Attachment 1 - Home Oxygen Price Worksheet 20200127.xlsx
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- VISN 17 HOME OXYGEN SERVICE CONTRACT Federal contract opportunity
- Solicitation number
- 36C25719R0027
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STX
VISN 17 HOME OXYGEN SERVICE CONTRACT
WORKSHEET
| South Texas Veterans Health Care System (671) | |||||
| The guaranteed minimum award amount for this contract is $50,000.00. The maximum aggregate value of the orders that can be placed under this contract is $55,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount. | |||||
| Line Item Number | Description | QTY | Unit of Measure | Unit Price | Amount |
| 0001 | New Set-Up – VA Owned Oxygen Concentrator 5 LPM flow capability to include VA Owned conserving device if prescribed. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | $0.00 | |||
| 0001AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0001AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0001AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0001AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0001AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0002 | New Set-Up –VA Owned Oxygen Concentrator 10 LPM flow capability to include VA Owned conserving device if prescribed. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | $0.00 | |||
| 0002AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0002AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0002AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0002AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0002AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0003 | New Set-Up –VA Owned Oxygen TransFill device (includes but not limited to self-fill station, regulator, concentrator, tanks, cart and bag) to include VA Owned conserving device if prescribed. New Set-Up will include a monthly visit for the first 3 months to ensure patient is compliant with equipment and equipment is working properly. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | $0.00 | |||
| 0003AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0003AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0003AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0003AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0003AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0004 | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask with 2 firesafe cannula valves (or equivalent); and humidifier when specified). Concentrator shall have a flow rate capacity up to 5LPM. | NSP | $0.00 | ||
| 0004AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0004AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0004AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0004AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0004AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0005 | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask with 2 firesafe cannula valves (or equivalent); and humidifier when specified). Concentrator shall have a flow rate capacity up to 10LPM. | 0 | $0.00 | ||
| 0005AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0005AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0005AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0005AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0005AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0006 | Rental portable concentrator set up with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). | 0 | $0.00 | ||
| 0006AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0006AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0006AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0006AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0006AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0007 | Rental portable concentrator system (compressed gas source) shall provide a minimum of 92% (+/-3%) oxygen concentration at all flow settings. Weight <20 lbs. w Power. FAA approved for flight. | 0 | $0.00 | ||
| 0007AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0007AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0007AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0007AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0007AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0008 | Set up of VA owned portable concentrator for primary use. This CLIN will also be used in the provision of VA owned portable concentrators for temporary use (i.e., travel). | 0 | $0.00 | ||
| 0008AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0008AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0008AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0008AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0008AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0009 | Delivery or relocation of equipment due to change in beneficiary’s residence, change in prescription or equipment and/or pick up of equipment from expired or discontinued patients. | 0 | $0.00 | ||
| 0009AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0009AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0009AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0009AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0009AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0010 | Quarterly Maintenance – VA Owned TransFill units (with concentrators), will also include all non and sleep related CPAP/BiPAP/NIV, sleep only and cluster headache patients. The Contractors’ routine maintenance will include, but is not limited to: assuring unit is functioning correctly, validate O2 purity levels, validate patient is utilizing equipment correctly, back-up system, filters, number of hours used, flow rates, and alarm/shut down function. All peripherals, as described below, will be provided during this visit to last the patient a full three months. Information will be documented on the invoice and annotated on the individual concentrator internal log. Veteran or care provider must sign invoice indicating that the maintenance inspection was completed and he/she had an understanding of services rendered. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | 0 | $0.00 | ||
