CN-680000-ME220-A2.pdf

AHCA CONTRACT NO. MED220

AMENDMENT NO. 2

AHCA Contract No. MED220, Amendment No. 2, Page 1 of 20 April 2020

THIS CONTRACT, entered into between the State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and MYERS AND STAUFFER, LC, hereinafter referred to as the "Vendor," is hereby amended as follows:

1. Standard Contract, Section II., THE AGENCY HEREBY AGREES, Sub-Section A., Contract Amount, the first sentence, is hereby amended to now read as follows:

To pay for contracted services according to the conditions of Attachment I, Scope of Services, in an amount not to exceed $2,165,372.00 (an increase of $1,206,833.00) subject to the availability of funds.

2. Attachment I, Scope of Services, Section I., Services to be Provided, Sub-Section B., Overview and Purpose, is hereby amended to now include Item 5. and read as follows:

5. Provide an analysis of the Quarterly and Annual Pharmacy Claim Reconciliation Reports that are submitted to the Agency by all SMMC health plans to enable the Agency to drive health plan and PBM fiscal accountability and compliance with the SMMC contracts.

3. Attachment I, Scope of Services, Section II., Manner of Service(s) Provision, Sub-

Section A., Services Provided by the Agency, is hereby amended to now include Item 10.

and read as follows:

10. Provide the vendor with the following for the Pharmacy Claims

Reconciliation Report Project:

a. Annual and Quarterly Pharmacy Claims Reconciliation Reports submitted by the health plans and PBMs;

b. Quarterly and annual Achieved Savings Rebate (ASR) reports submitted by the health plans;

c. FMMIS encounter data for pharmacy claims for the applicable time period; and

d. Any other documents or data as approved by the Agency.

4. Attachment I, Scope of Services, Section II., Manner of Service(s) Provision, Sub-

Section B., Services Provided by the Vendor, is hereby amended to now include Item 23.

and read as follows:

23. Implement a Pharmacy Claims Reconciliation Report Project that includes, but is not limited to, the following:

a. Develop, and update as necessary, a Quarterly and Annual Pharmacy Claims Reconciliation Report Template, including ancillary reporting tools and accompanying instructions, and submit to the Agency for approval prior to its dissemination and use.

DocuSign Envelope ID: 39B2A618-E71F-47CB-9DAA-0DC10E53FC5D

AHCA Contract No. MED220, Amendment No. 2, Page 2 of 20

b. Request FMMIS encounter data for pharmacy claims for the applicable time periods from the Agency.

c. Provide a review, validation, and analysis of the Annual and Quarterly Pharmacy Claims Reconciliation Reports submitted by the health plans and PBMs for CY23, CY24, and CY25. The Vendor shall ensure the review shall accomplish, at minimum, the following:

i. Ascertain the reasonableness of the reported data through review of ASRs, contracts, claims data and other supporting documentation submitted by the health plan; through comparison of previous pharmacy claims reporting from the health plan and PBM; and through comparison across other health plans and industry norms; and

ii. Provide detailed data and oversight to ascertain the accuracy of expenditure data for the pharmacy benefit reported on the ASR Financial Report and determine any effect this may have had on the Agency’s actuary’s ability to set capitation rates.

d. Monitor compliance with the terms that any SMMC contracts and amendments (e.g., July 2022 SMMC Amendment) place on the provision of pharmacy benefits to promote health plan and PBM fiscal accountability.

