a given medical service or 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. When there is not a Medicare rate or VA Fee Schedule rate for the authorized service(s), the VA shall reimburse the Contractor at 50% of the provider’s billed charges.

CLIN X006

, Urgent and Emergent Medication:

CLIN X006, Urgent and Emergent Medication, VA will pay the Contractor for urgent and emergent medications dispensed by pharmacies in the Contractor's network without direct charges to the Veteran. VA will reimburse the Contractor for Brand Name (Sub CLIN X006AA) and Generic (Sub CLIN X006AB) medication based on a percentage of Average Wholesale Price (AWP). The Contractor shall invoice the Dispensing fee (Sub CLIN X006AC) at the awarded price for each dispensing activity.

Sub CLIN X006AA Brand Name Medication Sub CLIN X006AB Generic Medication Sub CLIN X006AC Dispensing Fee

CLIN X007, Disaster Response ONLY – Urgent and Emergent Medication:

OPTIONAL CLIN X007, Disaster Response ONLY – Urgent and Emergent Medication, VA will pay the Contractor for urgent and emergent medications dispensed by pharmacies in the Contractor's network without direct charges to the Veteran during a specified and approved “Disaster Response” scenario. CLIN X007 will only be exercised in the case of a disaster that prevents VA’s mail order pharmacy from delivering medications to Veterans. Prescription fills may be for 30-days under this CLIN. VA will reimburse the Contractor for Brand Name (Sub CLIN X007AA) and Generic (Sub CLIN X007AB) medication at based on a percent of AWP. The Contractor shall invoice the Dispensing fee (Sub CLIN X007AC) at the awarded price for each dispensing activity.

Sub CLIN X007AA Brand Name Medication Sub CLIN X007AB Generic Medication Sub CLIN X007AC Dispensing Fee

CLIN X008, Administrative Services:

CLIN X008, Administrative Services, VA will pay the Contractor for the administrative services required to manage and deliver the services purchased under this contract.

These costs are separate from the costs of providing medical services and implementation. Administrative services and activities include, but are not limited to, the following items:

• Claims Appeals

• Claims Processing

• Clinical Quality and Patient Safety Monitoring

• Alternative Payment Models

• Utilization Management

• Contractor Administrative Costs

• Contact Center

• Contractor Profits

• Credentialing

• Customer Service

• Data Analytics and Reporting

• Fee Schedule Updates

• Invoicing and Billing

• Medical Documentation Procedures

• Network Development and Management

• Program Integrity

• Project Management

• Referrals Management

• Training

This CLIN is paid following achievement of full healthcare delivery (HCD) based on the monthly Enrolled Veteran population in the Task Order's geographic jurisdiction/region.

Sub CLIN X008AA Administrative Services for Healthcare Services:

Sub CLIN X008AA, Administrative Services for Healthcare Services, VA will pay the Contractor for administrative services required to manage and deliver the healthcare services purchased under this contract.

Sub CLIN X008AB, Administrative Services for Pharmacy Benefits Management (PBM):

Sub CLIN X008AB, Administrative Services for Pharmacy Benefits Management (PBM), will pay the Contractor for administrative services required to manage and deliver the pharmacy services purchased under this contract.

CLIN X009, Organ Acquisition Cost:

CLIN X009, Organ Acquisition Cost, VA will pay the Contractor an equitable payment for reasonable organ acquisition services/costs required to support quality transplant programs in agreement with certified transplant centers (CTC). Medicare Standard Acquisition Charges (SACs) shall be used for reimbursement of the reasonable and necessary costs associated with solid organ acquisition.

The Contractor shall include provisions in agreement with CTCs that allows reimbursement for organ acquisition according to the most current Medicare Cost Report Data, under the D-4 Worksheet.

CLIN X010, Incentives/Disincentives:

VA will pay for incentives and disincentives related to performance metrics, quality of service, and other criteria as specified by the PWS; incentives encourage exceeding baseline performance requirements and disincentives address underperformance.

Sub CLIN X010AA, Adverse Credit Reporting Incentives:

Sub CLIN X010AA, Adverse Credit Reporting Incentives, VA will pay the Contractor for net incentive fees earned (less any disincentive fees assessed) for PO2.7 during the period of performance in accordance with “Performance Requirement Summary_Medical West_02_24_26 v3”.

