MPAPA_Exhibit_E-1.xlsx

XLSX spreadsheet 54 KB Posted Aug 7, 2013

Attached to: Medicare Part A Provider Cost Report Appeals (MPAPA)
Solicitation number: HHSM-500-2013-RFP-0030
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

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Exhibit E-1

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Other files

File	Type	Posted
Amendment_6-SECTION_L.pdf	PDF	Nov 1, 2013
Amendment_5-SECTION_L.pdf	PDF	Sep 11, 2013
Question.pdf	PDF	Aug 29, 2013
Cover_Page.docx	DOCX document	Aug 28, 2013
HHSM-500-2013-RFP-00301_8-28-2013_Amend_000003.pdf	PDF	Aug 28, 2013
Attachment_J.1-SOW_REVISED_082813_(2).pdf	PDF	Aug 28, 2013
Attachment_J.1-SOW_REVISED_082713.pdf	PDF	Aug 27, 2013
HHSM-500-2013-RFP-00301_8-27-2013 _Amend_000001.pdf	PDF	Aug 27, 2013
Questions_and_Answers_MPAPA-Amendment_000001.pdf	PDF	Aug 27, 2013
Attachment_J.8-_Past_Performance_Questionnaire.docx	DOCX document	Aug 22, 2013
RFP-Solicitation.pdf	PDF	Aug 8, 2013
Attachment_J.7_Compliance_Program_Attestation.pdf	PDF	Aug 7, 2013
MPAPA_Exhibit_E-3.xlsx	XLSX spreadsheet	Aug 7, 2013
Attachment_J.12_dcaap7641.90.pdf	PDF	Aug 7, 2013
Attachment_J.5_Non-Disclosure_Statement.pdf	PDF	Aug 7, 2013
Attachment_J.11_CMS_730A.pdf	PDF	Aug 7, 2013
Attachment_J.6_Intent_to_Submit_A_Proposal.pdf	PDF	Aug 7, 2013
Attachment_J.10__CMS_Incident_Reporting_Process.pdf	PDF	Aug 7, 2013
Attachment_J.8-_Past_Performance_Questionnaire.pdf	PDF	Aug 7, 2013
Attachment_J.1_SOW.pdf	PDF	Aug 7, 2013
Attachment_J.2_Contractors_Organizational_Conflict_of_Interest_Certif.pdf	PDF	Aug 7, 2013
Attachment_J.9_Consent_to_Subcontract_Check_List.pdf	PDF	Aug 7, 2013
MPAPA_Exhibit_E-2.xlsx	XLSX spreadsheet	Aug 7, 2013

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Summary

CLIN	DESCRIPTION	COST	FIXED FEE	TOTAL	PERIOD OF PERFORMANCE
0001	Base Year (Year 1 Costs)
0002	Option Year 1 (Year 2 Costs)
0003	Option Year 2 (Year 3 Costs)
0004	Option Year 3 (Year 4 Costs)
0005	Option Year 4 (Year 5 Costs)
TOTAL		$0.00	$0.00	$0.00	60 months
	Instructions:	Instructions will not print.
	1. All labor categories, subcontractors names, additional rows, and descriptive information and percentages required most be linked. (i.e. Summary to Recap to appropriate year)

2. Task columns (hours, rate & total) shall be the corresponding tasks of the SOW.

3. Contractors and subcontractors shall use indirect rates IAW their accounting practises.

4. When there are sub CLIN spreadsheets for any period, place them to the left of the combined period CLIN (e.g., CLIN 0001AA and CLIN 0001AB are sub CLINs of CLIN 0001).

5. Bujsiness proposal provide escalation rates used and their rationaleas a separate paragraph. The same procedure will be followed by subcontractors. Subcontractors who submitted sealed proposals shall also identify the escalation rates and rationale in their sealed proposals. Follow this same procedures for travel.

6. Travel, subcontractor, and other direct costs must be linked from their respective worksheets in to the spreadsheets of each year except when there are sub CLINs. If there are sub CLINs, then the links are into the respective fields of the sub CLINs.

7. All tab names must carry the specific title used in the solicitation/RFP including the appropriate CLIN number. If the government provides different labels in the draft spreadsheets than the labels used in Section B of the solicitation, use the titles in section B.

Edward M. Rutherford: Edward M. Rutherford:

8. No data are to be entered into the Summary and Summary Roll-up by CLIN tabs -- they should populate automatically from subordinate spreadsheets (combined CLIN and primary CLIN spreadsheets as opposed to sub CLIN spreadsheets).

