Veterans Affairs



5. PROJECT NO.CODE7. ADMINISTERED BY2. AMENDMENT/MODIFICATION NO.CODE6. ISSUED BY8. NAME AND ADDRESS OF CONTRACTOR4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE9A. AMENDMENT OF SOLICITATION NO.9B. DATEDPAGE OF PAGES10A. MODIFICATION OF CONTRACT/ORDER NO.10B. DATEDBPA NO.1. CONTRACT ID CODEFACILITY CODECODE 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 OffersE. 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 telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR AC- KNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAYis not extended.12. ACCOUNTING AND APPROPRIATION DATA(REV. 10-83)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 SIGNEDB. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGESSET 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 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.C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:D. OTHERBYContractor16C. DATE SIGNED14. DESCRIPTION OF AMENDMENT/MODIFICATION16B. UNITED STATES OF AMERICAExcept 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 SIGNER16A. NAME AND TITLE OF CONTRACTING OFFICER15B. CONTRACTOR/OFFERORSTANDARD FORM 30NSN 7540-01-152-8070PREVIOUS EDITION NOT USABLEPrescribed 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.)(No., 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)(If applicable)(SEE ITEM 11)(SEE ITEM 13)(X)(X)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 SOLICITATIONSAMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT(Signature of person authorized to sign)(Signature of Contracting Officer) 1 7A0000211/5/2013Marshall Cnty CBOC90CDepartment of Veterans AffairsNetwork Contracting Office 91639 Medical Center ParkwaySuite 400Murfreesboro TN 3712990CDepartment of Veterans AffairsNetwork Contracting Office 91639 Medical Center ParkwaySuite 400Murfreesboro TN 37129To all Offerors/BiddersVA249-13-R-025711-05-2013XXXX 1This is an amendment to solicitation VA249-13-R-0257 to make revisions to the solicitation, including removal andreplacement of the price schedule.Therefore, solicitation VA249-13-R-0257 is hereby amended as noted on the attached continuation pages which areincorporated herein by reference.This amendment does NOT alter the closing date of this solicitation.Christina B. SmithContracting OfficerContinuation PAGE – Amendment 2 to Va249-13-r-0257This solicitation, VA249-13-R-0257, is hereby amended as follows:Paragraph B.7. IT CONTRACT SECURITY beginning on page 11 is hereby amended to insert new paragraphs 4 & 5 as follows, and to renumber the remaining paragraphs in this section as noted: 4. INFORMATION SYSTEM DESIGN AND DEVELOPMENTNot Applicable.5. INFORMATION SYSTEM HOSTING, OPERATION, MAINTENANCE, OR USE Not Applicable.6. SECURITY INCIDENT INVESTIGATION(formerly paragraph number 4 - paragraph content/text remains unchanged)7. LIQUIDATED DAMAGES FOR DATA BREACH(formerly paragraph number 5 - paragraph content/text remains unchanged)8. SECURITY CONTROLS COMPLIANCE TESTING(formerly paragraph number 6 - paragraph content/text remains unchanged)9. TRAINING (formerly paragraph number 7 - paragraph content/text remains unchanged)Paragraph B.10. Price/Cost Schedule and Services beginning on page 18 is amended to remove the current schedule with the following schedule:10.1The following capitated rates are for provision of Primary Health Care and Mental Health Care at the Marshall County, MS Community Based Outpatient Clinic (CBOC):10.2Estimated enrollment numbers, and Minimum and Maximum quantities are stated for the purposed of pricing and evaluating proposals; they are not guaranteed. Contractual minimum and maximum: the guarantee minimum contract amount, including the base year and any option years exercised, is $500,000.00, and the maximum contract amount, including the base year and any option years exercised shall not exceed $10,000,000.00.10.4Orders: This is an Indefinite Delivery/Indefinite Quantity (IDIQ) contract (see FAR 52.216-22). Delivery Orders shall be placed against this IDIQ contract at the time of contract award and at the time of option period exercise annually thereafter, if option periods are exercised. The Delivery Orders shall specify the estimated quantities of services for each period of performance and shall comply with FAR 52.216-18 and 52.216-19. 10.5Base Period:Base Year: March 1, 2014 through February 30, 2015CLINDescriptionEstimated QuantityUnitUnit PricePercentage of Medicare RateTotal Amount0001Primary Care Services as Described in PWS Estimated monthly enrolled Veterans: 850(Per Capita)Per PatientPer Month$ N/A$0002Mental health services as described in PWS, including services provided by LSW and medication management by?Psychiatrist, APRN and/or PAEstimated monthly Veterans: 255(Per Capita)Per Patient requiring mental health servicesPer Month$N/A$Estimated Base Year Total10.6Option Period 1:Option Year 1: March 1, 2015 through February 30, 2016CLINDescriptionEstimated QuantityUnitUnit PricePercentage of Medicare RateTotal Amount1001Primary Care Services as Described in PWS Estimated monthly enrolled Veterans: 1,000(Per Capita)Per PatientPer Month$ N/A$1002Mental health services as described in PWS, including services provided by LSW and medication management by?Psychiatrist, APRN and/or PAEstimated monthly Veterans: 300(Per Capita)Per Patient requiring mental health servicesPer Month$N/A$Estimated Option Year 1 Total10.7Option Year 2:Option Year 2: March 1, 2016 through February 30, 2017CLINDescriptionEstimated QuantityUnitUnit PricePercentage of Medicare RateTotal Amount2001Primary Care Services as Described in PWS Estimated monthly enrolled: Veterans: 1,100(Per Capita)Per PatientPer Month$ N/A$2002Mental health services as described in PWS, including services provided by LSW and medication management by?Psychiatrist, APRN and/or PAEstimated monthly Veterans: 330(Per Capita)Per Patient requiring mental health servicesPer Month$N/A$Estimated Option Year 2 Total10.8Option Year 3:Option Year 3: March 1, 2017 through February 30, 2018CLINDescriptionEstimated QuantityUnitUnit PricePercentage