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Instructions
| ATTACHMENT B |
| Financial Proposal Form |
MDH Statewide Administration of Provider Enrollment, Revalidation, Reenrollment, and Update Activities for the Maryland Medicaid Program RFP
| Solicitation #: MDH-OCMP-25-22321 |
| In order to assist Offerors in the preparation of their Financial Proposal and to comply with the requirements of this solicitation, Financial Proposal Instructions and a Financial Proposal Form have been prepared. Offerors shall submit their Financial Proposal on the Financial Proposal Form in accordance with the instructions on the Financial Proposal Form and as specified herein. Do not alter the Financial Proposal Form or the Proposal may be determined to be not reasonably susceptible of being selected for award. The Financial Proposal Form is to be signed and dated, where requested, by an individual who is authorized to bind the Offeror to the prices entered on the Financial Proposal Form. |
The Financial Proposal Form is used to calculate the Offeror’s TOTAL Proposal PRICE. Follow these instructions carefully when completing your Financial Proposal Form:
| A) | All Unit and Extended Prices must be clearly entered in dollars and cents, e.g., $24.15. Make your decimal points clear and distinct. |
| B) | All Unit Prices must be the actual price per unit the State will pay for the specific item or service identified in this IFB and may not be contingent on any other factor or condition in any manner. |
| C) | All calculations shall be rounded to the nearest cent, i.e., .344 shall be .34 and .345 shall be .35. |
| D) | Any goods or services required through this IFB and proposed by the Offeror at No Cost to the State must be clearly entered in the Unit Price, if appropriate, and Extended Price with $0.00. |
| E) | Every blank in every Financial Proposal Form shall be filled in. Any blanks may result in the Offeror being regarded as non-responsive and thus rejected. Any changes or corrections made to the Financial Proposal Form by the Offeror prior to submission shall be initialed and dated. |
| F) | Except as instructed on the Financial Proposal Form, nothing shall be entered on or attached to the Financial Proposal Form that alters or proposes conditions or contingencies on the prices. Alterations and/or conditions usually render the Financial Proposal non-responsive, which means it will be rejected. |
| G) | It is imperative that the prices included on the Financial Proposal Form have been entered correctly and calculated accurately by the Offeror and that the respective total prices agree with the entries on the Financial Proposal Form. Any incorrect entries or inaccurate calculations by the Offeror will be treated as provided in COMAR 21.05.03.03E and 21.05.02.12, and may cause the Financial Proposal to be rejected. |
| H) | If option years are included, Offerors must submit pricing for each option year. Any option to renew will be exercised at the sole discretion of the State and comply with all terms and conditions in force at the time the option is exercised. If exercised, the option period shall be for a period identified in the RFP at the prices entered in the Financial Proposal Form. |
| I) | All Financial Proposal prices entered below are to be fully loaded prices that include all costs/expenses associated with the provision of services as required by the IFB. The Financial Proposal price shall include, but is not limited to, all: labor, profit/overhead, general operating, administrative, and all other expenses and costs necessary to perform the work set forth in the solicitation. No other amounts will be paid to the Contractor. If labor rates are requested, those amounts shall be fully-loaded rates; no overtime amounts will be paid. |
| J) | Unless indicated elsewhere in the IFB, sample amounts used for calculations on the Financial Proposal Form are typically estimates for evaluation purposes only. The Department does not guarantee a minimum or maximum number of units or usage in the performance of this Contract. |
| K) | Failure to adhere to any of these instructions may result in the Financial Proposal being determined non-responsive and rejected by the Department. |
| L) | The Future Activities section of the Financial Proposal Form includes the services detailed in § 2.7 of the PBS RFP. Offerors are to enter pricing estimates to support each Contract year of work for Enrollment Site Visits that may be exercised at the State's discretion. This pricing model, which parallels the one for Operations, is based on a PM/PM fee explicitly for those services. (Note: It is possible that even though the Contractor, who is required to provide a technical and financial response to this in their Proposal, may not be requested to deliver these services on behalf of the State under the Contract.) |
