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41NHA-S3992
Exhibit A - Key Performance Measures (KPMs)
| KPM # |
| Key Performance Measure |
| Threshold |
| Impact Severity |
| KPM 1 |
| Compliant with Nevada Law in all activities. (SOW 1.5.2) |
| 100% statutory compliance |
| 1 |
| KPM 2 |
| Compliant with Federal Law in all activities. (SOW 1.5.1) |
| 100% statutory compliance |
| 1 |
(Subject to FFP Carve-Out)
| KPM 3 |
| Compliant with all HIPAA and other relevant requirements for privacy and security in all activities. (SOW 14.2) |
| 100% compliance with HIPAA privacy and security regulations |
| 1 |
(Subject to Data Breach Carve-Out)
| KPM 4 |
| Ensure no breaches in data access occur in accordance with state and federal regulations. (SOW 14.2.9) |
| Zero data access breaches allowed |
| 1 |
(Subject to Data Breach Carve-Out)
| KPM 5 |
| Reporting of breaches in data access (hardcopy and electronic data) in accordance with state and federal regulations shall be reported by the Contractor to the State. (SOW 14.2.9) |
| Within one (1) hour of Contractor’s identification of the breach to State data. |
| 2 |
| KPM 6 |
| Provide detailed Root Cause Analysis (RCA) for any system error or noncompliance event. (SOW 17.2.3) |
| Submitted within 10 calendar days of resolution. Interim updates do not toll daily penalties. |
| 3 |
| KPM 7 |
| Timely replacement of vacant key personnel positions. (SOW 2.2) |
| Interim plan within 10 business days; permanent qualified replacement active within 60 calendar days |
| 1 |
| KPM 8 |
| Correct PBM web portal failures (any failure of hardware, software, or infrastructure related to online websites and portals.) (SOW 4.6) |
| 100% functional 24 hours / 7 days a week / 365 days a year. All failures resolved within 24 hours. |
| 3 |
(Subject to Outage Carve-Out)
| KPM 9 |
| Timely web portal maintenance notification. (SOW 14.5.4) |
| 100% of web portal standard maintenance notifications must occur at least three (3) calendar days prior to the web scheduled maintenance, excluding emergency (i.e., denial of service, hacking events, etc.) |
| 4 |
| KPM 10 |
| Timely posting of online website and portal information (SOW 4.5 and 4.6) |
| The contractor shall ensure that the contractor’s online documents and content are current, accurate, and complete. 100% of final content shall be posted to the web within one (1) business day. |
| 2 |
| KPM 11 |
| Maintain and staff a member and provider Help Desk including, but not limited to, toll-free lines, email communications, webinar communications, toll-free fax communication. (SOW 4) |
| Staff shall be available 24 hours a day/7 days a week. Dedicated Nevada specific staff shall be available from 8:00 a.m. to 5:00 p.m. Pacific Standard Time, Monday through Friday. |
| 2 |
| KPM 12 |
| Maintain help desk quality: Average Speed of Answer (ASA). (SOW 4.2.4) |
| 80% answered in < 2 minutes; 90% answered in < 5 minutes (measured as a cumulative average over a calendar month) |
| 2 |
| KPM 13 |
| Maintain help desk quality: Maximum Hold Time limits. (SOW 4.2.4) |
| Callers placed on hold only if necessary; hold duration shall not exceed 3 minutes (measured as a cumulative average over a calendar month). |
| 2 |
| KPM 14 |
| Maintain help desk quality: First-Contact Call Resolution Rate (SOW 4.2.4) |
| Minimum 90% of incoming inquiries resolved accurately on initial contact (measured as a cumulative average over a calendar month). |
| 2 |
| KPM 15 |
| Maintain help desk quality: Call Abandonment Rate thresholds. (SOW 4.2.4) |
| Daily abandonment rate must remain strictly below 3% after 1 minute in queue (measured as a cumulative average over a calendar month). |
| 2 |
| KPM 16 |
| Maintain help desk quality: Average Call Handle Time limits. (SOW 4.2.4) |
| Average call handle time must remain strictly under 7 minutes per call (measured as a cumulative average over a calendar month) |
| 2 |
| KPM 17 |
| Mandatory notification of claims system outages. (SOW 14.5.4) |
| Reported to NVHA within four (4) hours of discovery for adjudication platform interruptions lasting 10 minutes or longer. |
| 2 |
| KPM 18 |
| Develop business and technical impact analysis and a remediation plan for all data security breaches. (SOW 14.2.9.5) |
| Submit a preliminary impact analysis and remediation plan within eight (8) hours of Contractor’s initial discovery or reasonable suspicion of any unauthorized data access or data breach. The final format, contents, and implementation milestones of the remediation plan shall be exclusively directed and approved by NVHA. |
| 2 |
(Subject to Data Breach Carve-Out)
| KPM 19 |
| Processing turnaround for Member Prior Authorization requests. (SOW 12.14.3) |
