36C10G26R0004 0013 CCN Next Gen - Dental Network Amendment.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

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

(REV. 11/2016)

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:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

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

(Number, street, county, State and ZIP Code)

(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)

(X)

CHECK

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 5

0013 03-23-2026

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

36C10G26R0004

12-15-2025

X

X X

X

The purpose of this amendment (0013) is to:

1. Rescind the revisions made to CLIN X002 via Amendment 0012 posted on 3/20/2026. See continuation page for further details.

2. All other terms and conditions remain the same.

Jessica Portillo

Contracting Officer

CONTINUATION PAGE 36C10G26R0004 0013

This amendment provides a conformed copy of the CCN Next Generation Dental Network solicitation, noticed as 36C10G26R0004. 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 revision.

CHANGE 1:

Section B.5.4 Waivers of Payment Rates is hereby changed as follows:

FROM:

The VA has set a “not to exceed” (NTE) ceiling for rate waivers of 200% above Medicare or the

VA Fee Schedule. Rate waiver submissions exceeding 200% above Medicare of the VA Fee

Schedule will be denied without further review. The Contractor may submit a waiver of payment rates request to VA when payment to its providers aligned to DVAFS is insufficient to maintain the network in highly rural areas and/or for scarce resources. A highly rural area is defined as a county with fewer than seven individuals residing per square mile. Scarce resources are defined as situations where the Contractor is unable to meet network adequacy standards for specific dental services due to a lack of capable providers in a specific area as determined through the justification provided by the Contractor in the “Waiver of Payment Rates Request Form” described below.

If a waiver of payment rates is established for a network provider for specific dental services, the approved rates will be used to set the maximum price that the VA will pay the Contractor for authorized specific dental services. Approved rates shall be applied as a percentage of DVAFS.

The Contractor shall evaluate the billed charges versus the awarded maximum waiver rate; if the provider's billed charges are lower than the awarded maximum waiver rate specified in the contract, the Contractor shall pay the provider claim based on billed charges and the Contractor shall invoice VA in that amount.

The Contractor shall use the “Waiver of Payment Rates Request Form” provided in Attachment

Q, Network Adequacy Rate Waiver Form- Dental Network_02_24_26 v3.pdf. A waiver of payment rates request shall specify the localities for which the waiver is being requested, with consideration given for all localities associated with the Taxpayer Identification Number (TIN) and/or National Provider Identifier (NPI). The Contractor shall ensure that the Waiver of

Payment Rates Request Form is accurate, complete, and includes all required information related to the justification for the request, to include, but not limited to, the reasoning for submission in terms of network adequacy, the CDT codes to be used with the proposed rate, and whether the Contractor is at risk of not successfully retaining the network provider. Waivers of payment rates will only be applicable to active CDT codes, and VA will not reimburse non-active CDT codes nor modify active CDT codes submitted in a waiver request.

Waiver of payment rates requests are not guaranteed to be approved. VA will consider patient needs, market analyses, dental provider qualifications, or other factors. If the waiver request is approved and executed by the VA CO, the Contractor shall pay providers in accordance with the VA approved waiver rate schedule or the provider billed charges, whichever is less. The VA approved waiver rate will be effective for claims with a Date of Service (DOS) on or after VA’s final signature date and will remain in effect for the duration of the contract unless otherwise specified by VA. If VA denies the request, and the Contractor will be informed accordingly.

VA reserves the right to request that a waiver of payment rate be used for a specific provider or a specific specialty of a provider.

TO:

The Contractor may submit a waiver of payment rates request to VA when payment to its providers aligned to DVAFS is insufficient to maintain the network in highly rural areas and/or for scarce resources. A highly rural area is defined as a county with fewer than seven individuals residing per square mile. Scarce resources are defined as situations where the Contractor is unable to meet network adequacy standards for specific dental services due to a lack of capable providers in a specific area as determined through the justification provided by the Contractor in the “Waiver of Payment Rates Request Form” described below.

If a waiver of payment rates is established for a network provider for specific dental services, the approved rates will be used to set the maximum price that the VA will pay the Contractor for authorized specific dental services. Approved rates shall be applied as a percentage of DVAFS.

