Attachment-A-Statement-of-Work.docx

Attachment A – Statement of Work (SOW)

DMS-24/25-249

Table of Contents

4050 Esplanade Way Tallahassee, FL 32399-0950 850-488-2786

Ron DeSantis, Governor Pedro Allende, Secretary

DMS-24/25-249 Page 2 of 27 Attachment A: Statement of Work Scope of Work Purpose The Department of Management Services (“Department”) Division of State Group Insurance (“Division”) is seeking a qualified Contractor to provide the Department’s health insurance Enrollees and their eligible dependents with an online cost comparison tool for health care services and providers.

The purpose of the Contract is to contract with an entity that provides online information on the cost and quality of health care services and providers, allows an enrollee to shop for health care services and providers, and rewards the enrollee by sharing savings generated by the enrollee’s choice of services or providers. The Contractor must be able to meet the requirements set forth in section 110.12303(3)(a) – (d), Florida Statutes (F.S.), and the Contract. The Department seeks to partner with a transparency vendor that is innovative and flexible in developing tools for Enrollees of the State Group Health Insurance Plan.

All work completed under the Contract will be considered the intellectual property of the Department.

Definitions Access: To review, inspect, approach, instruct, communicate with, store data in, retrieve data from, or otherwise make use of any data, regardless of type, form, or nature of storage. Access to a computer system or network includes local and remote access.

Account Management Team: The individuals employed by the Vendor primarily responsible for the Department’s account.

Business Day: Monday through Friday, inclusive, except for those holidays specified in section 110.117, F.S., from 8:00 a.m. to 5:00 p.m., Eastern Time.

Calendar Day: Any day in a month, including weekends and holidays.

Confidential Information: Information that is trade secret or otherwise confidential or exempt from public disclosure under Florida or federal law.

Contract: Any binding agreement that results from this ITN, if any, between the Department and a Respondent.

Contract Administrator: The person designated pursuant to an executed Contract resulting from the successful award of the Healthcare Transparency Services solicitation.

Contract Manager: The person designated pursuant to an executed Contract resulting from the successful award of the Healthcare Transparency Services solicitation.

Contractor or Service Provider: The business entity that enters into a contract with the Department pursuant to this ITN.

Data or State of Florida Data: Data means a subset of structured information in a format that allows such information to be electronically retrieved and transmitted. Data includes the original form of the Data and all metadata associated with the Data.

Deliverables: Those services, items and/or materials provided, prepared and delivered to the Department in the course of performance under the Contract by the Contractor.

Department: The Florida Department of Management Services, a State agency.

Division: The Department’s Division of State Group Insurance.

Eligible Dependents: As defined in Rule 60P-1.003(8), Florida Administrative Code.

Eligible Service: A healthcare service for which Members may shop on Contractor’s Online Transparency Website.

Enrollee: As defined in section 110.123(2)(c), F.S.

Health Plan Member (Member): Enrollees and Covered Dependents thereof, as defined in section 110.123(2)(g), F.S.

Healthcare Provider: Any physician, hospital, or other institution, organization, or person that furnishes health care services and is licensed or otherwise authorized to practice in the State.

High Quality Provider: A Healthcare Provider or facility that has been identified as being high quality based on Contractor’s quality rating methodology.

Household: All Members under a particular Enrollee’s policy.

Implementation Date: January 1, 2026, at 12:00 A.M., Eastern Time (ET).

Implementation Plan: The written description provided by the Contractor, as approved by the Department, of the schedule of actions necessary to implement the services and begin fulfilling the Contract in a timely manner.

Invoice: A billing statement provided by the Contractor to the Department for reimbursement of Services.

Lower Cost Eligible Service: A healthcare service for which Members may shop on Contractor’s Online Transparency Website that is designated as a low-cost healthcare service based on Contractor’s price methodology.

Notice: Written notification from one Party to the other Party regarding performance under the Contract.

Online Transparency Program: The program established under this Contract that allows Members to shop online for healthcare services and allows Enrollees to receive Reward Payments when eligible.

Online Transparency Website: The Contractor’s website and mobile-optimized website or mobile application on which Members may shop for designated healthcare services.

Party or Parties: The Department and the Contractor, in the singular and plural, respectively.

Performance Guarantees: Specific measurement indicators assigned to Contract tasks representing timeliness and quality of task output.

Plan Year: Based on the calendar year from January 1st to December 31st.

Plans: Any of the insurance coverages offered through the Department, as authorized in section 110.123, F.S.

Program: The State Group Insurance Program defined in sections 110.123(3) and 110.12315, Florida Statutes.

Protected Health Information: Protected Health Information shall have the same meaning and effect as defined in 45 C.F.R. 160 and 164, limited to the information created, received, maintained or transmitted by the Contractor from or on behalf of the Department.

