B-17995 - SPO Signed NOA - Mid-Central Medical - DHS-Fox - 11.24.20.pdf

Notice of Award Form

V.19.3 Page 1 of 2

Agency and Awarded Vendor Information

*Description: DME Medicare Vendor for Fox

*Bid Number: B-17995 *Agency: DHS

*Vendor Selected for Award: Mid-Central Medical

*Line Item Description:

Durable Medical Equipment Vendor for the Wm. W. Fox Developmental Center in Dwight, IL (FY21-FY23) Pricing is dictated by Medicare. Must be able to provide all items contained within Medicare's Durable Medical Equipment classification. Ability to deliver to Center. Ability to bill Medicare Part B on behalf of the individual.

Must provide Explanation of Benefits from Medicare to dictate the co-pay (Medicaid portion) owed by the Center. PLEASE PROVIDE QUOTE OF THE PERCENTAGE THAT YOU WILL CHARGE MABLEY CENTER AFTER RECEIPT OF THE PAYER (MEDICARE) CONTRACTED RATE. This contract will be awarded to the most responsive and responsible vendor who will accept the lowest percentage of the Medicare fee schedule price for the remaining balance.

*Award Amount: 600,000.00 *Length of Initial Term: 3 years *Length of available renewal options: (2) 1-year

Farm Leases and Concessions

Value to the State:

Estimated Financial Return to the State for the Life of the Contract (Includes Renewals)

Value to the Vendor:

Estimated Gross Revenue to the Vendor for the Life of the Contract (Includes Renewals)

Business Enterprise Program/Veterans Business Program

% of BEP Per Utilization Plan: 7 % of VBP Per Utilization Plan: 0

Other:

Unsuccessful Bidder(s)

*Number of Responding Bidders: 1 *Number of Unsuccessful Bidder(s) 0 *Number of Awarded Bidder(s): 1

Bidder(s)/Offeror(s) Not Selected:

Agency Contact

Contact Name: John Baumgartner Telephone Number: 217-557-9041

Email Address: john.baumgartner@illinois.gov Fax Number: 217-944-6044

V.19.3 Page 2 of 2

Street Address: 401 N. 4th St. City: Springfield

State: Il Zip Code: 62702

SPO Written Determination for Contract Award Decision

General - Applies to Emergencies, Split Awards, Award to Other than Lowest Responsible and Responsive Bidder. The Rationale described by the purchasing agency in the recommendation to award seems reasonable, and serves as the basis for the contract decision.

Invitation for Bid - The contract was procured through the Invitation for Bid Process, and the contract has been awarded to the lowest priced responsive and responsible bidder.

Request for Proposal - Based on factors set forth in the Request for Proposal, the contract has been awarded to the offeror whose proposal is most advantageous to the State.

Renewal - The contract is a renewal in accordance with the terms of the existing contract. The award decision is based on justification presented by the purchasing agency's justification.

Comments:

Other:

Explanation of other terms:

SPO Signature: Date: Nov 24, 2020

V.19.3 Page of Agency and Awarded Vendor Information Farm Leases and Concessions Estimated Financial Return to the State for the Life of the Contract (Includes Renewals) Estimated Gross Revenue to the Vendor for the Life of the Contract (Includes Renewals) Business Enterprise Program/Veterans Business Program Unsuccessful Bidder(s) Bidder(s)/Offeror(s) Not Selected:

Agency Contact SPO Written Determination for Contract Award Decision 11.0.0.20130303.1.892433.887364