9. Follow the format in headers and footers.

10. The date required in the footer is the date submitted, not the date the spreadsheet is opened or printed.

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

RFP HHSM-500-2013-RFP-0030

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

Confidential Procurement Sensitive &"Arial,Bold Italic"&A

Summary Roll Up by CLIN

HHSM-500-2013-RFP-0030	CLIN 0001, Base Year				CLIN 0002, Year 2, Option Year 1				CLIN 0003, Year 3, Option Year 2				CLIN 0004, Year 4, Option Year 3				CLIN 0005, Year 5, Option Year 4				Total All Years
MPAPA
Tasks
	Total FTEs	Hours	Rates	Total	Total FTEs	Hours	Rates	Total	Total FTEs	Hours	Rates	Total	Total FTEs	Hours	Rates	Total	Total FTEs	Hours	Rates	Total	Total FTEs	Hours	Rates	Total
COST ELEMENTS
Direct Labor (Add appropriate categories)
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00	$0.00	$0	0.00	0.00		$0
SUBTOTAL DIRECT LABOR	0.00	0.00		$0	0.00	0.00		$0	0.00	0.00		$0	0.00	0.00		$0	0.00	0.00		$0	0.00	0.00		$0

Fringe Benefits (at ____%) (Indirect rates should be IAW KTR's standard practise) 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL DIRECT LABOR $0 $0 $0 $0 $0 $0

Travel (See separate schedule E-2)	$0	$0	$0	$0	$0	$0
Subcontractors (list all subcontractors)

Subcontractor Name
Total Subcontractor	0.00	0.00	$0.00	0.00	0.00	$0.00	0.00	0.00	$0.00	0.00	0.00	$0.00	0.00	0.00	$0.00	0.00	0.00	$0

Other Direct Costs (See separate schedule E-3) $0 $0 $0 $0 $0 $0

SUBTOTAL ALL DIRECT COSTS $0 $0 $0 $0 $0 $0

Indirect Costs (at ______ %) (Indirect rates should be IAW KTR's standard practise) 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0

SUBTOTAL COSTS BEFORE FEE $0 $0 $0 $0 $0 $0

G&A @ 0.00% (Indirect rates should be IAW KTR's standard practise) 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0

Fixed Fee (at ______%) 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL COSTS 0.00 0.00 $0 0.00 0.00 $0 0.00 0.00 $0 0.00 0.00 $0 0.00 0.00 $0 0.00 0.00 $0

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

&"Arial,Bold Italic"&A

CLIN 01 Base Year

HHSM-500-2013-RFP-0030
MPAPA		SOW Sections
	Total FTEs	Task 1			Task 2			Task 3			GRAND TOTAL
		Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total
COST ELEMENTS
Direct Labor (Add appropriate categories)
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
SUBTOTAL DIRECT LABOR	0.00	0.00		$0	0.00		$0	0.00		$0	0.00		$0

Fringe Benefits (at ____%) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL DIRECT LABOR $0 $0 $0 $0

Travel (See separate schedule E-2)	$0	$0	$0	$0
Subcontractors (list all subcontractors)

Subcontractor Name
Total Subcontractor	0.00	0.00	$0.00	0.00	0.00	0.00	0.00	$0.00	0.00	0.00

Other Direct Costs (See separate schedule E-3) $0 $0 $0 $0

SUBTOTAL ALL DIRECT COSTS 0.00 0.00 $0 $0 $0 $0

Indirect Costs (at ______ %) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

SUBTOTAL COSTS BEFORE FEE $0 $0 $0 $0

G&A @ 0.00% (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

Fixed Fee (at ______%) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL COSTS 0.00 $0 $0 $0 $0

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

&"Arial,Bold Italic"&A

CLIN 02 Yr 2 Opt Yr 1

HHSM-500-2013-RFP-0030
MPAPA		SOW Sections
	Total FTEs	Task 1			Task 2			Task3			GRAND TOTAL
		Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total
COST ELEMENTS
Direct Labor (Add appropriate categories)
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
SUBTOTAL DIRECT LABOR	0.00	0.00		$0	0.00		$0	0.00		$0	0.00		$0

Fringe Benefits (at ____%) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL DIRECT LABOR $0 $0 $0 $0

Travel (See separate schedule E-2)	$0	$0	$0	$0
Subcontractors (list all subcontractors)

Subcontractor Name
Total Subcontractor	0.00	0.00	$0.00	0.00	0.00	0.00	0.00	$0.00	0.00	0.00

Other Direct Costs (See separate schedule E-3) $0 $0 $0 $0

SUBTOTAL ALL DIRECT COSTS 0.00 0.00 $0 $0 $0 $0

Indirect Costs (at ______ %) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