Sub CLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive:

Sub CLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive, VA will pay the Contractor for net incentive fees earned (less any disincentive fees assessed) for PO5.1 during the period of performance in accordance with “Performance Requirement Summary_Medical West_02_24_26 v3”.

CLIN X011, Implementation:

CLIN X011, Implementation, VA will make a lump sum payment to the Contractor upon satisfactory completion of all start-up/implementation milestones identified in the contractor’s implementation plan and accepted by the CO. “Satisfactory completion” would mean the Contractor has completed all start-up/implementation milestones identified in the Contractor’s implementation plan and those milestones have been accepted by the CO. It also requires that the Contractor not invoice for implementation until full HCD is achieved across the region, with invoicing aligned to the firm fixed price performance-based milestones and covering the lump-sum transition/ implementation/ administrative services prior to full HCD (with implementation services excluded from CLIN X008, Administrative Services).

CLIN X012, Transition Out:

CLIN X012, Transition Out, VA will pay the Contractor for transition out and residual service tasks, including retroactive processing of referrals and claims adjudication, providing claims, transition open referrals, providing an inventory of assets, facilitating knowledge transfer, removal of government furnished information, and customer service transition. This CLIN will be paid as a fixed price upon VA initiation of the transition out period. Transition out services shall be excluded from CLIN X008, Administrative Services.

OPTIONAL CLIN X013, Task Implementation:

OPTIONAL Sub CLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility:

OPTIONAL Sub CLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility, VA will pay the Contractor for completion of the implementation of appointment scheduling and care coordination at a VA facility. VA will pay the awarded price for each VA Facility that orders appointment scheduling and comprehensive care coordination.

Implementation services shall be excluded from CLIN X008, Administrative Services and CLIN X011, Implementation. The Contractor is only eligible to invoice for one implementation payment per VA Facility during the Period of Performance of the contract.

OPTIONAL Sub CLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site:

OPTIONAL Sub CLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site, VA will pay the Contractor for completion of the implementation of appointment scheduling and care coordination at the Contractor’s site. VA will pay the awarded price for appointment scheduling and comprehensive care coordination at the Contractor's site. Implementation services shall be excluded from CLIN X008, Administrative Services and CLIN X011, Implementation. The Contractor is only eligible to invoice for one implementation payment during the period of performance of the contract.

OPTIONAL CLIN X014, Healthcare Appointment Scheduling and Comprehensive Care Coordination:

OPTIONAL Sub CLIN X014, Appointment Scheduling and Comprehensive Care Coordination, VA will pay the Contractor for appointment scheduling and care coordination at the awarded monthly price for the number of unique VA Approved Referrals for the tier ordered. If the Contractor receives unique referrals over the annual tiered volumes, the Contractor shall return those referrals to VA.

When the quantity of unique VA Approved Referrals exceeds a tier, the subsequent tier may be ordered.

The tiers are as follows:

CLIN X014 Number of Unique VA Approved Referrals by Period of Performance

Sub CLIN X014AA (Tier 1) 0 – 200,000 Sub CLIN X014AB (Tier 2) 200,001 – 300,000 Sub CLIN X014AC (Tier 3) 300,001 – 400,000 Sub CLIN X014AD (Tier 4) 400,001 – 500,000 Sub CLIN X014AE (Tier 5) 500,001 +

OPTIONAL CLIN X015, Care Coordination Follow-Up:

OPTIONAL CLIN X015, Care Coordination Follow-Up, VA will pay the Contractor for care coordination follow-up services at the awarded monthly price for the number of unique VA Approved Referrals, including implementing the care coordination follow-up process. Payments are limited to one payment per Veteran per month.

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development:

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development, VA will pay the Contractor for software design, customization, development, configuration, interface development, programming changes, and modifications to include system update services and process and proof of concepts changes in accordance with current software development methodologies associated with software solutions, as needed.

This CLIN is paid based on a fixed price for each instance of a software development, process, or proof of concept task aligned to the following task sizes:

OPTIONAL Sub CLIN X016AA Extra-Small (XS):

OPTIONAL SUBCLIN X016AA Extra-Small (XS), Small modifications to existing functionality. Architecturally insignificant, only involves one team, similar to work done in the past by team, no new technologies involved. An extra small task consists of 1 Sprint, over a 1–4-week period.

