Attachment_J.2-E_TO_0001_Business_Proposal_Forms.xlsx

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BFCC-QIO IDIQ Federal contract opportunity
Solicitation number
75FCMC18R0034
Issued by
Department of Health and Human Services Centers for Medicare and Medicaid Services

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J.2-E NCORC Business Proposal Forms

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BFCC_Pre-solicitation_Recording_Webex.docx DOCX document
May_15_BFCC_registered_participants_list.xlsx XLSX spreadsheet
2018-05-15_BFCC_Pre-Solicitation_Conference_Agenda.pdf PDF
2018-05-15_BFCC_Pre-Solicit_Conf_FINAL-508_Final.pptx PPTX presentation
Attachment_J.17_HCQIS_CFE_Guidelines_and_Requirements.docx DOCX document
Attachment_J.16_VDI_Onboarding.pdf PDF
Attachment_J.3-G_TO_0002_Task_Order_Terms_and_Conditions.docx DOCX document
Attachment_J.3-F_TO_0002_Business_Proposal_Instructions_Case_Review.docx DOCX document
SF-33_75FCMC18R0034.pdf PDF
Attachment_J.8_ServiceNow_CMS_Asset_and_Procurement_User_Guide.docx DOCX document
Attachment_J.2-C_TO_0001_Evaluation_Measures_Table_BFCC_NCORC.docx DOCX document
Attachment_J.12_565_Report_of_Accountable_Property.pdf PDF
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Attachment_J.4_Contractor_Business_Ethics_COI_and_Compliance_Program_Requirements.docx DOCX document
Attachment_J.3-C_TO_0002_Evaluation_Measures_Table.docx DOCX document
Attachment_J.2-F_TO_0001_Business_Proposal_Instructions_BFCC_NCORC.docx DOCX document
Attachment_J.11_Small_Business_Subcontracting_Plan.doc DOC document
Attachment_J.15_VPAT.doc DOC document
Attachment_J.1_BFCC_IDIQ_Statement_of_Work.docx DOCX document
Attachment_J.2-B_TO_0001_Schedule_of_Deliverables_BFCC_NCORC.docx DOCX document
Attachment_J.14_Question_Submission_Format_Sample.xlsx XLSX spreadsheet
Attachment_J.9_Information_Systems_Security_Requirements.docx DOCX document
Attachment_J.2-G_TO_0001_Task_Order_Terms_and_Conditions.docx DOCX document
Attachment_J.2-A_TO_0001_Statement_of_Work_BFCC_NCORC.docx DOCX document
Attachment_J.5_Personal_Conflicts_of_Interest_Financial_Disclosure.docx DOCX document
Attachment_J.3-D_TO_0002_Proposal_Instructions_and_Eval_Criteria_BFCC_Case_Review.docx DOCX document
Attachment_J.3-E_TO_0002_Business_Proposal_Forms_Case_Review_.xlsx XLSX spreadsheet
Attachment_J.10_Consent_to_Subcontract.docx DOCX document
Attachment_J.7_Compliance_Program_Guidance.pdf PDF
Attachment_J.3-B_TO_0002_Case_Review_SOD.docx DOCX document
Attachment_J.6_BFCC_Glossary_Terms_and_Acronyms.docx DOCX document
Attachment_J.3-H_LOE_by_Case.xlsx XLSX spreadsheet
Attachment_J.2-D_TO_0001_Proposal_Instructions_and_Eval_Criteria_BFCC_NCORC.docx DOCX document
Attachment_J.3-A_TO_0002_Case_Review_SOW.docx DOCX document
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BFCC-NCORC Sup Sch Total

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
00BFCC - NCORCFrom:12/31/99
0To:12/31/99
0
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total
HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
a. LABOR:
1.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
2.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
3.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
4.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
5.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
6.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
7.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
8.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
9.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
10.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
11.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
12.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
13.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
14.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
15.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
16.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
17.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
18.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
19.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
20. All Other (Non IT)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
41.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
42.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
43.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
44.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
45.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
46.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
47.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
48.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
49.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
50.0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
b. Leave0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
c. Fringe Benefits0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
2. Other Consultants0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
3. Other Subcontractors0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
e. Travel0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
f. Other Direct Costs0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0
SUBTOTAL - DIRECT0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0

g. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0
h. Fee$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
TOTAL COSTS WITH FEEERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0ERROR:#DIV/0!$0ERROR:#DIV/0!$0ERROR:#DIV/0!$0
Projected Volume - # of cases for:
Year 10000000000000000000000000
Year 20000000000000000000000000
Year 30000000000000000000000000
Year 40000000000000000000000000
Year 50000000000000000000000000
i. Pass-thru Costs

GRAND TOTAL: ERROR:#DIV/0! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#DIV/0! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#VALUE! ERROR:#DIV/0!

BFCC-NCORC Sup Sch YR1

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
BFCC - NCORCFrom:
To:

5. Expedited Single Case Reviews 6. Annual Performance Audits 7. Review for Preventable Patient Safety Events 8. BFCC Monitoring and Evaluation 9. Program Innovation Engine 10. Focused Reviews 11. Legal and Regulatory Affairs 12. Memorandums of Agreement and Joint Operating Agreements 13. Internal Quality Assurance and Surveillance 14. Training Medical Staff 15. Training Other Personnel 16. Information Services 17. Collaboration 18. Transparency Through Reporting 19. Transition Costs 20. Other Non-Review Activities BFC18 BFC19 BFC20 BFC21 BFC22 BFC23 BFC24 BFC25 BFC26 BFC27 BFC28 BFC29 BFC30 BFC35 and BFC36 BFC37 BFC38 BFC42 BFC48 BFC49 BFC50 21. Total

HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
a. LABOR:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. All Other (Non IT)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
b. Leave
c. Fringe Benefits
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors
2. Other Consultants$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
3. Other Subcontractors$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
e. Travel
f. Other Direct CostsERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - DIRECT0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0

g. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
h. Fee$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
TOTAL COSTS WITH FEEERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
Projected Volume - # of cases for:
Year 1
i. Pass-thru Costs$0

GRAND TOTAL: ERROR:#DIV/0! $0 $0 $0 $0 ERROR:#DIV/0! $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ERROR:#DIV/0!

