The Agency For Health Care Administration
RESPONDENT NAME: FORMTEXT ?????Where indicated in Table 1, Staffing Rates – Initial Contract Term, below, the respondent shall propose a fixed hourly rate for each identified staffing position. Staffing position requirements are outlined in Attachment B, Scope of Services, Section II., Manner of Service(s) Provision, Sub-Section E., Staffing.Where indicated in Table 2, Staffing Rates – Renewal Period, below, the respondent shall propose a fixed hourly rate for any renewal periods applicable to the resulting contract for each identified staffing position. Where indicated in Table 3, Hospital Pricing Staffing Rates – Initial Contract Term, below, the respondent shall propose a fixed hourly rate for each identified hospital pricing staffing position. Hospital pricing staffing position requirements are outlined in Attachment B, Scope of Services, Section II., Manner of Service(s) Provision, Sub-Section E., Staffing.Where indicated in Table 4, Hospital Pricing Staffing Rates – Renewal Period, below, the respondent shall propose a fixed hourly rate for any renewal periods applicable to the resulting contract for each identified hospital pricing staffing position. REMAINDER OF PAGE INTENTIONALLY LEFT BLANKTABLE 1STAFFING RATES – INITIAL CONTRACT TERMOctober 1, 2021– September 30, 2026A. Contract Lead ActuaryProposed Hourly Rate$ FORMTEXT ????? per hourB. Deputy Contract Lead ActuaryProposed Hourly Rate$ FORMTEXT ????? per hourC. Data ManagerProposed Hourly Rate$ FORMTEXT ????? per hourD. Senior ConsultantProposed Hourly Rate$ FORMTEXT ????? per hourE. ConsultantProposed Hourly Rate$ FORMTEXT ????? per hourF. Project ManagerProposed Hourly Rate$ FORMTEXT ????? per hourG. Senior Professional StaffProposed Hourly Rate$ FORMTEXT ????? per hourH. Professional StaffProposed Hourly Rate$ FORMTEXT ????? per hourI. Administrative AssistantProposed Hourly Rate$ FORMTEXT ????? per hourREMAINDER OF PAGE INTENTIONALLY LEFT BLANKTABLE 2STAFFING RATES – RENEWAL PERIODOctober 1, 2026 – September 30, 2031J. Contract Lead ActuaryProposed Hourly Rate$ FORMTEXT ????? per hourK. Deputy Contract Lead ActuaryProposed Hourly Rate$ FORMTEXT ????? per hourL. Data ManagerProposed Hourly Rate$ FORMTEXT ????? per hourM. Senior ConsultantProposed Hourly Rate$ FORMTEXT ????? per hourN. ConsultantProposed Hourly Rate$ FORMTEXT ????? per hourO. Project ManagerProposed Hourly Rate$ FORMTEXT ????? per hourP. Senior Professional StaffProposed Hourly Rate$ FORMTEXT ????? per hourQ. Professional StaffProposed Hourly Rate$ FORMTEXT ????? per hourR. Administrative AssistantProposed Hourly Rate$ FORMTEXT ????? per hourREMAINDER OF PAGE INTENTIONALLY LEFT BLANKTABLE 3 (OPTIONAL)HOSPITAL PRICING STAFFING RATES – INITIAL CONTRACT TERMOctober 1, 2021 – September 30, 2026S. Hospital Pricing LeadProposed Hourly Rate$ FORMTEXT ????? per hourT. Hospital Pricing ConsultantProposed Hourly Rate$ FORMTEXT ????? per hourTABLE 4 (OPTIONAL)HOSPITAL PRICING STAFFING RATES – RENEWAL PERIODOctober 1, 2026 – September 30, 2031U. Hospital Pricing LeadProposed Hourly Rate$ FORMTEXT ????? per hourV. Hospital Pricing ConsultantProposed Hourly Rate$ FORMTEXT ????? per hourIf the resulting Contract is renewed, it is the Agency’s policy to reduce the overall payment amount by the Agency to the successful Vendor by at least five percent (5%) during the period of the Contract renewal, unless it would affect the level and quality of services.REMAINDER OF PAGE INTENTIONALLY LEFT BLANK FORMTEXT ?????Respondent NameAuthorized Official SignatureDate FORMTEXT ?????Authorized Official Printed Name FORMTEXT ?????Authorized Official TitleExhibit A-5, Cost Proposal, shall not include a cost that exceeds the maximum contract amount listed in Attachment A, Instructions and Special Conditions, Section A.1., Instructions, Sub-Section A., Overview, Item 13., Type and Amount of Contract Contemplated. A response which contains a cost proposal that exceeds the Agency’s maximum contract amount will be rejected.Failure to submit, Exhibit A-5, Cost Proposal, signed by an authorized official may result in the rejection of response.REMAINDER OF PAGE INTENTIONALLY LEFT BLANK ................
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