S06 - 36C24625R0055 0001.pdf

36C24625R0055 Amendment 0001 Q&A

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

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6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

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

9A. AMENDMENT OF SOLICITATION NUMBER

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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)

0001 09-02-2025

N/A

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton VA 23667

To all Offerors/Bidders

36C24625R0055

08-21-2025

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 09-08-2025 12:00 EDT

X 1

1. The purpose of this Amendment is to answer vendor submitted questions and to extend proposal due date.

2. As a result of this Amendment the revised solicitation closing date is now on September 08, 2025 at 12:00 EST.

3. All other terms and conditions in the solicitation document remain unchanged.

David E. Smith

Contracting Officer

1. Question: 4.5.1.7. The number of transports under normal operating conditions will typically range from 55-60 transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract. Section 4.5.17 above states 55-60 transports per weekday. This is significantly more than the projected 6,500 trips per year, which would require significantly greater numbers of trucks and personnel to properly service the contract.

Please explain this discrepancy.

Governments Answer: The initial projection mentioned in the contract states 29 trips per day for

249 workdays, plus additional trips for holidays, leading to a total that significantly exceeds the initially projected 6,500 trips per year.

Breakdown of the detailed calculation:

• Workdays: 249 workdays.

• Trips per workday: 29 trips.

First, calculate the number of trips for the workdays:

29 trips/day×249 workdays=7,221 trips29 trips/day×249 workdays=7,221 trips

Next, consider the holidays. Assume there are 9 holidays and 15 trips per holiday as noted:

15 trips/holiday×9 holidays=135 trips15 trips/holiday×9 holidays=135 trips

Now, add the workday trips and holiday trips for the total number of projected trips:

7,221 trips+135 trips=7,356 trips7,221 trips+135 trips=7,356 trips

This clearly indicates a need for a much larger operation than initially projected. With the projected

7,356 trips being considerably higher than the initial 6,500 trips mentioned, this reflects an oversight in the original estimate. The actual number of necessary transports might vary, but based on the data provided for daily transports, the need for resources including trucks and personnel will indeed be greater.

In summary, the discrepancy arises from the initial underestimation of trips and actually suggests a much higher operational requirement to meet the contract's needs. The oversight points towards the necessity for adequate planning and resource allocation to handle the projected workload. Please see updated schedule attached.

2. Question: CLIN items 0005 & 0006, 1005 & 1006, 2005 & 2006, 3005 & 3006, 4005 & 4006 are all missing estimated quantities. This prevents competitive bidding and further prevents a total bid with accurate numbers.

Governments Answer: The Clinical Line-Item Numbers (CLINs) 0005 and 0006 are standardized nationally, ensuring consistency across all relevant contracts and operations. This standardization serves several purposes:

a) Uniformity: By having these CLINs standardized, we maintain a uniform approach to categorizing and handling services across different geographical locations and facilities. This ensures that there is a common understanding and expectation regarding what these CLINs cover, regardless of the specific contract or location.

b) Consistency: Standardized CLINs help in creating consistent processes and procedures, eliminating variations that could arise if each contract had unique or tailored CLINs. This consistency is crucial for maintaining the quality of services provided and ensuring seamless operations.

c) Efficiency: National standardization allows for more efficient management and procurement processes. It simplifies the training of personnel, the deployment of resources, and the overall administration of contracts, as everyone involved is familiar with the standardized CLINs and what they entail.

d) Benchmarking and Evaluation: With standardized CLINs, it becomes easier to benchmark performance and evaluate outcomes across different contracts and facilities. Comparisons can be made more straightforwardly when the baseline standards are the same.

In summary, the national standardization of CLINs 0005 and 0006 means that these items are defined and applied uniformly across all contracts. This standardization is critical for maintaining a high level of efficiency, consistency, and quality in the services provided under these contracts. The result is a more streamlined and effective operational framework that benefits all parties involved.

3. Question: Each of the four performance years is titled 10/1/2025-9/30/2026, whereas it appears that the second year should be titled 10/1/2026-9/30/2027, etc. However, if it is intended in the alternative that the bidder present four different bids for the same year, then it should be clarified.

