1. Title

RFP 26-86378

State of Indiana

2. Cost Summary

INSTRUCTIONS: The following will be used to assign cost points. Other than entering the Respondent's name at the top of the page, there is no response necessary on this worksheet.

TOTAL BID AMOUNT (4 Year Base Contract Total - use this total for Attachment C) $ 996,000.00

3. Staff Rates

INSTRUCTIONS: Fill in the yellow-shaded cells with proposed staff rates for both State-defined roles (Rows 12-21) and any Respondent-proposed roles (Rows 22-62). For more information about the requirements of for State-defined Vital and Non-Vital staff positions, please see Section 6 of Attachment K. Enter each Respondent-proposed staff position as a separate line for each role included in the Respondent's staffing plan for executing all components of the RFP scope. For any Respondent-proposed staff positions, Respondents should also indicate any minimum qualifications in Column D that affect the position's hourly rate. Provide the hourly rate for each position, inclusive of administrative overhead and any anticipated travel costs, for the initial contract term in Column E. Please input a proposed rate increase percentage, if any, to apply to staff rates for optional extension years in cell F8, "Rate Increase % for Optional Extension Years." The blue cells in Column F under "Hourly Rate (Optional Extension Years)" will automatically calculate based on the proposed rate increase percentage.

Rate Increase % for Optional Extension Years

4. M&O

INSTRUCTIONS: Please fill in the yellow cells in Table 2 "M&O Staff Costs" with the estimated monthly hours per position you anticipate needing for M&O services for the entire suite of Community Supports IT Systems (See Attachment K, Section 1.3). Blue cells will populate automatically based on the estimated number of monthly hours multiplied by the hourly rates provided on "Tab 3. Staff Rates." Table 1 will automatically calculate M&O totals for each Contract Year based on information entered into Table 2.

Please note:

- The M&O fees are fixed fees for providing the services in the RFP scope and in adherence with the stated performance standards in Attachment K. They are not tied to actual staff hours worked in a given month.

- If the Contractor needs to utilize additional staff for any given month (e.g., due to temporary increase in incidents) or is able to reduce their staffing levels due to efficiencies in their processes for any given month, the Contractor shall still invoice their monthly M&O fixed fee.

- For the purposes of this cost evaluation, Year 1 M&O costs will be for 6 months, following the 6-month Transition Period. Transition M&O costs in the first 6 months of Contract Year 1 are calculated in "Tab 5. Transition."

Table 1: M&O Cost Summary

Table 2: M&O Staff Costs

Position (auto-populated from Staff Rates sheet) Monthly Hours per Position for M&O Monthly Cost - Initial Term

5. Transition

The Year 1 M&O Monthly Cost is automatically populated from "Tab 4. M&O." To complete Table 1 below, please enter the percentage of the Year 1 M&O Monthly Cost proposed to be charged for each month of the Initial Transition Period.

Please fill in only the cells shaded yellow. Blue cells will populate automatically.

Year 1 M&O Monthly Cost $ - 0

Total Initial Transition Period Cost $ - 0

6. Enhancements

INSTRUCTIONS: Respondents must indicate which staff from "Tab 3. Staff Rates" will be responsible for enhancement activities via the drop-down menu in cells C13-22 in Table 1. In Table 2 an hourly blended rate will be calculated based on the Respondent's proposed enhancement staff from Table 1. In Table 3, the blended rate will be multiplied by the State's estimated enhancement pool by year to calculate the total estimated enhancement costs per year. For the purposes of evaluation, it has been assumed that the enhancement pool per year (12 months) will be 52,200 hours (4350/month). The final size of the enhancement pool may be altered during contracting and the State reserves the right to adjust the number of Enhancement pool hours depending on need. Please note: the amount the Contractor invoices for enhancements will be based on actual hours worked by staff position for non-Fixed Fee Enhancements and by fixed fee for Fixed Fee Enhancements (see Attachment K, Section 3.1).

Table 1: Enhancement Staff

(Optional Years)

Table 2: Blended Rate Calculation (for Evaluation Purposes)

Table 3: Enhancement Costs Projection (for Evaluation Purposes)

(optional)

(Optional Years)

7. Other

INSTRUCTIONS: Table 1 below shows estimated pass-through costs for interRAI subscriptions, royalties, Collaborative Action Plans (CAPs), booklets, and manuals for both Non-Waiver and Waiver covered lives. These exact cost amounts are not guaranteed; however any adjustments will not impact the cost of services provided by the Contractor and shall be directly passed through to the State. No Respondent input is needed. These pass-through costs will be automatically added to contract year totals for Contract cost estimation purposes. Any Contractor staffing costs for maintaining and operating the interRAI system, which enables users to access interRAI assessments, must be captured in "Tab 4. M&O" as part of standard M&O costs.

In Table 2 below, please list any expected non-staffing costs that were not reflected in previous tabs (e.g. licenses, subscriptions, environments) and are not reflected in Table 1 of this tab. Please indicate whether a cost is expected to be one-time or annual. Costs that are "one-time" will not be included in future years' annual costs (Column H and I).

Table 1: interRAI Pass-Through Costs

Table 2: Other Costs

Annual Costs Rate Increase % for Optional Extension Years

8. Non-Evaluative M&O Scenarios

INSTRUCTIONS: In Table 1 below, please provide the estimated reduction in monthly cost for each potential consolidation scenario, as described in Attachment K - Section 2.7. Respondents must indicate cost savings as a percentage impact that they anticipate each scenario would independently have on the overall monthly M&O fees. Cost saving percentages should be reflective of overall changes that a consolidation scenario has on M&O activities, including both the sunset of legacy system(s) (e.g., reduction in effort) and any expansion of functionality to the integrated system (e.g., increase in effort). In Attachment F - Technical Proposal, Respondents should clearly describe any efficiencies that drive potential cost savings for these scenarios in response to item 9 under 2.0 Maintenance and Operations (M&O). Please note: responses to these tables are considered estimated and will not be used for evaluation purposes, but rather to provide the State with a sense of the estimated workload under each system. Blue cells will populate automatically.

Table 1: M&O Staff Costs by Scenario

Monthly M&O Cost (Base Contract) $ - 0

System Title Proposed Monthly Cost Reduction (%) if System were Sunset/Integrated New Proposed Monthly Cost if System were Sunset