BPA NO. 1. CONTRACT ID CODE PAGE OF PAGES
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1 5
2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO.(If applicable)
0001 June 13, 2008
6. ISSUED BY
CODE 91 7. ADMINISTERED BY (If other than Item 6) CODE 91
Department of Veterans Affairs Department of Veterans Affairs
Chalmers P. Wylie Outpatient Clinic Chalmers P. Wylie Outpatient Clinic
543 Taylor Ave. 543 Taylor Ave.
Columbus OH 43203-1278 Columbus OH 43203-1278
8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code) (X) 9A. AMENDMENT OF SOLICITATION NO.
To all Offerors/Bidders VA-250-08-RP-0106
9B. DATED (SEE ITEM 11)
10A. MODIFICATION OF CONTRACT/ORDER NO.
10B. DATED (SEE ITEM 13)
CODE FACILITY CODE
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
x The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, x 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 __________ 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 MAY
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.
12. ACCOUNTING AND APPROPRIATION DATA (If required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.
(X) 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.
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).
C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
D. OTHER (Specify type of modification and authority)
E. IMPORTANT: Contractor x is not, 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.)
The solicitation is hereby amended to include the attached list of DRGs and the prospective payment methodology.
The list of DRGs is not all inclusive and only represents a sampling.
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 (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)
SUSAN J. WELCH
15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 16C. DATE SIGNED
(Signature of person authorized to sign) (Signature of Contracting Officer)
NSN 7540-01-152-8070 STANDARD FORM 30 (REV. 10-83)
PREVIOUS EDITION NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.243
Sampling List of Top 51 DRG Codes and Explanation of the Prospective Payment System
313 Chest pain
292 Heart Failure & shock w CC
194 Simple pneumonia & pleurisy w CC
291 Heart Failure & shock w MCC
871 Septicemia w/o MV 96+hours w MCC
287 Circulatory disorders except AMI, w card cath w/o MCC
460 Spinal fusion except cervical w/o MCC
88 Concussion w MCC
193 Simple pneumonia & pleurisy w MCC
378 G.I. hemorrhage w CC
308 Cardiac arrhythmia & conduction disorders w MCC
312 Syncope & collapse
683 Renal failure w CC
127 Heart Failure and shock
294 Deep vein thrombophelebitis w CC/MCC
310 Cardiac arrythmia & conduction disorders w/o CC/MCC
603 Cellulitis w/o MCC
682 Renal failure w MCC
690 Kidney & urinary tract infections w/o MCC
743 uterine & adneza proc for nomalignancy w/o CC/MCC
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237 Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair
286 Circulatory disorders except AMI, w card cath w MCC
296 Cardiac arrest, unexplained w MCC
303 Atheroscelorsis w/o MCC
309 Cardiac arrythmia & conduction disorders w CC
373 Major gastrointestinal disorders & peritoneal infections w/o CC/ MCC
395 Other digestive system diagnosos w/o CC/MCC
138 Mouth Procedures w/o CC/MCC
141 syncope & collapse w/CC
192 Chronic obstructive pulmonary disease w/o CC/MCC
207 Respitory system diagnosis w ventilator support 96+hours
314 other circulatory system diagnoses w MCC
392 Esophagitis, gastroent & misc digest disorders w/o MCC
468 Revision of hip or knee replacement w/o CC/MCC
557 Tendonitis, myositis & bursitis w MCC
638 Diabetes w CC
918 Poisoning & toxic effects of drugs w/o MCC
143 Chest pain (changed to 313)
Hip and femur procedures, except major joint procedures age greater
210 than 17 with CC
247 Perc cardiovasc proc w drug-eluting stent w/o MCC
249 Perc cardiovasc proc w non-drug eluting stent w/o MCC
329 Major small & large bowel procedures w MCC
359 Uterine & adneza proc for nomalignancy w/o CC
371 Major gastrointestinal disorders & peritoneal infections w MCC
377 G.I. hemorrhage w MCC
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473 Cervical spine fusion w/o CC/MCC
490 Back & neck proc exc spinal fusion w CC/MCC or disc device/neurotism
552 Medical back problems w/o MCC
576 Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC
637 Diabetes w MCC
The Prospective Payment System (PPS) is a system for payment of inpatient non-VA
hospital services. PPS was adopted on October 1, 1983, by Health Care Financing
Administration (HCFA), Department of Health and Human Services, as a method for
providing payments under Medicare Part A (Hospital Insurance) to hospital Medicare
providers. VA adopted the PPS methodology in June, 1990.
a. The prospective payment methodology is a method of dividing hospital patients into
clinically coherent groups, DRGs (diagnostic related groups) based on the consumption of
1. Patients are assigned to the groups based on their principal diagnosis (the reason
for admission), secondary diagnosis, procedures performed, and the patient's age,
sex, and discharge status.
2. These groups form the basis of one payment methodology for inpatient care.
b. The basis of this payment methodology is that the medical facility providing inpatient
care will receive a predetermined, specific rate for each discharge.
1. This predetermined rate may be more or less than the overall cost for providing
care to any one individual patient.
2. Once the principal diagnosis is determined, the treating facility knows what their
reimbursement will be.
3. Under PPS, a hospital may keep the difference between its prospective payment
rate and its operating costs incurred in furnishing inpatient services, and is at risk
for operating costs that exceed its payment rate.
4. The intent is to encourage all medical facilities to become more efficient in
providing medical care.
c. VA uses the HCFA Prospective Payment System methodology when paying non-VA
d. VA began using this method of payment in order to be more compatible with other
Federal hospital reimbursement programs.
e. VA refers to the prospective payment rate as the DRG rate and refers to the prospective
payment system calculation as the pricer.
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g. PPS Final Regulations were published in Volume 49, No. 171, of the Federal Register
dated August 31, 1984.
Remember: Prospective payment system is used to determine payment for both authorized
and unauthorized hospitalizations. The DRG payment methodology applies to treatment
rendered in the United States and Puerto Rico.
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