Attachment_J.12a__Business_Proposal_Instructions_Final.docx

NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORS BUSINESS PROPOSAL FORMAT

FOR UTILIZATION AND QUALITY CONTROL

QUALITY IMPROVEMENT ORGANIZATIONS

FORMS AND INSTRUCTIONS

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

BALTIMORE, MARYLAND

Attachment J.13(a) Business Proposal Instructions

TABLE OF CONTENTS

II.GENERAL INSTRUCTIONS 3

III.ADDITIONAL EXPLANATION AND JUSTIFICATION FOR BUSINESS

PROPOSALS 4

IV.BUSINESS PROPOSAL FORMS AND INSTRUCTIONS

A. CMS Form 718 BP - Network of Quality Improvement and Innovation ContractorsSOW Business Proposal Summary. 7

D. CMS Form 721 BP - Indirect Cost. 12

F. CMS Form STAFFING - Personnel Loading Charts. 15

G. CMS Form SC 2 – Subcontracts Proposal - Other. 19

H. CMS Form SUM - Staffing Proposal Summary. 21

V.APPENDIX A-1

1: DEFINITIONS AND GUIDELINES: NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORSSOW BUSINESS PROPOSAL A-1

I. INTRODUCTION

PURPOSE

This guideline package will assist you in preparing the standardized business proposal forms used to award Network of Quality Improvement and Innovation Contractors Medicare Quality Improvement Organization (NQIIC) contracts.

SCOPE

Offerors must use the electronic files that CMS provides to prepare and submit the business proposal. This guideline package provides instructions for completing the various business proposal forms in the CMS electronic file. The hardcopy version of this package includes a sample of the various forms.

Offerors are required to include the appropriate supporting documentation cross-referenced to the related column, line item, and form. Offerors do not need to submit invoices and vendor quotes. However Offerors are to submit detailed assumptions on how costs are calculated for each item. Offerors must include quantities proposed as applicable, unit costs and all calculations. CMS may request invoices and vouchers from bidders at a later point in time. The supporting documentation shall be detailed and, as appropriate, fully explain calculations, bases for estimates, etc. Examples include:

a. Market surveys;

b. Historical data;

c. Specific calculations used to estimate proposed costs and an explanation;

d. Catalog prices; and

e. Previous billing statements/expense vouchers.

METHOD OF SUBMISSION

CMS is providing you with the business proposal forms in an Excel spreadsheet file titled Business Proposal Template. You should enter your cost data in the Excel files and submit your completed business proposal in both electronic and hard-copy format.

The cost information in the electronic version of your completed business proposal must be in Excel2013 format or older. The narrative supporting information can be in Excel2013 (or older) or Word2013 (or older) format.

II. GENERAL INSTRUCTIONS

The following general instructions for the completion and submission of the business proposal forms are in addition to those instructions contained in the RFP issued by CMS to all offerors and in addition to the attached Section III – ADDITIONAL EXPLANATION AND JUSTIFICATION FOR BUSINESS PROPOSAL.

1. The CMS-provided electronic file and the specified Excel and Word versions are the only acceptable format for your cost proposal submission. Proposals received in any other format will be considered unacceptable.

The business proposal spreadsheets are formatted to accept one decimal place for entries relating to hours and whole dollars for entries relating to costs. However, where appropriate (e.g., hourly rates), the formatting will permit 2 decimal places for costs.

2. As used in this cost proposal process, the term "NQIIC" refers to both present potential NQIIC organizations.

4. All blocks on the forms that are shaded are filled out by formulae from within the form or from other forms or are for CMS use only, and they should not be filled out by the submitting NQIIC. Please fill out, as appropriate, only the unshaded blocks.

5. OMB INSTRUCTIONS REQUIRE THE FOLLOWING BURDEN DISCLOSURE NOTICE TO BE INCORPORATED ON ALL COLLECTIONS OF INFORMATION OR THE ACCOMPANYING INSTRUCTIONS.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0579. The time required to complete this information collection is estimated to average (22hours)(45minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.

III. ADDITIONAL EXPLANATION AND JUSTIFICATION FOR BUSINESS PROPOSAL

General

As a general rule you should explain how you calculated all items in your business proposal, with the exceptions provided below. ALL COSTS MUST BE VERIFIABLE.

