Attachment_J.2_-_WCRC_CLIN_Cost_Template_Amendment_2.xlsx

XLSX spreadsheet 14 KB Posted

Attached to
Workers Compensation Review Contractor Federal contract opportunity
Solicitation number
RFP-CMS-2016-8A-0008
Issued by
Department of Health and Human Services Centers for Medicare and Medicaid Services

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Amendment to Attachment J.1.2

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File Type Posted
RFP-CMS-2016-8A-0008_Amendment_000005.pdf PDF
Attachment_J.6_-_Ammendment_5_RFP_Questions_2.13.2017.xlsx XLSX spreadsheet
Attachment_J.4_-_Contractor_Personal_Conflict_of_Interest_Financial_Disclosure_Template.docx DOCX document
Attachment_J.7_-__Appendix_C_Tech_Ch_C_508_Compliance.pdf PDF
Attachment_J.1.1_-_Appendix_A_WCCCS_User_Guide_August_2010.pdf PDF
Attachment_J.1.2__-_Appendix_B_WCRC_Deliverable_Schedule_2.2.2017_Amendment_3.pdf PDF
Attachment_J.1.4_-_Appendix_D_WCRC_Monthly_Status_Report_Template.pdf PDF
Attachment_J.3.1_-_Past_Performance_Questionnaire_Contractor_Request_Letter.docx DOCX document
Attachment_J.5_-_Contractor_Business_Ethics_COI_and_Compliance_Program_Requirements.docx DOCX document
Attachment_J.3.2_-_Past_Performance_Questionnaire_CO_Letter.pdf PDF
Attachment_J.1.3_-_Appendix_C_WCRC_Weekly_Status_Report_Template.pdf PDF
Attachment_J.3.3_-_Past_Performance_Questionnaire_Instructions_and_Response.docx DOCX document
Attachment_J.1.2__-_Appendix_B_WCRC_Deliverable_Schedule_2.2.2017_Amendment_3.pdf PDF
Attachment_J.7_-__Appendix_C_Tech_Ch_C_508_Compliance.pdf PDF
Attachment_J.2_-_WCRC_CLIN_Cost_Template_Amendment_3.xlsx XLSX spreadsheet
RFP-CMS-2016-8A-0008_Amendment_000003.pdf PDF
WCRC_Solicitation_2.2.2017_Amendment_3.pdf PDF
Attachment_J.3.2_-_Past_Performance_Questionnaire_CO_Letter.pdf PDF
Attachment_J.3.3_-_Past_Performance_Questionnaire_Instructions_and_Response.docx DOCX document
Attachment_J.1.5_-_Appendix_E_WCMSA-Reference-Guide-Version-2_5_Online_Amendment_2.pdf PDF
Attachment_J.1.4_-_Appendix_D_WCRC_Monthly_Status_Report_Template.pdf PDF
Attachment_J.3.1_-_Past_Performance_Questionnaire_Contractor_Request_Letter.docx DOCX document
Attachment_J.3.2_-_Past_Performance_Questionnaire_CO_Letter.pdf PDF
