Attachment J-7.docx

BUSINESS PROPOSAL FORMAT

FOR UTILIZATION AND QUALITY CONTROL

END STAGE RENAL DISEASE (ESRD) NETWORK (NW) PROGRAM

FORMS AND INSTRUCTIONS

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

BALTIMORE, MARYLAND

Attachment J-7 ESRD Network Business Forms & Instructions February 2009

I. INTRODUCTION

PURPOSE

This guideline package will assist you in preparing the standardized business proposal forms used to award the End Stage Renal Disease (ESRD) Network (NW) Program contracts.

SCOPE

Offerors must use the electronic file that CMS provides to prepare and submit the business proposal. This guideline package provides instructions for completing the various business proposal forms in the CMS electronic file. The hardcopy version of this package includes a sample of the various forms.

Business proposals must also include appropriate supporting information, cross-referenced to the related column, line item, and form. The supporting information should be detailed and, as appropriate, fully explain calculations, bases for estimates, etc.

METHOD OF SUBMISSION

CMS is providing you with the business proposal forms in an Excel spreadsheet file titled ESRD BP Forms J-7 A. You must enter your cost data in these Excel files and submit your completed business proposal in both electronic and hard-copy format.

The business proposal forms in CMS’s Excel file were prepared in Excel2000 format and the narrative explanations in this guideline package were prepared in Word2000 format. The cost information in the electronic version of your completed business proposal must be in Excel2000 format. The narrative supporting information can be in Excel2000 or Word2000 format.

II. GENERAL INSTRUCTIONS

The following general instructions for the completion and submission of the business proposal forms are in addition to those instructions contained in the RFP issued by CMS to all offerors and in addition to the attached Section III – ADDITIONAL EXPLANATION AND JUSTIFICATION FOR BUDGET PROPOSAL.

1. The CMS-provided electronic file and the specified Excel and Word versions are the only acceptable format for your cost proposal submission. Proposals received in any other format will be considered unacceptable.

2. An ESRD NW organization proposing to administer a contract in more than one ESRD NW area must complete a separate business proposal for each ESRD NW area.

III. ADDITIONAL GENERAL EXPLANATION AND JUSTIFICATION FOR BUSINESS PROPOSAL

As a general rule contractors should explain how they calculated all items in their budget request, with the exceptions provided below. With the exception of salaries, which are discussed below, the ESRD NW should not inflate any line item for a year to year increase of greater than 2.8% without providing further justification. The ESRD NW should also make sure to indicate what rate of increase it is using on all non-salary line items, even when they are at or below the 2.8% rate of increase per year.

IV. FORMS AND INSTRUCTIONS

Business proposals, with the supporting documentation described in appendices A-G, must be completed for each year and submitted for the complete 12 month contract period and the transition period. Simply completing appendices A-G does not satisfy CMS’ requirement of submitting supporting documentation. Each offeror submitting a proposal for a Network contract shall submit supporting documentation in addition to the attached forms. Supporting documentation should clearly explain how each element of cost was calculated, including the rationale and assumptions underlying each calculation. The supporting documentation should be submitted as a separate section of the business proposal, which should include both narrative justifications/rationales and any exhibits that provide direct evidence for cost rates. (For example, a copy of the current lease or quote(s) from one or more viable location establishing market rate for appropriate office space in the Network’s area.) The Network must submit its business proposal using the forms and instructions provided in Attachment J-7 A and J-7 B.

Page 17 of Attachment J-7 contains the instructions and forms for completing an Annual Management Plan. ESRD Networks must also use these forms. CMS is providing each ESRD Network with electronic versions of the Business Proposal Forms, and Management Plan Forms. These forms are provided by CMS in MS Excel. The forms should be completed and submitted back to CMS in MS Excel version 2000.

NOTE: Business proposals will be rejected if all of the requested information is not submitted. Moreover, special projects requests should not be included in this Budget Proposal.

