RFP 27-87793

Attachment N Medicaid Enrollment Broker Services - Performance Exhibit Table of Contents

I. Consequential Damages – Failure to Meet Contract Requirements It is expressly agreed by the State and the Contractor that, in the event of a failure to meet the performance requirements listed below, damage shall be sustained by the State, and the Contractor shall pay to the State its actual damages according to the following subsection. Written notice of said failure to perform shall be provided to the Contractor, by the State.

II. Service Level Agreements – Failure to Meet Performance Requirements A. Areas of Non-Compliance The State monitors certain quality and performance standards and holds the Contractor accountable for delivering the statement of work and for being in compliance with contract terms. The State accomplishes this by working collaboratively with the Contractor to maintain and improve programs, and not to impair Contractor stability. The State may enforce any of the remedies listed in Section II of this Exhibit if the Contractor is non-compliant with the contract.

1. Non-Compliance with General Contract Provisions The objective of this requirement is to provide the State with an administrative procedure to address issues where the Contractor is not compliant with the contract. Through routine monitoring, the State may identify contract noncompliance issues. If this occurs, the State will notify the Contractor in writing of the nature of the non-performance issue. The State will establish a reasonable period of time, but not more than ten (10) business days nor less than five (5) business days, during which the Contractor must provide a written response to the notification. If the Contractor does not correct the non-performance issue within the time specified in the notice, the State may enforce any of the remedies listed in Section II of this Exhibit.

2. Non-Compliance with Helpline Performance Standards The Contractor must ensure that Helpline Performance Standards are met in full under this contract. The State may enforce any of the remedies listed in Section II of this Exhibit if the Contractor remains out of compliance with any of the standards in Section VII of the Statement of Work. The State may waive such remedies for the first three (3) months of operation (the ramp-up period). However, if it is determined by the State that the Contractor’s noncompliance with the standards for a certain month was caused by extenuating circumstances outside of the Contractor’s control, non-compliance for that month may be waived.

3. Non-Compliance with Member Education Performance Standards The Contractor must ensure that the Member Education services under this contract are met in full as listed in Section VII.a.2. of the Statement of Work.

4. Non-Compliance with Reporting Requirements The State may change the frequency of required reports, or may require additional reports, at the State’s reasonable discretion. Reports submitted incorrectly or not delivered complete, on time, and in the correct reporting formats constitute contractual non-compliance, as defined in Section VII.a.3. of the Statement of Work.

B. Non-compliance Remedies In the event that the Contractor fails to meet performance requirements or reporting standards set forth in the contract or other standards established by the State, the State will provide the Contractor with a written notice of non-compliance and may require any of the corrective actions or remedies discussed below.

If the State elects not to exercise a corrective action clause contained anywhere in the contract in a particular instance, this decision must not be construed as a waiver of the State's right to pursue future assessment of that performance requirement and associated damages, including damages that, under the terms of the Contract, may be retroactively assessed.

C. Corrective Actions The State may require corrective action(s) when the Contractor has failed to provide the requested services. The nature of the corrective action(s) will depend upon the nature, severity and duration of the deficiency and repeated nature of the non-compliance. The written notice of non-compliance corrective actions may be instituted in any sequence and include, but are not limited to, any of the following:

· Written Warning: The State may issue a written warning and solicit a response regarding the Contractor’s corrective action.

· Formal Corrective Action Plan: The State may require the Contractor to develop a formal corrective action plan to remedy the breach. The corrective action plan must be submitted under the signature of the Contractor’s chief executive and must be approved by the State. If the corrective action plan is not acceptable, the State may provide suggestions and direction to bring the Contractor into compliance.

· Withholding Full or Partial Invoice Payments: The State may suspend full or partial invoice payments for one (1) or more months when the State determines that the Contractor is non-compliant. The State must give the Contractor written notice ten (10) business days prior to the suspension of invoice payments and specific reasons for non-compliance that result in suspension of payments. The State may continue to suspend all invoice payments until non-compliance issues are corrected. However, the State may not return a portion of, or all invoice payments withheld in the event that there is a lost value of services that the State did not receive from the Contractor.

· Performance-Related Delayed Payments: Please see Section II.4 of this document for a description of Performance-Related Delayed Payments.

