1_AttachmentJ-8a9thSOWDisparitiesSpreadsheet.xls

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9th SOW Quality Improvement Contracts Federal contract opportunity
Solicitation number
CMS-2007-QIO9thSOW-NAHC
Issued by
Department of Health and Human Services Centers for Medicare and Medicaid Services

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Attachment J-8a Disparities

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F718 BP SUM

1. Name and Address of QIO Organization3. RFP #
4: Proposed Contract Period
2. QIO Area (State):From:
To:
Medicare5. Total Proposed6. CMS Recommended7. $8. %
ContractCostsCostsDifferenceDIfference
Direct Cost
a. LABOR:
1. Professional$0$0$00.0%
2. Information Systems$0$0$00.0%
3. Corporate Management$0$0$00.0%
4. Support Staff$0$0$00.0%
SUBTOTAL - Direct Labor$0$0$00.0%
b. Leave$0$0$00.0%
c. Fringe Benefits$0$0$00.0%
SUBTOTAL - Leave/Fringe$0$0$00.0%
d. Subcontractors
1. Physician Reviewers/ Phys.Advisors
2. Other Consultants$0$0$00.0%
3. Other Subcontracts$0$0$00.0%
SUBTOTAL - Subcontractors$0$0$00.0%
e. Travel$0$0$00.0%
f. Other Direct Costs$0$0$00.0%
SUBTOTAL - DIRECT$0$0$00.0%
g. Indirect Costs$0$0$00.0%
h. Pass-thru Costs$0$0$00.0%
TOTAL COSTS$0$0$00.0%
i. Fee$0$0$00.0%
TOTAL COST WITH FEE$0$0$00.0%
9.
10. Signature of Authorized Official:CMS USE ONLY
Fringe Rate
14. Proposal Receipt Date:
Indirect Rate11. Type or Print Name and Title:
Other Rate15. Review By:
12. DATE:13. Telephone #
16. Signature/Title:

&C&"Arial,Bold"QUALITY IMPROVEMENT ORGANIZATION 9th SOW BUSINESS PROPOSAL SUMMARY FOR DISPARITIES &"Arial,Regular"CENTERS FOR MEDICARE and MEDICAID SERVICES &LForm 718 BP&R&9Prepared on:

QIO F719

1. RFP Number:2. Name and Address of QIO Organization:3. QIO Area (State):4. Contract Period
00From:12/31/99
00To:12/31/99
0
5. Selection of Participants and Control Groups (Tasks 1-3)6. Other Tasks (Tasks 4-8)7. Plans/Reports to Optimize Performance (Tasks 9-10)8. Total
MEDICARE COSTS20. TOTAL
Theme: PreventionTheme: PreventionTheme: Prevention
HOURSCOSTSHOURSCOSTSHOURSCOSTSHOURSCOSTS
a. LABOR:
1. Professional0.0$00.0$00.0$00.0$0
2. Information Systems0.0$00.0$00.0$00.0$0
3. Corporate Management0.0$00.0$00.0$00.0$0
4. Support Staff0.0$00.0$00.0$00.0$0
SUBTOTAL - Direct Labor0.0$00.0$00.0$00.0$0
b. Leave0.0$00.0$00.0$00.0$ - 0
c. Fringe Benefits$0$0$0$ - 0
SUBTOTAL - Leave / Fringe0.0$00.0$00.0$00.0$ - 0
d. Subcontracts:
1. Physician Reviewers / Phys. Advisors
2. Other Consultants$0$0$0$ - 0
3. Other Subcontractors$0$0$0$ - 0
SUBTOTAL - Subcontracts0.0$00.0$00.0$00.0$ - 0
e. Travel$0$0$0$ - 0
f. Other Direct Costs$0$0$0$ - 0
SUBTOTAL - DIRECT0.0$00.0$00.0$00.0$0
g. Indirect Costs$0$0$0$ - 0
h. Pass-thru Costs$0$0$0$ - 0
TOTAL COSTS0.0$00.0$00.0$00.0$0
i. Fee$0$0$0$ - 0
TOTAL COSTS WITH FEE$0$0$0$ - 0

&C&11Quality Improvement Organization 9th SOW - Disparities Business Proposal&10 Centers for Medicare and Medicaid Services &L&11Form 719 BP&CPage &P&RPrepared on:

