Cost Sheet.pdf
PDF 449 KB Posted
- Attached to
- Medicaid Drug Rebate System (MDR)
- Solicitation number
- 124528 ON
- Issued by
- Lancaster County, Nebraska
About this file
This is a Cost Sheet form for RFP #124528 issued by the State of Nebraska Department of Health and Human Services for the procurement of a new Medicaid Drug Rebate System. The solicitation seeks qualified bidders to design, develop, test, and implement a comprehensive system to manage Medicaid drug rebates. The project is structured in two primary cost components: Part I covers project requirements and milestones across five defined phases (Requirements and Design, Development and Testing, Data/File Conversion and Migration, Operational Readiness, and Certification), each allocated at 20% of implementation fees; Part II addresses operational and customer support requirements during an initial five-year term followed by a three-year renewal period, with costs calculated on a monthly basis and converted to annual figures. The contract pricing submitted by bidders will remain fixed for the first five years following acceptance.
Bidders must complete all highlighted fields on the cost sheet without altering existing format and structure, though additional line items may be inserted if identified as essential to meet RFP requirements, provided they remain within the stated percentage allocations and follow the prescribed format. Part III addresses optional services including system enhancements and change orders, which are excluded from the Grand Total cost evaluation. Labor costs for miscellaneous support beyond contract requirements must be itemized by title or role with corresponding hourly rates, and material costs, equipment costs, and administrative overhead markups (not to exceed 10%) may be specified. The cost sheet explicitly prohibits the inclusion of additional fees not reflected in the pricing tables, ensuring transparency and comprehensive cost accounting throughout the contract term and any renewal periods.
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Cost Sheet
RFP#124528 ON
Medicaid Drug Rebate System State of Nebraska, Department of Health and Human Services
Bidder Name: ________________________________
Important Instructions: Bidders are to complete all fields highlighted in yellow.
Do not alter existing format or content within the Cost Sheet. However, if Bidder identifies that other items are essential in Part I and/or Part II to create full functionality, and meet the requirements as outlined in the RFP document and any related attachments, then additional lines may be inserted as needed. Such additional lines must be included in Part I and Part II pricing and be reflected in the Total Overall Cost.
Any inclusion of additional lines must still conform within the stated percentages as outlined in Part I and follow the prescribed format as provided. Important: In case of a mathematical error in extension of price, unit price shall govern.
Prices submitted on the cost sheet once accepted by the DHHS shall remain fixed for the first five years of the contract.
Please indicate the “Grand Total” for the Project Requirements / Milestones and Operation Requirements (Initial and Renewals), this amount shall equal the sum of the Total for both Part I and Part II. “Grand Total” $ _______________. Do not include any costs for Part III in the “Grand Total”, as these sections are not included in the cost evaluation.
Part I: PROJECT REQUIREMENTS / MILESTONES
Project section requirements as outlined in Section (V) of the Request for Proposal (RFP) document and any related attachments. Bidder to provide pricing for each of the project requirements/milestones categories listed. The sum of all project requirement categories listed directly below constitutes the Part I – Total. Important: Bidders are to ensure that allocation of their percentages is based on the % provided for each category and that the total of all categories within Part I does not exceed 100%.
Project Requirements / Milestones % Breakdown by Milestone Number of Units
Unit of Measure
(UOM)
Cost (Unit Price)
Requirements and Design Milestone (Section V.(I)(1)(a))
20% of Implementation fees 1 Each $ Development and Testing Milestone (Section V.(I)(1)(b))
20% of Implementation fees 1 Each $
Data/File Conversion and Migration Milestone (Section V.(I)(1)(c))
20% of Implementation fees 1 Each $
Operational Readiness Milestone (Section V.(I)(1)(d))
20% of Implementation fees 1 Each $
Certification Milestone (Section V.(I)(1)(e)
20% of Implementation fees 1 Each $
Project Requirements / Milestones – Total (Part I) $
(Remainder of this page intentionally left blank)
Medicaid Drug Rebate System State of Nebraska, Department of Health and Human Services
Part II: OPERATION REQUIREMENTS AND RENEWALS
Bidder’s price for annual operations shall include all associated costs or fees (including but not limited to subscriptions costs).
Important: Do not include statements in the RFP proposal submittals, attachments, etc. indicating that there will be additional fees which are not included in the table below. The sum of the extended cost (Unit of Measure x Monthly Price) constitutes the extended Annual Cost. Both the Initial Term and Renewal Totals will be evaluated for points associated with Cost.
A. OPERATION REQUIREMENTS (INITIAL TERM OF FIVE YEARS)
(Note: These items would be paid for on a monthly basis).
Part II Operations and Customer Support costs will begin in the first month following completion of Part I and remain fixed for the duration of the initial term of five years.
Operations Requirements Estimated Contract Term
Unit of Measure
(UOM)
Cost (Monthly Price)
Extended Annual Cost
Operation Requirements (Section V.(I)(2)) 48 months Monthly $ $
Customer Support Requirements (Section V.(I)(2))
48 months Monthly $ $
Operations Requirements – (Initial Term) $
B. OPERATION REQUIREMENTS (RENEWAL PERIOD OF THREE YEARS)
(Note: These items would be paid for on a monthly basis).
Operations Requirements Contract Term Unit of Measure
(UOM)
Cost (Monthly Price)
Extended Annual Cost
Operation Requirements (Section V.(I)(2)) 36 months Monthly $ $
Customer Support Requirements (Section V.(I)(2))
36 months Monthly $ $
Operations Requirements – (Renewals) $ Operations Requirements – TOTAL (Initial + Renewals) (Part II) $
Part III: Optional Services Miscellaneous Support and Enhancements (Do not include these amounts in the “Grand Total” associated with Part I and Part II)
DHHS acknowledges that during the duration of the contract there may be state directed System Enhancements-Change orders necessary to comply with evolving federal or state regulations, as well as business needs. DHHS will provide a written request for any system changes.
The vendor must provide a written scope of work which includes the technical and/or business requirement changes, inclusive of the schedule and costs associated with the system enhancement requested by the state, for the state’s consideration of approval. Once approved and after the system enhancement has been delivered, the vendor must submit a written request for deliverable acceptance of the system enhancement and obtain state approval prior to billing the system enhancement.
Optional Services Contract Term Unit of Measure
(UOM)
Cost (Unit Price)
Extended Cost
System Enhancements-Change order pool Base $ $
System Enhancements-Change order pool Optional renewals
Labor Costs (Utilizing the Hourly Rates table below)
Breakdown from table below
Material Costs (markup from retail/wholesale) _____% Equipment Costs _____% (can insert limits on this percentage) Administrative/Overhead Costs _____% (Markup cannot exceed 10%)
Optional Services – Grand Total
Medicaid Drug Rebate System State of Nebraska, Department of Health and Human Services
Hourly Rates for Miscellaneous Support and Enhancements (beyond RFP/Contract requirements) *The Bidder should provide the Title/Role with each respective hourly rate to perform additional services as requested and approved by DHHS during the duration of the contract term and any applicable renewals.
*Bidder may add additional lines as needed.
Title / Role such as, but not limited to: Hourly Rate (Example) Project Manager $
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