Copy of Attachment B - Cost Response.xlsx

XLSX spreadsheet 46 KB Posted May 22, 2026

Attached to: 26EHSKWPCMRFR-MassHealth PCA Program PCM Functions RFR
Solicitation number: BD-26-1039-EHS01-ASHWA-129810
Issued by: Massachusetts

About this file

Written by GovTribe AI · May 26, 2026

This is a cost proposal template for the Massachusetts Executive Office of Health and Human Services (EOHHS) Request for Responses to solicit Personal Care Management (PCM) agencies to provide PCM functions as part of the Personal Care Attendant (PCA) Program. The template, designated as Attachment B, requires bidders to submit a detailed first-year cost estimate including specific contracted PCM function costs, fixed costs, variable costs, and software upgrade costs. Bidders must provide information on estimated consumer volume and include supporting documentation such as their most recent Uniform Financial Statement with line-by-line expenditures and revenue for their PCM program if applicable. The spreadsheet contains multiple tabs designed to capture comprehensive cost data: a contract summary tab for bidder information and cost overview, a detailed cost proposal tab breaking down function costs by service type (initial evaluations, re-evaluations, intake and orientation, and monthly case management), staffing tabs for both current contractors and all bidders to detail personnel costs, and an execution page requiring authorized signature.

The cost proposal structure distinguishes between fixed costs that do not depend on consumer enrollment (such as personnel, equipment, and indirect administrative costs) and variable costs that scale with consumer enrollment. Current PCM contractors must complete a staffing tab using data from Fiscal Year 2025 (July 1, 2024 to June 30, 2025), while all bidders must complete a future staffing tab detailing proposed staff positions, roles, and associated costs. The cost proposal template requires bidders to present input rates incorporating all applicable personnel costs including direct staff, payroll taxes, and fringe benefits, along with operating costs and indirect costs such as administrative support, rent, and utilities. Bidders may include narrative explanations for their cost proposals and must provide detailed descriptions or rationale for any software upgrade costs. The template automatically aggregates all cost categories to generate a total contract cost summary, with all financial data entry restricted to designated blue cells to ensure accuracy and consistency across submissions.

View the file

Other files

File	Type	Posted
Attachment A - Model Contract~13.docx	DOCX document	May 22, 2026
Massachusetts Substitute Form W-9~15.pdf	PDF	May 22, 2026
Contractor Authorized Signatory Listing Form CASL for Sole Proprietors~8.pdf	PDF	May 22, 2026
Standard Contract Form Instructions and Contractor Certifications~18.pdf	PDF	May 22, 2026
Copy of Supplier Diversity Program SDP Plan Forms for Goods and Services.xlsx	XLSX spreadsheet	May 22, 2026
Contractor Authorized Signatory Listing Form CASL for Corporations~7.pdf	PDF	May 22, 2026
Commonwealth Terms and Conditions~33.pdf	PDF	May 22, 2026
Standard Contract Form~15.pdf	PDF	May 22, 2026
MassHealth PCA Program PCM Functions RFR.docx	DOCX document	May 22, 2026
MassHealth Federally Required Disclosures Form~7.pdf	PDF	May 22, 2026
EOHHS Required Bidder Certifications Form~5.docx	DOCX document	May 22, 2026
Evaluation Criteria~19.docx	DOCX document	May 22, 2026

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1. Instructions

Attachment B Cost Proposal, Instructions

This spreadsheet is to be used by the Bidder to provide a detailed cost estimate for the first year of this procurement. The Bidder must also include as part of this attachment, a copy of its most recent Uniform Financial Statement that includes its line-by-line expenditures and revenue for its Personal Care Management program, if applicable.

Tab 2. Contract Summary
	Enter Bidder information ONLY - The remaining information will pull from Tab 3 - Cost Proposal and serve as a summary of the detailed information submitted. Bidder may submit a Cost Response narrative on this tab.

Tab 3. Cost Proposal
	This tab is where the Bidder provides details for all Personal Care Management Costs for the first year of this procurement. More detail on the costs types is below:

Contracted PCM functions costs, include the estimated cost and estimated number of units annually, meaning the estimated number of consumers who would receive each contracted function

Fixed costs include all applicable fixed costs that don't depend on the number of consumers enrolled, such as personnel costs (e.g., direct personnel, payroll taxes, fringe benefits, and other personnel costs), operating costs (e.g., equipment, subcontract services, travel, and other operating costs), and indirect costs (e.g., administrative support personnel, rent, and utilities and other indirect costs).

Variable costs include all applicable variable costs that depend on the number of consumers enrolled, such as personnel costs (e.g., direct personnel, payroll taxes, fringe benefits, and other personnel costs), operating costs (e.g., equipment, subcontract services, travel, and other operating costs), and indirect costs (e.g., administrative support personnel, rent, and utilities and other indirect costs).

Software Upgrade Costs include a detailed list of all software upgrade related costs. Bidders must include a detailed description or rationale for the costs. If none, leave blank.

If additional rows are needed, please be sure to check formulas are included in the new rows.

Tab 4. Current Staffing (For Current Contracts ONLY)

Instructions:

-Only complete this tab if you are currently contracted as a PCM.

-Use data from SFY25 (July 1, 2024 to June 30, 2025).

-In Column A "Cost Category", specify where this staff has been considered in Tab 3 - Cost Proposal.

-List all staff members. If there are two staff members in the same role, list them each individually.

Tab 5. Future Staffing
	- All Bidders should complete this tab.

- This tab is an additional detail of the staff costs, which should already be represented in the Tab 3 - Cost Proposal. The total from this table is not added to the contract summary total.

