J.44 CLIN 0011 Cost Proposal Template - Option Year 4
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- Solicitation number
- 75FCMC19R0023
About this file
This document includes a solicitation for a Medicare Administrative Contractor to provide specified health insurance benefit administration services in support of the Medicare Fee-For-Service Program for Jurisdiction E, which covers California, Hawaii, Nevada, American Samoa, Guam, and Northern Mariana Islands. The contractor will perform claims processing, payment services, and establish provider relationships to ensure the financial integrity of the Medicare program in accordance with applicable laws and regulations. The solicitation is expected to be released on September 4, 2019, with proposals due November 4, 2019 and award anticipated by August 4, 2020. The contract will consist of a base year and six one-year options. The Centers for Medicare and Medicaid Services intends to award to the offeror providing the best overall value using a tradeoff process evaluating cost and technical factors.
RFP Attachment
Text of this file
CLIN 0011
| COST TEMPLATE - Attachment J.44 | ||||
| (Provide a cost spreadsheet for each CLIN proposed) | ||||
| CLIN 0011 | 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
75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
TRAVEL
| COST TEMPLATE - Attachment J.44 |
| TRAVEL SUMMARY |
| CLIN 0011 |
| 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 )
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
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| $ - | $ - | $ - | $ - | ||
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| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| TOTAL TRAVEL | $ - | ||||
| Travel Assumptions: |
75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
ODC
COST TEMPLATE - Attachment J.44
| CLIN 0011 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 |
75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
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