75D301-25-R-73216 Amend 0002 (03.18.25).pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

1 248

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

03/18/2025

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 X is extended, 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.)

See page 2 for description of the modification.

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 Amendment 0002

Page 14 continuation page.

The purpose of this amendment is to:

(a) Section B.

(1) Revise the period of performance for the Base/Transition-In Period and all option periods.

(2) Revise CLINs 1001, 2001, 3001, 4001, 5001, 6001, 7001, 8001, and 9001 to remove ad hoc all-member and targeted letters under Section 4.2.5 from these CLINs.

(3) Revise the start of healthcare delivery date to October 30, 2026.

(4) Add CLINs 1011, 2011, 3011, 4011, 5011, 6011, 7011, 8011, and 9011 for ad hoc all-member and targeted letters under Section 4.2.5.

(5) Re-number the Transition-out CLIN to CLIN 8012.

(6) Re-number the Transition-out dual operations CLIN to CLIN 9012.

(b) Performance Work Statement (PWS).

(1) Revise the period of performance for the Base/Transition-In Period and all option periods in Table 1.

(2) Revise the start of healthcare delivery date to October 30, 2026, in Section 4.1.1.

(3) Add a reference to the statutory language for federal holidays in footnote number 53 in Section 4.1.1.

(4) Clarify that the Transition-Out Dual Operations Period may be exercised by the Government at any time in Section 4.1.6.

(5) Add a task in Section 4.2.6 for the TPA Contractor to provide in-person training sessions with Other Program Contractors.

(6) Clarify the TPA Contractor’s responsibilities regarding controlled correspondence in Section

4.3.7.

(7) Add a task for the TPA Contractor to participate in annual Call Center Scripting reviews with the Program in Section 4.3.8.

(8) Remove “initial appointment scheduling” from the high-frequency call center topics in Table 2 in

Section 4.3.8.

(9) Clarify the TPA Contractor’s responsibilities pertaining to communicating information in the Member Profile to the PBM in Section 4.3.10.

(10) Revise the TPA Contractor’s responsibilities regarding re-affiliation with EPN providers in

Section 4.4.1.

(11) Provide additional requirements for the written provider agreements in Section 4.4.3.

(12) Clarify Program rules for retroactively dating provider agreements in Section 4.4.3.

(13) Stipulate that the TPA Contractor shall transfer rights and obligations established under provider agreements signed by providers in the EPN to any TPA designee or successor, upon request from the WTCHP, in Section 4.4.3.

(14) Add provider sex to required information in the Provider Directory in Section 4.4.4.

(15) Correct the numbering of the list of provider directory data in Section 4.4.4.

(16) Clarify the TPA Contractor’s responsibilities pertaining to prospective and retrospective utilization management in Section 4.5.2.

(17) Make several changes to Section 4.6.4 pertaining to the processing of medical claims.

(18) Clarify the member clinical history information that is to be available to providers in the Secure

Self-Service Portal in Section 4.7.2.

(19) Clarify the TPA Contractor’s responsibilities pertaining to data requests in Section 4.7.3.

(20) Revise EDI transaction formats in Section 4.7.5.

(21) Add a requirement for the information that is to be furnished to the Program in the Comprehensive

Data Extract in Section 4.7.7.

(22) Revise the travel requirements in Section 7 to clarify that stakeholder meetings will occur in the

Base/Transition-In Period and each of Option Periods 1 through 9, and to add Other Program Contractor training in the Base/Transition-In Period.

(23) Add Attachment ATT028, WTCHP Fee Schedule, to Section 9 and Table 7.

(c) Section C.

(1) Revise Section C2, FAR 52.212-5.

(2) Revise the deadline for requesting wage determinations in Section C5.

(3) Revise the CLIN numbers in Section C25.

(4) Add Section C26, FAR 52.223-23.

(d) Section D.

(1) Attachment ATT003, Quality Assurance Surveillance Plan (QASP).

(i) Clarify that the contract support hours are Monday through Friday in QASP performance standard 05.03.b.

(2) Attachment ATT006, Translation Guide.

(i) Change instance of the word “gender” to “sex.”

(3) Attachment ATT012, Member Transfer Handbook.

(4) Attachment ATT018, Key Elements of the WTCHP Member Profile.

(i) Change “gender” to “sex” throughout.

(5) Attachment ATT022, Key Elements of the Quarterly Progress Reports.

(6) Add Attachment ATT028, WTCHP Fee Schedule.

