RFP_Att_A_ATAMMC_ACC_Pricing Matrix (Attachment A)_v2.xlsx

XLSX spreadsheet 53 KB Posted

Attached to
AT Augusta Military Medical Center Ambulatory Care Center (ATAMMC ACC)
Solicitation number
HT001524R0030
Issued by

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Written by GovTribe AI ·

This pricing matrix template requests proposed pricing for medical services to support the AT Augusta Military Medical Center Ambulatory Care Center contract opportunity. Offerors must provide billing unit costs and proposed pricing for a variety of primary care, specialty care, ancillary, and administrative services over the potential five-year ordering period. Pricing is required for both TRICARE enrolled beneficiaries as well as non-enrolled patients, with per-member per-month rates calculated for enrolled population. The template also requires proposed pricing for supplies, equipment maintenance, utilities, and MRI leasing costs. The related federal contract opportunity is solicitation number HT001524R0030 for ambulatory care services at ATAMMC ACC through the Defense Health Agency.

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Other files

File Type Posted
HT0015-23-R-0030 0002.pdf PDF
Exhibit V_ATAMMC Drive Time.pdf PDF
Exhibit W_DMHRSI_Factsheet.pdf PDF
RFP_Att_F_QandA_ATAMMC ACC_12.11.23 (Attachment F).pdf PDF
Exhibit T_Enrollment Data By Age.xlsx XLSX spreadsheet
Exhibit U_MHS Genesis RM 2.0 Referral Management Guide.pdf PDF
ATAMMC_PWS_12.14.23.pdf PDF
HT0015-23-R-0030 0001.pdf PDF
RFP_Att_C_ATAMMC_ACC_Small Business Participation Plan (Attachment C)_v2.docx DOCX document
Exhibit R - JOES_Survey_Adult_202309_Child_202309.pdf PDF
HT001524R0030 ACC RFP.pdf PDF
Exhibit P-1 - NCR Market Branding ID Guidelines v4.pdf PDF
Exhibit AA-2 Historical Workload Data.xlsx XLSX spreadsheet
Exhibit I - DHA FY23 Annual Training List.pdf PDF
Exhibit J - Government Furnished Equipment.pdf PDF
RFP_Att_D_ATAMMC_ACC_Past Performance Questionnaire (Attachment D).docx DOCX document
Exhibit D - Radiology.pdf PDF
RFP_Att_C_ATAMMC_ACC_Small Business Participation Plan (Attachment C).docx DOCX document
Exhibit M-1 - ATAMMC CME Requirements.pdf PDF
Exhibit E - Credentialing Checklist.pdf PDF
Exhibit N - NCR Standardized Medical Staff Bylaws.pdf PDF
Exhibit C - Laboratory Services.pdf PDF
Exhibit K - Clinical Personnel Education and Training Requirements.pdf PDF
Exhibit S - Skill Types.pdf PDF
ATAMMC_PWS_FINAL.pdf PDF
Exhibit H - DHA Physical Security Checklist.pdf PDF
Exhibit F - Immunization Form.pdf PDF
Exhibit G - Site Security Criteria.pdf PDF
Exhibit O - Personnel Security.pdf PDF
RFP_Att_A_ATAMMC_ACC_Pricing Matrix (Attachment A).xlsx XLSX spreadsheet
Exhibit AA-3 - Wage Determination no.2015-4281 rev. 25.pdf PDF
Exhibit Q - Health Plan Employer Data and Information Set (HEDIS).pdf PDF
Exhibit M-2 - Credentials Management Policy (2018).pdf PDF
Exhibit AA-4 MGMA Encounter Requirements.pdf PDF
RFP_Att_B_ATAMMC_ACCs_Compensation_Plan (Attachment B).xlsx XLSX spreadsheet
Exhibit L - Fill-Vacancy Report.pdf PDF
Exhibit P-2 - ATAMMC logo_color.pdf PDF
RFP_Att_E_ATAMMC_ACC_QandA form (Attachment E).xlsx XLSX spreadsheet
Exhibit B Performance Requirements Summary.pdf PDF
Exhibit A - Beneficiaries Enrollment and Zip Code Data_7.10.23.pdf PDF
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Instructions

