2.2.1 Attachment 2 - Pricing Template (v2 - corrected) 101322.xlsx

XLSX spreadsheet 74 KB Posted Oct 13, 2022

Attached to: REQUEST FOR PROPOSAL: FEMA Medical and Behavioral Health Services
Solicitation number: 70FA4023R00000001
Issued by: Federal Emergency Management Agency

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File	Type	Posted
2.2.1 SOLICITATION 70FA4023R00000001 - SF1449 (v4 - 102122).pdf	PDF	Oct 21, 2022
2.2.1 Attachment 5 - Contractor Assurance Statement - v2 101322.pdf	PDF	Oct 13, 2022
1.1.3 PWS Medical and Behavioral Health Services - v2 Corrected 101322.pdf	PDF	Oct 13, 2022
2.2.1 Attachment 8 - Past Performance Questionnaire - v2 101322.docx	DOCX document	Oct 13, 2022
2.2.1 SOLICITATION 70FA4023R00000001 - SF1449 (v3 - 101322).pdf	PDF	Oct 13, 2022
Attachment 6 - Questions-ANSWERS Template - Corrected 101322.xlsx	XLSX spreadsheet	Oct 13, 2022
2.2.1 SOLICITATION 70FA4023R00000001 - Schedule thru Section M (v2 100422).pdf	PDF	Oct 4, 2022
2.2.1 Attachment 2 - Pricing Template.xlsx.xlsx	XLSX spreadsheet	Oct 4, 2022
2.2.1 Att 7 WD - Florida (Dade County).pdf	PDF	Oct 4, 2022
2.2.1 Att 7 WD - District of Columbia (Statewide).pdf	PDF	Oct 4, 2022
2.2.1 Attachment 6 - Questions Template.xlsx	XLSX spreadsheet	Oct 4, 2022
2.2.1 Attachment 4 - FAR 52.204-26 (Contains Fill-ins).pdf	PDF	Oct 4, 2022
2.2.1 SOLICITATION 70FA4023R00000001 - Schedule thru Section M.pdf	PDF	Oct 4, 2022
2.2.1 Attachment 3 - FAR 52.204-24 (Contains Fill-ins).pdf	PDF	Oct 4, 2022
2.2.1 Att 7 WD - California (LA county).pdf	PDF	Oct 4, 2022
2.2.1 Att 7 WD - Washinton (King County).pdf	PDF	Oct 4, 2022
2.2.1 Att 7 WD - New York (Queens County).pdf	PDF	Oct 4, 2022
2.2.1 Attachment 8 - Past Performance Questionnaire.docx	DOCX document	Oct 4, 2022
2.2.1 Att 7 WD - Texas (Dallas County).pdf	PDF	Oct 4, 2022
2.2.1 Attachment 1 - PWS.pdf	PDF	Oct 4, 2022
2.2.1 Attachment 5 - Contractor Assurance Statement (sign - Phase II).pdf	PDF	Oct 4, 2022

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Summary Cost (5 yr.)

FEMA Medical and Behavioral Services

5-Year Period of Performance

CLIN	Description	Base	Option 1	Option 2	Option 3	Option 4	Total Ceiling Price
0001	Medical and Behavioral Health Oversight and Management	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
0002	Labor (Fixed Sites)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
0003	Labor (Disaster Sites)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
0004	Labor (Disaster Activation Medical Services)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
0005	Fees for Individual Services Provided (Fixed and Disaster Sites)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
0006	Travel (Fixed Sites) (DO NOT CHANGE PRICE)	$ 47,500.00	$ 47,500.00	$ 47,500.00	$ 47,500.00	$ 47,500.00	$ 237,500.00
0007	Travel (Disaster Sites) (DO NOT CHANGE PRICE)	$ 160,000.00	$ 160,000.00	$ 160,000.00	$ 160,000.00	$ 160,000.00	$ 800,000.00
0008	ODCs (Fixed Sites)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
0009	ODCs (Disaster Sites)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total		$ 207,500.00	$ 207,500.00	$ 207,500.00	$ 207,500.00	$ 207,500.00	$ 1,037,500.00

Base Period

PRICING TEMPATE: Medical / Behavioral Contract
Base Period: 1 year
CLIN 0001: Medical and Behavioral Health Oversight and Management (T&M)				CLIN 0001 Total	$0.00
Description	Rate	OT Rate	Standard Hrs	Overtime Hrs.	Total	Notes
Program Manager (Clinical Services Operation)	$ - 0	$ - 0	2080	200	$0.00	Oversight and Management of Program
Physician (Oversight - Occupational Medicine Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Behavioral Health and Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program

CLIN 0002: Labor (Fixed Sites - includes HQ, and Region IV) (T&M)				CLIN 0002 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	Total	Estimated Work Schedule
Registered Nurse - FEMA HQ (may be activated at NRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Registered Nurse - Reg IV (may be activated at RRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Register Nurse - Regions I, II, III, V, VI, VII, VIII, IX, X (if activated at each region)	$ - 0		4500		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0		896		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0		896		$0.00

CLIN 0003: Labor (Disaster Sites) (T&M)				CLIN 0003 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	OT Hrs	Estimated Work Schedule
Paramedic	$ - 0	$ - 0	480	284	$0.00
Physcian Assistant	$ - 0	$ - 0	480	284	$0.00
Advanced Practice Provider (APP)	$ - 0	$ - 0	480	284	$0.00
Registered Nurse Disaster	$ - 0	$ - 0	480	284	$0.00
Nurse Practioner Disaster	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0	$ - 0	480	284	$0.00

CLIN 0004: - Labor (Disaster Activation Medical Services) (T&M)				CLIN 0004 Total	$0.00	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	Total	Estimated Work Schedule
Registered Nurse - FEMA HQ (when activated at NRCC and overtime will apply)			160	96	$0.00
Registered Nurse - Reg IV (when activated at RRCC and overtime will apply)			160	96	$0.00

