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125920 O3 Nebraska Medicaid Enrollment Broker Attachment 1 - Performance Measures
Medicaid Long-Term Care (MLTC) may require that the Enrollment Broker (EB) develop a Corrective Action Plan (CAP) for MLTC’s review and approval in situations where monetary penalties may be imposed. If a CAP is required, MLTC will monitor implementation of the CAP and set appropriate timelines to bring the EB into compliance with State and Federal regulations. MLTC will also monitor the effectiveness of the CAP either through required reporting or on-site evaluations.
| Performance Measure |
| Penalties |
| All system readiness requirements must be met as of the scheduled completion date. |
| $5,000 per calendar day late |
| All operational readiness requirements must be met as of the MLTC-specified date. |
| $5,000 per calendar day late |
| Vacant key staff positions must be filled within 30 calendar days by a qualified person approved by MLTC. |
| $1,000 per calendar day late |
| Reports and data must be delivered on time and prepared in the approved format. |
| $1,000 per calendar day late |
| Interface files must be processed according to the interface schedule for both incoming and outgoing interfaces. |
| $500 per calendar day late |
| Managed Care Organization (MCO) provider files must be updated to the EB’s system by 7:00 am CST of the next business day of receipt of files. |
| $100 per hour (rounded up) of delay |
| Recipient and enrollment databases must be updated by 7:00 am CST of the next business day of receipt of files. |
| $100 per hour (rounded up) of delay |
| Enrollment information must be communicated according to the interface schedule to not delay a member’s MCO enrollment. |
| $1,000 per calendar day a member’s MCO enrollment is delayed |
| On a monthly basis, average speed to answer (wait time from the time the caller is placed in the queue until the call is answered by a live person) must not exceed thirty (30) seconds.. |
| $500 per second (rounded up) above thirty (30) seconds per month |
| On a monthly basis, the average hold time (duration a customer spends in an agent-initiated hold status) must not exceed two (2) minutes. |
| $500 per minute (rounded up) above two (2) minutes per month |
| On a monthly basis, the call abandonment rate must be 5% or less. |
| $500 per percent (rounded up) above 5% abandonment rate, per month |
| On a monthly basis, the blocked call rate must not exceed 1%. |
| $1,000 per percent (rounded up) above 1% per month |
| All member and MCO calls must be returned within one (1) business day. |
| $100 per occurrence |
| 100% of initial notice of enrollment letters must be mailed by the next business day from receipt of the eligibility file. |
| $500 per occurrence |
| 100% of initial outreach packets must be mailed within two (2) business days of receiving the eligibility file. |
| $500 per occurrence |
| 100% of enrollment change notices must be mailed by the next business day from receipt of the eligibility file. |
| $500 per occurrence |
| 100% of Open Enrollment (OE) notices must be mailed at least sixty (60) days prior to the start of the OE period. |
| $500 per occurrence |
| 100% of OE letters including a comparison chart must be mailed within thirty (30) days prior to the start of the OE period. |
| $500 per occurrence |
| On a monthly basis, the web portal must be available 99% of the time, 24-hours-a-day, 7-days-a-week, except for MLTC-approved routine maintenance downtime. |
| $2,500 per percent (rounded up) below 99% |
| Operations must be restored within 72 hours of interruptions subject to the force majeure clause. |
| $1,000 per hour (rounded up) in excess of 72 hours |
| A complete turnover plan must be submitted within the required timeframes. |
| $5,000 per calendar day (rounded up) late, inaccurate, or incomplete. |
| Ad hoc reports must be submitted within five (5) business days from the date of request. |
| $1,000 per calendar day (rounded up) that the report is late, inaccurate, or incomplete. |
| The EB or its subcontractor(s) has influenced members to join a certain MCO. |
| $5,000 per member |