OPTIONAL Sub CLIN X016AB Small (S):

OPTIONAL SUBCLIN X016AB Small (S), Small modifications to existing functionality. Architecturally insignificant, few dependencies but only involves one team, similar to work done in the past by team, no new technologies involved. A small task consists of 2 Sprints, over a 1–2-month period.

Optional Sub CLIN X016AC Medium (M):

OPTIONAL SUBCLIN X016AC Medium (M), More significant modifications to existing functionality. Minor architectural changes, few dependencies across 1-2 teams, precedents exist for the work but teams are inexperienced in doing it, may involve new technologies. A medium task consists of 4 Sprints, over a 3–6-month period.

OPTIONAL Sub CLIN X016AD Large (L):

OPTIONAL SUBCLIN X016AD Large (L), No existing functionality to leverage.

Major architectural changes required, multiple dependencies across multiple teams, no precedents for the work, no experience on the teams, involves new technologies. A large task consists of 7 Sprints, over a 7–18-month period.

OPTIONAL Sub CLIN X016AE Extra Large (XL):

OPTIONAL SUBCLIN X016AE Extra Large (XL), No existing functionality to leverage. Major architectural changes required, multiple dependencies across multiple teams, no precedents for the work, no experience on the teams, involves new technologies. An extra-large task consists of 10 Sprints, over an 18+ month period.

TO:

CLIN X001, Healthcare Services:

CLIN X001, Healthcare Services, VA will pay the Contractor for all authorized medical services provided under this contract. The Contractor shall reimburse network providers at the lesser of the billed charges or the maximum allowable rate specified by Medicare.

The lesser of the billed charges means that if the amount billed by the network provider is lower than the maximum allowable Medicare rate, the Contractor shall reimburse the provider based on the billed amount rather than the Medicare rate.

Sub CLIN X001AA, Standard Medicare Rate Healthcare Services:

Sub CLIN X001AA, Standard Medicare Rate Healthcare Services, VA will pay the Contractor for authorized medical services at the locality-adjusted Medicare Rates.

Sub CLIN X001AB, PPS Exempt Healthcare Services:

Sub CLIN X001AB, PPS Exempt Healthcare Services, VA will pay the Contractor for authorized medical services that are excluded from IPPS and OPPS based on CMS-issued payment rules. This includes services delivered at All Payer Model Agreement Hospitals that are included in rate orders and unit rates approved by the State, unless there is a VA CO approved rate that sets an alternate rate for such services.

CLIN X002, Waivers of Payment Rates:

CLIN X002, Waiver of Payment Rates, VA will pay the Contractor for authorized services in highly rural areas and/or regions with scarce medical resources by allowing payment at a percentage above the locality-adjusted Medicare rate or the VA Fee Schedule rate, or the Alaska Fee Schedule rate. Upon VA approval and execution of a waiver request, the Contractor shall reimburse providers at the lesser of the approved rate or the billed charges for the specified services. The lesser of the billed charges means that if the provider's billed amount is lower than the rate approved through the waiver request, the Contractor will reimburse the provider based on the billed amount rather than the higher approved waiver rate.

CLIN X003, Seasonal Vaccinations and Adult Immunizations:

CLIN X003, Seasonal Vaccinations and Adult Immunizations, VA will pay the Contractor for administrating the influenza (trivalent, quadrivalent and high dosage), COVID-19 vaccines, and VA approved adult immunizations at retail pharmacies. Pricing for this

CLIN is determined by the Medicare rates and methodology for each vaccination. CLIN X003 includes the administration and product fee. See “Attachment Pa - CCN Legacy Vaccination_Medication Volumes”.

CLIN X004, Fee Schedules:

CLIN X004, Fee Schedule, covers all authorized non-Medicare medical services. VA will pay the Contractor the Fee Schedule rates 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.

Sub CLIN X004AA, VA Fee Schedule:

Sub CLIN X004AA, VA Fee Schedule, VA will pay the Contractor the VA Fee Schedule rate 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 there is an established VA Fee Schedule rate.

Sub CLIN X004AB, Alaska Fee Schedule:

Sub CLIN X004AB, Alaska Fee Schedule, covers all authorized non-Medicare medical services in the state of Alaska. VA will pay the Alaska Fee Schedule rate for services furnished in Alaksa using the Alaska Fee Schedule and the Alaska Professional Fee Schedule, unless there is a VA CO approved rate that sets an alternate rate for such services.