5. Attachment I, Scope of Services, Section II., Manner of Service(s) Provision, Sub- Section F., Reporting, Item 2., Monthly Reporting, Sub-item a., is hereby amended, and now reads as follows:

a. The Vendor shall submit monthly reports, during the completion of Phases

1, 2, and 3 of the PBM audit. At a minimum, monthly reports shall include the following:

6. Attachment I, Scope of Services, Section II., Manner of Service(s) Provision, Sub- Section F., Reporting, is hereby amended to now include Items 7 and 8. and read as follows:

7. Quarterly Pharmacy Claims Reconciliation Report Analysis

a. The Vendor shall submit a report that includes an analysis of the Pharmacy Claims Reconciliation Reports submitted by the health plans each quarter.

b. The Vendor shall include, at minimum, the following elements:

AHCA Contract No. MED220, Amendment No. 2, Page 3 of 20

i. An Executive Summary describing the purpose and overall content of the report;

ii. A description of the Vendor’s methodology and approach, including pharmacy contract review and survey sampling procedures;

iii. A description of the methodology by which the health plans and PBMs are reimbursing pharmacies that provides the Agency with insight into the fairness and adequacy of reimbursement relative to pharmacies’ cost to acquire drug products;

iv. Monitoring results of each health plan and associated PBMs’ performance as it relates to the goals of the program, including any compliance issues that should be addressed by the Agency;

v. Quantitative analysis of the data and documents received from the health plans, PBMs, and the Agency that compares expenditures to the ASR and FMMIS data; and

vi. A Conclusions and Recommendations section that provides preliminary findings that are linked to recommendations that may be undertaken by the Agency.

8. Annual Pharmacy Claims Reconciliation Report Analysis

a. The Vendor shall complete an analysis of all the Pharmacy

Claims Reconciliation Reports submitted by the health plans for the CY being evaluated.

b. The Vendor shall include, at minimum, the following elements:

i. An Executive Summary that describes the report’s purpose, provides a summary of the overall content of the report, key points of the analyses, major findings, conclusions, and recommendations;

ii. A high-level summary of the Vendor’s methodology and approach, including pharmacy contract review and survey sampling procedures;

iii. A high-level summary of the methodology by which the health plans and PBMs are reimbursing pharmacies and any recommendations for improvement;

AHCA Contract No. MED220, Amendment No. 2, Page 4 of 20

iv. A summary of aggregated monitoring results of the health plans and associated PBMs’ performance as it relates to the goals of the program, including any compliance issues that should be addressed by the Agency;

v. An aggregate of the Quarterly Pharmacy Claims

Reconciliation Report Analysis for the reporting period;

vi. Any recommendations for improvements to the

Pharmacy Claims Reconciliation Report Template;

vii. Any recommendations for changes to SMMC contracts and how these changes will promote health plan and PBM fiscal accountability;

viii. Any recommendations to enable the Agency to establish capitation rates related to pharmacy benefits based on transparent pricing and efficient practices;

ix. A description of any challenges, barriers, and lessons learned; and

x. A summary of the Conclusions and Recommendations from the Quarterly analyses that provides final findings that are linked to concrete, actionable recommendations that should be undertaken by the Agency.

9. Attachment I, Scope of Services, Section III., Method of Payment, Sub-Section A., Invoicing, Item 1., is hereby amended, and now reads as follows:

1. Invoices and all supporting documents shall be submitted on the Vendor’s letterhead to the Agency’s designated Contract Manager within fifteen (15) calendar days of completion and Agency approval of deliverables.

10. Attachment I, Scope of Services, Section III., Method of Payment, Sub-Section C., Financial Consequences as Liquidated Damages, Table 1., is hereby deleted in its entirety and replaced with Table 1-A, as follows. All references in this Contract to Table 1 shall hereinafter refer to Table 1-A.

AHCA Contract No. MED220, Amendment No. 2, Page 5 of 20

TABLE 1-A

PERFORMANCE STANDARDS AND LIQUIDATED DAMAGES

Performance Standard Requirement Liquidated Damages to be Imposed

Performance Bond

A performance bond in the amount of ten percent (10%) of the total annual amount of the Contract shall be furnished to the Agency by the Vendor within thirty (30) calendar days after execution of the Contract and prior to commencement of any work under the Contract.

$500.00 per calendar day for each calendar day after the due date until an acceptable performance bond is furnished to the Agency.

A performance bond shall be furnished on an annual basis, thirty (30) calendar days prior to the new Contract year and be in the amount of ten percent (10%) of the current annual Contract amount.