Full Time Equivalents (FTEs) and Salaries

Direct Labor: Offerors shall provide labor rates for all labor categories that are expected to be used in the performance of the task order.

FTEs proposed should be proposed on the basis of the most efficient method of performing the work under the sample task order. The total direct labor hours, and their distribution across labor categories (e.g. professional, support staff) proposed should be justified on the basis of the information provided in the technical proposal and/or capability.

All proposed labor rates shall be supported with matching rates or formal salary survey information conducted by your organization from an acceptable source. NQIICs shall also explain organizational salary increases. The organizational salary increase will be determined each year by the “Grand Total Percent Change” cell on the Person Loading Chart – Staffing (i.e. for the year 1 over the current year it is cell “O 112” on the Form Staffing).

Leave

Please summarize your leave policy. Also, explain any increase in your leave rate as a percentage of direct labor cost. All leave should be reported as part of the Fringe Benefit Category or in your approved Indirect Leave Rate.

Fringe Benefits

For Fringe Benefits, if you have an approved provisional rate, it can serve as the justification for the Fringe Benefit expense. If you do not have an approved provisional rate or you do not believe that this rate is correct for your five-year budget, please justify the rate requested, with emphasis on the major items of increase.

Other Consultants/Subcontracts

The prime shall submit a complete business proposal for all subcontractors proposed for the Sample Task Order. Subcontract direct labor shall be shown in the same manner.

For Consultants and Other Subcontracts, please justify the purpose of each proposed Consultant and Subcontract. Explain the methodology used to formulate each Consultant Service or Subcontract cost, including hourly rates and number of hours requested for the Consultants or for the personnel employed in the Subcontract. The NQIIC’s cost detail shall also include the determination if the rates are fully loaded. For all Subcontracts, you shall use the subcontractor’s business proposal as supporting documentation. Essentially, the Consultant(s)/Subcontractor(s) must complete the same level of detail as the Prime. If the Consultant(s)/Subcontractor(s) are not comfortable with submitting their proposal to the Prime, they may send it to CMS directly.

Example (for a Consultant):

***Note: The following items (Fee, Other Direct Costs and Travel) are not to be include in the Offeror’s business proposal.

Fee

The Offeror should not include fee on the business proposal spreadsheet. The percentage of fee will be established at the task order level.

Other Direct Costs (ODCs)

If ODCs are anticipated for this task order, they shall be referenced in the technical response but no costs are to be included in the business proposal.

Travel

There is no anticipated travel for this Task Order.

Indirect Costs

For Indirect Costs, if you have an approved provisional Indirect Rate it can serve as the justification for this cost. Provide any of the additional information if it applies to your indirect rate:

· Please explain how you calculated Rent, including information of how many square feet are currently rented, the number of square feet you propose to rent under the new contract, and the cost per square foot in the prior year and each year of the proposed contract.

· If you report AHQA dues, report the amount per year and how the amount was determined.

· If you report Board of Directors fees, please detail your basis of compensation per board meeting or for travel performed on behalf of the organization.

Indirect cost rates shall be based on twelve (12) month period of costs that represent the costs anticipated for the offeror’s fiscal year period. When calculating the indirect cost rates, the offeror should base their indirect rates on the budgeted cost for the 12 month period of the sample task order.

Indirect rates must include supporting documentation of budgeted and prior year actual cost by cost element for each pool and base and every indirect rate utilized by the offeror. Include a breakdown of the base cost elements to identify direct labor and indirect labor (separately identifying OH, G&A, B&P, or unallowable, as applicable) for the fringe base. For the indirect rate base, include direct labor, applicable leave or fringe, based on the application of the rate proposed, subs travel, rent, etc. and the visibility of the other direct costs in the indirect base, as applicable.

The Indirect rate proposal must also include an explanation of what the rates are based on as to how they were determined. The Government will not instruct contractors how to budget their costs, however, in order to make a determination of fair and reasonable, the Government must know the basis of the indirect rates proposed.