The Contractor shall evaluate the billed charges versus the awarded maximum waiver rate; if the provider's billed charges are lower than the awarded maximum waiver rate specified in the contract, the Contractor shall pay the provider claim based on billed charges and the Contractor shall invoice VA in that amount.

The Contractor shall use the “Waiver of Payment Rates Request Form” provided in Attachment

Q, Network Adequacy Rate Waiver Form- Dental Network_02_24_26 v3.pdf. A waiver of payment rates request shall specify the localities for which the waiver is being requested, with consideration given for all localities associated with the Taxpayer Identification Number (TIN) and/or National Provider Identifier (NPI). The Contractor shall ensure that the Waiver of

Payment Rates Request Form is accurate, complete, and includes all required information related to the justification for the request, to include, but not limited to, the reasoning for submission in terms of network adequacy, the CDT codes to be used with the proposed rate, and whether the Contractor is at risk of not successfully retaining the network provider. Waivers of payment rates will only be applicable to active CDT codes, and VA will not reimburse non-active CDT codes nor modify active CDT codes submitted in a waiver request.

Waiver of payment rates requests are not guaranteed to be approved. VA will consider patient needs, market analyses, dental provider qualifications, or other factors. If the waiver request is approved and executed by the VA CO, the Contractor shall pay providers in accordance with the VA approved waiver rate schedule or the provider billed charges, whichever is less. The VA approved waiver rate will be effective for claims with a Date of Service (DOS) on or after VA’s final signature date and will remain in effect for the duration of the contract unless otherwise specified by VA. If VA denies the request, and the Contractor will be informed accordingly.

VA reserves the right to request that a waiver of payment rate be used for a specific provider or a specific specialty of a provider.

CHANGE 2:

Section B.6 DENTAL CLIN STRUCTURE is hereby changed as follows:

FROM:

CLIN X002, Waivers of Payment Rates:

Waiver of Payment Rates, VA compensates the Contractor for authorized services in rural/highly rural areas and/or regions with scarce dental resources by allowing payment at a percentage above the DVAFS, not to exceed 200%. 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.

TO:

CLIN X002, Waivers of Payment Rates:

Waiver of Payment Rates, VA compensates the Contractor for authorized services in rural/highly rural areas and/or regions with scarce dental resources by allowing payment at a percentage above the DVAFS. 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.

CHANGE 3:

Section E.3 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 Price Schedule contains CLINs with varying pricing methodologies. The following CLINs and their corresponding Sub CLINs are pre-priced by VA: CLIN X001, CLIN X002 and CLIN X003. 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 Dental Network Pricing Template v2,” and provide an explanatory narrative that the Offeror provides as the basis for their proposed price.

TO:

All proposals must include a Price Volume to be considered for award. The Price Schedule contains CLINs with varying pricing methodologies. The following CLINs and their corresponding Sub CLINs are pre-priced by VA: CLIN X001 and CLIN X003. 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 Dental Pricing Template,” and provide an explanatory narrative that the Offeror provides as the basis for their proposed price.

CHANGE 4:

Section E.3 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS— COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES, Factor 4: Price, Directions for Pricing CLINs is hereby changed as follows:

FROM:

CLIN X002, Waivers of Payment Rates:

Waiver of Payment Rates: Not priced.

TO:

CLIN X002, Waivers of Payment Rates:

Waiver of Payment Rates: Offerors shall propose a maximum percentage above the Dental VA Fee Schedule (DVAFS), in percentages, for each year of the Period of Performance.

CHANGE 5:

The following language in Section D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS is hereby changed as follows:

FROM:

See attached document: ATTACHMENT 3- CCN Next Gen Dental Network Pricing Template v2

TO:

See attached document: ATTACHMENT 3- CCN Next Gen Dental Network Pricing Template

ATTACHMENTS:

- 36C10G26R0004 CCN Next Gen Dental Network Conformed Copy

- Attachment 3 - CCN Next Gen Dental Network Pricing Template

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