Governments Answer: The Period of performance for the base and all option years were incorrect and have been corrected please see updated schedule of service tables below.

4. Question: PWS references Critical Care Transport (CCT) Tiers I, II, and III; however, these levels are not defined within North Carolina OEMS guidelines. Can the Government please provide clarification on the requirements and expectations for each CCT tier under this contract?

Governments Answer:

CCT Tier I:

• Definition: Basic level of critical care transport involving stable patients who require basic life support (BLS) measures during transport.

• Requirements:

o An ambulance equipped with standard BLS medical equipment.

o Personnel trained and certified in BLS.

o Continuous monitoring of vital signs such as heart rate, blood pressure, and oxygen saturation.

CCT Tier II:

• Definition: Intermediate level of critical care transport involving patients who require advanced life support (ALS) measures and may need some advanced interventions.

o An ambulance equipped with both BLS and ALS medical equipment.

o Personnel trained and certified in ALS, including paramedics and advanced EMTs.

o Ability to administer medications, perform advanced airway management, and provide cardiac monitoring.

o Continuous and advanced monitoring of patient vital signs and management of intravenous lines.

CCT Tier III:

• Definition: Highest level of critical care transport involving patients with complex and unstable conditions who require intensive critical care measures during transport.

o An ambulance equipped with comprehensive critical care equipment, equivalent to a mobile intensive care unit (MICU).

o Personnel including critical care nurses, respiratory therapists, and physicians as needed, with training in advanced cardiac life support (ACLS) and pediatric advanced life support

(PALS), if applicable.

o Advanced monitoring and interventions, such as mechanical ventilation, invasive hemodynamic monitoring, and administration of high-risk medications.

o Access to telemedicine support for real-time consultation with specialist physicians if necessary.

These definitions serve to outline the expected capabilities and medical interventions required at each tier of Critical Care Transport. This tiered system allows for an appropriately scaled response based on the severity and complexity of the patient's condition, ensuring that all necessary medical care is provided during transport.

5. Question: PWS Section 4.5.1.7 states that under normal operating conditions the number of transports will typically range from 55–60 each weekday, and significantly less on weekends and holidays. However, the Price/Cost Schedule (CLIN 0002) establishes the maximum quantity for BLS

Non-Emergency trips at 6,500 one-way transport for the base year. Based on the daily range of 55–

60 weekday transports, annualized volumes could exceed the 6,500-trip ceiling. Can the Government please clarify whether:

a. The 6,500 trip maximum is intended to represent a true ceiling for the base year, or

b. The maximum quantity is a not-to-exceed estimate for pricing purposes, with actual trip volume authorized above this level if mission requirements dictate?

Additionally, would the Government consider adjusting the maximum to better align with the projected daily operational averages provided in Section 4.5.1.7?

Governments Answer: The typical range has been adjusted to 249 working days and 9 holidays for a total of 7,356 trips. Please refer to details outlined in the answer to question 1 and also see updated schedule attached.

6. Question: Section 4.6.3 requires ambulance personnel to provide a copy of the run sheet at the time of patient delivery for inclusion in the patient’s medical record. Our standard practice is to electronically submit the completed run sheet via fax to the designated VAMC number immediately upon trip completion. Since paper run sheets are not maintained or exchanged at the point of care, can the Government clarify whether electronic submission satisfies this requirement, or if a printed hard copy must still be provided at bedside?

Governments Answer: Electronic submission is generally acceptable for non-emergent transport.

7. Question: Section 3 on page 42 requires contractors to submit invoices via VA’s Electronic Invoice

Presentment and Payment system (e-Invoice/Tungsten) with sanitized invoices bi-weekly and encrypted invoices containing PHI sent to the COR. Section 4.5.1 requires all claims to be submitted via VetRide using the HCFA 1500, which must include patient identifiers (full name and SSN).

Section 4.9.4, however, requires invoices via VetRide and explicitly prohibits including patient information.

