CONSOLIDATED SERVICES - CALL CENTER RFP BPM057936 FINAL (R).docx

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Call Center
Solicitation number
BPM057936
Issued by
Maryland

About this file

Request for Proposals Summary

This is a Request for Proposals (RFP) issued by the Maryland Health Benefit Exchange (MHBE) seeking a qualified contractor to operate an integrated Consolidated Service Center providing comprehensive call center operations and related services. The MHBE, an independent unit of state government administering Maryland Health Connection, requires services including inbound and outbound call management, live chat support, Interactive Voice Response (IVR) provision and management, quality assurance, training and development, workforce management, and reporting. The solicitation number is BPM057936, with an issue date of November 2, 2026. The pre-proposal conference is scheduled for November 20, 2026, at 10:00 AM EST; questions are due December 7, 2026; and proposals are due December 17, 2026, at 11:00 AM EST. The procurement officer is Shirelle Green, reachable at 410-547-8151 or Shirelle.green1@maryland.gov. The contract award will be made as a single award using the Competitive Sealed Proposals method. The contract is a firm fixed price arrangement with an anticipated three-year base term from July 1, 2027, through June 30, 2030, with one optional two-year renewal period. The primary place of performance is a turn-key facility located within the State of Maryland.

The RFP establishes a Minority Business Enterprise (MBE) subcontract participation goal of 20% of the total contract dollar amount, including all renewal option terms. Federal funding will support this contract. Minimum qualifications for offerors include at least three years of experience within the past ten years with government entitlement program eligibility and enrollment (preferably Medicaid), experience utilizing a third-party customer relationship management solution such as Salesforce, and experience operating and maintaining a telephony system, demonstrated through three references on customer letterhead. Key staffing requirements include a Project Director, Account Manager, Operations Manager, Training Manager, Quality Assurance Manager, Workforce Manager, Security Specialist, and sufficient Customer Service Representatives, including a minimum of 60 bilingual Spanish-speaking CSRs maintained year-round. CSRs must receive a minimum starting pay rate of $18.00 per hour with at least a $3.00 per hour differential for Spanish-speaking bilingual representatives. The contractor must provide all facilities, equipment, technology infrastructure, telephony systems, and workforce management support. The contract includes comprehensive service level agreements with liquidated damages provisions for non-compliance; however, liquidated damages will not be assessed during the first 120 days of performance. Historical call volume data provided in the RFP demonstrates monthly call volumes ranging from approximately 74,800 to 156,662 calls offered, with significant fluctuations during open enrollment periods and special events.

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<<solicitationTitle>> Solicitation #: <<solicitationNumber>> RFP Document

STATE OF MARYLAND

REQUEST FOR PROPOSALS (RFP)

RFP NUMBER BPM057936

ISSUE DATE: NOVEMBER 2, 2026

A Prospective Offeror that has received this document from a source other than eMarylandMarketplace Advantage (eMMA) https://procurement.maryland.gov should register on eMMA https://emma.maryland.gov/

NOTICE TO OFFERORS

MINORITY BUSINESS ENTERPRISES ARE ENCOURAGED TO RESPOND TO THIS SOLICITATION.

STATE OF MARYLAND

MARYLAND HEALTH BENEFIT EXCHANGE (MHBE)

KEY INFORMATION SUMMARY SHEET

Request for Proposals
MHBE CONSOLIDATED SERVICE CENTER
Solicitation Number:
BPM057936
RFP Issue Date:
November 2, 2026
RFP Issuing Office:
MARYLAND HEALTH BENEFIT EXCHANGE (MHBE)
Procurement Officer:
Shirelle Green

750 Pratt Street, 6th, floor, Baltimore, MD

Email:

Phone Number:

Shirelle.green1@maryland.gov 410-547-8151

Proposals are to be sent to:
Submit on emma.maryland.gov under Solicitation Number

To submit a proposal, offerors must first register on emma.maryland.gov. We recommend registering in advance to become acquainted with the site.

Proposal Notice Feedback Form
*If you are not submitting a proposal for this solicitation, submit Attachment 1 with your reasons why.
Pre-Proposal Conference:
November 20, 2026, AT 10:00 AM EST Time
Questions Due Date and Time:
December 7, 2026
Proposal Due (Closing) Date and Time:
December 17, 2026, AT 11:00 AM EST Time

Offerors are reminded that a completed Feedback Form is requested if a no-proposal decision is made (see Attachment 1 - No Bid Notice/Vendor Feedback Form).

Procurement Method:
A Contract will be awarded in accordance with the Competitive Sealed Proposals method under COMAR 21.05.03.
Contract Type:
Firm Fixed Price
Contract Duration:
Three-year base with one two-year option July 1, 2027 – June 30, 2030
Primary Place of Performance:
Turn Key-Facility within the State of Maryland
SBR Designation:
NO
Federal Funding:
YES
MBE Subcontracting Goal:
An overall Minority Business Enterprise (MBE) or Disadvantaged Business Enterprise (DBE) subcontract participation goal of __20%___ percent of the total contract dollar amount, including all renewal option terms, if any, has been established for this procurement. The overall MBE or DBE subcontract participation goal includes the following subgoals, which have been established for this procurement:

_____% for African-American MBEs;

_____% for Asian-American MBEs;

_____% for Hispanic-American MBEs; and _____% for Woman-Owned MBEs.

Refer to Exhibit 1 for information on how goal setting was determined. Also, refer to Appendix 4 for information about the MBE or DBE program and goals.

Multiple or Alternate Bids:
Multiple or alternate Proposals will not be accepted.