CLIN 0005 - Fees (for Individual Services Provided)			CLIN 0005 Total	$0.00
------ Fees for Disaster and Fixed Sites
Service		Quantity	Rate	Total	Notes
Health Unit Services - Flat rate to include all serices listed as included services		1,500	$ - 0	$ - 0	Services for up to 1,500 employees (250 people per even x 6 events)
Ace Bandage		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval not work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval (Follow-up care)		0	$ - 0	$ - 0	Included Services FLAT RATE
Emergency Response (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Bedrest		0	$ - 0	$ - 0	Included Services FLAT RATE
Best Vision		0	$ - 0	$ - 0	Included Services FLAT RATE
BP measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
BP screening		0	$ - 0	$ - 0	Included Services FLAT RATE
Body temp		0	$ - 0	$ - 0	Included Services FLAT RATE
Cold, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Consultation with recipient (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Ear / Eye irrigation		0	$ - 0	$ - 0	Included Services FLAT RATE
Educational Programs		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Program		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Materials		0	$ - 0	$ - 0	Included Services FLAT RATE
Heat, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Ht and Wt measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
Medication Administration		0	$ - 0	$ - 0	Included Services FLAT RATE
Outside Directed Care		0	$ - 0	$ - 0	Included Services FLAT RATE
Referral to PMD		0	$ - 0	$ - 0	Included Services FLAT RATE
Removal of foreign body		0	$ - 0	$ - 0	Included Services FLAT RATE
Self-Directed Care NOS		0	$ - 0	$ - 0	Included Services FLAT RATE
VS Ht and Wt		0	$ - 0	$ - 0	Included Services FLAT RATE
Wound care		0	$ - 0	$ - 0	Included Services FLAT RATE
Glucose stick test (finger stick method)		260	$ - 0	$ - 0	Per usage
Venipuncture (Charged for each blood draw)		260	$ - 0	$ - 0	Per usage
Lipid Profile plus Glucose		260	$ - 0	$ - 0	Per usage
Hep B surface antibody, quant (Lab)		100	$ - 0	$ - 0	Per usuage
Colorectal Cancer Screening (EZ Detects)		100	$ - 0	$ - 0	Per usage
Lacatation Oversight and Management Fixed site only		3	$ - 0	$ - 0	Per usage and only applicable at HQs, Region IV and Region VII.
Medical Employability and Consultantion		10	$ - 0	$ - 0	Per usage
Respiratory Clearances		300	$ - 0	$ - 0	Per usuage
Commercial Driver's License		100	$ - 0	$ - 0	Per usage
EAP/Worklife and Back Up Dependent - Optional		5000	$ - 0	$ - 0	Per usuage
Telemedicine /Health Services		750	$ - 0	$ - 0	Per usuage
Tele-therapy (Behavorial Health Services)		500	$ - 0	$ - 0	Per usuage
Special Test -COVID 19 -Rapid/At-Home		1500	$ - 0	$ - 0	Per usage
Special Test -COVID 19 - PCR Testing		1000	$ - 0	$ - 0	Per usage
Special Test -COVID 19 - Voucher Outreach Clinic		1000	$ - 0	$ - 0	Per usage
CLIN 0005 Fees for Disaster and Fixed Site Services				$0.00
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Regional External Health Units
Service		Quantity	Rate	Total	Notes
Acute/Episodic Care by nurse - Flat rate to include all services listed as included services	* services covered in nurse hourly wage ***	DO NOT PRICE	$ - 0	$ - 0	***** services covered in nurse hourly wage ***
Ace Bandage		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Allergy Desensitization		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Not Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Potentially Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation (Follow-up Care)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nurse
Bedrest		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
BP measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Body Temp		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Cold application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Consultation with Recipient		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ear / Eye irrigation		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response Visitor		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response (tracking only)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Heat application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ht / Wt Measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Outside Directed Care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Referral to PMD		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Removal of foreign body		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Self-Directed Care NOS		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
VS Ht and Wt		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Wound care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Medication Administration		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Glucose stick test (finger stick method)		32	$ - 0	$ - 0	Per usuage
Lipid Profile plus Glucose (Lab)		32	$ - 0	$ - 0	Per usuage
Hep B surface antibody, quant (Lab)		15	$ - 0	$ - 0	Per usuage
Missed procedure for appts made with clinic		20	$ - 0	$ - 0	Failure to cancel pre-physical or procedure only appointment within 48 hrs (charged)
Special Test -COVID 19 - Rapid/At-Home		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - PCR Testing		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - Voucher Outreach Clinic		1000	$ - 0	- 0	Per usage
0				$ - 0
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Vaccinations (Disaster and Fixed Sites)
Service		Quantity	Price	Total	Notes
Influenza Vaccinne (Flu)		2500	$ - 0	$ - 0
Influenza (Voucher)		1500	$ - 0	$ - 0	Voucher: Vacinne to be provided at non-governmental facility (Ex.: Drugstore)
COVID-19 Vaccine - Vendor supplies the vaccination		500	$ - 0	$ - 0	If required
COVID-19 Vaccine - FEMA supplies the vaccination		0	$ - 0	$ - 0
COVID-19 Voucher Outreach		500	$ - 0	$ - 0
Other Travel Vaccinations/pandemic vaccinations		1000	$ - 0	$ - 0	Yellow Fever, Malaria, Typhoid, Tuberculosis, Quantiferion TB Gold, Venipuncture T with Every Lab Draw, Stamaril Vaccine, etc…
Hepatitis A Vaccination #1		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Hepatitis A Vaccination #2		50	$ - 0	$ - 0	Shot 1 of 2 shot series
Hepatitis A Vaccination #3		50	$ - 0	$ - 0	Shot 2 of 2 shot series
Hepatitis B Vaccination #1		50	$ - 0	$ - 0	Shot 1 of 3 shot series
Hepatitis B Vaccination #2		50	$ - 0	$ - 0	Shot 2 of 3 shot series
Hepatitis B Vaccination #3		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Pneumococcal Vaccine		50	$ - 0	$ - 0	Per usuage
TDAP Vaccine		50	$ - 0	$ - 0	Per usuage
Tetanus Diphtheria Vaccination		130	$ - 0	$ - 0	Per usuage
0				$ - 0

