VA791-16-R-0086-A00019001.docx

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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) A00019 See Block 16c.

Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden

CO

80401-5621 Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden

CO

80401-5621 To all Offerors/Bidders

VA791-16-R-0086

01-09-2018

X X X The purpose of this amendment is to provide an update on the status of the Community Care Network Acquisition.

VA has completed evaluations for CCN Region 4. No award will be made under this solicitation for Region 4, and the Region 4 competition will be cancelled. Requirements for Region 4, as noted below, are deleted.

Regions 1, 2, and 3 are unaffected at this time and the VA continues the evaluations for those Regions.

The VA may change its requirements for Region 4 and thereafter anticipates a new acquisition strategy to be executed under a new solicitation. See attached pages for further details of all sections deleted from this request for proposals.

David F Little Contracting Officer

CONTINUATION PAGE

Summary of Changes:

The following terms and conditions are deleted:

1. Section A.2 paragraph 4, Region 4 column is deleted in its entirety:

Region 4

Texas

New Mexico

Arizona

California

Nevada

Utah

Colorado

Wyoming

Idaho

Oregon

Washington

Montana

Alaska

Hawaii

Northern Mariana Islands

Guam

American Samoa

2. Section A.2 (OPTIONAL) CLIN XX12AC Region 4 table is deleted in its entirety:

Region 4:

Tier
Number of unique Approved Referrals for a period of performance
One (1)
0 – 331,400
Two (2)
331,401 – 773,300
Three (3)
773,301 – 1,215,200
Four (4)
1,215,201 – 1,657,000

3.

Page 1 of

4. Section A.2.4 Pricing Schedule Region 4 – TX, NM, AZ, CA, NV, UT, CO, WY, ID, OR, WA,MT, AK, HI, Northern Mariana Islands, Guam, America Samoa is deleted in its entirety:

CLIN
DESCRIPTION
UNIT
BASE
OPTION I
OPTION II
OPTION III
OPTION IV
OPTION V
OPTION VI
OPTION VII
4001
Healthcare Services
Each
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
4002
Reimbursement for Highly Rural Care Areas
Each
Up to ___% Medicare
Up to ___% Medicare
Up to ___% Medicare
Up to ___% Medicare
Up to ___% Medicare
Up to ___% Medicare
Up to ___% Medicare
Up to ___% Medicare
4003
Durable Medical Equipment
Each
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
4004
Home Health Care (Skilled and Unskilled)
4004AA
Skilled Home Health
Each
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
Up to 100% Medicare
4004AB
Unskilled Home Health
Each
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
4005
Seasonal Influenza Vaccination
Each
$_____
$_____
$_____
$_____
$_____
$_____
$_____
$_____
4006
Non-CMS Medical and Surgical Services, VA Fee Schedule
Each
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
Up to VA Fee Schedule
4007
Non-CMS, Non-VA Fee Schedule Medical and Surgical Services
Each
Pursuant to regulation
Pursuant to regulation
Pursuant to regulation
Pursuant to regulation
Pursuant to regulation
Pursuant to regulation
Pursuant to regulation
Pursuant to regulation
4008
Home Infusion Therapy
Each
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
See CLIN 4001, 4006, or 4007 as applicable in accordance with Section A.2, paragraph 8.
4009
Pharmacy: Urgent and Emergent Prescriptions pricing based on Average Wholesale Price (AWP)
4009AA
Brand Name Medications
Percent
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
4009AB
Generic Medications
Percent
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
Up to % _____AWP
4009AC
Dispensing Fee
Each
$______
$______
$______
$______
$______
$______
$______
$______
4010
Dental Services
Each
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
Negotiated rates per ADA CDT code
4011
Administrative Fees
4011AA
Healthcare Services: Administrative Services Per Member Per Month (PMPM)
Each Active Veteran 0-35,000
$______
$______
$______
$______
$______
$______
$______
$______
Each Active Veteran 35,001-75,000
$______
$______
$______
$______
$______
$______
$______
$______
Each Active Veteran 75,001+
$______
$______
$______
$______
$______
$______
$______
$______
4011AB
Dental: Administrative Services Per Member Per Month (PMPM)
Each Active Veteran 0-7,500
$______
$______
$______
$______
$______
$______
$______
$______
Each Active Veterans 7,501-15,000
$______
$______
$______
$______
$______
$______
$______
$______
Each Active Veteran 15,001+
$______
$______
$______
$______
$______
$______
$______
$______
4011AC
Pharmacy Benefits Management: Administrative Services Fee: Per Member Per Month (PMPM)
Each
$______
$______
$______
$______
$______
$______
$______
$______
4012
(Optional) Appointment Scheduling and Comprehensive Care Coordination
4012AA
Optional: Implementation for Appointment Scheduling and Comprehensive Care Coordination, VA Facility
Each
$______
$______
$______
$______
$______
$______
$______
$______
4012AB
Optional: Implementation for Appointment Scheduling and Comprehensive Care Coordination, Contractor’s Site
Each
$______
$______
$______
$______
$______
$______
$______
$______
4012AC
Optional: Appointment Scheduling and Comprehensive Care Coordination Services
Per Month Tier 1

