4-Attachment B - Scope of Work.docx

ATTACHMENT B - SCOPE OF WORK

Article 1

DEFINITIONS

1.1 Definitions. In this Contract, the following definitions apply:

"AHRQ" means Agency for Healthcare Research and Quality, a U.S. government agency under the Department of Health and Human Services. AHRQ conducts research, develops evidence-based tools and resources, and provides funding for healthcare research projects.

“CAHPS” means Consumer Assessment of Healthcare Providers and Systems. The CAHPS program is implemented by AHRQ and includes patient experience surveys for various healthcare settings and conditions, such as hospitals, health plans, home health care, and specific conditions like cancer care or end-of-life care.

“HEDIS” means Healthcare Effectiveness Data and Information Set. HEDIS is a widely used set of performance measures developed by the NCQA. It's used to assess and compare the quality of care provided by health insurance plans.

"NCQA" means National Committee for Quality Assurance, a not-for-profit quality assurance and accreditation organization for health plans.

Article 2

SERVICE REQUIREMENTS

2.1 Designated Survey Contractor. The Contractor shall be the designated survey contractor for two types of survey projects:

(1) annual CAHPS surveys on consumer satisfaction with health plans; and

(2) ad hoc, small surveys as required by DHHS.

2.2 Anticipated Survey Projects. The Contractor shall conduct surveys of patients from various carrier types, which include, but are not limited to:

(1) Medicaid-contracted health plans or accountable care organizations;

(2) prepaid mental health plans;

(3) Medicaid dental plans;

(4) home health care consumer assessment of healthcare providers and systems plans;

(5) CHIP-contracted health and dental plans;

(6) Medicaid fee for service enrollees;

(7) commercial managed care organizations;

(8) commercial preferred provider organizations;

(9) Public Employees Health Plan; and

(10) self-funded employer plans.

Article 3

SPECIFIC WORK TO BE PERFORMED

3.1 Coordination. DHHS shall notify the Contractor of the number of surveys to be conducted each year. The Contractor shall coordinate with DHHS staff and carrier representatives to administer the surveys.

3.2 Annual Survey Responsibilities. For each survey, the Contractor shall:

(1) prepare detailed instructions for preparing and submitting sampling frame files, and communicate this information to DHHS and all participating carriers each year;

(2) contact each carrier to collect relevant information and materials, such as logos and signature files;

(3) produce and distribute draft survey materials to each carrier and DHHS for approval;

(4) coordinate with DHHS staff to define, and with carriers to collect, appropriate survey sample frames according to NCQA guidelines;

(5) review the provided sampling frames to verify compliance with NCQA guidelines and make corrections as necessary, including, but not limited to, deleting duplicate numbers, institutional addresses, or numbers;

(6) draw a representative sample of enrollees from each sampling frame;

(7) conduct survey activities on a representative sample of enrollees from each health plan according to NCQA's survey specifications;

(8) provide a preliminary draft of the final report to DHHS for approval of the report format before survey completion;

(9) provide final survey data for each participating carrier to DHHS in a standardized *.csv file, along with frequency tables, dispositions, and response rates;

(10) provide a summary of all rating questions and composite scores each year for each carrier and provide each participating carrier with their portion of the above deliverables; and

(11) designate a backup for each key personnel member assigned to this project and notify DHHS within 14 calendar days of any staffing changes.

3.3 Survey Focus. In even years (2026, 2028, 2030), the focus must be on child surveys. In odd years (2027, 2029), the focus must be on adult surveys. The Contractor shall conduct child surveys of CHIP enrollees every year.

3.4 CAHPS Protocols. For CAHPS surveys, the Contractor shall anticipate using the CAHPS 5.1H Child Survey for child surveys and the CAHPS 5.1H Adult Survey for adult surveys. The exact survey protocols shall be identified during each year of the contract.

3.5 Additional Surveys. The Contractor shall have the capacity to incorporate additional surveys as requested by carriers, such as a CAHPS Adult Survey in a child year or an Experience of Care and Health Outcomes survey.

3.6 Sample Size and Methodology. For each survey, the Contractor shall employ the current version of the NCQA-developed sampling and data collection protocols, including de-duplication and over-sampling strategy. Each survey's sample size must follow NCQA's general guideline for the survey year, shown in the current Volume 3: HEDIS Specifications for Survey Measures.

3.7 Maximizing Response Rate. The Contractor shall calculate the survey response rate according to NCQA's general guideline as shown in the current Volume 3: HEDIS Specifications for Survey Measures.

(a) The eligible population for each survey is defined in NCQA's technical specifications. If out-of-state residents or employees of surveying health plans are included in the survey, the data must include a flag for each of those fields for easy identification during analysis.

(b) A survey will be assigned the disposition of complete and valid if the respondent appropriately answers the standard questions.

3.8 Custom Questions. DHHS plans to include at least six custom questions on all CAHPS surveys in all years. Each year, DHHS shall provide the Contractor a list of custom questions, approved by NCQA, which the Contractor shall include in the survey.

3.9 National CAHPS Benchmarking Database (“NCBD”). The Contractor shall complete data submission to the NCBD according to NCBD standards and by the required submission deadline.

3.10 Carrier Expansion of Surveys. Carriers may expand their surveys by oversampling or making other NCQA-approved changes to the survey methodology. Any such changes and additional charges shall be the sole responsibility of the carrier and the Contractor.

Article 4

MAIL AND TELEPHONE REQUIREMENTS

4.1 Mail Phase Requirements.

(a) The Contractor shall follow collection protocols as defined annually by AHRQ, including, but not limited to, a four-wave mail protocol which must include a first survey packet, a first reminder postcard, a second survey packet, and a second reminder postcard.

