Amendment_000005_HHSM-500-2015-RFP-0113.pdf

(x)

HHSM-500-2015-RFP-0113

x x copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted , such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

AGG/EB

Contract Specialist Eisha Banks

ASG - DPIFMC

BALTIMORE MD 21244-1850

7500 SECURITY BLVD., MS: B3-30-03

CMS,OAGM,ASG,DPIFMC

06/11/2015000005

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended , by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

05/06/2015

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This amendment revises the following solicitation section:

1.) B.2 Schedule and Services

Period of Performance: 09/15/2015 to 09/14/2020

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

AMY DUCKWORTH

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect .

HHSM-500-2015-RFP-0113 Medical Claims Review for Managed Care Organizations Amendment 000005

1.) This amendment revises (in bold) Section B.2 Schedule of Services as follows:

SECTION B – SUPPLIES OR SERVICES AND PRICES/COSTS

B.2 Schedule of Services

CLIN- Description Estimated Quantity FFP Per Claim Estimated Total

CLIN 0001- Claim Review Base Period 4,550 $ $ CLIN 0002 – Travel Base Period Not-to-Exceed $40,000.00 CLIN 1001- Claim Review Option Year 1 5,600 $ $ CLIN 1002 – Travel Option Year 1 Not-to-Exceed $40,000.00 CLIN 2001- Claim Review Option Year 2 7,350 $ $ CLIN 2002 – Travel Option Year 2 Not-to-Exceed $40,000.00 CLIN 3001- Claim Review Option Year 3 5,250 $ $ CLIN 3002 – Travel Option Year 3 Not-to-Exceed $40,000.00 CLIN 4001- Claim Review Option Year 4 6,650 $ $ CLIN 4002 – Travel Option Year 4 Not-to-Exceed $40,000.00

TOTAL 29,400 $

Please note that the quantities of supplies or services specified in the Schedule are estimates only and are not purchased by this contract. Except as this contract may otherwise provide, if the Government’s requirements do not result in orders in the quantities described as “estimated’’ or “maximum” in the Schedule, that fact shall not constitute the basis for an equitable price adjustment. The government reserves the right to increase the total number of Claims Reviewed up to 8000 for each period.

Task Orders: A task order will be issued against the Indefinite Delivery Requirements contract using a subCLIN for each Managed Care Organization (MCO) and the number of claims to be reviewed. If the MCO has multiple years, they will be separately listed. For example, Task Order 0001 is issued for the medical review of claims for three different MCOs:

subCLIN MCO Number of

Claims Fixed Price Per

Claim Total

0001AA

XYZ Corp, #123 Year 2012 - 2013 700 $50.00 $35,000.00

0001AB ABC Inc, #222 350 $50.00 $17,500.00

HHSM-500-2015-RFP-0113 Medical Claims Review for Managed Care Organizations Amendment 000005

Year 2013

0001AC

TTT LLC, #555

Year 2012 - 2014 1,000 $50.00 $50,000.00

0002 Travel NTE $40,000.00

GRAND TOTAL $142,500.00

For each subCLIN the contractor will be paid against the total subCLIN price based on the payment schedule in Section B.3.

Example:

SubCLIN

MCO

Contract

Year Plan Name

Installment Payment #1:

Upon COR approval of

Project Management

Plan 10%

Installment Payment #2:

Upon COR approval of Sampling

Plan 15%

Installment Payment #3:

Upon completion of Fieldwork and

Preliminary List of Exceptions Submitted to

MCO

25%

Installment Payment #4:

Upon COR

Approval of each Draft Report

30%

Installment Payment #5:

Upon COR approval of each Final Report with

ALL work-papers Submitted

20%

Total Amount

0001AB 222 2013

ABC,

Inc. $1,750.00 $ 2,625.00 $4,375.00 $ 5,250.00 $3,500.00 $17,500.00

End of Amendment