Attachment 1 - Performance Measures.pdf
PDF 83 KB Posted
- Attached to
- Nebraska Medicaid Enrollment Broker
- Solicitation number
- 125920 O3
- Issued by
- Nebraska
About this file
This is a Performance Measures attachment for the Nebraska Medicaid Enrollment Broker contract issued by the State of Nebraska Department of Health and Human Services. The document establishes specific performance standards and associated monetary penalties for the selected Enrollment Broker (EB) across multiple operational categories. Key performance requirements include system and operational readiness completion on specified dates, staffing of vacant key positions within 30 calendar days, timely delivery of reports and data in approved formats, and processing of interface files according to established schedules. The EB must also update MCO provider files, recipient databases, and enrollment databases by 7:00 am CST the next business day of receipt, with penalties for delays in member MCO enrollment communication. Customer service metrics include maximum average speed to answer of 30 seconds and average hold time not exceeding 2 minutes on a monthly basis, with call abandonment rates capped at 5% and blocked call rates not exceeding 1%.
Additional performance obligations encompass mailing requirements for initial notice of enrollment letters, outreach packets, enrollment change notices, and Open Enrollment notices within specified timeframes, with 100% compliance expected. The EB must maintain web portal availability at 99% uptime 24 hours per day, 7 days per week (excluding MLTC-approved maintenance), restore operations within 72 hours following interruptions, submit complete turnover plans within required timeframes, and provide ad hoc reports within five business days of request. Penalties range from $100 per hour to $5,000 per calendar day depending on the performance measure violated. The document also includes provisions for Corrective Action Plans when monetary penalties may be imposed, with MLTC monitoring compliance through required reporting or on-site evaluations. Notably, the EB is prohibited from influencing members to join a particular MCO, with a $5,000 penalty per member violation.
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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
125920 O3 Nebraska Medicaid Enrollment Broker Attachment 1 - Performance Measures
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
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