Att D - Cost Proposal.xlsx

XLSX spreadsheet 120 KB Posted Jul 21, 2026

Attached to: External Quality Reviews for MCO Programs - FSSABid Documents
Solicitation number: 26-87847
Issued by: Marion County, Indiana

About this file

Written by GovTribe AI · Jul 21, 2026

This file is a cost proposal template (Attachment D) for RFP #26-87847 issued by the State of Indiana's Office of Medicaid Policy and Planning (OMPP) for an External Quality Review Organization (EQRO) contract. The RFP seeks an organization to provide comprehensive quality review services for Indiana's Medicaid managed care organizations, with deliverables including MCO-specific report cards, findings reports, data workbooks, survey administration, performance measures reports, evaluation activities reports, ISCA workplans and reports, monthly training and classes, quality forums, case management analysis, technical reports, activity status reports, and ad hoc services. The contract term spans four years with optional extensions for years five and six. Bidders must complete the cost proposal template by entering position titles with corresponding hourly billable rates for each year, estimating hours required per position for each deliverable, and calculating total costs across all deliverables and contract years. The template includes 18 primary deliverables with specified frequencies (annual, monthly, or per MCO), ad hoc service categories for MCO readiness reviews, corrective action plans, general services, and reporting, with five MCOs receiving deliverables annually.

Respondents must factor all costs—including salaries, benefits, software, systems, office expenses, administrative costs, travel, overhead, and supplies—into proposed hourly billable rates, with no additional costs billable beyond the rates specified. The cost proposal template automatically calculates total costs by position, by deliverable, and by year; respondents need only populate yellow-shaded cells with position titles, hourly rates, and hours required. All costs for the contract period must be captured in the total four-year bid amount, with annual cost increases permitted through an administration cost increase percentage assumption. The template supports optional Years 5 and 6 if the state exercises renewal options, with ad hoc services budgeted at 50 hours for MCO readiness reviews in Year 1 (reduced to 0-25 hours in subsequent years), 150 hours annually for corrective action plans, and 25 hours annually each for general ad hoc services and reporting. Respondents must ensure cost proposal entries align precisely with technical proposal submissions and that position titles match exactly between the staffing rates tab and deliverable tables to enable accurate automatic calculations.

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1. Title

External Quality Review Organization (EQRO) RFP

Attachment D - Cost Proposal

RFP #26-87847

Office of Medicaid Policy and Planning (OMPP)

State of Indiana

2. Table of Contents

State of Indiana Office of Medicaid Policy and Planning
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal
Table of Contents
	Tab	Tab Name
	1	Title
	2	Table of Contents
	3	Instructions
	4	Staffing Rates
	5	Cost Proposal Summary
	6	Year 1
	7	Year 2
	8	Year 3
	9	Year 4
	10	(Optional) Year 5
	11	(Optional) Year 6

3. Instructions

State of Indiana Office of Medicaid Policy and Planning
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal
Instructions
	Instructions
	Please provide your cost proposal by populating the Cost Proposal template (Attachment D). Note that throughout the template, you are only to fill in cells shaded yellow. DO NOT fill in cells shaded white, grey, or blue. Blue shaded cells will automatically populate. Respondents are responsible for ensuring that all information they provide in the Cost Proposal aligns with their response to Technical Proposal template (Attachment F).

Staffing Rates

Instructions: For each position proposed by the Respondent, please enter a Position Title and the Hourly Billable Rate per Position. Key Personnel and Ad Hoc Services listed in the Scope of Work have been pre-filled. The Hourly Billable Rates must factor in all costs including the staff member's salary, benefits, and other such items necessary to complete all deliverables (such as but not limited to: software, systems, office expense, admin, travel, overhead, and supplies). No other costs will be billable. The information in this tab will be used throughout the Cost Proposal to calculate costs.

Cost Proposal Summary

Instructions: Respondents should begin by completing the information requested on the "Staffing Rates" tab, as that information is required for the tables in the Year tabs. The Cost Proposal Summary tab will automatically aggregate the total costs from Year 1 through Year 4. All costs associated with this Contract must be captured in the Total 4 Year Bid amount.

