Amendment-1.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

11 . CONTRACT ID CODE IPA~E OF PAGES

I 2

2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 15. PROJECT NO. (If applicable)

Amendment #1 See Block 16c

6. ISSUED BY CODE 7. ADMINISTERED BY (If other than Item 6) CODE I Federal Bureau of Prisons Federal Bureau of Prisons Field Acquisition Office Federal Correctional Complex U.S. Armed Forces Reserve Complex 1060 River Road 346 Marine Forces Drive Hopewell , VA 23860 Grand Prairie, TX 75051

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, Slate and ZIP Code) (X) 9A. AMENDMENT OF SOLICITATION

,_ NO.

RFPP01141700001

9B. DATED (SEE ITEM 11)

05/08/2017

10A. MODIFICATION OF CONTRACT/ORDER NO.

D 10B. DATED (SEE ITEM 13)

CODE !FACILITY CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

~ The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers D is extended, ~ is not extended.

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 items 8 and 15, and returning 1 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 ACKNOWLEDGMENT 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 your 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 .

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO.

IN ITEM 10A.

D D

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

D

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D D. OTHER (Specify type of modification and authority)

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

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

Solicitation RFPP01141700001 is amended to reflect the following changes:

Reference Attachment 1: Wage Index for CBSA 40060, Richmond, VA is changed to 0.9040.

(See Revised Attachment 1)

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 1 DA, as heretofore changed , remains unchanged and in full force and effect.

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

Darren Doggett, Contract Specialist

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

NSN 7540-01-152-8070

Previous edition unusable

15C. DATE SI 16C. DATE SIGNED

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

Attachment 1

Computation of Basic DRG Payments (i.e., Operating Federal Rate) CBSA 40060, Richmond, Virginia

Urban Area Payment Formula

Step 1

Step 2

Step 3

Step 4

Labor-related portion of the National Adjusted Operating Standardized Amount for Hospital Submitted Quality Data and is a Meaningful EHR User

Multiply the labor related portion of the standardized amount by the applicable wage index for the geographic area

Add the amount from Step 2 and the non-labor related portion of the standardized amount

Multiply the final amount from Step 3 by the relative weight corresponding to the applicable MS-DRG

Index Figures

Obtained from the Centers for Medicare and Medicaid Services for discharges on/after October 1, 2016.

National Adjusted Operating Standardized Amounts:

Labor-related portion:

Non-Labor-related portion:

Wage Index for by CBSA 40060, Richmond , VA:

MS-DRG Relative Weight, MS-DRG 76, Viral Meningitis w/o CC/MCC:

Application For MS-DRG 076 (example)

Step 1:

Step 2:

Step 3:

Step 4:

$3,420.01 $3,420.01 x .9040 $3,091 .69 + 2,096.13 $5,187.82 x .9596

= $3,091 .69 = $5,187.82 = $4,978.23

$3,420.01 $2,096.13

.9040

.9596

Payment for MS-DRG 76 under the contract would be $4,978.23 plus or minus any premium or discount established as the contract rate.