CLIN 0006: - Travel (All Travel for Fixed Sites) (Cost)			47,500.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year)
Travel, Per Diem, Lodging, ME&I and Rental	3	$ 12,500.00	$ 37,500.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I)

CLIN 0007: - Travel (All Travel for Disaster Sites) (Cost)			160,000.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year
Travel, Per Diem, Lodging, ME&I and Rental	10	$ 15,000.00	$ 150,000.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I) - 10 disasters

CLIN 0008: -Other Direct Cost (ODCs) - Fixed Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((3) Cots, (3) wheel Chair, (3) Oxygen Tanks) x 10 disasters / also includes expo equipment
Shipping Costs	10	$ - 0	$ - 0	shipping costs
Shipping Costs - FEMA ships	10	$ - 0	$ - 0	shipping costs
Bio-Hazardous Wast Disposal	10	$ - 0	$ - 0	cost estimated for 10 disaster

CLIN 0009: -Other Direct Cost (ODCs) - Disaster Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((2) Cots, (2) wheel Chair, (2) Oxygen Tanks) x 10 disasters
Go Kit - Equip Small Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
Go Kit - Equip Large Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
IT Connectivity and Data Equipment	10	$ - 0	$ - 0	estimated at 10 disasters
FFS Operational Health Unit Other Direct Costs: Office Supplies	10	$ - 0	$ - 0	non medical supplies x 10 disasters

Total Estimated Cost (Base Year) $207,500.00

Option Period 1

PRICING TEMPATE: Medical / Behavioral Contract
Option Period 1: 1-year
CLIN 0001: Medical and Behavioral Health Oversight and Management (T&M)					CLIN 0001 Total	$0.00
Description	Esimated # of Staff	Rate	OT Rate	Standard Hrs	Overtime Hrs.	Total	Notes
Program Manager / Case Manager (Clinical Services Operation)		$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Occupational Medicine Consultant (Case Review) (Task Order Level)		$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Behavioral Health and Consultant (Case Review) (Task Order Level)		$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program

CLIN 0002: Labor (Fixed Sites - includes HQ, Reg IV, VII) (T&M)				CLIN 0002 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	Total	Notes
Registered Nurse - FEMA HQ (may be activated at NRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Registered Nurse - Reg IV (may be activated at RRCC and overtime will apply)	$ - 0		2080		$0.00
Register Nurse - Regions I, II, III, V, VI, VII, VIII, IX, X (if activated at each region)	$ - 0		4500		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0		896		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0		896		$0.00

CLIN 0003: Labor (Disaster Sites) (T&M)				CLIN 0003 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	OT Hrs	Notes
Paramedic	$ - 0	$ - 0	480	284	$0.00
Physcian Assistant	$ - 0	$ - 0	480	284	$0.00
Advanced Practice Provider	$ - 0	$ - 0	480	284	$0.00
Registered Nurse Disaster (including overtime)	$ - 0	$ - 0	480	284	$0.00
Nurse Practioner Disaster	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0	$ - 0	480	284	$0.00
	2
CLIN 0004: - Labor (Disaster Activation Medical Services) (T&M)				CLIN 0004 Total	$0.00	$0.00
Description	Rate	OT Rate	Hrs		Total	Notes
Registered Nurse - FEMA HQ (when activated at NRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00
Registered Nurse - Reg IV (when activated at RRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00

