CN-680000-ME206-A5.pdf

AHCA CONTRACT NO. MED206

AMENDMENT NO.5

AHCA Contract No. MED206, Amendment No. 5, Page 1 of 2 April 2020

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and FLORIDA STATE UNIVERSITY, hereinafter referred to as the "Vendor," is hereby amended as follows:

1. Standard Contract, Section III., The Vendor and Agency Hereby Mutually Agree, Sub-

Section B., Contract Managers, Item 2., is hereby amended to now read as follows:

2. The Vendor’s Contract Manager’s contact information is as follows:

Jessica Day Florida State University 1115 West Call Street Tallahassee, Florida 32306-4300

(407) 608-8942 Jessica.Day@med.fsu.edu

2. Attachment I, Scope of Services, Exhibit A-2, Revised Deliverables, Associated

Payment and Financial Consequences is hereby deleted in its entirety and replaced with Exhibit A-3, Revised Deliverables, Associated Payment and Financial Consequences, attached hereto and made a part of this Contract. All references in this Contract to Exhibit A-2, shall hereinafter refer to Exhibit A-3.

All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.

This Amendment and all its attachments are hereby made a part of this Contract.

This Amendment cannot be executed unless all previous Amendments to this Contract have been fully executed.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

DocuSign Envelope ID: C8A8B681-DFD1-40E8-9F6F-1AFD9CFCDC0B

AHCA CONTRACT NO. MED206

AMENDMENT NO.5

AHCA Contract No. MED206, Amendment No. 5, Page 2 of 2

IN WITNESS WHEREOF, the Parties hereto have caused this fifty-seven (57) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid until signed and dated by both Parties.

FLORIDA STATE UNIVERSITY STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION

SIGNED

BY:

SIGNED

BY:

NAME: NAME:

TITLE: TITLE:

DATE: DATE:

List of Attachments included as part of this Amendment:

Specify Type Number Description Attachment I Exhibit A-3 Revised Deliverables, Associated Payment and Financial

Consequences (55 pages)

Rose Driber for Stacey Patterson

Vice President for Research

11/16/2023

Jason Weida

Secretary

11/29/2023

ATTACHMENT I

EXHIBIT A-3

REVISED DELIVERABLES, ASSOCIATED PAYMENT AND FINANCIAL CONSEQUENCES

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 1 of 55

1.

DELIVERABLE

DY20 Medicaid Data Request and Verification

SUPPORTING DOCUMENTATION

Part I: The Vendor shall send a detailed e-mail request for the specific data needed to the Agency’s Contract Manager. This Contract Manager will forward the request to the appropriate individual within the Agency. The request shall include data related to the following:

a. Medicaid Eligibility (SFY2017-2018)

b. Medicaid Claims (SFY2017-2018)

c. Medicaid Enrollment (SFY2017-2018)

d. Hospital Discharge data (SFY2017-2018)

e. Medicaid Encounter data (SFY2017-2018)

Part II: Upon receipt of all data requested, the Vendor shall conduct an assessment of the data’s internal consistency and reasonableness. The Vendor’s verification process shall include, but is not limited to:

• Loading the data into a testing warehouse

• Comparing the data to previous datasets to verify if the number of records is similar

• Checking for missing fields, percentages, and frequencies on certain categorical variables and dates

• Comparing claims and conducting trend analyses

• Reviewing the file for duplicates and errors

• Working with the Agency’s contract manager to resolve all issues and questions related to the data A follow-up verification e-mail with results of the assessment shall be submitted by the Vendor to the Agency’s Contract Manager within thirty (30) calendar days of data delivery. Assessment results shall include a description of the content of data files, including data sources, variables, number of records and date spans, as well as a statement regarding the data’s reasonableness. An approval memo initiating deliverable payment will be sent upon receipt of assessment results as described above.

EVALUATION CRITERIA

• Data use agreement(s) developed, if applicable;

• Email request for data that is received within fourteen (14) calendar days after

Contract execution; and

• Email(s) received within thirty (30) calendar days of data delivery, in which the

Vendor describes and verifies one hundred percent (100%) of the data received.

