Attachment F - Penalties.docx

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Attached to
Financial Mgmt. for PDS in 1915(c)HCBS Waiver Programs C5684
Solicitation number
RFP 746 2500000254 3
Issued by
Elliott County, Kentucky

About this file

This penalties document outlines 34 categories of performance requirements and associated financial penalties for a financial management services contract with the Commonwealth of Kentucky's Department for Medicaid Services (DMS) for Participant-Directed Services in 1915(c) Home and Community Based Services Medicaid waiver programs. The penalties apply to vendor performance across operational, technical, administrative, and compliance domains, ranging from call center support availability and system response times to disaster recovery capabilities, key personnel retention, and deliverable submission deadlines. Penalties are assessed on a per-day, per-incident, or lump-sum basis depending on the requirement, with daily reduction amounts varying from $50 to $30,000 per calendar day depending on violation severity and duration. Critical operational requirements include maintaining 24/7/365 system access with at least 99 percent uptime, achieving solution response times of three seconds or less, completing disaster recovery within four hours, maintaining 90 percent staffing levels, and meeting key milestone dates for implementation and turnover activities.

The penalty structure establishes vendor liability for operational failures, financial errors, security breaches, and delivery delays, with escalating penalties for continued non-compliance beyond initial grace periods. For example, key milestone date delays incur $2,000 per business day for the first ten days, $5,000 per business day for days 11-30, and $7,000 per calendar day thereafter. System outages below 99 percent monthly availability result in $5,000 reductions per percentage point below the threshold, while failure to notify DMS of security incidents within 30 minutes incurs a $5,000 penalty. Additional vendor obligations include maintaining updated disaster recovery and business continuity plans with annual testing, conducting annual third-party security assessments, providing monthly operations report cards, ensuring timely billing reconciliation, and managing erroneous payments with liability for recovery and interest costs. The contract emphasizes strict compliance with Commonwealth privacy, confidentiality, and security requirements, with penalties up to $10,000 per instance for incomplete or unmet security obligations.

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Penalties may be assessed for failure to comply with Contract Requirements.

Attachment F: Penalties

No.
Category
Contract requirement
Penalty/Reduction
2.001
Call Center Support
Provide toll-free telephone and facsimile access to support program initiatives Monday through Friday (excluding Federal holidays) during, at minimum, the hours of 8:00 a.m. through 6 p.m. Eastern Time.
DMS may reduce invoiced compensation up to five hundred dollars ($500) for each calendar day the Vendor fails to comply with this requirement.
2.002
Change Control
Perform systems maintenance and modifications for all component parts of the solution within the mutually agreed upon timeframes, as required by DMS.

Document at a high level new change control items within two (2) business days from the date that the Change Control items are identified.

Provide a full impact assessment within ten (10) business days from the date that the Change Order is logged.

DMS may reduce invoiced compensation up to five hundred dollars ($500) for each time the Vendor fails to comply with this requirement.

2.003
Contract Management – Billing/Invoicing
Provide to DMS, or its designee, each month an accurate reconciliation of billed charges to expenses incurred for approval.
DMS may reduce invoiced compensation up to five hundred dollars ($500) for each calendar day, or any part thereof (beginning the next calendar day), after the inaccurate reconciliation of billed charges to expenses incurred has been provided.
2.004
Contract Management Responsibilities
Meet all federal and state privacy, confidentiality, and security requirements within the Vendor's operation.
DMS may assess up to five thousand dollars ($5,000) if item identified as incomplete or not met.
2.005
Correctness of Payments – Notification to the Commonwealth
Notify DMS immediately upon discovery of any erroneous payments, irrespective of cause, and prior to initiating appropriate recovery action. Use the change request process to notify DMS of any system errors that result in a potential erroneous payment.
DMS may assess up to two thousand dollars ($2,000) for each instance in which the Vendor has not notified DMS of an erroneous payment within four (4) clock hours of discovery.
2.006
Correctness of Payments – Other
The following requirements included in correctness of payment: Provide accurate and timely buy-in accretion and deletion based upon DMS-supplied data and DMS-approved calculation logic.
Should pay or reimburse DMS for all costs associated with correcting the erroneous payments, including costs for reprocessing, back-out processing, distribution of corrections, and any other associated costs. DMS may assess up to two thousand dollars ($2,000) if item identified as incomplete or not met.
2.007
Correctness of Payments – Vendor Liability
Be responsible for any erroneous payments identified as a result of DMS or federal claims reviews or as reported by employees that are a result of incorrect Vendor staff action, inaccurate system data, or inaccurate processing.
The Vendor should pay to DMS any portion of an erroneous payment not recouped within one hundred and eighty (180) calendar days of its receipt of the direction initiating its recoupment. In addition to the amount of the erroneous payment(s), the Vendor should be liable for interest payments at the prevailing prime beginning from the date of erroneous payment through the date of payment to DMS.