CLIN X005, Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services:

CLIN X005, Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services, VA will pay the Contractor for authorized healthcare services when a given medical service or 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 or Alaska Fee Schedule. When there is not a Medicare rate or VA Fee Schedule rate or Alaska Fee Schedule Rate for the authorized service(s), VA will reimburse the claims based on a rate of 50% of billed charges.

CLIN X006, Urgent and Emergent Medication:

CLIN X006, Urgent and Emergent Medication, VA will pay the Contractor for urgent and emergent medications dispensed by pharmacies in the Contractor's network without direct charges to the Veteran. VA will reimburse the Contractor for Brand Name (Sub CLIN X006AA) and Generic (Sub CLIN X006AB) medication based on a percentage of Average Wholesale Price (AWP). The Contractor shall invoice the Dispensing fee (Sub CLIN X006AC) at the awarded price for each dispensing activity.

Sub CLIN X006AA Brand Name Medication Sub CLIN X006AB Generic Medication

Sub CLIN X006AC Dispensing Fee

CLIN X007, Disaster Response: Urgent and Emergent Medication:

CLIN X007, Disaster Response ONLY – Urgent and Emergent Medication, VA will pay the Contractor for urgent and emergent medications dispensed by pharmacies in the Contractor's network without direct charges to the Veteran during a specified and approved “Disaster Response” scenario. CLIN X007 will only be exercised in the event of a disaster that prevents VA’s mail order pharmacy from delivering medications to Veterans. Prescription fills may be for 30-days under this CLIN. VA will reimburse the Contractor for Brand Name (Sub CLIN X007AA) and Generic (Sub CLIN X007AB) medication based on a percentage of Average Wholesale Price (AWP). The Contractor shall invoice the Dispensing fee (Sub CLIN X007AC) at the awarded price for each dispensing activity.

Sub CLIN X007AA Brand Name Medication Sub CLIN X007AB Generic Medication Sub CLIN X007AC Dispensing Fee

CLIN X008, Administrative Services, VA will pay the Contractor for the administrative services required to manage and deliver the services purchased under this contract.

These costs are separate from the costs of providing medical services and implementation. Administrative services and activities include, but are not limited to, the following items:

• Claims Appeals

• Claims Processing

• Clinical Quality and Patient Safety Monitoring

• Alternative Payment Models

• Utilization Management

• Contractor Administrative Costs

• Contact Center

• Contractor Profits

• Credentialing

• Customer Service

• Data Analytics and Reporting

• Fee Schedule Updates

• Invoicing and Billing

• Medical Documentation Procedures

• Network Development and Management

• Program Integrity

• Project Management

• Referrals Management

• Training

This CLIN is paid following achievement of full healthcare delivery (HCD) based on the monthly Enrolled Veteran population in the Task Order's geographic jurisdiction/region.

Sub CLIN X008AA Administrative Services for Healthcare Services:

Sub CLIN X008AA, Administrative Services for Healthcare Services, VA will pay the Contractor for administrative services required to manage and deliver the healthcare services purchased under this contract.

Sub CLIN X008AB, Administrative Services for Pharmacy Benefits Management (PBM):

Sub CLIN X008AB, Administrative Services for Pharmacy Benefits Management (PBM), will pay the Contractor for administrative services required to manage and deliver the pharmacy services purchased under this contract.

CLIN X009, Organ Acquisition Cost:

CLIN X009, Organ Acquisition Cost, VA will pay the Contractor an equitable payment for reasonable organ acquisition services/costs required to support quality transplant programs in agreement with certified transplant centers (CTC). Medicare Standard Acquisition Charges (SACs) shall be used for reimbursement of the reasonable and necessary costs associated with solid organ acquisition.

The Contractor shall include provisions in agreement with CTCs that allows reimbursement for organ acquisition according to the most current Medicare Cost Report Data, under the D-4 Worksheet.

CLIN X010, Incentives/Disincentives:

VA will pay for incentives and disincentives related to performance metrics, quality of service, and other criteria as specified by the PWS; incentives encourage exceeding baseline performance requirements and disincentives address underperformance.