| Provide response within twenty-four (24) hours of receipt of a request for prior authorization |
| 1 |
| KPM 20 |
| Provide required contractual and operational reports. (SOW 12) |
| 100% compliance to timeframes determined by NVHA 100% compliance with delivery timeframes, formats, and frequencies exclusively directed by NVHA. |
| 2 |
| KPM 21 |
| Electronic Transactions Files Processing capacity. (SOW 17) |
| 99.99% transaction file processing capability functional 24/7/365, excluding approved maintenance. |
| 2 |
| KPM 22 |
| All incoming and outgoing pharmacy transactions (SOW 17.2.1) |
| 100% of pharmacy transactions processed within a maximum of five (5) seconds unless exempted by NVHA. |
| 1 |
| KPM 23 |
| Provide real-time access by State staff to the Contractor’s policy and procedure documents and all related business and clinical plans. (SOW 1.7) |
| 100% continuous system access compliance for state staff. |
| 1 |
| KPM 24 |
| Failure to produce and distribute final quarterly rebate invoices within sixty (60) calendar days after the end of each calendar quarter. (SOW 16.6.6) |
| 100% compliance |
| 1 |
| KPM 25 |
| Accuracy and collection of state drug rebate revenues. (SOW 16.5) |
| 100% collection compliance. Contractor shall reimburse NVHA for the exact dollar value of any uncollected or lost rebate. |
| 1 |
(Subject to Uncapped Revenue Restitution Carve-Out)
| KPM 26 |
| Vendor must perform according to approved project plans. (SOW 19.3) |
| 100% adherence to critical-path implementation timelines |
| 3 |
| KPM 27 |
| Systemwide Claims Adjudication Platform Availability. (SOW 14.5.4) |
| The Contractor shall maintain monthly availability of at least 99.9 percent for mission-critical components of the Contractor’s Solution |
| 1 |
(Subject to Critical System Outage Carve-Out)
| KPM 28 |
| Failure by the Contractor to comply with a Change Control Memorandum (CCM) or Corrective Action Plan (CAP). (SOW 1.7.7) |
| 100% operational implementation of NVHA-directed contents, formats, and remediation milestone timelines. |
| 1 |
| KPM 29 |
| Complete all implementation actions and requirements prior to Go-Live dates in accordance with approved schedules. (SOW 19) |
| 100% adherence to implementation timelines. |
| KPM 30 |
| Provide copies of current Nevada professional licenses for key staff. (SOW 13) |
| 100% of Key Personnel and required clinical staff must hold active, valid Nevada professional licenses prior to performing any contract services. Copies must be submitted to NVHA within five (5) business days of hire or renewal. |
| KPM 31 |
| Provide requested State operational, claims, or program data (SOW 14.2.4) |
| 100% compliance. All requested state data must be delivered to NVHA in an accurate, complete, and NVHA-approved format within the timeframes specified in the request. |
| 2 |
| KPM 32 |
| Outgoing contract end-of-lifecycle data offboarding (SOW 20.2) |
| Deliver 100% of all historical operational data, active claims history, and records to a successor vendor or NVHA in strict compliance with the approved Transition Plan milestones. |
| 1 |
| KPM 33 |
| Post-termination data purge certification. (SOW 20.11.3) |
| Provide a legally binding, executive-signed attestation verifying complete deletion and secure destruction of Nevada data from all private contractor environments, facilities, and cloud servers |
| 1 |
| KPM 34 |
| Obtain and maintain full federal system CMS certification. (SOW 1.4) |
| Achieve and maintain full CMS Certification for the PBM system solution to secure maximum federal matching funds. |
| 1 |
(Subject to Actual Loss of Federal FFP Match Dollars Carve-Out)
| KPM 35 |
| Defective system release updates and management (SOW 14.1.17) |
| Release deployments must result in zero platform instability, functionality loss, or interface disconnects with NVHA or MCO systems. |
| 1 |
| KPM 36 |
| Unapproved System infrastructure modifications (SOW 14.1.15) |
| Obtain explicit written NVHA authorization prior to altering or substituting any production code baseline or core application infrastructure software. |
| 1 |
Exhibit A – PBM Key Performance Measures KPMs
Impact Severity and Performance Credit Assessment
| Impact Severity Level |
| Performance Credit Assessment for Failure to meet Key Performance Measure |
| 1 |
| Two thousand dollars ($2,000.00) shall be deducted for each calendar day that the Contractor fails to meet each Tier 1 key performance measure. The amount of the deduction shall accrue each day the Contractor fails to meet each key performance measure. |
Each calendar day, the total deduction will equal two thousand ($2,000.00) multiplied by the total number of each unmet key performance measure.
