MCD702_CRP30751_SOW.pdf

MCD702 SFY24/25/26/27

OBLTSS Hotline Scope of Work Page 1 of 11July 1, 2023

ARTICLE I. Scope of Work

This Scope of Work is to operate the Ohio Benefits Long-Term Services and Supports (OBLTSS) call center and referral system (OBLTSS Hotline). Cleveland Sight Center (CONTRACTOR) will perform its responsibilities in accordance with the Scope of Work for the Ohio Department of Medicaid (ODM) as follows:

1. Call Center

a. CONTRACTOR will be responsible for securing and operating a call center system capable of handling at least 2,000 calls per month. The target is that at least 80% of the calls will be automatically routed to a local OBLTSS agency based on consumer’s input with the remaining calls handled by a Customer Service Representative (CSR) for those consumers who require assistance from a live person. CONTRACTOR will handle calls according to the following standards:

i. Advise a caller of his/her anticipated hold time if expected to be over 5 minutes;

ii. Allow a caller to leave a voicemail or request a callback;

iii. Provide information about the website; and

iv. Any other message deemed necessary by ODM.

b. CONTRACTOR will maintain phone system capability to warm (person-to-person) transfer callers to OBLTSS agencies with control of the caller-id to display a number specific to the OBLTSS toll-free number (844-644-6582 or other agreed-upon ODM-designated number).

c. CONTRACTOR will provide a telephone system that has the capacity to process both incoming and outgoing calls, as well as the ability to transfer calls, regardless of carrier.

d. The telephone system will route calls to specific queues, such as an automatic call distribution system as well as make digital recordings of the audio of the calls up to the point of transfer to an OBLTSS agency.

e. The telephone system will track call statistics including number of calls routed to each OBLTSS agency, how many callers were assisted by CSRs, average talk time, average wait time, and number of calls abandoned.

f. CONTRACTOR recognizes that certain services under this Contract are vital to ODM and must be continued without interruption. CONTRACTOR shall be prepared to continue providing such services identified by ODM, during periods of disaster, crisis, or other unexpected break in services based upon a Business Continuity Plan (Plan). CONTRACTOR is required to implement and maintain a sustainable Plan throughout the term of this Contract and provide the Plan to ODM upon request. The Plan will, at a minimum:

i. Enable continued performance under this Contract in the event of a disaster or other unexpected break in services; and

ii. Ensure the continuity for identified vital services and supporting facilities.

g. During periods of hold time greater than 15 minutes, the telephone system will allow a caller to enter a “call back” queue to leave a message and retain his/her place in the queue. CSRs must return the call when it would have come up in the queue.

h. ODM’s telecommunications provider will forward calls from the OBLTSS toll-free number to CONTRACTOR. ODM will incur all costs from ODM’s telecommunications provider. CONTRACTOR or ODM may decide to change telecommunications providers and will jointly coordinate such changes.

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i. CONTRACTOR will provide ODM’s telecommunications provider a direct dial phone number for ODM’s telecommunications provider to transfer calls into CONTRACTOR’s call center platform.

j. CONTRACTOR will coordinate all telecommunications integration with ODM and other vendors necessary to achieve project requirements and deliverables.

k. CONTRACTOR will receive and respond to inquiries from OBLTSS agencies and referral partners by phone or e-mail.

2. Referral System – ODM02399

a. CONTRACTOR will provide and manage a web referral form with the capability for the form to be embedded in the OBLTSS website or as a stand-alone form linked from the OBLTSS website.

b. The web referral form will have the capacity to collect at least 1,400 referrals per month.

c. The web referral form will be secured using HTTPS. CONTRACTOR will purchase and maintain one SSL certificate and one custom domain name (i.e.

obltss.org) for the exclusive use of this project. Upon ODM’s request the custom domain name will be transferred to ODM.

d. The web referral form will contain the data elements specified by ODM based on form ODM02399 Request for Medicaid Home and Community-Based Services (HCBS) Waiver.

e. The web referral form’s style may be customized by ODM’s OBLTSS website vendor so that it matches the look and feel of the OBLTSS website. ODM’s OBLTSS website vendor will provide the stylesheets/css that CONTRACTOR will apply to the web referral form.

f. The web referral form will generate PDFs that will be distributed according to the OBLTSS business rules (i.e. round robin to OBLTSS agencies within a geographic region).

g. CONTRACTOR will distribute PDFs to OBLTSS agencies using a secure document management system such as ShareFile®.

h. CONTRACTOR will report to ODM the distribution of the web referrals in a similar manner that CONTRACTOR will report the distribution of OBLTSS phone calls.