CLIN 0005 - Fees (for Individual Services Provided)			CLIN 0005 Total	$ - 0
------ Fees for Disaster and Fixed Sites
Service		Quantity	Rate	Total	Notes
Health Unit Services - Flat rate to include all serices listed as included services		1,500	$ - 0	$ - 0	Services for up to 1,500 employees (250 people per even x 6 events)
Ace Bandage		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval not work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval (Follow-up care)		0	$ - 0	$ - 0	Included Services FLAT RATE
Emergency Response (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Bedrest		0	$ - 0	$ - 0	Included Services FLAT RATE
Best Vision		0	$ - 0	$ - 0	Included Services FLAT RATE
BP measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
BP screening		0	$ - 0	$ - 0	Included Services FLAT RATE
Body temp		0	$ - 0	$ - 0	Included Services FLAT RATE
Cold, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Consultation with recipient (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Ear / Eye irrigation		0	$ - 0	$ - 0	Included Services FLAT RATE
Educational Programs		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Program		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Materials		0	$ - 0	$ - 0	Included Services FLAT RATE
Heat, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Ht and Wt measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
Medication Administration		0	$ - 0	$ - 0	Included Services FLAT RATE
Outside Directed Care		0	$ - 0	$ - 0	Included Services FLAT RATE
Referral to PMD		0	$ - 0	$ - 0	Included Services FLAT RATE
Removal of foreign body		0	$ - 0	$ - 0	Included Services FLAT RATE
Self-Directed Care NOS		0	$ - 0	$ - 0	Included Services FLAT RATE
VS Ht and Wt		0	$ - 0	$ - 0	Included Services FLAT RATE
Wound care		0	$ - 0	$ - 0	Included Services FLAT RATE
Glucose stick test (finger stick method)		260	$ - 0	$ - 0	Per usage
Venipuncture (Charged for each blood draw)		260	$ - 0	$ - 0	Per usage
Lipid Profile plus Glucose		260	$ - 0	$ - 0	Per usage
Hep B surface antibody, quant (Lab)		100	$ - 0	$ - 0	Per usuage
Colorectal Cancer Screening (EZ Detects)		100	$ - 0	$ - 0	Per usage
Lacatation Oversight and Management Fixed site only		3	$ - 0	$ - 0	Per usage and only applicable at HQs, Region IV and Region VII.
Medical Employability and Consultantion		10	$ - 0	$ - 0	Per usage
Respiratory Clearances		300	$ - 0	$ - 0	Per usuage
Commercial Driver's License		100	$ - 0	$ - 0	Per usage
EAP/Worklife and Back Up Dependent - Optional		5000	$ - 0	$ - 0	Per usuage
Telemedicine		750	$ - 0	$ - 0	Per usuage
Tele-therapy (Behavorial Health Services)		500	$ - 0	$ - 0	Per usuage
Special Test -COVID 19 - Rapid /At-home test		1500	$ - 0	$ - 0	Per usage
Special Test -COVID 19 - PCR Test		1000	$ - 0	$ - 0	Per usage
Special Test -COVID 19 - Voucher Outreach		1000	$ - 0	$ - 0	Per usage
				$0.00
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Regional External Health Units
Service		Quantity	Rate	Total	Notes
Acute/Episodic Care by nurse - Flat rate to include all services listed as included services	* services covered in nurse hourly wage ***	DO NOT PRICE	$ - 0	$ - 0	***** services covered in nurse hourly wage ***
Ace Bandage		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Allergy Desensitization		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Not Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Potentially Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation (Follow-up Care)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Bedrest		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
BP measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Body Temp		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Cold application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Consultation with Recipient		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ear / Eye irrigation		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response Visitor		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response (tracking only)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Heat application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ht / Wt Measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Outside Directed Care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Referral to PMD		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Removal of foreign body		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Self-Directed Care NOS		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
VS Ht and Wt		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Wound care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Medication Administration		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Glucose stick test (finger stick method)		32	$ - 0	$ - 0	Per usuage
Lipid Profile plus Glucose (Lab)		32	$ - 0	$ - 0	Per usuage
Hep B surface antibody, quant (Lab)		15	$ - 0	$ - 0	Per usuage
Missed procedure for appts made with clinic		20	$ - 0	$ - 0	Failure to cancel pre-physical or procedure only appointment within 48 hrs (charged)
Special Test -COVID 19 - Rapid /At-home test		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - PCR Test		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - Voucher Outreach		1000	$ - 0	- 0	Per usage
CLIN 0005 Fees for External Health Units				$ - 0
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Vaccinations (Disaster and Fixed Sites)
Service		Quantity	Price	Total	Notes
Influenza Vaccinne (Flu)		2500	$ - 0	$ - 0
Influenza (Voucher)		1500	$ - 0	$ - 0	Voucher: Vacinne to be provided at non-governmental facility (CVS, etc)
COVID-19 Vaccine - Vendor supplies the vaccination		500	$ - 0	$ - 0	If required
COVID-19 Vaccine - FEMA supplies the vaccination		500	$ - 0	$ - 0
COVID-19 Voucher Outreach		500	$ - 0	$ - 0
Other Travel Vaccinations/pandemic vaccinations		1000	$ - 0	$ - 0	Yellow Fever, Malaria, Typhoid, Tuberculosis, Quantiferion TB Gold, Venipuncture T with Every Lab Draw, Stamaril Vaccine, etc…
Hepatitis A Vaccination #1		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Hepatitis A Vaccination #2		50	$ - 0	$ - 0	Shot 1 of 2 shot series
Hepatitis A Vaccination #3		50	$ - 0	$ - 0	Shot 2 of 2 shot series
Hepatitis B Vaccination #1		50	$ - 0	$ - 0	Shot 1 of 3 shot series
Hepatitis B Vaccination #2		50	$ - 0	$ - 0	Shot 2 of 3 shot series
Hepatitis B Vaccination #3		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Pneumococcal Vaccine		50	$ - 0	$ - 0	Per usuage
TDAP Vaccine		50	$ - 0	$ - 0	Per usuage
Tetanus Diphtheria Vaccination		130	$ - 0	$ - 0	Per usuage
CLIN 0005 Fees For Vaccination				$ - 0

CLIN 0006: - Travel (All Travel for Fixed Sites) (Cost)			47,500.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year)
Travel, Per Diem, Lodging, ME&I and Rental	3	$ 12,500.00	$ 37,500.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I)

CLIN 0007: - Travel (All Travel for Disaster Sites) (Cost)			160,000.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year
Travel, Per Diem, Lodging, ME&I and Rental	10	$ 15,000.00	$ 150,000.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I) - 10 disasters

CLIN 0008: -Other Direct Cost (ODCs) - Fixed Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((3) Cots, (3) wheel Chair, (3) Oxygen Tanks) x 10 disasters / also includes expo equipment
Shipping Costs	10	$ - 0	$ - 0	shipping costs
Shipping Costs - FEMA ships	10	$ - 0	$ - 0	shipping costs
Bio-Hazardous Wast Disposal	10	$ - 0	$ - 0	cost estimated for 10 disaster

CLIN 0009: -Other Direct Cost (ODCs) - Disaster Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((2) Cots, (2) wheel Chair, (2) Oxygen Tanks) x 10 disasters
Go Kit - Equip Small Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
Go Kit - Equip Large Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
IT Connectivity and Data Equipment	10	$ - 0	$ - 0	estimated at 10 disasters
FFS Operational Health Unit Other Direct Costs: Office Supplies	10	$ - 0	$ - 0	non medical supplies x 10 disasters