Attachment_J.1.1_-_Appendix_A_WCCCS_User_Guide_August_2010.pdf PDF
Attachment_J.6_-_Ammendment_2_RFP_Questions_1.26.17.xlsx XLSX spreadsheet
Attachment_J.1.4_-_Appendix_D_WCRC_Monthly_Status_Report_Template.pdf PDF
Attachment_J.3.3_-_Past_Performance_Questionnaire_Instructions_and_Response.docx DOCX document
Attachment_J.7_-__Appendix_C_Tech_Ch_C_508_Compliance.pdf PDF
Attachment_J.1.5_-_Appendix_E_WCMSA-Reference-Guide-Version-2_5_Online_Amendment_2.pdf PDF
Attachment_J.3.1_-_Past_Performance_Questionnaire_Contractor_Request_Letter.docx DOCX document
Attachment_J.1.2__-_Appendix_B_WCRC_Deliverable_Schedule_Amendment_2.pdf PDF
Attachment_J.4_-_Contractor_Personal_Conflict_of_Interest_Financial_Disclosure_Template.docx DOCX document
Attachment_J.6_-_Ammendment_1_RFP_Questions.xlsx XLSX spreadsheet
RFP-CMS-2016-8A-0008_Amendment_1.pdf PDF
Attachment_J.3.1_-_Past_Performance_Questionnaire_Contractor_Request_Letter.docx DOCX document
Attachment_J.1.3_-_Appendix_C_WCRC_Weekly_Status_Report_Template.pdf PDF
Attachment_J.3.3_-_Past_Performance_Questionnaire_Instructions_and_Response.docx DOCX document
Attachment_J.7_-__Appendix_C_Tech_Ch_C_508_Compliance.pdf PDF
Attachment_J.4_-_Contractor_Personal_Conflict_of_Interest_Financial_Disclosure_Template.docx DOCX document
Attachment_J.6_-_RFP_Questions.xlsx XLSX spreadsheet
Attachment_J.1.2_-_Appendix_B_WCRC_Delivearble_Schedule.pdf PDF
Attachment_J.1_-_WCRC_SOW_11-29-16.pdf PDF
DRAFT_Attachment_J.1.4_-_Appendix_D_WCRC_Monthly_Status_Report_Template.pdf PDF
DRAFT_RFP-CMS-2016-8A-0008_11.23.16.pdf PDF
DRAFT_Attachment_J.4_-_Contractor_Personal_Conflict_of_Interest_Financial_Disclosure_Template.docx DOCX document
DRAFT_Attachment_J.3.3_-_Past_Performance_Questionnaire_Instructions_and_Response.pdf PDF
DRAFT_Attachment_J.2_-_WCRC_CLIN_Cost_Template.xlsx XLSX spreadsheet
DRAFT_Attachment_J.1.1_-_Appendix_A_WCCCS_User_Guide_August_2010.pdf PDF
DRAFT_Attachment_J.3.1_-_Past_Performance_Questionnaire_Contractor_Request_Letter.docx DOCX document
DRAFT_Attachment_J.1.3_-_Appendix_C_WCRC_Weekly_Status_Report_Template.pdf PDF
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Sheet1

