J.48 CLIN 0015 Cost Proposal Template - Option Year 6
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- Solicitation number
- 75FCMC19R0023
About this file
This document includes a cost proposal template and details for a federal contract opportunity to provide Medicare administrative services. The Centers for Medicare and Medicaid Services intends to issue a request for proposal for a Medicare Administrative Contractor to administer Medicare claims processing and payment services in Jurisdiction E, including California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands. Services include performing claims activities and establishing provider relationships to support healthcare services for Medicare beneficiaries for both institutional and professional inpatient and outpatient claims. The anticipated proposal due date is November 4, 2019, with an expected award date of August 4, 2020. The contract would include a base year plus six one-year options. The cost proposal template includes tables for direct labor costs, fringe benefits, travel expenses, subcontractor costs, other direct costs, and indirect costs.
RFP Attachment
Text of this file
CLIN 0015
| COST TEMPLATE - Attachment J.48 | ||||
| (Provide a cost spreadsheet for each CLIN proposed) | ||||
| CLIN 0015 | 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 |
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75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
TRAVEL
| COST TEMPLATE - Attachment J.48 |
| TRAVEL SUMMARY |
| CLIN 0015 |
| 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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| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| TOTAL TRAVEL | $ - | ||||
| Travel Assumptions: |
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75FCMC19R0023
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
ODC
COST TEMPLATE - Attachment J.48
| CLIN 0015 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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