Attachment_II_-_BPA_Pricing_Methodology.pdf

RFQP04021500003

ATTACHMENT II

BPA PRICING METHODOLOGY

Overview

Services are required to be provided in accordance with the Performance Work Statement included in this solicitation/Blanket Purchase Agreement (BPA). Quoters are required to submit, a completed copy of the Schedule of Items

Pricing Methodology

Price quotes will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of service to be provided, quoters will be allowed to propose a variance from the benchmark Medicare rate in the form of a discount from or a premium to Medicare rates established by the Centers for Medicare and Medicaid Services. The rates established in the resulting BPA shall not be construed as participation in the Medicare program; BPA rates will merely be equated to Medicare rates of reimbursement without reductions for deductibles, copayments, or coinsurance. When appropriate, outlier payments calculated in accordance with Medicare reimbursement methodologies shall be made in recognition of extremely costly stays. The outlier payment shall be calculated based upon the defined benchmark and will consist of the operating portion only. This structuring of the pricing methodology is not intended to be restrictive of any quoter; quoters need only to propose that percentage discount from or premium to the Medicare benchmark rate which will reflect the desired level of payment for the category of services rendered. If during BPA performance, it is determined that a necessary BPA deliverable is not covered by Medicare reimbursement methodologies, a separate rate shall be negotiated for such deliverable(s).

Medicare Part A. The Medicare benchmark to be utilized for all services covered by Medicare Part A shall be the most current Basic DRG payment (i.e., Operating Federal Rate) established for CBSA 20260 for Duluth, Minnesota. The Basic DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Quoters may propose a discount from or a premium to Basic DRG rates.

Medicare Part B Physician and Non-Physician Services. The Medicare benchmark to be utilized for all physician services and non-physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 00 for Duluth, Minnesota. The benchmark charges shall be those established for participating providers. Quoters may propose a discount from or a premium to the benchmark charges.

Medicare Part B Facility Services (including hospital outpatient services and ambulatory surgical centers). The Medicare benchmark to be utilized for all facility services covered by Medicare Part B shall be the most current APC and ASC rates calculated for CBSA 20260 for Duluth, Minnesota. Quoters may propose a discount from or a premium to the benchmark charges.

Estimated Quantities

Estimated quantities for the Blanket Purchase Agreement (BPA) period is detailed below. The estimated quantities provided are not a representation to the quoter / BPA Holder that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normal.

Inpatient and Outpatient Facility and Physician Services

Below is an annual estimate

Inpatient Days: Estimated 160 Days Outpatient Visits: Estimated 550 Visits

Outpatient Institution Services

Annual estimated quantities shall remain constant for the BPA. For Medicare-based services, duration of visits is listed for informational purposes only, as contracted rates will be based upon the Medicare allowable per procedure performed. The estimated quantities are not a representation to a quoter / BPA Holder that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normal.

Schedule of Items/Target for Participation of Small Disadvantaged Business Concerns

Quoters shall complete the following Schedule of Items.

Schedule of Items BPA Period Date of Award through period of performance.

1a. Inpatient Facility Services: -______ Discount or +______ Premium to Medicare Part A

1b. Outpatient Facility Services: -______ Discount or +______ Premium to Medicare Part B

2a. Inpatient Physician Services: -______ Discount or +______ Premium to Medicare Part B

2b. Outpatient Physician Services: -______ Discount or +______ Premium to Medicare Part B

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".