Post DAS Cost Sheet_Revised 092526.xlsx
XLSX spreadsheet 31 KB Posted
- Attached to
- Nebraska Medicaid Enrollment Broker
- Solicitation number
- 125920 O3
- Issued by
- Nebraska
About this file
This is a cost sheet template for the Nebraska Medicaid Enrollment Broker service contract (RFP #125920 O3) issued by the State of Nebraska Department of Health and Human Services. The solicitation seeks a qualified vendor to provide comprehensive enrollment broker services for Nebraska's Medicaid Managed Care Program, including choice counseling, member enrollment processing, managed care organization auto-assignment and disenrollment, provider directory maintenance, call center operations, member and provider education, data reporting, and program integrity functions. The planned member volume is 350,000, and the initial contract term spans five years commencing October 1, 2027, with an option to renew for one additional three-year period. Proposals were due September 30, 2026, at 2:00 PM Central Time, with a mandatory solicitation conference held on September 22, 2026, at 2:00 PM Central Time via Cisco Webex. The Intent to Award is scheduled for October 20, 2026, with contract award on November 13, 2026.
The cost sheet requires bidders to submit per-member-per-month pricing for each contract year and optional renewal years across specified member volume tiers. Pricing must be net and include all applicable fees, transportation, delivery charges, and all expenses necessary to perform project requirements, with no additional charges permitted for packing or partial deliveries. The cost sheet template includes sections for base and additional pricing per member per month across five years, plus option years, and detailed expense build-up categories such as direct labor, benefits, consultants, subcontractors, hardware, software licensing, telecommunications, facility costs, and administrative fees. Bidders must complete all yellow-highlighted fields and maintain the existing format; in cases of mathematical errors, unit price shall govern. Cost represents 20 points of the evaluation scoring, calculated using a comparative formula whereby the lowest realistic cost receives maximum points. A $500,000 performance bond is required.
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Text version
Operations Vendor's Company Name: ERROR:#REF!
| Nebraska Medicaid Enrollment Broker |
| Cost Sheet |
| of RFP # 125920 O3 |
Bidder Name:_________________________________________________ Important Instructions: Bidders must complete all fields highlighted in yellow. Do not alter the existing format or content within this Cost Sheet. Prices quoted shall be net, including transportation and delivery charges fully prepaid by the bidder, F.O.B. destination named in the Solicitation. No additional charges will be allowed for packing, packages, or partial delivery costs. Important: In case of a mathematical error in extension of price, unit price shall govern.
The prices indicated in Part I and II below shall reflect all applicable fees necessary to perform the project requirements and deliverables as outlined in section (S) of the Request for Proposal (RFP) document and any related attachments and/or documents.
Instructions For Bidders:
| Planned Member Volume | 350,000 | Year One | Year Two | Year Three | Year Four | Year Five | Total Base Contract Price |
| Expense Type | Member Volume Up To | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | |
| Base Price | 1 | $0.00 | |||||
| Additional Price Per Member Per Month | 350,000 | $0.00 |
| Total Planned Member Volume | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! |
| Total 350,000 Member Volume | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! |
| Planned Member Volume | 350,000 | Option Year One | Option Year Two | Option Year Three | Option Year Four | Option Year Five | Total Price All Option Years |
| Expense Type | Member Volume Up To | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | |
| Base Price | 1 | ||||||
| Additional Price Per Member Per Month | 350,000 |
| Total Planned Member Volume | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! |
| Total 350,000 Member Volume | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | ERROR:#REF! | $0.00 |
| Expense Build-Up - Base Price | ||
| Expense Type | Description | Monthly Expense Total |
| Direct Labor | ||
| Salaries | ||
| Benefits | ||
| Additional Expenses Types Not Related to Direct Labor | ||
| Consultants | ||
| Subcontractors | ||
| Hardware | ||
| Network support | ||
| Software (including license fees) | ||
| Telecommunications lines | ||
| Facility | ||
| Equipment | ||
| Office supplies | ||
| Postage/deliveries | ||
| Printing | ||
| Administrative support |
| Indirect rate cost | |
| Administrative fee | |
| Total of All Expenses | $ - 0 |
| Expand Schedule as Needed (keep formulas consistent) | |
| Pricing is based on the Total Price, which sums the total price for the price of self-selection and auto-assignment per member. | |
| Expense Build-Up is to provide the detail used by the bidder to achieve its price. The expense types shown are examples only. If more expense types are needed, add rows and link formulas if necessary. Total of All Expenses should equal the sum of all rows. |
Implementation Vendor's Company Name: ERROR:#REF!
| Nebraska Medicaid Enrollment Broker |
| Cost Sheet |
| of RFP # |
Enrollment Broker Implementation
| Expense Type | Description | Price |
| Direct Labor | ||
| Salaries | ||
| Benefits | ||
| Additional Expense Types Not Related to Direct Labor | ||
| Consultants | ||
| Subcontractors | ||
| Hardware | ||
| Network support | ||
| Software (including license fees) | ||
| Telecommunications lines | ||
| Facility | ||
| Equipment | ||
| Office supplies | ||
| Postage/deliveries | ||
| Printing | ||
| Administrative support |
| Indirect rate cost | |
| Administrative fee | |
| Total of All Expenses | $ - 0 |
| Expand Schedule as Needed (keep formulas consistent) | |
| The expense types shown are only examples. If more expense types are needed, add rows and link formulas if necessary. Total of All Expenses should equal the sum of all rows. |
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