8-Appendix G Cost Response Form.pdf

APPENDIX G

COST RESPONSE FORM

The evaluation of each Offeror’s cost proposal will be made based on Offerors’ Cost Proposal for the sum of the contact. Offerors are reminded that all costs are fully inclusive and shall include but are not limited to: all management, supervision, labor, materials, equipment, travel, training, transportation, configuration, installation, testing, overhead, profit and applicable gross receipt taxes.

Instructions:

• Please complete the table below. If an item that falls under desirable specifications is not applicable please mark “N/A”

• Please add the total costs separately for mandatory and desirable specifications where indicated..

COST RESPONSE FORM

Scope of Work Costs Offerors are asked to provide their cost response to coordinate with the Scope of Work of APPENDIX F; and should also reflect applicable costs associated with meeting the mandatory elements of the Information Technology Requirements of APPENDIX H. DOH will create deliverables based contract with the selected Offeror. The deliverables will be based on the Scope of Work.

Offerors should frame their costs based on their proposed schedule for initial transition to the new vendor (unless the contract for hosting is renewed), and subsequent Maintenance, Support and Enhancement/expansion costs. The costs for the initial transition to the awarded vendor must be provided in the One-Time Costs Table and the subsequent Maintenance, Support, and Enhancement/expansion costs must be provided in the Maintenance and Operations Costs Table. Task II.18 Transition Plan is considered a one-time cost and all offerors must provide this cost.

One-Time Costs Table Task # Task Description Costs Task I.1 Project Management, Plan, and Approach $________________ Task I.2 Project Management Communication and Reporting $________________ Task II.1 Data Submission Tool $________________ Task II.2 Data Collection Management $________________ Task II.3 Data Supplier Engagement-Onboarding $________________ Task II.4 Data Collection Status Reports $________________ Task II.5 Medicare Custodian $________________ Task II.6 Medicaid Data $________________ Task II.7 Data Collection Process Documentation $________________ Task II.8 Extract, Transform, and Load (ETL) $________________ Task II.9 Data Consolidation $________________ Task II.10 Patient Identity Resolution $________________ Task II.11 Provider Directory $________________ Task II.12 Data Storage Documentation $________________ Task II.13 Data Access $________________ Task II.14 Value-Added Components for Analytics $________________ Task II.15 Post-Load Quality Assurance and Validation $________________ Task II.16 Access to the Data Management Platform $________________ Task II.17 Maintenance and Support of Data Management Platform $________________ Task II.18 Transition Plan $________________ Task III Conversion $________________ Task IV.1 Consult on Development of an Analytics Master Plan $________________ Task IV.2 Implementation of the Analytics Master Plan $________________ Task IV.3 Analytic Reporting Platform $________________ Task IV.4 Patient Attribution Methodology $________________ Task IV.5 Attribute Providers to Groups or Work Sites $________________ Task IV.6 Construction or Programming of Quality Metrics $________________ Task IV.7 Quality Control $________________ Task IV.8 Open Source or Licensed Tools $________________ Task IV.9 Ongoing Software Maintenance $________________ Task IV.10 Cost and Quality Consumer facing Webtool $________________

Warranty Period (6 Months) starts immediately after Procuring Agency’s review and written acceptance of deployed solution

No Cost

TOTAL for Mandatory One-Time Costs $________________ Tasks that fall under Desirable Specifications (Optional) Task II.1 Indian Health Service (IHS) Data $________________ Task II.2 Worker’s Compensation Data $________________ Task II.3 Alternative Payment Data $________________ Task II.4 Episodes of Care Reporting $________________ Task IV.5 Total Cost of Care Reporting $________________ Task IV.6 Surprise Medical Billing Benchmarking $________________

Task IV.7 Converting Flat files to APCD CDL $________________ Task IV.8 Ad Hoc Requests $________________ Task IV.9 Additional Services $________________ TOTAL for Desirable Specifications (Optional) $________________

Maintenance and Operations Costs Table Task # Task Description Annual Costs Task II.1 Data Submission Tool $________________ Task II.2 Data Collection Management $________________ Task II.3 Data Supplier Engagement-Onboarding $________________ Task II.4 Data Collection Status Reports $________________ Task II.5 Medicare Custodian $________________ Task II.6 Medicaid Data $________________ Task II.8 Extract, Transform, and Load (ETL) $________________ Task II.9 Data Consolidation $________________ Task II.10 Patient Identity Resolution $________________ Task II.11 Provider Directory $________________ Task II.13 Data Access $________________ Task II.14 Value-Added Components for Analytics $________________ Task II.15 Post-Load Quality Assurance and Validation $________________ Task II.16 Access to the Data Management Platform $________________

Task II.17 Maintenance and Support of Data Management Platform

Task IV.3 Analytic Reporting Platform $________________ Task IV.5 Attribute Providers to Groups or Work Sites $________________ Task IV.7 Quality Control $________________ Task IV.8 Open Source or Licensed Tools $________________ Task IV.9 Ongoing Software Maintenance $________________ Task IV.10 Cost and Quality Consumer facing Webtool $________________ Annual TOTAL for Mandatory Maintenance and Operations Costs $________________ Tasks that fall under Desirable Specifications (Optional) Task V.1 Indian Health Service (IHS) Data $________________ Task V.2 Worker’s Compensation Data $________________ Task V.3 Alternative Payment Data $________________ Task V.4 Episodes of Care Reporting $________________ Task IV.5 Total Cost of Care Reporting $________________ Task IV.6 Surprise Medical Billing Benchmarking $________________ Task IV.7 Converting Flat files to APCD CDL $________________ Task IV.8 Ad Hoc Requests $________________ Task IV.9 Additional Services $________________ Annual TOTAL for Desirable Specifications (Optional) $________________