Reward Payment: The reward amount that shall be received by an Enrollee for utilizing the Contractor’s Services for the selection of a Rewardable Service.

Rewardable Service: A Lower Cost Eligible Service for which a Reward Payment is available.

Service Commencement Date: January 1, 2026, at 12:01 A.M., Eastern Time, the first date Services are provided to Members.

Services: Tasks to be performed by Vendor as specified in this Contract. The term “Services” includes but is not limited to, any unspecified task that is inherent in proper delivery or administration of a specified Service.

State: The State of Florida.

Subcontractor: The Contractor’s subcontractors and agents that deliver the Services required by this Contract. The term “Subcontractor” does not include healthcare providers.

Vendor Information Portal (VIP): The State’s bidding system developed in accordance with section 287.042(3)(b)2, F.S. Access VIP using the following URL: https://vendor.myfloridamarketplace.com.

Deliverables With the exception of any deviations identified in the Contract, the Contractor shall provide all Services as specified in the Contract, including all attachments thereto. The Department authorizes the Contractor to use its standard procedures for the provision of the Services that have been designed to ensure that the administration of Services is in compliance with applicable statutes and regulations. The Contractor shall provide the Services in accordance with the framework of policies, interpretations, rules, practices, and procedures as set forth in the Contract and Florida law, and as otherwise mutually agreed upon by the Parties or as directed by the Department. In the event of any conflict between this Contract and any of the Contractor’s policies and procedures, the Contract shall govern.

Online Transparency Program The Contractor shall establish an Online Transparency Program that allows Members to shop for Eligible Services and Enrollees to share in cost savings achieved through the use of services or products (if applicable) offered through the Online Transparency Program with the State of Florida (“State”).

The Contractor shall provide an online transparency tool that incorporates an Online Transparency Program for Members. The transparency tool must provide Members with information on Eligible Services that are available through network providers.

The Contractor’s transparency tool must provide information on the price and quality of healthcare services, including, at a minimum, the average amount paid in each county for Eligible Services. The average amounts paid for Eligible Services and providers may be expressed as service bundles, which include all services or products (if applicable) associated with a particular treatment or episode of care, or for separate and distinct products and services.

The Contractor’s transparency tool must allow Members to shop for healthcare services, providers, and products using the price and quality information that is provided by the online transparency tool.

Cost Savings The Contractor must identify the savings realized to the State when Members choose high-quality, lower-cost healthcare services or providers.

For each Eligible Service, the Contractor shall develop the methodology to determine the amount of savings to the State and the amount of savings to share with the Enrollee that will maximize value-based purchasing by Members. An independent validation of the methodology may be completed if desired by the State. The State of Florida reserves the right to approve methodology.

Enrollee Education The Contractor must provide outreach and education for Enrollees to learn about the Online Transparency Program, including but not limited to email correspondence, mailings, and benefit fair attendance.

Reports The Contractor must report monthly and annually on utilization, engagement, savings to Members, savings to the State of Florida, average savings per service or procedure, missed savings opportunities, and demographics of Members who utilize the Online Transparency Program.

Minimum Service Requirements The Contractor must comply with the following Minimum Service Requirements (“MSRs”):

Online Transparency Program The Contractor shall make available to Members and shall administer the Online Transparency Program as follows:

An Enrollee’s eligibility for a Reward Payment is based on the Household’s use of the Online Transparency Website, mobile app, or the Contractor’s members services, and selection of a Rewardable Service from a High-Quality Provider.

The Contractor, upon approval from the Department, shall determine the methodology(ies) for determining the quality of a healthcare provider or facility, the price for Eligible Services, and the Reward Payment by utilizing Department-approved information from reliable, industry-accepted sources.

The Contractor shall verify whether a Member received a Rewardable Service from a High-Quality Provider.

The Contractor shall be responsible for determining the Reward Payment due to an Enrollee.

The Contractor shall notify the Department of the determined Reward Payment for each Enrollee on a frequency approved by the Department. The Contractor shall exchange Reward Payment data on a frequency and in a file format approved by the Department.

The Contractor shall identify the savings realized by the Member and the State when the Member chooses a Lower Cost Eligible Service from a High-Quality Provider.

The Online Transparency Program shall include all Eligible Services and providers that provide each Eligible Service, which shall be updated on a frequency approved by the Department and made available to Members 24 hours a day, 7 days a week, except for approved downtimes.

The Contractor shall be responsible for program development and management, including updating transparency cost and quality data available to Members. The Contractor shall regularly monitor claims utilization and costs in order to develop, recommend, and implement program enhancements.

The Contractor shall make available a toll-free telephone number, website, and mobile-optimized website that Members may access to obtain information about the Online Transparency Program, including but not limited to provider-related cost information for Eligible Services and Reward Payments. The Contractor's customer service hours shall be on a schedule approved by the Department.

