J.2 - CFM Report.xlsx
XLSX spreadsheet 38 KB Posted
- Attached to
- State Medicaid Program Integrity Audits Federal contract opportunity
- Solicitation number
- 75FCMC24RJ002
About this file
This document is an Estimate at Completion (EAC) Report for a federal contract opportunity, specifically Contract Number 75FCMC19C0018 under Solicitation Number 75FCMC24RJ002 for State Medicaid Program Integrity Audits (SMPIA).
The EAC Report provides details on the cost elements, cumulative incurred costs, estimated additional costs to complete the work, and estimated total cost at completion for Contract Line Item Numbers (CLINs) 0034 QIC Demo and 0044 COVID Letter. The report includes information on the period of performance, contract value, amount funded, and cost variance explanations. Overall, the EAC report indicates that the costs are tracking within the contract value and funded amount for both CLINs.
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Instructions
| INSTRUCTIONS FOR COST REIMBURSEMENT CLIN/SLIN | |
| 1 | Adjust Cost Category (Column A) to align with your company's specific cost accounting structure. |
| 2 | If Column A was changed, adjust formulas accordingly. Make sure to edit/insert formulas and that all formulas are fully functioning when submitted. CMS should be able to view the formula to determine how the fields were calculated. |
| 3 | Enter period of performance for CLIN/SLIN in Column G, row 1. |
| 4 | Enter period of performance covered as indicated in red in Columns B, C and D, row 3. |
| 5 | Columns A, B, C and D are to be completed by Contractor. Column E has formulas to calculate totals from other columns. |
| 6 | Enter actual incurred cost to date in Column B for the period of performance of the specific CLIN. If that covers more than one Contractor accounting/fiscal year, separate the costs in to 2 periods (to align with fiscal year) and use both Column B and C. |
| 7 | Enter the estimate to complete the remaining work for that CLIN/SLIN in Column C. |
| 8 | Provide all indirect rates used per column in the designated space, rows 31-37 as applicable. |
| 9 | Enter contractor's accounting/fiscal year in the designated space in Column B, row 39. |
| 10 | Indicate Contractor's Fiscal Year period as indicated in red in Columns B, C and D, row 30. |
| 11 | If reporting on more than one CLIN or SLIN, make a copy of the CLIN 0001 template worksheet/tab for each and keep them all in this one workbook/spreadsheet. Rename the worksheet/tab appropriately as well as Cells A1 and B1. |
| Columns F and G are for CMS use. |
| Do not lock or password protect spreadsheet. |
CLIN 0001
CLIN 0001 Period of Performance: [Dates]
Cost Category Cumulative Incurred Cost to Date*
[enter applicable dates for period of performance covered for these costs] Cumulative Incurred Cost to Date*
[enter applicable dates for period of performance covered for these costs] Anticipated Estimate to Complete Work Through End of Period of Performance
[enter applicable dates for period of performance covered for these costs] Total Estimate at Completion (EAC) of Period of Performance Total Value per CLIN** Difference Between EAC and CLIN Value**
(positive is underrun, negative is overrun) Col. B+C+D Col. F-E
| Direct Labor | 15,000.00 | 2,000.00 | 50,000.00 | 67,000.00 |
| Fringe (rate identified below) | 3,000.00 | 420.00 | 9,500.00 | 12,920.00 |
| Subottal Labor with Fringe | 18,000.00 | 2,420.00 | 59,500.00 | 79,920.00 |
| Overhead (rate identified below) | 3,960.00 | 556.60 | 12,495.00 | 17,011.60 |
| Subtotal Labor/Fringe/OH | 21,960.00 | 2,976.60 | 71,995.00 | 96,931.60 |
| ODCs | ||||
| Subcontractor | 1,000.00 | 500.00 | 3,000.00 | 4,500.00 |
| Travel | 500.00 | 100.00 | 2,000.00 | 2,600.00 |
| Subtotal ODCs | 1,500.00 | 600.00 | 5,000.00 | 7,100.00 |
Subtotal Direct Costs 23,460.00 3,576.60 76,995.00 104,031.60
G&A (rate identified below) 3,519.00 500.72 12,319.20 16,338.92
Total Costs: 26,979.00 4,077.32 89,314.20 120,370.52 125,000.00 4,629.48
