36C25618R0078-00002004.docx

(Standard Form 1449, continuation of Block 20) Under the authority of Public Law 104-262, 38 U.S.C 8153 the contractor agrees to provide Primary Care and Mental Health services in accordance with Section B6 Performance Work Statement (PWS) and the terms and conditions stated herein. Contractor to furnish services to eligible Veteran beneficiaries enrolled with the Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA and provide these services in Houma, LA, at the prices specified below. A contract resulting from this solicitation will be awarded for a five-year term.

The quantities listed below are estimates only and are not to be considered a minimum or maximum.

The Government will order the below specified minimum contract value of services and may order up to and including the below specified maximum contract value of services through task orders under this basis Indefinite Delivery Indefinite Quantity (IDIQ) contract during the duration of the contract. The maximum amount under this contract is not guaranteed. The task orders shall be issued by each period of performance and will cover the funding/payments for services that are based on a monthly capitated rate, as further explained within this solicitation.

The total guaranteed minimum contract amount is $300,000.00 for the life of the contract and the maximum contract amount shall not exceed $25,000,000.00.

Ordering Procedures: VA has the sole authority to assign Veterans treated by the contractor into the PCMM software program used to track primary care clinic veteran rosters. Specific billable processes for issuing task orders under the resultant contract includes: determining veteran eligibility, enrollment eligibility, and patient vesting is further defined in section 6.2. Please review in detail section 6.2.1.1.4 to ensure compliance for issuance of subsequent task orders and payment processing.

Initial Period of Performance (POP): Anticipated 10/1/2018 to 09/30/2019 (unless changed due to delay then estimated total amount will be adjusted accordingly- unit price and monthly amounts will remain unchanged)

CLIN

Description

$ Total amount (x12 months)

Primary Care Services as Described in the Performance Work Statement

PMPM

PMPM

Estimated Total for Initial POP:

POP Year 1: 10/1/2019 to 09/30/2020

CLIN

Description

$ Total amount (x12 months)

Primary Care Services as Described in the Performance Work Statement

(Per Capitated rates)

PMPM

PMPM

Estimated Total for POP Year 1:

POP Year 2: 10/1/2020 to 09/30/2021

CLIN

$ Total amount (x12 months)

Primary Care Services as Described in the Performance Work Statement

(Per Capitated rates)

PMPM

PMPM

Estimated Total for POP Year 2:

POP Year 3: 10/1/2021 to 09/30/2022

$ Total Amount (x12 months)

Primary Care Services as Described in the Performance Work Statement

(Per Capitated rates)

PMPM

PMPM

Estimated Total for POP Year 3:

POP Year 4 10/1/2022 to 09/30/2023

$ Total amount (x12 months)

Primary Care Services as Described in the Performance Work Statement

(Per Capitated rates)

PMPM

(Per Capitated rates)

PMPM

Estimated Total for POP Year 4:

GRAND ESTIMATED TOTAL FOR FIVE (5) YEAR $ ___________________

NOTE: The specified rates for use if FAR Clause 52.217-8 is exercised by the Government will be those rates in effect under the contract/task order preceding this option. (Refer to Section E FAR 52.212-2 in regards to evaluation of this option)