The Vendor should make such payment to DMS within seven (7) calendar days of the expiration of the one hundred and eighty (180) calendar-day timeframe. In addition, DMS may assess up to ten thousand dollars ($10,000) for each instance if item identified as incomplete or not met.

2.008
Correctness of Payments – Accordance with Commonwealth Policies and Rules
All payments, adjustments, and other financial transactions made through the system should be made to active enrolled employees for approved services and in accordance with the payment rules and other policies of DMS. Notify DMS immediately upon discovery of any erroneous payments, irrespective of cause.
If an erroneous payment is made to a Provider and that payment is the result of a failure of the Vendor either to use available information or to process correctly, then the Vendor should be liable for the erroneous payment for which full recovery cannot be made using all reasonable procedures. The Vendor should pay or reimburse DMS for any costs associated with system and operations changes associated with fixing the error(s) that caused the erroneous payment, including costs DMS or its agents incur associated with re-processing of erroneous data distributed by the Vendor. In addition, DMS may assess up to one thousand dollars ($1,000) for each instance if item identified as incomplete or not met.
2.009
Delay or Interruption of Operations
Delays or interruptions in the operations and related services caused by any failure, act, or omission of the Vendor. Regardless if DMS elects to terminate this contract upon such a breach, it is nevertheless entitled to recoup: 1) The difference between the cost to DMS under this contract and the cost to it under any interim or substitute Contract or other method of operation; 2) The liability of DMS to any third person arising directly or consequentially out of the Vendor’s breach and cancellation of this contract; and 3) The cost to DMS of all actions taken by it to locate and secure a substitute or interim Vendor or method of operation.
The Vendor should be liable for all costs incurred by DMS to continue the current solution and operations.
2.010
Deliverables
Each deliverable, as defined in the approved Project Work Plan, should be delivered to DMS, in final form, in the number specified and on the date specified in the approved Project Work Plan.

All deliverables should be in a format approved by DMS and meet DMS’ content and accuracy requirements.

These requirements should be further defined and tied to media, format, content, and accuracy specifications outlined in the DEDs.

Manage the deliverable review process utilizing the 10-5-5 Review Cycle.

If the Vendor deviates without seeking DMS approval, a penalty should be assessed.

DMS may assess one hundred dollars ($500) for each business day, or any part thereof, that a deliverable is late, which includes providing less than the required copies or delivery on incorrect media. DMS may assess an additional one hundred dollars ($500) for each business day, or any part thereof, that a deliverable continues to not meet minimum content requirements or the approved format after its formal rejection by DMS, when appropriate.