| Award Fee | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
| Base Fee | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
| Fixed Fee (rate identified below) | 1,348.95 | 203.87 | 4,465.71 | 6,018.53 | 6,250.00 | 231.47 |
TOTAL 28,327.95 4,281.19 93,779.91 126,389.05 131,250.00 4,860.95
RATES: Actual End of Year Rate Used for Column Above
[enter applicable Fiscal Year date] Actual End of Year Rate Used for Column Above
[enter applicable Fiscal Year date] Anticipated End of Year Rate Used for Column Above
[enter applicable Fiscal Year date]
| Fringe | 20% | 21% | 19% |
| Overhead | 22% | 23% | 21% |
| G&A | 15% | 14% | 16% |
| Award Fee | |||
| Base Fee | |||
| Fixed Fee | 5% | 5% | 5% |
| Contractor's Accounting/Fiscal Year: | [enter dates] |
| *Period of Performance may cover more than one Contractor Accounting/Fiscal Year. Separate Column B and C to clearly indicate costs per Fiscal Year. It is understood that different rates may apply. | |
| **Columns F and G are for CMS use. |
&"Times New Roman,Regular"&8EAC Report ver.3
JH 0034 QIC
| Monthly Reporting Period: | May 2022 | MAC Jurisdiction: | Jurisdiction H | Date of Report: | 6/23/22 | ||||||
| MAC ESTIMATE AT COMPLETION (EAC) REPORT | Period of Performance (contract dates) | 6/01/2020-12/31/2021 | Contract Number: | 75FCMC19C0018 | |||||||
| SLIN: | 0034 QIC DEMO | Contractor Name: | Novitas Solutions, Inc. | ||||||||
| Approved By: | Jonathan Hogan | ||||||||||
| Expenditure Category | Cumulative Incurred Cost at End of Prior Month | Incurred Cost--Current Reporting Period | Cumulative Incurred Cost to Date | Estimated Additional Cost to Complete (ETC) at end of Period of Performance | Estimated Total Cost at Completion (EAC) of Period of Performance | Total SLIN value per Schedule B (TS/SB) as of the Date of This Report | EAC Variance (Over)* or Under TS/SB at end of Period of Performance | EAC % Variance (Over) or Under TS/SB at end of Period of Performance | Total Amount Funded at end of Period of Performance | EAC Variance Over or (Under)** Funded Amount at end of Period of Performance | EAC % Variance Over or (Under) Funded Amount at end of Period of Performance |
| Col. B+C | Col. D+E | Col. F-G | Col. H/G | Col. J-F | Col. K/J | ||||||
| A | B | C | D | E | F | G | H | I | J | K | L |
Direct Labor $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 0.0%
Fringe - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Travel - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Subcontractor Labor - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Subcontractor Direct - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Other Direct Costs - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Overhead - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
G&A - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Interorg - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Adjustment - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Total Expenditures - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0% - 0 - 0 0.0%
| Base Fee | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 0.0% | - 0 | - 0 | 0.0% |
| Fixed Fee | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 0.0% | - 0 | - 0 | 0.0% |
| Award Fee | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 0.0% | - 0 | - 0 | 0.0% |
(Less) Complimentary Credits - 0 - 0 - 0 - 0 - 0 0.0% - 0 0.0%
| TOTALS | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | 0.0% | $ - 0 | $ - 0 | 0.0% |
| ERROR:#DIV/0! | Current Cumulative Incurred Cost to Date as a Percentage of Funding To Date (Col. D / Col. J) | ||||||||||
| * (Over) in columns H & I means SLIN value needs to be increased, or the scope decreased ** (Under) in columns K & L means contractor requires incremental funding up to the SLIN value |
Cost Variance Explanations:
Direct Labor: The Estimate at Completion for labor was decreased due to lower than expected workload for QIC Demo.