QIO F720

FRINGE BENEFIT PROPOSAL
QUALITY IMPROVEMENT ORGANIZATION 9th SOW - DISPARITIES BUSINESS PROPOSAL
CENTERS FOR MEDICARE & MEDICAID SERVICES
1. Name and Address of QIO Organization3. RFP #
00
0
04: Proposed Contract Period
2. QIO Area (State):0From:12/31/99
To:12/31/99
6. Prior Year7. Projected8. Prior Year9. Projected
DETAIL COSTSTotalTotal 3-YRTotalTotal 3-YR
Organization CostsOrganization CostsMedicare CostsMedicare Costs
Fringe Benefits
a. Employer's FICA Expense$0$0
b. Federal Unemployment Insurance$0$0
c. State Unemployment Insurance$0$0
d. Disability Insurance$0$0
e. Pension Expense$0$0
f. Workers Compensation$0$0
g. Group Health Insurance$0$0
h. Group Life Insurance$0$0
i. Empl. Relations & Welfare$0$0
j. Leave$0$0
k. Other - see attached$0$0
l. Total Fringe Benefits$0$0
m. Fringe Benefit Rate0.00%0.00%0.00%0.00%

&LForm 720 BP&R&D

QIO F721

INDIRECT AND OTHER DIRECT COST
QUALITY IMPROVEMENT ORGANIZATION 9th SOW - DISPARITIES BUSINESS PROPOSAL
CENTERS FOR MEDICARE & MEDICAID SERVICES
1. Name and Address of QIO Organization3. RFP #
00
0
04: Proposed Contract Period
2. QIO Area (State):0From:12/31/99
To:12/31/99
5. Prior Year6. Projected7. Prior Year8. Projected9. Prior Year10. Projected
DETAIL COSTSTotalTotal 3yr.MedicareMedicare 3yrMedicareMedicare 3yr
Indirect CostsIndirect CostsIndirect CostsIndirect CostsOther Direct.Other Direct.
a. Indirect Labor$0$0
b. Indirect Leave$0$0
c. Indirect Fringe$0$0
d. Rent$0$0$0$0
e. Storage$0$0$0$0
f. Utilities$0$0$0$0
g. Maintenance & Repairs$0$0$0$0
h. Depreciation$0$0$0$0
i. Data Processing$0$0$0$0
j. Equipment Leasing & Rental$0$0$0$0
k. Office Supplies$0$0$0$0
l. Reproduction & Printing$0$0$0$0
m. Telephone$0$0$0$0
n. Postage & Express Mail$0$0$0$0
o. Consultants$0$0
p. Meeting & Conferences$0$0$0$0
q. Travel$0$0
r. Training$0$0$0$0
s. Garage & Parking Spaces$0$0$0$0
t. Dues & Subscriptions$0$0$0$0
u. Recruiting$0$0$0$0
v. Temporary Help$0$0$0$0
w. Continuing Education$0$0$0$0
x. Legal Fees$0$0$0$0
y. Accounting/Audit Fees$0$0$0$0
z. Board of Directors Fees$0$0$0$0
aa. Insurance$0$0$0$0
bb. Bank Charges$0$0$0$0
cc. Other - see attached$0$0$0$0
dd. ** TOTAL$0$0$0$0
ee. Indirect Cost Rate0.00%0.00%