CLIN 0001 Base Year (November 1, 2017 – June 30, 2018)QuantityUnit PriceTotal FFP
(# of Recomm)(Per Recomm)
CLIN 0003Price Per WCMSA Recommendation
SLIN 0003AAWCMSA Recommendations - MIP12,800*
SLIN 0003ABWCMSA Recommendations - Part D
SLIN 0003ACOptional WCMSA Recomm Additional Quantity - MIP3,200
SLIN 0003ADOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AEOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AFOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AGOptional WCMSA Recomm Additional Quantity - MIP1,000
SLIN 0003AHOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AIOptional WCMSA Recomm Additional Quantity - MIP1,000
SLIN 0003AJOptional WCMSA Recomm Additional Quantity - Part D
Total
CLIN 0002 Option Year 1 (July 1, 2018 – June 30, 2019)QuantityUnit PriceTotal FFP
(# of Recomm)(Per Recomm)
CLIN 0003Price Per WCMSA Recommendation
SLIN 0003AAWCMSA Recommendations - MIP19,200*
SLIN 0003ABWCMSA Recommendations - Part D
SLIN 0003ACOptional WCMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ADOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AEOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AFOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AGOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AHOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AIOptional WCMSA Recomm Additional Quantity - MIP1,000
SLIN 0003AJOptional WCMSA Recomm Additional Quantity - Part D
Optional NGHP Price Per LMSA Recommendation
SLIN 0003AKOptional LMSA & NFMSA Recomm - MIP19,200
SLIN 0003ALOptional LMSA & NFMSA Recomm- Part D
SLIN 0003AMOptional LMSA & NFMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ANOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AOOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003APOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AQOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AROptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003ASOptional LMSA & NFMSA Recomm Additional Quantity - MIP1,000
SLIN 0003ATOptional LMSA & NFMSA Recomm Additional Quantity- Part D
Total
CLIN 0003 Option Year 2 (July 1, 2019 – June 30, 2020)QuantityUnit PriceTotal FFP
(# of Recomm)(Per Recomm)
CLIN 0003Price Per WCMSA Recommendation
SLIN 0003AAWCMSA Recommendations - MIP19,200*
SLIN 0003ABWCMSA Recommendations - Part D
SLIN 0003ACOptional WCMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ADOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AEOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AFOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AGOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AHOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AIOptional WCMSA Recomm Additional Quantity - MIP1,000
SLIN 0003AJOptional WCMSA Recomm Additional Quantity - Part D
Optional NGHP Price Per LMSA Recommendation
SLIN 0003AKOptional LMSA & NFMSA Recomm - MIP19,200
SLIN 0003ALOptional LMSA & NFMSA Recomm- Part D
SLIN 0003AMOptional LMSA & NFMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ANOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AOOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003APOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AQOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AROptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003ASOptional LMSA & NFMSA Recomm Additional Quantity - MIP1,000
SLIN 0003ATOptional LMSA & NFMSA Recomm Additional Quantity- Part D
Total
CLIN 0004 Option Year 3 (July 1, 2020 – June 30, 2021)QuantityUnit PriceTotal FFP
(# of Recomm)(Per Recomm)
CLIN 0003Price Per WCMSA Recommendation
SLIN 0003AAWCMSA Recommendations - MIP19,200*
SLIN 0003ABWCMSA Recommendations - Part D
SLIN 0003ACOptional WCMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ADOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AEOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AFOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AGOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AHOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AIOptional WCMSA Recomm Additional Quantity - MIP1,000
SLIN 0003AJOptional WCMSA Recomm Additional Quantity - Part D
Optional NGHP Price Per LMSA Recommendation
SLIN 0003AKOptional LMSA & NFMSA Recomm - MIP19,200
SLIN 0003ALOptional LMSA & NFMSA Recomm- Part D
SLIN 0003AMOptional LMSA & NFMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ANOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AOOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003APOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AQOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AROptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003ASOptional LMSA & NFMSA Recomm Additional Quantity - MIP1,000
SLIN 0003ATOptional LMSA & NFMSA Recomm Additional Quantity- Part D
Total
CLIN 0005 Option Year 4 (July 1, 2021 – June 30, 2022)QuantityUnit PriceTotal FFP
(# of Recomm)(Per Recomm)
CLIN 0003Price Per WCMSA Recommendation
SLIN 0003AAWCMSA Recommendations - MIP19,200*
SLIN 0003ABWCMSA Recommendations - Part D
SLIN 0003ACOptional WCMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ADOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AEOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AFOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AGOptional WCMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AHOptional WCMSA Recomm Additional Quantity - Part D
SLIN 0003AIOptional WCMSA Recomm Additional Quantity - MIP1,000
SLIN 0003AJOptional WCMSA Recomm Additional Quantity - Part D
Optional NGHP Price Per LMSA Recommendation
SLIN 0003AKOptional LMSA & NFMSA Recomm - MIP19,200
SLIN 0003ALOptional LMSA & NFMSA Recomm- Part D
SLIN 0003AMOptional LMSA & NFMSA Recomm Additional Quantity - MIP5,800
SLIN 0003ANOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AOOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003APOptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003AQOptional LMSA & NFMSA Recomm Additional Quantity - MIP2,000
SLIN 0003AROptional LMSA & NFMSA Recomm Additional Quantity- Part D
SLIN 0003ASOptional LMSA & NFMSA Recomm Additional Quantity - MIP1,000
SLIN 0003ATOptional LMSA & NFMSA Recomm Additional Quantity- Part D
Total

Sheet3

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