(7) Attachment ATT101, Summary Volume Data.

(i) Change “gender” to “sex” throughout.

(ii) Add and correct various data sets, as described on the “overview” tab.

(8) Attachment ATT107, Pricing Template.

(i) Change the formatting of cells to restrict the offerors’ inputted values for labor hours and labor rates to round to two decimal places (0.00).

(ii) Remove the labor section for travel.

(iii) Remove travel costs for all option periods.

(iv) Re-number CLINs 8011 and 9011 to 8012 and 9012, respectively.

(v) Add CLINs 1011, 2011, 3011, 4011, 5011, 6011, 7011, 8011, and 9011 for ad hoc all-member and targeted letters under Section 4.2.5.

(9) Attachment ATT108, HHS Subcontracting Plan Template.

(i) Update the agency small business subcontracting goals to the fiscal year 2025 goals

(10) Attachment ATT111, Corporate Experience Questionnaire.

(i) Remove Question 7 and re-number questions accordingly.

(ii) Add contract list index field.

(iii) Add acronym list field.

(11) Remove the requirement to submit the completed Business Associate Agreement to receive access to the non-public attachments. Only the Offeror Non-Disclosure Agreement (NDA) must be submitted.

(e) Section E.

(1) Amend the solicitation timeline in Section E3(e).

(2) Revise Section E3(f) to reflect that CDC will publish a pre-recorded pre-proposal briefing in lieu of holding a re-scheduled pre-proposal conference.

(3) Revise the deadline for questions to May 2, 2025, and the date by which CDC intends to post final answers to May 9, 2025, in Section E3(g).

(4) Revise the dates for the discovery sessions to April 14, 2025, through April 24, 2025, and provide a new scheduling link in Section E3(h).

(5) Revise the instructions for Volumes 1-7 and Volume 10 in Section E3(i)(1) to permit cross-referencing among all technical volumes.

(6) Revise CLIN numbers in Section E3(i)(1)(ii)(C).

(7) Revise CLIN number in Section E3(i)(1)(viii)(A)(1)(a).

(8) Provide instructions for the submission of unburdened labor rates directly from proposed subcontractors to the Government in Section E3(i)(1)(viii)(A)(1)(b)(i)(D).

(9) Revise CLIN numbers in Section E3(i)(1)(viii)(A)(1)(d) and (f).

(10) Add pricing instructions for CLINs 1011, 2011, 3011, 4011, 5011, 6011, 7011, 8011, and 9011 in

E3(i)(1)(viii)(A)(1)(g).

(11) Clarify that the discussion of escalation rates in Section E3(i)(1)(viii)(A)(2)(a) is to include subcontracted labor.

(12) Revise the instructions for pricing travel in Section E3(i)(1)(viii)(A)(2)(c).

(13) Clarify that the identification of labor categories subject to Service Contract Labor Standards in

Section E3(i)(1)(viii)(A)(2)(d) is to include subcontracted labor.

(14) Clarify that the table in Section E3(i)(1)(viii)(A)(2)(e) is to include subcontracted labor.

(15) Increased the maximum page count for the basis of estimate document in Part A (Pricing) of

Volume 8 (Business volume) from 30 pages to 50 pages.

(16) Except the table in Section E3(i)(1)(viii)(A)(2)(e) from the page count for the basis of estimate document in Part A (Pricing) of Volume 8 (Business volume).

(17) Provide instructions for the submission of basis of estimate information directly to the

Government by proposed subcontractors in Part A (Pricing) of Volume 8 (Business volume).

(18) Extend the date to which the offeror holds its offer firm from September 15, 2025, to October 30, 2025, in Section E3(i)(1)(viii)(B)(1).

(19) Update the agency small business subcontracting goals to the fiscal year 2025 goals in Section

E3(i)(1)(viii)(C).

(20) Remove “and type” from Section E3(i)(1)(ix)(C)(10).

(21) Extend the due date for written proposals from April 11, 2025, to May 30, 2025.

(22) Revise the dates for the virtual session to June 9, 2025, through June 27, 2025, and revise the date by which offerors must schedule their virtual session to May 30, 2025, in Section E3(i)(2).

(23) Fix a typo in Section E3(i)(2)(i).

(24) In Section E3(j), revise the date for the competitive range determination to July 29, 2025. Revise the dates for discussions to July 29, 2025, through August 22, 2025.

(25) Revise the award date from August 29, 2025, to October 17, 2025, in Section E3(k).