(0 – 331,400 unique Approved Referrals)

$______
$______
$______
$______
$______
$______
$______
$______

Per Month Tier 2 (331,401 – 773,300 unique Approved Referrals)

$______
$______
$______
$______
$______
$______
$______
$______

Per Month Tier 3 (773,301 – 1,215,200 unique Approved Referrals)

$______
$______
$______
$______
$______
$______
$______
$______

Per Month Tier 4 (1,215,201 – 1,657,000 unique Approved Referrals)

$______
$______
$______
$______
$______
$______
$______
$______

Per Month Tier 5 (1,657,001 + unique Approved Referrals)

$______
$______
$______
$______
$______
$______
$______
$______
4013
(Optional) Care Coordination Follow-up
4013AA
Optional: Implementation for Care Coordination Follow-up
Each
$______
$______
$______
$______
$______
$______
$______
$______
4013AB
Optional: Care Coordination Follow-up per Lot 50 cases
Each

(0-35,000 unique Approved Referrals or 700 Lots)

$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50

Each (35,001-75,000 unique Approved Referrals or 800 Lots)

$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
Each (75,001+ unique Approved Referrals or 1500+ Lots)
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
$______ Per Lot 50
4014
(Optional) Comprehensive Case Management
4014AA
Optional: Implementation for Comprehensive Case Management
Each
$______
$______
$______
$______
$______
$______
$______
$______
4014AB
Optional: Comprehensive Case Management Per Member Per Month (PMPM)
Each (unique Approved Referral 0-35,000)
$______
$______
$______
$______
$______
$______
$______
$______
Each (unique Approved Referral 35,001-75,000)
$______
$______
$______
$______
$______
$______
$______
$______
Each (unique Approved Referral 75,001+)
$______
$______
$______
$______
$______
$______
$______
$______
4015
(Optional) Comprehensive Disease Management
4015AA
Optional: Implementation for Comprehensive Disease Management
Each
$______
$______
$______
$______
$______
$______
$______
$______
4015AB
Optional: Comprehensive Disease Management Per Member Per Month (PMPM)
Each (unique Approved Referral 0-35,000)
$______
$______
$______
$______
$______
$______
$______
$______
Each (unique Approved Referral 35,001-75,000)
$______
$______
$______
$______
$______
$______
$______
$______
Each (unique Approved Referral 75,001+)
$______
$______
$______
$______
$______
$______
$______
$______
4016
Implementation
Each
$______
$______
N/A
N/A
N/A
N/A
N/A
N/A
4017
RESERVED
4018
Data
Not Separately Priced (NSP)
NSP
NSP
NSP
NSP
NSP
NSP
NSP
NSP
4019
RESERVED
4020
Agreed Upon Procedures Audit
Each
$______
$______
$______
$______
$______
$______
$______
$______
4021
MILL BIL
Each
Up to 70% Medicare
Up to 70% Medicare
Up to 70% Medicare
Up to 70% Medicare
Up to 70% Medicare
Up to 70% Medicare
Up to 70% Medicare
Up to 70% Medicare

5.