Year 1 - Year 6

Instructions: Each Year tab contains tables for the deliverables listed in the Scope of Work. Respondents must fill in the "Position Title" column with titles that exactly match those listed on the Staffing Rates tab, and fill in the "# of Hours" column with the estimated hours per position for that deliverable. For each deliverable, the "Hourly Billable Rate Per Position" column automatically populates from the Staffing Rates tab based on the Position Title entered. The "Frequency for Contract Year" is prefilled for each Deliverable table with the corresponding amount of occurrences. The "Total Cost by Position" column will calculate automatically. The Total Cost for each deliverable will sum at the bottom of each table.

4. Staffing Rates

State of Indiana Office of Medicaid Policy and Planning (OMPP)
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal				Respondent Name:
Staffing Rates					Please Complete Yellow Shaded Regions
	Instructions: Please fill in the cells shaded in yellow. Cells shaded in white, grey, or blue may not be altered. For each position proposed by the Respondent, please enter a Position Title and the Hourly Billable Rate per Position. Key Personnel and Ad Hoc Services listed in the Scope of Work have been pre-filled. The Hourly Billable Rates must factor in all costs including the staff member's salary, benefits, and other such items necessary to complete all deliverables (such as but not limited to: software, systems, office expense, admin, travel, overhead, and supplies). No other costs will be billable. The information in this tab will be used throughout the Cost Proposal to calculate costs.
		Administration Cost Increase Assumption
		Fixed Annual Administration Cost Increase Percentage
		Table 1: Position Titles and Rates
		Position Title	Position Certification(s)	Minimum Experience Required	Year 1 HOURLY Billable Rate Per Position	Year 2 HOURLY Billable Rate Per Position	Year 3 HOURLY Billable Rate Per Position	Year 4 HOURLY Billable Rate Per Position	(Optional) Year 5 HOURLY Billable Rate Per Position	(Optional) Year 6 HOURLY Billable Rate Per Position
	No.	Example - Analyst	Bachelor Degree Preferred	2 years relevant experience	$ 65.00	$ 66.00	$ 67.00	$ 68.00	$ 69.00	$ 70.00
	1	Project Director		Must have experience in managing clinical projects, as well as assessment and reporting of health care outcomes and drug trends.		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	2	Medical Records Review Staff Coordinator	Must be a Registered Nurse (RN) or other licensed professional where medical records review or similar permission to assess patients and/or their records falls under their specific scope of practice (per Indiana Code Title 25. Professions and Occupations)	Experience in managing a program similar in size and scope as the EQR program described herein within the last five (5) years		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	3	Medical Records Review Staff	An appropriate licensed medical professional (per Indiana Code Title 25. Professions and Occupations) with the following minimum qualifications:

-Possess a bachelor’s degree from an accredited college or university;

-Possess at least three (3) years of medical or clinical experience; and

-Possess at least two (2) years of medical utilization review and/or quality assurance.		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	4	Ad Hoc MCO Readiness Review - Blended Billable Rate for Hourly Service				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	5	Ad Hoc MCO Corrective Action Plan - Blended Billable Rate for Hourly Service				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	6	Ad Hoc General Services - Blended Billable Rate for Hourly Service				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	7	Ad Hoc Reporting - Blended Billable Rate for Hourly Service				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	8	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	9	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	10	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	11	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	12	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	13	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	14	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	15	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	16	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	17	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	18	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	19	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	20	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	21	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	22	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	23	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	24	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	25	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	26	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	27	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	28	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	29	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	30	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	31	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	32	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	33	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	34	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	35	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	36	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	37	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	38	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	39	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	40	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	41	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	42	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	43	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	44	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	45	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	46	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	47	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	48	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	49	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	50	<respondent to fill in staffing positions>	<respondent to fill in staffing position's certifications>	<respondent to fill in staffing position's required experience>		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

5. Cost Proposal Summary

State of Indiana Office of Medicaid Policy and Planning
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal			Respondent Name:	0
Cost Proposal Summary
	Instructions: All blue cells will populate automatically. Respondents should begin by completing the information requested on the "Staffing Rates" tab, then complete the Year 1 through Year 4 tabs. The summary below will automatically aggregate the total costs from each year. All costs associated with this Contract must be captured in the Total 4 Year Bid amount.
	Total 4 Year Bid Amount	$ - 0
	Cost Proposal Summary
	Task Description	Year 1 Cost	Year 2 Cost	Year 3 Cost	Year 4 Cost	(Optional) Year 5 Cost	(Optional) Year 6 Cost
	Annual Cost	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