(26) Clarify the evaluation criteria for the transition-in technical sub-factor in Section E4(a)(1)(i).

(27) Revise CLIN numbers in Section E4(a)(3)(i).

(28) Revise Section E5, FAR 52.212-3.

All other terms and conditions remain unchanged.

Additionally, please find attached an updated version of Attachment ATT110, Questions and Answers (revised 03.18.25).

SECTION B - CONTINUATION OF SF1449

Base/Transition-In Period (9/15/2025 – 9/14/202610/30/2025 – 10/29/2026) Items:

ITEM SUPPLIES / SERVICES QTY / UNIT UNIT

PRICE

EXTENDED

PRICE

0001 Transition-In related services

Description: Includes Sections 4.1.1, 4.1.2, and 4.1.3; New York Metropolitan Area (NYMA) External Provider Network (EPN) adoption under Section 4.4.1; Nationwide Provider Network (NPN) network development before Start of Healthcare Delivery (SHCD) under Section 4.4.2; and initial provider enrollment and credentialing under Section 4.4.3.

Severability: Non-severable line item.

Contract type: Time-and-materials line item.1 Labor to be invoiced in accordance with the labor categories and labor rates in the labor rates table, below.

Period of performance: 9/15/2025 – 9/14/202610/30/2025 – 10/29/2026.

1 Job

0002 Travel

Description: Travel in support of the Base/Transition-In Period.

Severability: Severable line item.

Contract type: Cost-only. All travel will be reimbursed at-cost in accordance with the Federal Travel Regulation, 41 C.F.R. Subtitle F.

The Contractor shall obtain written approval from the Contracting Officer’s Representative (COR) prior to undertaking any travel.

Period of performance: 9/15/2025 – 9/14/202610/30/2025 – 10/29/2026.

1 This contract line item number (CLIN) may be converted to a firm-fixed-price CLIN through mutual written agreement of the Contractor and Government Contracting Officer. See the contract type conversion clause in Section C23.

Option Period 1 (9/15/2026 – 9/14/202710/30/2026 – 10/29/2027) Items:

EXTENDED

PRICE

1001 Contract management and regulatory compliance

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Sections 4.2 and

4.8 upon SHCD on 9/1510/30/2026, except ad hoc all-member and targeted letters under Section 4.2.5 which are included under CLIN 1011. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4. At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

Period of performance: 9/15/2026 – 9/14/202710/30/2026 – 10/29/2027.

12 Months

1002 Member services: enrollment application processing

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes Section 4.3.1 upon SHCD on 10/309/15/2026. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4.

At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.2

9,500 Enrollment Applications

EXTENDED

PRICE

1003 Member services: existing members

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.3 upon SHCD on 10/309/15/2026, except Section 4.3.1.

The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4. At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.3

1,831,200 Units (based on members eligible for benefits)

1004 Provider network management

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.4 upon SHCD on 10/309/15/2026, except NYMA EPN adoption under Section 4.4.1; initial NPN network development before SHCD under Section 4.4.2; and initial provider enrollment and credentialing under Section 4.4.3, all of which are performed during the Transition-In Period. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4. At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

EXTENDED

PRICE

1005 Medical benefits administration and policy

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.5 upon SHCD on 10/309/15/2026, except Section 4.5.2.

The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4. At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

1006 Utilization management

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes Section 4.5.2 upon SHCD on 10/309/15/2026. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4.

At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.4

1,044,000 on active members only)

EXTENDED

PRICE

1007 Claims processing

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.6 upon SHCD on 10/309/15/2026. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4. At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.5

780,400 Medical Claims

1008 Data and business information management exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.7 upon SHCD on 10/309/15/2026, except Sections 4.7.5 and 4.7.6. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4.

At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

EXTENDED

PRICE

1009 Data and information exchanges, integrity, and governance

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes Sections 4.7.5 and 4.7.6 upon SHCD on 10/309/15/2026. The first 30 days of performance are during the Dual Operations phase following the Transition-In Period, as described in Section 4.1.4. At the end of the Dual Operations phase, the Sustainment phase will begin as described in Section 4.1.5.

Severability: Severable line item.

Contract type: Time-and-materials line item.6 Labor to be invoiced in accordance with the labor categories and labor rates in the labor rates table, below.

1010 Travel

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Travel in support of Option Period 1.

Severability: Severable line item.

