Exhibit B Service Level Agreements Summary

This is a Service Level Agreements (SLA) document for West Virginia's Medicaid Managed Care Rate Setting and Program Administration contract. The document establishes performance standards and operational requirements that service providers must maintain throughout the contract term. The SLAs define measurable metrics and quality benchmarks across multiple operational areas including claims processing, member services, utilization management, and administrative functions. Response times for member inquiries and grievances are specified with target completion windows, typically ranging from 24 to 30 days depending on the nature of the request. The document outlines performance thresholds that providers must meet on a monthly or quarterly basis, with detailed reporting requirements to demonstrate compliance with contractual obligations.

The SLA document includes penalty structures for non-compliance with established performance standards, specifying remedial action procedures when providers fail to meet agreed-upon metrics. Performance measurement methodologies are detailed to ensure consistent evaluation across all reporting periods. The document addresses critical operational areas such as network adequacy, provider credentialing timelines, authorization decision turnaround times, and member communication protocols. Financial implications of performance failures are outlined, with potential reductions in payments or contract termination provisions tied to sustained non-compliance. The SLAs establish a framework for ongoing monitoring and accountability throughout the contract duration, ensuring that Medicaid managed care services meet state quality and operational standards.