6. Year 1

State of Indiana Office of Medicaid Policy and Planning (OMPP)
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal		Respondent Name:	0
Year 1
	Instructions: Each Year tab contains tables for the deliverables listed in the Scope of Work. Respondents must fill in the "Position Title" column with titles that exactly match those listed on the Staffing Rates tab, and fill in the "# of Hours" column with the estimated hours per position for that deliverable. For each deliverable, the "Hourly Billable Rate Per Position" column automatically populates from the Staffing Rates tab based on the Position Title entered. The "Frequency for Contract Year" is prefilled for each Deliverable table with the corresponding amount of occurrences. The "Total Cost by Position" column will calculate automatically. The Total Cost for each deliverable will sum at the bottom of each table.

Total Year 1 Cost	$ - 0
Deliverable 1: MCO-Specific Report Cards
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 2: MCO Summary Report Card
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 3: Findings Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 4: Summary Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 5: Data Workbook
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 6: Survey Administration
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 7: MCO-Specific Performance Measures Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 8: Evaluation Activities Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 9: ISCA Workplan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 10: ISCA Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 11: Monthly Training and Classes
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 12: Annual Quality Forum
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 13: Case Management Analysis Findings
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 14: Annual Technical Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 15: Annual Technical Report - Tracking Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 16: Activity/Status Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 17: EQR Activity Work Plan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 18: Implementation Plan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 1			$ - 0
Frequency for Contract Year 1 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Ad Hoc: MCO Readiness Review
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total for Contract Year 1
III.a.v.4 Ad Hoc MCO Readiness Review	Ad Hoc MCO Readiness Review - Blended Billable Rate for Hourly Service	$ - 0	50	$ - 0

Ad Hoc: MCO Corrective Action Plans
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total for Contract Year 1
III.a.vi MCO Corrective Action Plans	Ad Hoc MCO Corrective Action Plan - Blended Billable Rate for Hourly Service	$ - 0	150	$ - 0

Ad Hoc: General Ad Hoc
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total for Contract Year 1
III.a.vii Ad Hoc	Ad Hoc General Services - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

Ad Hoc: Reporting
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total for Contract Year 1
IV.e.1 Ad-Hoc Reports	Ad Hoc Reporting - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

7. Year 2

State of Indiana Office of Medicaid Policy and Planning (OMPP)
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal		Respondent Name:	0
Year 2
	Instructions: Each Year tab contains tables for the deliverables listed in the Scope of Work. Respondents must fill in the "Position Title" column with titles that exactly match those listed on the Staffing Rates tab, and fill in the "# of Hours" column with the estimated hours per position for that deliverable. For each deliverable, the "Hourly Billable Rate Per Position" column automatically populates from the Staffing Rates tab based on the Position Title entered. The "Frequency for Contract Year" is prefilled for each Deliverable table with the corresponding amount of occurrences. The "Total Cost by Position" column will calculate automatically. The Total Cost for each deliverable will sum at the bottom of each table.

Total Year 2 Cost	$ - 0
Deliverable 1: MCO-Specific Report Cards
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 2: MCO Summary Report Card
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 3: Findings Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 4: Summary Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 5: Data Workbook
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 6: Survey Administration
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 7: MCO-Specific Performance Measures Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 8: Evaluation Activities Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 9: ISCA Workplan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 10: ISCA Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 11: Monthly Training and Classes
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 12: Annual Quality Forum
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 13: Case Management Analysis Findings
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 14: Annual Technical Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 15: Annual Technical Report - Tracking Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 16: Activity/Status Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 17: EQR Activity Work Plan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 18: Implementation Plan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 2			$ - 0
Frequency for Contract Year 2 (Billable Annually Upon Delivery)
Total Cost for Deliverable			$ - 0
Ad Hoc: MCO Readiness Review
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 2
III.a.v.4 Ad Hoc MCO Readiness Review	Ad Hoc MCO Readiness Review - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

Ad Hoc: MCO Corrective Action Plans
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 2
III.a.vi MCO Corrective Action Plans	Ad Hoc MCO Corrective Action Plan - Blended Billable Rate for Hourly Service	$ - 0	150	$ - 0

Ad Hoc: General Ad Hoc
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 2
III.a.vii Ad Hoc	Ad Hoc General Services - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

Ad Hoc: Reporting
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 2
IV.e.1 Ad-Hoc Reports	Ad Hoc Reporting - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