Contract type: Cost-only. All travel will be reimbursed at-cost in accordance with the Federal Travel Regulation, 41 C.F.R. Subtitle F.

The Contractor shall obtain written approval from the COR prior to undertaking any travel.

EXTENDED

PRICE

1011 Ad hoc all-member and targeted letters

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Mail merge, printing, and mailing of ad hoc letters for all members or a targeted subset of the member population under Section 4.2.5. The Government will provide the content of these letters. This CLIN applies to the ad hoc letters described on page 1 of Attachment ATT008 (“the Communications and External Affairs Team [CEAT] estimates that approximately 5 all-member letters and 5 targeted member letters are sent out annually”). This CLIN does not include any of the enrollment letters, certification letters, or other letters, as described in Attachment ATT008.

Severability: Severable line item.

Contract type: Time-and-materials line item.6 Labor to be invoiced in accordance with the labor categories and labor rates in the labor rates table, below.

Period of performance: 10/30/2026 – 10/29/2027.

2 To develop the maximum quantity of 9,500 enrollment applications, the Government used its projection for the estimated number of enrollment applications anticipated during this option period. This line item is to be invoiced monthly in arrears for the number of enrollment applications finalized in a given month as of the last day of such month. A finalized enrollment application is defined as an enrollment application submitted by the Contractor to the World Trade Center Health Program (the “Program”) that has sufficient information for the Program to make an enrollment eligibility decision (e.g., Enroll, Deny, Defer). The determination of whether there is sufficient information is made by the Program and is based on the enrollment eligibility criteria described in the Program Administrative Manual, which is incorporated by reference herein as if fully set forth herein. The Program Administrative Manual is available at https://www.cdc.gov/wtc/ppm.html or any successor website. Enrollment applications that are determined by the Program to be incomplete (i.e., placed on Suspend) or duplicates of another enrollment application for the same unique individual are not considered finalized.

The Contractor is required to finalize up to the maximum quantity of 9,500 enrollment applications during the 12-month period of performance of this line item. The Contractor shall not perform above this maximum quantity. The Contractor shall notify the Government if and once it has reason to believe that the total number of enrollment applications that are to be invoiced under this line item in the next succeeding 30 days is expected to exceed 85 percent of the maximum quantity of this line item, or 8,075 enrollment applications. Any increase in the maximum quantity shall only be by mutual written agreement of the Contractor and Government Contracting Officer. See the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services.

The minimum guarantee is 6,500 enrollment applications. The minimum guarantee is defined both by the number of finalized enrollment applications (as such term is defined above) and the number of enrollment applications received by the Contractor but not yet finalized during the 12-month period of performance of this line item. An enrollment application that is received by the Contractor but not yet finalized means (1) an application submitted online and received in the Centralized Accessible Real-time Enterprise (CARE) Portal but does not have sufficient information https://www.cdc.gov/wtc/ppm.html for the Program to make an enrollment eligibility decision or has not yet been submitted to the Program, or (2) an application submitted through the Mail/Document Center that the Contractor has entered into the CARE Portal but does not have sufficient information for the Program to make an enrollment eligibility decision or has not yet been submitted to the Program. The Contractor is not paid for enrollment applications that are received by the Contractor but not yet finalized. Whether the minimum guarantee has been met will be determined by the Program using the following two-step procedure:

1. If the Contractor has finalized 6,500 or more enrollment applications during the 12-month period of performance of this line item, the minimum guarantee has been met.

2. If the Contractor has finalized fewer than 6,500 enrollment applications during the 12-month period of performance of this line item, the number of enrollment applications received by the Contractor but not yet finalized during the 12-month period of performance of this line item will then be added to the number of finalized enrollment applications during the 12-month period of performance of this line item.

a. If the total of finalized enrollment applications plus received-but-not-yet-finalized enrollment applications is 6,500 or more enrollment applications during the 12-month period of performance of this line item, the minimum guarantee has been met.

b. If the total of finalized enrollment applications plus received-but-not-yet-finalized enrollment applications is fewer than 6,500 enrollment applications during the 12-month period of performance of this line item, the Contractor is entitled to submit an invoice for any additional units (enrollment applications) adding up to the minimum guarantee of 6,500 enrollment applications.

Any invoice for additional units the Contractor is entitled to submit to meet the minimum guarantee, if any, shall be determined by the Program and submitted by the Contractor after the 12-month period of performance of this line item is complete.