Sub CLIN X010AA, Adverse Credit Reporting Incentives:

Sub CLIN X010AA, Adverse Credit Reporting Incentives, VA will pay the Contractor for net incentive fees earned (less any disincentive fees assessed) for PO2.7 during the period of performance in accordance with “Attachment C - Performance Requirement Summary_Medical West_04_10_26 v4”.

Sub CLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive:

Sub CLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive, VA will pay the Contractor for net incentive fees earned (less any disincentive fees assessed) for PO5.1 during the period of performance in accordance with “Attachment C - Performance Requirement Summary_Medical West _04_10_26 v4”.

CLIN X011, Implementation:

CLIN X011, Implementation, VA will make a lump sum payment to the Contractor upon satisfactory completion of all start-up/implementation milestones identified in the contractor’s implementation plan and accepted by the CO. “Satisfactory completion” would mean the Contractor has completed all start-up/implementation milestones identified in the Contractor’s implementation plan and those milestones have been accepted by the CO. It also requires that the Contractor not invoice for implementation until full HCD is achieved across the region, with invoicing aligned to the firm fixed price performance-based milestones and covering the lump-sum transition/ implementation/ administrative services prior to full HCD (with implementation services excluded from CLIN X008, Administrative Services).

CLIN X012, Transition Out:

CLIN X012, Transition Out, VA will pay the Contractor for transition out and residual service tasks, including retroactive processing of referrals and claims adjudication, providing claims, transition open referrals, providing assets, facilitating knowledge transfer, removal of government furnished information, and customer service transition.

This CLIN will be paid as a fixed price upon VA initiation of the transition-out period.

Transition out services shall be excluded from CLIN X008, Administrative Services.

OPTIONAL CLIN X013, Optional Task Implementation:

OPTIONAL Sub CLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility:

OPTIONAL Sub CLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility, VA will pay the Contractor for completion of the implementation of appointment scheduling and care coordination at a VA facility. VA will pay the awarded price for each VA Facility that orders appointment scheduling and comprehensive care coordination. Implementation services shall be excluded from CLIN X008, Administrative Services and CLIN X011, Implementation.

The Contractor is only eligible to invoice for one implementation payment per VA Facility during the Period of Performance of the contract.

OPTIONAL Sub CLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site:

OPTIONAL Sub CLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site, VA will pay the Contractor for completion of the implementation of appointment scheduling and care coordination at the Contractor’s site. VA will pay the awarded price for appointment scheduling and comprehensive care coordination at the Contractor's site. Implementation services shall be excluded from CLIN X008, Administrative Services and CLIN X011, Implementation.

The Contractor is only eligible to invoice for one implementation payment during the period of performance of the contract.

OPTIONAL CLIN X014, Appointment Scheduling and Comprehensive Care Coordination:

OPTIONAL Sub CLIN X014, Appointment Scheduling and Comprehensive Care Coordination, VA will pay the Contractor for appointment scheduling and care coordination at the awarded monthly price for the number of unique VA Approved Referrals for the tier ordered. If the Contractor receives unique referrals over the annual tiered volumes, the Contractor shall return those referrals to VA.

When the quantity of unique VA Approved Referrals exceeds a tier, the subsequent tier may be ordered.

The tiers are as follows:

CLIN X014

Number of Unique VA Approved Referrals by Period of Performance

Sub CLIN X014AA (Tier 1) 0 – 200,000 Sub CLIN X014AB (Tier 2) 200,001 – 300,000 Sub CLIN X014AC (Tier 3) 300,001 – 400,000 Sub CLIN X014AD (Tier 4) 400,001 – 500,000 Sub CLIN X014AE (Tier 5) 500,001 +

OPTIONAL CLIN X015, Care Coordination Follow-Up, VA will pay the Contractor for care coordination follow-up services at the awarded monthly price for the number of unique VA Approved Referrals, including implementing the care coordination follow-up process. Payments are limited to one payment per Veteran per month.

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development:

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development, VA will pay the Contractor for software design, customization, development, configuration, interface development, programming changes, and modifications to include system update services and process and proof of concepts changes in accordance with current software development methodologies associated with software solutions, as needed.

This CLIN is paid based on a fixed price for each instance of a software development, process, or proof of concept task aligned to the following task sizes:

OPTIONAL Sub CLIN X016AA Extra-Small (XS):

OPTIONAL SUBCLIN X016AA Extra-Small (XS), Small modifications to existing functionality. Architecturally insignificant, it only involves one team, similar to work done in the past by team, no new technologies involved. An extra small task consists of 1 Sprint, over a 1–4-week period.