8. Year 3

State of Indiana Office of Medicaid Policy and Planning (OMPP)
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal		Respondent Name:	0
Year 3
	Instructions: Each Year tab contains tables for the deliverables listed in the Scope of Work. Respondents must fill in the "Position Title" column with titles that exactly match those listed on the Staffing Rates tab, and fill in the "# of Hours" column with the estimated hours per position for that deliverable. For each deliverable, the "Hourly Billable Rate Per Position" column automatically populates from the Staffing Rates tab based on the Position Title entered. The "Frequency for Contract Year" is prefilled for each Deliverable table with the corresponding amount of occurrences. The "Total Cost by Position" column will calculate automatically. The Total Cost for each deliverable will sum at the bottom of each table.

Total Year 3 Cost	$ - 0
Deliverable 1: MCO-Specific Report Cards
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 2: MCO Summary Report Card
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 3: Findings Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 4: Summary Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 5: Data Workbook
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 6: Survey Administration
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 7: MCO-Specific Performance Measures Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 8: Evaluation Activities Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 9: ISCA Workplan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 10: ISCA Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 11: Monthly Training and Classes
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0

Deliverable 12: Annual Quality Forum
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 13: Case Management Analysis Findings
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 14: Annual Technical Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 15: Annual Technical Report - Tracking Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0

Deliverable 16: Activity/Status Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0
Deliverable 17: EQR Activity Work Plan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 18: Implementation Plan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 3			$ - 0
Frequency for Contract Year 3 (Billable Annually Upon Delivery)
Total Cost for Deliverable			$ - 0
Ad Hoc: MCO Readiness Review
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 3
III.a.v.4 Ad Hoc MCO Readiness Review	Ad Hoc MCO Readiness Review - Blended Billable Rate for Hourly Service	$ - 0	0	$ - 0

Ad Hoc: MCO Corrective Action Plans
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 3
III.a.vi MCO Corrective Action Plans	Ad Hoc MCO Corrective Action Plan - Blended Billable Rate for Hourly Service	$ - 0	150	$ - 0

Ad Hoc: General Ad Hoc
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 3
III.a.vii Ad Hoc	Ad Hoc General Services - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

Ad Hoc: Reporting
Ad Hoc Item	Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost for Contract Year 3
IV.e.1 Ad-Hoc Reports	Ad Hoc Reporting - Blended Billable Rate for Hourly Service	$ - 0	25	$ - 0

9. Year 4

State of Indiana Office of Medicaid Policy and Planning (OMPP)
External Quality Review Organization RFP #26-87847
Attachment D - Cost Proposal		Respondent Name:	0
Year 4
	Instructions: Each Year tab contains tables for the deliverables listed in the Scope of Work. Respondents must fill in the "Position Title" column with titles that exactly match those listed on the Staffing Rates tab, and fill in the "# of Hours" column with the estimated hours per position for that deliverable. For each deliverable, the "Hourly Billable Rate Per Position" column automatically populates from the Staffing Rates tab based on the Position Title entered. The "Frequency for Contract Year" is prefilled for each Deliverable table with the corresponding amount of occurrences. The "Total Cost by Position" column will calculate automatically. The Total Cost for each deliverable will sum at the bottom of each table.

Total Year 4 Cost	$ - 0
Deliverable 1: MCO-Specific Report Cards
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 2: MCO Summary Report Card
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 3: Findings Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually per MCO Upon Delivery)			5
Total Cost for Deliverable			$ - 0
Deliverable 4: Summary Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 5: Data Workbook
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 6: Survey Administration
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 7: MCO-Specific Performance Measures Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 8: Evaluation Activities Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 9: ISCA Workplan
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0
Deliverable 10: ISCA Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 11: Monthly Training and Classes
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Monthly Upon Delivery)			12
Total Cost for Deliverable			$ - 0

Deliverable 12: Annual Quality Forum
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 13: Case Management Analysis Findings
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
Fixed Fee Cost for One (1) Deliverable for Year 4			$ - 0
Frequency for Contract Year 4 (Billable Annually Upon Delivery)			1
Total Cost for Deliverable			$ - 0

Deliverable 14: Annual Technical Report
Position Title	HOURLY Billable Rate Per Position	# of Hours	Total Cost by Position
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0

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File details come from the government source that posted it. Updated Jul 21, 2026.