Instructions to Offerors:
1. Pricing Matrix
2. For the Base Year tab, populate cell B1 with your company name. It will autopopulate the remaining tabs.
3. For all services required in the PWS, add your proposed Billing Unit Cost in Column D, it will automatically calculate in Column E.
4. Admin transition costs (Base Year Only) are described in PWS paragraph 1.7.1.2 and are only for non-incumbent offerors (unless the incumbent proposes to use new facilities). Admin transition costs do NOT include Facility acquisition/leasing, designing, updating, remodeling, refurbishing costs, etc. (See PWS 1.7.1.3.) Non-incumbent offerors (or if incumbent proposes to use new facilities) should amortize all Facility Transition Requirement costs into their base year and option year PMPM rates, recognizing that the base year will include up to a 9-month transition period before health care delivery (and application of base year PMPM rates) begins.

*Base Year rates (other than Admin Transition Costs) for a non-incumbent will apply only to the extent the transition period is less than 1 year.

5. Verify your math is correctly computed.
6. Do not add or delete columns or rows and do not change the order of columns or rows.
7. B32:B35 on all tabs are for COST CLINs only and do not require offeror input.
Per Member Per Month is for ACC enrolled beneficiares for labor only (no supplies) when healthcare delivery starts for the following services:
•Primary Care, Urgent Care, Laboratory, and Radiology (enrollees only)
•Leasing (buildings, if applicable, not MRI equipment costs)
•Administrative FTEs
•Facility-related costs incurred during the transition period must be amoritized over the life of the contract except base year admin costs (if needed) (see item 4 above)

Base Year

Company Name
Fee for Service/Hours worked/Hours PaidQUANTITY (EST)BILLING UNITPRICE PER BILLING UNITEXT PRICENote
Per Member Per Month540000BENEFICIARIES$ - 0Rate per enrollee per month for 45K beneficiaries see PWS PMPM Clause (multiply 45K by 12 for the yearly cost-EXT PRICE)
Non enrollee cost per person-urgent care or primary care10524EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-lab8657EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-rad2876EACH$ - 0Non-enrollee Visit
Pharmacy Prescriptions Per Year576409EACH$ - 0Prescriptions
Admin Transition Costs (Base Year Only)1JOB$ - 0Only for non-incumbent offerors
Dermatology - Provider3374HOURS$ - 0
Dermatology- Support staff6849HOURS$ - 0
Optometry - Optometrist3374HOURS$ - 0
Optometry - Support Staff8503HOURS$ - 0
Ortho- PA3374HOURS$ - 0
Ortho- Support Staff8941HOURS$ - 0
Podiatry - Provider3374HOURS$ - 0
Podiatry - Support Staff6512HOURS$ - 0
Sports Medicine - Provider3374HOURS$ - 0
Sports Medicine - Support Staff8941HOURS$ - 0
Dietician3374HOURS$ - 0
Obstetrics- Provider6748HOURS$ - 0
Obstetrics- Support Staff10054HOURS$ - 0
OB On-Call1248HOURS$ - 0
OB In-House1248HOURS$ - 0
Physical Therapy - Provider10122HOURS$ - 0
Physical Therapy - Support Staff17917HOURS$ - 0
Occupational Therapy - Provider3374HOURS$ - 0
Occupational Therapy - Support Staff6478HOURS$ - 0
Immunization Clinic- Staff10122HOURS$ - 0
BH - Support Staff39680HOURS$ - 0
TOTAL HOURS166,981$ - 0
Medical Supplies$ 2,594,118COST ONLY
Equipment Mx$ 1,697,296COST ONLY
Utilities$ 360,140COST ONLY
MRI Lease$ 731,120COST ONLY