· Assigning the Contractor’s Responsibilities to Another Contractor: The State may assign the Contractor’s responsibilities to one (1) or more other contractors that also provide services for the Statement of Work, subject to consent by the contractor that would gain that responsibility. The State must notify the original Contractor in writing of its intent to transfer its responsibilities to another Contractor at least ten (10) business days prior to transferring any services.

· Appointing Temporary Management of the Contractor’s services: The State may assume management of the Contractor’s services or may assign temporary management of the Contractor’s services to the State’s agent, if at any time the State determines that the Contractor can no longer effectively manage the services for the Statement of Work.

· Contract Termination: The State reserves the right to terminate the contract pursuant to the contract termination clauses in the contract.

D. Performance-Related Delayed Payments The Contractor shall invoice to the State 90% of the total amount payable each period. The remaining 10% shall be held back according to the Contractor’s demonstrated and documented performance against the standards listed in this section. At the end of each quarter, the State shall determine whether the Contractor’s performance was sufficient to earn all or a portion of the performance related delayed payments for the quarter. It is the Contractor’s responsibility to submit the proper documentation/reports to provide proof regarding the Contractor’s ability to have met the performance standard for the quarter. If the State determines that payment of some or the entire withheld portion is due, the State shall pay the Contractor the proper percentage of the portion withheld within thirty (30) calendar days of the end of the quarter.

Any withhold amounts not released reflect the lost value of the services the State did not receive from the Contractor for the time period measured and thus will not be payable to the Contractor. The State’s decision to release some of or the entire withheld amount shall be final.

The release of performance-related delayed payments shall be based on the staff turnover rate absent voluntary attrition, compliance with helpline performance metrics, compliance with member education performance standards, and compliance with report submission performance standards for the quarter, as outlined in Section VII of the Statement of Work. Ten percent (10%) will be tied to the staff turnover rate absent voluntary attrition. Thirty percent (30%) will be tied to Member Education performance standards. Thirty percent (30%) will be tied to the reporting requirements. The remaining thirty percent (30%) of performance-related delayed payments will be tied to Helpline performance metric compliance.

The percentage payout of performance-related delayed payments shall be based on the following four (4) schedules:

1. Schedule 1: Compliance with Helpline Performance Metrics (30% of Performance-Related Delayed Payments)

For example, if during the quarter, the Contractor met seven (7) of the above listed ten (10) standards, the Contractor would receive none of the performance-related delayed payments held for the quarter allocated to Helpline requirements. The entire performance-related delayed payments allocated to Schedule 1 for that quarter reflect the lost value of the services the State did not receive from the Contractor during the quarter and will not be payable to the Contractor.

2. Schedule 2: Compliance with Member Education Performance Standards (30% of Performance-Related Delayed Payments)

Related Delayed Payments

For example, if during the quarter, the Contractor met six (6) of the member education standards, the Contractor would receive 75% of the 30% of the withhold allocated to Schedule 2.

Example Calculation:

· Where the number of quarterly invoices withheld is equal to 10% of each month.

· Where “0.3” represents 30% tied to Schedule 2

· Where “0.75” represents applicable percentage payout for the number of standards met in Schedule 2.

The remaining 25% of the performance-related delayed payments for Schedule 2 for that quarter would reflect the lost value of the services the State did not receive from the Contractor during the quarter and will not be payable to the Contractor.

3. Schedule 3: Compliance with Report Submission Performance Standards (30% of Performance-Related Delayed Payments)

Related Delayed Payments

For example, if during the quarter, the Contractor met five (5) or less of the report standards, the Contractor would receive none of the performance-related delayed payments held for the quarter allocated to reporting requirements. The entire performance-related delayed payments allocated to Schedule 3 for that quarter would reflect the lost value of the services the State did not receive from the Contractor during the quarter and will not be payable to the Contractor.

4. Schedule 4: Staff Turnover Rate (10% of Performance-Related Delayed Payments)

Related Delayed Payments

For example, if during the quarter, the Contractor had a staff turnover rate of 13%, the Contractor would receive half of the 10% of the withhold allocated to Schedule 4.

Example Calculation:

· Where the number of quarterly invoices withheld is equal to 10% of each month.

· Where “0.1” represents 10% tied to Schedule 4.

· Where “0.5” represents applicable percentage payout for the number of standards met in Schedule 4.

The remaining 50% of the performance-related payments for Schedule 4 for that quarter would reflect the lost value of the services the State did not receive from the Contractor during the quarter and will not be payable to the Contractor.