36C24920R0048 0004.docx
DOCX document 30 KB Posted
- Attached to
- MSO-2020-CMP-0025 Bowling Green CBOC Federal contract opportunity
- Solicitation number
- 36C24920R0048
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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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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