Total Estimated Cost (Base Year) $207,500.00

Option 2

PRICING TEMPATE: Medical / Behavioral Contract
Option Period 2: 1-year
CLIN 0001: Medical and Behavioral Health Oversight and Management (T&M)				CLIN 0001 Total	$0.00
Description	Rate	OT Rate	Standard Hrs	Overtime Hrs.	Total	Notes
Program Manager / Case Manager (Clinical Services Operation)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Occupational Medicine Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Behavioral Health and Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program

CLIN 0002: Labor (Fixed Sites - includes HQ, Reg IV, VII) (T&M)				CLIN 0002 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	Total	Notes
Registered Nurse - FEMA HQ (may be activated at NRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Registered Nurse - Reg IV (may be activated at RRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Register Nurse - Regions I, II, III, V, VI, VII, VIII, IX, X (if activated at each region)	$ - 0		4500		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0		896		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0		896		$0.00
	$ - 0
CLIN 0003: Labor (Disaster Sites) (T&M)				CLIN 0003 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	OT Hrs	Notes
Paramedic	$ - 0	$ - 0	480	284	$0.00
Physcian Assistant	$ - 0	$ - 0	480	284	$0.00
Advanced Practice Provider	$ - 0	$ - 0	480	284	$0.00
Registered Nurse Disaster (including overtime)	$ - 0	$ - 0	480	284	$0.00
Nurse Practioner Disaster	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0	$ - 0	480	284	$0.00
	0
CLIN 0004: - Labor (Disaster Activation Medical Services) (T&M)				CLIN 0004 Total	$0.00	$0.00
Description	Rate	OT Rate	Hrs		Total	Notes
Registered Nurse - FEMA HQ (when activated at NRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00
Registered Nurse - Reg IV (when activated at RRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00

CLIN 0005 - Fees (for Individual Services Provided)			CLIN 0005 Total	$ - 0
------ Fees for Disaster and Fixed Sites
Service		Quantity	Rate	Total	Notes
Health Unit Services - Flat rate to include all serices listed as included services		1,500	$ - 0	$ - 0	Services for up to 1,500 employees (250 people per even x 6 events)
Ace Bandage		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval not work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval (Follow-up care)		0	$ - 0	$ - 0	Included Services FLAT RATE
Emergency Response (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Bedrest		0	$ - 0	$ - 0	Included Services FLAT RATE
Best Vision		0	$ - 0	$ - 0	Included Services FLAT RATE
BP measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
BP screening		0	$ - 0	$ - 0	Included Services FLAT RATE
Body temp		0	$ - 0	$ - 0	Included Services FLAT RATE
Cold, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Consultation with recipient (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Ear / Eye irrigation		0	$ - 0	$ - 0	Included Services FLAT RATE
Educational Programs		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Program		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Materials		0	$ - 0	$ - 0	Included Services FLAT RATE
Heat, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Ht and Wt measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
Medication Administration		0	$ - 0	$ - 0	Included Services FLAT RATE
Outside Directed Care		0	$ - 0	$ - 0	Included Services FLAT RATE
Referral to PMD		0	$ - 0	$ - 0	Included Services FLAT RATE
Removal of foreign body		0	$ - 0	$ - 0	Included Services FLAT RATE
Self-Directed Care NOS		0	$ - 0	$ - 0	Included Services FLAT RATE
VS Ht and Wt		0	$ - 0	$ - 0	Included Services FLAT RATE
Wound care		0	$ - 0	$ - 0	Included Services FLAT RATE
Glucose stick test (finger stick method)		260	$ - 0	$ - 0	Per usage
Venipuncture (Charged for each blood draw)		260	$ - 0	$ - 0	Per usage
Lipid Profile plus Glucose		260	$ - 0	$ - 0	Per usage
Hep B surface antibody, quant (Lab)		100	$ - 0	$ - 0	Per usuage
Colorectal Cancer Screening (EZ Detects)		100	$ - 0	$ - 0	Per usage
Lacatation Oversight and Management Fixed site only		3	$ - 0	$ - 0	Per usage and only applicable at HQs, Region IV and Region VII.
Medical Employability and Consultantion		10	$ - 0	$ - 0	Per usage
Respiratory Clearances		300	$ - 0	$ - 0	Per usuage
Commercial Driver's License		100	$ - 0	$ - 0	Per usage
EAP/Worklife and Back Up Dependent - Optional		5000	$ - 0	$ - 0	Per usuage
Telemedicine		750	$ - 0	$ - 0	Per usuage
Tele-therapy (Behavorial Health Services)		500	$ - 0	$ - 0	Per usuage
Special Test -COVID 19 -Vendor provides the testing kits		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
Special Test -COVID 19 - FEMA to provides testing Kits		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
Special Test -COVID 19 - Voucher Outreach Clinic		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
CLIN 0005 Fees for Disaster and Fixed Site Services				$0.00
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Regional External Health Units
Service		Quantity	Rate	Total	Notes
Acute/Episodic Care by nurse - Flat rate to include all services listed as included services	* services covered in nurse hourly wage ***	DO NOT PRICE	$ - 0	$ - 0	***** services covered in nurse hourly wage ***
Ace Bandage		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Allergy Desensitization		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Not Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Potentially Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation (Follow-up Care)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Bedrest		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
BP measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Body Temp		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Cold application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Consultation with Recipient		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ear / Eye irrigation		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response Visitor		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response (tracking only)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Heat application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ht / Wt Measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Outside Directed Care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Referral to PMD		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Removal of foreign body		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Self-Directed Care NOS		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
VS Ht and Wt		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Wound care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Medication Administration		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Glucose stick test (finger stick method)		32	$ - 0	$ - 0	Per usuage
Lipid Profile plus Glucose (Lab)		32	$ - 0	$ - 0	Per usuage
Hep B surface antibody, quant (Lab)		15	$ - 0	$ - 0	Per usuage
Missed procedure for appts made with clinic		20	$ - 0	$ - 0	Failure to cancel pre-physical or procedure only appointment within 48 hrs (charged)
Special Test -COVID 19 -Vendor provides the testing kits		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - FEMA to provides testing Kits		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - Voucher Outreach		1000	$ - 0	- 0	Per usage
CLIN 0005 Fees for External Health Units				$ - 0
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Vaccinations (Disaster and Fixed Sites)
Service		Quantity	Price	Total	Notes
Influenza Vaccinne (Flu)		2500	$ - 0	$ - 0
Influenza (Voucher)		1500	$ - 0	$ - 0	Voucher: Vacinne to be provided at non-governmental facility (CVS, etc)
COVID-19 Vaccine - Vendor supplies the vaccination		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
COVID-19 Vaccine - FEMA supplies the vaccination		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
COVID-19 Voucher Outreach		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
Other Travel Vaccinations/pandemic vaccinations		1000	$ - 0	$ - 0	Yellow Fever, Malaria, Typhoid, Tuberculosis, Quantiferion TB Gold, Venipuncture T with Every Lab Draw, Stamaril Vaccine, etc…
Hepatitis A Vaccination #1		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Hepatitis A Vaccination #2		50	$ - 0	$ - 0	Shot 1 of 2 shot series
Hepatitis A Vaccination #3		50	$ - 0	$ - 0	Shot 2 of 2 shot series
Hepatitis B Vaccination #1		50	$ - 0	$ - 0	Shot 1 of 3 shot series
Hepatitis B Vaccination #2		50	$ - 0	$ - 0	Shot 2 of 3 shot series
Hepatitis B Vaccination #3		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Pneumococcal Vaccine		50	$ - 0	$ - 0	Per usuage
TDAP Vaccine		50	$ - 0	$ - 0	Per usuage
Tetanus Diphtheria Vaccination		130	$ - 0	$ - 0	Per usuage
CLIN 0005 Fees For Vaccination				$ - 0

