J.33 Cost Template Summary Sheet.xlsx

XLSX spreadsheet 22 KB Posted

Attached to
Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Jurisdiction C
Solicitation number
75FCMC19R0041
Issued by

About this file

This document includes a cost template summary sheet and description of a federal contract opportunity for Durable Medical Equipment Medicare Administrative Contractor services. The cost template summary provides a breakdown of cost elements by contract line item and contract period for the DME MAC services requirement in Jurisdiction C, which covers Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, and the U.S. Virgin Islands. The contract opportunity is solicitation number 75FCMC19R0041 being issued by the Centers for Medicare and Medicaid Services to provide specified Medicare claims processing, payment, and administrative services for the DME MAC work in Jurisdiction C.

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Summary COST TEMPLATE - Attachment J.33

CLIN 0001CLIN 0002CLIN 0003CLIN 0004CLIN 0005CLIN 0006CLIN 0007CLIN 0008CLIN 0009CLIN 0010CLIN 0011CLIN 0012CLIN 0013CLIN 0014CLIN 0015CLIN 0016
Summary SheetTotal FTEsImplementationBase PeriodOption Year 1Option Year 2Option Year 3Option Year 4Option Year 5Option Year 6Outgoing Contractor Workload Transition ActivitiesBase Period MPIPOption Year 1 MPIPOption Year 2 MPIPOption Year 3 MPIPOption Year 4 MPIPOption Year 5 MPIPOption Year 6 MPIP
HoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotalHoursRatesTotal
COST ELEMENTS
Direct Labor
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subtotal Direct Labor0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00

Fringe Benefits (at ____%) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Total Direct Labor $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Travel$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Subcontractor Name0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00
Total Subcontractor0$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$00$0.00

Other Direct Costs (See separate schedule. Total should match.) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Indirect Costs (at ______ %) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

TOTAL OTHER BEFORE FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Base Fee (at ____%)$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
Award Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
Fixed Fee (at ______%)$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00

TOTAL OTHER AFTER FEE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0.00

Complementary Credits$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
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$0$0$0$0$0$0$0$0$0$0$0$0$0$0.00
Number of hours in full-time, one year schedule =
20190918

&"-,Bold"75FCMC19R0041

DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive &P

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