(b) The Contractor shall ensure that survey materials contain the correct logos, signatures, and other required elements, and shall receive approval from each carrier before mailing.

(c) The Contractor shall be responsible for the printing, mailing, and postage of survey instruments, including cover letters, questionnaires, outgoing envelopes, postage-paid return envelopes, and reminder postcards. The Contractor shall conduct quality control measures to ensure proper matching of cover letters and questionnaires. The Contractor shall include carrier representatives as artificial respondents so they receive copies of all survey materials.

(d) The Contractor shall prepare a cover letter with English on one side and Spanish on the reverse side. The Spanish side must list a toll-free number where respondents may call to request a Spanish version of the survey by mail. Each reminder postcard must include a comment box with the same toll-free number.

(e) The Contractor shall follow the time frames specified by NCQA for the survey.

4.2 Telephone Follow-up Interview Requirements.

(a) The Contractor shall make a minimum of three and a maximum of six attempts to call each respondent. The Contractor shall implement a system to optimize callback attempts so each applicable phone number is called at different times of the day and different days of the week to maximize survey response rates. Carriers may request no calls on Sundays.

(b) All telephone follow-up calls must be conducted in a central interviewing facility using Computer-Assisted Telephone Interviewing software systems.

(c) All interviewers shall be trained in the basics of standardized survey interviewing techniques, including neutral probing and other aspects of appropriate demeanor. All interviewers working on the survey shall be hired and ready for training before the beginning of data collection each year.

(d) The Contractor shall provide bilingual Spanish-speaking interviewers who shall conduct telephone survey interviews using Spanish version questionnaires. Bilingual interviewers shall be hired and ready to work at the time of the survey-specific interviewer training session each year.

(e) All interviewers shall be supervised, and their performance monitored continuously. Supervisory personnel shall not conduct telephone interviews while supervising interviewers.

(f) During the telephone interview period each year, the Contractor shall provide a minimum of two remote monitoring opportunities to DHHS staff.

(g) The Contractor shall provide weekly status updates in writing to DHHS. During data collection periods each year, the status report must include weekly response rate updates for each survey.

Article 5

COMPLIANCE AND DELIVERABLES

5.1 Materials for Review. The Contractor shall produce the following materials for review by DHHS:

(1) in even years, the CAHPS Health Plan Survey 5.1H Child Questionnaire (without Children with Chronic Conditions (CCC) Measure) in English;

(2) in odd years, the most recent adult version of the CAHPS Health Plan Survey in English;

(3) official cover letter and postcard in both English and Spanish; and

(4) a copy of the carrier logo and signature block on questionnaires and letters for each carrier in both English and Spanish.

5.3 Respondent Support. The Contractor shall provide respondent support through the following methods: a toll-free respondent support line in English and Spanish, answered live from 9:00 AM to 8:00 PM MT. The Contractor shall also support alternate language requests.

5.4 DHHS Review and Audit. Upon reasonable request by DHHS, the Contractor shall allow DHHS to perform a review of the facilities, systems, books, records, agreements, policies, and procedures relating to the survey to determine the Contractor’s compliance. DHHS may require the Contractor to conduct a risk assessment that addresses administrative, technical, and physical risks, if reasonable and appropriate.

5.5 Project Deliverables. The Contractor shall provide the following deliverables:

(1) project plan and status updates to DHHS and carriers throughout the field period;

(2) plan-level datasets for each carrier submitted in a comma-delimited file, organized as a single record for each member composed of a string of fields containing data values, including a data file layout with defined labels and values for each dataset sent to DHHS;

(3) aggregate dataset to DHHS;

(4) one electronic banner book or frequency report for each carrier sample, with plan-level frequencies, plan-level aggregate score, and complete disposition results for internal calculations of response rates; and

(5) one overview report for each carrier sample with plan-level reports containing four overall rating questions, composite scores, sample information, and response rates.

(a) In all data presentations, such as banner books, overview reports, or graphical reports, the Contractor shall suppress any results or cells with less than 11 cases and replace them with "NA," per Centers for Medicare & Medicaid Services specifications.

(b) Deliverables are due to DHHS no later than July 1st of each survey year.

(c) Records and scanned images of returned, completed surveys must be retained for three years.

Article 6

OUTCOMES

6.1 Expected Outcomes. This work is expected to improve patient care and experience by reporting patient perspectives, identifying areas for improvement, informing strategies for targeted interventions, and benchmarking performance. CAHPS surveys allow organizations, including DHHS, to track progress over time, enhance transparency and accountability, and provide results to the public to inform patient and employer-sponsor choices and provide transparency. This data will help to guide policy decisions, foster trust and improve communication.

6.2 Outcome Measures. Outcome will be measured in changes to the survey results over time. The survey measures the same outcomes that are expected to be improved. Views to the website and requests for data will be tracked.

6.3 Reporting Requirement. The Contractor will report survey data to DHHS, NCBD, and carriers. DHHS will report the data to Medicaid and post a report online. DHHS will also make the data available to internal and external data requesters as allowed by statute and rule.

Article 7

BILLING REQUIREMENTS

7.1 Billing. The Contractor shall submit invoices to the DHHS designee that include:

(1) contractor’s name, payment address, phone number, and signature;

(2) contract number;

(3) invoice number;

(4) invoice date; and

(5) details of services billed.

7.2 Payment Schedule. The Contractor will invoice DHHS for deliverables completed during each yearly survey cycle according to the following schedule:

(1) first month - 25% of the contract amount for the deliverables completed during the first five months of the cycle;

(2) third month - 25% of the contract amount for the deliverables completed during the first five months of the cycle; and

(3) final delivery - 50% remaining contract amount for delivery of the final data and documents.