February 2009 Attachment J 7

Filling out the various Appendices described below in the Excel Spreadsheet will automatically transfer the total for each Appendix to the appropriate line item on the ESRD BUSINESS PROPOSAL FORM SUMMARY (pg. 7), with the exception of fee and travel, which should be entered on the form. (DO NOT MANUALLY ENTER AMOUNTS, with the exception of the fee and travel).

Appendix A

LABOR

The forms in Appendix A should be used to list all proposed direct labor costs to be incurred by all ESRD Network employees in performing activities (Administrative, Quality Improvement, Information Management, and Community Information and Resource) delineated in the ESRD Network Organization Contract. See Position Title General Definitions in Notes, below.

Subtotal The Total amount in the SUBTOTAL - DIRECT LABOR block is formula driven. (DO NOT MANUALLY ENTER TOTAL COST AMOUNT.)

NOTE: Submit supporting justification for each line item (including projected hours, hourly rate, etc.)

SUBMIT SEPARATE FORM FOR EACH YEAR.

ANY BLANK CELL WILL COUNT AS IF OFFEROR HAD ENTERED A “0” IN THAT CELL.

The total amount for each position on Appendix A will automatically be transferred to the line for that position under Labor (line a) of the ESRD BUSINESS PROPOSAL FORM SUMMARY (pg. 7).

(DO NOT MANUALLY ENTER AMOUNT.)

POSITION TITLE GENERAL DEFINITIONS:

1. PROJECT DIRECTOR/EXECUTIVE DIRECTOR: This is the position most Networks prefer to describe as the “Executive Director” or “ED”. In many Network Administrative Organizations, it is the position analogous to “Chief Executive Officer (CEO)” in larger organizations or to the “full-charge manager” in some smaller organizations. This position has line authority and typically reports directly to a COO, CEO, or directly the Board of Directors, depending on the overall size and structure of the organization holding a Network administrative organization contract.

2. QUALITY IMPROVEMENT MANAGER (QIM): Most Networks use the term “Quality Improvement Manager”. This is the person who leads and oversees all quality improvement efforts. This person reports directly to the Network’s Executive Director.

3. RN (NEPHROLOGY): This is an RN with nephrology experience, who usually works on quality-improvement and also on other activities required under the Network contract.

4. OFFC MGR./BOOKKEEPER: This position keeps the office running and/or maintains the general ledger on a daily basis (to the extent the Executive Director delegates such activities as the general ledger and purchasing/logistics management). An offer proposing to employ an “administrative assistant” who does not conduct office-management or bookkeeping activities should list that employee under # 9, “EXECUTIVE/ADMINISTRATIVE ASSISTANT”

5. DATA/INFO. SYSTEMS MANAGER: This position will be responsible for day-to-day management of the Network’s Data responsibilities. The Data Manager’s responsibilities may include those of a Local-Area Network (LAN) administrator. If offeror proposes to employ a separate LAN administrator or other Information Technology/Systems analyst position, that position should be proposed separately (as another employee, or as a consultant, as appropriate to reflect offeror’s anticipated actual operations).

6. DATA ENTRY & TRACKING CLERICAL SUPPORT: If Network proposes to maintain more than one data entry clerk position; the position listed on this line should be the senior or highest-skill-level data clerk. If there are multiple part-time data entry clerks proposed, each should be accounted for individually (use additional lines on report).

7. COMMUNITY OUTREACH COORDINATOR: This position serves as a specialist in partnership, collaboration, and education that will be responsible for enhancing community outreach and collaboration activities of the Network. This position will plan and facilitate education, information dissemination and training to ESRD professionals, patients, and their family members and other members of the renal community, and will be the staff liaison lead to the Patient Advisory Committee. He/she may work with consultants (e.g. website, statistical) and provide support across Network program lines to improve quality of care for patients through education, web site outreach, coalition and partnership building. To adequately perform these responsibilities, the individual must have related experience (e.g., communications, material development, organizing volunteers, etc.) and where possible be a patient with CKD/ESRD, or have personal, first hand experience with a family member, spouse, or other significant individual with CKD/ESRD. Because this position provides support across Network program lines, each offeror should propose whether the responsibilities will be fulfilled through one dedicated (part or full time position) or shared among other positions.