For example, failure to meet one (1) key performance measure for three (3) days could result in a deduction of two thousand dollars ($2,000.00) multiplied by three (3) days to total six thousand dollars ($6,000.00). Failure to meet two key performance measures for three (3) days could result in a deduction of four thousand dollars ($4,000.00) per day multiplied by three (3) days to total twelve thousand ($12,000.00). For system availability or claims adjudication metrics, any unapproved outage occurring during a calendar day constitutes an automatic full-day assessment, subject to the Critical Safeguard Carve-Out below.
| 2 |
| One thousand dollars ($1000.00) shall be deducted for each calendar day that the Contractor fails to meet each Tier 2 key performance measure. |
One thousand dollars ($1000.00) multiplied by the total number of calendar days of the failure may be deducted for each subsequent calendar day the same key performance measure is unmet.
For example, failure to meet one (1) key performance for two (2) days could result in a deduction of $1000.00 multiplied by two (2) days for a deduction of two thousand ($2,000.00).
For trend-based performance measures evaluated on a monthly average (including KPM 12 through KPM 16), a failure to achieve the threshold across a calendar month means the Contractor shall be deemed out of compliance for every day of that month, and the daily Tier 2 assessment shall apply retrospectively.
| 3 |
| Two hundred and fifty dollars ($250.00) shall be deducted for each calendar day that the Contractor fails to meet each Tier 3 key performance measure. |
Two hundred and fifty dollars ($250.00) multiplied by the total number of calendar days of the failure may be deducted for each subsequent calendar day the same key performance measure is unmet.
For example, failure to meet one (1) key performance measure for two (2) days could result in a deduction of two hundred and fifty dollars ($250.00) multiplied by two (2) days for a deduction of one thousand ($500.00).
| 4 |
| One hundred twenty-five dollars ($125.00) shall be deducted per individual occurrence, per calendar day that the Contractor fails to satisfy a Tier 4 key performance measure. Deductions shall accrue continuously for each separate occurrence from the date of the initial failure until the deficiency is fully resolved to the satisfaction of NVHA. For example, if the Contractor fails to update three (3) distinct required key performance measures (3 occurrences) for a period of four (4) calendar days, the performance credit deduction shall equal $125.00 multiplied by 3 occurrences multiplied by 4 days = $1,500.00. |
| Repeat Occurrence Multiplier |
| If the same or substantially similar Contractor key performance measure failure occurs three (3) or more times within any rolling twelve (12)-month period, the applicable performance credit for the third occurrence shall be multiplied by two (2). For the fourth and all subsequent occurrences, the multiplier shall increase to three (3). NVHA retains the absolute authority to determine whether a failure is the same or substantially similar to a prior failure. |
| Critical Safeguard Carve-Out |
| Notwithstanding the standardized daily assessments above, the following specific damage formulations shall supersede the standard daily rate where applicable: |
1. Critical System Outage Damages: For core Claims Adjudication Platforms (KPM 27), Web Portals (KPM 8), and the Drug Rebate System (KPM 25), if system downtime exceeds zero-point-one percent (0.1%) in a calendar month (excluding NVHA-approved scheduled maintenance), damages shall accrue at fifty dollars ($50.00) per minute for cumulative monthly downtime between 0.1% and 1.0%, and one hundred dollars ($100.00) per minute for any cumulative monthly downtime exceeding 1.0%.
2. Data Security Incident Damages (Uncapped Restitution): For data access breaches, privacy violations, or reporting/analysis failures (KPM 3, KPM 4, and KPM 18), the Contractor shall be subject to an uncapped make-whole remedy. The Contractor shall fully indemnify and reimburse NVHA for one hundred percent (100%) of all actual costs incurred by the State to respond to, mitigate, and remediate the incident.
3. Federal Financial Participation (FFP) Match Protection: For failures impacting federal system certification or reporting standards (KPM 2 and KPM 34), the Contractor shall fully indemnify NVHA and be held directly liable for the actual dollar value of any loss of Federal Financial Participation (FFP) matching funds sustained by NVHA.
4. Drug Rebate Accuracy Damages (Uncapped Revenue Restitution): For rebate management or invoicing failures (KPM 25), the Contractor shall pay direct restitution to NVHA equal to the exact, un-capped dollar-for-dollar value of any drug rebates that would have otherwise accrued to NVHA but went uncollected due to the Contractor’s performance failure.
Exhibit A – Key Performance Measures (KPMs) Impact Severity and Performance Credits
Exhibit A- Key Performance Measures (KPMs)
Impact Severities and Corrective Action Plan
| Impact Severity Level |
| Corrective Action Plan timeline for Failure to meet Key Performance Measure |
| 1 |
| A corrective action plan will be put in place requiring that deficiencies be corrected within 1 week. |
| 2 |
| A corrective action plan will be put in place requiring that deficiencies be corrected within 2 weeks. |
| 3 |
| A corrective action plan will be put in place requiring that deficiencies be corrected within 3 weeks. |
| 4 |
| A corrective action plan will be put in place requiring that deficiencies be corrected within 4 weeks. |
Exhibit A – Key Performance Measures Impact Severities and Corrective Action Plan