DUE DATE(S)

Request Due: Within fourteen (14) calendar days after Contract execution.

Verification Due: Within thirty (30) calendar days of data delivery.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 2 of 55

AMOUNT

$74,721.00

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

$100.00 per incident of non-correction and/or non-response per report and/or deliverable.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 3 of 55

2.

DELIVERABLE

DY21 Medicaid Data Request and Verification

SUPPORTING DOCUMENTATION

Part I: The Vendor shall send a detailed e-mail request for the specific data needed to the Agency’s Contract Manager. This Contract Manager will forward the request to the appropriate individual within the Agency. The request shall include data related to the following:

a. Medicaid Eligibility (SFY2018-2019)

b. Medicaid Claims (SFY2018-2019)

c. Medicaid Enrollment (SFY2018-2019)

d. Hospital Discharge data (SFY2018-2019)

e. Medicaid Encounter data (SFY2018-2019)

Part II: Upon receipt of all data requested, the Vendor shall conduct an assessment of the data’s internal consistency and reasonableness. The Vendor’s verification process shall include, but is not limited to:

• Loading the data into a testing warehouse

• Comparing the data to previous datasets to verify if the number of records is similar

• Checking for missing fields, percentages, and frequencies on certain categorical variables and dates

• Comparing claims and conducting trend analyses

• Reviewing the file for duplicates and errors

• Working with the Agency’s contract manager to resolve all issues and questions related to the data A follow-up verification e-mail with results of the assessment shall be submitted by the Vendor to the Agency’s Contract Manager within thirty (30) calendar days of data delivery. Assessment results shall include a description of the content of data files, including data sources, variables, number of records and date spans, as well as a statement regarding the data’s reasonableness. An approval memo initiating deliverable payment will be sent upon receipt of assessment results as described above.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality

Standards Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

Request Due: Due within fifteen (15) calendar days of Contract execution.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 4 of 55

$74,721.00

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

$100.00 per incident of non-correction and/or non-response per report and/or

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 5 of 55

3.

Internal Quality Control Plan

SUPPORTING DOCUMENTATION

The Vendor shall submit an internal quality control plan to the Agency for approval. The internal quality control plan shall demonstrate the Vendor’s internal processes to effectively meet the standards for research, analysis and deliverable submission.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

Due within fifteen (15) calendar days of Contract execution.

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 6 of 55

4.

DY22 (SFY2019-2020) Survey Materials*

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit survey materials for Demonstration Year 20 to include:

• Enrollee Satisfaction Surveys;

• Enrollment and Participation Surveys; and

• DOH engagement surveys.

Drafts of survey materials are not required. In addition, the survey materials are not reimbursable deliverables under this Contract.

*Results from this survey will be incorporated in the DY22 Evaluation Report.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality

Standards Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

Due within thirty (30) calendar days of Contract execution.

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 7 of 55

5.

Background Screening Policies and Procedures

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit policies and procedures related to the criminal background screening requirement to the Agency for review and approval as outlined in Table 1, Performance Standards and Liquidated Damages.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

Due within thirty (30) calendar days of Contract execution.

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$250.00 per calendar day beyond the due date

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 8 of 55

6.

Work Plan

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit a work plan that details the tasks, methodology and time lines associated with the scope of work in accordance with Exhibit B, Example Work Plan Template.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

Due within thirty (30) calendar days of Contract execution.

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 9 of 55

7.

Institutional Review Board (IRB) Protocol and Approval (DOH, UF, FSU)

SUPPORTING DOCUMENTATION

Part I: The Vendor shall develop and submit an Institutional Review Board (IRB) Protocol for prior approval before use. IRB renewals shall be submitted by the Vendor on an annual basis or as necessary.

Part II: The Vendor shall submit to the Agency a copy of the IRB Protocol approval letter.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

Protocol Due: Within forty-five (45) calendar days of Contract execution and annually, thereafter.

