3. Attachment B - Performance Guarantees.pdf

RFP No.: DMS-24/25-312 Medicare Advantage Prescription Drug Plans Page 1 of 18

ATTACHMENT B: PERFORMANCE GUARANTEES

It is critical to the success of the State’s benefits plans that Services be maintained in a timely manner and that the Contractor operates in a reliable manner. It would be impracticable and difficult to repair the actual damage sustained by the State in the event of certain delays or failures in scheduled Services and the provision of Services to Members served by this Contract. The Department and Contractor, therefore, agree that in the event of certain delays and failures, the amount of damage that will be sustained will be the amount set forth in this Attachment.

Further, Contractor agrees that in the event of any such failure of performance, Contractor shall pay such amount as financial consequences under section 287.058(1)(h), F.S., and not as a penalty. At its option, the Department may, for any amount due to the State as financial consequences, deduct such amount from any money payable to Contractor or may bill Contractor as a separate item.

All references to ARs are to the Administrative Requirements of Attachment A.

PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

I. Implementation 1A Final

Implementation Plan

AR-1

The Contractor must submit the Final Implementation Plan to the Department for approval within ten (10) Business Days following the Effective Date of the Contract.

Delivery must occur within ten (10) Business Days from the Effective Date of the Contract.

One (1) time measurement

$5,000 per Business Day late beyond the ten (10) Business Days.

Measured as the difference between the due date and the actual date the Final Implementation Plan is received by the Department.

1B Final Implementation Plan

AR-1

If the final Implementation Plan is submitted, but is not subsequently approved by the Department, the Contractor shall submit revisions to the Final Implementation Plan within five (5) Business Days of receiving feedback from the Department setting forth the reason(s) why the

Revisions to Final Implementation Plan within five (5) Business Days of receiving feedback from the Department.

One (1) time measurement

$2,500 per Business Day beyond the five (5) Business Days.

Measured as the number of days between the due date and the actual date the revised Implementation Plan is received by the Department.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

Department did not approve the submitted Plan.

2 Implementation Status Meetings

AR-1, AR-6

The Account Management Team shall schedule and hold weekly Implementation status meetings with the Department.

Must begin within ten

(10) Calendar Days of contract execution and continue weekly through January 1, 2026.

Weekly $500 for each weekly meeting missed without prior approval from the Department.

Measured as the difference between the total number of weekly meetings held and the number of weekly meetings missed without prior approval.

3 Final Operational Readiness

AR-2

The Contractor must complete all implementation activities as outlined in the approved Final Implementation Plan

(AR-1).

The Contractor and all applicable Services must be 100% operational prior to the Implementation Date of January 1, 2026, 12:00 A.M. ET.

One (1) time measurement

$10,000 per Calendar Day beyond the deadline.

Measured from January

1, 2026, 12:00 A.M. ET

to the date that all services, including customer support, enrollment processing, and IT systems, are fully functional.

4 Website

AR-1, AR-20

The Contractor shall finalize the State of Florida Plan specific website by the date specified.

Website must be functional and available to Participants by September 1, 2025.

One (1) time measurement

$1,000 per Calendar Day past the due date.

Measured as the difference between the due date and the date the website is functional and available to Participants.

5 Phone Line

AR-1, AR-18

The Contractor shall establish a phone line by the date specified.

Phone line must be functional and available to Participants by September 1, 2025.

One (1) time measurement

$1,000 per Calendar Day past the due date.

Measured as the difference between the due date and the date the phone line is functional and available to Participants.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

II. Account Management 6 Quarterly

Performance Review Meetings

AR-6b

The Account Management Team is required to attend and actively participate in all scheduled quarterly performance review meetings, whether in person, via web conferencing, or over the telephone, as outlined in AR-6 of this Contract.

One hundred percent (100%) attendance

Quarterly $500 per occurrence if any member of the Account Management Team is absent from a quarterly meeting without prior approval from the Department.

Measured by determining if the scheduled quarterly meeting was missed by one or more members of the Account Management Team without prior approval.