For example, assuming that the unit price per enrollment application is $5.00:

• If the Contractor finalizes 8,000 enrollment applications during the 12-month period of performance of this line item, the minimum guarantee of 6,500 enrollment applications has been met and the Contractor is not entitled to any further compensation. The Contractor would be paid the unit price of $5.00 multiplied by 8,000 finalized enrollment applications, or $40,000.00.

• If the Contractor finalizes 6,000 enrollment applications during the 12-month period of performance of this line item, the Contractor would be paid the unit price of $5.00 multiplied by the 6,000 finalized enrollment applications, or $30,000.00. Assume further that 1,000 enrollment applications were received by the Contractor but not yet finalized during the 12-month period of performance of this line item. The total of finalized (6,000) plus received-but-not-yet-finalized (1,000) enrollment applications is 7,000. The minimum guarantee of 6,500 enrollment applications has been met and the Contractor is not entitled to any further compensation beyond the $30,000.00.

• If the Contractor finalizes 6,000 enrollment applications during the 12-month period of performance of this line item, the Contractor would be paid the unit price of $5.00 multiplied by the 6,000 finalized enrollment applications, or $30,000.00. Assume further that 200 enrollment applications were received by the Contractor but not yet finalized during the 12-month period of performance of this line item. The total of finalized (6,000) plus received-but-not-yet-finalized (200) enrollment applications is 6,200. The minimum guarantee of 6,500 enrollment applications has not been met. The Contractor is entitled to submit an invoice for 300 additional units (enrollment applications) to meet the 6,500 minimum guarantee (6,500 – 6,200). At the end of the 12-month period of performance, the Contractor would submit an invoice for 300 additional enrollment applications and be paid the unit price of $5.00 multiplied by 300 enrollment applications, or $1,500.00. The Contractor’s total compensation for this line item would be $31,500.00 ($30,000.00 for the 6,000 finalized enrollment applications plus the additional $1,500.00).

Additionally, see the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services, regarding changes to the minimum guarantee.

3 To develop the maximum quantity of 1,831,200 units for the year, the Government multiplied the estimated average number of members anticipated to be eligible for benefits during this option period by 12 months (152,600 members * 12 months = 1,831,200 per member per month [PMPM] units). This PMPM compensation arrangement establishes a fixed unit price to be invoiced monthly in arrears for each member eligible for benefits as of the close of business on the last day of the month. The number of members eligible for benefits is defined as the number of unique individuals who are currently enrolled in the Program, meaning that they have not disenrolled from the Program and are not deceased. For example, if the number of members eligible for benefits as of the close of business on the last day of the month is 150,000 members, the Contractor would submit an invoice for 150,000 units for that month. If the number of members eligible for benefits as of the close of business on the last day of the month remained at 150,000 members for each month of the year, the Contractor would have cumulatively billed for 1,800,000 units for the year (150,000 members * 12 months = 1,800,000 PMPM units).

The Contractor is required to perform up to the maximum quantity of 1,831,200 units during the 12-month period of performance of this line item. The Contractor shall not perform above this maximum quantity. The Contractor shall notify the Government if and once it has reason to believe that the total number of units that are to be invoiced under this line item in the next succeeding 30 days is expected to exceed 85 percent of the maximum quantity of this line item, or 1,556,520 units. Any increase in the maximum quantity shall only be by mutual written agreement of the Contractor and Government Contracting Officer. See the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services.

The minimum guarantee is 1,591,200 units during the 12-month period of performance of this line item. This minimum guarantee was developed by multiplying the estimated minimum average number of members anticipated to be eligible for benefits during this option period by 12 months (132,600 members * 12 months = 1,591,200 PMPM units). To the extent that fewer than 1,591,200 units have been invoiced at the end of the 12-month period of performance of this line item, the Contractor is entitled to submit an invoice for any additional units adding up to the minimum guarantee.

For example, assuming that the unit price is $2.00 PMPM:

• At the end of the 12-month period of performance of this line item, there were 1,600,000 units invoiced, and the Contractor was paid $3,200,000.00. The minimum guarantee of 1,591,200 units has been met and the Contractor is not entitled to any further compensation beyond the $3,200,000.00.

• At the end of the 12-month period of performance of this line item, there were 1,500,000 units invoiced, and the Contractor was paid $3,000,000.00. The minimum guarantee of 1,591,200 units has not been met.

The Contractor is entitled to submit an invoice for an additional 91,200 units to meet the 1,591,200 unit minimum guarantee. At the end of the 12-month period of performance, the Contractor would submit an invoice for 91,200 additional units and be paid $182,400.00, for a total compensation of $3,182,400.00 for the period of performance of this line item.