$500.00 per calendar day for each calendar day after the due date until an acceptable performance bond is furnished to the Agency.

HIPAA

The Vendor shall comply with provisions of Health Insurance Portability and Accountability Act (HIPAA) / Health Information Technology for Economic and Clinical Health (HITECH).

$500.00 to $5,000.00, per incident, per occurrence, depending upon the severity. In addition, Federal penalties may apply in accordance with the HIPAA Act of 1996.

The Vendor shall not inappropriately release

PHI.

$500.00 to $5,000.00, per incident, per occurrence, depending upon the severity.

Records

The Vendor shall comply with public records laws, in accordance with Section 119.0701, F.S.

$5,000.00 for each incident in which the Vendor does not comply with a public records request.

Background Screening

Complete initial and renewal background screenings within required timeframes.

$250.00 per occurrence.

Submit policies and procedures within thirty

(30) calendar days of Contract execution.

$250.00 per calendar day beyond the due date.

AHCA Contract No. MED220, Amendment No. 2, Page 6 of 20

Security Rating Score

Annually maintain a top tier security rating score from the Agency’s selected information security rating service.

$5,000.00 per occurrence and $250.00 per calendar day, if the Vendor does not improve to a top tier security rating score within three (3) months after its initial failure notification by the Agency, to annually obtain a top tier security rating score.

Service Organization Controls (SOC) 2 Type II Audit

Submit the SOC 2 Type II audit report by thirty (30) days following execution of this Contract.

$1,000.00 per calendar day for each calendar day beyond the due date.

Services

(This section is reserved for contract specific services that are not detailed in a specific deliverable)

Implement the approved Corrective Action Plan (CAP) by the Agency specified date.

$500.00 per calendar day for each calendar day that the approved CAP is not implemented to the satisfaction of the Agency.

The Vendor shall submit an Implementation Plan pursuant to Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection C. Implementation Plan.

$500.00 per calendar day for each calendar day beyond the due date.

The Vendor shall submit Monthly (PBM Audit only), Phase 1, Phase 2, Phase 3, Quarterly Pharmacy Claims Reconciliation Report Analysis, Annual Pharmacy Claims Reconciliation Report Analysis, and Ad Hoc Reports pursuant to Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Sub-Section D., Reporting.

$500.00, depending on report type, per calendar day for each calendar day beyond the due date.

The Agency reserves the right to inspect at any time all working papers produced by the Vendor during the performance of an audit under this Contract, including Vendor prepared work papers, timekeeping, and expense records (“Records”), and documents in the Vendor’s possession submitted by the audited provider. The Vendor shall make available for review

The Agency shall withhold payments due until the requested documentation is received and impose $500.00 per day for each calendar day that the requested documentation is overdue.

AHCA Contract No. MED220, Amendment No. 2, Page 7 of 20 requested documents to the Agency within ten (10) calendar days of the request.

At the conclusion of this Contract, or upon termination of this Contract by either party, copies of all working papers produced during the performance of an audit under this Contract shall be submitted to the Agency within thirty (30) days of the end of the Contract.

$500.00 per day for each calendar day beyond the due date.

The Vendor shall not assign, sell, destroy, give away, or otherwise dispose of records provided by the Agency or the provider, or prepared by the Vendor in completing the Agency assignments without the written prior approval of the Agency. Information stored on routine back-up media for the purpose of disaster recovery will be subject to destruction in due course. Latent data such as deleted files and other non-logical data types, such as memory dumps, swap files, temporary files, printer spool files and metadata that can customarily only be retrieved by computer forensics experts and are generally considered inaccessible without the use of specialized tools and techniques will not be within the requirement for written approval prior to the destruction of records as contemplated by this paragraph.

$500.00 per day until the records are returned to the Agency or the Agency provides written approval of these actions.

The Vendor shall not use Program data or enrollee information for activities outside those required by this Contract. All use of Program data or recipient information must be approved by the Agency.

