75D301-25-R-73216 Amend 0001 (01.31.25).pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

1 3

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

01/31/2025

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE 8219 7. ADMINISTERED BY (If other than Item 6) CODE Centers for Disease Control and Prevention Chamblee Campus Building 102, MS S102-4 4770 Buford Hwy Atlanta, GA 30341-3717

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

X

9A. AMENDMENT OF SOLICITATION NO.

75D301-25-R-73216

9B. DATED (See Item 11)

01/16/2025

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (See Item 13)

CODE FACILITY CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, X is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this amendment is to revise Section 4.4.4 of the Performance Work Statement, as shown in redline on pages 2-3 of this amendment.

All other terms and conditions remain unchanged.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

16A. NAME OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

15C. DATE SIGNED

16B. UNITED STATES OF AMERICA

BY ___________________________________________

(Signature of Contracting Officer)

16C. DATE SIGNED

NSN 7540-01-152-8070 STANDARD FORM 30 (REV. 10-83)

PREVIOUS EDITION UNUSABLE 30-105 Prescribed by GSA

FAR (48 CFR) 53.243

ITEM 10A.

75D301-25-R-73216 0001

Section 4.4.4 – Provider Directory

The TPA Contractor shall create a Provider Directory that captures provider information for all providers authorized to provide services to one or more Program members, including the NYMA EPN providers and the NPN Network providers. The TPA Contractor shall deliver an initial Provider Directory 60 calendar days prior to SHCD.

Upon SHCD, the Provider Directory shall be online and accessible at the acceptable quality levels indicated in the QASP. Access to the Provider Directory shall be role-based. For example, members living within NYMA should see EPN providers, but not NPN providers. Furthermore, asterisked information below is required to be shared with the Program and/or other Program contractors but shall not be included in any public-facing directory. The Provider Directory shall be searchable and filterable based on key criteria (e.g., distance from member home, gender, accepting new patients) and clearly communicate the following information to members, the Program, and Program partners:

a. Provider Name.

b. Provider Gender.

c. Accepts New Patients (Y/N).

d. Telehealth Availability (Y/N).

e. Telehealth States Practiced In.

f. National Provider Identifier (NPI).

g. Provider Taxpayer Identification Number (TIN).*

h. Provider Drug Enforcement Administration Number (if applicable).*

i. Program Network Affiliation (NPN, EPN, or Both)Provider Place of Service/Rendering Address (or “virtual only,” if practice is telehealth only).

j. Provider Languages Spoken.

k. Provider Office Hours.

l. Provider Appointment Phone Number.

m. Provider Business Phone Number.*

n. Provider Fax Number.*

o. Provider and/or Provider Group Email Address.*

p. Provider Type (Monitoring, Primary Care, Urgent Care, Behavioral Health, Specialist, Hospital, and/or Clinic, etc.).

q. Provider Specialty (with the ability to document multiple specialties, where appropriate).

r. Provider Sub-specialty.

s. Associated Billing Provider or Provider Group (if applicable).*

t. Provider Remittance Address.*

u. Provider Bank Account Information (Account Type, Routing Number, Bank Account (EFT) Number).*

v. Provider Quality Indicator(s).

w. Provider Accepted Insurances.

x. Provider CCE/NPA Credentialing Affiliations (if applicable).*

75D301-25-R-73216 0001

y. Provider Website (if available).

z. Participates in Health Information Exchange (Y/N).*

aa. Provider Electronic Address (Health Information Service Provider (HISP) address).*

bb. Authorized CCE/NPA Prescriber (Y/N).*

cc. Prescriber CCE/NPA Credentialing Affiliations (if applicable).*

The TPA Contractor shall maintain an accurate and complete Provider Directory. The TPA Contractor shall assess the content of the provider data for accuracy and completeness upon receipt of the initial EPN provider file during Transition-In (Section 4.4.1) and provide their findings in the QPR. The TPA Contractor shall verify the accuracy of the Provider Directory every 90 days and report this verification in the QPR. Verification means that the TPA Contractor has confirmed with a provider that the provider’s information in the Provider Directory is accurate and up to date.

Within thirty (30) calendar days of provider enrollment, the TPA Contractor shall add the provider to the Provider Directory and claims processing system. TPA Contractor shall update the Provider Directory and claims processing systems within three (3) business days of notification of a provider no longer participating in the network, for whatever reason. A summary of changes to the provider network shall be itemized and shared with the Program and other Program contractors identified by the Program monthly.

Section 4.4.4 – Provider Directory