Any invoice for additional units the Contractor is entitled to submit to meet the minimum guarantee, if any, shall be determined by the Program and submitted by the Contractor after the 12-month period of performance of this line item is complete.

Additionally, see the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services, regarding changes to the minimum guarantee.

4 To develop the maximum quantity of 1,044,000 units for the year, the Government multiplied the estimated average number of active members anticipated during this option period by 12 months (87,000 members * 12 months = 1,044,000 PMPM units). This PMPM compensation arrangement establishes a fixed unit price to be invoiced monthly in arrears for each active member as of the close of business on the last day of the month. The number of active members is defined as the number of unique members who have demonstrated participation in the Program, as evidenced by the Contractor’s receipt of at least one medical (to include dental) claim for WTC-related services in the prior 18 months as of the last day of the month. For example: At the close of business on December 31, 2025, the number of active members would equal the number of members for whom the Contractor has received at least one medical claim for WTC-related services in the period of time starting on July 1, 2024, and ending on December 31, 2025 (18 total months). If the number of active members as of the close of business on the last day of the month is 75,000 members, for example, the Contractor would submit an invoice for 75,000 units for that month.

If the number of active members as of the close of business on the last day of the month remained at 75,000 members for each month of the year, the Contractor would have cumulatively billed for 900,000 units for the year (75,000 members * 12 months = 900,000 PMPM units).

The Contractor is required to perform up to the maximum quantity of 1,044,000 units during the 12-month period of performance of this line item. The Contractor shall not perform above this maximum quantity. The Contractor shall notify the Government if and once it has reason to believe that the total number of units that are to be invoiced under this line item in the next succeeding 30 days is expected to exceed 85 percent of the maximum quantity of this line item, or 887,400 units. Any increase in the maximum quantity shall only be by mutual written agreement of the Contractor and Government Contracting Officer. See the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services.

The minimum guarantee is 775,200 units during the 12-month period of performance of this line item. This minimum guarantee was developed by multiplying the estimated minimum average number of active members anticipated during this option period by 12 months (64,600 members * 12 months = 775,200 PMPM units). To the extent that fewer than 775,200 units have been invoiced at the end of the 12-month period of performance of this line item, the Contractor is entitled to submit an invoice for any additional units adding up to the minimum guarantee.

For example, assuming that the unit price is $2.00 PMPM:

• At the end of the 12-month period of performance of this line item, there were 800,000 units invoiced, and the Contractor was paid $1,600,000.00. The minimum guarantee of 775,200 units has been met and the Contractor is not entitled to any further compensation beyond the $1,600,000.00.

• At the end of the 12-month period of performance of this line item, there were 700,000 units invoiced, and the Contractor was paid $1,400,000.00. The minimum guarantee of 775,200 units has not been met. The Contractor is entitled to submit an invoice for an additional 75,200 units to meet the 775,200 unit minimum guarantee. At the end of the 12-month period of performance, the Contractor would submit an invoice for 75,200 additional units and be paid $150,400.00, for a total compensation of $1,550,400.00 for the period of performance of this line item.

Any invoice for additional units the Contractor is entitled to submit to meet the minimum guarantee, if any, shall be determined by the Program and submitted by the Contractor after the 12-month period of performance of this line item is complete.

Additionally, see the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services, regarding changes to the minimum guarantee.

5 To develop the maximum quantity of 780,400 medical (to include dental) claims, the Government used its projection of estimated medical claims anticipated during this option period. This line item is to be invoiced monthly in arrears for the number of finalized medical claims sent through electronic data interchange (EDI) to the Centers for Medicare & Medicaid Services (CMS), or a designated contractor of CMS, in a given month as of the last day of such month. A finalized medical claim sent through EDI is defined as a medical claim submitted by a provider, including a corrected claim or claim appeal, that has completed adjudication (approved or denied) and has been sent to CMS or a designated CMS contractor for issuance of remittance advice (and, if approved, also the issuance of payment). This definition excludes claims that are reprocessed by the TPA Contractor solely as a result of an act, omission, or error of the TPA Contractor in processing the same claim previously.