These three requirements appear contradictory. Can the Government please clarify:

a) Which invoicing platform is controlling for this contract — VetRide, e-Invoice/Tungsten, or both?

b) What level of patient information (if any) must be included on the HCFA 1500 or invoice submissions?

c) Whether “sanitized” invoices and “correlated encrypted” invoices (Section 3) remain applicable, or if VetRide replaces this process.

Governments Answer:1. Both, 2. No 1500 is needed for billing., 3. VetRide

8. Clarification of Cancellation Billing and CLIN Structure

Question: The Performance Work Statement, specifically PWS §4.5.2.1.1, details the reimbursement methodology for a "no-show" as being "based upon the base rate for the type of service requested

(Stretcher Transports, BLS, ALS, CCT) and the one-way mileage...accrued enroute."

Governments Answer: When a transportation provider shows up to pick up a patient and the patient isn't there or cannot be transported, the provider still gets paid.

Question: However, the Price/Cost Schedule provides only a single line item for cancellations (e.g., CLIN 0004, "Stretcher Cancellation"). This creates a conflict between the PWS reimbursement instructions and the pricing structure. To comply with the PWS and accommodate proper invoicing for cancelled trips, would the Government consider adding separate cancellation CLINs corresponding to the primary transport CLINs (0001 - Emergent ALS, 0002 - BLS, and 0003 - Non-

Emergent ALS)?

Governments Answer: When a transportation provider shows up to pick up a patient and the patient isn't there or cannot be transported, the provider still gets paid based upon the base rate for the type of service requested (Stretcher Transports, BLS, ALS, CCT) and the one-way mileage accrued enroute.

In order to simplify the conflict between the PWS & schedule line items 0005, 0006, 1005, 1006, 2005, 2006, 3005, 3006, 4005, 4006 have been added. Please see the updated schedule attached.

9. Clarification of “Included” Wait Time

Question: Regarding PWS §4.9.1, which states each transport "shall include thirty (30) minutes of wait time," could the Government please clarify if the cost for this initial 30-minute period is expected to be priced into the base rate for each trip type, or if this is simply a 30-minute non-billable period before the billable wait time (e.g., CLIN 0006) can commence? This clarification is crucial for accurately pricing the base transport rates.

1. Governments Answer: Priced into the Base Rate: The cost for this first 30 minutes should be included in the base rate for each type of transport.

o Example: If you charge $100 for a transport, this price already covers the first 30 minutes of waiting.

2. Non-Billable Period: This 30 minutes is a free period, and billing for wait time starts only after these 30 minutes have passed (like with CLIN 0006).

o Example: If the transport arrives and starts waiting, the first 30 minutes are free. After these 30 minutes, the provider can start charging for additional wait time.

This clarification helps ensure that the transport providers know how to set their prices accurately.

10. Inquiry Regarding Bariatric Transport Services:

Question: Could you please advise if there is a historical requirement for bariatric ambulance transport under the predecessor contract or an anticipated need for the forthcoming contract? If so, to ensure proper vehicle and staffing resources are accounted for, would the Government consider adding a distinct CLIN for Bariatric Transport services to the Price/Cost Schedule?

Governments Answer: Line Items 0009, 1009, 2009, 3009, 4009 have been added to capture

Bariatric Transport Services. Please see updated schedule of service attached.

11. Question: Is this due electronically via email or does the submission need to be mailed to the address listed on the Offeror Form?

Governments Answer: This is due electronically via email to David.Smith78@va.gov on the due date and time listed on page one box 8.

12. Question: E.1 Instructions for Proposal Submission, Offers shall be submitted in five sections.

Can the document be submitted in one document that is clearly labeled in five sections per the instructions?

Governments Answer: Yes, as long as each section is clearly labeled. Government prefers separate attachment but not required.

mailto:David.Smith78@va.gov

B.2 PRICE/COST SCHEDULE

** The guarantee minimum quantity number of trips, including the base year and all option years if exercised, is five (5) and the maximum quantity amount of trips, including the base year and all option years if exercised, shall not exceed 37,005 trips. **

AMBULANCE (Ground)

SCHEDULE OF SERVICES – PRICE SCHEDULE

Fayetteville NC VA Coastal Healthcare System

NOTE: A price proposal must be provided for all data elements shaded in YELLOW within this SCHEDULE OF

SERVICES – PRICE SCHEDULE for any offeror to be determined technically acceptable for consideration for an award.

