ESRD BP Instructions_ REDESIGN.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 Business Proposal Format June 2012

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, basis 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 Excel2007 format and the narrative explanations in this guideline package were prepared in Word2007 format. The cost information in the electronic version of your completed business proposal must be in Excel2007 format. The narrative supporting information can be in Excel2007 or Word2007 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 1.6% 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 1.6% 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 entire contract 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-7A.

Page 16 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 in MS Excel. The forms should be completed and submitted back to CMS in MS Excel version 2007.

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 proposal.

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. 9 – Appendix G), with the exception of fee, which should be entered manually on the form.

NETWORK TRANSITION COLUMN

This column should only be used for offerors that are bidding on a contract that they do not currently hold. Due to the competitive process, prior to January 1, 2013, CMS may transfer certain ESRD Networks from the incumbent Network to a new contractor to ensure uninterrupted service. These columns should not be completed by incumbent ESRD Networks - only new bidders. Refer to the following Appendices for further instructions.

June 2012 Attachment J 7

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 delineated in the ESRD Network Organization Contract.

a.1 - a.15 Enter the proposed direct labor costs to be incurred for all Medicare direct labor. All labor positions, for the entire contract, should be listed in Appendix A – Network Transition chart. The listed positions will transfer to the subsequent labor charts and the ESRD Business Proposal Form Summary. If there are no hours to report for the period specified, leave the No. of FTEs, hourly rate, and number of hours cells blank.

Each individual position should be listed separately. For instance, if there are two persons employed as data entry clerks, use a separate line for each position. The Total Cost for each individual position per year is formula driven by multiplying the hourly rate times the number of hours. (DO NOT MANUALLY ENTER TOTAL COST AMOUNT.)

· Labor hours: The proposed hours/costs for labor and leave must be based on a work year of 2,080 hours. If leave is included in the salary, the proposed number of direct labor hours should equal 2,080. However, if leave hours are included in the Fringe Benefit, then the proposed direct labor hours for each employee should not include leave hours and must be adjusted. For example, 1 FTE should not equal 2,080 hours. The apportionment is at the discretion of the Network.

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. 9). (DO NOT MANUALLY ENTER AMOUNT.)

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. Administrative consultants including legal and accounting consultants should be included in Appendix B under lines 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 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 SUMMARY BUSINESS PROPOSAL FORM (pg. 9). (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.

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. 9).

(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)

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 = $2,500),

· 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, beverages, promotional items including, but not limited to clothing, pens, cups, folders, lanyards, bags, 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). If the offeror has an approved provisional leave rate, then the offeror is permitted to use this rate in their proposal. The Network must override the cells labeled LEAVE by entering the total leave costs for each period. The offeror must enter this rate in the box labeled, “Leave Rate/Costs”. Offerors should also supply a copy of the current provisional rate letter in the proposal. Again, if your organization does not have an approved rate, then complete lines 1-11 or leave blank, per the previous instructions.

If the offeror has an approved provisional fringe benefit rate, then the offeror is permitted to use this rate in their proposal. The Network must override the formula in the TOTAL Fringe Benefit cells with proposed Fringe Benefit costs. The offeror must enter this rate in the box labeled, “Fringe Benefit Rate/Costs”. Offerors should also supply a copy of the current provisional rate letter in the proposal. Again, if your organization does not have an approved rate, then complete lines 1-11.

· 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) / OVERHEAD

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. However, if the offeror has an approved provisional indirect rate, then you are permitted to use this rate and not compute the G&A line items below – see Indirect Rate.

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.

· Indirect Costs (if applicable) – If the offeror has an approved provisional indirect rate, then you are permitted to use this rate and not compute the G&A line items above. If using an approved indirect rate, the offeror must adjust the form to override the TOTAL G&A cells and replace with the proposed indirect costs. Offerors should also enter their approved indirect rate in the appropriate cell labeled “Indirect Rate” beneath the G&A chart and supply a copy of the current provisional rate letter in the proposal. Again, if your organization does not have an approved rate, then complete the line items above.

· Other - Use line 6 to record other G&A costs and provide a detailed list of these costs.

NOTE: SUBMIT FORM AND SUPPORTING PROPOSAL/JUSTIFICATIONS FOR EACH

YEAR.

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

Appendix H

TRAVEL DETAIL WORKSHEETS

These templates are formatted to ensure that adequate travel cost detail is provided when completed. Below are step by step instructions on how to complete these templates:

Name and Address of ESRD NW Organization Entry not required. This information will automatically transfer from worksheet BP J-7A.

ESRD NW Area (NW # __) Enter the ESRD Network number (make sure this information is entered in the box shown at cell F6) in worksheets Year 1 and Transition Period (if applicable). Note: This information is linked throughout the following worksheets.

Mileage Rate.

ESRD NWs should enter the current Federal Travel Regulation mileage rate.

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 of travel 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, if applicable.

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 I

ANNUAL MANAGEMENT PLAN

The Annual Management Plan contains 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 listed.

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 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