INSTRUCTIONS FOR CMS FORM 718 BP

NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORSSOW

BUSINESS PROPOSAL SUMMARY

ITEM

1. Name and Address of NQIIC Organization. Enter the name and address of the organization submitting the proposal (make sure the information is entered in the boxes shown at cells A3, A4 and A5)

2. NQIIC Area. Enter the State or other area that the proposed NQIIC contract will cover (make sure the information is entered in the box shown at cell C7).

3. RFP Number. Enter the CMS RFP number for the proposed NQIIC contract (make sure the information is entered in the box shown at cell J3.)

4. Proposed Contract Period. Enter the beginning and ending dates of the proposed NQIIC contract (make sure the information is entered in the boxes shown at cells K7 and K9.)

5. Total Proposed Costs. This column contains your total proposed costs for the 5-year contract period. The proposed costs are listed for each line item category. No entries are required because the proposed costs automatically flow from Form 719 BP.

6. CMS Recommended Costs. No entries required. For CMS internal use only.

7. $ Difference. No entries required. For CMS internal use only.

8. % Difference. No entries required. For CMS internal use only.

9. Fringe, Indirect, and Other Rates. NQIICs should enter their approved fringe benefit rate and indirect cost rate in the appropriate spaces. Leave the fringe and indirect rate spaces blank if you are a new NQIIC and do not have approved rates.

10. Signature of Authorized Official. The appropriate official of the organization submitting the business proposal should sign here.

13. Telephone #. Enter the organization’s phone number, starting with the area code.

14. For CMS use only.

15. For CMS use only.

16. For CMS use only.

BLANK PAGE

RESERVED FOR INSERTION OF FORM 718 BP SUM

INSTRUCTIONS FOR CMS FORM 719 BP

NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORSSOW BUSINESS PROPOSAL

ITEM

1. RFP#. No entry required. This information automatically flows from Form 718 BP.

2. Name and Address of NQIIC Organization. No entry required. This information automatically flows from Form 718 BP.

3. NQIIC Area. No entry required. This information automatically flows from Form 718 BP.

4. Proposed Contract Period. No entry required. This information automatically flows from Form 718 BP.

COST CENTER COLUMNS

THE NEXT COLUMN SERVES AS THE COST CENTER FOR NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORS AS INDICATED BELOW:

NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORS - This column is used for all costs directly attributable to the activities described in this SOW under Quality Improvement Network.

THE NEXT COLUMN SERVES AS THE COST CENTER FOR INFORMATION SERVICES AS INDICATED BELOW:

INFORMATION SERVICES – This column is used for all cost directly attributable to information services activities described in the SOW, and which are further described in the Appendix to these instructions under the section on Information Services.

Note: For direct contract costs that cannot be attributed to provided costs centers, the NQIIC/Offeror shall allocate those direct costs to each of the cost centers, using an allocation method consistent with organization practice. This does not include costs related to governance. These costs benefit the entire organization and should be included in indirect.

LINE ITEMS

a.1- a.4 Labor. No entry required. The hours and costs for each direct labor category are automatically calculated from the Staffing Proposal Summary sheet (Form SUM).

b. Leave. Note: include all paid time off (leave) in Fringe Benefit pool unless your organization has an approved separate Indirect Leave Rate (ILR). If your organization has an approved ILR, enter the appropriate hours and cost for each category for the 5-year contract period.

c. Fringe Benefits. Enter the fringe benefits cost for the 5-year contract period that applies to the particular column cost center. Include all paid time off (leave) unless your organization has an approved separate indirect leave rate.

d.1- d.2 Subcontracts. No entry required. The hours and costs for each category are automatically calculated from the Subcontracts Proposal sheet (Form SC 2).

e. Indirect Costs. Enter the indirect costs for the 5-year contract period that applies to the particular column cost center.

TOTAL

No entry required. This column automatically calculates the total hours and costs for each line item category from the entries in the cost center columns.

RESERVED FOR INSERTION OF FORM 719 BP

INSTRUCTIONS FOR CMS FORM 721 a-d BP

INDIRECT COST

NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORSSOW BUSINESS PROPOSAL

NOTE*** Forms 721 b-d are only to be completed by Offerors that utilize multiple Indirect rates. Offerors are to complete one form per indirect rate type. For example; If an Offeror has both G&A and Overhead, the Offeror is to enter G&A costs on Form 721 a and Overhead costs on Form 721 b.