TABLE OF CONTENTS – RFP

1Minimum Qualifications7
1.1Offeror Minimum Qualifications7
2Contractor Requirements: Scope of Work8
2.1Summary Statement8
2.2Background and Purpose8
2.3Contractor Responsibilities and Tasks9
2.4Experience and Personnel9
2.5Substitution of Personnel12
2.6Supplemental Category of Work Requirements and Responsibilities15
3Standard Terms and Conditions16
3.1Contract Initiation Requirements16
3.2End of Contract Transition16
3.3Invoicing16
3.4Liquidated Damages19
3.5Problem Escalation Procedure 19
3.5aRequired IT System Security and Privacy Self-Assessments and Audits 19
3.6Work Orders20
3.7Payments by Electronic Funds Transfer21
3.8Prompt Payment Policy21
3.9Federal Funding Acknowledgement22
3.10Conflict of Interest Affidavit and Disclosure22
3.11Non-Disclosure Agreement23
3.12Maryland Healthy Working Families Act Requirements23
3.13The State of Maryland’s Commitment to Purchasing Environmentally Preferred Products and Services (EPPs)23
3.14Insurance Requirements24
3.15Non-Compete Clause Prohibition25
4Proposal Submission Information and Instructions26
4.1eMaryland Marketplace Advantage (eMMA)26
4.2Electronic Means26
4.3Pre-Proposal Conference26
4.4Questions27
4.5Proposal Due (Closing) Date and Time27
4.6Economy of Preparation27
4.7Public Information Act Notice27
4.8Oral Presentation28
4.9Duration of Proposals28
4.10Revisions to the RFP28
4.11Cancellations28
4.12Incurred Expenses29
4.13Protest/Disputes29
4.14Offeror Responsibilities29
4.15Acceptance of Terms and Conditions30
4.16Compliance with Laws/Arrearages30
4.17Verification of Registration and Tax Payment30
4.18False Statements30
5Proposal Format31
5.1Two Part Submission31
5.2Proposal Delivery and Packaging31
5.3Volume I - Technical Proposal33
5.4Volume II – Financial Proposal43
6Evaluation and Selection Process44
6.1Evaluation Committee44
6.2Technical Proposal Evaluation Criteria44
6.3Financial Proposal Evaluation Criteria44
6.4Reciprocal Preference44
6.5Selection Procedures45
6.6Documents Required upon Notice of Recommendation for Contract Award RFP Attachments (Table B)46
7RFP Appendices and Exhibits48
7.1Appendices (Table C)48
7.2Exhibits (Table D)49

1 Minimum Qualifications

1.1 Offeror Minimum Qualifications

The Offeror shall have at least three (3) years of experience within the past ten (7) years with: (1) government entitlement program eligibility and enrollment, preferably with eligibility and enrollment in Medicaid programs; (2) experience utilizing a third-party customer relationship management (CRM) solution such as Salesforce; and (3) experience operating and maintaining a telephony system.

As proof of meeting this requirement, the Offeror shall submit a minimum of three references from customers on customer’s letterhead who can attest to the Offeror’s experience with the activities described above.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

2 Contractor Requirements: Scope of Work

2.1 Summary Statement

2.1.1 It is MHBE’s intention to obtain services, as specified in this RFP, through a Contract between the selected Offeror and the MHBE. The anticipated duration of services to be provided under this Contract is three (3) years with one (1) two -year renewal options.

2.1.2 The MHBE intends to make a single award as a result of this RFP.

2.1.3 An Offeror, either directly or through its subcontractor(s), must be able to provide all services and meet all the requirements requested in this solicitation. The successful Offeror (the Contractor) shall remain responsible for Contract performance regardless of subcontractor’s participation in the work.

2.1.4 The Offeror shall be prepared to comply with all requirements of 42 CFR 438.810 upon submission of its Proposal, ensuring full regulatory adherence immediately upon the Contract commencement date and the initiation of performance.

2.2 Background and Purpose

The Maryland Health Benefit Exchange (MHBE) is an independent unit of state government responsible for the administration of Maryland Health Connection, the state’s health insurance marketplace, under the Patient Protection and Affordable Care Act of 2010 (AC) and subsequent state legislation. The MHBE works with the Maryland Department of Health, Department of Human Services, Maryland Insurance Administration, and stakeholders statewide to make insurance affordability programs available to all eligible Marylanders.

The mission of the MHBE is to improve the health and well-being of Marylanders by connecting them with high-quality, affordable health coverage through innovative programs, technology and customer service. We value diversity, innovation, collaboration, and the highest standards of professional ethics. To that end we issue the following RFP seeking a qualified Offeror to operate our integrated consolidated service center functions.

The first year of this contract will coincide with the MHBE’s 15th open enrollment period. Over that time, the MHBE has grown from a small start-up to a nationally recognized leader in IT development, operations, and customer service excellence. The MHBE seeks to continue and extend its commitment to providing Marylanders exemplary systems and services.

The RFP outlines the technical specifications required, but the MHBE also invites Offerors to suggest alternative approaches if they can demonstrate an effective strategy for meeting the overall goal of excellence in customer service in an inclusive and employee-engaged manner. The MHBE seeks a contractual partner dedicated to fostering employee retention and advancement, maintaining policy continuity and delivering exceptional customer service. The Offeror should demonstrate the ability to respond efficiently to rapid changes in technology, policy, and customer service expectations. The Offeror should demonstrate their willingness to be flexible and transparent in all aspects of engagement with this project.

2.3 Contractor Responsibilities and Task

The selected Offeror shall be responsible for all products and services required by this RFP. All subcontractors must be identified and a complete description of their role relative to the Proposal (“Role”) must be included in the Offeror’s Proposal. If applicable, subcontractors utilized in meeting the established MBE participation goal(s) for this solicitation shall be identified as provided in the appropriate Attachment(s) of this RFP.

