Attachment L - Current Contact Center Operations Overview RFP 758 27000000097.docx

Attachment L: Current Contact Center Operations Overview Cabinet for Health and Family Services (CHFS) Request for Proposal – Contact Center as a Service (CCaaS) Updated August 2025

Table of Contents

Current Operations Overview Approximately thirty-two (32) Toll-Free Numbers and an additional set of Direct Inward Dial (DID) and local numbers are utilized by business areas. The selected Vendor shall assume ownership of these numbers by transferring them from the incumbent vendor to the Vendor’s designated telephony carrier through completion of the Responsible Organization (RespOrg) documentation. Upon contract termination or expiration, the Vendor shall transfer ownership of all such numbers back to CHFS or to another Vendor as directed by CHFS.

The selected Vendor shall complete all facility setup, recruitment, and training of staff, and shall be fully prepared to transition operations from the incumbent vendor on the agreed go-live date.

The vendor shall note the following as a generally observed peak call arrival pattern, but it can change due to various unforeseen events such as natural disasters or policy changes.

· Time of day: 8:00 AM to 10:00 AM EST and 12:00 PM to 2:00 PM EST

· Days of the week: Monday to Wednesday and the day after any holiday

· Time of year: During Open Enrollment for October to January.

The picture below provides a bird’s-eye view of current contact center operations.

Attachment L – Current Contact Center Operations Overview RFP 758 2700000097 – Contact Center as a Service (CCaaS) Attachment L – Current Contact Center Operations Overview RFP 758 2700000097 – Contact Center as a Service (CCaaS)

The following sections outline information for each participating agency and provide an overview of services provided, a summary of current operations, IVR, and call volume for twelve months. Appendix A provides the current web services and outbound campaign information.

Department of Community Based Services (DCBS): Family Services

The Division of Family Support is responsible for administering the Supplemental Nutrition Assistance Program (SNAP), the Kentucky Transitional Assistance Program (KTAP), Kentucky Works Program (KWP), FAST- Family Assistance Short Term, Medicaid programs, Kinship Care Program (Kinship), Child Care Assistance Program (CCAP) and any other state or federal programs that will be initiated during the contract period. DCBS family support services are administered through a network of nine service regions and offices in each of Kentucky's 120 counties.

DCBS Family Services uses the Managed Services model for the majority of Tier 1 calls. DCBS Family Services uses internal staff located in local county offices throughout the Commonwealth to handle Tier 1 calls not handled by vendor T1 vendor staff and all of the Tier 2 Contact Center operations.

DCBS Tier 1 Agents Responsibilities:

· Answer inbound calls, callbacks, make outbound calls, respond to e-mail and chat, and create a CRM ticket for each contact.

· Provide basic information and eligibility requirements for SNAP/ Medicaid.

· Application intake, assist with recertification and case changes for SNAP/Medicaid, eligibility determination, and enrolling in MCO.

· Explain special notices and documentation that are acceptable for eligibility.

· Guide callers for online application and account changes.

· Triage calls for transfers or referrals to other departments.

· Answer questions related to SEBT.

· Assist callers with online access issues, password resets, and reporting application issues to the CHFS helpdesk.

Summary of Current Operations

DCBS Family Support IVR

Call History DCBS Family Support

DCBS Family Support (Vendor Tier 1) includes Kinship Calls

Department for Community-Based Services (DCBS): Child Protection Services Administers Child and Adult Protective Services (Central Intake) and family support programs. Central Intake workers consist of state employees located throughout the Commonwealth that are responsible for handling reports of neglect and/or abuse. Central Intake is available 24 hours per day, 7 calendar days a week, with a contracted Vendor to handle calls received outside of normal business hours and on state holidays.

DCBS CPS uses CCaaS technology and internal and contracted staff to handle the calls

Summary of Current Operations:

CRM: N/A

WFM: N/A

Reporting: N/A

Self-Service: N/A

Concurrent Agents: 50–60

Support Staff: 8–10

Other channels: Not used

DCBS Child Protection Services

Department for Medicaid Services (DMS) and Kentucky Health Benefits Exchange (KHBE) DMS administers the Medicaid and Kentucky Children’s Health Insurance Program (KCHIP). KHBE administers the Kentucky Health Benefit Exchange Programs. It also includes Technical Helpdesk

DMS and KHBE operate as one unit and use the Managed Services model for Tier 1 & Tier 2 operations. All the requirements under the Managed Services will be applicable for this engagement. It also has a technical helpdesk that provides callers with assistance for resolving technical issues related to the self-service portal. Callers can reach out to the helpdesk for support with system access problems, including login difficulties and password resets. The helpdesk serves as the first point of contact to guide users, troubleshoot issues, and ensure they can successfully access and use the portal.