| 0010AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0010AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0010AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0010AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0010AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0011 | Routine Maintenance – VA Owned Oxygen Concentrators (exception is for the trans fill concentrators which are quarterly). Provided every 30-45 days, the Contractor’s routine maintenance will include, but is not limited to: assuring unit is functioning correctly, validate O2 purity levels, validate patient is utilizing equipment correctly, inspect back-up system, replace filters when needed, document number of hours used, flow rates, and alarm/shut down function. All peripherals, as described below, will be provided during this visit to last the veteran patient a full month. Information will be documented on the invoice and annotated on the individual concentrator internal log. Veteran or care provider must sign invoice indicating that the maintenance inspection was completed and he/she had an understanding of services rendered. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, humidifiers, two FireSafe/FailSafe devices for each device, to include VA owned and contractor concentrators. Contractor will provide one bunn compressor when prescribed. | 0 | $0.00 | ||
| 0011AA | Price: Base Year | 1.00 | LB | $0.00 | |
| 0011AB | Price: Option Year 1 | 1.00 | LB | $0.00 | |
| 0011AC | Price: Option Year 2 | 1.00 | LB | $0.00 | |
| 0011AD | Price: Option Year 3 | 1.00 | LB | $0.00 | |
| 0011AE | Price: Option Year 4 | 1.00 | LB | $0.00 | |
| 0012 | Rental self-filling oxygen concentrator: single piece concentrator with capability to refill portable oxygen cylinder. | 0 | $0.00 | ||
| 0012AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0012AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0012AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0012AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0012AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0013 | Contractor supplied cylinder with contents, size H, J, K or M60 set-up consisting of regulator, flow meter, safety stand, humidifier, and disposable supplies. This is for primary and/or emergency means of oxygen delivery (cluster headaches, etc.). Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise (i.e., concentrator for cluster headaches) or when medically indicated for the need of more. | 0 | $0.00 | ||
| 0013AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 001AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0013AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0013AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0013AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0014 | Contractor supplied cylinder with contents, size H, J, K or M60 replacement consisting of regulator, flow meter, safety stand, humidifier, and disposable supplies. This is for primary and/or emergency means of oxygen delivery (cluster headaches, etc.). Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise or medically indicated for the need of more. | 0 | $0.00 | ||
| 0014AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0014AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0014AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0014AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0014AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0015 | Contractor supplied cylinders consist of “E”, “D”, or “B” (M6) size aluminum cylinder with contents (number of cylinders will be based on clinical prescription). Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise or medically indicated for the need of more. Contractor will provide one bunn compressor when prescribed. | 0 | $0.00 | ||
| 0015AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0015AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0015AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0015AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0015AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0016 | Contractor supplied “E, D and/or BM6” cylinders (aluminum-each) as requested by the COR, for participating Medical Centers for availability to issue home oxygen beneficiaries who deplete their portable units during appointments or need oxygen to travel home after hospital discharge. Approx. 40/MO. Note: issued tanks will be credited to the Veteran who tank was issued to. Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise or medically indicated for the need of more. | 0 | $0.00 | ||
| 0016AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0016AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0016AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0016AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0016AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0017 | Contractor supplied rental liquid oxygen system (90-110 lbs.) with stationary reservoir per beneficiary E0439 including all necessary peripherals. | 0 | $0.00 | ||
| 0017AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0017AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0017AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0017AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0017AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0018 | Contractor supplied brand name or equal rental portable liquid oxygen system (continuous, Helios, Marathon) that is filled from the reservoir, per beneficiary. | 0 | $0.00 | ||
| 0018AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0018AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0018AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0018AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0018AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0019 | Rental portable liquid oxygen system with conserving device and consists of large reservoir and portable unit that is filled from the reservoir. | 0 | $0.00 | ||
| 0019AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0019AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0019AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0019AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0019AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0020 | Contractor supplied liquid oxygen per pound (stationary oxygen contents, liquid, 1 month’s supply = 1 unit). | 0 | $0.00 | ||
| 0020AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0020AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0020AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0020AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0020AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0021 | Static Testing of all VA owned tanks. Static testing will be conducted per manufacturer’s recommendations. | 0 | $0.00 | ||
| 0021AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0021AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0021AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0021AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0021AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0022 | Rental demand pulse conserver device (not included with any above set-up rate) not less than a 5:1 ratio or 60ML/pulse. | 0 | $0.00 | ||