Online Transparency Website The Contractor shall provide, maintain, and update (1) a website and (2) a mobile application or a mobile-optimized website, both of which must provide 24/7 access for Members to log in and shop online for Eligible Services. The website will include data aggregated from various sources in a data file format used by all sources, including the Department and its contracted vendors.

The website and mobile application or mobile-optimized website shall:

1.1.1.1. Require all users to login securely as mutually agreed upon by the Parties;

1.1.1.2. Contain a comprehensive list of Eligible Services;

1.1.1.3. Display all Eligible Services and providers that provide each Eligible Service under a Member’s health plan;

1.1.1.4. As mutually agreed upon by the Parties, display the average amount that Members and the State pay for each Eligible Service provided by a provider or facility in each county. The average amount for Eligible Services may be expressed as service bundles or for separate and distinct services or products (if applicable);

1.1.1.5. Display a Price for Eligible Services by provider or facility in a geographic region, which may be expressed in a manner other than the average amount that Members and the State pay for each Eligible Service provided by a provider or facility in each county. The price for Eligible Services may be expressed as service bundles or for separate and distinct services or products (if applicable);

1.1.1.6. Display a quality rating for each provider and facility (where available) that offers an Eligible Service;

Allow Members to shop by Eligible Service, average amount or Price, the provider or facility, the provider or facility quality rating (where available), and location;

1.1.1.7. Display the Reward Payment for Rewardable Services;

1.1.1.8. Link to the Department's website and other state, federal, and condition-specific websites as appropriate to make available a variety of information to Members; and

1.1.1.9. Provide self-service tools for Members including frequently asked questions and an online tutorial on using the website.

1.1.1.10. The information contained on the website and mobile application or mobile-optimized website shall be updated according to the Contractor’s schedule to provide Members the most up-to-date and accurate cost, quality, provider, and Reward Payment information, and shall be made available to Members 24 hours a day, 7 days a week, except for approved downtimes. The Contractor shall provide the schedule to the Department prior to the go-live date (January 1, 2026) and any subsequent updates.

System Functionality

1.1.1.11. Functionality – The Online Transparency Website will be a self-service, secure, and interactive website that will contain all the elements identified in . In addition to this base system functionality, the Contractor may implement additional optimization initiatives that will enhance existing system functionality with prior notice to the Department. The Online Transparency Website shopping tool shall be based upon two (2) previous years of claims data, which the Contractor shall obtain following execution of the Contract.

1.1.1.12. The Contractor shall provide hardware, service pack upgrades, security patches when necessary, new versions, and other software releases through the Contract's term at no additional cost to the State. The Contractor will provide the Online Transparency Website functionality throughout the term of the Contract.

1.1.1.13. The Contractor shall furnish, install, operate, and maintain all property, e.g., hardware and software, upgrades, security patches, and other releases, required to perform the Contractor's obligations under this Contract at no additional cost to the Department. The Contractor shall host and maintain all data from sources designated by the Department. The Contractor shall maintain logical separation of the Department’s data from all other Contractor data. The Department shall own all State of Florida Data regardless of where the data resides. To the extent allowable under Florida law, metadata, such as search logs, generated by the Contractor shall remain the property of the Contractor with the exception of personally identifiable information and Confidential Information such as Protected Health Information.

1.1.1.14. The Contractor shall use its standard information technology environment, as follows:

a. A physically isolated network where all analytical work takes place for all of the Contractor’s clients. This work includes anything that requires Protected Health Information.

b. A web environment where all the Contractor’s clients share the Contractor’s web infrastructure with logically isolated data. This environment shall not include personally identifiable information and confidential information such as Protected Health Information, with the exception of encrypted Member log-in information.

c. The Contractor shall be responsible for integrating into the Department’s existing single sign-on database and engine. The Department agrees to comply with the Contractor’s standard for single sign-on (SSO) via SAML 2.0 (Security Assertion Markup Language) or dynamic URL, or the current industry best practice with prior Department approval. The Online Transparency Website shall be HTML 5 compliant and support all major browsers.

d. The Contractor shall provide a data interface plan including a data map and all necessary corresponding documents showing how the data is mapped and other particulars. This information shall be deemed to be property of the State. The data interface plan shall describe all interfaces that are inbound to and outbound from the Contractor or a Subcontractor. This plan shall include at a minimum the following elements:

i. File name (technical and common)

ii. File description

iii. Name of entity the file is sent to or received from

iv. Frequency of the interface

v. File layout and detailed build / load specifications

vi. For outbound files, where the file is generated from (SAP or Data Warehouse)

vii. For inbound files, where the file is loaded to (SAP or Data Warehouse)

e. The Contractor shall provide the Department with access to the necessary software / license(s) at no additional cost to the Department.

f. The Contractor shall only store or access State of Florida Data within the continental United States (U.S.). The Department reserves the right to inspect the Contractor’s data centers and facilities during the term of the Contract. The Contractor's transition services shall include a listing of any equipment and software licenses used to provide services, submission of a schedule for transition activities, and return of Department-owned data and materials being used by the Contractor.