2.011
Disaster Recovery
Create and maintain a DRP, BCP, and System Backup Plan throughout the life of the Contract. These plans should clearly outline the roles and responsibilities of both the vendor and the DMS, ensuring alignment with DMS’s processes and fulfilling all necessary requirements. Complete initial and annual testing of the plan. Failure to update the Disaster Recovery Plan (DRP), Business Continuity Plan (BCP), and System Back-up Plan, at a minimum annually, may result in penalties from the deliverables section.
DMS may reduce invoiced compensation up to five percent (5%) per calendar day, or any part thereof, for each calendar day after a declared disaster in which the Vendor’s solution fails to recover within four (4) clock hours of the disaster event. DMS may also pursue consequential or liquidated damages. DMS may reduce invoiced compensation up to two thousand dollars ($2,000) per calendar day, or any part thereof, for each calendar day of delay in conducting a DR Test. DMS may assess up to ten thousand dollars ($10,000) for each failed test.
2.012
Disaster Recovery – Alternate Operations Site
In the event of a disaster to the primary physical hosting site, the system should provide the ability to recover and be operational in an alternate site within four (4) clock hours from the time of the disaster event.
DMS may reduce compensation up to ten thousand dollars ($10,000) per calendar day, or any part thereof, for each calendar day after a declared disaster in which the Vendor’s solution fails to recover within four (4) clock hours of the disaster event. DMS may also pursue financial damages.
2.013
Documentation
Provide DMS with complete, accurate, and timely documentation. Such documentation should be defined through the Deliverable Expectation Document (DED) process, be in accordance with specifications approved by DMS and delivered according to the project schedule.

Any changes that occur to the operational system should be documented according to specifications approved by DMS.

Documentation of any such changes should be provided to DMS based on the project schedule.

DMS may reduce compensation up to five hundred dollars ($500) for each business day, or any part thereof, beginning the next business day after the documentation due date the required documentation has not been provided to DMS. DMS may reduce compensation up to five hundred dollars ($500) for each business day, or any part thereof, during which the documentation is unacceptable as to format, accuracy, and completeness based on DMS review.

Reduction in compensation should be imposed until the Vendor provides DMS with acceptable documentation.

2.014
Employee Onboarding
All new employees should be onboarded within thirty (30) days, unless the FMA can attest to delays outside of their control such as incomplete packet submission, the submission of inaccurate employee information or delays by the employee to submit required background checks.
For each day of delay beyond the agreed-upon onboarding deadline, the Vendor should pay a penalty of five hundred dollars ($500) to DMS.
2.015
IRS
Produce and mail out 1099 and/or W9 earnings reports no later than January 31st of each year and report to the IRS no later than March 1st, or no later than the extended due date if the Vendor has received approval from DMS to file for an extension.
The Vendor should pay IRS penalties/damages for late distribution of 1099s and/or W9s.

DMS may assess up to five thousand dollars ($5,000) if item identified as incomplete or not met.

2.016
Key Milestone Dates
Design, develop, test, and implement the system no later than the contractually agreed upon implementation date.

Accomplishment of certain specified activities by the key milestone dates, as defined in the work plan, should be necessary to ensure project(s) are on track.

DMS may reduce compensation up to two thousand dollars ($2,000) per business day, or any part thereof, for each of the first ten (10) business days of delay in meeting a milestone date.

DMS may reduce compensation up to five thousand dollars ($5,000) per business day, or any part thereof, for each of the next twenty (20) business days of delay in meeting a milestone date.

DMS may reduce compensation up to seven thousand dollars ($7,000) per business day, or any part thereof, for each additional calendar day of delay in meeting a milestone after thirty (30) business days.

Approval of a Contract or Project Work Plan modification does not waive DMS's ability to impose damages and/or reductions in compensation if warranted by other terms of the Contract.

The reductions in compensation as listed in this RFP should be in addition to any amounts assessed for delays in meeting the operational start date.

2.017
Key Personnel
Key and lead personnel commitments contained in the Vendor's proposal for all phases of the contract should not be changed without prior written approval of the DMS Contract Administrator, unless due to the death, disability, resignation, termination, or military recall of any key or lead individual. Staffing includes the staff proposed for all key and lead positions required within this RFP at the levels of effort proposed or as specified in the Contract. Maintain staffing levels throughout the project at ninety percent (90%) or more of the Project Staffing Plan agreed to during project planning.
DMS may assess up to twenty thousand dollars ($20,000) in reduction in compensation for each key personnel and ten thousand dollars ($10,000) in reduction in compensation for each lead personnel proposed in the Vendor’s response to the RFP who is changed for reasons other than death, disability, resignation, termination, or military recall.