ITEM

1. Name and Address of NQIIC Organization. No entry required. This information automatically flows from Form 718 BP.

2. NQIIC Area. No entry required. This information automatically flows from Form 718 BP.

3. RFP#. No entry required. This information automatically flows from Form 718 BP.

4. Proposed Contract Period. No entry required. This information automatically flows from Form 718 BP.

Note: If a NQIIC has an approved provisional indirect cost rate and the NQIIC determines that this approved rate will accurately reflect projected 5-year indirect costs, it is not necessary to complete the individual line items on Form 721 BP pertaining to indirect costs. Instead, enter the indirect cost rate on Line ee.

If the NQIIC believes that the approved rate is not appropriate for projecting 5-year costs, the NQIIC should complete the individual line items in columns 6 and 8, as explained below. In any case, as explained in “Section 3 - Additional Explanation and Justification for Business Proposal” you should explain all rental costs, AHQA dues, or Board of Directors fees in that section.

COLUMN 5 - Prior Year Total Indirect Costs

LINE

a. - dd. Individual line item categories. Disregard these line items. No entries should be made on these line items in column 5.

ee. Indirect Cost Rate. Enter the indirect cost rate for the latest 12-month period completed, for which cost data is available. Identify this 12-month period in your supporting documentation and explain the base (i.e., denominator) used to calculate this rate.

COLUMN 6 - Projected Total 5-yr Indirect Costs

LINE

a. - cc. Individual line item categories. On each line item, enter the indirect cost projected for your organization for the 5-year period that the NQIIC contract would be operating.

Your supporting documentation should explain, in detail, any amount you entered on line item cc. The supporting documentation should also fully explain the assumptions and bases you used for your organization’s projection, including appropriate cost projection schedules.

dd. Total. No entry required. This line item automatically calculates the total of line items a. thru cc.

ee. Indirect Cost Rate. Enter the indirect cost rate that applies to the amount on line item dd. (Total). In your supporting documentation, give a detailed explanation of the method used to calculate this rate.

COLUMN 7 - Prior Year Medicare Indirect Costs

LINE

a. - ee. Individual line item categories. Disregard these line items. No entries should be made on these lines in column 7.

COLUMN 8 - Projected Medicare 5-yr Indirect Costs

LINE

a. & b. Indirect Labor and Indirect Leave. On each line item, enter the portion of the corresponding line item cost in column 6. (Projected Total 5-yr Indirect Costs) allocated to the proposed Medicare NQIIC contract.

c. - cc. Individual line item categories. On each line item, enter the portion of the corresponding line item cost in column 6. (Projected Total 5-yr Indirect Costs) allocated to the proposed Medicare NQIIC contract.

Your supporting documentation should explain, in detail, any amount you entered on line item cc. The supporting documentation should also fully explain the assumptions and bases you used to allocate a portion of your organization’s total projected indirect costs to the proposed Medicare NQIIC contract.

dd. Total. No entry required. This line item automatically calculates the total of line items a. thru cc.

ee. Indirect Cost Rate. No entry required, as the indirect rate that applies has already been provided in column 6.

RESERVED FOR INSERTION OF FORM 721 BP

INSTRUCTIONS FOR PERSONNEL LOADING CHARTS

STAFFING PROPOSAL

FORM STAFFING

These instructions apply to the personnel loading charts for all four labor categories. It is preferable that positions should be listed in the following order: (1) Corporate Management, (2) Professional, (3) Information Systems, and (4) Support Staff. You should not list each type of labor category on a separate sheet. Positions will be sorted by labor category based on the labor category code (see col. 3 below). The form will automatically summarize information by labor category under the Grand Total line. Please note that all entries for employees concerning proposed hours for labor and leave, whether direct or indirect, must be based on a work year of 2,080 hours.

COLUMN

2. Position Title. Enter the employee’s Position Title.

3. Labor Category Code. Enter the employee’s Labor Category code: P for Professional; I for Information Systems; C for Corporate Management; S for Support Staff.