If an Offeror that seeks to perform or provide the services required by this RFP is the subsidiary of another entity, all information submitted by the Offeror, including but not limited to references, financial reports, or experience and documentation (e.g. insurance policies, bonds, letters of credit) used to meet minimum qualifications, if any, shall pertain exclusively to the Offeror, unless the parent organization will guarantee the performance of the subsidiary. If applicable, the Offeror shall submit with its Proposal an explicit statement, signed by an authorized representative of the parent organization, stating that the parent organization will guarantee the performance of the subsidiary.

A parental guarantee of the performance of the Offeror under this Section will not automatically result in crediting the Offeror with the experience and/or qualifications of the parent under any evaluation criteria pertaining to the Offeror’s experience and qualifications. Instead, the Contractor shall be evaluated on the extent to which the State determines that the experience and qualification of the parent are transferred to and shared with the Offeror, the parent is directly involved in the performance of the Contract, and the value of the parent’s participation as determined by the State.

The Maryland Health Benefit Exchange utilizes a Consolidated Service Center (CSC) to assist consumers seeking support in determining eligibility and enrollment in insurance affordability programs including private health and dental plans and Medicaid programs. In addition, MHBE partners with individual market vision plans and offers health plans to small employers and their employees through Maryland Health Connection for Small Business; at this time, the CSC is expected to provide warm hand-offs to third parties to assist with enrollment in vision and small business plans. During the course of this contract the MHBE may develop and offer other related insurance products such as Individual Coverage Health Resources Accounts (HRAs), Health Savings Accounts (HSAs), or , a stand-alone prescription drug plan. The Offeror, in partnership with MHBE, should be able to revise its staffing plan or other procedures to accommodate customer needs with additional products.

The Consolidated Service Center operations include but are not limited to: inbound call management, outbound calls, live chat service, Interactive Voice Response (IVR) provision and management, telephony systems provision and management, quality assurance management, training and development, workforce management and reporting. In addition, the Consolidated Service Center will assist Medicaid recipients with the enrollment into a Managed Care Organization (MCO), selection of a primary care provider (PCP), and completion of a health assessment questionnaire. The CSC will assist with MCO enrollments for both MAGI and non-MAGI consumers. The contractor shall provide permanent dedicated direct dial lines designated for Producers and Application Counselors seeking case escalation support. During annual Open Enrollment periods, contractor shall provide telephony connectivity and technical support for the MHBE program referred to as Producer Assisted Transfer service (BATPhone) which is currently active during open enrollment periods. This support may extend beyond the open enrollment period if determined in the best interest of the MHBE.

The Consolidated Service Center will provide Full-Time Equivalent (FTE) staff and provide equipment, materials, facilities, and required connectivity to receive and respond to calls and data all year with a maximum effort expected during projected peak call volume periods. Full-Time Equivalent means an employee working a minimum of 40 hours of working hours during normal business hours. The MHBE will allow for the Contractor to determine appropriate staffing levels for the majority of Customer Service Representatives and other staff assigned to the Contract based upon a forecast made by the Contractor with assumptions and data provided by MHBE. However, MHBE will require that at least 60 bilingual Spanish speaking Customer Service Representatives (CSRs) should be maintained all year.

Upon the MHBE contract monitors’ approval a hybrid home/office model for staff who exceed minimum expectations (ie, attendance, schedule adherence, talk time and quality assurance averages) contingent on Offeror providing a comprehensive plan for training and oversight of work from home staff. Additionally, in the event of a declared public health emergency or catastrophic event, no less than fifty-one percent (51%) of the total number of employees shall be physically located within the State of Maryland. The remaining employees, constituting no more than forty-nine percent (49%) of the total workforce, shall be physically located within the continental United States.

If there is a significant shift in customer service delivery methods as a result of new technologies such that it becomes appropriate to change the method of measuring interactions with consumers, the MHBE may exercise its option to adjust the manner in which compensation is calculated to accommodate the change. For example, MHBE has developed an AI powered IVR system for the Consolidated Service Center that is anticipated to replace components of the telephony system, with features such as call routing, informative voice response system, automated call queue handling, AI voice prompts, and screen/voice recordings, and may replace the whole telephony system at some point during the Contract.

Scope of Work The following Scope of Work outlines the Exchange’s overall expectations. Potential Bidders are encouraged to develop their own, more detailed approach in response to this RFP. The successful Offeror shall provide Consolidated Service Center operations from the Go-Live Date through the Contract end date, including any option years, in compliance with all applicable State and federal laws in effect at the time the services are offered, including the Affordable Care Act and its regulations together with any regulations promulgated thereunder.

The following chart depicts monthly call volumes offered year over year from January 1, 2024 through June 30, 2026. Please note that this chart includes the Public Health Emergency Unwinding, a one-time event that started in April 2023 and ended in July 2024 which resulted in higher-than-normal call volumes. MHBE does not anticipate that another event of this nature will occur during this Contract, however, the Contractor must remain flexible and be able to accommodate these types of potential events.