DMS may assess up to an additional one thousand dollars ($1,000) in reduction in compensation per calendar day after the initial thirty (30) calendar days allowed for Vendor to find an acceptable replacement for the key or lead personnel and an acceptable replacement has not been provided.

If the Vendor fails to maintain ninety percent (90%) of the mutually agreed to Project Staffing Plan for a period exceeding thirty (30) contiguous calendar days, DMS may assess up to an additional one thousand dollars ($1,000) in reduction in compensation per calendar day after the initial thirty (30) calendar days allowed for Vendor to find an acceptable replacement to maintain the ninety percent (90%) staffing level.

2.018
Lack of Collaboration
Commit to full cooperation with all other DMS Vendors and DMS employees.

Not commit or permit any act that interferes with the performance of work by any other Vendor or by DMS employees. If the Vendor fails to demonstrate effective collaboration, DMS may assess the situation and take appropriate actions.

DMS may provide formal, written notice with details for correction, including action(s) to be taken. If action(s) are not taken within five (5) business days, DMS may reduce invoiced compensation up to one thousand dollars ($1,000) per business day. If action(s) are not resolved in thirty (30) business days, then DMS may reduce compensation up to two thousand dollars ($2,000) per each business day.

2.019
Monthly Report Card
Produce within the first fifteen (15) calendar days of the month a Monthly Operations Performance Report Card, for the previous month. Due to the changing environment, report card performance standard Contract requirements and Vendor-supplied Measurements are to be re-evaluated quarterly for appropriateness. Any additions to the report card should be finalized through joint negotiation between DMS and the Vendor.
DMS may reduce invoiced compensation up to five hundred dollars ($500) per calendar day, starting on calendar day sixteen (16) through calendar day twenty (20), or any part thereof, that the Report Card has not been supplied to DMS. DMS may reduce invoiced compensation up to one thousand dollars ($1,000) per calendar day, or any part thereof, for each additional calendar day of delay after the first twenty (20) calendar days, and continuing thereafter, that the Report Card has not been supplied to DMS.
2.020
Online Access to Solution
Ensure access to all screens, systems, and data, including all Web-enabled capabilities, twenty-four (24) clock hours per day, seven (7) days per week, and three hundred sixty-five (365) days per year (24/7/365), except for Commonwealth-approved scheduled and emergency outages.

Continuously monitor the entire solution uptime and report all unapproved outages to authorized Commonwealth staff, including DMS Information Security immediately after the outage. Ensure DMS is notified of the incidents per the category defined below.

Ensure the mode of notification and elapsed time between issue and notification is decided during JAD. Severity of issues that trigger a notification.

1. Critical: Total system failure or a major component not working and has critical impact to business.

2. High: Associate function not working with no work-around available. Moderate to severe impact to business functions.

3. Moderate: System/functional error that can be bypassed. System/functional errors that occur outside normal routine.

4. Low: Low to moderate impact to business function. Possible design problem questions. Low impact to business function/workaround exists.

DMS may reduce compensation up to five thousand dollars ($5,000) for every percentage point below ninety-nine percent (99%) for each month in which Commonwealth does not have online access available as required in the contract.

2.021
Operational Start Date
The solution should be operational no later than the contractually agreed upon implementation date.
Compliance with the contractual operational start date is critical to DMS’s interest. If the Vendor does not fully meet the operational start dates approved in the DDI Phase Detailed Project Work Plan, then the Vendor should be liable for all costs incurred by DMS. The Vendor should also forfeit all claims for payment of monthly expenses and operational payments for that month and each month thereafter until DMS approves operational readiness.

In addition, DMS may assess up to five thousand dollars ($5,000) per calendar day if item identified as incomplete or not met.

