Scope of Work - Nevada Department of Employment, Training and ...
Scope of Work - Nevada Department of Employment, Training and ...
Scope of Work - Nevada Department of Employment, Training and ...
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ATTACHMENT CCFEE SCHEDULEProviders must provide detailed fixed prices for all costs associated with the responsibilities <strong>and</strong> relatedservices. This applies to all providers wherein the service is not contained in the State <strong>of</strong> <strong>Nevada</strong>’sMedicaid Rate Schedule or an established fee schedule in the <strong>Scope</strong> <strong>of</strong> <strong>Work</strong>.The fee schedule shall include the provider’s name, service description, rate <strong>and</strong> fees associated with theservice <strong>and</strong> any additional associated costs. Additional pages may be attached if necessary.Contact InformationProvider Representative:Business Name:Telephone Number:Email:Service DescriptionRate/Feehourly daily milestone other _______________hourly daily milestone other _______________hourly daily milestone other _______________hourly daily milestone other________________hourly daily milestone other _______________hourly daily milestone other _______________hourly daily milestone other _______________Associated CostsDescriptionRate/FeeThe fee schedule is only valid upon the Administrator <strong>of</strong> Vocational Rehabilitation’s approval.Administrator’s SignatureDateRevised: 01/10/2013
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