The Department will verify the attendance of the Account Management Team at each meeting.

7 Corrective Action Plan

AR-3

Upon request by the Department, the Contractor shall develop and submit a corrective action plan (CAP) within ten (10) Calendar Days of the request, subject to approval by the Department.

Contractors must submit the CAP to the Department for approval, and once approved, they must implement them within ten (10) Calendar Days. If the Department does not approve the CAP, A) Contractor shall revise, to incorporate Department feedback, and resubmit within five (5) Business Days.

Upon request by the

Department

$2,500 per Calendar Day late beyond the ten (10) Calendar Days.

$2,500 per Calendar Day beyond the five (5) Business

Measured from the date of delivery of the approved CAP and is measured in Calendar of delivery of the CAP feedback from the Department and is measured in Business

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

B) Contractor shall complete implementation of the approved CAP within ten

(10) Calendar

$2,500 per beyond the ten (10) Calendar of delivery of the approved CAP and is measured in Calendar

III. Support Services 8 Open Enrollment

Benefit Fairs

AR-7

The Contractor shall ensure that trained and knowledgeable staff are present at each annual Open Enrollment Benefit Fair sponsored by the Department or its designee, as outlined in AR-7 of this Contract.

One hundred percent (100%) of Open Enrollment Benefit Fairs shall be staffed by trained and knowledgeable personnel.

Annually $5,000 for each Open Enrollment Benefit Fair that is not staffed according to the specified requirements.

Measured by verifying the attendance of trained and knowledgeable Contractor staff at each annual Open Enrollment Benefit Fairs scheduled by the Department or its designee.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

9A Plan Materials

Submission of Marketing and Communication Materials

AR-8

The Contractor shall provide all CMS-approved marketing, promotional, educational, or any other materials related to the Plan to the Department for review and written approval at least 30 Calendar Days prior to use and dissemination.

Submission of all materials to the Department at least 30 Calendar Days before use.

Ongoing $250 per Calendar Day late beyond the 30-day requirement.

Measured from the date materials are submitted to the Department to the date the materials are used and disseminated.

9B Plan Materials

Printed Materials

AR-8

Upon Department request, the Contractor shall provide printed materials in a language other than English and in formats widely accepted for participants with hearing or visual impairments within 30 Calendar Days.

Submission of requested materials within 30 Calendar Days of the Department’s request.

Ongoing $250 per Calendar Day late beyond the 30-day requirement.

Measured from the date the request is received to the date the materials are mailed.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

10 Distribution of Membership Materials

AR-9

The Contractor must mail enrollment materials to new enrollees within four (4) Business Days of receiving the enrollment file.

100% of materials mailed within four (4) Business Days.

Quarterly $2,500 per Business Day beyond the four (4) Business Days.

Measured from the date the enrollment file is received to the date the enrollment materials are mailed.

11A ID Cards

Implementation

AR-10

The Contractor shall mail ID cards no later than December 15 of the implementation year, provided a processable Enrollment File is received by the Contractor no later than December 1.

One hundred percent (100%) of ID cards mailed no later than December 15.

One-time measurement

$1,000 per Business Day beyond December 15

Measured from December 15 to the date the ID cards are mailed.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

11B ID Cards

Annual Open Enrollment

AR-10

The Contractor shall mail ID cards no later than December 1 of the applicable plan year for each subsequent annual Open Enrollment, provided a processable Enrollment File is received by the Contractor no later than November 15 of the applicable plan year.

One hundred percent (100%) of ID cards mailed no later than December 1.

Annually $1,000 per Business Day beyond December 1.

Measured from December 1 of each year to the date the ID cards are mailed.

11C ID Cards

Routine

AR-10

The Contractor must issue ID cards to new enrollees in compliance with regulatory requirements.

ID cards must be issued within seven

(7) Calendar Days of enrollment file receipt.

Quarterly $1,000 per Business Day beyond the seven (7) Calendar Days.