6. Section B.16 Performance Work Statement Section 2.2.1 Table with the potential list of sites the VA recommends for consideration for SHCD Region 4 column is deleted in its entirety:

Region 4

Urban
Rural
Portland (648)
Amarillo (504)
Spokane (668)
Fort Harrison (436)

7. Section B.16 Performance Work Statement Section 3.5 Table 5 Region 4 column is deleted in its entirety:

CCN Region 4

Texas

New Mexico

Arizona

California

Nevada

Utah

Colorado

Wyoming

Idaho

Oregon

Washington

Montana

Alaska

Hawaii

Northern Mariana Islands

Guam

American Samoa

8. Section B.16 Performance Work Statement Section 6.1 the following requirement is deleted in its entirety: “For CCN Region 4, 7AM to 7PM requirement applies to Hawaii as well. American Samoa, Northern Mariana Islands, and Guam may have more limited coverage as agreed to by VA and the Contractor.”

9. Section B.16 Performance Work Statement Section 6.2 the following requirement is deleted in its entirety: “For CCN Region 4, 7AM to 7PM requirement applies to Hawaii as well. American Samoa, Northern Mariana Islands, and Guam may have more limited coverage as agreed to by VA and the Contractor.”

10. Section E.5.10.6 Region 4 Table is deleted in its entirety:

Region 4:

CLIN
Description
Weight
Sub-Weight
XXX2
Reimbursement for Highly Rural Care Areas
41.6%
XXX5
Seasonal Influenza Vaccination
2.6%
XXX9
Urgent and Emergent Medications
3.8%
100.0%

Brand Name Medication

14.0%

Generic Medication

79.5%

Dispensing Fee

6.5%

XX10
Dental Services
18.1%
XX11
Administrative Fees
18.2%
100.0%
XX11AA
Administrative Services for Healthcare Services

0-35,000 Active Veterans

19.6%

35,001-75,000 Active Veterans

22.4%

75,001+ Active Veterans

48.2%

XX11AB
Administrative Services for Dental

0-7,500 Active Veterans

4.6%

7,501-15,000 Active Veterans

4.5%

15,001+ Active Veterans

0.6%

XX11AC
Administrative Services Fee for Pharmacy Benefits Management

0.1%

XX12
(Optional) Appointment Scheduling and Comprehensive Care Coordination
10.4%
100.0%
XX12AA
(Optional) Implementation for Appointment Scheduling and Comprehensive Care Coordination at a VA Facility

0.1%

XX12AB
(Optional) Implementation for Appointment Scheduling and Comprehensive Care Coordination at Contractor Facility

1.1%

XX12AC
(Optional) Appointment Scheduling and Comprehensive Care Coordination

Tier 1 Volume:

43.6%

Tier 2 Volume:

50.6%

Tier 3 Volume:

4.6%

Tier 4 Volume: (no usage planned)

0.0%

Tier 5 Volume: (no usage planned)

0.0%

XX13AB
(Optional) Care Coordination Follow-up
1.9%
100.0%

0-35,000 or 700 lots

23.9%

35,001-75,000 or 800 lots

27.3%

75,001+ or 1500+ lots

48.8%

XX14AB
(Optional) Comprehensive Case Management Program Administration
1.8%
100.0%

0-35,000

14.9%

35,001-75,000

16.9%

75,001+

68.2%

XX15AB
(Optional) Comprehensive Disease Management Program Administration
0.4%
100.0%

0-35,000

11.9%

35,001-75,000

13.6%

75,001+

74.5%

XX16
Implementation
1.2%

100.0%

11. Section C.23 Region 4 Guaranteed Contract Minimums and Contract Maximums are deleted from the tables in their entirety:

Region
Minimum per Option Period
4
$ 7,110,000
Region
Maximum
4
$ 27,960,092,095.00

12. Section D Attachments will not be revised; any and all information pertaining to Region 4 contained in any attachment listed is deleted in its entirety.

13. Section E.5 Solicitation Attachments will not be revised; any and all information pertaining to Region 4 contained in any attachment listed is deleted in its entirety.

[End of Summary of Changes]

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