| 0022AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0022AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0022AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0022AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0022AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0023 | Ventilator Initial Set Up – includes training to veteran and caregiver(s) provided by Contractor both in the hospital at discharge and/or home setting whichever is applicable, delivery of VA owned ventilator, back up ventilator, stand, double battery pack and charger and pull cart if applicable along with contractor ventilator supplies to the hospital and/or home setting based upon the clinical prescription. Written instructions will be left for patient and/or caregivers to refer back to. Includes a complete environmental and equipment home assessment using equipment specified in the patient’s plan of care, home environment, home safety electrical supply check, smoke detector verification, validate settings, ensure back-up ventilator is accessible and fully charged, provide preventative maintenance if applicable (send equipment back to manufacturer or authorized repair source), ensure back-up ventilator is available at all times. Contractor will notify the local power company of the patient being home with a life support system. This will be verified on the set-up documentation as to time/date, vendor and contact name and number of the one notified. Initial set up includes a 24-hour, 72-hour and 1 week documented in-home follow up with the patient and /or caregiver. Compliance/equipment/supply issues identified during these visits must be reported to VA staff within 24 hours. | 0 | $0.00 | ||
| 0023AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0023AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0023AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0023AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0023AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0024 | VA owned ventilator Monthly Monitoring by a Licensed Respiratory Therapist – includes: home assessment, delivery of needed supplies, validate settings, ensure back-up ventilator is accessible and fully charged, provide preventative maintenance if applicable to both primary and back-up ventilator; routine inspection performed per manufacturer’s specifications, send equipment back to manufacturer or authorized repair source if needed, ensure VA owned back-up ventilator is available at all times, provide additional training as needed to the veteran and their caregivers. Written instructions will be left for caregivers to refer back to. All compliance/equipment/supply issues identified during these visits must be reported to designated VA staff within 24 hours. | 0 | $0.00 | ||
| 0024AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0024AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0024AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0024AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0024AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0025 | Contractor Furnished Ventilator Supplies, not limited to the following: | 0 | $0.00 | ||
| 0025AA | Price: Base Year | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0026 | Emergency service and/or set up for Ventilator Service (includes exchanging defective VA owned ventilators). This is not for general use but specific emergencies for down equipment and back up failure. This includes weekends and established holidays. This service will only be authorized/approved by the Clinical Home Oxygen coordinator or COR. | 0 | $0.00 | ||
| 0026AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0026AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0026AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0026AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0026AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0027 | Emergency service and/or set up for Home Oxygen Services - will only be authorized/approved by the Clinical Home Oxygen coordinator or COR. This includes weekends and established holidays. | 0 | $0.00 | ||
| 0027AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0027AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0027AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0027AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0027AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0028 | Smoke detector with carbon monoxide feature. Contractor furnished but paid for by VA. | 0 | $0.00 | ||
| 0028AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0028AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0028AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0028AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0028AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0029 | Non-Sleep related CPAP /BiPAP/NIV initial set up service. | 0 | $0.00 | ||
| 0029AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0029AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0029AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0029AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0029AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0030 | Suction Machine initial service – VA supplied when requested by VA. | 0 | $0.00 | ||
| 0030AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0030AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0030AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0030AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0030AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0031 | Follow up for any Equipment Concerns or Additional Ventilator Training and Education to Veteran or Caregiver – Contractor will make additional visits (additional Certified Respiratory Therapist (CRT) Registered Respiratory Therapist (RRT) or Registered Nurse (RN) visit) to the hospital and/or home if a lack of competence is identified so retraining can be provided. Follow up will include home assessment, delivery of needed VA equipment and/or Contractor supplies, validate settings, ensure VA owned back-up ventilator is accessible and fully charged, provide preventative maintenance if applicable (send equipment back to manufacturer or authorized repair source), ensure VA owned back-up ventilator is available at all times, provide any additional training as needed to the veteran and their caregivers. Written instructions will be left for caregivers to refer back to. Compliance/equipment/supply issues identified during these visits must be reported to VA staff within 24 hours. | 0 | $0.00 | ||