3. Referral System – spreadsheet uploads

a. CONTRACTOR will be responsible for accepting at least one hundred fifty (150) referrals (e.g. veteran referrals) per month in a format approved by ODM (e.g.

Microsoft® Excel spreadsheet) using a secure document management system such as ShareFile®.

b. The referrals received from spreadsheets will generate PDFs that will be distributed according to OBLTSS business rules (i.e. round robin to OBLTSS partners within a geographic region).

c. CONTRACTOR will distribute PDFs to OBLTSS agencies using a secure document management system such as ShareFile®.

d. CONTRACTOR will report to ODM the distribution of the spreadsheet referrals in a similar manner that CONTRACTOR will report the distribution of OBLTSS phone calls

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4. Referral System – API and OBLTSS Website

a. CONTRACTOR will be responsible for operating an application programming interface (API) which will allow ODM or ODM’s designee to programmatically submit at least 50 referrals per month from a “Contact Us” form embedded on the OBLTSS website.

b. CONTRACTOR will collaborate with ODM or ODM’s designee to operate and monitor the system.

c. The API will generate PDFs that will be distributed according to the OBLTSS business rules (i.e. round robin to OBLTSS agencies within a geographic region).

d. CONTRACTOR will distribute PDFs to OBLTSS agencies using a secure document management system such as ShareFile®.

e. CONTRACTOR will provide training instructions and on-going support to end-users of the secure document management system.

f. CONTRACTOR will report to ODM the distribution of the API referrals in a similar manner that CONTRACTOR will report the distribution of the OBLTSS phone calls.

5. Referral Systems – Text Messaging

a. CONTRACTOR will be responsible for implementing and managing a text messaging referral system capable of sending and receiving at least 1,500 text messages (150 text message referrals at approximately 10 text messages each) per month.

b. CONTRACTOR will implement an automated text messaging system that will receive text messages and respond according to script for the purposes of collecting the information specified by ODM in order to generate a referral to an OBLTSS agency. The text messaging system will operate in English and Spanish.

c. CONTRACTOR will maintain the text message script and provide to ODM for review and approval of any changes.

d. With ODM approval, the CONTRACTOR will adjust the script and system.

e. The system is capable of receiving and sending text messages via a local direct dial, toll free or short code.

f. CONTRACTOR will lease one local direct dial and one toll free for use by the text messaging referral system.

g. Requests received by text messaging will generate referrals that will be distributed according to the OBLTSS business rules (i.e. round robin OBLTSS agencies within a geographic region).

h. CONTRACTOR will distribute referrals to OBLTSS agencies via PDFs using a secure document management system such as ShareFile®.

i. CONTRACTOR will report to ODM the distribution of the text message referrals in a similar manner that CONTRACTOR will report the distribution of the OBLTSS phone calls.

j. ODM retains ownership of all planning, launch, and maintenance documentation regarding operation of the text messaging system. Upon request, CONTRACTOR will provide all documentation and instructions related to the text messaging system.

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6. Operations

a. The call center will be located in Ohio. CONTRACTOR’s Designated

Representative and critical project staff will be available to travel to ODM, located at the Lazarus Building, 50 West Town Street, Columbus, Ohio 43215, up to six times per year when requested by ODM for meetings and training.

b. Customer service representatives will answer calls Monday through Friday from 9:00 a.m. to 5:00 p.m. EST. These hours may be adjusted by mutual agreement of CONTRACTOR and ODM according to CONTRACTOR’s fee schedule.