1.1.1.15. System Security

a. The Contractor shall develop and host the Online Transparency Website. The Online Transparency Website shall have Secure Sockets Layer (SSL) to establish a secure link between a Member’s browser and the Online Transparency Website.

b. The Contractor shall establish, maintain, and enforce (and the Contractor shall ensure its affiliates and Subcontractors establish, maintain, and enforce) a policy that prohibits the sending of any State of Florida Data that is customarily considered to be sensitive or confidential in nature (e.g., social security number, Protected Health Information, etc.) by electronic mail. The Contractor agrees to encrypt the transmission of all State of Florida Data that is customarily considered to be sensitive or confidential in nature (e.g., social security number). The Service Provider shall notify the Department of the encryption software and procedures used by the Contractor.

c. The Online Transparency Website and the Contractor’s facilities shall comply with all requirements of Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended, and the Health Information Technology for Economic and Clinical Health (HITECH) Act. The Contractor shall execute and comply with all terms of ITN Attachment E, Privacy, Security, and Confidentiality Business Associate Agreement.

d. The Contractor shall develop a data security plan that describes the procedures and security measures for the protection of State of Florida Data and related information that is processed and stored by the Contractor, as well as safeguard the Contractor and Department’s valuable IT resources and assets. The Contractor shall provide the data security plan to the Department as part of the implementation plan. The data security plan shall include an audit component, that includes maintenance, retention, and review of audit logs to determine if personally identifiable information, personal health information, and State of Florida Data is accessed, modified, added, deleted, or transmitted.

1.1.1.16. Ongoing System Maintenance and Corrections

a. The Contractor shall have an ongoing obligation under the Contract to perform customary maintenance on the Online Transparency Website and to correct all newly identified or mutually agreed upon system defects, at no additional cost to the Department. The Parties may agree to changes to the Online Transparency Website through email between designated and authorized personnel of the Parties. For purposes of this Section, customary maintenance of the Online Transparency Website includes, but is not limited to, all work customarily performed with respect to:

i. adding, deleting, and updating health plans that contract with the Department;

ii. adding, deleting, and updating Eligible Services, referenced-based prices, providers, and provider quality ratings;

iii. implementing new and updating existing file-transfer protocols to create and send secure file transmissions on behalf of the State; and

iv. implementing existing interface files with additional users.

v. This Section shall not restrict the Contractor’s ability to maintain and upgrade its systems and services according to the Contractor’s normal operations cycle, as well as out-of-band patching.

1.1.1.17. Scheduled System Downtime

a. Scheduled system releases and maintenance will be performed by the Contractor and Subcontractors between 12:00 p.m. on Saturday to 12:00 a.m. on Sunday Eastern Time (ET). For system enhancements, major system projects, emergency patching, and for all system maintenance and releases that will occur outside the defined window, the Contractor and applicable Subcontractor shall coordinate with the Department regarding the required downtime window to minimize the impact in providing Services.

1.1.1.18. Quality Control and Auditing

a. The Contractor shall document all changes made to the Online Transparency Program system, including any mapping changes from the Contractor to third parties, and changes in process. The Contractor shall develop a data migration / transition plan to detail the activities that will occur in the event of Contract termination or expiration in order for the Services to be transferred back to the Department or an alternative service provider.

b. Online Transparency Website errors must be corrected within three (3) Business Days of discovery. Errors for this section shall include provider listings, provider and procedure pricing, Price, quality ratings, and Reward Payments.

c. The Contractor shall provide the Department with a data quality checklist. The checklist must identify and define the data quality measures used by the Contractor to validate the integrity of data submitted by the Department and its contracted vendors (health plans, PBM, and human resource third party administrator).

d. The Contractor shall maintain all historical data received during the term of the Contract and provide a methodology satisfactory to the State for the archiving and retrieving of historical data at no additional cost to the State. All historical data shall remain the property of the State, and shall be retained by the Contractor, pursuant to the State of Florida General Records Schedule GS1-SL for State and Local Government Agencies or returned to the State upon Contract expiration as detailed in the data migration/transition plan.

1.1.1.19. Training

a. The Contractor shall provide training and training materials to Department employees. Training should be provided prior to implementation on January 1, 2026. The Contractor shall provide training and training materials with each major upgrade, release, or version. Training may be delivered by webinar.