BASE YEAR: 10-01-2025 to 9-30-2026

Line

Item

Description of Services

12-Month

Quantity

(Estimated

Maximum)

Unit of

Issue

Unit Price Total Price

(Maximum

NTE)

Base Rate Transport

(Using Bing Maps)

One-Way

Trip

0001 (A0427) Advanced Life

Support) Emergent Transport, Level 1 (ALS 1) Advanced

Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 25 miles)

One-way trip is equivalent to one each for the unit of issue

30 minutes

15 Maximum

(One-way

Trips)

Per Trip

(One-Way)

EA

0002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs)

7,356

Maximum who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. (base rate, to include first 25 miles) One-

Way trip is equivalent to one each for the unit of issue 30 minutes

0003 (A0426) Non-Emergent

Advance Life Support

Transport, Level 1 (ALS 1)

((base rate to include first 25 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes

30 Maximum

0004 (ZZ0021) Stretcher

Cancellation, (A0427)

Advanced Life Support)

5 Maximum

(One-Way

Trips)

0005 (ZZ0021) Stretcher

Cancellation, (A0428) Basic

Life Support, Non-Emergency

Transport

25 Maximum

(One-Way

Trips)

0006 (ZZ0021) Stretcher

Cancellation, (A0426) Non-

Emergent Advance Life

Support Transport, Level 1

(ALS 1)

5 Maximum

(One-Way

Trips)

0007 (A0425) Mileage Trip

Outside the Base Rate

Price Per

Mile

0008 (A0420) Waiting Time (more than 30 minutes shall be paid in 15-minute increments).

Each

(15-minute

Increment)

0009 Bariatric Transport Fee (a single patient with body weight equal to or more than 350 lbs.)

Each

Total Estimated Cost of Base Year: $____________________

AMBULANCE (Ground)

NOTE: A price proposal must be provided for all data elements shaded in YELLOW within this

SCHEDULE OF SERVICES – PRICE SCHEDULE for any offeror to be determined technically acceptable for consideration for an award.

OPTION YEAR 1: 10-01-2026 to 9-30-2027

Quantity

(Estimated

Maximum)

1001 (A0427) Advanced Life

Support) Emergent

Transport, Level 1 (ALS 1)

Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a

BLS ambulance. The unit is staffed by at least one paramedic who has more than

1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 25 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes

1002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. (base rate, to include first 25 miles) One-

Way trip is equivalent to one each for the unit of issue 30 minutes

1003 (A0426) Non-Emergent

Advance Life Support

Transport, Level 1 (ALS 1)

((base rate to include first 25 miles) One-way trip is

1004 (ZZ0021) Stretcher

Cancellation, (A0427)

Advanced Life Support)

5 Maximum

(One-Way

Trips)

1005 (ZZ0021) Stretcher

Cancellation, (A0428) Basic

Life Support, Non-Emergency

Transport

25 Maximum

(One-Way

Trips)

1006 (ZZ0021) Stretcher

Cancellation, (A0426) Non-

Emergent Advance Life

Support Transport, Level 1

(ALS 1)

5 Maximum

(One-Way

Trips)

1007 (A0425) Mileage Trip

1008 (A0420) Waiting Time (more than 30 minutes shall be paid in 15-minute increments).

Each

1009 Bariatric Transport Fee (a single patient with body weight equal to or more than

350 lbs.)