OPTIONAL Sub CLIN X016AB Small (S):

OPTIONAL SUBCLIN X016AB Small (S), Small modifications to existing functionality.

Architecturally insignificant, few dependencies but only involves one team, similar to work done in the past by team, no new technologies involved. A small task consists of 2 Sprints, over a 1–2-month period.

Optional Sub CLIN X016AC Medium (M):

OPTIONAL SUBCLIN X016AC Medium (M), More significant modifications to existing functionality. Minor architectural changes, few dependencies across 1-2 teams, precedents exist for the work, but teams are inexperienced in doing it, may involve new technologies. A medium task consists of 4 Sprints, over a 3–6-month period.

OPTIONAL Sub CLIN X016AD Large (L):

OPTIONAL SUBCLIN X016AD Large (L), No existing functionality to leverage. Major architectural changes required, multiple dependencies across multiple teams, no precedents for the work, no experience on the teams, involves new technologies. A large task consists of 7 Sprints, over a 7–18-month period.

OPTIONAL Sub CLIN X016AE Extra Large (XL):

OPTIONAL SUBCLIN X016AE Extra Large (XL), No existing functionality to leverage.

Major architectural changes required, multiple dependencies across multiple teams, no precedents for the work, no experience on the teams, involves new technologies. An extra-large task consists of 10 Sprints, over an 18+ month period.

Change 4:

The following language in the section E.1 ADDENDUM TO FAR 52.212-1

INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES, FACTOR 4: PRICE is hereby changed as follows:

FROM:

All proposals must include a Price Volume to be considered for award. The Pricing Template in “Attachment 3 – CCN Next Gen Medical – West TOPR Price Schedule v5”, contains CLINs with varying pricing methodologies. The following CLINs and their corresponding Sub CLINs are pre-priced by VA: CLIN X001; CLIN X004; CLIN X005;

CLIN X009 and CLIN X010. The Offeror must propose pricing for all non-pre-priced CLINs (i.e., populate all cells within the Price Schedule), including all CLINs identified as optional. Offerors must provide pricing for the base year and all option periods for all non-pre-priced CLINs. Failure to price the base and all option periods shall cause the offer to be rejected from further consideration. Offerors shall submit their prices using “Attachment 3 – CCN Next Gen Medical – West TOPR Price Schedule v5” and provide an explanatory narrative that the Offeror provides as the basis for their proposed price.

The Offeror’s completed Price Schedule constitutes its price proposal to the Government. VA requires the Offeror to propose pricing for all non-pre-priced CLINs (X002, X003; CLIN X006; X007; X008; X011; X012; X013; X014; X015; and X016), for each applicable year of the period of performance. Green colored cells require Offeror input. Gray colored cells are not priced by Offerors. Do not add or change gray cells.

The formulas, calculations, and links shall not be hidden. Print image files or files/worksheets containing only values are not acceptable.

Price Rounding: The Government requires the Offeror to propose prices that are two decimal places. The Offeror shall ensure that the actual values in the spreadsheet cells are no more than two decimal places.

The Offeror shall provide a narrative description of its price proposal, in PDF, addressing the following items. The narrative description of the Price Volume shall be limited to 50 pages (Excel files do not count against page count).

1. The Offeror must clearly provide a basis of estimate (BOE) for each CLIN that it is proposing and describe any additional conditions or exceptions upon which its price proposal is based.

2. The BOE shall include methodology, source and build-up of prices and rates, source of inflation index, geographic location, and any ground rules and assumptions that impact the price proposal (e.g., rurality, facility and provider locations). As previously indicated, prices proposed in the Price Schedule, in Microsoft Excel, do not count against the page limit, however, there is a 10-page limit for the BOE.

3. The proposed unit prices and rates do not need to be duplicated in the Price Volume if listed in the Price Schedule.

4. The BOE will not be evaluated for realism, accuracy of assumptions, or validity of estimating methods, and will not be used in the determination of cost or price realism. The VA will not conduct a price realism analysis as part of this procurement.

If a proposal is not received from a HubZone small business concern, the price evaluation will not consider the preference for HubZone small business concerns (FAR 52.219-4).