- In Column A "Cost Category", specify where this staff has been considered in Tab 3 - Cost Proposal.

- List all staff members. If there are two staff members in the same role, list them each individually.

Tab 6. Execution Page
	Please complete all requested information on this form. This form must be signed by the same individual who signs the Response Cover Letter.

&A &P o f&N

2. Contract Summary

COST PROPOSAL SUMMARY

Only enter information in the Blue cells.

Do not enter any other information. All data pulls from other tabs.

	Estimated Consumers	Contracted PCM Function Costs	Other Fixed Costs	Other Variable Costs	Software Upgrade Costs	Total Cost
Contract Summary	0	$ - 0	$0.00	$0.00	$0.00	$0.00

Bidder notes

Narrative may be included here…..

&A &P of &N

3. Cost Proposal

3. COST PROPOSAL, Personal Care Management Functions Costs

Instructions: Enter information as requested in blue cells only.

Please add the Bidder name to cell C10.

- The Bidder should present an input rate derived from all applicable personnel costs (e.g., direct personnel, payroll taxes, fringe benefits, and other personnel costs), operating costs (e.g., equipment, subcontract services, travel, and other operating costs), and indirect costs (e.g., administrative support personnel, rent, and utilities and other indirect costs).

- Specific Contracted PCM Functions: provide estimated cost of all applicable fixed Contract costs, that don't depend on the number of Consumers enrolled.

- Other Fixed or Variable Costs: provide a detailed list of all applicable variable costs, that depend on the number of Consumers enrolled.

- Software Upgrade Costs: detailed list of all software upgrade related costs. Bidders must include a detailed description or rationale for the costs. If none for the Bidder, leave blank.

Bidder:

Estimated Consumers to be served:

		Table 1. Specific Contracted PCM Function Costs
		Category	Description	Cost/
Fee per Unit	Anticipated Units	Total Annual Cost	Bidder Notes
		Initial Evaluation (99456)	Initial evaluation of a member to determine the need, and
extent of the need, for PCA services. Per evaluation.	$ - 0		$ - 0
		Re-Evaluation (99456 TS)	Re-evaluation of a member for PCA services. Per Evaluation.	$ - 0	$ - 0
		Intake & Orientation (T1023)	Per session charge for intake and orientation services provided to a member who does not yet have PA for PCA services. Maximum three sessions per person.	$ - 0	$ - 0
		Per Member Per Month (T2022)	Case management per month.	$ - 0	$ - 0
		Subtotal - Specific Contracted PCM Function Costs			$ - 0

		Table 2. Other Fixed Costs
		Category	Description	Cost/
Fee per Unit	Anticipated Units, if N/A put 1	Total Annual Cost	Bidder Notes
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
		Subtotal - Other Fixed Costs			$ - 0

		Table 3. Other Variable Costs
		Category	Description	Cost/
Fee per Unit	Anticipated Units, if N/A put 1	Total Annual Cost	Bidder Notes
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
				$ - 0	$ - 0
		Subtotal - Other Variable Costs			$ - 0

Table 4. Software Upgrade Costs
Category	Description	One Time Costs	Narrative / Justification
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
Subtotal - Software Upgrade Costs		$ - 0

Table 5. Summary Table (Automatically Updates)
Subtotal - Contracted PCM Function Costs	$ - 0
Subtotal - Other Fixed Costs	$ - 0
Subtotal - Other Variable Costs	$ - 0
Subtotal - Software Upgrade Costs	$ - 0

TOTAL Costs $ - 0

&A &P of &N

4. Current Staffing

4. Staffing - Current Contractors Only

Instructions:

-Only complete this tab if you are currently contracted as a PCM.

-Use data from SFY25 (July 1, 2024 to June 30, 2025).

-In Column A "Cost Category", specify where this staff has been considered in Tab 3 - Cost Proposal.

-List all staff members. If there are two staff members in the same role, list them each individually.

								OR
	Category of Costs for Role (Use Dropdown Menu)	Job Title / Role	Leadership / Management Role
(Use Dropdown Menu)	Description of Role and Responsibilities
for Function / Task Identified	Full time or Part time
(Use Dropdown Menu)	Rate/Hour	Hours Worked Annually	Annual Cost	Annual Salary ($)
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
					$ - 0		$ - 0
						Total Cost	$ - 0

5. Future Staffing

5. Staffing - All Bidders

Instructions:

- All Bidders should complete this tab.

- This tab is an additional detail of the staff costs, which should already be represented in the Tab 3 - Cost Proposal. The total from this table is not added to the contract summary total.

- In Column A "Cost Category", specify where this staff has been considered in Tab 3 - Cost Proposal.

- List all staff members. If there are two staff members in the same role, list them each individually.

	Category of Costs for Role (Use Dropdown Menu)	Job Title / Role	Leadership / Management Role
(Use Dropdown Menu)	Description of Role and Responsibilities
for Function / Task Identified	Is this role already filled?
(Use Dropdown Menu)	Full time or Part
(Use Dropdown Menu)	Rate/Hour	Hours Worked Annually	Annual Cost	Annual Salary ($)
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
					$ - 0		$ - 0	$
						Total Cost	$ - 0	$ - 0

6. Execution Page

6. Execution Page
BIDDER NAME:
TYPE NAME & TITLE OF PERSON SIGNING ON BEHALF OF BIDDER:
EMAIL:
PHONE NUMBER:
MAILING ADDRESS:
CITY & STATE & ZIP:
BIDDER’S AUTHORIZED SIGNATURE:	DATE:

&A &P of &N

File details come from the government source that posted it. Updated May 26, 2026.