EXHIBIT D - Rate Proposal Form.pdf
PDF 263 KB Posted
- Attached to
- Parenteral Products, Services and Equipment
- Solicitation number
- RFQQ K13020
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
About this file
This is a Cost Proposal Form (Exhibit D) for Washington State Department of Corrections RFQQ K13020 soliciting bids for Parenteral Products, Services, and Equipment, specifically Total Parenteral Nutrition (TPN) and Peripheral Parenteral Nutrition (PPN) solutions along with other intravenous products and controlled substances. Bidders may submit pricing proposals for all regions or individual regions, which include: West Region (Stafford Creek Correction Center, Washington Correction Center), Central Region (Clallam Bay Corrections Center, Monroe Correctional Complex, Washington Correction Center Women), and East Region (Airway Heights Correction Center, Coyote Ridge Correction Center, Washington State Penitentiary). The cost proposal must break down total costs by Healthcare Common Procedure Coding System (HCPCS) code, with separate itemization for bag costs versus related costs such as per diem rates and delivery charges. The initial contract term is two years with provisions for subsequent term extensions.
Bidders must provide comprehensive pricing inclusive of all personnel, materials, administrative, and delivery costs, with no charges exceeding the total costs identified in the RFQQ. For TPN and PPN solutions, pricing must be categorized by solution volume (1 liter, greater than 1 liter to 2 liters, greater than 2 liters to 3 liters, and greater than 3 liters). For all other IV products including controlled substances, bidders must explicitly state prescription and intravenous medication rates expressed as a formula (e.g., Average Wholesale Price minus X percent) and may propose equipment pricing such as self-administration devices. The proposal must identify all available discounts to the Department, including those for bulk purchases, extended delivery windows of 48 hours instead of 24 hours, and prompt payment incentives. Proposed rates must remain fixed throughout the entire initial two-year contract term, and bidders must specify their cost escalation rate for any subsequent term extensions.
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Text version
Washington State RFP K13020 Page 1 of 4 Department of Corrections Exhibit D 26RCP
EXHIBIT D
COST PROPOSAL FORM
TPN & PPN Services
Bidder must submit pricing by completing the Cost Proposal Form (EXHIBIT D). Bidder may bid on all regions or each region individually. Bidder’s cost proposal must provide the total cost for each mixture/ service by each HCPCS code. The cost must also be broken out between the bag and other costs if any (e.g., per diem rates). Under no circumstances will DOC pay a cost greater than the total cost identified in this RFQQ.
Total cost shall be inclusive and factor in all personnel, materials, administrative, and delivery costs, as well as any other expenses necessary for Bidder to accomplish the tasks and to produce the products/services/equipment required under this RFQQ. Bidder’s cost proposal must indicate any discounts available to the DEPARTMENT and the amount of any such discounts. Discounts may include, but are not limited to, savings for:
purchase of more than 1 PN bag at a time;
for less urgent deliveries allowing delivery within 48 instead of 24 hours;
prompt payment
The rates proposed by the successful bidder bust remain in effect throughout the entire initial two-year contract term. DOC will not review or consider any Bidder cost or pricing information in any other portion of the Bid. EXHIBIT I provides a list of statewide facility locations by region.
WEST
(Stafford Creek Correction Center, Washington Correction Center)
Therapy HCPCS Code Total cost by HCPCS code (break out by bag vs related cost and discounts)
EXAMPLE S9365 $100.00
TPN & PPN ≤ 1 liter of solution
TPN & PPN > 1 liter – 2 liters
TPN & PPN > 2 liters – 3 liters
TPN & PPN > 3 liters
Washington State RFP K13020 Page 2 of 4
CENTRAL
(Clallam Bay Corrections Center, Monroe Correctional Complex, Washington Correction Center Women)
Therapy HCPCS Code Total cost by HCPCS code (break out by bag vs related cost and discounts)
EXAMPLE S9365 $100.00
TPN & PPN ≤ 1 liter of solution
TPN & PPN > 1 liter – 2 liters
EAST
(Airway Heights Correction Center, Coyote Ridge Correction Center, Washington State Penitentiary)
Therapy HCPCS Code Total cost by HCPCS code (break out by bag vs related cost and discounts)
EXAMPLE S9365 $100.00
TPN & PPN ≤ 1 liter of solution
TPN & PPN > 1 liter – 2 liters
Washington State RFP K13020 Page 3 of 4
ALL OTHER IV PRODUCTS, INCLUDING CONTROLLED SUBSTANCES
Bidder’s cost proposal must provide the total cost for each by each HCPCS code. The cost must be broken out between the medication and other costs if any (e.g. per-diem rates). Under no circumstances will
DOC pay a cost greater than the total cost identified in this RFQQ.
Total cost shall be inclusive and factor in all personnel, materials, administrative, and delivery costs, as well as any other expenses necessary for Bidder to accomplish the tasks and to produce the deliverables required under this RFQQ. Additionally, the Bidder will propose a prescription and intravenous medication rate (e.g., AWP minus X%) for each IV product provided. Bidder’s cost proposal must indicate any discounts available to the DEPARTMENT and the amount of any such discounts. Discounts may include, but are not limited to, savings for:
purchase of more than one bag at a time;
for less urgent deliveries allowing delivery within 48 instead of 24 hours;
prompt payment
The per diem rate and medication rates must remain in effect throughout the entire initial two-year contract term. DOC will not review or consider any Bidder cost or pricing information in any other portion of the
Bid. Bidder may only propose non-PN products for the regions proposed in the PN section above.
WEST
(Stafford Creek Correction Center, Washington Correction Center)
Therapy HCPCS Code Total cost by HCPCS code (break out by bag vs related cost and discounts). The prescription and intravenous medication rate must be explicitly stated (e.g., AWP minus X%). If equipment is available (e.g.
self-administration), please list this pricing as well.
EXAMPLE S9365 $100.00
Washington State RFP K13020 Page 4 of 4
CENTRAL
(Clallam Bay Corrections Center, Monroe Correctional Complex, Washington Correction Center Women)
Therapy HCPCS Code Total cost by HCPCS code (break out by bag vs related cost and discounts). The prescription and intravenous medication rate must be explicitly stated (e.g., AWP minus X%). If equipment is available (e.g.
EAST
(Airway Heights Correction Center, Coyote Ridge Correction Center, Washington State Penitentiary)
Medication HCPCS Code Total cost by HCPCS code (break out by bag vs related cost and discounts). The prescription and intravenous medication rate must be explicitly stated (e.g., AWP minus X%). If equipment is available (e.g.
Cost Escalation Rate
Bidder must identify their cost escalation rate for each subsequent term extension in the space below:
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