Approval Letter Due: Within fourteen (14) calendar days of IRB approval.

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 10 of 55

8.

Data Use Agreements (Vital Statistics and Healthy Start)

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit a Vital Statistics Data Use Agreement(s) (DUA) as necessary.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

Due within forty-five (45) calendar days of Contract execution and due annually, thereafter.

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 11 of 55

9.

Privacy Compliance Plan

SUPPORTING DOCUMENTATION

The Vendor shall submit a communication plan which specifies in detail the manner in which the Vendor shall ensure full compliance with all State and Federal Communication Privacy Laws.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

Due within forty-five (45) calendar days of Contract execution and due as required, thereafter.

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 12 of 55

10.

3rd Quarter Progress Report

SUPPORTING DOCUMENTATION

The Vendor shall submit a quarterly progress report. The progress report shall include but is not limited to:

• A brief summary of current activities;

• Disclosure of issues; and

• Updates for the upcoming quarter.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

First report:

4/15/2020

Ongoing:

4/15/2021 4/15/2022 4/15/2023 4/15/2024 4/15/2025 4/15/2026

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

$100.00 per incident of non-correction and/or non-response per report and/or deliverable.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 13 of 55

11.

Family Planning Waiver DY20/21 (SFY2017-2018 and 2018-2019) Interim Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit an Interim Evaluation report for DY20 and DY21 that shall address a subset of evaluation questions that are included in the CMS approved Evaluation Design as agreed upon by the Agency and Vendor, and shall include the following components: an executive summary with preliminary results to date; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); preliminary evaluation findings, including a discussion of the findings by research question (interpretation and policy context); and successes, challenges, and lessons learned during the waiver period. Questions will be answered to the extent possible based on data availability, as approved by the Agency.

Draft due thirty (30) calendar days prior to deliverable due date.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

5/15/2020

AMOUNT

$111,425.00

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 14 of 55

12.

4th Quarter Progress Report

SUPPORTING DOCUMENTATION

• Updates for the upcoming quarter.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

First report:

7/15/2020

Ongoing:

7/15/2021 7/15/2022 7/15/2023 7/15/2024 7/15/2025

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 15 of 55

13.

DY23 (SFY2020-2021) Survey materials*

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit survey materials for Demonstration Year 21 to

*Results from this survey will be included in the DY23 Evaluation Report.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

7/17/2020

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 16 of 55

14.

Family Planning Waiver DY20/21 (SFY2017-2018 and 2018-2019) Final Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit an Evaluation report for DY20 and DY21 that shall address all evaluation questions in accordance with the CMS approved Evaluation Design and shall include the following components: an executive summary with final results; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); final evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); and successes, challenges, and lessons learned during the waiver period.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

10/15/2020

AMOUNT

$112,738.00

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 17 of 55

15.

1st Quarter Progress Report

SUPPORTING DOCUMENTATION

• Updates for the upcoming quarter.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

First Report:

10/15/2020

Ongoing:

10/15/2021 10/15/2022 10/15/2023 10/15/2024 10/15/2025

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 18 of 55

16.

2nd Quarter Progress Report

SUPPORTING DOCUMENTATION

The Vendor shall submit a quarterly progress report. The progress report shall include but is not limited to:

• A brief summary of current activities;

• Disclosure of issues; and

• Updates for the upcoming quarter.

EVALUATION CRITERIA

Commentary grid(s) or other documentation, as approved by the Agency, indicating 100% of requested edits required for deliverable approval were completed.

DUE DATE(S)

First Report:

1/15/2021

Ongoing:

1/15/2022 1/15/2023 1/15/2024 1/15/2025 1/15/2026

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 19 of 55

17.

