J.40 CLIN 0007 Cost Proposal Template - Option Year 2
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- Solicitation number
- 75FCMC19R0023
About this file
This document contains a federal contract opportunity for Medicare administrative services. The Centers for Medicare and Medicaid Services is seeking a Medicare Administrative Contractor to provide specified health insurance benefit administration services including Medicare claims processing and payment services in Jurisdiction E, which includes California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands. The selected contractor will perform numerous functions to support healthcare services for Medicare beneficiaries such as performing claims-related activities and establishing relationships with healthcare providers. The anticipated proposal due date is November 4, 2019, with an expected award date of August 4, 2020. The contract will include a base year plus six one-year options. The solicitation is expected to be issued pending availability of funds.
RFP Attachment
Text of this file
CLIN 0007
| COST TEMPLATE - Attachment J.40 | ||||
| (Provide a cost spreadsheet for each CLIN proposed) | ||||
| CLIN 0007 | P.1.11 | |||
| Total FTEs | Medicare Healthcare Provider Intervention Program (MPIP) | |||
| Hours | Rates | Total | ||
| COST ELEMENTS |
| Direct Labor | |||
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| Add Other Appropriate Labor Categories (note: labor categories should match WBS) | 0 | $0.00 | $0.00 |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| Subtotal Direct Labor | 0 | $0.00 | $0.00 |
Fringe Benefits (at ____%) $0
Total Direct Labor $0
| Travel (See separate schedule. Total should match) | $0 | |
| SUBCONTRACTORS | ||
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Total Subcontractor | 0 | $0.00 |
Other Direct Costs (See separate schedule. Total should match.) $0
TOTAL ALL DIRECT COSTS $0
Indirect Costs (at ______ %) $0
TOTAL OTHER BEFORE FEE $0
| Base Fee (at ____%) | $0 |
| Award Fee (at ______%) | $0 |
| Fixed Fee (at ______%) | $0 |
TOTAL OTHER AFTER FEE $0
| GRAND TOTAL | $0 |
| v1 04252012 |
20180525
&"Arial,Bold"&12
75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
TRAVEL
| COST TEMPLATE - Attachment J.40 |
| TRAVEL SUMMARY |
| CLIN 0007 |
| 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
ODC
COST TEMPLATE - Attachment J.40
| CLIN 0007 A/B SERVICES | GRAND | |
| Cost Element | Amount | TOTAL |
| $0.00 | ||
| Add costs by category | $0.00 | |
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| TOTAL ODCs | $0.00 | $0.00 |
&"Arial,Bold"&12
75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
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