Attachment 2 - Reporting Requirements.pdf
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- Attached to
- Nebraska Medicaid Enrollment Broker
- Solicitation number
- 125920 O3
- Issued by
- Nebraska
About this file
This is a reporting requirements attachment for the Nebraska Medicaid Enrollment Broker contract administered by the Nebraska Department of Health and Human Services, Medicaid and Long-Term Care (MLTC) division. The document outlines comprehensive reporting obligations for the selected enrollment broker across multiple reporting cadences. Monthly reports due by the 15th of each month include call center queue statistics, call reasons, call center quality summaries, enrollment activity metrics, enrollment methods, primary care physician selection data, executive dashboards, operational summaries, health plan change reports, for-cause request documentation, file transfer reports, mailed materials counts, returned mail details, website availability and response time data, enrollment broker grievances, health plan grievances, and fraud, waste, and abuse reports. Quarterly reporting requirements include an open enrollment change period report due by April 15th. Annual reporting obligations, due at various dates throughout the year, encompass an open enrollment executive summary dashboard (by January 15th), a fully executed engagement letter with the CPA (by December 1st), an audit report (by June 1st), a systems refresh plan (by January 31st), an independent security audit report (within 30 days of completion), ownership disclosure documentation (by January 31st), and a member education plan (by November 30th).
All reports must be submitted using MLTC-provided templates or in formats approved by MLTC, with adjustments to due dates when they fall on weekends or state-recognized holidays, moving to the next business day. Ad hoc reports addressing any data related to enrollment broker duties and obligations must be submitted within five business days of request from MLTC, MLTC designees, the State Legislature, or Centers for Medicare & Medicaid Services.
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Text version
125920-03 Nebraska Medicaid Enrollment Broker
Attachment 2 – Reporting Requirements
If a due date falls on a weekend or State recognized holiday, the report is due the next business day. All reports must be submitted in an MLTC provided template or in a format approved by MLTC.
Ad Hoc Reports Description Due Date
Any data related to Enrollment Broker (EB) duties and obligations
The EB must prepare and submit any other reports as required and requested by Medicaid and Long-Term Care (MLTC), any MLTC designees, the State Legislature, or Centers for Medicare & Medicaid Services (CMS).
5 business days from date of request
Monthly Reports Description Due Date
Call Center Queue Statistics Data summarizing call center operations. Monthly, no later than the 15th
Call Reasons Report showing reason for calls. Monthly, no later than the 15th
Call Center Quality Summary of phone & chat quality monitoring. Monthly, no later than the 15th
Enrollment Activity Number of enrollment actions in the EB process’s. Monthly, no later than the 15th
Enrollment Methods Enrollments confirmed during the reporting month by MMIS. Monthly, no later than the 15th
Primary Care Physician (PCP) Selection Total enrollees who have selected a PCP and not selected a PCP. Monthly, no later than the 15th
Executive Dashboard Summary Dashboard of call center SLA’s and enrollments. Monthly, no later than the 15th
Executive Operational Summary Summary of accomplishments and challenges. Monthly, no later than the 15th
Health Plan Changes Number of health plan changes within the initial 90 days; including reason for change.
Monthly, no later than the 15th
For Cause Number of for cause requests by health plan; including approvals and denials.
Monthly, no later than the 15th
File Transfers Report showing the file processing timeline and status. Monthly, no later than the 15th
Mailed Materials Report showing count of various mailed materials. Monthly, no later than the 15th
Returned Mail Report detailing returned mail including member information, item sent, sent date, returned date, reason for return, and action taken by EB.
Monthly, no later than the 15th
125920-03 Nebraska Medicaid Enrollment Broker
Attachment 2 – Reporting Requirements
If a due date falls on a weekend or State recognized holiday, the report is due the next business day. All reports must be submitted in an MLTC provided template or in a format approved by MLTC.
Website Availability & Response Time Up & down time including response time. Monthly, no later than the
Enrollment Broker (EB) Grievances Report showing details of grievances filed against the EB. Monthly, no later than the 15th
Health Plan Grievances Report showing details of health plan grievances received by the EB and actions taken.
Monthly, no later than the 15th
Fraud, Waste and Abuse (FWA) Number, description, and resolution of potential FWA. Monthly, no later than the 15th
Quarterly Reports Description Due Date Open Enrollment (OE) Change Period Report showing details of members changing health plans after participating in open enrollment.
Quarterly, no later than April
Annual Reports Description Due Date
Open Enrollment Executive Summary Dashboard
Summary of open enrollment activity. Annually, no later than January 15th
Fully Executed Engagement Letter The EB must submit a copy of the fully executed engagement letter with the CPA to MLTC.
Annually, no later than December 1st
Audit Report The EB must submit a copy of its audit report to MLTC. Annually, no later than June 1st
Systems Refresh Plan The plan must outline how Information Systems will be systematically assessed to determine the need to modify, upgrade, or replace application software, operating hardware and software, telecommunications capabilities, or information management policies and procedures in response to changes in business requirements, technology obsolescence, staff turnover, or any other relevant issues.
Annually, no later than January 31st
Independent Security Audit The EB must, at its own expense, submit to an annual independent security audit each year. The audit must cover its internal controls and other system functions. The EB must supply MLTC with an exact copy of the report.
Annually, within 30 days of completion
Ownership Disclosure Federal laws require full disclosure of ownership, management, and control of Medicaid EBs (42 CFR 455.100-455.106). This information must be provided annually.
Annually, no later than January 31st
Member Education Plan The EB’s proposed plan for member outreach includes outreach packets, other methods of communication, and ongoing member education.
Annually, no later than November 30th
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