1.1.1.20. System Upgrades, Enhancements and Problems

a. The Contractor shall provide prior notice of any significant planned system upgrades, migrations, or other material changes, including but not limited to claims, customer service, enrollment, operating systems, and any other changes that may materially affect the administration of the Online Transparency Program. The Contractor shall provide the Department with thirty (30) days’ written notice for any system upgrades, migrations, and other material changes that fundamentally alter the system.

b. The Contractor shall immediately notify the Department upon the discovery of problems or issues impacting Reward Payment processing related to the Online Transparency Program. Failure to timely notify the Department shall be considered a material breach of Contract.

c. The Contractor shall not take corrective action related to systemic problems or issues impacting Reward Payment processing related to the program without the written approval of the Department, which approval shall not be unreasonably withheld or delayed.

Reward Payments

1.1.1.21. The Contractor shall determine and facilitate Reward Payments to Enrollees, as follows:

a. The Contractor, upon approval from the Department, shall determine the Reward Payment methodologies, Reward Payment amounts, and the Rewardable Services. Reward Payment methodologies, Reward Payment amounts, and Rewardable Services may only change upon approval by the Department, which shall not be unreasonably withheld or delayed.

b. An Enrollee will be eligible to receive a Reward Payment if the Enrollee or his or her Eligible Dependent used the Online Transparency Website and received a Rewardable Service from a High-Quality Provider. For inpatient services, the Contractor’s quality ratings will define High-Quality Provider. For outpatient services, all providers licensed by the State (as evidenced by health plan payments to the providers) are deemed high-quality.

c. The Contractor shall determine Reward Payments to eligible Enrollees based upon a Reward Payment methodology(ies) mutually agreed upon by the Contractor and the Department.

d. The Contractor shall determine the amount of each Reward Payment on a frequency approved by the Department. The Contractor must confirm that the Member complied with the requirements of the Online Transparency Program and selected a Lower Cost Eligible Service from a High-Quality Provider.

e. The Contractor shall notify the Department of each Reward Payment determination on a frequency approved by the Department.

f. The Contractor may send a confirmation notice to an Enrollee for each Reward Payment that is earned.

g. The Contractor shall accept and load data from any health plan, including a health plan that severs ties with the Department, for the tracking and accurate determination of Reward Payments.

h. The Contractor is not responsible for providing Reward Payments to Enrollees.

Online Transparency Program Materials and Communications Plan

1.1.1.22. The Contractor shall develop and distribute to each Enrollee educational materials to promote the Online Transparency Program, at the sole cost and expense of the Contractor. Such educational materials may require customization for the Online Transparency Program at no additional cost to the Department. Costs associated with printing, distributing, and mailing all materials shall be borne by the Contractor.

1.1.1.23. The Contractor shall be responsible for writing, printing, and distributing (electronically or by mail) Online Transparency Program materials based on a Department-approved communications plan.

1.1.1.24. The Contractor shall develop a Department-approved communications plan for the Online Transparency Program. At a minimum, the communications plan shall include 1) at least one digital or print communication annually to Enrollees about the Online Transparency Program, and 2) content for inclusion in the annual benefits guide. The Contractor will provide digital copy for open enrollment materials. The Department will deliver content on the program to Members.

1.1.1.25. The Contractor shall provide, upon request, printed materials in a medium widely accepted for the visually impaired and comply with any and all applicable federal and state laws and regulations.

1.1.1.26. All printed material shall be provided in electronic format with final versions submitted to the Department in a PDF file format.

1.1.1.27. The Contractor shall submit copies of all promotional and Enrollee educational materials to the Department for prior written approval. All materials shall be approved in writing by the Department prior to use. The Department shall have five (5) business days to approve material.

1.1.1.28. The Contractor shall assist the Department (e.g., review, clarify, edit, and confirm accuracy) as requested in developing Department communications on the Online Transparency Program.

Third Party Outreach

1.1.1.29. The Contractor shall use reasonable efforts to integrate with the Department’s vendors, including the Department’s health plans, pharmacy benefits manager, third-party administrator, and human resource third party administrator to enable the Contractor to effectively administer the Online Transparency Program and any current or future programs. The Contractor shall also make reasonable efforts to integrate with any other third party, as requested by the Department. The timeline for these integrations will be agreed upon during implementation.

1.1.1.30. The Contractor shall utilize data provided in the format and timeframes agreed upon between the Contractor and the Department.

Implementation Plan

1.1.1.31. The Contractor shall submit the final implementation plan to the Department for approval no later than ten (10) Business Days following execution of the contract. If the Department deems the implementation plan to be insufficient, the Contractor shall work diligently to deliver an updated, final implementation plan satisfactory to the Department, recognizing that time is of the essence. Implementation plan shall be based on the proposed implementation plan submitted by the Contractor during the procurement process.

1.1.1.32. The implementation plan shall fully detail all steps necessary to begin full performance of the contract on January 1, 2026, 12:00:00 a.m., ET, and specifically identify due dates of all tasks with a person assigned responsibility for each task.