Measured from the date the enrollment file is received to the date the ID cards are mailed.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

12A Formulary Changes

Scheduled Adjustments

AR-11

Provide written notification to affected Members and prescribing providers at least 60 Calendar Days before any formulary change that removes a drug, alters cost-sharing/tier placement, or adds utilization management requirements.

100% of formulary change notifications issued at least 60 days in advance.

Ongoing

$250 per late beyond the 60-day requirement.

Measured from the date the Members and prescribing providers are notified to the date the formulary change takes effect.

12B Formulary Changes

Emergency Adjustments

AR-11

If a drug is removed due to an FDA recall or manufacturer withdrawal, the Contractor shall provide immediate notification to impacted Members, providers, and the Department.

Notification issued within 24 hours of FDA recall or manufacturer withdrawal.

Ongoing $1,000 per Calendar Day late beyond the 24-hour requirement.

Measured from the date the FDA recall or manufacturer withdrawal is issued until impacted Members, providers, and the Department are notified.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

13 Legislative & Public Record Requests

AR-12, AR-13,

AR-14

The Contractor must respond to Department requests related to legislative inquiries and public records.

One hundred percent (100%) of requests must be responded to within the Department’s specified timeframe.

Quarterly $2,500 per request not responded to on time.

Measured from the date of the request until the request is fulfilled.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

IV. Customer Service 14 Average Speed to Answer

AR-18

The Customer Service Unit phone line shall achieve an average response time of thirty

(30) seconds or less, measured from the moment the call is initially placed in the queue.

Calls shall be answered within an average of thirty (30) seconds or less.

Quarterly $1,000 per each second over thirty

(30) seconds.

The calculation of "Average Speed to Answer" involves measuring the total number of seconds from when a caller joins the queue until the call is answered by either a live customer service representative or an Interactive Voice Response Unit (IVRU).

This total duration for all callers within a quarter is then divided by the total number of calls handled by a live customer service representative or IVRU on the member service telephone line within the quarter.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

15 Call Abandonment Rate

AR-18

The call abandonment rate of the dedicated toll-free customer service phone line shall not exceed the specified rate.

Less than or equal to three percent (3%).

Quarterly $2,500 per percentage point, or fraction thereof, greater than three percent (3%).

The call abandonment rate percentage is calculated by dividing the number of calls abandoned in the queue in a quarter, where the caller disconnects before reaching a live customer service representative, by the total number of calls in a quarter.

16 Accuracy of Information

AR-18

Ninety-five percent (95%) of callers shall receive accurate information. Phone calls requiring additional research are excluded from the calculation of this metric.

Internal audit performed on accuracy of information provided to Plan Participants.

The internal audit shall be conducted by Contractor or Contractor’s Subcontractor on a statistically valid sample. The Contractor shall submit the audit reports to the Department quarterly.

Quarterly $2,000 for each full percentage point below ninety-five percent (95%).

Measured by dividing the number of calls from Plan Participants that were answered with accurate information by the total number of calls received from Plan Participants, excluding those requiring additional research.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

17 Initial Call Resolution

AR-18

Ninety percent (90%) of caller inquiries shall be resolved during the initial call (excluding appeals, billing, errors and escalations).

Internal audit performed on initial call resolution for Plan Participants.

The internal audit shall be conducted by Contractor or Contractor’s Subcontractor on a statistically valid sample. The Contractor shall submit the audit reports to the Department quarterly.

Quarterly $2,000 for each full percentage point below ninety percent (90%).

Measured by dividing the number of caller inquiries from Plan Participants resolved during the initial call by the total number of calls received from Plan Participants, excluding those related to appeals, billing issues, errors, and escalations.

18 Toll-Free Phone Lines Downtime

Unscheduled

AR-18

The Customer Service Unit toll-free phone lines shall be promptly answered by a live customer service representative or Interactive Voice Response Unit (IVRU) during the hours of 8:00 A.M. to 5:00 P.M. ET, Monday through Friday, excluding State holidays.

