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RFP #– Program Services for the Health Professionals’ Services Program (HPSP) Att G
Attachment G – Price Proposal for Administrative Activities
PART 1: ADMINISTRATIVE ACTIVITIES (incl. Subcontractor) Overall lowest anticipated cost will receive the highest number of points possible for the Cost Proposal (80 points).
Profit margins are not being scored, they are for informational purposes only.
All section references below refer to Exhibit A, Statement of Work.
| Service |
| Tasks |
| Anticipated Cost |
| Unit |
| Administration of Program |
| · Verification of Board referral as specified in section 2.2.1 (a) or provisional enrollment status as specified in section 2.3.1 (a) |
· Orient Licensee to Program as specified in section 2.2.1 (b) (c) (d) or 2.3.1 (b) (c) (d) (e)
· Enroll Licensee as specified in section 2.2.2 - 2.2.5 or 2.4.2 (a) (b) (c) , 2.4.3 (a) (b), 2.5.1 (a) (b) (c), and 2.5.2
· Ensure monitoring agreements meet the requirements of section 2.10
· Program transfers as specified in section 2.6.2.
· Ensure that all Licensees have an assigned Agreement Monitor who meets the criteria specified in section 2.10 and who monitors Licensee(s) per Monitoring Agreement(s)
· Perform evaluations on Licensees as described in section 2.14
· When an employer is identified, assess employer's ability to supervise Licensee
· Maintaining a network of testing collection facilities and laboratories that meet the requirements outlined in section 2.12 and can support the testing requirements for Licensees outlined in section 2.13
· Validate third party credentials as described in section 2.8.1
· Annual updates as described in section 2.8.2
· Participating in regularly scheduled meetings as described in section 6
· Activities described in section 10
| Program Oversight and Quality Assurance |
| · Maintaining Program oversight as described in section 3 |
· Maintaining quality assurance and performance improvement as described in section 4
| Training and Educational Materials |
| Development and/or maintenance of training/orientation/presentation materials for: |
· employer(s) as specified in section 2.7.2 and 11.3 (a) and providing training opportunities/materials as specified in section 2.7.3, 2.7.4, and 2.7.5
· Third part evaluators and treatment providers as described in section 2.8.3 and 11.2
· Licensee outreach as described in section 11.1
| Reporting |
| · Weekly compliance report as identified in section 2.16. |
· Weekly activity report as described in section 7.1
· Written monthly report the Program Advisory Committee including items described in section 7.2
· Reports to employers as described in section 8
· Substantial non-compliance reporting as described in section 2.17.2
· Bi-annual stakeholder survey reports as described in section 7.3
· Annual financial report as described in section 7.4
| Other |
| Please identify other items. Examples may include administrative and/or accounting fees |
| $ |
Total Anticipated Cost
| Total Yearly Estimate for Program FY YR 1 |
| $ |
| Total Yearly Estimate for Program FY YR 2 |
| $ |
| Total Yearly Estimate for Program FY YR 3 |
| $ |
| Total Yearly Estimate for Program FY YR 4 |
| $ |
| Total Program Estimate for Contract Term (four years) |
| $ |
PART 2: Value Add (incl. Subcontractor)
Part 2 of the Cost proposal does not factor into the 80 points possible for the Cost Proposal and is for information only.
| Service |
| Tasks |
| Est. cost |
| Unit |
| Yearly Total |
| % Profit |
| Total Yearly Estimate for Program FY YR 1 |
| $ |
PART 3: SAMPLE PRICING FOR LICENSEES
Part 3 of the Cost proposal does not factor into the 80 points possible for the Cost Proposal. No points are assigned to Part 3 of the Cost Proposal. A total of five (5) preference points may be earned in this section preference points may be earned in Part 3 of the Cost Proposal (5 preference points possible).
A. Provide a sample of anticipated costs to Licensees for common tests. Preferences points will be awarded to the lowest anticipated cost to Licensees:
Panel designed for street drugs
| Drug |
| Screen (ng/ml) |
| Confirmation (ng/ml) |
| Cannabinoids (marijuana) |
| 50 |
| 15 |
Cost to Licensee: ________
Panel designed for health professionals
| Drug |
| Screen (ng/ml) |
| Confirmation (ng/ml) |
| Amobarbital (amytal) |
| 200 |
| 200 |
| Butabarbital (butisol) |
| 200 |
| 200 |
| Butalbital (fiorinal) |
| 200 |
| 200 |
| Pentobarbital (nembutal) |
| 200 |
| 200 |
| Phenobarbital (luminal) |
| 200 |
| 200 |
| Secobarbital (seconal) |
| 200 |
| 200 |
| Alprazolam (xanax) |
| 200 |
| 100 |
| Chlordiazepoxide (librium) |
| 200 |
| 100 |
| Clonazepam (klonopin) |
| 200 |
| 100 |
| Clorazepate (tranxene) |
| 200 |
| 100 |
| Diazepam (valium) |
| 200 |
| 100 |
| Flurazepam (dalmane) |
| 200 |
| 100 |
| Lorazepam (ativan) |
| 200 |
| 100 |
| Midazolam (versed) |
| 200 |
| 100 |
| Prazepam (centrax) |
| 200 |
| 100 |
| Temazepam (restoril) |
| 200 |
| 100 |
| Triazolam (halcyon) |
| 200 |
| 100 |
| Cannabinoids (marijuana) |
| 20 |
| 15 |
| Cocaine <metabolites> |
| 150 |
| 100 |
| Phencyclidine (PCP) |
| 25 |
| 25 |
| Hydrocodone (lortab) |
| 300 |
| 75 |
| Hydromorphone (dilaudid) |
| 300 |
| 75 |
| Meperidine (demerol) |
| 200 |
| 100 |
| Methadone (dolophine) |
| 300 |
| 100 |
| Oxycodone (percodan) |
| 100 |
| 75 |
| Oxymorphone (numorphan) |
| 100 |
| 75 |
| Propoxyphene (darvon) |
| 300 |
| 100 |
| Tramadol (ultram) |
| 200 |
| 100 |
EtG/ETS Panel
| Drug |
| Screen (ng/ml) |
| Confirmation (ng/ml) |
B. Provide Proposer’s anticipated costs to Licensee for providing regional face-to-face Consultation Group Meetings as specified in section 2.15.1 for the following:
| Number of Licensees in Group |
| $ Per Licensee |
Preferences points will be awarded to the lowest anticipated cost to Licensees.
C. Provide Proposer’s anticipated costs to Licensee for proving regional one-on-one, face-to-face meetings for mental health disorders as specified in section 2.16:
Preferences points will be awarded to the lowest anticipated cost to Licensees.
| Number of Licensees in Group |
| $ Per Licensee |
PART 4: Proposed Method for Cost Sharing (Part 4 is not scored. This is information only.)
Proposer shall include a description of how Proposer anticipates splitting the cost of the Program amongst the participating Boards to ensure each Board is paying their share of Program costs. Examples may include sharing percentages of costs, per head estimates, equal share of base costs, and more. Proposer shall include how frequently cost splitting assessments will be made.
Description of Proposed
RFP # S-DASOBO-00012632 - HPSP Page 1 of 9