| 0031AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0031AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0031AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0031AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0031AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0032 | Follow up for any VA and/or Contractor Equipment Concerns or Additional Home Oxygen Training and Education to Veteran or Caregiver – Contractor will make additional visits (additional Certified Respiratory Therapist (CRT) Registered Respiratory Therapist (RRT) or Registered Nurse (RN) visit) to the hospital and/or home if a lack of competence is identified so retraining can be provided. Follow up will include home assessment, delivery of needed supplies, validate settings, ensure back-up equipment is accessible and full, provide preventative maintenance if applicable (send equipment back to manufacturer or authorized repair source), ensure back-up equipment is available at all times, provide any additional training as needed to the veteran and their caregivers. Written instructions will be left for caregivers to refer back to. Compliance/equipment/supply issues identified during these visits must be reported to VA staff within 24 hours. | 0 | $0.00 | ||
| 0032AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0032AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0032AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0032AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0032AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0033 | Transition Phase-In/Phase-Out Services IAW 52.237-3 Continuity of Services: Costs associated with transitioning from incumbent contractor to new contractor. While not an all inclusive list, items to consider are equipment transfers, inventory transfers, recruitment, background/badging, training, etc. | $0.00 | |||
| 0033AA | Phase-In Services: Not to exceed 90 calendar days | 1.00 | JB | $0.00 | |
| 0033AB | Phase-Out Services: Not to exceed 90 calendar days | 1.00 | JB | $0.00 | |
| TOTAL FOR STX | $0.00 |
Attachment 1 36C25719R0027 January 27, 2020
CTX
VISN 17 HOME OXYGEN SERVICE CONTRACT
WORKSHEET
| Central Texas Veterans Health Care System (674) | |||||
| The guaranteed minimum award amount for this contract is $50,000.00. The maximum aggregate value of the orders that can be placed under this contract is $55,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount. | |||||
| Line Item Number | Description | QTY | Unit of Measure | Unit Price | Amount |
| 0001 | New Set-Up – VA Owned Oxygen Concentrator 5 LPM flow capability to include VA Owned conserving device if prescribed. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | $0.00 | |||
| 0001AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0001AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0001AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0001AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0001AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0002 | New Set-Up –VA Owned Oxygen Concentrator 10 LPM flow capability to include VA Owned conserving device if prescribed. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | $0.00 | |||
| 0002AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0002AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0002AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0002AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0002AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0003 | New Set-Up –VA Owned Oxygen TransFill device (includes but not limited to self-fill station, regulator, concentrator, tanks, cart and bag) to include VA Owned conserving device if prescribed. New Set-Up will include a monthly visit for the first 3 months to ensure patient is compliant with equipment and equipment is working properly. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | $0.00 | |||
| 0003AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0003AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0003AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0003AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0003AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0004 | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask with 2 firesafe cannula valves (or equivalent); and humidifier when specified). Concentrator shall have a flow rate capacity up to 5LPM. | NSP | $0.00 | ||
| 0004AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0004AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0004AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0004AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0004AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0005 | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask with 2 firesafe cannula valves (or equivalent); and humidifier when specified). Concentrator shall have a flow rate capacity up to 10LPM. | 0 | $0.00 | ||
| 0005AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0005AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0005AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0005AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0005AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0006 | Rental portable concentrator set up with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). | 0 | $0.00 | ||
| 0006AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0006AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0006AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0006AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0006AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0007 | Rental portable concentrator system (compressed gas source) shall provide a minimum of 92% (+/-3%) oxygen concentration at all flow settings. Weight <20 lbs. w Power. FAA approved for flight. | 0 | $0.00 | ||
| 0007AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0007AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0007AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0007AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0007AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0008 | Set up of VA owned portable concentrator for primary use. This CLIN will also be used in the provision of VA owned portable concentrators for temporary use (i.e., travel). | 0 | $0.00 | ||
| 0008AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0008AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0008AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0008AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0008AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0009 | Delivery or relocation of equipment due to change in beneficiary’s residence, change in prescription or equipment and/or pick up of equipment from expired or discontinued patients. | 0 | $0.00 | ||