4. Current Hourly Rate. Enter the employee’s current hourly rate of pay.

5. Proposed Year 1 Hourly Rate. Enter the employee’s hourly pay rate for year 1 of the proposed Medicare NQIIC contract.

6. Percent Change. No entry required. This column automatically calculates the percentage change in the hourly pay rate from the current rate to the year 1 rate of the proposed Medicare NQIIC contract.

7. Proposed Year 2 Hourly Rate. Enter the employee’s hourly pay rate for year 2 of the proposed Medicare NQIIC contract.

8. Percent Change. No entry required. This column automatically calculates the percentage change in the hourly pay rate from year 1 of the proposed Medicare NQIIC contract to year 2.

9. Proposed Year 3 Hourly Rate. Enter the employee’s hourly pay rate for year 3 of the proposed Medicare NQIIC contract.

10. Percent Change. No entry required. This column automatically calculates the percentage change in the hourly pay rate from year 2 of the proposed Medicare NQIIC contract to year 3.

11. Proposed Year 4 Hourly Rate. Enter the employee’s hourly pay rate for year 4 of the proposed Medicare NQIIC contract.

12. Percent Change. No entry required. This column automatically calculates the percentage change in the hourly pay rate from year 3 of the proposed Medicare NQIIC contract to year 4.

13. Proposed Year 5 Hourly Rate. Enter the employee’s hourly pay rate for year 5 of the proposed Medicare NQIIC contract.

14. Percent Change. No entry required. This column automatically calculates the percentage change in the hourly pay rate from year 4 of the proposed Medicare NQIIC contract to year 5.

15. Average Network of Quality Improvement and Innovation Contractors Hours Per Year. Enter one-fifth of the total direct labor hours the employee would devote to Network of Quality Improvement and Innovation Contractors during the 5-year Medicare NQIIC contract period.

16. Total 5-yr Network of Quality Improvement and Innovation Contractors Labor Costs. No entry required. This column automatically calculates the total direct labor costs for Network of Quality Improvement and Innovation Contractors activities based on the amounts you entered in the previous columns. The calculation assumes that an employee has the same direct labor hours for each of the 5 contract years based on your column 15 entry.

17. Average IS Hours Per Year. Enter one-fifth of the total direct labor hours the employee would devote to information services activities during the 5-year Medicare NQIIC contract period.

18. Total 5-yr Information Services Labor Costs. No entry required. This column automatically calculates the total direct labor costs for Information Services based on the amounts you entered in the previous columns. The calculation assumes that an employee has the same direct labor hours for each of the 5 contract years based on your column 17 entry.

39. Average Total Direct Labor Hours Per Year. No entry required. The amounts in this column are automatically calculated from your previous entries in the individual cost center columns dealing with average direct labor hours per year.

40. Total 5-yr Direct Labor Costs. No entry required. The amounts in this column are automatically calculated from the entries in the individual cost center columns dealing with 5-yr labor costs.

41. Average Indirect Labor Hours Per Year. Enter one-fifth of the total indirect labor hours estimated for the employee during the 5-year Medicare NQIIC contract period.

42. Total 5-yr Indirect Labor Costs. No entry required. This column is automatically calculated based on the amounts you entered in the previous columns. The calculation assumes that an employee has the same indirect labor hours for each of the 5 contract years based on your column 41 entry.

43. Average Total Labor Hours Per Year. No entry required. This column is automatically calculated based on your previous entries for average direct and indirect labor hours per year.

44. Total 5-yr Labor Costs. No entry required. This column automatically combines the amounts entered for total direct labor costs and total indirect labor costs in previous columns.

45. Average Direct Leave Hours Per Year. Not Applicable. Include all paid time off (leave) in Fringe Benefits unless your organization has an approved separate Indirect Leave Rate.

46. Total 5-yr Direct Leave Costs. Not Applicable. Include all paid time off (leave) in Fringe Benefits unless your organization has an approved separate indirect leave rate.

47. Average Indirect Leave Hours Per Year. Enter one-fifth of the total indirect leave hours estimated for the employee during the 5-year Medicare NQIIC contract period.

48. Total 5-yr Indirect Leave Costs. No entry required. This column is automatically calculated based on the amounts you entered in the previous columns. The calculation assumes that an employee has the same indirect leave hours for each of the 5 contract years based on your column 47 entry.