2.022
Performance Specifications for Batch or Web-Based Interfaces for Data Exchanges
Response time for batch or web-based interfaces for data exchanges should not be greater than five (5) seconds for at least ninety-five percent (95%) of the transactions measured weekly.
DMS may reduce invoiced compensation up to one thousand dollars ($1,000) for each time the response time for batch or web services-based interface transactions for data exchanges is greater than five (5) seconds for at least ninety-five percent (95%) of the transactions measured weekly.
2.023
Post Implementation Maintenance and Support
Adhere to the below post-implementation maintenance and support severity guidelines:

1. Critical: Total system failure; major component is not working; mission critical impact to business function.

2. High: Associated function not working with no workaround available; moderate to severe impact to business function.

3. Medium: System/functional error that can be bypassed; system/functional errors that occur outside normal routine.

4. Low: Low-to-moderate impact to business function; possible design problem; low impact to business function/workaround exists.

DMS may reduce invoiced compensation as follows:

1. Critical: Two thousand dollars ($2000) for each incident when response time is greater than one (1) clock hour.

2. High: One thousand dollars ($1000) for each incident in which response time is greater than four (4) clock hours.

3. Medium: Two hundred dollars ($200) for each incident in which response time is greater than twenty-four (24) clock hours.

4. Low: Fifty dollars ($50) for each incident in which the response time is greater than seventy-two (72) clock hours.

2.024
Privacy and Confidentiality
Meet all Commonwealth privacy and confidentiality requirements within the Vendor’s operation.
DMS may pursue consequential or liquidated damages for each violation as deemed necessary and appropriate.
2.025
Security
Create and maintain security controls and services listed in this RFP at all times. Upon discovering a suspected security incident or data breach, should notify DMS immediately, and no later than thirty (30) minutes, failure to notify DMS may result in a penalty.

DMS defines a Security Incident and a Data Breach as the following: Security Incident - Any event that violates DMS security policies and procedures. Security Breach - A security incident that affects data confidentiality, integrity, or availability, which requires the notification of affected individuals, regulatory agencies, and other affected parties.

Provide comprehensive reports documenting the results of all security testing activities on a timely basis as mutually agreed upon.

Meet exit criteria for each phase of testing as mutually agreed upon by the Vendor and DMS.

Failure of the Vendor to notify DMS of a suspected data breach within the specified timeframe may result in a penalty of five thousand dollars ($5,000). DMS may reduce invoiced compensation up to five thousand dollars ($5,000) per event (multiple occurrences during a single event) in which the Vendor’s solution fails to meet a security requirement, control, or service. DMS may also pursue consequential or liquidated damages.

2.026
Security Assessment
Have a third-party security assessment done at their expense on an annual basis for both Infrastructure and Applications. Assessment results to be provided to DMS. Follow DMS standard Statement of Work (SOW) for security assessment. Any changes to SOWs are to be approved by DMS IT Security group.

Comply with this requirement of a third-party security assessment to be completed within the first quarter of every calendar year.

DMS may reduce invoiced compensation up to five thousand dollars ($5,000) per calendar month after the first quarter, until this requirement is met.

2.027
Solution Response Time
Ensure that response time should be less than or equal to three (3) seconds for mobile applications and/or website response and online transactions.

Continuously monitor the entire solution response time and report all Contract failures to authorized DMS staff.

DMS may reduce compensation up to one thousand dollars ($1,000) per calendar day for any online transactions that has a documented response time greater than three (3) seconds.

2.028
System Compliance
Comply with all of laws, regulations, and rules under System Compliance through the life of the project.
Comply with all of laws, regulations, and rules under System Compliance through the life of the project.
2.029
System Performance – EVV & Payroll Issues
Resolve any issues related to EVV and payroll within three (3) business days. If resolution is not possible within that timeframe, the Vendor should provide updates to DMS on the situation every 24 hours until resolved.
DMS may reduce invoiced compensation up to five hundred dollars ($500) for each calendar day the Vendor fails to comply with this requirement.
2.030
Technical Support
Establish and maintain a technical support team that is available per the requirements of this RFP.

