Attachment_J.2_-_WCRC_CLIN_Cost_Template.xlsx
XLSX spreadsheet 13 KB Posted
- Attached to
- Workers Compensation Review Contractor Federal contract opportunity
- Solicitation number
- RFP-CMS-2016-8A-0008
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Attachment J.2 WCRC CLIN Cost Template
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Sheet1
| CLIN 0001 Base Year (July 1, 2017 - June 30, 2018) | Quantity (# of Recommendations) | Unit Price (Per Recommendation) | Total FFP | |
| CLIN 0001 | Price Per WCMSA Recommendation | |||
| SLIN 0001AA | WCMSA Recommendations - MIP | 12,800* | ||
| SLIN 0001AB | WCMSA Recommendations - Part D | |||
| SLIN 0001AC | Optional WCMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0001AD | Optional WCMSA Recommendations Additional Quantity - Part D | |||
| Total |
| CLIN 0002 Option Year 1 (July 1, 2018 - June 30, 2019) | Quantity (# of Recommendations) | Unit Price (Per Recommendation) | Total FFP | |
| CLIN 0002 | Price Per WCMSA Recommendation | |||
| SLIN 0002AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0002AB | WCMSA Recommendations - Part D | |||
| SLIN 0002AC | Optional WCMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0002AD | Optional WCMSA Recommendations Additional Quantity - Part D | |||
| Optional LMSA & NFMSA Price Per LMSA Recommendation | ||||
| SLIN 0002AE | Optional LMSA & NFMSA Recommendations - MIP | 19,200 | ||
| SLIN 0002AF | Optional LMSA & NFMSA Recommendations- Part D | |||
| SLIN 0002AG | Optional LMSA & NFMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0002AH | Optional LMSA & NFMSA Recommendations Additional Quantity- Part D | |||
| Total |
| CLIN 0003 Option Year 2 (July 1, 2019 - June 30, 2020) | Quantity (# of Recommendations) | Unit Price (Per Recommendation) | Total FFP | |
| CLIN 0003 | Price Per WCMSA Recommendation | |||
| SLIN 0003AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0003AB | WCMSA Recommendations - Part D | |||
| SLIN 0003AC | Optional WCMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0003AD | Optional WCMSA Recommendations Additional Quantity - Part D | |||
| Optional LMSA & NFMSA Price Per LMSA Recommendation | ||||
| SLIN 0003AE | Optional LMSA & NFMSA Recommendations - MIP | 19,200 | ||
| SLIN 0003AF | Optional LMSA & NFMSA Recommendations- Part D | |||
| SLIN 0003AG | Optional LMSA & NFMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0003AH | Optional LMSA & NFMSA Recommendations Additional Quantity- Part D | |||
| Total |
| CLIN 0004 Option Year 3 (July 1, 2020 - June 30, 2021) | Quantity (# of Recommendations) | Unit Price (Per Recommendation) | Total FFP | |
| CLIN 0004 | Price Per WCMSA Recommendation | |||
| SLIN 0004AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0004AB | WCMSA Recommendations - Part D | |||
| SLIN 0004AC | Optional WCMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0004AD | Optional WCMSA Recommendations Additional Quantity - Part D | |||
| Optional LMSA & NFMSA Price Per LMSA Recommendation | ||||
| SLIN 0004AE | Optional LMSA & NFMSA Recommendations - MIP | 19,200 | ||
| SLIN 0004AF | Optional LMSA & NFMSA Recommendations- Part D | |||
| SLIN 0004AG | Optional LMSA & NFMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0004AH | Optional LMSA & NFMSA Recommendations Additional Quantity- Part D | |||
| Total |
| CLIN 0005 Option Year 4 (July 1, 2021 - June 30, 2022) | Quantity (# of Recommendations) | Unit Price (Per Recommendation) | Total FFP | |
| CLIN 0005 | Price Per WCMSA Recommendation | |||
| SLIN 0005AA | WCMSA Recommendations - MIP | 19,200* | ||
| SLIN 0005AB | WCMSA Recommendations - Part D | |||
| SLIN 0005AC | Optional WCMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0005AD | Optional WCMSA Recommendations Additional Quantity - Part D | |||
| Optional LMSA & NFMSA Price Per LMSA Recommendation | ||||
| SLIN 0005AE | Optional LMSA & NFMSA Recommendations - MIP | 19,200 | ||
| SLIN 0005AF | Optional LMSA & NFMSA Recommendations- Part D | |||
| SLIN 0005AG | Optional LMSA & NFMSA Recommendations Additional Quantity - MIP | 500 | ||
| SLIN 0005AH | Optional LMSA & NFMSA Recommendations Additional Quantity- Part D | |||
| Total | ||||
| Contractor shall be paid the Fixed Unit Price for delivery of each MSA Recommendation. The unit price shall be split using the following ratios, based upon two separate funding sources, 67% Medicare Integrity Program (MIP) Funds and 33% Part D Funds. | ||||
| For example if the Fixed Price is $100 then the split would be $67 MIP and $33 Part D. | ||||
| *Minimum Guaranteed Amount |
Sheet2
Sheet3
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