&LForm 721 BP &R&D

QIO STAFFING

11. AverageSelection of Participants and Control Groups (Tasks 1-3)Selection of Participants and Control Groups (Tasks 1-3)Selection of Participants and Control Groups (Tasks 1-3)Selection of Participants and Control Groups (Tasks 1-3)12. Total 3yrSelection of Participants and Control Goups (Tasks 1-3)Selection of Participants and Control Goups (Tasks 1-3)Selection of Participants and Control Goups (Tasks 1-3)Selection of Participants and Control Goups (Tasks 1-3)13. AverageOther Tasks (Tasks 4-8)Other Tasks (Tasks 4-8)Other Tasks (Tasks 4-8)Other Tasks (Tasks 4-8)14. Total 3yrOther Tasks (Tasks 4-8)Other Tasks (Tasks 4-8)Other Tasks (Tasks 4-8)Other Tasks (Tasks 4-8)15. AveragePlans/Reports to Optimize Performance (Tasks 9-10)Plans/Reports to Optimize Performance (Tasks 9-10)
4a current4b current4c current4d current5. Proposed Year 15aProposedYr 15bPropYr15c Prop Yr 15d Prop Yr 17. Proposed Year 27aProposedYr7bPropYr27c Prop Yr 27d Prop Yr 29. Proposed Year 39aProposedYr 39bPropYr39c Prop Yr 39d Prop Yr 3Selection of Participants and Control Groups (Tasks 1-3)Prof. HoursIS hrsCorp AdminSupportSelection of Participants and Control Groups (Tasks 1-3)Prof. LaborIS laborCorp AdminCommunity Provider/Recruitment SelectionOther Tasks (Tasks 4-8)Prof. HoursIS hrsCorp AdminSupportOther Tasks (Tasks 4-8)Prof. LaborIS laborCorp AdminSupportPlans/Reports to Optimize Performance (Tasks 9-10)Prof. HoursIS hrs
1. Staff2. Position3. Labor4. Currenthourlyhourlyhourlyhourlyhourlyhourlyhourlyhourly6. Percenthourlyhourlyhourlyhourly8. Percenthourlyhourlyhourlyhourly10. Percentper yearper yearhours per yrStaff Hrs percosts/yr$$ per yearLabor $ per yrper yearper yearhours per yrStaff Hrs percosts/yr$$ per yearLabor $ per yrStaff Hrs perper yearper year
NameTitleCategory CodeHourly RateprofessionalISCorp Adminsupport staffHourly RateprofessionalISCorp Adminsupport staffChangeHourly RateprofessionalISCorp Adminsupport staffChangeHourly RateprofessionalISCorp Adminsupport staffChangeHours Per Yearavgavgavgyr, avgLabor CostsavgavgavgLabor $$yr, avgHours Per Yearavgavgavgyr, avgLabor CostsavgavgavgLabor $$yr, avgHours Per Yearavgavg
1$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
2$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
3$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
4$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
5$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
6$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
7$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
8$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
9$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
10$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
11$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
12$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
13$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
14$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
15$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
16$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
17$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
18$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
19$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
20$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
21$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
22$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
23$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
24$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
25$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
26$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
27$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
28$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
29$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
30$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
31$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
32$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
33$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
34$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
35$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
36$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
37$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
38$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
39$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
40$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
41$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
42$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
43$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
44$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
45$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
46$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
47$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
48$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
49$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
50$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
51$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
52$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
53$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
54$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
55$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
56$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
57$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
58$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
59$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
60$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
61$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
62$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
63$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
64$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
65$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
66$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
67$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
68$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
69$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
70$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
71$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
72$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
73$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
74$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
75$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
76$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
77$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
78$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
79$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
80$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
81$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
82$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
83$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
84$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
85$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
86$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
87$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
88$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
89$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
90$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
91$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
92$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
93$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
94$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
95$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
96$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
97$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
98$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
99$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
100$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
101$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
102$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
103$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
104$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
105$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
106$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
107$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.000.0%0000$0$ - 0$ - 0$ - 0$ - 00000$0$ - 0$ - 0$ - 0$ - 000
Grand TotalN/AN/AN/A$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.000.0%$0.00$0.00$0.00$0.00$0.000.0%$0.0000000.0%0.00000$0$ -$ -$ -$ -0.00000$0$ -$ -$ -$ -0.000
By Category
P=Professional$0.00$0.000.0%$0.000.0%$0.000.0%0.0$ - 00.0$ - 00.0
I=Info Systems$0.00$0.000.0%$0.000.0%$0.000.0%0.0$ - 00.0$ - 00.0
C=Corp Mgmt$0.00$0.000.0%$0.000.0%$0.000.0%0.0$ - 00.0$ - 00.0
S=Support Staff$0.00$0.000.0%$0.000.0%$0.000.0%0.0$ - 00.0$ - 00.0
Check Cell for Columns: Sum of 114 through 117 should equal value in 1120.0$ - 00.0$ - 00.0
Averaging
Counts0000000000000000000

&CStaffing Proposal Personnel Loading Chart Quality Improvement Organization 9th SOW - Disparities Business Proposal &LForm Staffing&CPage &P&R&D

QIOSubconts 2

2. Selection of Participants and Control Groups (Tasks 1-3)3. Other Tasks (Tasks 4-8)4. Plans/Reports to Optimize Performance (Tasks 9-10)5. Total 3 YR Costs
6.7.
1. NameCurrent ActivityProposed Activity
1Other Consultants:
a$0
b$0
c$0
d$0
e$0
f$0
g$0
h$0
i$0
j$0
k(See Attached)$0
Subtotal - Other Consultants$0$0$0$0
2Other Subcontractors:
a$0
b$0
c$0
d$0
e$0
f$0
g$0
h$0
i$0
j$0
k(See Attached)$0
Subtotal - Other Subcontractors$0$0$0$0

