J.42 CLIN 0009 Cost Proposal Template - Outgoing Contractor Workload Transition Activities.xlsx

XLSX spreadsheet 23 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 proposal template and related files for a Centers for Medicare and Medicaid Services solicitation for Durable Medical Equipment Medicare Administrative Contractor services in Jurisdiction C. The template provides instructions and categories for offerors to submit pricing for workload transition activities under Contract Line Item Number 0009, including direct labor costs by labor category, fringe benefits, travel expenses, subcontractor costs, other direct costs, and indirect costs. The related federal contract opportunity notice identifies the requirement as providing Medicare claims processing and payment services for 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 are to use the template and guidelines provided to submit pricing proposals for the transition of the incumbent contractor's workload under this Centers for Medicare and Medicaid Services solicitation for Durable Medical Equipment Medicare Administrative Contractor services in Jurisdiction C.

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J.39 CLIN 0006 Cost Proposal Template - Option Year 4 (PM, MIP, RAC).xlsx XLSX spreadsheet
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J.32 Systems of Records.docx DOCX document
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Text version

CLIN-0009

COST TEMPLATE - Attachment J.42
(Provide a cost spreadsheet for each CLIN proposed)
CLIN 0009 - Outgoing Contractor Workload Transition Activities CloseoutC.5.2I
DME SERVICESTotal FTEsWorkload Closeout Project PlanAWARD FEEGRAND TOTAL
HoursRatesTotalHoursRatesTotalHoursTotal
COST ELEMENTS
Direct Labor
0$0.00$00$0.00
0$0.00$00$0.00
0$0.00$00$0.00
0$0.00$00$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)0$0.00$00$0.00
0$0.00$00$0.00
0$0.00$00$0.00
0$0.00$00$0.00
0$0.00$00$0.00
0$0.00$00$0.00
Subtotal Direct Labor0$00$0.00

Fringe Benefits (at ____%) $0 $0.00

Total Direct Labor $0 $0.00

Travel (see separate schedule)$0$0.00
SUBCONTRACTORS
Subcontractor Name0$00$0.00
Subcontractor Name0$00$0.00
Subcontractor Name0$00$0.00
Subcontractor Name0$00$0.00
Subcontractor Name0$00$0.00
Subcontractor Name0$00$0.00
Total Subcontractor0$00$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

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DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

Confidential Procurement Sensitive &P

ODC Schedule

ODC SCHEDULE - Attachment J.42
(Provide an ODC Spreadsheet for each CLIN Proposed)
CLIN 0009 DME SERVICES
Cost ElementTOTAL

Add costs by category

TOTAL ODCs $0.00

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TRAVEL

Attachment J.42
TRAVEL SUMMARY
CLIN 0009
Purpose of TripSOW WBS
CrosswalkLabor Category Taking TripTrip OriginDestination# 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:

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DME MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)

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