8. EXECUTIVE SECRETARY/ADMINISTRATIVE ASSISTANT: If the offeror proposes to employ an administrative assistant or executive assistant (not a bookkeeper or office manager), this position should be proposed on this line.

9. CLERICAL SUPPORT: This position would be a general file clerk or clerk-typist. If offeror proposes to use more than one of these positions (more than one FTE or an FTE split among part-time persons), list highest-paid here and list others in additional lines. If this position is not proposed to also serve as the Network’s Receptionist, the Receptionist position should be reported on one of the additional lines on the form. (Receptionist duties are defined as answering the telephone, greeting visitors at the front desk, monitoring entry and exit of visitors, perhaps signing for and logging in packages and correspondence.)

10. PATIENT SERVICES COORDINATOR: This position is responsible for resolving patient and/or facility complaints and grievances, conducting educational training on managing difficult situations, and conflict resolution.

Appendix B

PROGRAM CONSULTANTS

The forms in Appendix B should be used to list the proposed direct costs to be incurred by all Program Consultants (Nurses, Social Worker, Statistician, etc.). Administrative consultants including legal and accounting consultants should be included in Appendix B under sections B-1 through B-15.

1 - 15 Enter each proposed cost to be incurred for all Consultants (by line item).

Use the attached form to indicate each Consultant cost.

The Total amount in the attached CONSULTANTS Appendix B block is formula driven.

(DO NOT MANUALLY ENTER AMOUNT.)

Use the attached form to indicate each Consultant cost.

The total amount will automatically be transferred to the line for Consultant (line b) of the ESRD BUSINESS PROPOSAL FORM SUMMARY (pg. 7). (DO NOT MANUALLY ENTER AMT.)

NOTE: SUBMIT SEPARATE FORM FOR EACH YEAR.

ANY BLANK CELL WILL COUNT AS IF OFFEROR HAD ENTERED A “0” IN THAT CELL.

TRAVEL

Appendix C-1

CMS should receive adequate cost breakout for all travel costs that are submitted, CMS has now created travel costs templates for contractors to complete when submitting travel costs. These templates are formatted to ensure that all adequate cost detail is provided when completed.

Please see the attached excel templates included with this guide titled, “Travel Chart In-State.xls”, and, “Travel Chart Out-of-State.xls”. Below, are step by step instructions on how to complete these templates:

RFP Number Enter the CMS Request for Proposal (RFP) number for the proposed contract (make sure the information is entered in the box shown at cell A6) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

Name and Address of ESRD NW Organization Enter the name and address of the organization submitting the proposal (make sure the information is entered in the boxes shown at cells B6, B7 and B8) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

ESRD NW Area (NW # __) Enter the area that the proposed ESRD NW contract will cover (make sure the information is entered in the box shown at cell G6) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

Proposed Contract Period Enter the beginning and ending dates of the proposed ESRD NW contract (make sure the information is entered in the boxes shown at cells K6 and K7) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

Mileage Rate.

ESRD NWs should enter the current Federal Travel Regulation mileage rate used for the proposed NW contract.

Trip Title & Description.

Enter a proposed trip title and provide a brief description of the purpose of the trip.

# of Days per Trip.

Enter the proposed number of days the trip will occur.

# of Nights per Trip.

Enter the proposed number of nights the trip will occur.

# of Travelers per Trip.

NWs should enter the number of travelers, per trip, in whole figures.

Airfare per Person.

NWs should enter the proposed airfare per person.

Departing from.

Enter the city and state the travelers are departing from.

Arriving to.

Enter the city and state the travelers will arrive to.

