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 document is an attachment to a contract opportunity with the State of Nebraska's Medicaid Long-Term Care (MLTC) program for an Enrollment Broker (EB) service. The attachment outlines performance measures and associated monetary penalties designed to ensure the EB meets operational and system readiness requirements. Key service areas include system and operational readiness, staffing requirements, data reporting and delivery, interface file processing, database management, member enrollment communication, call center operations, mail delivery of notices, web portal availability, business continuity and disaster recovery, ad hoc reporting, and prohibition against influencing member MCO selection. Performance standards span both time-sensitive requirements (such as system completion deadlines and data delivery windows measured in hours) and ongoing monthly metrics (including call center speed-to-answer, hold times, abandonment rates, and web portal uptime).
The document establishes a comprehensive penalty structure to enforce compliance, with daily penalties ranging from $500 to $5,000 for various operational failures, hourly penalties of $100 to $1,000 for specific delays, and per-occurrence penalties of $100 to $5,000 for notification and reporting deficiencies. Call center performance violations carry specific per-second and per-minute penalties, while web portal availability shortfalls are assessed at $2,500 per percentage point below the 99% uptime requirement. The EB may be required to develop and implement a Corrective Action Plan (CAP) for violations subject to MLTC monitoring and oversight. The document does not specify contract pricing, term length, award date, or other financial terms within this attachment.
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Text version
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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