Atch1_36C25522Q0099_CSS_SleepStudies_Price_Schedule.pdf

Combined Synopsis-Solicitation for Commercial Items Request for Quotation (RFQ) 36C25522Q0099

ATTACHMENT 1: PRICE SCHEDULE

BASE YEAR

LINE ITEM

NO.

DESCRIPTION OF

SUPPLIES/SERVICES

ESTIMATED

QUANTITY UNIT UNIT PRICE AMOUNT

1.00 Not Priced

On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2022 POP End: 01-31-2023

0001AA

600.00 EA $____________ $____________

CMS CPT 95800 – Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study – Completed and Scored.

0001AB

60.00 EA $____________ $____________

CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study – Unable to Complete Scoring.

Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.

0002AA

10.00 EA $_____________ $____________

Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

8:00 a.m. to 4:30 p.m.

0002AB

3.00 EA $_____________ $____________

Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.

Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation 4:30 p.m. to 8:00 a.m.

0003AA

150.00 EA $_____________ $____________

Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

0003AB

50.00 EA $_____________ $____________

Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study

– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

0003AC

100.00 EA $_____________ $____________

Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

0003AD

55.00 EA $_____________ $____________

Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

0003AE

75.00 EA $_____________ $____________

Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

0003AF

Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated 178 incomplete/failed studies this period of performance.

BASE YEAR ESTIMATED TOTAL $____________

OPTION YEAR ONE (1)

LINE ITEM

NO.

DESCRIPTION OF

SUPPLIES/SERVICES

ESTIMATED

On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2023 POP End: 01-31-2024

1001AA

1001AB

CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score

Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.

1002AA

Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

1002AB

Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.

Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation

1003AA

Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

1003AB

Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study

– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

1003AC

Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

1003AD

Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

1003AE

Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

1003AF

Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated

OPTION YEAR 1 ESTIMATED TOTAL $____________

OPTION YEAR TWO (2)

NO.

DESCRIPTION OF

SUPPLIES/SERVICES

ESTIMATED

On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2024 POP End: 01-31-2025

2001AA

2001AB

CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score

Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation

8:00 a.m. to 4:30 p.m.

2002AA

Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

2002AB

Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.

Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation

2003AA

Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

2003AB

Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study

– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

2003AC

Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

2003AD

Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

2003AE

Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

2003AF

Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated

OPTION YEAR 2 ESTIMATED TOTAL $____________

OPTION YEAR THREE (3)

LINE ITEM

NO.

DESCRIPTION OF

SUPPLIES/SERVICES

ESTIMATED

On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2025 POP End: 01-31-2026

3001AA

3001AB

CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score

Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.

3002AA

Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

3002AB

Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.

Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation

3003AA

Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

3003AB

Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study

– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

3003AC

Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

3003AD

Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

3003AE

Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

3003AF

Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated

OPTION YEAR 3 ESTIMATED TOTAL $____________

OPTION YEAR FOUR (4)

NO.

DESCRIPTION OF

SUPPLIES/SERVICES

ESTIMATED

On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2026 POP End: 01-31-2027

4001AA

4001AB

CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score

Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.

4002AA

Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

4002AB

Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.

Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation

4003AA

Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

4003AB

Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study

– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

4003AC

Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

4003AD

Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

4003AE

Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.

4003AF

Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.

Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated

OPTION YEAR 4 ESTIMATED TOTAL $____________

Estimated Total Quantity – All five (5) periods of performance – estimated 5,565 studies - estimated 4,675 completed studies and estimated 890 incomplete/failed studies.

ESTIMATED GRAND TOTAL ALL PERIODS OF PERFORMANCE $_________________

FAR 52.217-9 (Option Years 1, 2, 3 and 4) may be exercised at the sole discretion of the Government.

FAR 52.217-8 may be exercised at the sole discretion of the Government.

ATTACHMENT 1: PRICE SCHEDULE