Attachment_J.2_-_WCRC_CLIN_Cost_Template_Amendment_3.xlsx
XLSX spreadsheet 15 KB Posted
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- Workers Compensation Review Contractor Federal contract opportunity
- Solicitation number
- RFP-CMS-2016-8A-0008
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WCRC Cost Template
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Sheet1 CLIN 0001 Transition Period (July 1, 2017 – September 30, 2017) Total FFP
| CLIN 0001 | Transition Activities | |||
| SLIN 0001AA | Month #1 Transition | |||
| SLIN 0001AB | Month #2 Transition | |||
| SLIN 0001AC | Month #3 Transition | |||
| CLIN 0002 Base Year (October 1, 2017 – June 30, 2018) | Quantity | Unit Price | Total FFP | |
| (# of Proposal Submissions) | (Per Recomm) | |||
| CLIN 0002 | Price Per WCMSA Recommendation | |||
| SLIN 0002AA | WCMSA Recommendations - MIP | 14,400* | ||
| SLIN 0002AB | WCMSA Recommendations - Part D | |||
| SLIN 0002AC | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0002AD | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0002AE | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0002AF | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0002AG | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0002AH | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0002AI | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0002AJ | Optional WCMSA Recomm Additional Quantity - Part D | |||
| Total |
| CLIN 0003 Option Year 1 (July 1, 2018 – June 30, 2019) | Quantity | Unit Price | Total FFP | |
| (# of Proposal Submissions) | (Per Recomm) | |||
| CLIN 0003 | Price Per WCMSA Recommendation | |||
| SLIN 0003AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0003AB | WCMSA Recommendations - Part D | |||
| SLIN 0003AC | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0003AD | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0003AE | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0003AF | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0003AG | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0003AH | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0003AI | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0003AJ | Optional WCMSA Recomm Additional Quantity - Part D | |||
| Optional NGHP Price Per LMSA Recommendation | ||||
| SLIN 0003AK | Optional LMSA & NFMSA Recomm - MIP | 1,000 | ||
| SLIN 0003AL | Optional LMSA & NFMSA Recomm- Part D | |||
| SLIN 0003AM | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0003AN | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0003AO | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0003AP | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0003AQ | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0003AR | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0003AS | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0003AT | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| Total |
| CLIN 0004 Option Year 2 (July 1, 2019 – June 30, 2020) | Quantity | Unit Price | Total FFP | |
| (# of Proposal Submissions) | (Per Recomm) | |||
| CLIN 0004 | Price Per WCMSA Recommendation | |||
| SLIN 0004AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0004AB | WCMSA Recommendations - Part D | |||
| SLIN 0004AC | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0004AD | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0004AE | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0004AF | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0004AG | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0004AH | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0004AI | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0004AJ | Optional WCMSA Recomm Additional Quantity - Part D | |||
| Optional NGHP Price Per LMSA Recommendation | ||||
| SLIN 0004AK | Optional LMSA & NFMSA Recomm - MIP | 3,000 | ||
| SLIN 0004AL | Optional LMSA & NFMSA Recomm- Part D | |||
| SLIN 0004AM | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0004AN | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0004AO | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0004AP | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0004AQ | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0004AR | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0004AS | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0004AT | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| Total |
| CLIN 0005 Option Year 3 (July 1, 2020 – June 30, 2021) | Quantity | Unit Price | Total FFP | |
| (# of Proposal Submissions) | (Per Recomm) | |||
| CLIN 0005 | Price Per WCMSA Recommendation | |||
| SLIN 0005AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0005AB | WCMSA Recommendations - Part D | |||
| SLIN 0005AC | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0005AD | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0005AE | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0005AF | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0005AG | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0005AH | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0005AI | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0005AJ | Optional WCMSA Recomm Additional Quantity - Part D | |||
| Optional NGHP Price Per LMSA Recommendation | ||||
| SLIN 0005AK | Optional LMSA & NFMSA Recomm - MIP | 5,000 | ||
| SLIN 0005AL | Optional LMSA & NFMSA Recomm- Part D | |||
| SLIN 0005AM | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0005AN | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0005AO | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0005AP | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0005AQ | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0005AR | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0005AS | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0005AT | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| Total |
| CLIN 0006 Option Year 4 (July 1, 2021 – June 30, 2022) | Quantity | Unit Price | Total FFP | |
| (# of Proposal Submissions) | (Per Recomm) | |||
| CLIN 0006 | Price Per WCMSA Recommendation | |||
| SLIN 0006AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0006AB | WCMSA Recommendations - Part D | |||
| SLIN 0006AC | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0006AD | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0006AE | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0006AF | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0006AG | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0006AH | Optional WCMSA Recomm Additional Quantity - Part D | |||
| SLIN 0006AI | Optional WCMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0006AJ | Optional WCMSA Recomm Additional Quantity - Part D | |||
| Optional NGHP Price Per LMSA Recommendation | ||||
| SLIN 0006AK | Optional LMSA & NFMSA Recomm - MIP | 9,000 | ||
| SLIN 0006AL | Optional LMSA & NFMSA Recomm- Part D | |||
| SLIN 0006AM | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0006AN | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0006AO | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 5,000 | ||
| SLIN 0006AP | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0006AQ | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0006AR | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| SLIN 0006AS | Optional LMSA & NFMSA Recomm Additional Quantity - MIP | 10,000 | ||
| SLIN 0006AT | Optional LMSA & NFMSA Recomm Additional Quantity- Part D | |||
| Total | ||||
| *Fixed Price will be paid in 3 increments, 20% for Month #1, 30% for Month #2, and 50% for Month #3. | ||||
| **Minimum Quantity Guaranteed |
Sheet3
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