ATAMMC ACC Special Clause - Contract Per Member Per Month rates.pdf
PDF 113 KB Posted
- Solicitation number
- HT0015-24-RFI-ATAMMC
- Issued by
-
Defense Health Agency
About this file
This document outlines a special clause regarding contract per member per month rates for a federal contract opportunity. The clause stipulates that the government will pay the contractor a per member per month rate under a specific contract line item number. This rate encompasses costs for primary care, urgent care, ancillary services, administrative functions, and other work statement requirements. To determine the monthly payment amount, the government will provide the number of enrolled beneficiaries and the number of those enrolled who are empaneled to contractor or government primary care managers. The contractor can invoice the full per member per month rate for beneficiaries empaneled to actively providing contractor or government primary care managers, up to a 1,300 beneficiary limit per full-time equivalent provider. Beneficiaries exceeding that limit or empaneled to suspended providers are considered "ghost empaneled" and not eligible for the full rate. The contractor can invoice 75% of the per member per month rate for non-empaneled beneficiaries.
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Other files
| File | Type | Posted |
|---|---|---|
| ATAMMC ACC RFI Feedback update 1 20231017 V2.xlsx | XLSX spreadsheet | |
| ATAMMC ACC RFI Feedback update 1 20231017.xlsx | XLSX spreadsheet | |
| ATAMMC ACC CLINS.pdf | ||
| ATAMMC_PWS.pdf | ||
| ATAMMC ACC Exhibit B Performance Requirements Summary.pdf | ||
| ATAMMC ACC RFI_20231004.pdf | ||
| ATAMMC ACC Exhibit C - Laboratory Services.pdf | ||
| ATAMMC ACC RFI Feedback 20231004.xlsx | XLSX spreadsheet | |
| ATAMMC ACC Exhibit D- Radiology.pdf |
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Text version
Special Clause: Contract Per Member Per Month (PMPM) Rates
The Government’s PMPM payment to the Contractor under CLIN XXXX encompasses all facility-related requirements and costs (PWS 5.25), administrative costs (PWS 5.3, 5.4, 5.5, 5.16.11) and the Performance Work Statement (PWS) requirements associated with the following services:
1. Primary Care (PWS 5.16.2) (all costs)
2. Urgent Care (PWS 5.16.6) (all costs)
3. Ancillary Services (Radiology, Laboratory, and Pharmacy) (PWS 5.16.7) (all costs)
The amount of the Government’s monthly PMPM payment to the Contractor under CLIN XXXX will be determined based on (a) the number of beneficiaries enrolled to the ACC(s) on the last day of the given month and (b) the extent to which those enrolled beneficiaries are empaneled to contractor or government primary care managers (PCMs) on the last day of the given month.
The Contractor will calculate its monthly PMPM CLIN invoice amount based on enrollment and empanelment information provided by the Government, as follows: First, the Government will provide the Contractor a DEERS Enrollment Report documenting the number of beneficiaries enrolled to the ACC(s) on the last day of the month. Second, the Government will provide the Contractor with a DEERS Enrollment Report documenting the number of enrolled beneficiaries who are empaneled to a contractor or government primary care manager on the last day of the month. Third, the Government and the Contractor will then mutually determine, applying the stipulations addressed in the following paragraph, the number of beneficiaries who were empaneled to contractor and government PCMs who were actively providing services at the ACC(s) on the last day of the month.
For purposes of determining the number of beneficiaries empaneled to contractor PCMs actively providing services at the ACC, the Government will enforce an empanelment limit of 1300 enrollees to one (1) FTE PCM. If any contractor PCM is assigned more than 1300 empaneled beneficiaries as of the last day of the month, then the number of empaneled beneficiaries for that provider exceeding 1300 will be considered not empaneled. Any beneficiaries who are not empaneled to a PCM or who are empaneled to a PCM who is no longer actively providing services at the ACC will be considered “ghost empaneled,” and thus not empaneled for purposes of this clause. If a PCM has been suspended (see PWS 5.15.3), then that PCM will be considered as no longer actively performing services at the ACC, and any beneficiaries assigned to that PCM will be considered “ghost empaneled.” Any enrollee who is empaneled to a government primary care manager will be considered empaneled for payment purposes.
The Contractor may invoice the Government for the full per member per month (PMPM) rate specified in the contract (see CLIN XXXX) for the number of beneficiaries who are empaneled to contractor or government PCMs who are actively providing services at the ACC. The contractor may invoice the Government 75% of the PMPM rate specified in the contract for the number of beneficiaries who are not empaneled to a contractor PCM who is actively providing services at the ACC.
Special Clause: Contract Per Member Per Month (PMPM) Rates
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