$500.00 to $5,000.00 per incident, per occurrence, depending upon the severity, in which the Vendor inappropriately uses Program data or recipient information.

The Vendor shall submit requested document(s) and information by the due date as agreed upon by the Agency and Vendor.

$500.00 per day beyond the due date until provided to the Agency.

The Vendor shall respond to Agency inquiries (e.g., voice mail, email) within one

(1) business day.

$100.00 per day beyond the due date until provided to the Agency.

The Vendor shall address staff or staffing levels as directed by the Agency and in a

$1,000 per month in which minimum staffing requirements are not met and $200.00 per day for each day past the

AHCA Contract No. MED220, Amendment No. 2, Page 8 of 20 time frame approved by the Agency, in order to remedy all identified staffing deficiencies timeframe the Agency requires for resolution.

11. Attachment I, Scope of Services, Section VIII., Performance Bond, Table 2-A., Revised Performance Bond Requirements, is hereby deleted in its entirety and replaced with Table 2-B, Revised Performance Bond Requirements, as follows. All references in this Contract to Table 2-A shall hereinafter refer to Table 2-B.

TABLE 2-B

REVISED PERFORMANCE BOND REQUIREMENTS

Contract Term “Estimated” Annual

Contract Amount

Performance Bond Amount

(10%)

Contract Year 22/23 (8/31/22 – 6/30/23) $958,539.00 $95,853.90 Contract Year 23/24 (7/01/23 – 6/30/24) $250,476.00 $25,047.60 Contract Year 24/25 (7/01/24 – 6/30/25) $427,476.00 $42,747.60 Contract Year 25/26 (7/01/25 – 6/30/26) $440,303.00 $44,030.30 Contract Year 26/27 (7/01/26 – 8/30/26) $88,578.00 $8,857.80

12. Attachment I, Scope of Services, Exhibit A-2, 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, as follows. All references in this Contract to Exhibit A 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

AHCA Contract No. MED220, Amendment No. 2, Page 9 of 20

IN WITNESS WHEREOF, the Parties hereto have caused this twenty (20) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid until signed and dated by both Parties.

MYERS AND STAUFFER, LC 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

Robert Hicks

Member

7/26/2023 8/24/2023

Secretary

Jason Weida

ATTACHMENT I

SCOPE OF SERVICES

EXHIBIT A-3

DELIVERABLES, ASSOCIATED PAYMENT, AND FINANCIAL CONSEQUENCES

AHCA Contract No. MED220, Amendment No. 2, Page 10 of 20

1.

DELIVERABLE

Implementation Plan

SUPPORTING DOCUMENTATION

The vendor shall submit the Implementation Plan to the Agency for approval, as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Sub-Section C, Comprehensive Implementation Plan.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Comprehensive Implementation Plan and provide feedback to the Vendor to be incorporated into the final version of the plan. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

Initial draft due no later than seven (7) calendar days following initial kick-off project meeting with the Agency. Final plan due within five (5) calendar days of receiving Agency’s feedback on the draft plan.

AMOUNT

No cost associated with this deliverable.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

$500.00 per day for each business day past the due date that the Agency has not received the supporting documentation.

2.

DELIVERABLE

Phase 1 Reports – Planning and Risk Assessment:

The Vendor shall submit for approval data request templates and questionnaires to be sent to the health plans and associated PBMs.

SUPPORTING DOCUMENTATION

The Vendor shall provide the Agency with a summary of the Phase 1: Planning and Risk Assessment for each stage, as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 3, Phase 1 Reports – Planning and Risk Assessment.

EVALUATION CRITERIA

The Agency’s Contract Manager shall evaluate the Vendor’s report(s) for inclusion of the necessary information for the Agency to make an informed decision for Phase 2 scope of services.

DUE DATE(S)

No later than sixty (60) calendar days after initiating each stage of Phase 1. Extensions may be required at the Agency’s discretion, if the Vendor experiences delays from the health plans.

AMOUNT

$28,348.39 per documented completion of a planning and risk assessment report of one SMMC plan in Phase 1, Stage 1, 2 and 3;

Not to exceed a total of $368,529.00 for all three (3) stages.

AHCA Contract No. MED220, Amendment No. 2, Page 11 of 20

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

3.

Phase 2 – Data Collection and Analysis

SUPPORTING DOCUMENTATION

The Vendor shall disseminate the data collection tools to the previously approved health plans/PBMs.

Upon receipt of data requested, the Vendor shall upload into Vendor’s internal database for detailed analysis.

The Vendor shall report to the Agency’s Contract Manager details of data collection with a description of requests sent out, requests received, and any noted omissions from the data requests.

EVALUATION CRITERIA

The Agency will review the draft templates and questionnaire and provide feedback to the Vendor to be incorporated into the final versions of these documents. The Agency will review data collection information submitted by the Vendor to confirm Vendor has completed deliverable.

DUE DATE(S)

No later than sixty (60) days from completion of Phase 1. Extensions may be requested and approved at the Agency’s discretion if the Vendor experiences delays from the health plans.

AMOUNT

$61,210.00 per documented completion and Agency approval of data collection and analysis activities for the first health plan. Thereafter, $33,200.00 per documented completion and Agency approval of data collection and analysis activities for each additional plan up to twelve

(12) plans.

$52,500.00 upon documented completion of additional risk assessment and analysis activities for Sunshine health plan for calendar year 2019.

Not to exceed $512,110.00.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

4.

Phase 3 - Data Analysis Report

SUPPORTING DOCUMENTATION

Draft report to be present to the Agency, after discussion and review a FINAL report will be delivered.

AHCA Contract No. MED220, Amendment No. 2, Page 12 of 20

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Data Analysis Report and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

Initial draft no later than thirty (30) days from the completion of Phase 2; final report due within fifteen (15) days from receiving Agency feedback. Extensions may be requested and approved at the Agency’s discretion if the Vendor experiences delays from the health plans.

AMOUNT

Not to exceed $77,900.00 per documented completion and Agency approval of the Data Analysis Report.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

$500.00 per day for each business day past the due date that the Agency has not received the supporting documentation.

5.

Monthly Progress Report through July 15th, 2023.

SUPPORTING DOCUMENTATION

Meeting with CM and other Agency staff. The Vendor shall provide the Agency with preliminary data, findings, and any difficulties in obtaining information from health plans and PBMs.

EVALUATION CRITERIA

The Agency will review for timely submission.

DUE DATE(S)

Monthly. No later than the fifteenth (15th) of the month.

AMOUNT

No cost associated with this deliverable.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

$500.00 per day for each business day past the due date that the Agency has not received

6.

CY23 2nd Quarter Pharmacy Claims Reconciliation Report Analysis (April – June)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans, as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

AHCA Contract No. MED220, Amendment No. 2, Page 13 of 20

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than October 1, 2023. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$83,492.00 upon approval of final 2nd Quarter Analysis.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

$500.00 per day for each calendar day past the due date that the Agency has not received the

7.

CY23 3rd Quarter Pharmacy Claims Reconciliation Report Analysis (July – September)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than January 1, 2024. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$83,492.00 upon approval of final 3rd Quarter Analysis.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

8. DELIVERABLE

CY23 4th Quarter Pharmacy Claims Reconciliation Report Analysis (October - December)

AHCA Contract No. MED220, Amendment No. 2, Page 14 of 20

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than April 1, 2024. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$83,492.00 upon approval of final 4th Quarter Analysis.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

9.

CY23 Annual Pharmacy Claims Reconciliation Report Analysis (January 1, 2023 – December 31, 2023)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Annual Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 8. Annual Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Annual Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than July 18, 2024. FINAL due within seven (7) calendar days of receiving Agency feedback.

AMOUNT

$83,492.00 upon approval of final CY23 Annual Analysis.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

AHCA Contract No. MED220, Amendment No. 2, Page 15 of 20

LIQUIDATED DAMAGES

$1,000.00 per day for each calendar day past the due date that the Agency has not received

10.

CY24 1st Quarter Pharmacy Claims Reconciliation Report Analysis (January – March)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than July 1, 2024. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$85,996.00 upon approval of final 1st Quarter Analysis.

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

$500.00 per day for each calendar day past the due date that the Agency has not received

11.

CY24 2nd Quarter Pharmacy Claims Reconciliation Report Analysis (April – June)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than October 1, 2024. FINAL due within five (5) calendar days of receiving Agency feedback.

AHCA Contract No. MED220, Amendment No. 2, Page 16 of 20

AMOUNT

$85,996.00 upon approval of final 2nd Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

12.

CY24 3rd Quarter Pharmacy Claims Reconciliation Report Analysis (July – September)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than January 1, 2025. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$85,996.00 upon approval of final 3rd Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

13.

CY24 4th Quarter Pharmacy Claims Reconciliation Report Analysis (October - December)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

AHCA Contract No. MED220, Amendment No. 2, Page 17 of 20

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than April 1, 2025. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$85,996.00 upon approval of final 4th Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

14.

CY 24 Annual Pharmacy Claims Reconciliation Report Analysis (January 1, 2024 – December 31, 2024)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Annual Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 8. Annual Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Annual Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than July 18, 2025. FINAL due within seven (7) calendar days of receiving Agency feedback.

AMOUNT

$85,999.00 upon approval of final CY24 Annual Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

15.

CY25 1st Quarter Pharmacy Claims Reconciliation Report Analysis (January – March)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly

AHCA Contract No. MED220, Amendment No. 2, Page 18 of 20

Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than July 1, 2025. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$88,576.00 upon approval of final 1st Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

16.

CY25 2nd Quarter Pharmacy Claims Reconciliation Report Analysis (April – June)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than October 1, 2025. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$88,576.00 upon approval of final 2nd Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

17. DELIVERABLE

CY25 3rd Quarter Pharmacy Claims Reconciliation Report Analysis (July – September)

AHCA Contract No. MED220, Amendment No. 2, Page 19 of 20

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than January 1, 2026. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$88,576.00 upon approval of final 3rd Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES

18.

CY25 4th Quarter Pharmacy Claims Reconciliation Report Analysis (October - December)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Quarterly Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 7. Quarterly Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Quarterly Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version.

Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than April 1, 2026. FINAL due within five (5) calendar days of receiving Agency feedback.

AMOUNT

$88,576.00 upon approval of final 4th Quarter Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

AHCA Contract No. MED220, Amendment No. 2, Page 20 of 20

LIQUIDATED DAMAGES

19.

CY25 Annual Pharmacy Claims Reconciliation Report Analysis (January 1, 2025 – December 31, 2025)

SUPPORTING DOCUMENTATION

The Vendor shall submit a DRAFT of the Annual Pharmacy Claims Reconciliation Report Analysis for all participating SMMC plans as outlined in Attachment I, Scope of Services, Section II, Manner of Service(s) Provision, Subsection F. Reporting, Item 8. Annual Pharmacy Claims Reconciliation Report Analysis; final due within five (5) calendar days from Agency feedback.

EVALUATION CRITERIA

The Agency’s Contract Manager shall monitor for timely and complete submission of the deliverable. The Agency will review the draft Annual Pharmacy Claims Reconciliation Report Analysis and provide feedback to the Vendor to be incorporated into the final version. Review and approval of the final deliverable for payment will be based on confirmation that all identified issues were addressed.

DUE DATE(S)

DRAFT due no later than July 18, 2026. FINAL due within seven (7) calendar days of receiving Agency feedback.

AMOUNT

$88,578.00 upon approval of final CY25 Annual Analysis

PERFORMANCE STANDARDS

The Vendor shall submit the required deliverable one hundred percent (100%) complete and on time.

LIQUIDATED DAMAGES