SUBTOTAL COSTS BEFORE FEE $0 $0 $0 $0

G&A @ 0.00% (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

Fixed Fee (at ______%) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL COSTS 0.00 $0 $0 $0 $0

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

&"Arial,Bold Italic"&A

CLIN 03 Yr 3 Opt Yr 2

HHSM-500-2013-RFP-0030
MPAPA		SOW Sections
	Total FTEs	Task 1			Task 2			Task 3			GRAND TOTAL
		Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total
COST ELEMENTS
Direct Labor (Add appropriate categories)
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
SUBTOTAL DIRECT LABOR	0.00	0.00		$0	0.00		$0	0.00		$0	0.00		$0

Fringe Benefits (at ____%) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL DIRECT LABOR $0 $0 $0 $0

Travel (See separate schedule E-2)	$0	$0	$0	$0
Subcontractors (list all subcontractors)

Subcontractor Name
Total Subcontractor	0.00	0.00	$0.00	0.00	0.00	0.00	0.00	$0.00	0.00	0.00

Other Direct Costs (See separate schedule E-3) $0 $0 $0 $0

SUBTOTAL ALL DIRECT COSTS 0.00 0.00 $0 $0 $0 $0

Indirect Costs (at ______ %) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

SUBTOTAL COSTS BEFORE FEE $0 $0 $0 $0

G&A @ 0.00% (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

Fixed Fee (at ______%) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL COSTS 0.00 $0 $0 $0 $0

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

&"Arial,Bold Italic"&A

CLIN 04 Yr 4 Opt Yr 3

HHSM-500-2013-RFP-0030
MPAPA		SOW Sections
	Total FTEs	Task 1			Task 2			Task 3			GRAND TOTAL
		Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total
COST ELEMENTS
Direct Labor (Add appropriate categories)
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
SUBTOTAL DIRECT LABOR	0.00	0.00		$0	0.00		$0	0.00		$0	0.00		$0

Fringe Benefits (at ____%) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL DIRECT LABOR $0 $0 $0 $0

Travel (See separate schedule E-2)	$0	$0	$0	$0
Subcontractors (list all subcontractors)

Subcontractor Name
Total Subcontractor	0.00	0.00	$0.00	0.00	0.00	0.00	0.00	$0.00	0.00	0.00

Other Direct Costs (See separate schedule E-3) $0 $0 $0 $0

SUBTOTAL ALL DIRECT COSTS 0.00 0.00 $0 $0 $0 $0

Indirect Costs (at ______ %) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

SUBTOTAL COSTS BEFORE FEE $0 $0 $0 $0

G&A @ 0.00% (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

Fixed Fee (at ______%) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL COSTS 0.00 $0 $0 $0 $0

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

&"Arial,Bold Italic"&A

CLIN 05 Yr 5 Opt Yr 4

HHSM-500-2013-RFP-0030
MPAPA		SOW Sections
	Total FTEs	Task 1			Task 2			Task 3			GRAND TOTAL
		Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total	Hours	Rates	Total
COST ELEMENTS
Direct Labor (Add appropriate categories)
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
	0.00	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0	0.00	$0.00	$0
SUBTOTAL DIRECT LABOR	0.00	0.00		$0	0.00		$0	0.00		$0	0.00		$0

Fringe Benefits (at ____%) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL DIRECT LABOR $0 $0 $0 $0

Travel (See separate schedule E-2)	$0	$0	$0	$0
Subcontractors (list all subcontractors)

Subcontractor Name
Total Subcontractor	0.00	0.00	$0.00	0.00	0.00	0.00	0.00	$0.00	0.00	0.00

Other Direct Costs (See separate schedule E-3) $0 $0 $0 $0

SUBTOTAL ALL DIRECT COSTS 0.00 0.00 $0 $0 $0 $0

Indirect Costs (at ______ %) (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

SUBTOTAL COSTS BEFORE FEE $0 $0 $0 $0

G&A @ 0.00% (Indirect rates should be IAW KTR's standard practice) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

Fixed Fee (at ______%) 0.00% $0 0.00% $0 0.00% $0 0.00% $0

TOTAL COSTS 0.00 ERROR:#REF! ERROR:#REF! ERROR:#REF! ERROR:#REF!

Exhibit E.1 &"Arial,Italic"(Company Name)&"Arial,Regular"

MPAPA &P of &N

&"Arial,Bold Italic"Date used is the date sent to OAGM, not the date button from above.&"Arial,Regular"

&"Arial,Bold Italic"&A

File details come from the government source that posted it. Updated Nov 14, 2017.