Management personnel must also be working and supporting OBLTSS during business hours listed above.

c. In the absence of the declaration of an emergency by the President of the United States, a Federal Agency with appropriate authority, Governor of the State of Ohio, or a State Agency with appropriate authority, CONTRACTOR will provide staff during regularly scheduled business hours.

d. CONTRACTOR will close the call center and use voicemail or a callback system to answer calls on days when OBLTSS is closed including these actual and observed holidays: New Year’s Day, Martin Luther King Day, President’s Day, Easter, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, the day after Thanksgiving, and Christmas Day.

The call center will also be closed on any new Federal or State holidays that are designated during the contract period.

e. CONTRACTOR will have in place a comprehensive plan to handle call volume that exceeds staff capacity. This plan will include the capacity to either roll calls over to other phone centers operated by CONTRACTOR within one hour of the increase in call volume, and/or provide a voicemail or callback system to callers. If a voice mail or callback system is used, CONTRACTOR assures that calls will be returned to consumers in the order received within 1 business day.

f. Within one hour of its occurrence, CONTRACTOR will notify ODM of any problems with telephone lines, telephone equipment, computer systems, computer equipment, or staff shortages.

g. During regular business hours, CONTRACTOR will accommodate vision-, speech-and hearing-impaired and Limited-English Proficient (LEP) individuals. Information for the speech- and hearing-impaired will be provided through an employee of CONTRACTOR. Information for LEP individuals will be provided through a combination of CONTRACTOR personnel fluent in one or more non-English languages, the use of a third-party interpreter service such as LanguageLine, through a comparable service at the vendor’s cost, or a combination of the above.

h. CONTRACTOR will report any threat, emergency, theft, or breach of personal health information to ODM within one hour of the occurrence. CONTRACTOR will call the ODM Contract Manager or designee to verbally report the incident and submit a written report within 24 hours. CONTRACTOR will report incidents occurring during nonbusiness hours by 8:00 a.m. the next business day.

i. In order to meet the requirements in this scope of work, CONTRACTOR may make use of a SUBCONTRACTOR. If a SUBCONTRACTOR is used CONTRACTOR will assure that service is provided at a comparable level of quality and performance. If subcontracting is implemented, CONTRACTOR will train and manage the SUBCONTRACTOR.

j. CONTRACTOR assumes responsibility for all work, in whole or in part, by CONTRACTOR, or a SUBCONTRACTOR. CONTRACTOR will be the sole point of contact with regard to contractual matters, including payment of all charges

OBLTSS Hotline Scope of Work Page 5 of 11July 1, 2023 resulting from the Scope of Work. CONTRACTOR will be fully responsible for any default by the subcontractor just as if CONTRACTOR itself had defaulted.

k. CONTRACTOR may remove the SUBCONTRACTOR if doing so is necessary for legal or disciplinary reasons. However, CONTRACTOR must make a reasonable effort to give ODM 30 calendar day’s prior written notice of the removal. If CONTRACTOR or SUBCONTRACTOR's personnel leave the respective entity, CONTRACTOR must provide ODM with immediate notice and all relevant information regarding replacement personnel.

l. CONTRACTOR will maintain a call flow that achieves the goal of handling at least 80% of calls with the automated system. (Appendix 2 – Call Flow).

m. ODM will notify the CONTRACTOR within 2 business days of any actions taken on the part by ODM that may alter the average monthly call volume by more than a 10% increase or decrease.

7. Information Technology Systems

a. CONTRACTOR will provide reliable high quality customer service that utilize a variety of Information Technology Systems (IT).

b. CONTRACTOR has the ability to communicate with ODM electronically, including sending and receiving secure e-mail, and receiving files in a software package compatible with ODM such as Microsoft Office.

c. CONTRACTOR’s IT system will have appropriate safeguards to protect against theft, use or disclosure of Protected Health Information (PHI) as required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

d. CONTRACTOR has the ability to store and generate data on a weekly, monthly, annual, and ad hoc basis. Data including audio recordings will be retained for at least 90 days. Data requiring longer storage may be transmitted to ODM for ODM to archive.

e. CONTRACTOR’s IT staff will communicate with ODM and other state agency IT staff as necessary.