DY22 Medicaid Data Request and Verification

SUPPORTING DOCUMENTATION

Part I: The Vendor shall send a detailed e-mail request for the specific data needed to the Agency’s Contract Manager. This Contract Manager will forward the request to the appropriate individual within the Agency. The request shall include data related to the following:

a. Medicaid Eligibility (SFY2019-2020)

b. Medicaid Claims (SFY2019-2020)

c. Medicaid Enrollment (SFY2019-2020)

d. Hospital Discharge data (SFY2019-2020)

e. Medicaid Encounter data (SFY2019-2020)

Part II: Upon receipt of all data requested, the Vendor shall conduct an assessment of the data’s internal consistency and reasonableness. The Vendor’s verification process shall include, but is not limited to:

• Loading the data into a testing warehouse

• Comparing the data to previous datasets to verify if the number of records is similar

• Checking for missing fields, percentages, and frequencies on certain categorical variables and dates

• Comparing claims and conducting trend analyses

• Reviewing the file for duplicates and errors

• Working with the Agency’s contract manager to resolve all issues and questions related to the data A follow-up verification e-mail with results of the assessment shall be submitted by the Vendor to the Agency’s Contract Manager within thirty (30) calendar days of data delivery.

Assessment results shall include a description of the content of data files, including data sources, variables, number of records and date spans, as well as a statement regarding the data’s reasonableness. An approval memo initiating deliverable payment will be sent upon receipt of assessment results as described above.

EVALUATION CRITERIA

• Data use agreement(s) developed, if applicable;

• Email request for data that is received by the deliverable request date; and

• Email(s) received within thirty (30) calendar days of data delivery, in which the Vendor describes and verifies one hundred percent (100%) of the data received.

DUE DATE(S)

Request Due: 1/15/2021

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 20 of 55

$79,711.40

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 21 of 55

18.

Family Planning Waiver DY22 (SFY2019-2020) Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit an Evaluation report for DY22 that addresses all evaluation questions in accordance with the CMS approved Evaluation Design and shall include the following components: an executive summary with final results; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); final evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2019-2020; and successes, challenges, and lessons learned during the waiver period.

Draft due forty-five (45) calendar days prior to deliverable due date.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

5/14/2021

AMOUNT

$318,845.60

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 22 of 55

19.

DY24 (SFY2021-2022) Survey Materials*

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit survey materials for Demonstration Year 22 to

*Results from this survey will be included in the DY24 Evaluation Report.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

7/16/2021

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 23 of 55

20.

DY23 Medicaid Data Request and Verification

SUPPORTING DOCUMENTATION

Part I: The Vendor shall send a detailed e-mail request for the specific data needed to the Agency’s Contract Manager. This Contract Manager will forward the request to the appropriate individual within the Agency. The request shall include data related to the following:

a. Medicaid Eligibility (SFY2020-2021)

b. Medicaid Claims (SFY2020-2021)

c. Medicaid Enrollment (SFY2020-2021)

d. Hospital Discharge data (SFY2020-2021)

e. Medicaid Encounter data (SFY2020-2021)

Part II: Upon receipt of all data requested, the Vendor shall conduct an assessment of the data’s internal consistency and reasonableness. The Vendor’s verification process shall include, but is not limited to:

• Loading the data into a testing warehouse

• Comparing the data to previous datasets to verify if the number of records is similar

• Checking for missing fields, percentages, and frequencies on certain categorical variables and dates

• Comparing claims and conducting trend analyses

• Reviewing the file for duplicates and errors

• Working with the Agency’s contract manager to resolve all issues and questions related to the data A follow-up verification e-mail with results of the assessment shall be submitted by the Vendor to the Agency’s Contract Manager within thirty (30) calendar days of data delivery.

Assessment results shall include a description of the content of data files, including data sources, variables, number of records and date spans, as well as a statement regarding the data’s reasonableness. An approval memo initiating deliverable payment will be sent upon receipt of assessment results as described above.

EVALUATION CRITERIA

• Data use agreement(s) developed, if applicable;

• Email request for data that is received by the deliverable request date; and

• Email(s) received within thirty (30) calendar days of data delivery, in which the Vendor describes and verifies one hundred percent (100%) of the data received.

DUE DATE(S)

Request Due: 1/14/2022

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 24 of 55

$78,822.80

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 25 of 55

21.