1.1.1.33. The implementation plan shall include the following action items:

a. The establishment and maintenance of an interactive website, mobile app or mobile-optimized website(s), dedicated toll-free phone line, interactive voice response system, and Department-approved communications at least two (2) weeks in advance of the fall 2025 open enrollment period for the 2026 plan year.

b. Participation in select fall 2025 open enrollment for the 2026 plan year benefit fairs, meetings, and conference calls coordinated by the Department.

c. Scheduling regular implementation status meetings and/or conference calls with the Contract Manager. The Contractor shall appoint one of its team members to be responsible for recording detailed meeting minutes and follow-up action items on behalf of all team members, including assignment of tasks and due dates. Minutes of decisions made and a list of action items shall be sent to the Contract Manager within five (5) Business Days of the end of the meeting/call.

d. Conducting background checks in accordance with Contract section 3.2.4, including subcontractors.

e. Setting up for secure data feeds from each of the Department’s health plans, pharmacy benefits manager, and the Department’s human resource third party administrator.

f. Testing enrollment and claims files, key procedures, and program process controls (e.g., approval, design, testing, acceptance, user involvement, segregation of duties, and documentation). Department must render functional acceptance prior to Go Live (January 1, 2026).

g. Submission to a service delivery readiness assessment.

h. Finalizing and validating billing procedures, invoice design, banking, reconciliation, and other financial processes, all subject to Department’s prior approval.

i. Designing and presenting to the Department for approval all communication materials to be used.

j. Finalizing a process for tracking and responding to Member inquiries and complaints, which includes measuring and reporting turn-around time.

1.1.1.34. The Contractor shall be one hundred percent (100%) operational prior to the effective date of January 1, 2026, 12:00:00 a.m., ET. The Contractor pays the Amount of Risk listed in the Performance Guarantees for failure to meet this milestone.

Account Manager and Management Team

1.1.1.35. The Contractor shall assign a dedicated, but not necessarily exclusive, account manager as the primary contact for the Department. The account manager shall participate on the implementation team and coordinate, troubleshoot, advance, and track the State’s interests and requests throughout the organization.

1.1.1.36. The Contractor shall assign a dedicated, but not necessarily exclusive, Account Management Team that may include an executive sponsor, an account manager, claims manager, and customer service manager.

1.1.1.37. The Contractor shall provide a written list of its Account Management Team members within ten (10) Calendar Days of contract execution. Changes to the individuals listed shall be sent to the Department in writing within ten (10) calendar days of the change.

1.1.1.38. The replacement of personnel to the Account Management Team assigned to this Contract shall be subject to the Department’s prior written approval, should the Department request it at the time.

1.1.1.39. The Account Management Team shall be able to devote the time and resources needed to successfully manage the account including being available for frequent telephonic, email, and on-site consultations, if necessary.

1.1.1.40. The Account Management Team shall be familiar with the Contractor’s functions and operations that relate directly or indirectly to the Department, the Online Transparency Program, and the Department’s relationships with third parties.

1.1.1.41. The Contractor shall maintain a current Account Management Team organizational chart. The Contractor shall promptly notify the Department of any changes and provide detailed information regarding new personnel including name, professional background, mailing and physical address, email address, and work and cell phone numbers along with an updated organizational chart.

1.1.1.42. The Department may give a plan performance review to the Account Management Team or separately to each team member. An action plan, as determined by the Department, must be implemented based on measurement criteria listed in the Performance Guarantees section.

1.1.1.43. The Contractor shall participate in regularly scheduled meetings or calls as mutually agreed upon by the Parties to discuss the Online Transparency Program and website administration.

Background Checks The Contractor shall comply with employee and Subcontractor security requirements, including performing background checks described in Contract Section 4.2.4.

Meetings/Conference Calls

1.1.1.44. Quarterly Meetings: the Contractor shall attend all quarterly meetings at the State offices in Tallahassee, Florida, or by telephone conference call as directed by the Department. The Contractor shall not be entitled to additional compensation for meeting preparation or attendance. Quarterly reports are due within forty-five (45) calendar days following quarter end and meetings/calls are to be held within sixty (60) calendar days following quarter end. The fourth quarter meeting shall include both quarterly and annual calendar year reports and deliverables. Requirements also include quarterly reports and meetings as may be required by the Department throughout the term of the Contract or following termination of the Contract.

a. Agenda: At the Department’s request, the Contractor shall provide for the Department’s approval a draft agenda five (5) Business Days in advance of a meeting allowing changes to the agenda and a reasonable opportunity to prepare for the meeting. At a minimum, the Contractor and Department will review the Contractor’s quarterly reports and other issues such as performance guarantees, operations, program changes or enhancements, utilization patterns, program outcomes, customer service issues, future goals and planning, and other issues reasonably related to the Contract. The Contractor shall address past performance, anticipated future performance, and compare the Contractor’s performance under the Contract to 1) the Contractor’s total book of business and 2) other governmental clients.

b. Minutes: Within five (5) Business Days after any meeting, the Contractor shall provide the Department detailed draft meeting minutes. Department will review and revise the draft minutes as appropriate and return to the Contractor. The Contractor shall provide the Department with final minutes within three (3) Business Days after revised minutes. Minutes shall include a list and description of follow up Deliverables, with assigned person and due date.