Total Estimated Cost of Option Year 1: $____________________

OPTION YEAR 2: 10-01-2027 to 9-30-2028

Quantity

(Estimated

Maximum)

2001 (A0427) Advanced Life

Transport, Level 1 (ALS 1)

Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a

BLS ambulance. The unit is staffed by at least one paramedic who has more than

1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 25 miles) One-way trip is equivalent to one

2002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency automated external defibrillator and basic drug administration. (base rate, to include first 25 miles) One-

Way trip is equivalent to one each for the unit of issue 30 minutes

2003 (A0426) Non-Emergent

Advance Life Support

Transport, Level 1 (ALS 1)

((base rate to include first 25 miles) One-way trip is

2004 (ZZ0021) Stretcher

Cancellation, (A0427)

Advanced Life Support)

5 Maximum

(One-Way

Trips)

2005 (ZZ0021) Stretcher

Cancellation, (A0428) Basic

Life Support, Non-Emergency

Transport

25 Maximum

(One-Way

Trips)

2006 (ZZ0021) Stretcher

Cancellation, (A0426) Non-

Emergent Advance Life

Support Transport, Level 1

(ALS 1)

5 Maximum

(One-Way

Trips)

2007 (A0425) Mileage Trip

2008 (A0420) Waiting Time (more than 30 minutes shall be paid in 15-minute increments).

Each

2009 Bariatric Transport Fee (a single patient with body

Total Estimated Cost of Option Year 2: $____________________

OPTION YEAR 3: 10-01-2028 to 9-30-2029

Quantity

(Estimated

Maximum)

3001 (A0427) Advanced Life

Transport, Level 1 (ALS 1)

Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a

BLS ambulance. The unit is staffed by at least one paramedic who has more than

1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 25 miles) One-way trip is equivalent to one

3002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have automated external defibrillator and basic drug administration. (base rate, to include first 25 miles) One-

Way trip is equivalent to one each for the unit of issue 30 minutes

3003 (A0426) Non-Emergent

Advance Life Support

Transport, Level 1 (ALS 1)

((base rate to include first 25 miles) One-way trip is

3004 (ZZ0021) Stretcher

Cancellation, (A0427)

Advanced Life Support)

5 Maximum

(One-Way

Trips)

3005 (ZZ0021) Stretcher

Cancellation, (A0428) Basic

Life Support, Non-Emergency

Transport

25 Maximum

(One-Way

Trips)

3006 (ZZ0021) Stretcher

Cancellation, (A0426) Non-

Emergent Advance Life

Support Transport, Level 1

(ALS 1)

5 Maximum

(One-Way

Trips)

3007 (A0425) Mileage Trip

3008 (A0420) Waiting Time (more than 30 minutes shall be paid in 15-minute increments).

Each

3009 Bariatric Transport Fee (a single patient with body

Total Estimated Cost of Option Year 3: $____________________

OPTION YEAR 4: 10-01-2029 to 9-30-2030

Quantity

(Estimated

Maximum)

4001 (A0427) Advanced Life

Transport, Level 1 (ALS 1)

Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a

BLS ambulance. The unit is staffed by at least one paramedic who has more than

1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 25 miles) One-way trip is equivalent to one

4002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have automated external defibrillator and basic drug administration. (base rate, to include first 25 miles) One-

Way trip is equivalent to one each for the unit of issue 30 minutes

4003 (A0426) Non-Emergent

Advance Life Support

Transport, Level 1 (ALS 1)

((base rate to include first 25 miles) One-way trip is

4004 (ZZ0021) Stretcher

Cancellation, (A0427)

Advanced Life Support)

5 Maximum

(One-Way

Trips)

4005 (ZZ0021) Stretcher

Cancellation, (A0428) Basic

Life Support, Non-Emergency

Transport

25 Maximum

(One-Way

Trips)

4006 (ZZ0021) Stretcher

Cancellation, (A0426) Non-

Emergent Advance Life

Support Transport, Level 1

(ALS 1)

5 Maximum

(One-Way

Trips)

4007 (A0425) Mileage Trip

$____ Price

Per Mile

4008 (A0420) Waiting Time (more than 30 minutes shall be paid in 15-minute increments).

Each (15-minute

4009 Bariatric Transport Fee (a single patient with body

Total Estimated Cost of Option Year 4: $____________________

Total Estimated Cost of Base and All Option Years: $____________________