CLIN 0006: - Travel (All Travel for Fixed Sites) (Cost)			47,500.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year)
Travel, Per Diem, Lodging, ME&I and Rental	3	$ 12,500.00	$ 37,500.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I)

CLIN 0007: - Travel (All Travel for Disaster Sites) (Cost)			160,000.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year
Travel, Per Diem, Lodging, ME&I and Rental	10	$ 15,000.00	$ 150,000.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I) - 10 disasters

CLIN 0008: -Other Direct Cost (ODCs) - Fixed Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((3) Cots, (3) wheel Chair, (3) Oxygen Tanks) x 10 disasters / also includes expo equipment
Shipping Costs	10	$ - 0	$ - 0	shipping costs
Shipping Costs - FEMA ships	10	$ - 0	$ - 0	shipping costs
Bio-Hazardous Wast Disposal	10	$ - 0	$ - 0	cost estimated for 10 disaster

CLIN 0009: -Other Direct Cost (ODCs) - Disaster Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((2) Cots, (2) wheel Chair, (2) Oxygen Tanks) x 10 disasters
Go Kit - Equip Small Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
Go Kit - Equip Large Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
IT Connectivity and Data Equipment	10	$ - 0	$ - 0	estimated at 10 disasters
FFS Operational Health Unit Other Direct Costs: Office Supplies	10	$ - 0	$ - 0	non medical supplies x 10 disasters

Total Estimated Cost (Base Year) $207,500.00

Option 3

PRICING TEMPATE: Medical / Behavioral Contract
Option Period 3: 1-year
CLIN 0001: Medical and Behavioral Health Oversight and Management (T&M)				CLIN 0001 Total	$0.00
Description	Rate	OT Rate	Standard Hrs	Overtime Hrs.	Total	Notes
Program Manager / Case Manager (Clinical Services Operation)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Occupational Medicine Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program
Physician (Oversight - Behavioral Health and Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	1000	200	$0.00	Oversight and Management of Program

CLIN 0002: Labor (Fixed Sites - includes HQ, Reg IV, VII) (T&M)				CLIN 0002 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	Total	Notes
Registered Nurse - FEMA HQ (may be activated at NRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Registered Nurse - Reg IV (may be activated at RRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Register Nurse - Regions I, II, III, V, VI, VII, VIII, IX, X (if activated at each region)	$ - 0		4500		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0		896		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0		896		$0.00

CLIN 0003: Labor (Disaster Sites) (T&M)				CLIN 0003 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	OT Hrs	Notes
Paramedic	$ - 0	$ - 0	480	284	$0.00
Physcian Assistant	$ - 0	$ - 0	480	284	$0.00
Advanced Practice Provider	$ - 0	$ - 0	480	284	$0.00
Registered Nurse Disaster (including overtime)	$ - 0	$ - 0	480	284	$0.00
Nurse Practioner Disaster	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0	0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0	0	480	284	$0.00
	2
CLIN 0004: - Labor (Disaster Activation Medical Services) (T&M)				CLIN 0004 Total	$0.00	$0.00
Description	Rate	OT Rate	Hrs		Total	Notes
Registered Nurse - FEMA HQ (when activated at NRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00
Registered Nurse - Reg IV (when activated at RRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00