Month
Calls Offered
Calls Handled
Calls Abandoned
Chats
Avg Call Handle Time
Medicaid Calls
Qualified Health Plan Calls
Spanish Calls Offered
Spanish Interpreter Calls
Comments
Jan 2024
147,992
125,362
21,060
30,513
13:48
81,876
19,509
23,945
1,444
OE 11 + Public Health Emergency
Feb 2024
104,852
98,036
6,081
13,085
12:30
59,701
9,882
18,642
913
Mar 2024
90,792
86, 054
4,149
10,868
12:03
54,052
8,503
15,859
762
Apr 2024
90,574
84,882
4,845
10,548
12:06
52,097
7,884
15,654
718
May 2024
85,318
79,376
5,067
9,455
12:03
50,290
7,234
15,188
668
Jun 2024
74,800
69,570
4,525
10,310
12:37
45,592
5,999
13,393
531
Jul 2024
98,107
89,846
7,063
14,955
11:59
60,467
7,489
17,625
687
Public Health Emergency Officially Ended
Aug 2024
90,214
86,194
10,775
16,527
11:55
57,429
7,488
16,769
440
Sept 2024
96,414
73,366
20,989
16,679
12:20
55,668
6,696
16,737
338
Oct 2024
106,959
88,760
16,600
18,393
13:46
64,550
8,568
18,656
449
Nov 2024
115,903
88,392
25,852
22,240
14:13
66,536
13,486
20,775
384
Dec 2024
138,546
98,400
39,243
28,012
13:52
87,478
19,394
25,484
425
Jan 2025
156,662
103,886
51,682
37,120
13:33
97,729
23,717
29,698
491
Feb 2025
114,132
84,580
28,052
23,552
12:48
66,948
11,212
24,226
551
Mar 2025
111,356
89,369
20,782
20,878
13:05
68,636
10,975
22,430
529
Apr 2025
101,888
93,540
7,767
14859
13:29
65,686
10,686
17,574
462
May 2025
87,927
84,439
3,258
12,294
13:04
60,811
8,899
14,719
455
June 2025
82,909
78,816
3,907
10,729
12:38
57,658
8,786
14,740
480
July 2025
96,883
89,388
7,226
12,496
12:41
68,351
9,659
18,562
742
Medicaid 1135 waiver ended effective 6/30/2025
Aug 2025
84,669
83,713
4,482
11,864
13:26
62,540
8,567
16,860
1,111
MHBE Marketing - Email sent to 220,000 QHP enrollees notifying of reconciliation bill changes late Aug.
Sept 2025
89,453
84,127
8,456
13,321
14:05
65,196
8,004
18,298
2,372
Oct 2025
89,372
88,439
4,585
13,802
13:53
65,506
9,591
18,546
6,158
Nov 2025
93,739
99,010
9,653
16,855
15:23
63,310
15,224
20,234
6,446
Dec 2025
118,168
112,958
11,131
21,094
14:20
75,954
27,716
23,101
8249
Carefirst Pay Now Issues (approx 2100 affected, Carefirst improper non-payment terms (change files sent to carrier vs add file).
Jan 2026
122,720
114,359
13,105
15,150
14:09
78,159
21,605
23,981
8,818
Feb 2026
99,583
94,019
5,118
25,820
13:20
61,647
12,776
19,736
6215
Mar 2026
101,632
100,207
5,163
12,370
13:06
69,057
13,523
20,105
6,719
Large Essential Health Benefit Marketing Campaign (Emails (30k) and Texts)
Apr 2026
99,856
91,700
11,440
13,089
13:24
65,253
13,621
18,941
4,719
May 2026
86,529
79,357
10,224
11,923
13:27
61,489
10,419
15,540
4,261
June 2026
92,015
80,973
10,361
10,049
13:11
65,160
9,965
16,307
3,346

The chart below depicts 7 months of the most common types of calls handled by the CSC for the period Dec 2025 - June 2026.

The chart below depicts 7 months of other types of calls handled by the CSC for the period Dec 2025 - June 2026.

2.3 Contractor Requirements

ID #
Task
Requirement
2.3.1
Account Management Services
The Contractor shall provide an Account Manager, see Section staffing requirements , to ensure service expectations and performance standards are being met across all aspects of provided services. The Account Manager must be dedicated to MHBE on a full-time basis.

Account Management responsibilities include, but are not limited to, the following:

a. Serving as liaison between the MHBE and Contractor’s leadership and support teams;

b. Updating MHBE on an ongoing basis of all CSC issues, joint initiatives, and change requests;

c. Providing reports as specified in the mutually agreed upon format and on an ad hoc basis;

d. Ensuring deliverables are met in accordance with contractual and service level requirements;

e. In the event of systems-related occurrences that impact the Service Center, acting as the primary point of contact for all solution participants and ensuring the MHBE is involved in the event via a common communication bridge;

f. Acting as primary point of contact for the MHBE when service-impacting events occur and participating in issue resolution conference calls as needed;

g. Coordination of information flow from the MHBE to operations staff;

h. Coordination of urgent escalations, call reviews and corrective actions;

i. Participation in and response to SOC 2 audit requests, PII Breach reporting and general compliance.

2.3.2
Customer Service Representative (CSR) Staffing
The Contractor shall recruit, develop and retain highly skilled and informed Customer Service Representatives.

The following are minimum competencies required for entry level CSRs:

a. High school diploma or GED required

b. Associates degree or higher from an accredited college or university preferred

c. At least three (3) years of relevant experience required

d. Proficiency in Microsoft Word

e. Willingness to work with culturally and linguistically diverse and disadvantaged populations in a courteous and effective manner

f. Must be able to navigate and efficiently use customer relationship management (CRM) and Maryland Health Connection (MHC) systems

g. Effective communication and critical thinking skills

h. Ability to perform comfortably in a fast-paced environment

The Contractor shall be able to plan and execute swift recruitment, training and testing activities during annual Open Enrollment periods and as required to sustain staff levels. Contractor should thoroughly describe their hiring, training and long-term retention methods and attrition targets and how to achieve them.

The Contractor shall offer a minimum starting pay rate for CSRs of at least $18.00 per hour, and a differential of at least $3.00 per hour for Spanish-speaking bi-lingual CSRs. The pay of Team Leads, Supervisors, and Managers should be proportionately increased based on these starting rates.

If Contractor uses a temporary staff hire practice, the Contractor should have a plan to convert high-performing staff from temporary to permanent upon 90 or 120 days with a pay rate of $18.00 for CSRs with a differential of at least $3.00 per hour for Spanish-speaking bi-lingual CSRs.