FTR Meals & Inc. Daily Rate.

NWs must enter the current Federal Travel Regulations (FTR) Meals and Incidental Rate for the current year based on www.gsa.gov. Note: The formula embedded in the Total column will calculate the max Per Diem rate for the first and last day based on the number of days reported previously.

FTR Lodging per Night.

NWs must enter the current Federal Travel Regulations (FTR) maximum Lodging Rate (excluding taxes) for the Primary Destination for each trip based on www.gsa.gov. Note: The formula embedded in the Total column will calculate the lodging costs based on the nights reported previously.

# of Trips for Year 1, 2, or 3.

Enter the number of trips for the respective year.

Mileage per Traveler per Trip.

Input the roundtrip mileage per trip, if applicable.

# of Rental Cars per Trip.

Enter the number of rental cars needed for each trip.

Daily Rental Car Rate.

Enter the proposed daily rental car rate.

Miscellaneous Cost per Person per Trip.

Enter the miscellaneous cost per person per trip. You may include parking fees, gas, taxi, metro fees, and the like.

Notes.

Provide a detailed explanation of the proposed miscellaneous cost calculations (what and how your organization reached the proposed figures).

** Shaded cells represent no entry required.

Appendix C

SUBCONTRACTOR(S)

The forms in Appendix C should be used to list subcontractor information, if applicable. Enter all of the requested information in the appropriate column(s). Enter the Total proposed costs to be incurred for all Subcontractor(s) expenses in the "Total Costs" column.

This amount will automatically be transferred to the SUBCONTRACTORS line item of the ESRD BUSINESS PROPOSAL FORM SUMMARY (pg. 7).

(DO NOT MANUALLY ENTER AMOUNT.)

NOTE: SUBMIT SUPPORTING JUSTIFICATION.

SUBMIT A SEPARATE FORM FOR EACH YEAR’S PROPOSED SUBCONTRACTOR COSTS.

ANY BLANK CELL WILL COUNT AS IF OFFEROR HAD ENTERED A “0” IN THAT CELL.

Appendix D

OTHER DIRECT COSTS

ODC refers to costs used in direct support of the contract. The proposed costs for ODCs should be inclusive of service, material and equipment. CMS requires each contractor to submit an ODC spreadsheet (see RFP for specific instructions) that depicts the proposed ODC by line item and in total. Examples of commonly utilized ODCs include, but, are not limited to:

· Continuing Education

CMS reviews and verifies all proposed contractor ODCs to ensure they are cost reasonable, relevant and necessary to complete the Statement of Work (SOW). In addition, CMS reviews and verifies ODC costs to ensure that the proposed technical approach matches the proposed costs.

Contractors must provide CMS all rationale and supporting documentation for CMS to find the proposed ODCs reasonable. CMS must be able to crosswalk the proposed costs to the supporting documentation and proposed rationale. Examples of commonly utilized supporting documentation include, but, are not limited to:

· Specific price quotes,

· Detailed cost per FTE data,

· Market surveys,

· Historical data,

· Previous billing statements/expense vouchers; and

· Catalog prices.

Contractors must ensure the following when submitting ODC supporting documentation and rationale:

· Do show all unit cost and volume detail (i.e.: 500 binders for Conference participants @ $5/each = $2500),

· Do directly charge for contract-specific ODCs (i.e.: project-specific brochures),

· If applicable, Do indirectly charge all general ODCs (i.e.: general office supplies),

· Do show/explain rationale of how you determined cost reasonable in narrative and spreadsheet,

· Do not bill for any food, beverage, etc.,

· Do not just list ODC costs in total; and

· Do not just state “historical cost” as justification; crosswalk back to current RFP/SOW.

General rule of thumb: The more substantive detail you provide; the better! CMS will request additional supporting documentation from contractors if the appropriate details aren’t included in the proposal.