of Medicare RateTotal Amount3001Primary Care Services as Described in PWS Estimated monthly enrolled Veterans: 1,200(Per Capita)Per PatientPer Month$ N/A$3002Mental health services as described in PWS, including services provided by LSW and medication management by?Psychiatrist, APRN and/or PAEstimated monthly Veterans: 360(Per Capita)Per Patient requiring mental health servicesPer Month$N/A$Estimated Option Year 3 Total10.9Option Year 4:Option Year 4: March 1, 2018 through February 30, 2019CLINDescriptionEstimated QuantityUnitUnit PricePercentage of Medicare RateTotal Amount4001Primary Care Services as Described in PWS Estimated monthly enrolled Veterans: 1,300(Per Capita)Per PatientPer Month$ N/A$4002Mental health services as described in PWS, including services provided by LSW and medication management by?Psychiatrist, APRN and/or PAEstimated monthly Veterans: 390(Per Capita)Per Patient requiring mental health servicesPer Month$N/A$Estimated Option Year 4 TotalTotal Estimated Contract Amount:$________________________10.10 NOTE:If Contractor proposes a price for Nurse Only Visits, then for pricing and evaluation purposes the current Centers for Medicare and Medicaid Services (CMS) rates should be used in pricing this item for the base and option years and Contractor must enter a percent of Medicare that the unit price represents. The Percent of Medicare entry is extremely important since the contract award will be at that rate. Throughout the life of the contract the VA shall pay the percentage of Medicare rate effective at the time the service is provided by the Contractor.PWS Section 4.6.22. NURSE ONLY VISITS: beginning on page 61 is amended to remove and replace the paragraph as follows:4.6.22Nurse Only Visits (Non-Enrolled Veteran Visits): These visits occur when a non-enrolled Veteran, but one who is an otherwise eligible Veteran, comes to the clinic seeking limited care. The clinic shall ensure that the Veteran is triaged by a nurse and that any basic care that can be provided by the nurse is so provided. An example of this type of care would be a Veteran traveling from Texas to Virginia who is enrolled at a VAMC in Texas but needs assistance with changing a dressing on a wound. If the Contractor proposes to receive reimbursement for these visits then the rate for these services shall be based on current Medicare rates and the rate annotated on the price schedule as a percentage (%) of Medicare rates; and reimbursement shall be based on current Medicare rates at the time the service is provided.4.6.22.1By way of example and for record keeping purposes, an appropriate CPT code for Nurse Only Visits includes 99211, Office or Other Outpatient Services, which code is used to report a low-level Evaluation and Management (E/M) service that does not require the presence of a physician. The patient’s CPRS record shall be reviewed to ensure the patient has received care through the VA in the past three (3) years. These visits are in-person only and the patient’s CPRS record shall be annotated to note the visit, including the reason for the visit and any care provided. 4.6.22.2 Non-Enrolled Veterans presenting for care shall be asked by the Contractor's staff to provide their insurance and/or Medicare card(s). Per the national mandate, the Contractor's staff will then scan the insurance cards (front and back) into the DSS program for processing. In the event the card is not able to be scanned, a photocopy of the front and back should be made and faxed to the MS CPAC, IV Section at 615-355-1429. The copy of the card must be faxed no later than the end of the second business day the non-enrolled Veteran is seen. 4.6.22.3Examples of the types of services that may be performed include the following:4.6.22.3.1.Injection of VA-supplied medications such as Flu vaccine, Vitamin B-12, Pneumovax vaccine, goserelin acetate, testosterone, antipsychotics, certain HIV medications, rheumatology medication, neurology medications, or depot antipsychotic medications.4.6.22.3.2.VA-ordered suture removal.4.6.22.3.3.VA –ordered dressing change.4.6.22.3.4.VA-ordered wound check/care.4.6.22.3.5.VA-ordered blood pressure/vital sign check.4.6.22.3.6.VA-ordered lab draws and preparation for sending to the Memphis VAMC.4.6.22.3.7.Assisting a diabetic patient with a minor blood sugar issue; or Nursing Education for Diabetes and Glucose Meter training.4.6.22.3.8.Referring the patient for other care in the community or at the closest VAMC as appropriate.4.6.22.3.9.TB test reading – VA ordered test.4.6.22.3.10.Eye: Superficial removal of foreign bodies.4.6.22.3.11.Ear: Simple procedures (e.g. irrigation, drainage ext. ear abscess, removal foreign body).4.6.22.3.12.Triage for patient concerns.PWS Paragraph 6.11. INVOICE CATEGORIES is hereby amended to add another subparagraph 6.11.4. as follows:6.11.4.If the Contractor is obtaining reimbursement for Nurse Only Visits then a separate line item shall be included on the invoice for the Nurse Only Visits billed for the month. The line shall include a total amount for all such visits and shall also include the following information for each such visit: date of service; patient name; and the VA patient ID number.Section C – CONTRACT CLAUSES, clause C.7 52.216-19 on page 94 is hereby amended to remove and replace the paragraph with the following:C.7 52.216-19 ORDER LIMITATIONS (OCT 1995) (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $100,000.00, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract. (b) Maximum order. The Contractor is not obligated to honor-- (1) Any order for a single item in excess of $2,000,000.00; (2) Any order for a combination of items in excess of $2,500,000.00; or (3) A series of orders from the same ordering office within 30 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section. (c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section. (d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 14 days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.(End of Clause) ................
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