J.33 Cost Template Summary Sheet clean Amend 1.xlsx
XLSX spreadsheet 22 KB Posted
- Solicitation number
- 75FCMC20R0008
About this file
This document contains a cost template summary sheet for a solicitation seeking proposals for Part A and Part B Medicare Administrative Contractor services in Jurisdiction L. Key details include:
The Centers for Medicare and Medicaid Services is soliciting proposals to award a contract to provide Medicare claims processing and payment services for Jurisdiction L, which includes Delaware, Maryland, New Jersey, Pennsylvania, Washington D.C., and parts of Virginia. The contractor will administer Medicare Fee-For-Service programs for the region. The cost template summary sheet includes 16 cost line items and multiple option years for consideration. It requires proposed labor categories, rates, hours, and costs to be included for direct labor, fringe benefits, travel, subcontractors, and other direct costs. Indirect costs, fees, and complementary credits should also be accounted for in the final proposed total.
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Summary
RFP # 75FCMC20R0008
COST TEMPLATE - Attachment J.33
| CLIN 0001 | CLIN 0002 | CLIN 0003 | CLIN 0004 | CLIN 0005 | CLIN 0006 | CLIN 0007 | CLIN 0008 | CLIN 0009 | CLIN 0010 | CLIN 0011 | CLIN 0012 | CLIN 0013 | CLIN 0014 | CLIN 0015 | CLIN 0016 | ||||||||||||||||||||||||||||||||||
| Summary Sheet | Total FTEs | Implementation | Base Period (PM, MIP, RAC) | Option Year 1 (PM, MIP, RAC) | Option Year 2 (PM, MIP, RAC) | Option Year 3 (PM, MIP, RAC) | Option Year 4 (PM, MIP, RAC) | Option Year 5 (PM, MIP, RAC) | Option Year 6 (PM, MIP, RAC) | Outgoing Contractor Workload Transition Activities | Base Period (MPIP) | Option Year 1 (MPIP) | Option Year 2 (MPIP) | Option Year 3 (MPIP) | Option Year 4 (MPIP) | Option Year 5 (MPIP) | Option Year 6 (MPIP) | ||||||||||||||||||||||||||||||||
| Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | Hours | Rates | Total | ||
| COST ELEMENTS |
| Direct Labor | ||||||||||||||||||||||||||||||||||
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| Add Other Appropriate Labor Categories (note: labor categories should match WBS) | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 | |
| Subtotal Direct Labor | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $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 Name | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| Subcontractor Name | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0.00 |
| Total Subcontractor | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $0 | 0 | $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 = |
| 20200121 |
&"-,Bold"75FCMC20R0008
PART A & PART B (A/B) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)
Confidential Procurement Sensitive &P
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