49. Average Total Leave Hours Per Year. No entry required. This column is automatically calculated based on your previous entries for average indirect leave hours per year.

50. Leave as a % of Hours Worked. No entry required. This column calculates automatically based on amounts you entered in previous columns.

51. Total 5-yr Leave Costs. No entry required. This column automatically combines the amounts entered for total indirect leave costs in previous columns.

52. Average Total Labor and Leave Hours Per Year. No entry required. This column automatically combines the amounts for average yearly direct and indirect labor and leave hours in previous columns.

53. Total 5-yr Labor/Leave Costs. No entry required. This column automatically calculates the total 5-yr cost of your proposed contract for labor and leave combined.

54. FTE Per Year. No entry required. This column automatically calculates the average yearly FTE for each employee. The calculation considers all employee hours -- labor, leave, direct, and indirect.

Your proposed hours for labor and leave must be based on a work year of 2,080 hours.

RESERVED FOR INSERTION OF FORM NQIIC STAFFING

INSTRUCTIONS FOR CMS FORM SC 2

SUBCONTRACTS PROPOSAL - OTHER

NOTE: Please enter the requested cost information separately for each other consultant in Section 1 and each other subcontractor in Section 2. If you have more than 10 entries for Section 1 or 2, provide the additional consultant/subcontractor information on an attachment and carry the attachments subtotals to line k.

COLUMN

1. Name. Enter the first initial and last name of the subcontractor, when appropriate. If it is more appropriate to identify the subcontractor by a company or organizational name, enter this name instead of an individual’s name. Enter TBD If you are proposing a particular subcontracting activity for the 5-year Medicare contract but have not yet identified a particular subcontractor.

2. Total 5-yr Network of Quality Improvement and Innovation Contractors Costs. For each consultant/subcontractor, enter the total costs that you propose for Network of Quality Improvement and Innovation Contractors costs during the 5-year Medicare NQIIC contract period.

3. Total 5-yr Information Services Costs. Enter the total information services costs that you propose for each consultant/subcontractor, for the 5-year Medicare NQIIC contract period.

4. Total 5-yr Costs. No entry required. The amounts in this column are automatically calculated from the entries in the individual cost center columns.

5. Current Activity. If applicable, enter a short description of the work that the consultant/subcontractor is currently performing. Otherwise, enter NA.

6. Proposed Activity. Enter a short description of the work that the consultant/subcontractor would perform during the 5-year Medicare NQIIC contract. Provide a detailed explanation of the activity in your supporting documentation.

RESERVED FOR INSERTION OF FORM SC 2

INSTRUCTIONS FOR CMS FORM

STAFFING SUMMARY PROPOSAL

NOTE: This form summarizes hour and cost information by labor category and cost center. No entries are required, as all information is automatically calculated from the individual personnel loading charts for each labor category.

COLUMN

1. Average Current Hourly Rate. For each labor category, this amount corresponds to the related current hourly rate for that labor category. This amount is an average of the individual entries in the loading chart column.

2. Proposed Average Year 1 Hourly Rate. For each labor category, this amount corresponds to the total Proposed Year 1 Hourly Rate for that labor category. This amount is an average of the individual entries in the loading chart column.

3. Percent Change. For each labor category, this amount reflects the percentage change in the average hourly pay rate from the current average rate to the average rate for year 1 of the proposed Medicare NQIIC contract.

4. Proposed Average Year 2 Hourly Rate. For each labor category, this amount corresponds to the total Proposed Year 2 Hourly Rate for that labor category. This amount is an average of the individual entries in the loading chart column.

5. Percent Change. For each labor category, this amount reflects the percentage change in the average hourly pay rate from year 1 of the proposed Medicare NQIIC contract to year 2.

6. Proposed Average Year 3 Hourly Rate. For each labor category, this amount corresponds to the total Proposed Year 3 Hourly Rate for that labor category. This amount is an average of the individual entries in the loading chart column.

7. Percent Change. For each labor category, this amount reflects the percentage change in the average hourly pay rate from year 2 of the proposed Medicare NQIIC contract to year 3.

8. Proposed Average Year 4 Hourly Rate. For each labor category, this amount corresponds to the total Proposed Year 4 Hourly Rate for that labor category. This amount is an average of the individual entries in the loading chart column.