The contractor shall ensure that all staff engaged for this project have access to high-quality, affordable health insurance either through a group health plan or by helping staff secure coverage in the individual marketplace.

The Contractor shall provide staff sufficient to support forecasted call center volumes and maintain levels of service as described throughout this solicitation.

The wait/hold time for callers to receive a live voice response in all initial calls shall be no longer than three (3) minutes (180 Secs.) average speed of answer (ASA) for 80% of all incoming calls during non-open enrollment periods and six (6) minutes (360 Secs) ASA for 80% of all incoming calls during open enrollment periods. The Wait Time shall be defined as the time elapsed between a call being initially answered including answered by an Automated Call Distribution (ACD) System and a response by a live operator to a caller's inquiry.

2.3.2b
Customer Service Representative (CSR) Functions
All CSRs shall perform the following tasks:

a. Documenting all consumer interactions and work processes in State-provided Customer Relationship Management (CRM) solution and the MHC worker portal

b. Providing information about QHP, SADP and Medicaid/MCHP Managed Care Organizations (MCOs) offerings

c. Informing consumers how to make premium payments to carriers

d. Assisting Medicaid eligible consumers with selecting an MCO and choosing a Primary Care Provider (PCP), while following MDH MCO scripts precisely

e. Assisting Medicaid-eligible consumers in completing a Health Service Needs Information (HSNI) form

f. Responding to inquiries related to eligibility status, enrollment status, coverage dates and change in circumstances

g. Researching and resolving or escalating consumer issues and account discrepancies

h. Assisting and educating consumers on appeal and complaint processes; properly escalating when necessary

i. Assisting Medicaid-eligible consumers with Annual Right to Change (ARC) requests for MCO Enrollment

j. Assisting Medicaid eligible consumers with transfers between MCOs if disenrolled “For Cause” reasons.

k. Answering questions and assisting with problems related to 1095A and 1095B forms

l. Providing assistance with password resets (tech support)

m. Provide referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit, the MIA, and local departments of social services for applicants and enrollees with grievances, complaints, questions, or the need for other social services;

n. Responding to inquiries related to eligibility status, enrollment status, coverage dates and change in circumstances

o. Researching and resolving or escalating consumer issues and account discrepancies

p. Assisting and educating consumers on appeal and complaint processes; properly escalating when necessary

q. Assisting Medicaid-eligible consumers with Annual Right to Change (ARC) requests for MCO Enrollment

r. Assisting Medicaid eligible consumers with transfers between MCOs if disenrolled “For Cause” reasons.

s. problems related to 1095A and 1095B forms

t. Providing assistance with password resets (tech support).

u. Answering questions and assisting with

v. Provide referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit, the MIA, and local departments of social services for applicants and enrollees with grievances, complaints, questions, or the need for other social services;

w. Documenting all consumer interactions and work processes in State-provided Customer Relationship Management (CRM) solution and the MHC worker portal

x. Providing consumers assistance in navigating the web portal, assisting with enrollment and financial assistance eligibility and comparing health and dental plans

y. Collecting the necessary eligibility criteria into an online application to assist individuals with

z. applying for or renewing health coverage

aa. Providing information about Advance Premium Tax Credit (APTC) and cost sharing reductions.

ab. Assisting consumers with changes during the plan year including income changes, address changes, and qualifying special enrollment period (SEP) events.

ac. Reciting attestations upon completion of applications for consumers’ acknowledgements.

Customer Service Representative (CSR) Functions
ad. Answering questions and assisting with
ae.Provide referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit, the MIA, and local departments of social services for applicants and enrollees with grievances, complaints, questions, or the need for other social services;

af. Documenting all consumer interactions and work processes in State-provided Customer Relationship Management (CRM) solution and the MHC worker portal

ag. Providing consumers assistance in navigating the web portal, assisting with enrollment and financial assistance eligibility and comparing health and dental plans

ah. Collecting the necessary eligibility criteria into an online application to assist individuals with

ai. applying for or renewing health coverage

aj. Providing information about Advance Premium Tax Credit (APTC) and cost sharing reductions.

ak. Assisting consumers with changes during the plan year including income changes, address changes, and qualifying special enrollment period (SEP) events.

al. Reciting attestations upon completion of applications for consumers’ acknowledgements.

MHBE Consolidated Service Center – RFP #BPM028490 – March 11, 2022 PAGE 43 | Page

2.3.3
CSR Support Staff
The Contractor’s CSC organizational structure shall have an adequate team lead, supervisor, and manager staff to CSR ratio to ensure a culture of continuous CSR support, coaching and development.

The Contractor shall provide sufficient management staff to support supervisors and perform other operational and project related duties.

The Contractor shall provide supervisory staff to oversee CSR staff functions.

Supervisors may also perform escalation functions such as taking calls requesting a supervisor, administrative tasks, staff feedback, coaching, mentoring, development, recognition and retention activities.

The Contractor shall engage team leads to focus on the important task of first line support to staff answering calls (call assist, navigation, finding/interpreting scripts, task guides, call documentation and data entry review for compliance and escalation submission approval). The team lead may also triage escalated calls prior to routing them to a supervisor.

2.3.4
Consumer Assistance Worker Support
The Contractor shall provide a direct phone line and dedicated resources, known as Consumer Assistance Worker Support, for Producers and Application Counselors who need assistance with application and enrollment issue troubleshooting. These should be dedicated English & Spanish speaking CSRs with fluency in communicating with a wide variety of worker types and knowledge levels.

The Contractor shall evaluate the number of required Consumer Assistance Worker Support staff annually based on the volume of incoming calls to determine and assign the number of resources necessary to meet MHBE required service level agreements to perform the tasks described in this section.