8. Call Center Metrics

a. CONTRACTOR will meet the following criteria used by ODM to evaluate the quality of service provided by CONTRACTOR when call volume is at or below the contract standard of 2,000 calls per month.

b. The monthly average speed to answer incoming calls must be within 120 seconds of the call entering the queue.

c. Any recorded information provided at the beginning of a call (e.g., the call may be monitored for quality purposes or public service announcements) must be in Spanish as well as English.

d. The call abandonment rate must not exceed 5% monthly when call volume does not exceed contract standards. Calls abandoned in less than 24 seconds after entering the queue should not be counted in the abandonment rate nor will repeat callers who are served that same day.

e. The expected average time to reply to e-mails from OBLTSS agencies or partners is within one (1) business day.

9. Audits and Compliance

a. CONTRACTOR agrees that ODM will evaluate, at least semi-annually, throughout the life of this Contract and at the discretion of ODM, various components of the deliverables to determine the level of compliance.

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b. CONTRACTOR will collaborate with ODM on defining the elements of a well handled call, institute a quality assurance system, and transparently report results and provide remediation if results are below the required thresholds.

CONTRACTOR will fully cooperate with ODM in conducting semi-annual performance, telephone, and personnel audits and ad hoc evaluations to review:

i. Staff qualification;

ii. CSR’s general call process;

iii. CSR’s customer service skills;

iv. Accuracy of information given during telephone calls; and

v. Call center metrics.

At a minimum, CONTRACTOR will conduct quarterly monitoring of telephone calls for each employee to ensure that the information provided is correct and in accordance to protocols and that the expected quality of customer service is provided. The results must be available to ODM upon request.

c. CONTRACTOR will comply with performance standards when providing services according to the Service Level Agreement (Appendix 1). Upon evidence that CONTRACTOR has not met one or more of the standards, CONTRACTOR agrees to work with ODM to meet the standard(s). If, during the course of performance of this CONTRACT, a dispute relating to the scope of work, service delivery, or standards arises between ODM or CONTRACTOR, ODM and CONTRACTOR will first attempt to resolve the dispute through the following informal process: Either ODM or CONTRACTOR, through its Designated Representative, may initiate the process by notifying the other party that it wishes to confer in an attempt to resolve the dispute. Once the process has been initiated, the Designated Representatives will arrange a meeting. The meeting will take place as soon as practicable, either by phone or in person at a mutually agreeable location. At the meeting, the Designated Representatives will discuss, and attempt informally to resolve, the dispute. If it cannot be resolved within five business days, the Designated Representatives may take any other steps that are authorized under the CONTRACT or if necessary, the provisions in the Standard and Special Terms and Conditions for the State of Ohio Community Rehabilitation Program contracts.

d. CONTRACTOR will be responsible for maintaining and monitoring a Quality Assurance Plan. The Quality Assurance Plan will be developed in partnership with ODM and will include the following elements at a minimum:

i. Documentation of systems and workflows

ii. System availability

iii. Data quality

iv. Customer service

v. Roster of OBLTSS agencies

vi. Ongoing monitoring of the referral systems

10. Reporting

a. CONTRACTOR will transmit data and reports electronically to ODM in a format that is compatible with ODM. CONTRACTOR will provide the following reports:

i. Monthly Report: CONTRACTOR will submit a monthly report to ODM. The report is due to the ODM Contract Manager or designee by the tenth business day of each month for the preceding month. The monthly report will contain the following information:

1. A statistical summary of activity including:

a. Total number of callers;

b. Total number of calls requiring CSR assistance;

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c. Total number of calls routed by the automated system;

d. Total number of calls, text message referrals, spreadsheet referrals, web referrals and contact-us referrals identifying the OBLTSS agency to which the call or referral was referred;

e. Total number of calls received during non-business hours;

f. Number of calls by language;

g. The monthly average speed to answer incoming calls;

h. A narrative summary of the month’s events which will include referral and marketing activities;

i. A list of any complaints received; and

j. The status of any training provided.