CLIN 0005 - Fees (for Individual Services Provided)			CLIN 0005 Total	$ - 0
------ Fees for Disaster and Fixed Sites
Service		Quantity	Rate	Total	Notes
Health Unit Services - Flat rate to include all serices listed as included services		1,500	$ - 0	$ - 0	Services for up to 1,500 employees (250 people per even x 6 events)
Ace Bandage		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval not work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval work related		0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval (Follow-up care)		0	$ - 0	$ - 0	Included Services FLAT RATE
Emergency Response (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Bedrest		0	$ - 0	$ - 0	Included Services FLAT RATE
Best Vision		0	$ - 0	$ - 0	Included Services FLAT RATE
BP measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
BP screening		0	$ - 0	$ - 0	Included Services FLAT RATE
Body temp		0	$ - 0	$ - 0	Included Services FLAT RATE
Cold, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Consultation with recipient (tracking only)		0	$ - 0	$ - 0	Included Services FLAT RATE
Ear / Eye irrigation		0	$ - 0	$ - 0	Included Services FLAT RATE
Educational Programs		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Program		0	$ - 0	$ - 0	Included Services FLAT RATE
Health Education Materials		0	$ - 0	$ - 0	Included Services FLAT RATE
Heat, application		0	$ - 0	$ - 0	Included Services FLAT RATE
Ht and Wt measurement		0	$ - 0	$ - 0	Included Services FLAT RATE
Medication Administration		0	$ - 0	$ - 0	Included Services FLAT RATE
Outside Directed Care		0	$ - 0	$ - 0	Included Services FLAT RATE
Referral to PMD		0	$ - 0	$ - 0	Included Services FLAT RATE
Removal of foreign body		0	$ - 0	$ - 0	Included Services FLAT RATE
Self-Directed Care NOS		0	$ - 0	$ - 0	Included Services FLAT RATE
VS Ht and Wt		0	$ - 0	$ - 0	Included Services FLAT RATE
Wound care		0	$ - 0	$ - 0	Included Services FLAT RATE
Glucose stick test (finger stick method)		260	$ - 0	$ - 0	Per usage
Venipuncture (Charged for each blood draw)		260	$ - 0	$ - 0	Per usage
Lipid Profile plus Glucose		260	$ - 0	$ - 0	Per usage
Hep B surface antibody, quant (Lab)		100	$ - 0	$ - 0	Per usuage
Colorectal Cancer Screening (EZ Detects)		100	$ - 0	$ - 0	Per usage
Lacatation Oversight and Management Fixed site only		3	$ - 0	$ - 0	Per usage and only applicable at HQs, Region IV and Region VII.
Medical Employability and Consultantion		10	$ - 0	$ - 0	Per usage
Respiratory Clearances		300	$ - 0	$ - 0	Per usuage
Commercial Driver's License		100	$ - 0	$ - 0	Per usage
EAP/Worklife and Back Up Dependent - Optional		5000	$ - 0	$ - 0	Per usuage
Telemedicine		750	$ - 0	$ - 0	Per usuage
Tele-therapy (Behavorial Health Services)		500	$ - 0	$ - 0	Per usuage
Special Test -COVID 19 -Vendor provides the testing kits		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
Special Test -COVID 19 - FEMA to provides testing Kits		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
Special Test -COVID 19 - Voucher Outreach Clinic		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
CLIN 0005 Fees for Disaster and Fixed Site Services				$0.00
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Regional External Health Units
Service		Quantity	Rate	Total	Notes
Acute/Episodic Care by nurse - Flat rate to include all services listed as included services	* services covered in nurse hourly wage ***	DO NOT PRICE	$ - 0	$ - 0	***** services covered in nurse hourly wage ***
Ace Bandage		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Allergy Desensitization		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Not Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation Potentially Work Related		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Assessment and Evaluation (Follow-up Care)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Bedrest		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
BP measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Body Temp		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Cold application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Consultation with Recipient		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ear / Eye irrigation		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response Visitor		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Emergency Response (tracking only)		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Heat application		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Ht / Wt Measurement		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Outside Directed Care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Referral to PMD		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Removal of foreign body		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Self-Directed Care NOS		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
VS Ht and Wt		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Wound care		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Medication Administration		0	$ - 0	$ - 0	Covered under cost of Acute/Episodic Care by nuse
Glucose stick test (finger stick method)		32	$ - 0	$ - 0	Per usuage
Lipid Profile plus Glucose (Lab)		32	$ - 0	$ - 0	Per usuage
Hep B surface antibody, quant (Lab)		15	$ - 0	$ - 0	Per usuage
Missed procedure for appts made with clinic		20	$ - 0	$ - 0	Failure to cancel pre-physical or procedure only appointment within 48 hrs (charged)
Special Test -COVID 19 -Vendor provides the testing kits		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - FEMA to provides testing Kits		1000	$ - 0	- 0	Per usage
Special Test -COVID 19 - Voucher Outreach		1000	$ - 0	- 0	Per usage
CLIN 0005 Fees for External Health Units				$ - 0
CLIN 0005 (con't - Fees for Individual Services Provided)
---- Fees for Vaccinations (Disaster and Fixed Sites)
Service		Quantity	Price	Total	Notes
Influenza Vaccinne (Flu)		2500	$ - 0	$ - 0
Influenza (Voucher)		1500	$ - 0	$ - 0	Voucher: Vacinne to be provided at non-governmental facility (CVS, etc)
COVID-19 Vaccine - Vendor supplies the vaccination		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
COVID-19 Vaccine - FEMA supplies the vaccination		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
COVID-19 Voucher Outreach		0	$ - 0	$ - 0	Per usage (RATE SHOULD STILL BE PROVIDED EVEN THOUGH QTY IS ZERO)
Other Travel Vaccinations/pandemic vaccinations		1000	$ - 0	$ - 0	Yellow Fever, Malaria, Typhoid, Tuberculosis, Quantiferion TB Gold, Venipuncture T with Every Lab Draw, Stamaril Vaccine, etc…
Hepatitis A Vaccination #1		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Hepatitis A Vaccination #2		50	$ - 0	$ - 0	Shot 1 of 2 shot series
Hepatitis A Vaccination #3		50	$ - 0	$ - 0	Shot 2 of 2 shot series
Hepatitis B Vaccination #1		50	$ - 0	$ - 0	Shot 1 of 3 shot series
Hepatitis B Vaccination #2		50	$ - 0	$ - 0	Shot 2 of 3 shot series
Hepatitis B Vaccination #3		50	$ - 0	$ - 0	Shot 3 of 3 shot series
Pneumococcal Vaccine		50	$ - 0	$ - 0	Per usuage
TDAP Vaccine		50	$ - 0	$ - 0	Per usuage
Tetanus Diphtheria Vaccination		130	$ - 0	$ - 0	Per usuage
CLIN 0005 Fees For Vaccination				$ - 0