DMS Tier 1 Agents Responsibilities:

· Answer inbound calls, callbacks, make outbound calls, respond to e-mail and chat, and create a CRM ticket for each contact.

· Provide basic information and eligibility requirements for Medicaid, KCHIP, KIHIPP, and QHP.

· Application intake, assist with recertification and case changes for Medicaid/KCHIP/KIHIPP/QHP, eligibility determination, and enrolling in MCO/QHP.

· Explain special notices and documentation that are acceptable for eligibility.

· Guide callers for online application and account changes, including MCO/QHP changes.

· Triage calls for transfers or referrals to other departments.

· Answer questions related to Form 1095-A and Form 1095-B.

· Assist callers with online access issues, password resets, and reporting application issues to the CHFS helpdesk.

DMS Tier 2 Agents Responsibilities:

· Handle direct calls and inbound transferred calls from Tier 1 for MCO & QHP enrollees.

· Assist callers with issues related to policy, claims, billing, and pharmacy issues for Medicaid and KCHIP programs.

· Research and resolve issues related to MCO/KCHIP/QHP.

· Create SR&I tickets for escalated issues related to QHP.

· Complete outbound outreach for MCO/QHP enrollees.

· Create CRM incidents for escalated issues related to MCO/QHP to DMS state workers.

8:00 AM to 5:00 PM EST (during Open Enrollment)

CRM: Oracle RightNow

WFM: NICE IEX

Reporting: PureInsights

Support Professional IVR Tax IVR

Self-Service: 19 prerecorded; 3 data integrated

Concurrent Agents: 200–250

Support Staff: 12–15

Other channels (Email, Chat, SMS, Social Media): Not used

DMS & KHBE IVR

The department has three IVR to services callers.

· DMS & KHBE Tier1 IVR: This IVR is used by Medicaid Members

· Support Professional IVR: This IVR is used by Agents, Kynectors, Employers and Providers.

· Tax IVR: This IVR is used by Medicaid & KHBE Members

· Kynect Technical Helpdesk : This IVR is used for technical helpdesk

DMS & KHBE Main IVR

T1 DMS & KHBE

Kynect Technical Helpdesk

Medicaid Partner Portal Application (MPPA)and Medicaid Waiver Management (MWMA) MPPA is Kentucky’s web-based portal that automates Medicaid provider enrollment, maintenance, and revalidation. MWMA is Kentucky’s online system for enrolling and managing individuals in 1915(c) Home and Community-Based Services (HCBS) waiver programs—including PACE (Program of All-Inclusive Care for the Elderly)—and managing their care plans.

MPPA and MWMA uses the Managed Staffing model to staff the Contact Center operations.

The Tier1 agents shall perform the following and any other activities assigned during the contract period.

· Answer inbound calls, callbacks, make outbound calls, and respond to e-mails. Create CRM ticket for each contact.

· Assist the callers from Waiver case management agencies with concerns and case issues, including navigation and process questions.

· Assist callers with online access issues, password resets, and reporting application/system issues to CHFS helpdesk.

The Supervisors shall perform the following and any other activities assigned during the contract period.

· Interview, hire, and ensure initial and ongoing training is completed for team members.

· Assist agents with escalated contacts or issues.

· Perform QA and performance evaluation, create productivity reports, and provide one-on-one feedback.

· Ensure the call center is staffed for the forecasted call volume. Monitor and modify agent schedules.

· Author articles for Knowledge Base.

· Monitor and approve incident escalation to the CHFS helpdesk.

MWMA has an email inbox to receive queries from end users. Currently, the e-mail is responded to with an automatic response, and a CRM ticket is created by attaching the inbound email. The vendor must transition this functionality to the proposed CCaaS solution. The vendor shall complete any requests for changing the automatic response as system maintenance and not a billable change request. The timeline for replacing the automatic response will be mutually agreed upon based on business needs.

Summary of Current Operations

CRM: Oracle RightNow

WFM: Not Applicable

Reporting: PureInsights

IVR & Self-Service

Support Professional IVR

Self-Service: 0 prerecorded; 0 data integrated

Concurrent Agents: 20 –22

Support Staff: 3

Other channels (Chat, SMS, Social Media): Not used

MPPA & MWMA IVR

This group gets calls routed from the Support Professional IVR.

