J.34 CLIN 0001 Cost Proposal Template - Implementation.xlsx
XLSX spreadsheet 32 KB Posted
- Solicitation number
- 75FCMC19R0023
About this file
This document includes a solicitation for a Medicare Administrative Contractor to provide health insurance benefit administration services for Medicare Part A and Part B in Jurisdiction E. The contractor will be responsible for claims processing and payment, provider relations, and ensuring financial integrity of the Medicare Fee-For-Service Program in California, Hawaii, Nevada, American Samoa, Guam, and Northern Mariana Islands. The Centers for Medicare and Medicaid Services intends to award a single contractor through a full and open competition evaluated using a best value tradeoff process. The solicitation is expected to be released on September 4, 2019 with a proposal due date of November 4, 2019 and anticipated award date of August 4, 2020. The contract would have a one-year base period and six one-year options. The document includes templates for a cost proposal and other attachments to respond to the requirements of the upcoming solicitation.
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Text version
CLIN-0001
| COST TEMPLATE - Attachment J.34 | |||||||||
| (Provide a cost spreadsheet for each CLIN proposed) | |||||||||
| CLIN 0001 - Implementation | C.5.1 | I | |||||||
| A/B SERVICES | Total FTEs | Workload Implementation Requirements | AWARD FEE | GRAND TOTAL | |||||
| Hours | Rates | Total | Hours | Rates | Total | Hours | Total | ||
| COST ELEMENTS |
| Direct Labor | |||||
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| Add Other Appropriate Labor Categories (note: labor categories should match WBS) | 0 | $0.00 | $0 | 0 | $0.00 |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $0.00 | $0 | 0 | $0.00 | |
| 0 | $1.00 | $0 | 0 | $0.00 | |
| Subtotal Direct Labor | 0 | $0 | 0 | $0.00 |
Fringe Benefits (at ____%) $0 $0.00
Total Direct Labor $0 $0.00
| Travel (see separate schedule) | $0 | $0.00 | ||
| SUBCONTRACTORS | ||||
| Subcontractor Name | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0.00 |
| Total Subcontractor | 0 | $0 | 0 | $0.00 |
Other Direct Costs (See separate schedule) $0 $0.00
TOTAL ALL DIRECT COSTS $0 $0.00
Indirect Costs (at ______ %) $0 $0.00
TOTAL OTHER BEFORE FEE $0 $0.00
| Base Fee (at ____%) | $0 | $0.00 | |
| Award Fee (at ______%) | $0 | $0.00 | |
| Fixed Fee (at ______%) | $0 | $0.00 |
TOTAL OTHER AFTER FEE $0 $0 $0.00
| Complementary Credits | |||
| Note: comp. credit information will be provided by CMS prior to final proposal revision. Offerors should not propose amounts at this time. | |||
| GRAND TOTAL | $0 | $0 | $0.00 |
20180208
&"Arial,Bold"&12 75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
ODC Schedule
| ODC SCHEDULE - Attachment J.34 | |
| (Provide an ODC Spreadsheet for each CLIN Proposed) | |
| CLIN 0001 A/B SERVICES | |
| Cost Element | TOTAL |
Add costs by category
TOTAL ODCs $0.00
&"Arial,Bold"&12 75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
TRAVEL
| TRAVEL - Attachment J.34 |
| TRAVEL SUMMARY |
| CLIN 0001 |
| Purpose of Trip | SOW WBS | |||
| Crosswalk | Labor Category Taking Trip | Trip Origin | Destination | # People |
| (A) | # Trips | |||
| (B) | # Days | |||
| (C) | # Nights | |||
| (D) | Lodging Rate | |||
| (E) | Lodging | |||
| (F=E*D*A) | M&IE | |||
| (G) | Total Lodging |
and M&IE
| (H=F+G) | Airfare |
| (I) | Car Rental |
| (J) | Misc |
| (K) | Local |
Mileage
| (L) | Total Per Trip |
| (M=H+I+J+K+L) | Total For All Trips |
(N=M*B )
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
| $ - | $ - | $ - | $ - |
TOTAL TRAVEL $ -
Travel Assumptions:
&"Arial,Bold"&12 75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
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