CLIN 0006: - Travel (All Travel for Fixed Sites) (Cost)			47,500.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year)
Travel, Per Diem, Lodging, ME&I and Rental	3	$ 12,500.00	$ 37,500.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I)

CLIN 0007: - Travel (All Travel for Disaster Sites) (Cost)			160,000.00
Service	Quantity	Price	Total	Notes
Gas ( Flat rate for up to 30 days) / Mileage for fixed site local travel		$ 10,000.00	$ 10,000.00	(DO NO CHANGE PRICE - Flat rate for gas, GSA mileage for local travel per year
Travel, Per Diem, Lodging, ME&I and Rental	10	$ 15,000.00	$ 150,000.00	(DO NO CHANGE PRICE - - Lodging, Per Diem, & M&I) - 10 disasters

CLIN 0008: -Other Direct Cost (ODCs) - Fixed Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((3) Cots, (3) wheel Chair, (3) Oxygen Tanks) x 10 disasters / also includes expo equipment
Shipping Costs	10	$ - 0	$ - 0	shipping costs
Shipping Costs - FEMA ships	10	$ - 0	$ - 0	shipping costs
Bio-Hazardous Wast Disposal	10	$ - 0	$ - 0	cost estimated for 10 disaster

CLIN 0009: -Other Direct Cost (ODCs) - Disaster Sites (Cost)			- 0
Service	Quantity	Price	Total	Notes
Equipment Costs (if needed)	10	$ - 0	$ - 0	((2) Cots, (2) wheel Chair, (2) Oxygen Tanks) x 10 disasters
Go Kit - Equip Small Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
Go Kit - Equip Large Scale Deploy	10	$ - 0	$ - 0	incl Equipment to establish a health unit x 10 disatesr for 500 employees (per disaster)
IT Connectivity and Data Equipment	10	$ - 0	$ - 0	estimated at 10 disasters
FFS Operational Health Unit Other Direct Costs: Office Supplies	10	$ - 0	$ - 0	non medical supplies x 10 disasters

Total Estimated Cost (Base Year) $207,500.00

Option 4

PRICING TEMPATE: Medical / Behavioral Contract
Option Period 4: 1-year
CLIN 0001: Medical and Behavioral Health Oversight and Management (T&M)				CLIN 0001 Total	$0.00
Description	Rate	OT Rate	Standard Hrs	Overtime Hrs.	Total	Notes
Program Manager / Case Manager (Clinical Services Operation)	$ - 0	$ - 0	900	200	$0.00	Oversight and Management of Program
Physician (Oversight - Occupational Medicine Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	900	200	$0.00	Oversight and Management of Program
Physician (Oversight - Behavioral Health and Consultant (Case Review) (Task Order Level)	$ - 0	$ - 0	900	200	$0.00	Oversight and Management of Program

CLIN 0002: Labor (Fixed Sites - includes HQ, Reg IV, VII) (T&M)				CLIN 0002 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	Total	Notes
Registered Nurse - FEMA HQ (may be activated at NRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Registered Nurse - Reg IV (may be activated at RRCC and overtime will apply)	$ - 0	$ - 0	2080		$0.00
Register Nurse - Regions I, II, III, V, VI, VII, VIII, IX, X (if activated at each region)	$ - 0		4500		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0		896		$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0		896		$0.00
	$ - 0
CLIN 0003: Labor (Disaster Sites) (T&M)				CLIN 0003 Total	$0.00
Description	Rate	OT Rate	Hrs	Overtime Hrs.	OT Hrs	Notes
Paramedic	$ - 0	$ - 0	480	284	$0.00
Physcian Assistant	$ - 0	$ - 0	480	284	$0.00
Advanced Practice Provider	$ - 0	$ - 0	480	284	$0.00
Registered Nurse Disaster (including overtime)	$ - 0	$ - 0	480	284	$0.00
Nurse Practioner Disaster	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor - Virtual suppor (No Travel).	$ - 0	$ - 0	480	284	$0.00
Stress Counselors (Behavioral Health) - Critical Incident Counselor (Travel Needed)	$ - 0	$ - 0	480	284	$0.00

CLIN 0004: - Labor (Disaster Activation Medical Services) (T&M)				CLIN 0004 Total	$0.00	$0.00
Description	Rate	OT Rate	Hrs		Total	Notes
Registered Nurse - FEMA HQ (when activated at NRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00
Registered Nurse - Reg IV (when activated at RRCC and overtime will apply)	$ - 0	$ - 0	160	96	$0.00

CLIN 0005 - Fees (for Individual Services Provided)		CLIN 0005 Total	$ - 0
------ Fees for Disaster and Fixed Sites
Service	Quantity	Rate	Total	Notes
Health Unit Services - Flat rate to include all serices listed as included services	1,500	$ - 0	$ - 0	Services for up to 1,500 employees (250 people per even x 6 events)
Ace Bandage	0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval not work related	0	$ - 0	$ - 0	Included Services FLAT RATE
Assessment and Eval work related	0	$ - 0	$ - 0	Included Services FLAT RATE

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 Oct 13, 2022.