Historical purchasing patterns and volume data, provided as Attachment P “Health Care Historical Volumes and Estimated Enrolled and Eligibility,” can be used to inform Offerors’ proposals and network development. There is no guarantee for future purchase volumes.

Price Schedule

The Price Schedule contains CLINs with varying pricing methodologies. VA requires the Offeror to propose pricing for all non-pre-priced CLINs, for each applicable year of the Period of Performance. The X in the CLIN number stands for the year of the contract, with zero being the base year (e.g., CLIN X001 in the base year is CLIN 0001). Refer to Section B.4, Medical CLIN Structure, for a description of each CLIN/subCLIN.

Calculations supporting the percentages may be submitted in the applicable tab in the “Attachment 3 – CCN Next Gen Medical – West TOPR Price Schedule v5”.

Directions for Pricing CLINs

The Offeror shall input their proposed prices/rates in the green colored cells. Proposed prices for Option Year 9 will be used to determine the price for the optional extension period for evaluation purposes.

CLIN X001, Healthcare Services:

SubCLIN X001AA, Standard Medicare Rate Healthcare Services

Government-provided rate - Not priced.

SubCLIN X001AB, PPS Exempt Healthcare Services

Government-provided rate - Not priced.

CLIN X002, Waivers of Payment Rates:

Priced. Offerors shall propose a maximum percentage above locality-adjusted Medicare Rate, in percentages, for each year of the Period of Performance.

X003, Seasonal Vaccinations and Adult Immunizations:

Priced. Offerors shall propose a unit price, in dollars, to administer and dispense a single seasonal vaccine and VA approved adult immunization. The cost of the vaccination medications shall be captured under CLIN X001. Pricing for this CLIN is determined by the Medicare rates and methodology for each vaccination.

CLIN X004, Fee Schedules:

SubCLIN X004AA, VA Fee Schedule

Government-provided rate - Not priced.

SubCLIN X004AB, Alaska Fee Schedule

Government-provided rate - Not priced.

CLIN X005, Non-Medicare, Non-Fee Schedule Healthcare Services:

CLIN X006, Urgent and Emergent Medication:

SubCLIN X006AA, Brand Name Medication

Priced. Offerors shall propose a unit price for brand name medications, excluding dispensing fees, as a percentage of the AWP price, for each year of the Period of Performance.

SubCLIN X006AB, Generic Medication

Priced. Offerors shall propose a unit price, for generic medications, excluding dispensing fees, as a percentage of the AWP price, for each year of the Period of Performance.

SubCLIN X006AC, Dispensing Fee

Priced. Offerors shall propose a unit price, in dollars, for each medication that is dispensed for each year of the Period of Performance.

CLIN X007, Disaster Response ONLY - Urgent and Emergent Medication:

SubCLIN X007AA, Brand Name Medication

Priced. Offerors shall propose a unit price, for brand name mediations, excluding dispensing fees, as a percentage of the AWP price, for each year of the Period of Performance.

SubCLIN X007AB, Generic Medication

Priced. Offerors shall propose a unit price, for generic mediations, excluding dispensing fees, as a percentage of the AWP price, for each year of the Period of Performance.

SubCLIN X007AC, Dispensing Fee

Priced. Offerors shall propose a unit price, in dollars, for each medication that is dispensed, for each year of the Period of Performance.

CLIN X008, Administrative Services:

SubCLIN X008AA Administrative Services for Healthcare Services:

Priced. Offerors shall propose a unit price, in dollars, that applies to the monthly enrolled Veteran population for each year of the Period of Performance.

SubCLIN X008AB, Administrative Services for Pharmacy Benefits Management

(PBM):

Priced. Offerors shall propose a unit price, in dollars, that applies to the monthly enrolled Veteran population for each year of the Period of Performance.

CLIN X009, Organ Acquisition Cost:

Government-provided rate - Not priced.

CLIN X010, Incentives/Disincentives:

SubCLIN X010AA, Adverse Credit Reporting Incentives

Government-provided rate - Not priced.

SubCLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive

Government-provided rate - Not priced.

CLIN X011, Implementation:

Priced. Offerors shall propose a lump sum price, in dollars, to be paid following completion of implementation. The Offeror’s BOE shall include milestones associated with meeting concrete implementation goals, such as completion of the network build, system readiness, and achievement of proposed staffing goals.

