J.34 CLIN 0001 Cost Proposal Template - Implementation.xlsx
XLSX spreadsheet 32 KB Posted
- Solicitation number
- 75FCMC19R0041
About this file
This cost proposal template and related solicitation provide details for the Durable Medical Equipment Medicare Administrative Contractor contract for Jurisdiction C. The Centers for Medicare and Medicaid Services is seeking proposals to administer Medicare claims processing and payment services in 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. Offerors must provide cost and pricing details for the implementation period and ongoing operations across direct labor, travel, subcontractors, other direct costs, indirect costs, fees, and complementary credits. Proposals are due by the date specified in solicitation number 75FCMC19R0041 to provide DME MAC services for the region.
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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 | |||||||
| DME 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 |
201918
&"Arial,Bold"&12 75FCMC19R0041
DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
ODC Schedule
| ODC SCHEDULE - Attachment J.34 | |
| (Provide an ODC Spreadsheet for each CLIN Proposed) | |
| CLIN 0001 DME SERVICES | |
| Cost Element | TOTAL |
Add costs by category
TOTAL ODCs $0.00
&"Arial,Bold"&12 75FCMC19R0041
DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
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 75FCMC19R0041
DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive
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