This ODC form should be completed to indicate other direct costs. This form includes all costs delineated and specified in the ESRD contract as other direct costs. Supporting documentation for the rationale/underlying assumptions for calculating the proposed cost values should be submitted in the supporting documentation/narrative justification and rationale section of the business proposal.

· Enter the proposed cost for each line item specified in the attached form.

· Use the attached form to indicate all proposed Other Direct Costs.

· The Total amount in the attached OTHER DIRECT COSTS block is formula driven. (DO NOT MANUALLY ENTER AMOUNT.)

ODC LINE ITEM DESCRIPTIONS

· Storage - Used to record the cost of warehouse space used to store records and documents in privately or publicly owned building used by the organization for the benefit of the contracts. State if included in rent.

· Utilities - Used to record costs of utility charges (i.e., electric, gas, water, etc.) billed to the organization. State if included in rent.

· Maintenance & Repairs - Used to record maintenance and repair costs incurred that are necessary to keep buildings, capitalized and non-capitalized equipment in an efficient operating condition. State if maintenance costs are included in rent.

· Depreciation - Used to record portions of a systematic and rational allocation of the cost of capitalized assets over their estimated useful life. (Include only assets not purchased with government funds.)

· Data Processing - (Computer Hardware/Software) Used to record computer operating costs, other than personnel costs, equipment rental or leasing, and maintenance and repairs.

· Office Supplies - Used to record costs paid or accrued for all purchases of office supplies.

· Postage & Express Mail - Used to record costs incurred or accrued for external mailing and delivery. This includes the cost associated with postage and express mail fees.

· Meetings & Conferences - Used to record costs incurred for meetings and conferences and costs associated with the conduct of meetings and conferences for company's professional staff. For example, the cost of renting facilities, speakers' fees.

· Garage & Parking Spaces - Used to record costs incurred in garage and parking facilities for professional staff whose time is directly allocable to revenue sources. It includes gross rental expense from all garage and parking spaces accrued.

· Dues & Subscriptions - Used to record costs of the organization's membership in civic, business, technical and professional organizations. The costs include the cost of the organization's subscriptions to civic, business, professional, and technical periodicals.

· Recruiting - Used to record recruiting costs and costs associated with recruiting personnel who will be directly billable to the contract (i.e., "help wanted" advertising, operating cost of an employment office, cost of operating an educational testing program, travel expenses in accordance with Federal Travel Regulations guidelines including food and lodging of employee while engaged in recruiting personnel, travel cost of an applicant for interviews and prospective employment, and other related expenses). These costs include fees paid to agencies and costs of recruiting employees.

· Temporary Help - Used to record costs incurred in securing part-time or temporary services for a particular short period. The work performed must relate to the current contract. These costs include fees paid to agencies and costs of securing the temporary help.

· Continuing Education and Training- Used to record costs incurred or accrued for preparation and maintenance of a program of instruction including, but not limited to on-the-job, classroom, and apprenticeship training, designed to increase vocational effectiveness of employees. These costs will include training materials, textbooks, tuition, and fees when training is in an institution not operated by the organization. The costs must be related to the training of professional staff hired for this contract.

· Legal Fees - Used to record costs paid or accrued for legal fees identifiable with any contract activity in the statement of work of the CMS Medicare contract.

· Accounting/Auditing Fees - Used to record all fees paid or accrued for preparing corporate financial statements, tax returns, and coordinating internal audit work, and audits by independent accountants.

· Printing and Reproduction - Used to record costs incurred or accrued for copying, reproduction, and printing of material, documents and records, which are directly associated with this contract .

· Other - (Attach Schedule and Supporting Justification(s)

NOTE: SUBMIT FORM AND SUPPORTING /JUSTIFICATIONS FOR EACH YEAR.

ANY BLANK CELL WILL COUNT AS IF THE OFFEROR HAD ENTERED “0”.

Appendix E

FRINGE BENEFITS

This form should be completed to indicate fringe benefits. This form includes the allocated fringe benefit expenses for each direct contract activity type.

