J.49 CLIN 0016 Cost Proposal Template - Option Year 6 (MPIP).xlsx
XLSX spreadsheet 30 KB Posted
- Solicitation number
- 75FCMC19R0041
About this file
This document contains templates for a federal contract proposal including cost templates for labor, travel, and other direct costs (ODCs). The templates are to be used in responding to solicitation number 75FCMC19R0041 issued by the Department of Health and Human Services Centers for Medicare and Medicaid Services. The solicitation is for a Durable Medical Equipment Medicare Administrative Contractor to provide specified health insurance benefit administration services including Medicare claims processing and payment services in support of the Medicare Fee-For-Service program for Jurisdiction C, which includes the states of 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 templates require pricing information for direct labor costs by labor category, travel costs by trip including number of travelers, destinations, duration and expenses, and ODCs by category.
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Text version
CLIN 0016
| COST TEMPLATE - Attachment J.49 | |||
| (Provide a cost spreadsheet for each CLIN proposed) | |||
| CLIN 0016 | T.8 | ||
| Total FTEs | Medicare Healthcare Provider Intervention Program (MPIP) | ||
| Hours | 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 |
| V2 04242012 |
| 20180524 |
| 20180829 |
| 8/29/19 |
&"Arial,Bold"&12 75FCMC19R0041 DME Medicare Administrative Contractor (MAC)
Confidential, Procurement Sensitive
TRAVEL
| COST TEMPLATE - Attachment J.49 |
| TRAVEL SUMMARY |
| CLIN 0016 |
| 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: |
Confidential, Procurement Sensitive
ODC
COST TEMPLATE - Attachment J.49
| CLIN 0016 DME 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 |
Confidential, Procurement Sensitive
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