Item Schedule- PIHCS.xlsx

XLSX spreadsheet 23 KB Posted May 19, 2023

Attached to: VA Home Oxygen Services for Pacific Islands
Solicitation number: 36C26123Q0231
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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Other files

File	Type	Posted
36C26123Q0231 VAPIHCS.pdf	PDF	May 19, 2023
RFQ 36C26123Q0231.pdf	PDF	May 8, 2023
WAGE DETERMINATIONS - Pacific.pdf	PDF	May 8, 2023
QASP - Home Oxygen.pdf	PDF	May 8, 2023
Home Oxygen VAPIHCS Item Schedule v2 SAM.xlsx	XLSX spreadsheet	May 8, 2023

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PIHCS

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
1	Rental of Contractor	E1392	Concentrator, Colored Tubing, Adapter	Base Period: June 1, 2023-August 31, 2023	480	$ - 0	Month	$ - 0
	Owned Portable Concentrator		Humidifier (when required), Cannulas or	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	480	$ - 0	Month	$ - 0
	System		Masks and other required supplies and
			equipment, including back up systems.
	Priced Per Month		Perform Equipment Maintenance in
			accordance with manufacturer standards.
			At a minimum of once every 90 calendar
			days, visit and assess patient to assure
			equipment complinace, change filters and
			provide disposable supplies.

1a	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: June 1, 2023-August 31, 2023	775	$ - 0	Month	$ - 0
	Owned Low Decibel		maintenance and 90 calendar day visit as	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	775	$ - 0	Month	$ - 0
	Concentrator System		described in Item 1

Priced Per Month

1b	Rental of Contractor	K0738	To include all supplies, equipment	Base Period: June 1, 2023-August 31, 2023	35	$ - 0	Month	$ - 0
	Owned Home Fill		maintenance and 90 calendar day visit as	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	35	$ - 0	Month	$ - 0
	Oxygen System		described in Item 1

Priced Per Month

1c	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: June 1, 2023-August 31, 2023	130	$ - 0	Month	$ - 0
	Owned Hi Flow		maintenance and 90 calendar day visit as	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	130	$ - 0	Month	$ - 0
	Concentrator System		described in Item 1

Priced Per Month

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
2	Rental of Contractor	E0431	Portable System, Regulator,	Base Period: June 1, 2023-August 31, 2023	800	$ - 0	Month	$ - 0
	Owned Portable O2		Flowmeter, Humidifier, Cannulas,	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	800	$ - 0	Month	$ - 0
	Gaseous System for		or Masks, Tubing,
	use with or without		Conserving Device and O2 Tank
	Stationary System		Cylinder Stands capable of holding
	Priced Per Month		12 cylinders, sizes E, D, C & M-6

3	Rental of Contractor	E0439	Resevoir, Regulator, Flowmeter,	Base Period: June 1, 2023-August 31, 2023	4	$ - 0	Month	$ - 0
	Owned Stationary		Humidifier, Cannulas or Masks, and	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	4	$ - 0	Month	$ - 0
	Liquid O2 System		Colored Tubing.

Priced Per Month

4	Rental of Contractor	E0434	Portable Container, Refill Adapter	Base Period: June 1, 2023-August 31, 2023	4	$ - 0	Month	$ - 0
	Owned Portable		Flowmeter, Cannulas or Masks, and	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	4	$ - 0	Month	$ - 0
	Liquid O2 System		Colored Tubing. Resevoir will be provided
			if another Stationary System (e.g.
	Priced Per Month		Concentrator) is rented.

5	Continuous Positive	E0601	Delivery, Set-up & Training of	Base Period: June 1, 2023-August 31, 2023	13	$ - 0	Each	$ - 0
	Airway Device		Government Owned CPAP in	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	13		Each	$ - 0
	(CPAP) Set-up		Patient's Home to include all supplies
			Mask will be provided by VA
	Priced Per Each

6	CPAP Maintenance	E0601	Maintenance of Government Owned	Base Period: June 1, 2023-August 31, 2023	13	$ - 0	Each	$ - 0
	As Requested		CPAP, to include maintenance in	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	13		Each	$ - 0
			accordance with Manufacturer
	Priced Per Each		recommendation, replacement of
			Mask, Headgear, Chinstraps, Tubing
			& Filters Disposible/Non-Disposible
			in Patients Home. Mask will be provided by VA
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
7	Continuous Positive	E0601	Delivery, Set-up & Training of	Base Period: June 1, 2023-August 31, 2023	13	$ - 0	Each	$ - 0
	Airway Device		Government Owned CPAP at the	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	13	$ - 0	Each	$ - 0
	(CPAP) Set-up		Contractors Facility to include all
			supplies
	Priced Per Each		Mask will be provided by VA