1.1.1.45. Other Meetings: progress meetings, issue meetings, and emergency meetings shall be held as necessary. Either party may call such a meeting, subject to reasonable notice. Any meeting held in person shall be at the State’s offices in Tallahassee, Florida. The Contractor shall not be entitled to additional compensation for meeting preparation or attendance.

Benefit Fairs

1.1.1.46. The Contractor shall participate in all locations of the annual open enrollment benefit fair locations that are sponsored by the Department or its designee. The Contractor’s representatives attending the benefit fairs shall be employees of the Contractor (not subcontractors or temporary personnel) and adequately trained and knowledgeable about the Online Transparency Program and website. The Contractor shall educate Enrollees on the Online Transparency Program and website benefits, services, and other tips to ensure a positive Member experience. Open enrollment is held annually in the fall for enrollment coverage effective the following January 1st.

1.1.1.47. The Contractor shall be responsible for all costs associated with participating in benefit fairs, including travel and a proportionate share of facility fees.

1.1.1.48. The Contractor shall not discuss with Enrollees or prospective Enrollees or in any manner allude to coverage, products, or materials other than those explicitly related to the Online Transparency Program without the permission of the Department.

Mail The Contractor shall maintain a minimum of one dedicated post office box (e.g., for Claims, appeals, general correspondence, returned mail). The Contractor shall hold returned mail for thirty (30) calendar days, during which time the Contractor shall search for an updated address with each subsequent file coming from the state’s human resource administrator (People First). After thirty (30) Calendar Days, the Contractor shall store copies on its document imaging system and destroy the returned mail.

Department Inquiries, Account Service and Dispute Support

1.1.1.49. The Contractor shall, upon request of the Department or its attorneys and at no additional cost, assist the Department in responding to inquiries received by the Department from Enrollees, Members, providers, or other persons related to any aspect of Services delivered under the Contract. Such requests shall be a) given a priority status, b) subject to a method of tracking, c) result in the delivery of all requested information, documentation, etc., and d) handled or overseen by a lead customer service person.

1.1.1.50. The Contractor shall immediately assist the Department in preparing its reply when the Department requires an emergency response, including providing data and documentation within the time frames prescribed by the Department given at that time.

Public Records Requests and Subpoenas The Contractor shall, upon request and at no additional cost, provide the Department with any necessary data, documents, and so forth, to enable the Department to respond in a timely manner to public records requests and subpoenas related to any aspect of Services delivered under the contract.

Requests for Legislative Initiatives and Legislative Reports The Contractor shall make available, at no additional cost to the Department, all necessary resources to assist the Department in responding to bill analyses and legislative inquiries and requests, including but not limited to the Account Management Team, analytics and outcomes, research and development, and government relations related to any aspect of Services delivered under the Contract. The Contractor shall respond within the timeframe set by the Department, which shall be determined at the time of the inquiry depending upon the scope and complexity of the request.

Customer Service Unit

1.1.1.51. The Contractor shall maintain a customer service unit dedicated, but not necessarily exclusive, to performing all aspects of Member-related customer service and shall include a call center. Calls to this unit shall be accepted and answered promptly during hours mutually agreed upon by the Parties, currently Monday through Friday 9 a.m. to 6 p.m. (EST), excluding State holidays set forth in section 110.117, Florida Statutes.

1.1.1.52. The Contractor shall maintain a toll-free customer service number, which will permit access anywhere in the United States. Customer service unit is subject to pertinent requirements in the Performance Guarantees section.

1.1.1.53. The Contractor shall record one hundred percent (100%) of all customer service calls. Audio copies of call recordings must be provided to the Department within three (3) Business Days upon request. Call recording must be provided electronically.

Customer Service Operations

1.1.1.54. The customer service operation shall include, at a minimum, the following:

a. Program-specific training and knowledge to assist Members, prospective Enrollees, physicians, etc., regarding the Online Transparency Program;

b. Assistance to Members who contact the Contractor’s customer service unit with limiting identifying information;

c. If applicable, maintaining of an updated enrollment file that identifies eligible Members and other pertinent information regarding Members;

d. Processes for triaging emergency requests;

e. Adequate and appropriate access to the customer service system for Members with disabilities (e.g., TTY and online access);

f. Sufficient personnel available to provide multi-lingual (Spanish, at a minimum) service and the ability to provide service to the hearing and vision impaired; and

g. Information systems capable of electronically transmitting, receiving, and updating Enrollee profile information from People First. Maintain a service disruption plan or procedure to continue customer service activities when temporarily unavailable due to either scheduled or unforeseen events (e.g., relocating offices, repairing/restoring utility or power supply, upgrading phone systems, and other events). The Department shall be notified as soon as possible for scheduled disruptions and other events.

