Amendment_1-75FCMC18R0040.pdf

(x)

75FCMC18R0040

x x copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT 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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

AGG/DT

410-786-8163 Contracting Specialist Danielle Tapp

MSCG - DMPC

BALTIMORE MD 21244-1850

7500 SECURITY BLVD., MS: B3-30-03

CMS,OAGM,MSCG,DMPC

MAC19001011/15/20180001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

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

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

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

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

11/15/2018

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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

ORDER NO. IN ITEM 10A.

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

The purpose of this amendment is to:

1. Update the following RFP Sections:

• H.18, System of Records

• L.12.2, Volume II, TAB B, Basis of Estimate

(BOE)

• L.14.3, Volume IV, TAB C, Written Narrative and Other than Cost or Pricing Data

2. Delete and Replace the following RFP

Attachments:

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

Mohammed Islam

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

Previous edition unusable

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

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 4

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75FCMC18R0040/0001

• Attachments J.22, Basis of Estimate

3. Answer Offeror's questions in response to the solicitation.

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

75FCMC18R0040 A/B MAC Jurisdiction 5

Amendment 0001

A. RFP Section H.18, System of Records, is hereby amended to include additional applicable

Systems of Record:

FROM: The Privacy Act of 1974, Public Law 93-579, and the Regulations and General

Instructions issued by the Secretary pursuant thereto, are applicable to this contract, and to all subcontractors there under to the extent that the design, development, operation or maintenance of a system of records as defined in the Privacy Act is involved. The following system of records will be applicable to this contract and made available to the Contractor:

Common Working File (CWF)

System Record Number: 09-70-0526

Intern and Resident Information System (IRIS)

System Record Number: 09-70-0524

Provider Enrollment Chain and Ownership System (PECOS)

System Record Number: 09-70-0532

Fiscal Intermediary Shared System (FISS)

System Record Number: 09-70-0503

Medicare Multi-Carrier Claims System (MCS)

System Record Number: 09-70-0501

TO: The Privacy Act of 1974, Public Law 93-579, and the Regulations and General

Instructions issued by the Secretary pursuant thereto, are applicable to this contract, and to all subcontractors there under to the extent that the design, development, operation or maintenance of a system of records as defined in the Privacy Act is involved. The following system of records will be applicable to this contract and made available to the Contractor:

Common Working File (CWF)

System Record Number: 09-70-0526

Intern and Resident Information System (IRIS)

System Record Number: 09-70-0524

Provider Enrollment Chain and Ownership System (PECOS)

System Record Number: 09-70-0532

Fiscal Intermediary Shared System (FISS)

System Record Number: 09-70-0503

Medicare Multi-Carrier Claims System (MCS)

75FCMC18R0040 A/B MAC Jurisdiction 5

Amendment 0001

System Record Number: 09-70-0501

Medicare Appeals System (MAS)

System Record Number: 09-70-0566

Individuals Authorized Access to CMS Computer Services (IACS)

System Record Number: 09-70-0538

Medicare Integrated Data Repository (IDR)

System Record Number: 09-70-0571

B. RFP Section L.12.2, Volume II, TAB B, Basis of Estimate (BOE), is hereby amended to correct an administrative error to the version of Excel to be used:

FROM: The BOE must be completed using Excel format (2010 version). Offerors should only provide an electronic submittal of Attachment J.22 with its DVD/CD-ROM submission. Offerors are not required to submit hard copies of Attachment J.22.

TO: The BOE must be completed using Excel format (2013 version). Offerors should only provide an electronic submittal of Attachment J.22 with its DVD/CD-ROM submission. Offerors are not required to submit hard copies of Attachment J.22.

C. RFP Section L.14.3, Volume IV, TAB C, Written Narrative and Other than Cost or Pricing

Data, is hereby amended to update:

FROM: The Offeror must submit the following information applicable to each CLIN

(Implementation, Base Year, and Option Years) J5. The below must also be submitted for each proposed cost-reimbursement type (i.e. CPFF, CPAF, T&M, etc.) subcontractor. Subcontractor data or information considered proprietary and/or confidential to the subcontractor may be submitted in a separately sealed package.

TO: The Offeror must submit the following information applicable to each CLIN

(Implementation, Base Year, and Option Years). The below must also be submitted for each proposed cost-reimbursement type (i.e. CPFF, CPAF, T&M, etc.) subcontractor. Subcontractor data or information considered proprietary and/or confidential to the subcontractor may be submitted in a separately sealed package.

END OF MODIFICATION