8	Bilevel Positive Airway	E0470	Delivery, Set-up & Training of	Base Period: June 1, 2023-August 31, 2023	5	$ - 0	Each	$ - 0
	Pressure Device		Government Owned BiLevel in	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	5	$ - 0	Each	$ - 0
	Set-up		Patient's Home to include all supplies
			Mask will be provided by VA
	Priced Per Each

9	BiLevel Maintenance	E0470	Maintenance of Government Owned	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
	As Requested		BiLevel, to include maintenance in	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			accordance with Manufacturer
			recommendation, replacement of
	Priced Per Each		Mask, Headgear, Chinstraps, Tubing
			& Filters Disposible/Non-Disposible
			in Patients Home Mask will be provided by VA

10	BiLevel Set-up	E0470	Delivery, Set-up & Training of	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
			Government Owned BiLevel at the	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			Contractors Facility to include al supplies
	Priced Per Each		Mask will be provided by VA

11	Nebulizers	E0570	Delivery, Set-up and Training of	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
			Government Owned Nebulizer,	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			Compressor or Battery Powered as
	Priced Per Each		ordered

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
12	Suction Pump	E0600	Purchase, Delivery, Set-up and	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
			Training of Contractor Home Model	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			Respiratory Suction Pump, portable
	Priced Per Each		or stationary electric to include all
			supplies

13	Suction Pump Rental	E0600	Delivery, Set-up, and Training of	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
			Contractor Owned Suction Pump to	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			Include all supplies
	Priced Per Each

14	Rental of Contractor	E0465 & E0466	Delivery, Set-up, Training, and	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Month	$ - 0
	Owned Volume		Maintenance of Contractor Owned	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Month	$ - 0
	Ventilator		Stationary or Portable Ventilator, to
			include back up Ventilator
	Priced Per Month

15	Air Compressor	E0565	Rental of Contractor Owned and	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Month	$ - 0
			Maintained continuous or intermittent	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Month	$ - 0
			air compressor for use with
			equipment not self contained or
	Priced Per Month		cylinder driven, to include all
			associated supplies

16	Full Face Masks	A7030	CPAP/Bilevel Full Face Masks	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
			Including Headgear	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0

Priced Per Each

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES

17	Nasal Interface Mask	A7034	CPAP/Bilevel Masks, Nasal	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
	or Cannula Type		Interface, Nasal Pillows & Nasal	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			Cushions (Mask or Cannula Type)
	Priced Per Each		Including Headgear

18	Delivery Charge	A9901	Deliveries not made under all other	Base Period: June 1, 2023-August 31, 2023	0	$ - 0	Each	$ - 0
			line items	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	0	$ - 0	Each	$ - 0

Priced Per Each

19	Respiratory Therapist	VA120	Government requested Respiratory	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Each	$ - 0
	Visit		Therapist visit not covered by other	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Each	$ - 0
			Line Items
	Priced Per Each

Hawaii specific pricing instructions

Line Items 1-1c Require Quarterly Maintenance Visits

Line Items 5-10 - VA provided Mask

Line Items 6 & 9 Maintenance upon request

				REFILLS - ALL QUANTITIES ARE MONTHLY		ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION		CONTRACT PERIOD	3-MONTH	CYLINDER	PURCHASE	ESTIMATED COST
		CODE				QUANTITIES	PRICE
R1	E Cylinder	E0443	E Cylinder Refill		Base Period: June 1, 2023-August 31, 2023	213	$ - 0	Cylinder	$ - 0
					Option Period 1: Sept. 1, 2023-Nov. 30, 2023	213	$ - 0	Cylinder	$ - 0

R2	D Cylinder	E0443	D Cylinder Refill	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Cylinder	$ - 0

R3	C Cylinder	E0443	C Cylinder Refill	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	Cylinder	$ - 0

R4	M-6 Cylinder	E0443	M-6 Cylinder Refill	Base Period: June 1, 2023-August 31, 2023	107	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	107	$ - 0	Cylinder	$ - 0

R5	H Tank	E0443	H Tank Refill	Base Period: June 1, 2023-August 31, 2023	4	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	4	$ - 0	Cylinder	$ - 0

						UNIT PER LB
						PRICE
R6	Liquide Oxygen	E0444	Liquide Oxygen	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	LBS	$ - 0
			Refill	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 0	LBS	$ - 0

PRICING TOTAL PAGE

LINE ITEMS 1 THROUGH 19
TOTAL ESTIMATED ANNUAL PRICE - BASE PERIOD	$ - 0
TOTAL ESTIMATED ANNUAL PRICE - OPTION PERIOD 1	$ - 0

LINE ITEMS R1 - R6
TOTAL ESTIMATED ANNUAL PRICE - BASE PERIOD	$ - 0
TOTAL ESTIMATED ANNUAL PRICE - OPTION PERIOD 1	$ - 0

TOTAL ESTIMATED PRICE - BASE AND ALL OPTION PERIODS $ - 0

GRAND TOTAL $ - 0

File details come from the government source that posted it. Updated May 19, 2023.