Fringe: Billed fringe cost is lower due to decreased fringe on the direct labor.
Travel: The variance in this cost element is below the 10% threshold.
Subcontractor Labor: The variance in this cost element is below the 10% threshold.
Subcontractor Direct: The variance in this cost element is below the 10% threshold.
Other Direct Costs: The variance in this cost element is below the 10% threshold.
Overhead Costs: Decreased Overhead costs on the direct labor and fringe cost above.
G&A: Decreased G&A costs on the Direct Labor, Fringe, and Indirect cost above.
JH 0044 COVID LTR
| Monthly Reporting Period: | May 2022 | MAC Jurisdiction: | Jurisdiction H | Date of Report: | 6/23/22 | ||||||
| MAC ESTIMATE AT COMPLETION (EAC) REPORT | Period of Performance (contract dates) | 12/13/2021-3/31/2022 | Contract Number: | 75FCMC19C0018 | |||||||
| SLIN: | 0044 COVID Letter | Contractor Name: | Novitas Solutions, Inc. | ||||||||
| Approved By: | Jonathan Hogan | ||||||||||
| Expenditure Category | Cumulative Incurred Cost at End of Prior Month | Incurred Cost--Current Reporting Period | Cumulative Incurred Cost to Date | Estimated Additional Cost to Complete (ETC) at end of Period of Performance | Estimated Total Cost at Completion (EAC) of Period of Performance | Total SLIN value per Schedule B (TS/SB) as of the Date of This Report | EAC Variance (Over)* or Under TS/SB at end of Period of Performance | EAC % Variance (Over) or Under TS/SB at end of Period of Performance | Total Amount Funded at end of Period of Performance | EAC Variance Over or (Under)** Funded Amount at end of Period of Performance | EAC % Variance Over or (Under) Funded Amount at end of Period of Performance |
| Col. B+C | Col. D+E | Col. F-G | Col. H/G | Col. J-F | Col. K/J | ||||||
| A | B | C | D | E | F | G | H | I | J | K | L |
Direct Labor $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 0.0%
Fringe - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Travel - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Subcontractor Labor - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Subcontractor Direct - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Other Direct Costs - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Overhead - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
G&A - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Interorg - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Adjustment - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0%
Total Expenditures - 0 - 0 - 0 - 0 - 0 - 0 - 0 0.0% - 0 - 0 0.0%
| Base Fee | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 0.0% | - 0 | - 0 | 0.0% |
| Fixed Fee | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 0.0% | - 0 | - 0 | 0.0% |
| Award Fee | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | - 0 | 0.0% | - 0 | - 0 | 0.0% |
(Less) Complimentary Credits - 0 - 0 - 0 - 0 - 0 0.0% - 0 0.0%
| TOTALS | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | 0.0% | $ - 0 | $ - 0 | 0.0% |
| ERROR:#DIV/0! | Current Cumulative Incurred Cost to Date as a Percentage of Funding To Date (Col. D / Col. J) | ||||||||||
| * (Over) in columns H & I means SLIN value needs to be increased, or the scope decreased ** (Under) in columns K & L means contractor requires incremental funding up to the SLIN value |
Cost Variance Explanations:
Direct Labor: The variance in this cost element is below the 10% threshold.
Fringe: The variance in this cost element is below the 10% threshold.
Travel: The variance in this cost element is below the 10% threshold.
Subcontractor Labor: The variance in this cost element is below the 10% threshold.
Subcontractor Direct: The variance in this cost element is below the 10% threshold.
Other Direct Costs: The variance in this cost element is below the 10% threshold.
Other Direct Costs: The variance in this cost element is below the 10% threshold.
G&A: The variance in this cost element is below the 10% threshold.
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