OptYear1

Company Name0
Fee for Service/Hours worked/Hours PaidQUANTITY (EST)BILLING UNITPRICE PER BILLING UNITEXT PRICENote
Per Member Per Month612000BENEFICIARIES$ - 0Rate per enrollee per month for 51K beneficiaries see PWS PMPM Clause (multiply 51K by 12 for the yearly cost-EXT PRICE)
Non enrollee cost per person-urgent care or primary care10524EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-lab8657EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-rad2876EACH$ - 0Non-enrollee Visit
Pharmacy Prescriptions Per Year576409EACH$ - 0Prescriptions
Dermatology - Provider3824HOURS$ - 0
Dermatology- Support staff7763HOURS$ - 0
Optometry - Optometrist3824HOURS$ - 0
Optometry - Support Staff9636HOURS$ - 0
Ortho- PA3824HOURS$ - 0
Ortho- Support Staff10134HOURS$ - 0
Podiatry - Provider3824HOURS$ - 0
Podiatry - Support Staff7380HOURS$ - 0
Sports Medicine - Provider3824HOURS$ - 0
Sports Medicine - Support Staff10134HOURS$ - 0
Dietician3824HOURS$ - 0
Obstetrics- Provider7648HOURS$ - 0
Obstetrics- Support Staff11396HOURS$ - 0
OB On-Call1248HOURS$ - 0
OB In-House1248HOURS$ - 0
Physical Therapy - Provider11472HOURS$ - 0
Physical Therapy - Support Staff20305HOURS$ - 0
Occupational Therapy - Provider3824HOURS$ - 0
Occupational Therapy - Support Staff7342HOURS$ - 0
Immunization Clinic- Staff11472HOURS$ - 0
BH - Support Staff44970HOURS$ - 0
TOTAL HOURS188,916$ - 0
Medical Supplies$ 3,351,600COST ONLY
Equipment Mx$ 1,979,420COST ONLY
Utilities$ 367,343COST ONLY
MRI Lease$ 731,120COST ONLY

OptYear2 Company Name 0 tc={7FDDF051-083C-48FD-B3F0-FE3DE5DF6FA9}: [Threaded comment]

Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924

Comment:

@Troff, Erik A CIV DHA DHA OGC (USA)

Fee for Service/Hours worked/Hours PaidQUANTITY (EST)BILLING UNITPRICE PER BILLING UNITEXT PRICENote
Per Member Per Month612000BENEFICIARIES$ - 0Rate per enrollee per month for 51K beneficiaries see PWS PMPM Clause (multiply 51K by 12 for the yearly cost-EXT PRICE)
Non enrollee cost per person-urgent care or primary care10524EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-lab8657EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-rad2876EACH$ - 0Non-enrollee Visit
Pharmacy Prescriptions Per Year576409EACH$ - 0Prescriptions
Dermatology - Provider3824HOURS$ - 0
Dermatology- Support staff7763HOURS$ - 0
Optometry - Optometrist3824HOURS$ - 0
Optometry - Support Staff9636HOURS$ - 0
Ortho- PA3824HOURS$ - 0
Ortho- Support Staff10134HOURS$ - 0
Podiatry - Provider3824HOURS$ - 0
Podiatry - Support Staff7380HOURS$ - 0
Sports Medicine - Provider3824HOURS$ - 0
Sports Medicine - Support Staff10134HOURS$ - 0
Dietician3824HOURS$ - 0
Obstetrics- Provider7648HOURS$ - 0
Obstetrics- Support Staff11396HOURS$ - 0
OB On-Call1248HOURS$ - 0
OB In-House1248HOURS$ - 0
Physical Therapy - Provider11472HOURS$ - 0
Physical Therapy - Support Staff20305HOURS$ - 0
Occupational Therapy - Provider3824HOURS$ - 0
Occupational Therapy - Support Staff7342HOURS$ - 0
Immunization Clinic- Staff11472HOURS$ - 0
BH - Support Staff44970HOURS$ - 0
TOTAL HOURS188,916$ - 0
Medical Supplies$ 3,418,632COST ONLY
Equipment Mx$ 2,019,008COST ONLY
Utilities$ 374,690COST ONLY
MRI Lease$ 731,120COST ONLY

OptYear3 Company Name 0 tc={D3F30F90-9593-4586-A64A-49F562D4EB45}: [Threaded comment]

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Comment:

@Troff, Erik A CIV DHA DHA OGC (USA)