9. Percent Change. For each labor category, this amount reflects the percentage change in the average hourly pay rate from year 3 of the proposed Medicare NQIIC contract to year 4.

10. Proposed Average Year 5 Hourly Rate. For each labor category, this amount corresponds to the total Proposed Year 5 Hourly Rate for that labor category. This amount is an average of the individual entries in the loading chart column.

11. Percent Change. For each labor category, this amount reflects the percentage change in the average hourly pay rate from year 4 of the proposed Medicare NQIIC contract to year 5.

during the 5-year Medicare NQIIC contract period.

12. Total Network of Quality Improvement and Innovation Contractors Labor Costs. For each labor category, this amount is the total direct labor cost proposed for Network of Quality Improvement and Innovation Contractors activities during the 5-year Medicare NQIIC contract period.

13. Total Network of Quality Improvement and Innovation Contractors Labor Hours. For each labor category, this amount is the total direct labor hours proposed for Network of Quality Improvement and Innovation Contractors activities during the 5-year Medicare NQIIC contract period.

14. Total Information Services Labor Hours. For each labor category, this amount is the total direct labor hours proposed for nursing home safety learning network/collaborative activities during the 5-year Medicare NQIIC contract period.

15. Total Information Services Labor Costs. For each labor category, this amount is the total direct labor cost proposed for nursing home safety learning network/collaborative activities during the 5-year Medicare NQIIC contract period.

16. Total Direct Labor Hours. For each labor category, this amount is the total direct labor hours proposed for all activities during the 5-year Medicare NQIIC contract period.

17. Total Direct Labor Costs. For each labor category, this amount is the total direct labor costs proposed for all activities during the 5-year Medicare NQIIC contract period.

18. Total Indirect Labor Hours. For each labor category, this amount is the total indirect labor hours you propose to apply to the 5-year Medicare NQIIC contract period.

19. Total Indirect Labor Costs. For each labor category, this amount is the total indirect labor costs you propose to apply to the 5-year Medicare NQIIC contract period.

20. Total Labor Hours. For each labor category, this amount is the total direct and indirect labor hours you propose for the 5-year Medicare NQIIC contract period.

21. Total Labor Costs. For each labor category, this amount is the total direct and indirect labor costs you propose for the 5-year Medicare NQIIC contract period.

22. Total Direct Leave Hours. Not Applicable. Include all paid time off (leave) in Fringe Benefits unless your organization has an approved separate Indirect Leave Rate.

23. Total Direct Leave Costs. Not Applicable. Include all paid time off (leave) in Fringe Benefits unless your organization has an approved separate Indirect Leave Rate.

24. Total Indirect Leave Hours. For each labor category, this amount is the total indirect leave hours you propose to apply to the 5-year Medicare NQIIC contract period.

25. Total Indirect Leave Costs. For each labor category, this amount is the total indirect leave costs you propose to apply to the 5-year Medicare NQIIC contract period.

26. Total Leave Hours. For each labor category, this amount is the total direct and indirect leave hours you propose for the 5-year Medicare NQIIC contract period.

27. Leave as a % of Hours Worked. For each labor category, this amount provides the percentage relationship of leave hours to labor hours. It is based on the entries you made on the individual personnel loading charts for each labor category regarding direct and indirect labor and leave hours.

28. Total Leave Costs. For each labor category, this amount is the total direct and indirect leave costs you propose for the 5-year Medicare NQIIC contract period.

29. Total Labor and Leave Hours. For each labor category, this amount is the total labor and leave hours (indirect) you propose for the 5-year Medicare NQIIC contract period.

30. Total Labor and Leave Costs. For each labor category, this amount is the total labor and leave costs (indirect) you propose for the 5-year Medicare NQIIC contract period.

31. Total FTE Per Year. For each labor category, this amount is the full-time equivalent per year. It is based on total labor and leave hours (direct and indirect) and a work year of 2,080 hours.