2. A busy hour report that lists the number of calls received per hour per day and a cumulative percentage of calls received by hour; and

3. Personnel staffing levels (number of customer service representatives handling calls).

ii. Weekly Export Report: CONTRACTOR will provide ODM and OBLTSS partners an Excel spreadsheet export of the data contained in all ShareFile® referral PDFs for a web referral, veteran referral, text message referral or contact-us referral.

iii. Ad-Hoc Reporting: CONTRACTOR will provide ODM with ad hoc reports as requested within a time limit established by ODM.

iv. CONTRACTOR’s project manager will be available, at a minimum of once per month, to review with ODM staff the performance of the Scope of Work.

Discussions will take place in person or via phone at ODM’s discretion.

11. Invoicing and Payment

a. CONTRACTOR will invoice ODM monthly for services provided at the agreed upon rates (Appendix 3 – Quote ) with payment due 30 days upon receipt of the invoice.

CONTRACTOR will provide ODM a detailed report of usage at the time of invoicing. Invoices will be emailed to: invoices@ohio.gov.

b. CONTRACTOR will bill ODM for one unit of Account Maintenance for each system that is deployed for service during the month.

c. CONTRACTOR will bill ODM for Dedicated Hours for each hour CSRs, Program Coordinators, or someone acting in one of those capacities are performing work.

The total time for the month will be rounded to the nearest whole hour.

d. CONTRACTOR will bill ODM for Productive Minutes for all time spent serving a caller including any post-call work. CONTRACTOR will not bill ODM for any calls that are not handled, any time the caller is on hold, or any time after the caller is transferred. CONTRACTOR will bill ODM for each Productive Minute using the actual time rounded up to 1/10th of a minute. The total minutes for each day will be rounded up to the nearest minute. Each day will have a minimum of 90 Product Minutes.

e. CONTRACTOR will provide ODM up to twenty hours of System Development time at no cost each year for minor system or reporting updates.

f. CONTRACTOR will provide ODM up to 2,400 minutes of Translation Service at no cost each year to serve callers in languages other than English.

g. CONTRACTOR will provide ODM the prescribed discounts according to the Service Level Agreement when any penalties are incurred.

mailto:invoices@ohio.gov

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12. Designated Representatives CONTRACTOR and ODM will designate representatives as the primary points of communication for scope of work, invoicing, reporting or contractual issues.

The designated representative for ODM is:

Ohio Department of Medicaid Althea Letang, MPA OBLTSS Policy Administrator/Agreement Manager Bureau of Long-Term Services & Supports

(614) 752-2062 Althea.Letang@medicaid.ohio.gov

The designated representative for CONTRACTOR is:

Cleveland Sight Center Jassen Tawil, MNO Vice President, Strategic Initiatives

1909 East 101st Street Cleveland, OH 44106

(216) 658-7336 jtawil@clevelandsightcenter.org

Either party may change its representative at any time by notifying the other party in writing.

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Appendix 1 - Service Level Agreement

Cleveland Sight Center intends and will make every effort to provide high quality and reliable service. The following pages define this commitment. The definitions, service levels, and exceptions are provided to explain and clarify the commitment.

Definitions

These definitions explain the nature of the commitments and how performance measures will be calculated:

“Agent” is a person handling calls, e-mails, or performing related tasks.

“Total Monthly Time” is the total number of minutes in the applicable calendar month where a customer can Receive Service.

“Unavailable Monthly Time” is the total number of minutes in the applicable calendar month where the customer cannot Receive Service.

“Receive Service” is the ability for the caller to hear a personalized greeting, speak to an agent during business hours, leave a voicemail, or request a callback.

“Actual Monthly Availability Percentage” is the calculated monthly availability as a percentage using (A – B)/A, where:

A = Total Monthly Time B = Unavailable Monthly Time

“Hold Time” is the time that a caller waits on hold as measured in seconds using A – B, where:

A = Timestamp when caller connects to agent B = Timestamp when caller requests to speak to an agent

“Average Monthly Hold Time” is the average Hold Time expressed in seconds of all callers during the month using A / B, where:

A = Cumulative seconds of Hold Time B = Number of calls

“Abandon” is the number of callers who hang-up before speaking to agent. Callers who wait on hold less than 24 seconds and hang-up and repeat callers who call, hang-up, call back and are served will not be counted as an abandon.