&C&11Subcontracts Proposal Quality Improvement Organization 9th SOW - Disparities Business Proposal &"Arial,Bold"Other Consultants and Other Subcontractors &LForm SC 2 &CPage &P&RPrepared on:

QIO Staff Sum

Labor Category1. Average2. Proposed4. Proposed6. Proposed8. Total Selection of Participants and Control Groups (Tasks 1-3) Hours9. Total Selection of Participants and Control Groups (Tasks 1-3) Labor Costs10. Total Other Tasks (Task 4-8) Hours11. Total Other Tasks (Tasks 4-8) Labor Costs12. Total Plans/Reports to Optimize Performance (Tasks 9-10) Hours13. Total Plans/Reports to Optimize Performance (Tasks 9-10) Labor Costs14. Total15. Total16. Total17. Total18. Total19. Total20. Total21. Total22. Total23. Total24. Total25. Leave as a26. Total27. Total28. Total
CurrentAverage Year 13. PercentAverage Year 25. PercentAverage Year 37. PercentDirect LaborDirect LaborIndirect LaborIndirect LaborLaborLaborDirect LeaveDirect LeaveIndirect LeaveIndirect LeaveLeave% of HoursLeaveLabor and LeaveLabor and Leave29. Total FTE
Hourly RateHourly RateChangeHourly RateChangeHourly RateChangeHoursCostsHoursCostsHoursCostsHoursCostsHoursCostsHoursWorkedCostsHoursCostsPer Year
Professional$ - 0$ - 00.0%$ - 00.0%$ - 00.0%0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.00.0%$00.0$00.00
Information Systems$ - 0$ - 00.0%$ - 00.0%$ - 00.0%0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.00.0%$00.0$00.00
Corporate Management$ - 0$ - 00.0%$ - 00.0%$ - 00.0%0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.00.0%$00.0$00.00
Support Staff$ - 0$ - 00.0%$ - 00.0%$ - 00.0%0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.00.0%$00.0$00.00
Total$ - 0$ - 00.0%$ - 00.0%$ - 00.0%0.0$00.0$00.0$00.0$00.0$00.0$00.0$00.0$00.00.0%$00.0$00.00

&CStaffing Proposal Summary Quality Improvement Organization 9th SOW - Disparities Business Proposal &LForm Sum&CPage &P&RPrepared on:

QIO ODC

OTHER DIRECT COST FOR DISPARITIES
QUALITY IMPROVEMENT ORGANIZATION 9th SOW BUSINESS PROPOSAL
CENTERS FOR MEDICARE & MEDICAID SERVICES
1. Name and Address of QIO Organization3. RFP #
00
0
04: Proposed Contract Period
2. QIO Area (State):0From:12/31/99
To:12/31/99
DETAIL COSTS5. Selection of Participants and Control Groups (Tasks 1-3)6. Other Tasks (Tasks 4-8)7. Plans/Reports to Optimize Performance (Tasks 9-10)Total Projected Medicare - 3yr Other Direct Costs
d. Rent$0$0$0$0
e. Storage$0$0$0$0
f. Utilities$0$0$0$0
g. Maintenance & Repairs$0$0$0$0
h. Depreciation$0$0$0$0
i. Data Processing$0$0$0$0
j. Equipment Leasing & Rental$0$0$0$0
k. Office Supplies$0$0$0$0
l. Reproduction & Printing$0$0$0$0
m. Telephone$0$0$0$0
n. Postage & Express Mail$0$0$0$0
o. Consultants
p. Meeting & Conferences$0$0$0$0
q. Travel
r. Training$0$0$0$0
s. Garage & Parking Spaces$0$0$0$0
t. Dues & Subscriptions$0$0$0$0
u. Recruiting$0$0$0$0
v. Temporary Help$0$0$0$0
w. Continuing Education$0$0$0$0
x. Legal Fees$0$0$0$0
y. Accounting/Audit Fees$0$0$0$0
z. Board of Directors Fees$0$0$0$0
aa. Insurance$0$0$0$0
bb. Bank Charges$0$0$0$0
cc. Other - see attached$0$0$0$0
TOTAL$0$0$0$0

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