Use the attached form to indicate all proposed Fringe Benefits (by line item).

The Total amount in the attached FRINGE BENEFITS appendix is formula driven.

(DO NOT MANUALLY ENTER AMOUNT.)

· Employer's FICA Expense - Used to record amounts paid or accrued for the employer's share of the Federal Insurance Contribution Act (FICA) tax liability.

· Federal Unemployment Tax - Used to record amount of tax paid for employer's contribution to the Federal Unemployment Compensation Act tax.

· State Unemployment Insurance - Used to record the amount of taxes paid for employer's contribution to the State Unemployment Insurance programs.

· Disability Insurance - Used to record employer's contribution to the disability insurance of its employees.

· Pension Expense - Used to record the cost incurred or amount paid and accrued for funding the company's pension plan for its employees.

· Worker's Compensation Insurance - Used to record the cost of Worker's Compensation Insurance for employees.

· Group Health Insurance - Used to record the cost of group health insurance coverage provided to employees.

· Group Life Insurance - Used to record the costs of group life insurance coverage provided to employees.

· Employee Relations & Welfare - Used to record costs associated with or cost incurred in maintaining satisfactory relations between the organization and its employees. It includes cost of labor management committees, employee publications, and other related activities.

· Leave - Used to record costs for the leave portion of employees' proposed total labor costs. Leave is defined to include all types of leave, namely, holiday, vacation, sick leave, and other authorized leave per the ESRD Network's organizational policy. If leave is included in the salary, enter "0" on line 10, and annotate in the supporting proposal/justification(s).

· Other - Attach Schedule and Submit Supporting Justification(s)

NOTE: SUBMIT SUPPORTING FORM ANDJUSTIFICATIONS FOR EACH YEAR.

ANY CELL LEFT BLANK WILL COUNT AS IF THE OFFEROR HAD ENTERED “0”.

Appendix F

GENERAL AND ADMINISTRATIVE (G&A)

This form should be completed to indicate G & A costs. This form includes all proposed G&A costs to be incurred by each ESRD Network.

Enter the proposed G&A cost to be incurred for this contract (by line item).

NOTE: The Total amount in the Appendix F - GENERAL and ADMINISTRATIVE block is formula driven (DO NOT MANUALLY ENTER AMOUNT.)

· Rent - Used to record the cost of space in privately or publicly owned building used by the organization for the benefit of this contract.

· Leased Equipment - Used to record expense for leased furniture and equipment.

· Telephone Expense - Used to record cost incurred or accrued for telephone services, local and long distance calls, telegrams, radiograms, and other communication costs.

· Insurance - Used to record general liability and other non-health insurance costs which includes: Property, Staff Liability, Committee Member Liability, Network Liability, etc.

· Other - Use lines 5-15 to record other G&A costs.

NOTE: SUBMIT FORM AND SUPPORTING PROPOSAL/JUSTIFICATIONS FOR EACH

YEAR.

ANY CELL LEFT BLANK WILL COUNT AS IF THE OFFEROR HAD ENTERED "0".

Annual Management Plan

The Annual Management Plan form is provided in Attachment J-7 B, Annual Mgmt. Plan. The Annual Management Plan will contain information for direct labor and consultants costs.

List the total contract hours and fill in the correct percentage of the level of effort/time that will be spent in each labor category, (i.e., Administration, Quality Improvement, Information Management, and Community Information and Resource).

The total percentage of each staff member or consultant's level of effort/time should equal 100%, which is reflected in the last column.

NOTE: Less than full-time equivalent (FTE) positions will be noted in the FTE column. For the reporting of percentage of time in each category (i.e. Administration, Quality Improvement, Information Management, Community Information) for each position, the total hours for each position should be considered as 100%, even if it is less than 1 FTE.

For the total of hours for all Direct Labor positions combined and for Program Consultants combined, please indicate the percentage of total hours in each category.

Attachment J-7