2.3.5
Live-Chat Support
The Contractor shall provide dedicated resources to receive and respond to live chat inquiries on the Maryland Health Connection website. Chat agents should be able to handle two chats simultaneously & efficiently.

Those dedicated to providing Live Chat support should have excellent problem solving, writing skills and the ability to handle two chats simultaneously if volume permits.

The Contractor shall evaluate the number of Live Chat staff routinely to ensure based on the volume of incoming calls to determine the number of resources necessary to meet MHBE required service level agreements to and perform the tasks described in this section.

2.3.6
Manual MCO Tracker
The Contractor shall provide dedicated resources for MCO manual case tracking. Medicaid cases requiring manual MCO enrollments must be escalated, vetted, entered on a tracker spreadsheet and handed off to MDH monitors. Average of 900 cases handled per month.
2.3.7
Quality Assurance Team
The Contractor shall manage all processes related to quality monitoring and controls. The Contractor shall provide Quality Assurance staff to monitor CSRs’ interaction with consumers and to provide feedback to the training team to assist in any additional training needs for staff.

The Contractor shall review a sampling of 12 calls per CSR per month or 3 calls per week per CSR. All scores from all evaluated calls for CSRs with tenure over 90 days will be averaged for the subject month’s service level score. MHBE and/or MDH-designated staff may also provide independent quality assessment reviews. During Open Enrollment periods (November - January), the Contractor will review a sampling of 8 calls per CSR per month, of which 4 should be Penalty of Perjury (POP) calls. The Contractor shall review a sampling of Live Chat consumer interactions equal to 3% of the total Live Chat interactions during a calendar month, spread equally amongst the CSRs doing Live Chat interactions.

2.3.8
Producer Assisted Transfer (BATPhone)
The MHBE requires Producer connectivity to the call center telephony system for each annual open enrollment period. Telephony connection, set-up and training for approximately 50 Producers (Number of Producers may change due to volume) will occur in each October prior to Open Enrollment. The participating Producer will receive calls transferred from call center representatives to assist eligible consumers in selecting QHP insurance plans during Open Enrollment. The Contractor is required to provide thorough training to the participating Producers to ensure they know how to connect. Two technical support representatives must be assigned to provide direct technical support to BATPhone Producers during the open enrollment period.
2.3.9
Live Chat Service
Live Agent Chat functionality is used in conjunction with the current MHBE Chatbot, "Flora". Flora provides automated responses to frequently asked questions (FAQs) as specified by MHBE, facilitates automated password reset functionality and other consumer queries. Within Flora, consumers have the option to click a button to connect to a "Live Chat Agent" at any time or be presented with an option to transfer to a live chat agent when Flora detects a comprehensive response may be required for the consumer query. The Live Chat Agent is responsible for PII validation, Salesforce CRM documentation, HBX application assistance and, if applicable, escalated Supervisor assistance and/or return outbound

call assistance for longer handle time inquiries. Live Chat demand may increase as future updates are made to the MHC application to give greater access to a live chat agent.

2.3.10
Training
The Contractor shall be responsible for administering a comprehensive MHBE-specific customer service training program delivered through a variety of modalities, tools, and adult learning methodologies.

a. The Contractor shall provide sufficient qualified staff to provide new hire training, refresher training and new procedural training. Contractor is to provide adequate training staff to effectively train new hires until fully staffed at initial ramp up and during seasonal ramp up periods. Training is ongoing and driven by monthly system updates, performance trends and concerns, new processes and policy updates.

b. Training staff, along with quality assurance staff is expected to continue the learning cycle by listening to calls and documenting any gaps in training. Materials should be continuously updated with new MHBE-provided information and job aids, and gap training should be delivered as needed. Materials are to be presented to MHBE for review prior to roll out.

c. The Contractor shall create all training content and materials relative to customer service protocols, scripts, work instructions and CRM use utilizing training content provided by the MHBE.

d. CSR training will consist of a minimum of approximately three weeks of classroom training with weekly proficiency testing, and a ‘nesting’ period of four weeks for continued development and observation. Contractor should require CSRs to demonstrate their work performance level before they are assigned a teleworking role.

e. A CSR candidate must pass a MHBE provided final exam achieving a score of seventy-five percent (75%) or higher to qualify for a CSC enrollment permit and be able to assist consumers in determining eligibility. The final exam may be taken three times. CSR candidates who do not pass the final exam after three attempts will not be able to become a CSR.

f. A CSR will be placed into an on-the-job training role (i.e.: Nesting, Peer Mentoring, or transition training) for at least 2 weeks before being allowed to answer calls unassisted once formal training has been conducted.

g. The Contractor will submit a training work plan, schedule and all training materials for approval by MHBE annually by August 1 or as materially modified or newly developed.

h. The contractor should utilize independent training tools and applications that allow CSRs to sharpen their knowledge and reinforce knowledge if trouble areas are identified. The Contractor should describe what is used.

2.3.11
Workforce Management
The Contractor shall provide workforce management support for real-time call management, forecasting and staffing, and service level attainment.

The Contractor shall maintain an appropriate level of Workforce Management (WFM) staff to support the CSC operations. WFM staff will be expected to provide services including but not limited to: preparing call volume forecasts, managing staff schedules, monitoring real-time schedule adherence and monitoring all related processes to optimize resource utilization.

The WFM staff shall develop a plan to achieve and maintain weekly schedule adherence standards of eighty-five (85%) percent or higher.

2.3.12
Culturally and linguistically appropriate services
The Consolidated Service Center will be fully compliant with American Disabilities Act requirements.

The contractor will ensure representatives support video relay 3rd party calls for hearing impaired consumers.