| 0009AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0009AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0009AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0009AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0009AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0010 | Quarterly Maintenance – VA Owned TransFill units (with concentrators), will also include all non and sleep related CPAP/BiPAP/NIV, sleep only and cluster headache patients. The Contractors’ routine maintenance will include, but is not limited to: assuring unit is functioning correctly, validate O2 purity levels, validate patient is utilizing equipment correctly, back-up system, filters, number of hours used, flow rates, and alarm/shut down function. All peripherals, as described below, will be provided during this visit to last the patient a full three months. Information will be documented on the invoice and annotated on the individual concentrator internal log. Veteran or care provider must sign invoice indicating that the maintenance inspection was completed and he/she had an understanding of services rendered. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, filters, humidifiers and two FireSafe/FailSafe devices for each delivery device. Contractor will provide one bunn compressor when prescribed. | 0 | $0.00 | ||
| 0010AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0010AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0010AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0010AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0010AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0011 | Routine Maintenance – VA Owned Oxygen Concentrators (exception is for the trans fill concentrators which are quarterly). Provided every 30-45 days, the Contractor’s routine maintenance will include, but is not limited to: assuring unit is functioning correctly, validate O2 purity levels, validate patient is utilizing equipment correctly, inspect back-up system, replace filters when needed, document number of hours used, flow rates, and alarm/shut down function. All peripherals, as described below, will be provided during this visit to last the veteran patient a full month. Information will be documented on the invoice and annotated on the individual concentrator internal log. Veteran or care provider must sign invoice indicating that the maintenance inspection was completed and he/she had an understanding of services rendered. Contractor provided peripheral supplies include but not limited to masks, nasal cannulas, tubing, humidifiers, two FireSafe/FailSafe devices for each device, to include VA owned and contractor concentrators. Contractor will provide one bunn compressor when prescribed. | 0 | $0.00 | ||
| 0011AA | Price: Base Year | 1.00 | LB | $0.00 | |
| 0011AB | Price: Option Year 1 | 1.00 | LB | $0.00 | |
| 0011AC | Price: Option Year 2 | 1.00 | LB | $0.00 | |
| 0011AD | Price: Option Year 3 | 1.00 | LB | $0.00 | |
| 0011AE | Price: Option Year 4 | 1.00 | LB | $0.00 | |
| 0012 | Rental self-filling oxygen concentrator: single piece concentrator with capability to refill portable oxygen cylinder. | 0 | $0.00 | ||
| 0012AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0012AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0012AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0012AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0012AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0013 | Contractor supplied cylinder with contents, size H, J, K or M60 set-up consisting of regulator, flow meter, safety stand, humidifier, and disposable supplies. This is for primary and/or emergency means of oxygen delivery (cluster headaches, etc.). Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise (i.e., concentrator for cluster headaches) or when medically indicated for the need of more. | 0 | $0.00 | ||
| 0013AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 001AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0013AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0013AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0013AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0014 | Contractor supplied cylinder with contents, size H, J, K or M60 replacement consisting of regulator, flow meter, safety stand, humidifier, and disposable supplies. This is for primary and/or emergency means of oxygen delivery (cluster headaches, etc.). Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise or medically indicated for the need of more. | 0 | $0.00 | ||
| 0014AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0014AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0014AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0014AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0014AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0015 | Contractor supplied cylinders consist of “E”, “D”, or “B” (M6) size aluminum cylinder with contents (number of cylinders will be based on clinical prescription). Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise or medically indicated for the need of more. Contractor will provide one bunn compressor when prescribed. | 0 | $0.00 | ||
| 0015AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0015AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0015AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0015AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0015AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0016 | Contractor supplied “E, D and/or BM6” cylinders (aluminum-each) as requested by the COR, for participating Medical Centers for availability to issue home oxygen beneficiaries who deplete their portable units during appointments or need oxygen to travel home after hospital discharge. Approx. 40/MO. Note: issued tanks will be credited to the Veteran who tank was issued to. Only 1 contractor owned regulator/flow meter and storage rack if applicable will be provided per patient unless prescribed otherwise or medically indicated for the need of more. | 0 | $0.00 | ||
| 0016AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0016AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0016AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0016AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0016AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0017 | Contractor supplied rental liquid oxygen system (90-110 lbs.) with stationary reservoir per beneficiary E0439 including all necessary peripherals. | 0 | $0.00 | ||
| 0017AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0017AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0017AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0017AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0017AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0018 | Contractor supplied brand name or equal rental portable liquid oxygen system (continuous, Helios, Marathon) that is filled from the reservoir, per beneficiary. | 0 | $0.00 | ||
| 0018AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0018AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0018AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0018AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0018AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0019 | Rental portable liquid oxygen system with conserving device and consists of large reservoir and portable unit that is filled from the reservoir. | 0 | $0.00 | ||