If the Vendor finds a Severity 1 defect, maintenance issue, or data problem, should notify DMS within one business (1) hour. (A data problem does not include a data breach.).

If the Vendor finds a Severity 2 defect, maintenance issue, or data problem, should notify DMS within four (4) business hours.

Notify DMS of all other defects, maintenance issues, or data problems within one (1) calendar day.

Perform all research, coding, and testing required to resolve the issue, defect, or data problem.

DMS may reduce invoiced compensation up to one thousand dollars ($1,000) for each time the Vendor fails to comply with this requirement.

2.031
Training
Ensure all Training activities are planned well in advance. DMS approves all trainings (e.g., date, time, audience, agenda, and materials) thirty (30) business days prior to the training. Ensure training evaluations are conducted for each session and the results are shared with DMS within five (5) business days of the training event.
DMS may reduce invoiced compensation up to five hundred dollars ($500) for each business day after the Vendor fails to comply with this requirement
2.032
Turnover
Be required to provide full support for system turnover activities in accordance with the DMS approved Vendor Turnover Plan as follows: a) Assistance and support in turnover activities necessary to affect an orderly, structured, smooth turnover to enable DMS and the new Vendor achieve successful transition of system operations to a new solution operated by DMS or its agent. Accomplishment of certain specified turnover activities by key milestone dates, as established in DMS-approved Turnover Plan, should be necessary to ensure full compliance with the start date.

If, for any reason, the Vendor is delayed in meeting these key milestone dates and a Contract Modification to the Turnover Plan is not approved, a reduction in compensation may be assessed. Approval of a Contract or Turnover Plan modification does not waive DMS's ability to impose damages and/or reductions in compensation if warranted by other terms of the Contract. The reductions in compensation should be in addition to any amounts assessed for delays in meeting the operational start date.

DMS may reduce compensation up to ten thousand dollars ($10,000) per calendar day, or any part thereof, for each of the first ten (10) calendar days of delay in meeting a milestone date.

DMS may reduce compensation up to twenty thousand dollars ($20,000) per calendar day, or any part thereof, each of the next twenty (20) calendar days of delay in meeting a milestone date. DMS may reduce compensation up to thirty thousand dollars ($30,000) per calendar day, or any part thereof, for each additional calendar day of delay in meeting a milestone after thirty (30) calendar days.

2.033
Turnover Phase Deliverable Due Dates
Copies of each deliverable, as defined in Section 2.15– Minimum Contract Deliverable Requirements, should be delivered to DMS, when appropriate, in final form, in the number specified and, on the date, specified in the approved Turnover Plan. DMS, when appropriate, may require one (1) paper copy and one (1) electronic copy of all deliverables. The electronic copy should be compatible with Microsoft Word or other application software as requested by DMS, when appropriate, and submitted on DMS-specified media. All deliverables should be in a format approved by DMS when appropriate and meet content and accuracy requirements specified or as subsequently defined by DMS, when appropriate. These requirements should be further defined and bound to media for content and accuracy requirements in the specified DEDs.
DMS may assess up to one thousand dollars ($1,000) for each calendar day, or any part thereof, that a deliverable is late which includes providing less than the required copies or delivery on incorrect media. DMS may assess up to an additional one thousand dollars ($1,000) for each calendar day or any part thereof that a deliverable continues to not meet minimum content requirements or the approved format after its formal rejection by DMS, when appropriate.
2.034
United States Department of Health and Human Services (US DHHS) Sanctions
Perform all of its Medicaid functions according to the terms and conditions required by the SMM, Part 11.
If during the Operations, Maintenance and Modification Phase, CMS imposes fiscal sanctions against DMS as a result of the Vendor's or any subcontractor's action or inaction, the Vendor should compensate DMS the entire amount lost by DMS by the imposition of DMS sanctions. DMS may assess up to five thousand dollars ($5,000) if item identified as incomplete or not met.

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