| M) | The Work Orders section of the Financial Proposal Form includes the circumstances addressed in § 3.14 of the PBS RFP. Offerors are to enter pricing estimates to support each listed labor category for potential Work Orders. Offerors are advised that the calculated blended rate for all labor category prices for potential Work Order will be used in the evaluation process, regardless of the Offerors's employment of resources that do not fall under any of the listed categories for Work Order purposes. (Note: The blended rate listed by the Contractor for the PBS Work Orders section on the Proposal Form will be the standard rate used for resources utilized to execute additional Work Orders.) |
Proposal Form
| ATTACHMENT B |
| Financial Proposal Form |
MDH Statewide Administration of Provider Enrollment, Revalidation, Reenrollment, and Update Activities for the Maryland Medicaid Program RFP
| Solicitation #: MDH-OCMP-25-22321 |
| Instructions: Offerors shall provide proposed costs in the yellow highlighted cells. The number of hours is primarily for evaluation purposes only and do not guarantee a number of hours. |
| Implementation Phase: Firm fixed-price figure to be provided by the Contractor for all Implementation activities over the estimated seven (7)-month period prior to entering Operations. The State will issue payment for the accepted total cost in partial installments based on the approval of associated Contract Deliverables during respective PBS Implementation milestones against the stated payment percentage. |
| Operations Phase: The PP/PM rate to be provided by the Contractor for every year of Operations, including Option Terms, for the comprehensive provision of PBS services (i.e., all requirements encapsulated by the RFP scope of work). (Note: this excludes activities associated with Enrollment Site Visits). |
| Future Activities: The PP/PM rate to be provided by the Contractor for every year of Operations, including Option Terms, regarding Enrollment Site Visit activities and based on the estimated number of Moderate- and High-risk Providers in Maryland. |
| Work Orders: Sample labor category rates to be considered and blended rate to be paid for any Work Orders not associated with the Implementation or Operations Phases. |
| Implementation Phase (Refer to RFP § 2.4.1) | | |
| Item | Fixed Price Cost | Percentage of Fixed Cost |
| Enrollment, Revalidation, Reenrollment, and Update Activities Implementation | $ - 0 | |
| Final Project Master Schedule | $ - 0 | 15% |
| Final Staffing Management Plan | $ - 0 | 22.5% |
| Final Training Management Plan | $ - 0 | 22.5% |
| Specialized Provider Notices | $ - 0 | 5% |
| Final Business Continuity and Disaster Recovery Plan | $ - 0 | 5% |
| Go-Live Readiness Signoff | $ - 0 | 30% |
| Operations Phase (Refer to RFP § 2.4.2) | | | | |
| Item | Per Provider, Per Month Administrative Fee | Enrollment | Number of Months | Total Annual Cost |
| Contract Year 1 | $ - 0 | 130,000 | 12 | $ - 0 |
| Contract Year 2 | | 135,000 | 12 | $ - 0 |
| Contract Year 3 | $ - 0 | 145,000 | 12 | $ - 0 |
| Contract Year 4 | $ - 0 | 150,000 | 12 | $ - 0 |
| Option Term 1 | $ - 0 | 155,000 | 12 | $ - 0 |
| Option Term 2 | $ - 0 | 160,000 | 12 | $ - 0 |
| TOTAL PRICE | | | | $ - 0 |
| Future Activities (Refer to RFP § 2.7) | | | | |
| Item | Per Provider, Per Month Administrative Fee | Enrollment | Number of Months | Total Annual Cost* |
| Contract Year 1 | $ - 0 | 20,000 | 12 | $ - 0 |
| Contract Year 2 | $ - 0 | 23,000 | 12 | $ - 0 |
| Contract Year 3 | $ - 0 | 26,000 | 12 | $ - 0 |
| Contract Year 4 | $ - 0 | 29,000 | 12 | $ - 0 |
| Option Term 1 | $ - 0 | 32,000 | 12 | $ - 0 |
| Option Term 2 | $ - 0 | 35,000 | 12 | $ - 0 |
| TOTAL PRICE | | | | $ - 0 |
| Work Orders (Refer to RFP §§ 3.10.3 and 3.14) | | | |
| Item | Hourly Rate | Number of Hours Evaluated | Cost |
| Project Manager | $ - 0 | | |
| Provider Services Manager | $ - 0 | | |
| Call Center Manager | $ - 0 | | |
| Application Processing Manager | $ - 0 | | |
| Outreach and Education Manager | $ - 0 | | |
| Blended Rate (Average) | $ - 0 | 15,000 | $ - 0 |
| Total Price of Implementation Phase (Deliverables/Staffing/Training) | $ - 0 |
| Total Price of Operations Phase | $ - 0 |
| Total Price of Option Terms (Two 1-Year Renewals) | $ - 0 |
| Total Price of Future Activities during Operations (Enrollment Site Visit) | $ - 0 |
| Total Price of Future Activities Option Terms (Two 1-Year Renewals) | $ - 0 |
| Total Proposal Price for Work Orders | $ - 0 |
| Total Proposal Price for Implementation and Operations Phases | $ - 0 |
| Total Proposal Price for Implementation and Operations Phases and Future Activities | $ - 0 |
| Total Proposal Price for Implementation and Operations Phases, Future Activities, and Option Terms | $ - 0 |
| Total Evaluated Proposal Price | $0.00 |
| Submitted by: | |
| Offeror: | |
| Offeror Name (please print or type) |
| By: | |
| Signature of Authorized Representative |
| Printed Name: | |
| Printed Name |
| Title: | |
| Title |
| Date: | |
| Date |
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Company Address