Any period of downtime where the phone lines are not functional and prohibits calls from being accepted and answered in excess of two (2) hours from start to finish will be subject to associated Financial Consequences.

Constant $2,000 for each hour the toll-free phone lines are unavailable or non-functional beyond the initial two (2) hours from start to finish.

Measured from the initial two (2) hours of downtime until the toll-free phone lines are fully restored and functional.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

19 Plan Website Downtime

Unscheduled

AR-20

The Plan specific website must be available twenty-four

(24) hours a day, seven

(7) days a week.

Any period of downtime where the website is not functional that exceeds twenty-four

(24) hours from start to finish will be subject to associated Financial Consequences.

Constant $5,000 for each greater-than-twenty-four (24) hour period the website is not available and/or functional.

Measured as the start of downtime and ending with the restoration and full functionality of the Plan website.

20 Participant Satisfaction Survey

AR-21

The Contractor shall guarantee that the overall satisfaction rate of Participants with Services, evaluated using a satisfaction survey instrument approved by the Department, reaches a minimum of ninety percent (90%).

Annual survey performed on statistically valid sample of Participants.

Annually. The data should be reported in the fourth quarter of the Plan Year.

$2,500 per percentage point, or fraction thereof, below ninety percent (90%).

Measurement of the variance between the overall satisfaction level, as indicated by the survey results showing the percentage of satisfied Participants, and the targeted satisfaction rate of ninety percent (90%).

21 Written Inquiry Response Time

AR-19

Ninety-nine percent (99%) of written inquiries related to the Plan will be acknowledged and addressed in twenty-one

(21) Calendar Days.

Written inquires includes communication via mail, email, and fax from Participants.

Quarterly audit performed on written inquiries from Participants.

Quarterly $2,000 per full percentage point, or fraction thereof, below ninety-nine percent (99%).

Measured by dividing the number of written inquiries acknowledged and addressed within twenty-one (21) Calendar Days by the total number of written inquiries received from Plan Participants.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

V. Data and Interface 22 Protection of PHI

& Breach Notification

AR-23, AR-24

The Contractor must comply with the terms of Attachment F (PRIVACY, SECURITY, AND

CONFIDENTIALITY

BUSINESS ASSOCIATE

AGREEMENT).

One hundred percent (100%) compliance with Attachment F

(PRIVACY,

SECURITY, AND

CONFIDENTIALITY

BUSINESS

ASSOCIATE

AGREEMENT).

Ongoing $10,000 per incidence of non-compliance

Measured by the number of HIPAA-related breaches and the timeliness of incident or breach notifications pursuant to the terms of Attachment F

(PRIVACY, SECURITY,

AND CONFIDENTIALITY

BUSINESS ASSOCIATE

AGREEMENT).

23A Enrollment Files

Routine Updates

AR-29

Enrollment files shall be accurately and timely loaded within the time frame specified.

One hundred percent (100%) of enrollment files loaded within two

(2) Business Days of receipt.

Quarterly $2,000 for each Business Day past the deadline, per incident.

Measured from the date/time of receipt of a processable enrollment file until the file is loaded.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

23B Enrollment Files

Non-Routine Updates

AR-29

Ad hoc or non-routine manual enrollment updates at the request of the Department or its designee shall be completed in the time frame specified.

One hundred percent (100%) within the same Business Day if requested during normal business hours; otherwise, during the next Business Day

Quarterly $1,000 for each day over the deadline, per incident

Measured from the date/time of receipt of a processable enrollment file until the file is loaded.

23C Enrollment File Discrepancies

AR-25

Eligibility discrepancies shall be reported by Contractor to the Department and eligibility Contractor in the time frame specified.

One hundred percent (100%) within two (2) Business Days of receipt

Monthly $1,000 for each day over the deadline, per incident

Measured from the date/time of receipt of a processable enrollment file until the discrepancies are reported.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

VI. Reporting and Deliverables 24A Timeliness of the Delivery of Reports and Deliverables

Weekly

AR-34

Reports and Deliverables shall be delivered to the Department and/or the Department's designee within the period specified in this PG, or by a later date, if requested by the Department.