CLIN X012, Transition Out:

Priced. Offerors shall propose a lump sum price, in dollars, for each year of the Period of Performance to be paid when CLIN X012 is exercised.

OPTIONAL CLIN X013, Optional Task Implementation:

OPTIONAL SubCLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility

Priced Offerors shall propose a lump sum per VA facility price, in dollars, to be paid following completion of implementation at each VA facility where CLIN X013 is exercised, for each year of the Period of Performance.

OPTIONAL SubCLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site

Priced. Offerors shall propose a lump sum, in dollars, to be paid following completion of implementation at the Contractor’s site when CLIN X013 is exercised, for each year of the Period of Performance.

OPTIONAL CLIN X014, Appointment Scheduling and Comprehensive Care Coordination Administration

Offerors shall propose a unit price, in dollars, that applies to each Approved Referral for appointment scheduling, by quantity tier, for each year of the Period of Performance.

OPTIONAL SubCLIN X014AA, Appointment Scheduling Administration and Comprehensive Care Coordination Tier 1

Priced. Offerors shall propose a unit price by quantity tier.

OPTIONAL SubCLIN X014AB, Appointment Scheduling Administration and Comprehensive Care Coordination Tier 2

Priced. Offerors shall propose a unit price by quantity tier.

OPTIONAL SubCLIN X014AC, Appointment Scheduling Administration and Comprehensive Care Coordination Tier 3

Priced. Offerors shall propose a unit price by quantity tier.

OPTIONAL SubCLIN X014AD, Appointment Scheduling Administration and Comprehensive Care Coordination Tier 4 Priced. Offerors shall propose a unit price by quantity tier.

OPTIONAL SubCLIN X014AE, Appointment Scheduling Administration and Comprehensive Care Coordination Tier 5

Priced. Offerors shall propose a unit price by quantity tier.

OPTIONAL CLIN X015, Care Coordination Follow-Up:

Priced. Offerors shall propose a unit price, in dollars, that applies to each Approved Referral for care coordination follow-up each year of the Period of Performance.

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development:

Offerors shall propose a unit price, in dollars, for each instance of a software, process, and proof of concept development task aligned to the task sizes below, for each year of the Period of Performance.

OPTIONAL SubCLIN X016AA, Extra-Small (XS) Software, Process, and Proof of Concept Development Task Size

Priced. Offerors shall propose a unit price aligned to the XS task size.

OPTIONAL SubCLIN X016AB, Small (S) Software, Process, and Proof of Concept Development Task Size

Priced. Offerors shall propose a unit price aligned to the S task size.

OPTIONAL SubCLIN X016AC, Medium (M) Software, Process, and Proof of Concept Development Task Size

Priced. Offerors shall propose a unit price aligned to the M task size.

OPTIONAL SubCLIN X016AD, Large (L) Software, Process, and Proof of Concept Development Task Size

Priced. Offerors shall propose a unit price aligned to the L task size.

OPTIONAL SubCLIN X016AE, Extra-Large (XL) Software, Process, and Proof of Concept Development Task Size

Priced. Offerors shall propose a unit price aligned to the XL task size.

TO:

All proposals must include a Price Volume to be considered for award. The Pricing Template in “Attachment 3 – CCN Next Gen Medical – West TOPR Price Schedule v5”, contains CLINs with varying pricing methodologies. The following CLINs and their corresponding Sub CLINs are pre-priced by VA: CLIN X001; CLIN X004; CLIN X005;

CLIN X009 and CLIN X010. The Offeror must propose pricing for all non-pre-priced CLINs (i.e., populate all cells within the Price Schedule), including all CLINs identified as optional. Offerors must provide pricing for the base year and all option periods for all non-pre-priced CLINs. Failure to price the base and all option periods shall cause the offer to be rejected from further consideration. Offerors shall submit their prices using “Attachment 3 – CCN Next Gen Medical – West TOPR Price Schedule v5” and provide an explanatory narrative that the Offeror provides as the basis for their proposed price.

The Offeror’s completed Price Schedule constitutes its price proposal to the Government. VA requires the Offeror to propose pricing for all non-pre-priced CLINs (X002, X003, X006; X007, X008, X011, X012, X013, X014, X015, and X016), for each applicable year of the period of performance.