Fee for Service/Hours worked/Hours PaidQUANTITY (EST)BILLING UNITPRICE PER BILLING UNITEXT PRICENote
Per Member Per Month612000BENEFICIARIES$ - 0Rate per enrollee per month for 51K beneficiaries see PWS PMPM Clause (multiply 51K by 12 for the yearly cost-EXT PRICE)
Non enrollee cost per person-urgent care or primary care10524EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-lab8657EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-rad2876EACH$ - 0Non-enrollee Visit
Pharmacy Prescriptions Per Year576409EACH$ - 0Prescriptions
Dermatology - Provider3824HOURS$ - 0
Dermatology- Support staff7763HOURS$ - 0
Optometry - Optometrist3824HOURS$ - 0
Optometry - Support Staff9636HOURS$ - 0
Ortho- PA3824HOURS$ - 0
Ortho- Support Staff10134HOURS$ - 0
Podiatry - Provider3824HOURS$ - 0
Podiatry - Support Staff7380HOURS$ - 0
Sports Medicine - Provider3824HOURS$ - 0
Sports Medicine - Support Staff10134HOURS$ - 0
Dietician3824HOURS$ - 0
Obstetrics- Provider7648HOURS$ - 0
Obstetrics- Support Staff11396HOURS$ - 0
OB On-Call1248HOURS$ - 0
OB In-House1248HOURS$ - 0
Physical Therapy - Provider11472HOURS$ - 0
Physical Therapy - Support Staff20305HOURS$ - 0
Occupational Therapy - Provider3824HOURS$ - 0
Occupational Therapy - Support Staff7342HOURS$ - 0
Immunization Clinic- Staff11472HOURS$ - 0
BH - Support Staff44970HOURS$ - 0
TOTAL HOURS188,916$ - 0
Medical Supplies$ 3,487,005COST ONLY
Equipment Mx$ 2,059,389COST ONLY
Utilities$ 382,183COST ONLY
MRI Lease$ 731,120COST ONLY

OptYear4 Company Name 0 tc={42AD562C-C2D9-4483-A113-2FBD5BFB3ACD}: [Threaded comment]

Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924

Comment:

@Troff, Erik A CIV DHA DHA OGC (USA)

Fee for Service/Hours worked/Hours PaidQUANTITY (EST)BILLING UNITPRICE PER BILLING UNITEXT PRICENote
Per Member Per Month612000BENEFICIARIES$ - 0Rate per enrollee per month for 51K beneficiaries see PWS PMPM Clause (multiply 51K by 12 for the yearly cost-EXT PRICE)
Non enrollee cost per person-urgent care or primary care10524EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-lab8657EACH$ - 0Non-enrollee Visit
Non enrollee cost per person-rad2876EACH$ - 0Non-enrollee Visit
Pharmacy Prescriptions Per Year576409EACH$ - 0Prescriptions
Dermatology - Provider3824HOURS$ - 0
Dermatology- Support staff7763HOURS$ - 0
Optometry - Optometrist3824HOURS$ - 0
Optometry - Support Staff9636HOURS$ - 0
Ortho- PA3824HOURS$ - 0
Ortho- Support Staff10134HOURS$ - 0
Podiatry - Provider3824HOURS$ - 0
Podiatry - Support Staff7380HOURS$ - 0
Sports Medicine - Provider3824HOURS$ - 0
Sports Medicine - Support Staff10134HOURS$ - 0
Dietician3824HOURS$ - 0
Obstetrics- Provider7648HOURS$ - 0
Obstetrics- Support Staff11396HOURS$ - 0
OB On-Call1248HOURS$ - 0
OB In-House1248HOURS$ - 0
Physical Therapy - Provider11472HOURS$ - 0
Physical Therapy - Support Staff20305HOURS$ - 0
Occupational Therapy - Provider3824HOURS$ - 0
Occupational Therapy - Support Staff7342HOURS$ - 0
Immunization Clinic- Staff11472HOURS$ - 0
BH - Support Staff44970HOURS$ - 0
TOTAL HOURS188,916$ - 0
Medical Supplies$ 3,556,745COST ONLY
Equipment Mx$ 2,100,576COST ONLY
Utilities$ 389,827COST ONLY
MRI Lease$ 731,120COST ONLY

TEP

Total Evaluated Price Base Year + Option Years + 6 month extension
$ 35,182,706.00

File details come from the government source that posted it. Updated .