B-48471 Mabley DME Vendor Specifications and Requirements FY26-FY28~3.docx

DME SPECIFICATIONS & REQUIREMENTS:

IDHS/Jack Mabley Developmental Center

25-444DHS-DEVDI-B-48471

Brief Description:

The Illinois Department of Human Services supports strategic initiatives throughout the State of Illinois designed to increase the availability, accessibility and/or quality of life and public services for Illinois families. Medical care and medical services are required by regulatory and statutory codes. This request for quote (RFQ) is issued by the Illinois Department of Human Services, Division of Developmental Disabilities to secure a Medicare Part B primary Durable Medical Equipment vendor to conduct services and maintenance to the Illinois Department of Human Services, Division of Developmental Disabilities.

This contract will be awarded to the Vendor who charges the lowest percentage of the Medicare fee schedule price to the State. Due to the critical nature of the goods and services required under this contract, failure to the meet the any of the mandatory contract terms may force the State to pursue a different Vendor for these services.

The Mandatory Contract Term Agreements and Vendor Certifications listed below must be completed and submitted as part of your quote to be eligible for this contract.

CONTRACT TERM - The desired contract term is date of execution to 06/30/28

SUPPLIES AND/OR SERVICES REQUIRED:

The Vendor shall provide Durable Medical Equipment (DME) under Medicare Part B regulations to the Illinois Department of Human Services, Division of Developmental Disabilities -

MANDATORY CONTRACT TERMS

(Vendor shall check each box verifying agreement with these mandatory contract terms)

VENDOR AGREEMENT (Vendor will indicate agreement by entering YES/NO)

The Vendor will provide products and services that are eligible under the Medicare Part B Rules and Regulations. Only Medicare Part B products and services requested by the Centers shall be provided. Other products and services may be added by mutual agreement of the State and the Vendor. Vendor shall refer to the most recent CMS DMEPOS fee schedule which is located at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html.

In payment for the DME and all related services included herein, the Vendor will accept the assignment of benefits under Medicare Part B – DME and submit claims to Medicare Part B on behalf of the individual receiving services for the price set on the Medicare fee schedule.

Vendor shall bill IDHS for the agreed upon percentage of Price, where Price is set in the Medicare Fee Schedule. The amount billed to the State will not be greater than the difference between the Medicare fee schedule price and the reimbursement made by Medicare. Vendors should enter the percentage of price they are willing to accept in the space below.

Vendor shall bill IDHS for the annual deductible as applied by Medicare to the secondary insurance.

The Vendor shall deliver products to the Center, with products identified for each individual served who is the recipient of these products.

The Vendor will provide enteral products specified by the physician’s order, e.g. can or bottle and size of unit requested. The Contractor will supply Enteral Feeding Pumps and supplies needed for the pumps at no cost to the Centers or the individuals. All pumps provided shall be the same model and training is to be provided to the Center on the use of the pumps.

The Vendor shall deliver only specified product brands. Exceptions can be made if mutually agreed to; if a specified brand is not available, and the substitution will not endanger the health and well-being of the individuals the Centers serve. Consent by the Center must be attained for any exception of this type.

The Vendor shall be responsible for supplying and initiating the following list of forms which must be approved by the Center before use:

A. Resident Information Form and/or Authorization for Release of Information – A signed resident information form or authorization for release of information will be completed specifically for releasing assignment of benefits used to bill Medicare Part B or other third-party payer. This form is to be completed before any shipment of products.

B. Certificate of Medical Necessity or Prescription signed and dated by the attending physician.

C. Delivery Ticket – A delivery ticket listing all items delivered to the facility is to be included with each shipment of products. This list shall have an individual listing of products delivered to each individual.

D. Monthly Order Listing – A listing shall also be sent monthly to the Center listing all individuals receiving products as well as the quantity of each product.

E. Client Service Agreement when required by Medicare.

The Vendor will visit the Center as needed to clear up any problems or concerns.

The Vendor shall contact the designated person(s) at the Center monthly to review the individuals’ requirements and adjust order quantities to meet those requirements.

The Vendor will honor all warranties, express or implied. The Vendor shall provide a sufficient supply of loaner Durable Medical Equipment to replace any defective equipment while the defective equipment is being repaired or replaced by the manufacturer. The Vendor will supply a DME equipment loan within 24 hours of being notified. The Vendor will make arrangements with the Center to pick up any defective equipment.

At any time during this contract, should Medicare implement bid zones for any DME items, this contract is void for that item.

Vendor certifies that they are certified with Medicare as a DME Vendor.

Vendor accepts the assignment of benefits under Medicare Part B – DME

VENDOR: PLEASE ENTER THE PERCENTAGE OF THE MEDICARE FEE SCHEDULE PRICE THAT YOU WILL CHARGE THIS CENTER IF AWARDED THE CONTRACT FOR 25-444DHS-DEVDI-B-48471 :

****Vendor shall offer the same discount to Medicare as offered in this bid to the state, as applicable

Vendor Name: ________________________________________________________

Vendor Authorized Representative Signature: ______________________________

Date: ____________________