Post DAS Cost Sheet_Revised 100726.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 for the Nebraska Medicaid Enrollment Broker, RFP #125920 O3, used to capture bidder pricing for both operations and implementation phases of the contract. The solicitation requests pricing for enrollment broker services supporting a planned member volume of 350,000 members. Bidders must complete all yellow-highlighted fields on the form, with pricing submitted on a per-member-per-month basis across five contract years plus five option years. The cost sheet requires detailed expense build-up documentation including direct labor (salaries and benefits), consultants, subcontractors, hardware, software licenses, telecommunications, facility costs, equipment, office supplies, and administrative expenses.

Pricing must be submitted as net pricing with all transportation and delivery charges fully prepaid and F.O.B. destination, with no additional charges permitted for packing or partial deliveries. The cost sheet specifies that all quoted prices must include all applicable fees necessary to perform project requirements and deliverables as outlined in the RFP's section (S) and related attachments. Mathematical errors in price extensions will be corrected using the unit price as the governing figure. The form includes separate pricing tables for the base contract period and option years, with an expense build-up template allowing bidders to expand line items as needed while maintaining formula consistency.

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Other files

File Type Posted
Addendum One Q&A.docx DOCX document
Addendum Six SOE.docx DOCX document
Attachment 3 - Technical Requirements.pdf PDF
Addendum Four SOE.docx DOCX document
Attachment 5 - CMS Certification Outcomes.pdf PDF
Attachment 3 - Technical Requirements.docx DOCX document
Addendum One Q&A.pdf PDF
Attachment 2 - Reporting Requirements.pdf PDF
RFP Update 10.22.26.docx DOCX document
Attachment 5 - CMS Certification Outcomes.docx DOCX document
Addendum Two Schedule of Events.docx DOCX document
Addendum Three Q&A.docx DOCX document
Attachment 1 - Performance Measures.docx DOCX document
Attachment 2 - Reporting Requirements.docx DOCX document
Attachment 4 - Deliverables for Due Dates.pdf PDF
Addendum Six SOE.pdf PDF
RFP Update 10.22.26.pdf PDF
Addendum Two Schedule of Events.pdf PDF
Attachment 4 - Deliverables for Due Dates.docx DOCX document
Attachment 6.docx DOCX document
Addendum Five Q&A.pdf PDF
Attachment 6.pdf PDF
EB Historical Data.pdf PDF
SolicitationEvaluationCriteria.docx DOCX document
Addendum Five Q&A.docx DOCX document
Addendum Four SOE.pdf PDF
Attachment 1 - Performance Measures.pdf PDF
SolicitationEvaluationCriteria.pdf PDF
Addendum Three Q&A.pdf PDF
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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 Volume350,000Year OneYear TwoYear ThreeYear FourYear FiveTotal Base Contract Price
Expense TypeMember Volume Up ToPrice Per Member Per MonthPrice Per Member Per MonthPrice Per Member Per MonthPrice Per Member Per MonthPrice Per Member Per Month
Base Price1
Additional Price Per Member Per Month350,000

Total Planned Member Volume $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Planned Member Volume350,000Option Year OneOption Year TwoOption Year ThreeOption Year FourOption Year FiveTotal Price All Option Years
Expense TypeMember Volume Up ToPrice Per Member Per MonthPrice Per Member Per MonthPrice Per Member Per MonthPrice Per Member Per MonthPrice Per Member Per Month
Base Price1
Additional Price Per Member Per Month350,000

Total Planned Member Volume $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Expense Build-Up - Base Price
Expense TypeDescriptionMonthly 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 TypeDescriptionPrice
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.

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