Draft of Draft Interim Evaluation Report DY20, 21 and 22 (SFY2017-2018, 2018- 2019 and 2019-2020)

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit a Draft Interim Evaluation report that merges evaluation results previously reported for the completed years of the Demonstration, including, but not limited to, DY20, DY21, and DY22,to be submitted to CMS that shall include the following components: an executive summary with draft final results; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); draft final evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2019- 2020; and successes, challenges, and lessons learned during DYs 20, 21 and 22. The Vendor shall report on all evaluation questions in accordance with the CMS approved Evaluation Design.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

3/1/2022

AMOUNT

$98,528.50

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 26 of 55

22.

Final Draft Interim Evaluation Report DY20, 21 and 22 (SFY2017-2018, 2018-2019 and 2019-2020)

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit a Final Draft Interim Evaluation report that merges results previously reported for the completed years of the Demonstration, including, but not limited to, DY20, DY21, and DY22, to be submitted to CMS that shall include the following components: an executive summary with final results; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population including in the evaluation (by age, gender, race/ethnicity, etc.); final evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2019-2020; and successes, challenges, and lessons learned during DYs 20, 21 and 22. The Vendor shall report on all evaluation questions in accordance with the CMS approved Evaluation Design.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

5/1/2022

AMOUNT

$39,411.40

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 27 of 55

23.

Family Planning Waiver DY23 (SFY2020-2021) Interim Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit an Interim Evaluation Report for DY23 that addresses evaluation questions 1, 6, 7, 8, 9, and 10 in accordance with the CMS approved Evaluation Design and shall include the following components: an executive summary; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); interim evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2020- 2021; and successes, challenges, and lessons learned during the waiver period.

Draft due forty-five (45) calendar days prior to deliverable due date.

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

5/13/2022

AMOUNT

$106,410.78

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 28 of 55

24.

DY25 Survey (SFY2022-2023) Materials*

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit survey materials for Demonstration Year 23 to

*Results from this survey will be included in the DY25 Evaluation Report.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

7/15/2022

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 29 of 55

25.

Family Planning Waiver DY23 (SFY2020-2021) Final Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit a Final Evaluation Report for DY23 that addresses all evaluation questions in accordance with the CMS approved Evaluation Design and shall include the following components: final results, a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions; a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); final evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2020-2021; and successes, challenges, and lessons learned during the waiver period.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality

Standards Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

9/30/2022

AMOUNT

$70,940.52

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 30 of 55

26.

DY24 Medicaid Data Request and Verification

SUPPORTING DOCUMENTATION

Part I: The Vendor shall send a detailed e-mail request for the specific data needed to the Agency’s Contract Manager. This Contract Manager will forward the request to the appropriate individual within the Agency. The request shall include data related to the following:

a. Medicaid Eligibility (SFY2021-2022)

b. Medicaid Claims (SFY2021-2022)

c. Medicaid Enrollment (SFY2021-2022)

d. Hospital Discharge data (SFY2021-2022)

e. Medicaid Encounter data (SFY2021-2022)

Part II: Upon receipt of all data requested, the Vendor shall conduct an assessment of the data’s internal consistency and reasonableness. The Vendor’s verification process shall include, but is not limited to:

• Loading the data into a testing warehouse

• Comparing the data to previous datasets to verify if the number of records is similar

• Checking for missing fields, percentages, and frequencies on certain categorical variables and dates

• Comparing claims and conducting trend analyses

• Reviewing the file for duplicates and errors

• Working with the Agency’s contract manager to resolve all issues and questions related

• to the data

A follow-up verification e-mail with results of the assessment shall be submitted by the Vendor to the Agency’s Contract Manager within thirty (30) calendar days of data delivery.

Assessment results shall include a description of the content of data files, including data sources, variables, number of records and date spans, as well as a statement regarding the data’s reasonableness.

An approval memo initiating deliverable payment will be sent upon receipt of assessment results as described above.

