36C24920R0048 0004.docx

DOCX document 30 KB Posted

Attached to
MSO-2020-CMP-0025 Bowling Green CBOC Federal contract opportunity
Solicitation number
36C24920R0048
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9

About this file

This document is an amendment to a solicitation for medical services at the Bowling Green Community Based Outpatient Clinic. The amendment adjusts the estimated quantities for primary care and mental health services to be provided on a capitated, per-member per-month basis over a base year and six option years. The estimated quantities increase slightly each option year. Offerors must acknowledge receipt of the amendment by July 21, 2020 for proposal number 36C24920R0048 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9. All other terms and conditions of the solicitation remain unchanged.

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Other files for this federal contract opportunity

Other files attached to MSO-2020-CMP-0025 Bowling Green CBOC, newest first.
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S06 - 36C24920R0048 0003 Extending Due Date.docx DOCX document
36C24920R0048 0002.docx DOCX document
36C24920R0048 0001.docx DOCX document
Infrastructure Standard for Telecommunications Spaces.pdf PDF
Attachment 10 - TVHS Memorandums - 626.pdf PDF
Attachment 6 - Deliverables-Reports Table - updating.pdf PDF
Attachment 11 - SB Goals FY 20.pdf PDF
IB 10-441 Enrollment Priority Group.pdf PDF
Attachment 17 - Past Performance Questionnaire.pdf PDF
Attachment 1 - Quality Assurance Surveillance Plan.docx DOCX document
Attachment 7a - VSC - Security_CompletePacket.pdf PDF
Attachment 8b - OIT Design Guide templates.pdf PDF
PACT Space Module Design Guide.pdf PDF
Attachment 9 - WDOL 2015-4677 Rev 10 07-16-2019.pdf PDF
Attachment 18 - VISN-09 PBM CBOB Formulary.xlsx XLSX spreadsheet
Attachment 2 - Contractor Organizational Conflict of Interest.pdf PDF
Attachment 4 - Contractor Rules of Behavior 2019.pdf PDF
Attachment 12 - TVHS Memoradum 626-18-11-30 Anticoagalation management.pdf PDF
Attachment 7d - VSC - Self Cert.pdf PDF
36C24920R0048.docx DOCX document
Attachment 16 - Management of the Impaired Practioner.pdf PDF
Attachment 7b - VSC - 306.pdf PDF
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Attachment 8 - CFM- CBOC Prototype Design.pdf PDF
Attachment 7 - VSC Security Package Flowchart.pdf PDF
Attachment 3 - Contractor Certification of Immigration and Nationality Act of 1952 - As amended.pdf PDF
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Text version

Replaced with this Price Schedule

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) None Department of Veterans Affairs Network Contracting Office 9 (90C)

NCO 9

1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129 90C Network Contracting Office 9 Department of Veterans Affairs Network Contracting Office (90C) 1639 Medical Center Parkway Suite 400 Murfreesboro TN 37129 To all Offerors/Bidders

36C24920R0048

X X

The purpose of this amendment is to adjust the Bowling Green CBOC CLIN structure estimated quantities starting with the Base year and continuing through Option year 6.

The proposal is due July 21, 2020.

All other terms, conditions remain the same and in effect.

End of amendment.

Darryl Scherer Contracting Officer

CONTINUATION PAGE

BASE PERIOD – April; 1, 2021 through March 31, 2022

CLIN No.
Services
Unit
Estimated Quantity per month
Price Per Unit
Total Estimated Cost
0001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,075
0002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
700

Total for Base Period $________________________ OPTION PERIOD 1 – April; 1, 2022 through March 31, 2023

CLIN No.
Services
Unit
Estimated Quantity
Price Per Unit
Total Estimated Cost
1001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,100
1002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
750

Total for Option Period 1 $________________________

OPTION PERIOD 2 – April; 1, 2023 through March 31, 2024
CLIN No.
Services
Unit
Estimated Quantity
Price Per Unit
Total Estimated Cost
2001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,125
2002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
800

Total for Option Period 2 $________________________ OPTION PERIOD 3 – April; 1, 2024 through March 31, 2025

CLIN No.
Services
Unit
Estimated Quantity
Price Per Unit
Total Estimated Cost
3001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,150
3002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
825

Total for Option Period 3 $________________________ OPTION PERIOD 4 – April; 1, 2025 through March 31, 2026

CLIN No. 5
Services
Unit
Estimated Quantity
Price Per Unit
Total Estimated Cost
5001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,175
5002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
850

Total for Option Period 4 $________________________ OPTION PERIOD 5 – April; 1, 2026 through March 31, 2027

CLIN No.
Services
Unit
Estimated Quantity
Price Per Unit
Total Estimated Cost
4001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,200
4002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
875

Total for Option Period 5 $________________________ OPTION PERIOD 6 – April; 1, 2027 through March 31, 2028

CLIN No.
Services
Unit
Estimated Quantity
Price Per Unit
Total Estimated Cost
4001
Primary Care Services at capitation rates per member per month (PMPM)
PMPM
4,225
4002
Mental Health Services at capitation rates per member per month (PMPM)
PMPM
900

Total for Option Period 6 $________________________

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