| 0019AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0019AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0019AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0019AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0019AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0020 | Contractor supplied liquid oxygen per pound (stationary oxygen contents, liquid, 1 month’s supply = 1 unit). | 0 | $0.00 | ||
| 0020AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0020AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0020AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0020AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0020AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0021 | Static Testing of all VA owned tanks. Static testing will be conducted per manufacturer’s recommendations. | 0 | $0.00 | ||
| 0021AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0021AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0021AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0021AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0021AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0022 | Rental demand pulse conserver device (not included with any above set-up rate) not less than a 5:1 ratio or 60ML/pulse. | 0 | $0.00 | ||
| 0022AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0022AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0022AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0022AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0022AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0023 | Ventilator Initial Set Up – includes training to veteran and caregiver(s) provided by Contractor both in the hospital at discharge and/or home setting whichever is applicable, delivery of VA owned ventilator, back up ventilator, stand, double battery pack and charger and pull cart if applicable along with contractor ventilator supplies to the hospital and/or home setting based upon the clinical prescription. Written instructions will be left for patient and/or caregivers to refer back to. Includes a complete environmental and equipment home assessment using equipment specified in the patient’s plan of care, home environment, home safety electrical supply check, smoke detector verification, validate settings, ensure back-up ventilator is accessible and fully charged, provide preventative maintenance if applicable (send equipment back to manufacturer or authorized repair source), ensure back-up ventilator is available at all times. Contractor will notify the local power company of the patient being home with a life support system. This will be verified on the set-up documentation as to time/date, vendor and contact name and number of the one notified. Initial set up includes a 24-hour, 72-hour and 1 week documented in-home follow up with the patient and /or caregiver. Compliance/equipment/supply issues identified during these visits must be reported to VA staff within 24 hours. | 0 | $0.00 | ||
| 0023AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0023AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0023AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0023AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0023AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0024 | VA owned ventilator Monthly Monitoring by a Licensed Respiratory Therapist – includes: home assessment, delivery of needed supplies, validate settings, ensure back-up ventilator is accessible and fully charged, provide preventative maintenance if applicable to both primary and back-up ventilator; routine inspection performed per manufacturer’s specifications, send equipment back to manufacturer or authorized repair source if needed, ensure VA owned back-up ventilator is available at all times, provide additional training as needed to the veteran and their caregivers. Written instructions will be left for caregivers to refer back to. All compliance/equipment/supply issues identified during these visits must be reported to designated VA staff within 24 hours. | 0 | $0.00 | ||
| 0024AA | Price: Base Year | 1.00 | EA | $0.00 | |
| 0024AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| 0024AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| 0024AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| 0024AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| 0025 | Contractor Furnished Ventilator Supplies, not limited to the following: | 0 | $0.00 | ||
| 0025AA | Price: Base Year | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AB | Price: Option Year 1 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AC | Price: Option Year 2 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AD | Price: Option Year 3 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 | ||
| ab. Required supplies not listed – Contractor must have approval from the prescribing clinician before providing alternate supplies to the ventilator patient. | 1.00 | EA | $0.00 | ||
| 0025AE | Price: Option Year 4 | 1.00 | EA | $0.00 | |
| a. Ventilator Circuits. | 1.00 | EA | $0.00 | ||
| b. Ventilator Circuits w/o peep. | 1.00 | EA | $0.00 | ||
| c. Dual Metered Dose Inhaler. | 1.00 | EA | $0.00 | ||
| d. Hygroscopic Condenser Humidifier. | 1.00 | EA | $0.00 | ||
| e. 7’ Oxygen tubing. | 1.00 | EA | $0.00 | ||
| f. Oxygen Enrichment Adaptor. | 1.00 | EA | $0.00 | ||
| g. Pressure Valve for O2 Bleed in. | 1.00 | EA | $0.00 | ||
| h. Resuscitator, Manual Adult Bag. | 1.00 | EA | $0.00 | ||
| i. Ballard Suction Catheters. | 1.00 | EA | $0.00 | ||
| j. Sprint Battery Manager. | 1.00 | EA | $0.00 | ||
| k. Spring Battery Pack. | 1.00 | EA | $0.00 | ||
| l. Airlife Disposable Bacteria Filters. | 1.00 | EA | $0.00 | ||
| m. Airlife, Mask Intubation Adaptor. | 1.00 | EA | $0.00 | ||
| n. Airlife, Cuff Connector 22 mm. | 1.00 | EA | $0.00 | ||
| o. Trach Ring. | 1.00 | EA | $0.00 | ||
| p. Airlife Valve Tee Adaptor. | 1.00 | EA | $0.00 | ||
| q. Suction Catheter 14 Fr. | 1.00 | EA | $0.00 | ||
| r. Yankauer, Bulb Tip. | 1.00 | EA | $0.00 | ||
| s. Suction Canister 800 CC. | 1.00 | EA | $0.00 | ||
| t. Suction Filter. | 1.00 | EA | $0.00 | ||
| u. Suction Connecting Tubing 6”. | 1.00 | EA | $0.00 | ||
| v. Airlife, Omniflex Adaptors/Cuffs. | 1.00 | EA | $0.00 | ||
| w. Dale Trach Holder/Ties. | 1.00 | EA | $0.00 | ||
| x. Shiley Inner Trach 8DIC. | 1.00 | EA | $0.00 | ||
| y. Saline Vials 5 ml. | 1.00 | EA | $0.00 | ||
| z. Pulse Oximetry Unit & Probes for non-stable patients. | 1.00 | EA | $0.00 | ||
| aa. Nasal Cannula – Comfort Soft Plus by Westmed | 1.00 | EA | $0.00 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .