VA791-16-R-0086-0025000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE

OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

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:

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication 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 is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, 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.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

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

D. OTHER

BY

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 09-19-2018 Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden

CO

80401-5621

To all Offerors/Bidders

VA791-16-R-0086

09-18-2018

X X X October 2, 2018 at 2:00 pm MT The projected award for Regions 1-3 is quarter 1 of calendar year 2019.

In accordance with FAR 15.307, offerors in region 1 and region 2 are requested to submit final proposal revisions to the addresses listed in RFP Section E.2.3.1. Final proposal revisions for region 1 and region 2 are due by October 2, 2018 at 2:00 pm MT.

Discussions will remain open for region 1 and region 2 through September 20, 2018 at 4:00 pm MT. Discussions for region 3 remain open and VA will provide additional guidance regarding the closing date/time for discussions in region 3.

Please see the attached pages for additional details.

David F. Little

1. RFP Section E.2.3.1 is deleted and replaced with the following:

E.2.3.1 Proposals shall be submitted in a sealed envelope or box and shall be addressed to the office specified below and shall show the time specified for receipt, the solicitation number, and the name, address and DUNS number of the offeror. Responses are due by the time specified in Block 8 of the SF 1449. The only authorized means of proposal submission is paper hard copy and compact discs (CDs) delivered to:

Denver Logistics Center Attention: David Little 555 Corporate Circle Golden, CO 80401

For proposal revisions, offerors are required to mail 8 individual hard copies of Volume I track changes in Microsoft Word and 5 individual copies of the conformed Adobe PDF version (see section E.2.3.2.1).

For Volume I, use the following address to mail all 8 of the individual hard copies of the track changes in Microsoft Word, 4 of the 5 individual hard copies of the conformed Adobe PDF version and the Microsoft Excel file that contains current provider data:

The MITRE Corporation 7596 Colshire Drive McLean, VA 22102-7539 ATTN: Lori Woolf Mail Stop: J600

Offerors may hand deliver Volume I to The MITRE Corporation and dial 703-470-7001 or 703-983-4833 when arriving at the location for assistance.

Submit the 5th individual copy of the conformed Adobe PDF Volume I version and all proposal revisions for Volumes II, III and IV to:

Denver Logistics Center Attn: David Little 555 Corporate Circle Golden CO, 80401

2. RFP Section D is updated to delete RFP Attachment E Rev 2 Summary Demand Data and to replace it with RFP Attachment E Rev 3 Summary Demand Data. Three excel worksheets were updated. All worksheet tabs with “091818” contain new data.

3. RFP Section A.2 Schedule of Services is amended to delete the existing regional tiers and replace the regional tiers for SubCLIN XX12AC as follows:

Region 1:

Region 2:

Region 3:

4. RFP Section E.2.5.1 is deleted and replaced with the following:

All Volumes shall be spiral bound or contained in a three-ring binder.

5. RFP Section E.2.8.1.8 is deleted and replaced with the following:

E.2.8.1.8 For calendar years 2016 and 2017, provide claims processing and adjudication experience to include total monthly claims volume processed, total monthly dollar amount paid for claims, average monthly percentage of claims processed within 30 days of receipt, percentage of monthly rejected claims, percentage of monthly provider reconsiderations processed, percentage of claims auto-adjudicated (first pass percentage rate), a description of the process for paper to electronic claims conversion, and an explanation of the flexibility and adaptability of creation/inclusion of business rules into the claims processing systems. Also, the Technical Volume shall include experience, if applicable, adopting new business rules or variations in health plan administration and how the rules engine has been modified to accommodate such changes.

6. RFP Section E.2.9.3 is deleted and replaced with the following:

E.2.9.3 For each of the contracts the offeror describes in a Performance Data Sheet (Solicitation Attachment 1), the offeror is required to provide a Past Performance Questionnaire (Solicitation Attachment 2) to a reference at the organization that awarded the contract. Questionnaires are limited to two per contract reference. Past Performance Questionnaires returned by the offeror, and not by the reference, will not be evaluated. The completed Past Performance Questionnaire (Solicitation Attachment 2) shall be submitted to VA any time BEFORE THE DUE DATE FOR PROPOSALS directly to Ms. Cynthia Turk (Cynthia.turk@va.gov). The offeror, NOT THE GOVERNMENT, is responsible for ensuring that the Government receives the questionnaires on its behalf.

7. Section E.2.9.5 of the RFP is deleted and replaced with the following:

E.2.9.5 All offerors, other than small businesses, shall provide a narrative that demonstrates the extent to which the offeror attained applicable goals for small business participation under Federal contracts that required subcontracting plans for fiscal year 2014, 2015 and 2016. The Government may consider a narrative that demonstrates the extent to which an offeror’s joint venture partner(s) or an offeror’s affiliate(s) / parent organization(s) attained applicable goals for small business participation under Federal contracts that required subcontracting plans for fiscal year 2014, 2015 and 2016 if the narrative provided shows that the workforce, management facilities or other resources of the JV partner(s), affiliate(s) / parent organization(s) will bear on the likelihood of successful performance by the offeror.

8. Section E.2.9.8 is deleted in its entirety and marked “RESERVED”.

9. RFP Section E.2.10.5 is deleted and replaced with the following:

E.2.10.5 Provide the names and DUNS of specific Veteran Owned and Service Disabled Veteran Owned small business firms that will be providing the proposed range of services and supplies under any resulting contract.

10. RFP Section E.2.10.8 is deleted and replaced with the following:

E.2.10.8 Offerors designated as large businesses shall submit an Individual Subcontracting Plan pursuant to FAR 52.219-9 and VAAR 852.219-9. Offerors designated as small businesses may submit a subcontracting plan to demonstrate small business participation. “Subcontract,” as used in this provision, means any agreement (other than one involving an employer-employee relationship) entered into by a Federal Government prime contractor or subcontractor calling for supplies or services required for performance of the contract or subcontract, unless the type of agreement is expressly excluded. Agreements with Community Care Network providers, with the exception of subcontracts with dialysis providers, shall not be used in the calculation of subcontract values or towards the attainment of the minimum goals. Any offeror, other than small businesses, is required to include dialysis spend in their subcontracting plan/goals. The Individual Subcontracting Plan must be submitted with initial offer and approved prior to contract award. See Solicitation Attachment 3 for an example. The subcontracting plan should meet the minimum VA subcontracting goals set forth below. VA reserves the right to accept proposed subcontracting goals that are less than the goals defined below:

11. RFP Section E.5.8.1 is amended to delete the definition for “Not Relevant” and replace it with:

Not Relevant – Past/Present performance effort involved none of the scope or magnitude of effort or complexities this solicitation requires.

12. The following tables under Section E.5.10.6 of the RFP are deleted and replaced with the following:

Region 1:

0-35,000 Active Veterans

46.3%

35,001-75,000 Active Veterans

46.1%

75,001+ Active Veterans

1.7%

0-7,500 Active Veterans

5.8%

7,501-15,000 Active Veterans

0.0%

15,001+ Active Veterans

0.0%

0.1%

0.3%

2.4%

Tier 1 Volume:

42.9%

Tier 2 Volume:

49.9%

Tier 3 Volume:

4.5%

Tier 4 Volume: (no usage planned)

0.0%

Tier 5 Volume: (no usage planned)

0.0%

0-35,000

34.2%

35,001-75,000

38.9%

75,001+

26.9%

0-35,000

27.3%

35,001-75,000

31.2%

75,001+

41.5%

100.0%

Region 2:

Brand Name Medication

14.0%

Generic Medication

79.5%

Dispensing Fee

6.5%

0-35,000 Active Veterans

33.6%

35,001-75,000 Active Veterans

38.4%

75,001+ Active Veterans

22.8%

0-7,500 Active Veterans

5.1%

7,501-15,000 Active Veterans

0.0%

15,001+ Active Veterans

0.0%

0.1%

0.2%

1.7%

Tier 1 Volume:

43.3%

Tier 2 Volume:

50.3%

Tier 3 Volume:

4.5%

Tier 4 Volume: (no usage planned)

0.0%

Tier 5 Volume: (no usage planned)

0.0%

0-35,000

24.3%

35,001-75,000

27.7%

75,001+

48.0%

0-35,000

19.4%

35,001-75,000

22.2%

75,001+

58.4%

100.0%

Region 3:

Brand Name Medication

14.0%

Generic Medication

79.5%

Dispensing Fee

6.5%

0-35,000 Active Veterans

30.6%

35,001-75,000 Active Veterans

34.9%

75,001+ Active Veterans

27.7%

0-7,500 Active Veterans

6.4%

7,501-15,000 Active Veterans

0.3%

15,001+ Active Veterans

0.0%

0.1%

0.1%

1.6%

Tier 1 Volume:

43.4%

Tier 2 Volume:

50.4%

Tier 3 Volume:

4.5%

Tier 4 Volume: (no usage planned)

0.0%

Tier 5 Volume: (no usage planned)

0.0%

0-35,000

22.4%

35,001-75,000

25.6%

75,001+

52.0%

0-35,000

17.9%

35,001-75,000

20.5%

75,001+

61.6%

100.0%

13. Paragraph 8 in Section A.2 Schedule of Services is changed as follows:

FROM:

(OPTIONAL) CLIN XX13AB, Care Coordination Follow Up (optional task) for all Healthcare Services is based on a lot model. VA will pay the negotiated price per lot of 50 unique Approved Referrals that contain CLIN XX13AB.

Referrals for a period of performance

TO:

(OPTIONAL) CLIN XX13AB, Care Coordination Follow-Up (optional task) for all Healthcare Services VA will pay the contractor the monthly firm fixed price per Veteran that receives Care Coordination Follow Up services. Payments are limited to one payment per Veteran per month.