BFCC-NCORC Sup Sch YR2

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
00BFCC - NCORCFrom:12/31/99
0To:12/31/99
0
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total
HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
a. LABOR:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. All Other (Non IT)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0
b. Leave
c. Fringe Benefits
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0
d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors
2. Other Consultants$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
3. Other Subcontractors$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0
e. Travel
f. Other Direct CostsERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - DIRECT0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0

g. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0
h. Fee$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
TOTAL COSTS WITH FEEERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
Projected Volume - # of cases for:
Year 2
i. Pass-thru Costs$0

GRAND TOTAL: ERROR:#DIV/0! $0 $0 $0 $0 ERROR:#DIV/0! $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ERROR:#DIV/0!

BFCC-NCORC Sup Sch YR3

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
00BFCC - NCORCFrom:12/31/99
0To:12/31/99
0
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total
HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
a. LABOR:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. All Other (Non IT)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
b. Leave
c. Fringe Benefits
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors
2. Other Consultants$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
3. Other Subcontractors$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
e. Travel
f. Other Direct CostsERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - DIRECT0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0

g. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0$00.0$0$0
h. Fee$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
TOTAL COSTS WITH FEEERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
Projected Volume - # of cases for:
Year 3
i. Pass-thru Costs$0

GRAND TOTAL: ERROR:#DIV/0! $0 $0 $0 $0 ERROR:#DIV/0! $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ERROR:#DIV/0!

BFCC-NCORC Sup Sch YR4

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
00BFCC - NCORCFrom:12/31/99
0To:12/31/99
0
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total
HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
a. LABOR:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. All Other (Non IT)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
b. Leave
c. Fringe Benefits
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors
2. Other Consultants$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
3. Other Subcontractors$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
e. Travel
f. Other Direct CostsERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - DIRECT0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0

g. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
h. Fee$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
TOTAL COSTS WITH FEEERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
Projected Volume - # of cases for:
Year 4
i. Pass-thru Costs$0

GRAND TOTAL: ERROR:#DIV/0! $0 $0 $0 $0 ERROR:#DIV/0! $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ERROR:#DIV/0!

BFCC-NCORC Sup Sch YR5

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
00BFCC - NCORCFrom:12/31/99
0To:12/31/99
0
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total
HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
a. LABOR:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. All Other (Non IT)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
b. Leave
c. Fringe Benefits
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
d. SUBCONTRACTS:
1. Physician Reviewers / Phys. Advisors
2. Other Consultants$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
3. Other Subcontractors$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
e. Travel
f. Other Direct CostsERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0ERROR:#DIV/0!$0ERROR:#DIV/0!$0ERROR:#DIV/0!$0
SUBTOTAL - DIRECT0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0

g. Indirect Costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $ - 0

TOTAL COSTS0.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0ERROR:#DIV/0!0.0$00.0
h. Fee$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0
TOTAL COSTS WITH FEEERROR:#DIV/0!$0$0$0$0ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0$0$0ERROR:#DIV/0!$0ERROR:#DIV/0!$0ERROR:#DIV/0!$0ERROR:#DIV/0!ERROR:#DIV/0!ERROR:#DIV/0!$0$0$0$0$0$0$0$0$0$0
Projected Volume - # of cases for:
Year 5
i. Pass-thru Costs$0

GRAND TOTAL: ERROR:#DIV/0! $0 $0 $0 $0 ERROR:#DIV/0! $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ERROR:#DIV/0! $0 ERROR:#DIV/0! $0 ERROR:#DIV/0! $0 ERROR:#DIV/0! ERROR:#DIV/0! ERROR:#DIV/0! $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 ERROR:#DIV/0!

Add'l Labor Categ.

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
00BFCC - NCORCFrom:12/31/99
0To:12/31/99
0
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total

Year 1

HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
20. All Other (LABOR) :
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUBTOTAL - 20. All Other (LABOR)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
Case Volume00
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total

Year 2

HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
20. All Other (LABOR) :
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUBTOTAL - 20. All Other (LABOR)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
Case Volume00
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total

Year 3

HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
20. All Other (LABOR) :
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUBTOTAL - 20. All Other (LABOR)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
Case Volume00
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total

Year 4

HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
20. All Other (LABOR) :
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUBTOTAL - 20. All Other (LABOR)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0
Case Volume00
5. Expedited Single Case Reviews6. Annual Performance Audits7. Review for Preventable Patient Safety Events8. BFCC Monitoring and Evaluation9. Program Innovation Engine10. Focused Reviews11. Legal and Regulatory Affairs12. Memorandums of Agreement and Joint Operating Agreements13. Internal Quality Assurance and Surveillance14. Training Medical Staff15. Training Other Personnel16. Information Services17. Collaboration18. Transparency Through Reporting19. Transition Costs20. Other Non-Review Activities0BFC18BFC19BFC20BFC21BFC22BFC23BFC24BFC25BFC26BFC27BFC28BFC29BFC30BFC35 and BFC36BFC37BFC38BFC42BFC48BFC49BFC5021. Total

Year 5

HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTSHOURS
20. All Other (LABOR) :
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUBTOTAL - 20. All Other (LABOR)0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0

Case Volume 0 0

QIOSubconts 2

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Service Area:4. Contract Period:
000From:12/31/99

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