EVALUATION CRITERIA

• Data use agreement(s) developed, if applicable;

• Email request for data that is received by the deliverable request date; and

• Email(s) received within thirty (30) calendar days of data delivery, in which the Vendor describes and verifies one hundred percent (100%) of the data received.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 31 of 55

DUE DATE(S)

Request Due: 1/16/2023

Verification Due: Within thirty (30) calendar days of data delivery.

AMOUNT

$80,203.00

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor failed to meet the quality standards.

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 32 of 55

27.

Family Planning Waiver DY24 (SFY2021-2022) Interim Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit an Interim Evaluation Report for DY24 that addresses evaluation questions 1, 6, 7, 8, 9, and 10 in accordance with the CMS approved Evaluation Design and shall include the following components: an executive summary; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions: a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); interim evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2021- 2022; and successes, challenges, and lessons learned during the waiver period.

Draft due forty-five (45) calendar days prior to deliverable due date.

EVALUATION CRITERIA

• 100% of quality criteria are checked as “accepted” on the Minimum Quality Standards

Rubric;

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

4/3/2023

AMOUNT

$192,487.20

PERFORMANCE STANDARDS

One-hundred percent (100%)

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 33 of 55

$100.00 per day for each calendar day beyond the due date until provided to the Agency unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 34 of 55

28.

DY26 Survey (SFY2023-2024) Materials*

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit survey materials for Demonstration Year 26 to

*Results from this survey will be included in the DY25 Evaluation Report.

EVALUATION CRITERIA

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

7/14/2023

AMOUNT

N/A

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency, unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 35 of 55

29.

Family Planning Waiver Draft of Draft Summative Evaluation Report DY20, 21, 22, 23, and 24 (SFY17/18, 18/19, 19/20, 20/21, and 21/22)

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit a Draft of Draft Summative Evaluation Report for DY20, 21, 22, 23 that addresses all evaluation questions and DY24 that addresses evaluation questions 1,6,7,8,9,10 in accordance with the CMS approved Evaluation Design. The report shall include the following components: an executive summary; a description of the demonstrations, including programmatic goals, interventions implemented, and resulting impact of these interventions: a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); final evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during DYs; and successes, challenges, and lessons learned during the waiver period.

• Commentary grid(s) or other documentation, as approved by the Agency, indicating

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

2/1/2024

AMOUNT

$80,451.20

PERFORMANCE STANDARDS

One-hundred percent (100%)

FINANCIAL CONSEQUENCES

$100.00 per day for each calendar day beyond the due date until provided to the Agency unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 36 of 55

30.

Family Planning Waiver DY24 (SFY2021-2022) Final Evaluation Report

SUPPORTING DOCUMENTATION

The Vendor shall develop and submit an Interim Evaluation Report for DY24 that addresses evaluation questions 2, 3, 4, and 5 in accordance with the CMS approved Evaluation Design and shall include the following components: an executive summary; a description of the demonstration, including programmatic goals, interventions implemented, and resulting impact of these interventions: a summary of the evaluation design employed, including research questions, hypotheses, study design, measures, data sources, and analyses; a description of the population included in the evaluation (by age, gender, race/ethnicity, etc.); interim evaluation conclusions and recommendations, including a discussion of the findings by research question (interpretation and policy context); results and findings from the enrollee satisfaction surveys, enrollment and participation surveys, and DOH engagement surveys administered during SFY2021- 2022; and

100% of requested edits required for deliverable approval were completed; and

• An updated work plan that identifies the tasks that have been completed for the deliverable and the date each task was completed.

DUE DATE(S)

10/13/2023

AMOUNT

$120,676.80

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 37 of 55 unless the Vendor received written approval from the Agency for an extension to the due date.

$500.00 per report and/or deliverable immediately or per incident in which the Vendor

AHCA Contract No. MED206, Attachment I, Exhibit A-3, Page 38 of 55

31.

DY25 Medicaid Data Request and Verification

SUPPORTING DOCUMENTATION

Part I: The Vendor shall send a detailed e-mail request for the specific data needed to the Agency’s Contract Manager.