14. Section A.2 Schedule of Services, paragraph 6. is changed as follows:

FROM:

6. VA's payment to the contractor for CLINs XXX1, XXX2, XXX3, XXX4, XXX6, XXX7, XXX8 (for services with available Medicare pricing), XXX9AA, XXX9AB, XX19 and XX21 will be the lesser of the value paid to the CCN community provider or the rate identified in the applicable CLIN. This will occur each instance the CCN community provider invoices the Contractor at a rate less than the applicable CCN contract price. The CLINs listed in this paragraph are considered a pass-through of invoice amounts from the CCN community provider to the Contractor to the VA.

TO:

6. VA's payment to the contractor for CLINs XXX1, XXX2, XXX3, XXX4, XXX6, XXX7, XXX8 (for services with available Medicare pricing), XXX9AA, XXX9AB, XX19 and XX21 will be the lesser of the value paid to the CCN community provider or the rate identified in the applicable CLIN. This will occur each instance the CCN community provider invoices the Contractor at a rate less than the applicable CCN contract price. The CLINs listed in this paragraph are considered a pass-through of invoice amounts from the CCN community provider to the Contractor to the VA.

15. Section B.15 Invoices: Addendum to 52.212-4, Paragraph 1.5.2 is deleted and replaced with the following:

1.5.2 Care Coordination Follow-Up CLIN XX13AB; The Contractor must always submit the monthly invoice in accordance with the Optional Task ordered by the VA. The Contractor's monthly invoice for Care Coordination Follow-Up services shall include the total number of Veterans that received Care Coordination Follow-Up services in the prior month. VA will verify the accuracy of the invoice by comparing the number of Veterans listed in deliverable item 94 against the count of Veterans in the contractor's monthly invoice.

16. Section E.2.7.1 is deleted and replaced with the following:

E.2.7.1 The Offeror shall submit completed forms required in Section E.2.2 in this section. These completed forms shall be submitted with the Price Volume.

17. Section E.2.7.2 is deleted and replaced with the following:

E.2.7.2 Representations and Certifications: The offeror shall submit a completed copy of representations and certifications (FAR 52.212-3) or a statement that the completion of these requirements was accomplished in the System for Award Management (SAM) website, found at https://www.sam.gov with paragraph 52.212-3(b)(2) completed. Completed representations and certifications or the required statement of completion through https://www.sam.gov shall be submitted with the Price Volume.

18. Section E.5.10 is deleted and replaced with the following:

E.5.10 Factor 4 – Price. Price analysis techniques as described in FAR Part 15 will be used to determine prices fair and reasonable. The contracting officer may determine the proposed prices fair and reasonable based solely on an analysis of the cumulative weighted score in accordance with this section.

19. Section 12.5 Issuance of EOB, is deleted and replaced to provide new hyperlinks as follows:

The Contractor must always issue an EOB to Veterans. The EOB must always be available through electronic means, including but not limited to a web-based portal. The EOB must always be mailed in hard copy, unless the Veteran has provided verbal or written agreement to receive the EOB electronically. EOBs must always be available in a paper monthly summary upon the Veteran’s request. The EOB must always comply with the requirements of 38 U.S.C. § 7332, 38 C.F.R. § 1.460-1.496, and VHA Directive 1605.1, Privacy and Release of Information. For further information, see the following:

1. VHA Directive 1605.1, Privacy and Release of information:

https://www.va.gov/vhapublications/

a. For VHA Directive 1605, VHA Privacy Program; Transmittal Sheet, dated April 11, 2012, see: https://www.va.gov/vhapublications/

2. 38 U.S.C. § 7332, 38 C.F.R. § 1.460-1.496 (as applicable);

a. 38 C.F.R. § 1.460-1.461: https://www.gpo.gov/fdsys/pkg/CFR-2015-title38-vol1/pdf/CFR-2015-title38-vol1-sec1-460.pdf

b. 38 C.F.R. § 1.461-1.464: https://www.gpo.gov/fdsys/pkg/CFR-2015-title38-vol1/pdf/CFR-2015-title38-vol1-sec1-461.pdf

20. RFP Sections A.2.1 – A.2.3 are deleted and replaced as follows:

(0-122,120 unique Approved Referrals)

Per Month Tier 2 (122,121-284,960 unique Approved Referrals)

Per Month Tier 3 (284,961- 447,800 unique Approved Referrals)

Per Month Tier 4 (447,801- 610,600 unique Approved Referrals)

Per Month Tier 5 (610,601- 936,201 unique Approved Referrals)

(0 – 155,800 unique Approved Referrals)

Per Month Tier 2 (155,801 – 363,500 unique Approved Referrals)

Per Month Tier 3 (363,501 – 571,300 unique Approved Referrals)

Per Month Tier 4 (571,301 – 779,000 unique Approved Referrals)

Per Month Tier 5 (779,001 – 1,194,401 unique Approved Referrals)

(0 -194,700 unique Approved Referrals)

Per Month Tier 2 (194,701 – 454,350 unique Approved Referrals)

Per Month Tier 3 (454,351 – 713,960 unique Approved Referrals)

Per Month Tier 4 (713,961 – 973,600 unique Approved Referrals)

Per Month Tier 5 (973,601 – 1,492,881) unique Approved Referrals)

All other terms and conditions remain unchanged.

End Summary of Changes.

See attached document: Attachment E Rev 3 Summary Demand Data.