Note: the amount at risk applies to each report outlined in Attachment A – Administrative Requirements.

Within two (2) Business Days of receipt of the enrollment file

Weekly $250 per day for each Business Day past the due date that a report or Deliverable is not received

Measured from the date/time of receipt of a processable enrollment file until the report is received.

24B Timeliness of the Delivery of Reports and Deliverables

Monthly

AR-35

Reports and Deliverables shall be delivered to the Department and/or the Department's designee within the period specified in this PG, or by a later date, if requested by the Department.

Note: the amount at risk applies to each report outlined in Attachment A – Administrative Requirements.

Within fifteen (15) Calendar Days of the end of the reporting month.

Monthly $250 per day for each Calendar Day past the due date that a report or deliverable is not received.

Measured from the date the report or deliverable is due until the report or deliverable is received.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

24C Timeliness of the Delivery of Reports and Deliverables

Quarterly

AR-36

Reports and Deliverables shall be delivered to the Department and/or the Department's designee within the period specified in this PG, or by a later date, if requested by the Department.

Note: the amount at risk applies to each report outlined in Attachment A – Administrative Requirements.

Within forty-five (45) Calendar Days of end of the reporting quarter or otherwise specified in Attachment A – Administrative Requirements.

Quarterly $250 per day for each Calendar Day past the due date that a report or deliverable is not received.

Measured from the date the report or deliverable is due until the report or deliverable is received.

24D Timeliness of the Delivery of Reports and Deliverables

Annual

AR-37

Reports and Deliverables shall be delivered to the Department and/or the Department's designee within the period specified in this PG, or by a later date, if requested by the Department.

Note: the amount at risk applies to each report outlined in Attachment A – Administrative Requirements.

Within forty-five (45) Calendar Days of the end of the reporting year or as otherwise specified in Attachment A – Administrative Requirements.

Annually $250 per day for each Calendar Day past the due date that a report or Deliverable is not received.

Measured from the date the report or deliverable is due until the report or deliverable is received.

VII. Claims Processing 25 Claims

Processing Timeliness

The Contractor must process 100% of claims within 30 Calendar Days of receipt.

One hundred percent (100%) of claims processed within the timeframe.

Quarterly $2,500 per percentage point below the 100% threshold

Measured from the date the claim is received by the Contractor to the date the claim is fully adjudicated.

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PG

Performance Indicator Standard/Goal Measurement Criteria Frequency of

Measurement Financial

Consequences Measurement Methodology

AR-42

IX. Audits 26 Audit Response

Timeliness

AR-47, AR-48

Contractor shall provide a written response to draft audit reports within ten

(10) Business Days of receipt.

One hundred percent (100%) of audit responses (redacted and non-redacted) submitted within 10 Business Days

Per audit occurrence

$1,000 per Calendar Day late

Measured from the date the draft audit report responses are due to the date the responses are received.

27 Corrective Action Plan and Remediation

AR-49

Contractor shall submit a Corrective Action Plan (CAP) as directed by the Department and fully remediate all audit findings within 60 Calendar Days of the audit report’s issuance.

One hundred percent (100%) of audit findings remediated within 60 Calendar Days

Per audit occurrence

$500 per Calendar Day beyond the 60-day period

Measured from the date the audit findings are to be remediated to the date the remediations are completed.

28 Timely Reimbursement to Impacted Participants

AR-50

Contractor shall reimburse impacted Participants for all financial findings identified during internal audits within twenty (20) Business Days of notification from the Department of the final amount due.

Reimbursements issued to all impacted Participants within 20 Business Days of Department’s notification.

Per audit finding

$100 per Participant not reimbursed on time.

Measured from the twenty

(20) Business Days to the date the Participant is reimbursed.

ATTACHMENT B: PERFORMANCE GUARANTEES