The Consolidated Service Center will meet the needs of Maryland consumers with representatives that are bi- or multilingual Spanish speakers and ensure handling all languages via 3rd party interpreter service. Currently 3rd party interpreter services are provided by MHBE through a separate state contract with Language Line, but the MHBE may ask the Contractor to provide the services on a pass- through basis during the term of this contract. Providing the services as pass-through will only be required with the agreement of the Contractor.

At the end of the transition-in period, a minimum of 60 CSR staff shall be bilingual in Spanish/English languages. This number will be evaluated routinely by the contractor and MHBE and determined based upon the percentage of Spanish speaking enrollees and Spanish call volumes to ensure sufficient staffing to respond to calls in the Spanish queue within service level and to minimize reliance on 3rd party interpreter services for Spanish calls.

To the extent that any additional other limited English proficient population might exceed 10% of the population of Maryland, the Contractor shall provide call center staff bilingual in the appropriate language in a percentage to be determined by the MHBE.

2.3.13
Reporting
The Contractor shall produce standard and ad hoc reporting and analysis to demonstrate work product and contract compliance. The Contractor shall provide an interactive client dashboard, which is preferred, to facilitate real-time access to key performance metrics and operational data in addition to the reporting requirements identified below.

All reporting will be made available to the MHBE and identified partners via MHBE and Contractor provided systems (hourly, daily, weekly and monthly).

The Contractor shall report and track systems-related occurrences that impact the Service Center to include:

a. Date, time, triage steps, Service Level Impact, steps recommended to resolve, steps taken to resolve outage or system delay events and outcomes.

b. Prepare Post-event root-cause report/analysis and provide feedback to the MHBE for incorporation into process improvement of processes and controls.

The Contractor will prepare weekly update reports on call trends, quality assurance, escalated cases and other work activities to present at bi-weekly client check-in meetings.

2.3.14
Work from Home/Teleworking
The Contractor should have in place a policy and protocols for a full remote or hybrid telework policy and a sample of policy and remote operational protocols should be included with the bid response. Protocols should include employee expectations and methods of training, communication, performance evaluation and oversight by leadership. As part of supporting a remote or hybrid telework delivery model, MHBE will allow for CSRs during their initial onboarding and training to use their own computing devices to complete their training. It is expected that any full remote or hybrid telework employees, after 90 days of employment, would be provided with devices by the Contractor at Contractor’s expense.
2.3.15
Facility
The Contractor shall provide turn-key facilities, within the State of Maryland, including furniture, cubicles, office supplies, etc. to perform the required work, including facilities and resources for training. The facility shall meet the following requirements:

a. Facilities shall meet HIPAA security and Privacy requirements.

b. The Contractor's security plan shall ensure physical and technical safeguards which comply with HIPAA compliance standards, and those related to ARC-AMPE or NIST 800-53 Rev5, PII, IIHI. All necessary hardware and software for the Service Center will be provided by the contractor.

c. The Contractor’s call center facility shall be equipped with CSR workstations, training rooms, break rooms, rest rooms, managerial and meeting space appropriate to the overall work plan; hybrid work optional.

d. The Contractor shall ensure adequate technology enabled training space for multiple classes conducted simultaneously during initial and periodic staff ramp up periods.

2.3.16
Telephony System Requirements
The Contractor shall provide a telephony system, that will be delivered through an IP infrastructure which provides the minimum functionality described below

a. Cloud Based Automated Call Distribution (ACD) - Telephony system will provide intelligent routing of customer contacts based on predefined thresholds, monitoring real-time consumer support center statistics such as but not limited to, agent skill, longest available agents, and wait time.

b. Interactive Voice Response (IVR) - the telephony solution shall provide call queuing and self-service at the edge of the network, allowing for redundancy so that calls can be routed to alternate consumer support centers in the event of a failure.

c. Weighted Skills-Based Routing: the telephony system shall consolidate contacts to a centralized queue and dynamically route to representatives according to pre-defined business rules and contact priority.

d. Call prioritization: the telephony system shall have the capability to tag/prioritize calls within the IVR/ACD to move “critical” calls ahead in the queue (e.g., account issue, etc.)

e. Auto answer: the telephony system shall allow for an automatic connection to incoming calls when an agent is in a ready state. This feature can be leveraged to improve speed to answer.

f. Courtesy callback: the telephony system shall provide a courtesy callback feature to reduce the time callers are waiting on hold or in a queue. The feature offers callers who meet predetermined criteria the option to be called back by the system instead of waiting on the phone for an agent. Callers who decide to be called back by the system leave their names and phone numbers. When the system determines that an agent will be available soon (or is available), the system then places a call back to the caller. The caller answers, confirms that he/she is the original caller, and is connected by the system to the agent after a much shorter wait.

g. Whisper feature: the telephony system should provide a whisper feature that will alert a Customer Service Representative of the type of incoming call based on queue selection, providing information such as whether the call is coming from a Producer, Application Counselor, or the language line.

h. Utilize Computer Telephony Integration (CTI) with ACD, IVR and the MHBE Salesforce database to provide caller identification pop, call tracking and reporting.

2.3.17
Telephony System — ACD & IVR System Monitoring & Operational Requirements
The Contractor shall:
a.Monitor the ACD and IVR for uptime and accuracy.
b.Initiate an internal resolution process for any outages or abnormal ACD or IVR behavior.
c.Integrate data from reports generated from the ACD and IVR into weekly and monthly reports that will be provided to the MHBE.
d.Proactively identify call routing and message changes within the IVR to improve consumer experience and containment rate.
e.Maintain and improve the IVR call trees based upon consumer contact types, call volumes, IVR failure rates, etc. Examples include testing new scripting and providing results and analysis to the MHBE.
f.Program Customer Satisfaction Survey (CSAT) into IVR menu.
g.Provide the ability to make ad hoc changes and updates to IVR messaging and call routing menus swiftly to manage caller demand.
h.Develop IVR menu options for caller self-service.
i.Provide forwarding capabilities through ANI and SIP to MHBE AI based IVR to provide Customers with automatic support for password resets, enrollment status, 1095 requests, general information and other assistive channels as developed by MHBE.

j. Provide a duplicate lower environment for development and testing of the configurations of MHBE Agentic AI capabilities.

k. Collaborate and work with MHBE IT seamlessly and without unnecessary delay to develop new voice channels for automated assistance during and after call center hours.

