J.49 CLIN 0016 Cost Proposal Template - Option Year 6 (MPIP) clean Amend 1.xlsx
XLSX spreadsheet 32 KB Posted
- Solicitation number
- 75FCMC20R0008
About this file
This document contains a cost proposal template for Option Year 6 of a Part A/Part B Medicare Administrative Contractor contract. The template includes tables for direct labor costs by labor category and FTE, subcontractor costs, other direct costs including a separate travel schedule and ODC table, and indirect costs using prescribed rates. The contract is to provide specified Medicare claims processing and payment services in support of the Medicare Fee-For-Service Program for Jurisdiction L, which covers Delaware, Maryland, New Jersey, Pennsylvania, Washington D.C., and parts of Virginia. The Centers for Medicare and Medicaid Services intends to award this contract to administer health insurance benefit administration services for the Medicare Program in the listed jurisdictions.
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Text version
CLIN 00016
RFP # 75FCMC20R0008
COST TEMPLATE - Attachment J.49
| (Provide a cost spreadsheet for each CLIN proposed) | ||||
| CLIN 0016 | P.1.11 | |||
| Total FTEs | Medicare Healthcare Provider Intervention Program (MPIP) | |||
| Hours | Rates | 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 |
| v1 04252012 |
20181115
75FCMC20R0008
PART A & PART B MEDICARE ADMINISTRATIVE CONTRACTOR
Confidential Procurement Sensitive &P
TRAVEL
RFP # 75FCMC20R0008
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: |
75FCMC20R0008
PART A & PART B MEDICARE ADMINISTRATIVE CONTRACTOR
Confidential Procurement Sensitive &P
ODC
RFP # 75FCMC20R0008
COST TEMPLATE - Attachment J.49
| CLIN 0016 | 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 |
75FCMC20R0008
PART A & PART B MEDICARE ADMINISTRATIVE CONTRACTOR
Confidential Procurement Sensitive &P
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