MHCC 27-003 Attachment B Financial Proposal Form.xlsx

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Attached to
MHCC 27-003 MHCC 27-003 Actuarial Consultant - Prior Authorization and Step Therapy Coverage of Nonopioid Drugs
Solicitation number
BPM058086
Issued by
Maryland

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Written by GovTribe AI ·

This is a Financial Proposal Form for MHCC 27-003, an actuarial consulting contract with the Maryland Health Care Commission. The contract requires deliverables including a Work Plan, Framework and Rationale Outline, Framework and Rationale Report, and Commission Meeting Presentation related to actuarial consulting on the impact of limiting prior authorization and step therapy for nonopioid drugs. The form is designed to capture labor costs and pricing for the identified key deliverables across three staffing categories: Principal Actuary, and two Actuarial Consultant positions.

The Financial Proposal Form requests offerors to provide pricing using an hours and rate format for each deliverable, with columns for hours, hourly rates, and total costs for each staff category, culminating in a Total Fixed Price and Total Contract Price. The form requires signature and authorization from an authorized representative of the offeror, along with company address and contact information. All pricing fields on the submitted form are currently blank, indicating this is a template for prospective contractors to complete with their proposed costs.

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MHCC 27-003 Actuarial Consultant - Prior Authorization and Step Therapy Coverage of Nonopioid Drugs.pdf PDF

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Sheet1 MHCC 27-003 Financial Proposal Form

Key DeliverablePrincipal ActuaryActuarial ConsultantActuarial Consultant
HoursRate$Total$HoursRate$Total$HoursRate$Total$Total Fixed Price
3.2.B. Work Plan$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
3.2.C.1. Framework and Rational Outline$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
3.2.C.2. Framework and Rationale Report$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
3.2.D Commission Meeting Presentation$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Contract Price$ - 0
Submitted by:
Offeror:
Offeror Name (please print or type)
By:
Signature of Authorized Representative
Printed Name:
Printed Name
Title:
Title
Date:
Date:
Address:
Company Address

File details come from the government source that posted it. Updated .