2.3.18
Telephony System – Customer Satisfaction Survey Reporting & Functionality
The Contractor shall provide a Customer Satisfaction Survey through the IVR menu. The Customer Satisfaction Survey shall prompt the caller for participation prior to connecting with live CSR and present the survey after CSR completes the call. Survey.
2.3.19
Telephony System – Reporting & Records Maintenance
The Contractor shall record 100% of all voice calls (inbound and outbound) and provide the State the ability to retrieve the call information for up to 10 years.

The Contractor’s telephony applications shall be compatible for integration with the MHBE’s Salesforce CRM database.

The Contractor shall notify the MHBE of any disruption to service and provide continued updates to the MHBE contract monitor or designee when resolution cannot be achieved within the agreed upon Service Level Agreement (SLAs).

The Contractor’s telephony system should have automated outbound dialing capability for any high volume outreach campaigns directed by the MHBE.

2.3.20
Technology
The Contractor must provide enough bandwidth to record 100% of all voice and data traffic.

The MHBE will provide CRM Users License sufficient for the number of required staff and Maryland.gov email addresses and Virtru encryption access for managerial and escalation staff as jointly determined necessary by MHBE and Contractor.

The contractor must maintain their intranet and internet connectivity to the following applications via internet and through site-to-site VPN tunnel:

●The HBX, SailPoint
●The Exchange’s Learning Management System

(LMS)

● The Exchange’s Customer Relationship Management System (CRM)

● The Exchange’s SharePoint and/or Google Docs and other shared resources as deemed necessary by MHBE.

The Contractor will ensure desktop upgrades to support CSC tools to CSR desktops. Contractor will use an updated version of Google Chrome or supported browser that is compatible with MHBE applications, or such other upgraded versions as required, to connect to the HBX applications;

The Contractor will provide the capability to record 100% of all calls and screens viewed (i.e.: chat). The recordings must be exportable in a format that can be viewed and heard and will supply support to MHBE as needed if calls and recordings are needed for MHBE review.

The Contractor shall provide computing systems workstations with the following minimum specifications to provide sufficient responsiveness and handle multiple applications running at once:

● Workstation Computing and Hardware Specifications The Contractor shall provide high-performance computing systems and dual-monitor workstations capable of seamlessly running all project-related software, web applications, CRM platforms, and real-time communication tools simultaneously without system latency or performance degradation. At a minimum, each workstation shall meet or exceed the following specifications:

· Displays: Dual 24-inch (or larger) Full HD monitors configured in an extended desktop layout.

· Processing Power: Modern multi-core enterprise-grade processor capable of supporting concurrent multitasking and real-time voice/data processing.

· System Memory: Minimum 16 GB RAM.

· Storage: Minimum 256 GB Solid State Drive (SSD)

· Security: Enterprise-grade Full Disk Encryption (FDE) using AES-256 standard or equivalent industry best practice.

The Contractor shall have technical support for all provided systems, desktops, telephony (including remote telephony) and network connectivity.

The Contractor shall provide a technical lead to manage and coordinate all aspects of technology, including but not limited to voice, data, desktops and cloud-based systems and to whom all technical communications will be communicated.

The Contractor shall have capability to add remote locations and remote employees for business redundancy and expansion planning.

The Contractor must provide appropriate network infrastructure and expert support services to acquire and complete circuit connectivity within the Servicer Center facility.

The Contractor will work with the State technology division to arrange for connectivity to the Worker Portal via means of direct connection from the State to Contractor premises and/or site to site VPN tunnel.

The Contractor must provide phones, headsets, computers, monitors, keyboards, mice and other peripheral equipment necessary for CSRs to perform call center activities.

The Contractor must supply all PCs, monitors, printers, network routers, network switches, and data center racks.

The Contractor will provide redundant DHCP and DNS network services.

The Contractor is required to provide battery backup for all routers, switches, and servers on premise or other similar alternatives such as back up generator.

The Contractor must provide enough storage and bandwidth to record 100% of all voice and data traffic.

The Exchange will provide CRM Users License sufficient for the number of required staff and Maryland.gov email addresses for managerial and escalation staff as jointly determined necessary by MHBE and Contractor.

The contractor must provide internet connectivity to the following applications:

●The HBX
●The Exchange’s Learning Management System

(LMS)

● The Exchange’s Customer Relationship Management System (CRM)

● The Exchange’s Gmail and Google Docs.

The Contractor will ensure desktop upgrades to support CSC tools to CSR desktops. Contractor will use Google Chrome for MHBE application access, or other upgraded versions as required, to connect to the hosted Exchange applications The Contractor will provide the capability to record 100% of all calls and screens viewed (i.e.: chat). The recordings must be exportable in a format that can be viewed and heard. The Contractor will provide recording database access the MHBE contract monitor and Quality Assurance Analyst.

The Contractor shall provide a help desk resource for internal technology-related escalations.

The Contractor shall have technical support for all provided systems, desktops, telephony (including remote telephony) and network connectivity.

The Contractor shall provide a technical lead to manage and coordinate all aspects of technology, including but not limited to voice, data, desktops and cloud-based systems and to whom all…

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