“Average Abandon Rate” is the calculated monthly abandon rate as a percentage using A / B, where:

A = Number of Abandons B = Number of Callers Requesting a Live Agent

“Time to Reply” is the difference in time between when an e-mail arrives and when it is sent or resolved using A – B, where:

A = Timestamp when an e-mail is sent or marked as resolved (no reply needed)

B = Timestamp when an e-mail arrived

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“Average Time to Reply” is the calculated monthly average for Time to Reply using A / B, where:

A = Cumulative Time to Reply B = Number of inbound e-mails handled

“Contracted Volume” is the number of calls or e-mails contracted to be handled within a month plus or minus 10%.

“Significant Outage” is a documented incident where a customer cannot Receive Service. Each Significant Outage will be documented with a sequentially assigned number, timestamp when the incident began, timestamp when the incident ended, and a Reason for Outage Report.

“Reason for Outage Report” is a written document that will summarize a Significant Outage, identify the root cause, and recommendations to prevent recurrence. Reason for Outage Reports will be drafted and sent to the customer within 10 business days of the end of the Significant Outage.

“Performance Incident Report” is a documented incident when a contracted Service Level Commitment is not met. Each Performance Incident will be documented with a sequentially assigned number, explanation of the incident, any penalty incurred, and recommendations to prevent recurrence. Performance Incident Reports will be drafted and sent to the customer within 10 business days or prior to invoicing (whichever is sooner).

Commitments

Cleveland Sight Center will meet these commitments and will be penalized for not meeting these commitments:

Actual Monthly Availability Percentage – 99.95%

Commitment - CSC will achieve an Actual Monthly Availability Percentage of no less than 99.95%.

Penalty – 10% discount of total monthly invoice for each hour of unavailable monthly time in excess of commitment.

Average Monthly Hold Time – 120 seconds

CSC will achieve an Average Monthly Hold Time of no more than 120 seconds when the call volume is within the Contracted Volume.

Penalty – 10% discount of total monthly invoice for each 60 seconds of average monthly hold time beyond commitment.

Average Abandon Rate – 5%

CSC will achieve an Average Abandon Rate of no more than 5% when the call volume is within the Contracted Volume.

Penalty – 10% discount of the total monthly invoice for each percentage of average abandon rate above monthly commitment.

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Exceptions and Clarifications

These exceptions and clarifications are provided to avoid misunderstanding in the unlikely event that CSC does not meet a service level commitment.

1. The total monthly discount is the largest penalty for not meeting one of the contracted commitments. Penalties are not combined and the maximum penalty in any one month is a 100% discount.

2. An incident of unavailable time begins the latter of when it is confirmed that the customer cannot receive service or when a customer’s service was schedule to begin but the customer cannot receive service.

3. An incident of unavailable time ends once it is confirmed that the customer is receiving service.

4. Downtime during scheduled maintenance windows is not included in Unavailable Monthly Time.

5. Downtime due to factors out of CSC’s control or where responsibility for the downtime is uncertain are not included. Examples include: The customer’s telecommunications provider is having an outage; The Microsoft 365 account provided by the customer is having an outage; The customer’s telecommunications provider claims there is no outage but test calls to or from the customer’s telecommunications provider fail; Acts of God; Emergencies declared by the President of the United States (or delegated Federal agency), Governor of Ohio (or delegated State agency), or Mayor of Cleveland (or delegated local agency).

6. Time waiting for a customer’s other vendors to take action is not included as unavailable time.

7. Misconfiguration errors are not included. For example: The caller hears an out-of-date personalized greeting; The caller hears a default greeting put into place during troubleshooting.

8. Quality of service issues are not included. For example: Caller can connect to an agent but the caller or agent hears line noise, delays, or one-way-audio; Call disconnects while an agent is serving a caller; An e-mail attachment is missing; A report has incorrect or missing information;

9. Waiting on hold and hanging up before connecting to an agent is not an availability factor.

10. To account for delays in the sender’s e-mail system, the time an e-mail arrives will be when it actually arrives, not when it was sent.

11. To account for delays in the receiver’s e-mail system, the time an e-mail was sent will be when it was sent, not when it arrives.

Exceptions and Clarifications