The Contractor is required to finalize up to the maximum quantity of 780,400 medical claims during the 12-month period of performance of this line item. The Contractor shall not perform above this maximum quantity. The Contractor shall notify the Government if and once it has reason to believe that the total number of medical claims that are to be invoiced under this line item in the next succeeding 30 days is expected to exceed 85 percent of the maximum quantity of this line item, or 663,340 medical claims. Any increase in the maximum quantity shall only be by mutual written agreement of the Contractor and Government Contracting Officer. See the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services.

The minimum guarantee is 601,600 finalized medical claims during the 12-month period of performance of this line item. To the extent that fewer than 601,600 finalized medical claims have been invoiced at the end of the 12-month period of performance of this line item, the Contractor is entitled to submit an invoice for any additional units (medical claims) adding up to the minimum guarantee.

For example, assuming the unit price is $2.00 per finalized medical claim:

• At the end of the 12-month period of performance of this line item, there were 700,000 finalized medical claims invoiced, and the Contractor was paid $1,400,000.00. The minimum guarantee of 601,600 finalized medical claims has been met and the Contractor is not entitled to any further compensation beyond the $1,400,000.00.

• At the end of the 12-month period of performance of this line item, there were 600,000 finalized medical claims invoiced, and the Contractor was paid $1,200,000.00. The minimum guarantee of 601,600 finalized medical claims has not been met, and the Contractor is entitled to submit an invoice for an additional 1,600 medical claims to meet the 601,600 minimum guarantee. At the end of the 12-month period of performance, the Contractor would submit an invoice for 1,600 additional medical claims and be paid $3,200.00, for a total of $1,203,200.00 for the period of performance of this line item.

Any invoice for additional units the Contractor is entitled to submit to meet the minimum guarantee, if any, shall be determined by the Program and submitted by the Contractor after the 12-month period of performance of this line item is complete.

Additionally, see the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services, regarding changes to the minimum guarantee.

6 This CLIN may be converted to a firm-fixed-price CLIN through mutual written agreement of the Contractor and Government Contracting Officer. See the contract type conversion clause in Section C23.

Option Period 2 (9/15/2027 – 9/14/202810/30/2027 – 10/29/2028) Items:

EXTENDED

PRICE

2001 Contract management and regulatory compliance

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Sections 4.2 and

4.8 during the Sustainment phase, except ad hoc all-member and targeted letters under Section 4.2.5 which are included under CLIN 2011.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

Period of performance: 9/15/2027 – 9/14/202810/30/2027 – 10/29/2028.

2002 Member services: enrollment application processing

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes Section 4.3.1 during the Sustainment phase.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.7

EXTENDED

PRICE

2003 Member services: existing members

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.3 during the Sustainment phase, except Section 4.3.1.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.8

1,918,800 on members

2004 Provider network management exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.4 during the Sustainment phase, except NYMA EPN adoption under Section 4.4.1; initial NPN network development before SHCD under Section 4.4.2; and initial provider enrollment and credentialing under Section 4.4.3, all of which are performed during the Transition-In Period.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

EXTENDED

PRICE

2005 Medical benefits administration and policy

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.5 during the Sustainment phase, except Section 4.5.2.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

2006 Utilization management

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes Section 4.5.2 during the Sustainment phase.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.9

1,094,400 on active

2007 Claims processing exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.6 during the Sustainment phase.

Severability: Severable line item.

Contract type: Firm-fixed-unit-price, to be invoiced monthly in arrears.10

814,500

EXTENDED

PRICE

2008 Data and business information management

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes all tasks in Section 4.7 during the Sustainment phase, except Sections 4.7.5 and 4.7.6.

Severability: Severable line item.

Contract type: Firm-fixed-price. To be invoiced in arrears monthly in twelve equal installments.

2009 Data and information exchanges, integrity, and governance

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Includes Sections 4.7.5 and 4.7.6 during the Sustainment phase.

Severability: Severable line item.

Contract type: Time-and-materials line item.11

Labor to be invoiced in accordance with the labor categories and labor rates in the labor rates table, below.

EXTENDED

PRICE

2010 Travel

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Travel in support of Option Period 2.

Severability: Severable line item.

Contract type: Cost-only. All travel will be reimbursed at-cost in accordance with the Federal Travel Regulation, 41 C.F.R. Subtitle F.

The Contractor shall obtain written approval from the COR prior to undertaking any travel.

2011 Ad hoc all-member and targeted letters

This is an optional CLIN. This CLIN must be exercised by the Government prior to the TPA Contractor beginning work.