Member Satisfaction Surveys The Contractor shall conduct an annual Member satisfaction survey to measure overall satisfaction, subject to Section 4: Performance Guarantees of this Attachment 2. Survey instrument, methodology, timing, and distribution are subject to Department approval. In addition to the Contractor’s annual Member survey, the Department may conduct its own Member satisfaction survey. The Department may select the survey instrument and may either conduct or have it conducted by an independent third party. Survey results may be used, in part, to determine satisfactory performance of the Contract. If the survey shows unsatisfactory performance, the Contractor shall implement a corrective action plan approved by the Department.

Protected Health Information The Contractor agrees to adhere to leading industry practices in the development, implementation, and application of administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the Protected Health Information that the Contractor creates, receives, maintains, or transmits in the Contractor’s administration of the Contract, as required by the Health Insurance Portability and Accountability Act (HIPAA) security standards and all applicable HIPAA administrative simplification rules.

Use of Plan Data

1.1.1.55. The Contractor shall not sell or share the State of Florida Data, any health plan’s data, or any metadata without the prior written authorization of the Department.

1.1.1.56. The Contractor agrees that the only compensation to be received by or on behalf of its organization in connection with this Contract shall be that which is paid directly by the State.

Data Transfers as Required File and data transfers between the Contractor and Department and/or the Contractor and Department authorized third parties is required and shall be exchanged using a method, format, and frequency required by the Department. The Contractor agrees that the Department's enrollment file shall be the official system of record. The Contractor shall not overwrite, update, or in any way change the enrollment information without express written direction from the Department or People First.

Records Retention The Contractor shall retain records as required by the Contract or longer, if required by state and/or federal laws or regulations.

Eligibility Verification The Contractor shall verify Member eligibility before authorizing a Member to select an Eligible Service. The Contractor may rely on the most recent eligibility file for verification of eligibility.

Inaccurate Reward Payments

1.1.1.57. Upon discovery, notification, or recoveries as part of audits (e.g., Contractor self-audit, Department audit, etc.), the Contractor shall fully rectify the inaccurate Reward Payments, including but not limited to reimbursing the Department whenever payment is made that is not in accordance with the terms of the Contract or Department-approved methodology. The Contractor shall reimburse the Department one hundred percent (100%) of all identified overpayments that are a result of errors on the part of the Contractor. Such overpayments shall not be reduced by contingency fees or other fees charged by an auditor or other recovery service. The Contractor must hold harmless the Enrollee for any overpayment.

1.1.1.58. The Contractor shall send payment of these recoveries to the State via an electronic fund transfer. The Contractor must provide to the Department a reconciliation report in a format and frequency approved by the Department.

Recovery Procedures for other Payments

1.1.1.59. The Contractor shall have procedures in place for recovery of fees and financial errors identified in all audits (e.g., Contractor self-audit, Department audit, eligibility audit, etc.). The Contractor shall recover and send payment of these recoveries to the State.

1.1.1.60. The Contractor shall reimburse the Department for any and all overpayments regardless of how the error was discovered. Reimbursement shall be made to the Department via an electronic fund transfer within sixty (60) days of identifying the overpayment.

Appeal Services

1.1.1.61. The Contractor shall administer appeals in accordance with the appeals process described herein and as otherwise required by the Department and state and federal law.

1.1.1.62. The Contractor shall establish a Level I appeal process. The appeal process shall allow the Member to supply any information or documentation to support the appeal. The Contractor will review the Level I appeal and all documentation and approve or deny the appeal. Upon determining that the Level I appeal is without merit, the Contractor will deny the Level I appeal in writing and provide a notification to the Member that the Member has an opportunity to file a Level II appeal with the Department. The Department will then handle all Level II appeals. The Contractor will assist the Department with Level II appeals and administrative hearings, as needed.

1.1.1.63. The Department must approve and may customize any and all correspondence, letters, and other communications related to any part of the appeals process. The Contractor shall adhere to the standards in Section 4: Performance Guarantees of this Attachment 2. The Contractor shall maintain a record of all grievances/appeals from Members and shall provide a summary of grievances/appeals to the Department quarterly or more frequently, as requested. Upon request, Contractor shall provide a narrative summary of the reasons for the grievances/appeals, the disposition thereof, and any corrective action plans implemented as the result of the grievance/appeal.

1.1.1.64. Upon the request of the Department or its attorneys, and within specified…