RHTP Evaluation Cost Proposal Form.xlsx
XLSX spreadsheet 31 KB Posted
- Solicitation number
- RFP - 10A - 202608126
- Issued by
- Maine
About this file
This is a Cost Proposal Form for the State of Maine Department of Health and Human Services related to RFP# 202608126 for the Evaluation of Maine's Rural Health Transformation Program. The procurement spans a five-year period divided into three distinct performance phases: an Initial Period of Performance from November 1, 2026, through October 31, 2027; Renewal Period #1 from November 1, 2027, through October 31, 2029; and Renewal Period #2 from November 1, 2029, through October 31, 2031. Bidders are required to provide comprehensive cost proposals for all evaluation services and deliverables as outlined in the RFP, with the form structured to capture costs across multiple budget categories including salaries, subcontractors or consultants, travel, and supplies for each performance period.
The total annual funding available for services under this RFP cannot exceed the Department's CMS-approved budget of $750,000. Bidders must submit detailed line-item costs for each performance period on the provided schedules, with salary costs broken down by position title, hourly rate, and total hours proposed. Travel reimbursement must comply with the State of Maine's travel policies. Additionally, bidders are instructed to provide hourly rates for any positions that may be requested for ad-hoc work; however, these ad-hoc rates will not be considered during the evaluation process or counted against the annual available funding allocation. The cost proposal form requires bidders to complete all white spaces with corresponding budget data, with formulas automatically calculating totals for each cost category and performance period.
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Other files
| File | Type | Posted |
|---|---|---|
| Eval for RHTP Proposed Services Response Form_Final.docx | DOCX document | |
| RFP# 202608126 Evaluation of RHTP_Final.docx | DOCX document |
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Text version
Schedule 1 - Total Cost
| State of Maine | |||
| Department of Health and Human Services | |||
| COST PROPOSAL FORM | |||
| RFP# 202608126 | |||
| Evaluation of Maine’s Rural Health Transformation Program | |||
| Bidder Name: | |||
| Contact Person: | |||
| Instructions: Provide all cost for the 5-year procurement period to perform and deliver all services as outline in the RFP. In addition, provide cost associate with any ad-hoc work related to the evaluation services and requested by the Department. The total annual funding available for the services outlined in this RFP cannot exceed the Department’s CMS approved budget of $750,000. | |||
| Line | Deliverables | Cost | |
| 1 | Initial Period of Performance (11/1/2026 - 10/31/2027) | ||
| (Schedule 2) | $ - 0 | ||
| 2 | Renewal Period #1 (11/1/2027 - 10/31/2029) | ||
| (Schedule 3) | $ - 0 | ||
| 3 | Renewal Period #2 (11/1/2029 - 10/31/2031) | ||
| (Schedule 4) | $ - 0 | ||
| 4 | Total Cost | $ - 0 |
| Ad-Hoc Work | |
| Instructions: Bidders must provide hourly rates of positions in which ad-hoc work is requested under the contract resulting from this RFP. Ad-hoc rates will not be used or considered during the evaluation process, or considered as part of the annual available funding for the services outlined in the RFP. | |
| Position(s) | Hourly Rate |
Schedule 2 - Initial Period
| State of Maine | ||||||||
| Department of Health and Human Services | ||||||||
| COST PROPOSAL FORM | ||||||||
| RFP# 202608126 | ||||||||
| Evaluation of Maine’s Rural Health Transformation Program | ||||||||
| Bidder Name: | ||||||||
| Contact Person: | ||||||||
| Bidders must complete the budget form by entering data in the white spaces. Bidders should take caution when adding additional lines ensuring existing formulas calculate correctly. Do not include any cost related to ad-hoc work. | ||||||||
| Initial Period of Performance (11/1/2026 - 10/31/2027) | ||||||||
| 1 | Salaries | |||||||
| (list positons proposed for this RFP and the rate for each) | Hourly Rate | x | Total # of Hours | = | Amount | |||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| 2 | Total Salary | $0.00 | ||||||
| Subcontractor(s)/Consultant(s) | Amount |
| Total Subcontractor Costs | $0.00 |
| Other | |
| Travel - Justification | |
| Provide all related travel costs (i.e. mileage, lodging, airfare, incidentals, etc.) Travel reimbursement must align with the State's travel policies. https://www.maine.gov/osc/travel | Amount |
Supplies - Justification
| Total Other Expenses | $0.00 |
| Total Cost | $0.00 |
Schedule 3 - Renewal 1
| State of Maine | ||||||||
| Department of Health and Human Services | ||||||||
| COST PROPOSAL FORM | ||||||||
| RFP# 202608126 | ||||||||
| Evaluation of Maine’s Rural Health Transformation Program | ||||||||
| Bidder Name: | ||||||||
| Contact Person: | ||||||||
| Bidders must complete the budget form by entering data in the white spaces. Bidders should take caution when adding additional lines ensuring existing formulas calculate correctly. Do not include any cost related to ad-hoc work. | ||||||||
| Renewal Period #1 (11/1/2027 - 10/31/2029) | ||||||||
| 1 | Salaries | |||||||
| (list positons proposed for this RFP and the rate for each) | Hourly Rate | x | Total # of Hours | = | Amount | |||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| 2 | Total Salary | $0.00 | ||||||
| Subcontractor(s)/Consultant(s) | Amount |
| Total Subcontractor Costs | $0.00 |
| Other | |
| Travel - Justification | |
| Provide all related travel costs (i.e. mileage, lodging, airfare, incidentals, etc.) Travel reimbursement must align with the State's travel policies. https://www.maine.gov/osc/travel | Amount |
Supplies - Justification
| Total Other Expenses | $0.00 |
| Total Cost | $0.00 |
Schedule 4 - Renewal 2
| State of Maine | ||||||||
| Department of Health and Human Services | ||||||||
| COST PROPOSAL FORM | ||||||||
| RFP# 202608126 | ||||||||
| Evaluation of Maine’s Rural Health Transformation Program | ||||||||
| Bidder Name: | ||||||||
| Contact Person: | ||||||||
| Bidders must complete the budget form by entering data in the white spaces. Bidders should take caution when adding additional lines ensuring existing formulas calculate correctly. Do not include any cost related to ad-hoc work. | ||||||||
| Renewal Period #2 (11/1/2029 - 10/31/2031) | ||||||||
| 1 | Salaries | |||||||
| (list positons proposed for this RFP and the rate for each) | Hourly Rate | x | Total # of Hours | = | Amount | |||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| x | = | $0.00 | ||||||
| 2 | Total Salary | $0.00 | ||||||
| Subcontractor(s)/Consultant(s) | Amount |
| Total Subcontractor Costs | $0.00 |
| Other | |
| Travel - Justification | |
| Provide all related travel costs (i.e. mileage, lodging, airfare, incidentals, etc.) Travel reimbursement must align with the State's travel policies. https://www.maine.gov/osc/travel | Amount |
Supplies - Justification
| Total Other Expenses | $0.00 |
| Total Cost | $0.00 |
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