RESERVED FOR INSERTION OF FORM NQIIC STAFF SUM

V. APPENDIX

APPENDIX 1: DEFINITIONS AND GUIDELINES

NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORSSOW BUSINESS PROPOSAL

I. GENERAL.

The forms that you need to complete your business proposal are forwarded electronically in an Excel spreadsheet file. (Sample forms are also included in the hardcopy version of this guideline package.) Upon opening the Excel file, the forms are accessible by clicking the various tabs at the bottom of your screen. Each tab represents one of the hardcopy business proposal forms. The forms and their related tab titles are as follows:

Form Tab Title Description

718 BP F718 BP SUM Business proposal summary

719 BP NQIIC F719 5-year proposed costs by cost center

721 BP NQIIC F721 Indirect and Other Direct Cost

Staffing NQIIC Staff Personnel loading chart for all NQIIC Staff

SC 2 NQIIC Subconts2 Personnel loading chart for other consultants and other subcontractors

Sum NQIIC Staff Sum Personnel loading chart summary

Most of the cost information is entered on the individual Personnel Loading Charts and the Subcontracts Proposal form. The information you enter on these forms flows to the Form 719 BP. There are only a few line items on Form 719 BP that require your direct entry. Cells that do not require your entry are blocked. For specific data entry instructions, please see Section IV of the Table of Contents.

The following information is provided in a format consistent with the line item categories on CMS Form 719 BP. This information also applies to similar terms on other forms and worksheets used for the business proposal end for the Financial Information and Vouchering System (FIVS).

a. LABOR. All proposed labor rates shall be supported with matching rates or formal salary survey information conducted by your organization from an acceptable source (i.e. www.salary.com, www.indeed.com, or etc.).

NOTE: The Line designations listed below apply both to the Forms BP719 of the FIVS 719 + 719A

b. LEAVE. This line item should be completed by all organizations that have an approved Indirect Leave Rate. This line item includes all indirect leave such as vacation, sick, holiday, and military leave. Accounting treatment of leave as an indirect cost must be consistent for all contracts or lines of business.

c. FRINGE BENEFITS. This line item includes allowances provided by the contractor to its employees as compensation in addition to regular wages and salaries. The Fringe Benefits line includes all direct costs such as employer’s share of FICA, federal unemployment tax, state unemployment insurance, disability insurance, pension expense, workers compensation, group health insurance, group life insurance, employee relations, and welfare. It also covers leave costs for those organizations that include these costs in the fringe benefit pool. This category does not include benefits provided some, but not all, full-time employees.

d. SUBCONTRACTS

1. PHYSICIAN REVIEWERS/ADVISORS. This line item includes all direct hours and costs related to subcontracts or agreements with physician reviewers or physician advisors to perform medical case review (and related) activities required by the statement of work (SOW). This applies to physicians who are not employees.

2. OTHER CONSULTANTS. This line item includes all direct costs related to subcontracts with physician and non-physician consultants (other than the physician reviewers and physician advisors performing medical case review, noted above) to perform activities required by the SOW.

3. OTHER SUBCONTRACTS. This line item is for all direct subcontracting costs not reportable on lines d.1. or d.2. This includes all direct hours and costs for subcontract arrangements (including those with universities and other organizations) meeting the requirements of the FAR, incurred in performance of the SOW, and not involving consultative services.

e. INDIRECT COSTS. This line item includes costs allocated to the Medicare contract but incurred for common or joint objectives. These costs fit in one of the following categories:

1. Costs that benefit all lines of business.

2. Costs that directly benefit the Medicare contract but which cannot be readily allocated to one or more specific cost centers. These costs are also referred to as general overhead costs of the Medicare contract.

Accounting treatment of indirect costs must be applied consistently to all contracts or lines of business and in accordance with the FAR and OMB Circular A-122.

III. COST CENTER COLUMN CATEGORIES

a. NETWORK OF QUALITY IMPROVEMENT AND INNOVATION CONTRACTORS - This column is used for all cost directly attributable to the activities described in this SOW under Network of Quality Improvement and Innovation Contractors.

b. INFORMATION SERVICES. This column includes all costs directly attributable to information services activities described in the SOW. This includes standard data processing system costs. Except for data entry costs, report all costs for activities that allow NQIICs to comply with their data processing and reporting responsibilities (i.e., reporting, retrieval, data validation, ADP systems analysis, and electronic data interchange).

Include costs for the following activities:

5. FIVS compilation and reporting (but do not include financial accounting activities).