Description: Mail merge, printing, and mailing of ad hoc letters for all members or a targeted subset of the member population under Section 4.2.5. The Government will provide the content of these letters. This CLIN applies to the ad hoc letters described on page 1 of Attachment ATT008 (“the Communications and External Affairs Team [CEAT] estimates that approximately 5 all-member letters and 5 targeted member letters are sent out annually”). This CLIN does not include any of the enrollment letters, certification letters, or other letters, as described in Attachment ATT008.

Severability: Severable line item.

Contract type: Time-and-materials line item.11 Labor to be invoiced in accordance with the labor categories and labor rates in the labor rates table, Period of performance: 10/30/2027 – 10/29/2028.

7 To develop the maximum quantity of 9,500 enrollment applications, the Government used its projection for the estimated number of enrollment applications anticipated during this option period. This line item is to be invoiced monthly in arrears for the number of enrollment applications finalized in a given month as of the last day of such month. A finalized enrollment application is defined as an enrollment application submitted by the Contractor to the Program that has sufficient information for the Program to make an enrollment eligibility decision (e.g., Enroll, Deny, Defer). The determination of whether there is sufficient information is made by the Program and is based on the enrollment eligibility criteria described in the Program Administrative Manual, which is incorporated by reference herein as if fully set forth herein. The Program Administrative Manual is available at https://www.cdc.gov/wtc/ppm.html or any successor website. Enrollment applications that are determined by the Program to be incomplete (i.e., placed on Suspend) or duplicates of another enrollment application for the same unique individual are not considered finalized.

The Contractor is required to finalize up to the maximum quantity of 9,500 enrollment applications during the 12-month period of performance of this line item. The Contractor shall not perform above this maximum quantity. The Contractor shall notify the Government if and once it has reason to believe that the total number of enrollment applications that are to be invoiced under this line item in the next succeeding 30 days is expected to exceed 85 percent of the maximum quantity of this line item, or 8,075 enrollment applications. Any increase in the maximum quantity shall only be by mutual written agreement of the Contractor and Government Contracting Officer. See the clause in Section C24, Changes in the maximum quantity or minimum guarantee for firm-fixed-unit-price services.

The minimum guarantee is 6,500 enrollment applications. The minimum guarantee is defined both by the number of finalized enrollment applications (as such term is defined above) and the number of enrollment applications received by the Contractor but not yet finalized during the 12-month period of performance of this line item. An enrollment application that is received by the Contractor but not yet finalized means (1) an application submitted online and received in the Centralized Accessible Real-time Enterprise (CARE) Portal but does not have sufficient information for the Program to make an enrollment eligibility decision or has not yet been submitted to the Program, or (2) an application submitted through the Mail/Document Center that the Contractor has entered into the CARE Portal but does not have sufficient information for the Program to make an enrollment eligibility decision or has not yet been submitted to the Program. The Contractor is not paid for enrollment applications that are received by the Contractor but not yet finalized. Whether the minimum guarantee has been met will be determined, by the Program, using the following two-step procedure:

1. If the Contractor has finalized 6,500 or more enrollment applications during the 12-month period of performance of this line item, the minimum guarantee has been met.

2. If the Contractor has finalized fewer than 6,500 enrollment applications during the 12-month period of performance of this line item, the number of enrollment applications received by the Contractor but not yet finalized during the 12-month period of performance of this line item will then be added to the number of finalized enrollment applications during the 12-month period of performance of this line item.

a. If the total of finalized enrollment applications plus received-but-not-yet-finalized enrollment applications is 6,500 or more enrollment applications during the 12-month period of performance of this line item, the minimum guarantee has been met.

b. If the total of finalized enrollment applications plus received-but-not-yet-finalized enrollment applications is fewer than 6,500 enrollment applications during the 12-month period of performance of this line item, the Contractor is entitled to submit an invoice for any additional

Any invoice for additional units the Contractor is entitled to submit to meet the minimum guarantee, if any, shall be determined by the Program and submitted by the Contractor after the 12-month period of performance of this line item is complete.

For example, assuming that the unit price per enrollment application is $5.00:

• If the Contractor finalizes 8,000 enrollment applications during the 12-month period of performance of this line item, the minimum guarantee of 6,500 enrollment applications has been met and the Contractor is not entitled to any further compensation. The Contractor would be paid the unit price of $5.00 multiplied by 8,000 finalized enrollment applications, or $40,000.00.

• If the Contractor finalizes 6,000 enrollment applications during the 12-month period of performance of this line item, the Contractor would be paid the…