MPPA & MWMA

Long Term Services and Support (LTSS) Kentucky’s Medicaid LTSS program is structured to meet a broad spectrum of long-term care needs—from home-based services and elderly community care to institutional support and specialized care for people with disabilities. Central components like HCBS waivers and PACE promote independence and reduce reliance on institutional settings, while tools like KLOCS help streamline eligibility and care coordination.

The current Vendor provides the CCaaS to this group. LTSS, staffed by state employees, University of Kentucky contractors, and Adecco temporary employees, oversees programs for Kentuckians who need ongoing support due to their age, medical condition, or disability. LTSS offers a variety of options to meet each individual’s unique needs.

LTSS uses internal and contracted staff to staff the Contact Center operations.

LTSS has an email box to receive queries from end users. Currently, the email is responded to with an automatic response, and a CRM ticket is created by attaching the inbound email. The vendor must transition this functionality to the proposed CCaaS solution. The vendor shall complete any requests to change the automatic response as system maintenance and not a billable change request. The timeline for replacing the automatic response will be mutually agreed upon based on business needs.

Summary of Current Operations

CRM: Oracle RightNow

WFM: Not Applicable

Reporting: PureInsights

IVR & Self-Service

LTSS IVR

Self-Service: 0 prerecorded; 0 data integrated

Concurrent Agents: 8 –10

Support Staff: 3 to 5

Other channels (Chat, SMS, Social Media): Not used

LTSS IVR

LTSS

Department for Public Health (DPH) DPH provides services and programs to improve the health and safety of people in Kentucky. To carry out this important mission, DPH administers and oversees a variety of programs designed to improve the lives of residents and visitors to the Commonwealth through the prevention of negative health outcomes, promotion of healthy lifestyles, protection from diseases, injury, and environmental health impacts. These programs and services are delivered locally under the supervision of DPH via sixty-one (61) local health departments/districts serving all one hundred twenty (120) Commonwealth counties.

DPH uses the Managed Services model for Contact Center operations. The DPH agents are dual-skilled to handle DPH and DMS calls.

Tier 1 Agent DPH performs the following tasks:

1. Answer inbound calls, perform callbacks (if requested by email), and answer emails from a shared email inbox.

2. Address concerns or questions by Kentucky residents inquiring about infectious diseases.

CRM: Oracle RightNow

WFM: NICE IEX

Reporting: PureInsights

Self-Service: 0 prerecorded; 0 data integrated

Concurrent Agents: 2

Support Staff: 1

Other channels (Email,Chat, SMS, Social Media): Not used

Department of Public Health IVR

Dept. of Public Health

Provider Enrollment (PE) The Provider Enrollment Group of Kentucky Medicaid manages the enrollment, credentialing, and ongoing compliance of healthcare providers to ensure they can deliver covered services to Medicaid members.

Provider Enrollment uses CCaaS technology and internal staff to staff the Contact Center operations.

Summary of Current Operations

CRM: Oracle RightNow

WFM: Not Applicable

Reporting: PureInsights

Self-Service: 0 prerecorded; 0 data integrated

Concurrent Agents: 6 – 9

Support Staff: 2

Other channels (Email, Chat, SMS, Social Media): Not used

Provider Enrollment IVR This group gets calls routed from the Support Professional IVR.

Call History Provider Enrollment

Agent Referral Line Agents provide assistance with questions, applications, and enrollment for Medicaid, KCHIP, and health plans.

The Agent Referral line uses internal staff to staff the Contact Center operations.

Self-Service: 0 prerecorded; 0 data integrated

Concurrent Agents: 40 to 50

Support Staff: 0

Agent Referral Line IVR Agent Referral line

Tier 3 Operations and Triage Support (OATS) OATS administers a broad range of Cabinet programs and services, from information technology to facilities management. OATS is dedicated to providing efficient, effective, quality services for CHFS staff and the public. OATS Division of Social Support Systems, OATS DES and OATS DADS provides Tier 3 helpdesk support for escalated Contact Center issues using CRM. OATS Division of Strategic Services provides overall Vendor management for the Contact Center The vendor shall configure the CRM system to support Tier3 operations. Tier 3 OATS uses internal staff.

Concurrent Agents: 40 to 50

Support Staff: 0

IVR: Not Applicable Call History: Not applicable Office of Medical Cannabis (OMC)

OMC administers Medical Cannabis program to meet the program mission to ensure Kentuckians suffering from serious medical conditions have safe, affordable access to medical cannabis.

OMC uses Managed Staffing model to staff the Contact Center operations.

Tier 1 Agent for OMC shall help the callers with the following Applying for a medical cannabis license Medical Cannabis license access Application Status Dispensary questions – when and where will they be opened.

Escalate calls to OMC voice mail box Answer and escalate law enforcement personal calls to OMC voice mail box

OMC Patient IVR

Office of Medical Cannabis Patient

OMC Law Enforcement IVR

Office of Medical Cannabis Law Enforcement

Child Support Enforcement (CSE) – Optional CSE in the Department for Income Support provides assistance to parents with minor children seeking financial support from a noncustodial parent. The CSE program helps parents and legal guardians of minor children with the enforcement of child support obligations, court orders, and collections of support from noncustodial parents.

CSE is no longer with the Cabinet for Health and Family Services. This information is being provided so that the vendor can propose a Value-Add proposal and cost for migrating current operations to the Office of Attorney General, which would require adding them as an authorized agency to the resulting contract and setting up a separate CCaaS installation specific to that agency.

CSE uses the Managed Staffing model to staff Contact Center operations.

Tier 1 Agent for CSE shall perform the following:

1. Answer inbound calls, make some outbound calls, and create a CRM ticket for each contact

2. Assist the callers with general payment information, make payments, and answer general program questions. Transfer calls or refer callers to appropriate parties when needed.

3. Assist callers with online access setup or issues, password resets, and reporting application/system issues to CHFS or portal customer service.

4. Applications used: CRM, KASES, MAINFRAME, CSE WORKSPACE, CSE Electronic Case File Summary of Current Operations:

CRM: Oracle RightNow

WFM: Not Applicable

Reporting: PureInsights

Self-Service: 0 prerecorded; 0 data integrated

Concurrent Agents: 3

Support Staff: 0

Other channels (Email, Chat, SMS, Social Media): Not used

Child Support Enforcement IVR

Child Support Enforcement

Vendor Helpdesk

The vendor provides a dedicated helpdesk that supports all users of the CCaaS platform through both voice and email channels. The helpdesk serves as the primary point of contact for troubleshooting technical issues, addressing user queries, and guiding users on system functionality. Support is delivered in alignment with defined SLAs to ensure timely responses and issue resolution. The vendor also tracks and reports on helpdesk performance to measure efficiency and adherence to service standards.

Vendor Helpdesk IVR:

Table of Contents

Vendor Helpdesk

TFN

Welcome/Language Choice/Greeting

End Point

Vendor HD

WELCOME GREETING Helpdesk Welcome

855-637-6575

Schedule/Greeting

Open Schedule

T1_Plus_HBE_Tier3

Holiday Greeting

After Hours

Vendor Helpdesk

Knowledgebase Migrate approximately 350 articles to the proposed system. On average, 20 new articles are created annually

Reporting Requirements & Schedules CHFS currently receives the following types of reports, which may inform—but will not dictate—the structure and content of the vendor’s proposed communication and reporting approach. All reports must be generated separately for each agency using the CCaaS platform for contact center operations, whether managed by the vendor or the agency, except for meeting minutes, CCaaS system status, monthly operations, and service interruption reports.

The vendor shall present monthly operational reports to each agency where they provide managed services or managed staffing.

Agencies may request modifications to report content based on operational needs during the contract term.

Details of Content for Monthly Operational Report Financial

· Yearly spend and SLA penalty history (life of contract)

· Monthly spend history (past 12 months) Business

· Previous month’s updates

· Next month’s plans

· Value additions

· Risks, issues, and concerns Self-Service

· 12-month usage trends for each self-service Outbound Campaigns

· 12-month usage trends for each campaign CCaaS Operations

· System uptime, response time, and downtime (12-month trends with root cause & resolution plan)

· License and telephony minutes usage trends (past 12 months) Voice Signature & Pre-Recorded Scripts

· 12-month usage trends by signature type

· 12-month usage trends by script type Call Recording

· One-to-one match required between ACD inbound/outbound calls and recordings Vendor Helpdesk Performance

· SLA-based statistics for voice and email Operations Metrics

· 12-month trends: IVR call volume, forecast vs. actual call volume, transfer rates

· ASA (Average Speed of Answer), AHT (Average Handle Time), and Abandonment Rate

· Staffing required vs. actual, attrition rate, repeat callers

· Interval-based AHT & ASA trends Staffing

· Headcount, hiring pipeline, attrition, absenteeism (last 3 months) Quality Control

· Quality scores by contact type

· Customer Satisfaction survey results

· First Call Resolution

· Tier 2 escalation trends Contact Reasons

· Top 10 reasons by contact type Risks and Issues

· Operational risks/issues with action plan Training Delivery

· Interview-to-hire ratios

· Training start-to-completion ratios

Appendix A Web Services

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