HomeMy WebLinkAboutC23-014 CODPHE_amendment 2Amendment Contract Number: 2021CMIP020A2 Page 1 of 3
CONTRACT AMENDMENT #2
SIGNATURE AND COVER PAGE
State Agency
Department of Health Care Policy and Financing
Original Contract Number
2021CMIP020
Contractor
Eagle County
Amendment Contract Number
2021CMIP020A2
Current Contract Maximum Amount
Initial Term
Contract Performance Beginning Date
July 1, 2020
State Fiscal Year 2021 $27,157.57
Extension Terms Current Contract Expiration Date
June 30, 2023 State Fiscal Year 2022 $27,157.57
State Fiscal Year 2023 $35,901.01
Total for All State Fiscal Years $90,216.15
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment
and to bind the Party authorizing his or her signature.
CONTRACTOR
Eagle County
By:______________________________________________
Date: _________________________
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care Policy and Financing
By:______________________________________________
Date: _________________________
In accordance with §24-30-202 C.R.S., this Amendment is not valid until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:___________________________________________
Amendment Effective Date:_____________________
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1/4/2023 | 12:59 PST 1/4/2023 | 13:00 PST
1/6/2023 | 07:20 PST
Amendment Contract Number: 2021CMIP020A2 Page 2 of 3
1. PARTIES
This Amendment (the “Amendment”) to the Original Contract shown on the Signature and Cover
Page for this Amendment (the “Contract”) is entered into by and between the Contractor and the
State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract.
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date
shown on the Signature and Cover Page for this Amendment. The State shall not be bound
by any provision of this Amendment before that Amendment Effective Date, and shall have
no obligation to pay Contractor for any Work performed or expense incurred under this
Amendment either before or after of the Amendment term shown in §3.B of this Amendment.
B. Amendment Term
The Parties’ respective performances under this Amendment and the changes to the Contract
contained herein shall commence on the Amendment Effective Date shown on the Signature
and Cover Page for this Amendment and shall terminate on the termination of the Contract
or June 30, 2023.
4. PURPOSE
The purpose of this Amendment is to create and revise performance -based benchmarks and
deliverables for county departments of human/social services to achieve certain performance
standards related to County Administration, Medical Assistance Eligibility and cooperation with
other Medical Assistance-related entities. This Amendment includes one new Performance
Incentive and the removal of two other Performance Incentives.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Initial Contract Expiration Date on the Contract’s Signature and Cover Page is
hereby deleted and replaced with the Current Contract Expiration Date shown on the
Signature and Cover Page for this Amendment.
B. The Contract Maximum Amount table on the Contract’s Signature and Cover Page is hereby
deleted and replaced with the Current Contract Maximum Amount table shown on the
Signature and Cover Page for this Amendment.
C. Exhibit A, STATEMENT OF WORK, is hereby deleted in its entirety and replaced with
Exhibit A-1, STATEMENT OF WORK, attached below. All references to Exhibit A shall
now reference Exhibit A-1.
D. Exhibit B, RATES, is hereby deleted in its entirety and replaced with Exhibit B-1, RATES,
attached below. All references to Exhibit B shall now reference Exhibit B-1.
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
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amendments or other modifications to the Contract, if any, remain in full force and effect except
as specifically modified in this Amendment. Except for the Special Provisions contained in the
Contract, in the event of any conflict, inconsistency, variance, or contradiction between the
provisions of this Amendment and any of the provisions of the Contract or any prior modification
to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and
control. The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment specifically
modifies those Special Provisions.
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EXHIBIT A-1, STATEMENT OF WORK
1. TERMINOLOGY
1.1. The following list is provided to assist the reader in understanding acronyms, abbreviations and
terminology used throughout this document.
1.1.1. Applicant - An individual for whom the Contractor is performing a Determination.
1.1.2. Average Speed to Answer (ASA) – A key Call Center metric measuring the average amount
of time it takes to answer a phone call from a customer, from the point of call connection to
being connected to a live agent, including the time waiting in queue. ASA does not include
calls that can be answered through automated means and do not require a live agent.
1.1.3. Benchmark - degrees of performance between undesired current performance and target
performance (example: current timeliness 90%, benchmark for next month = 93% until we
reach 95%)
1.1.4. Business Day - any day in which the State is open and conducting business, but shall not
include Saturday, Sunday, or any day which the State observes one of the holidays listed in
C.R.S. §24-11-101(1).
1.1.5. Call Center - A Call Center is defined as having one dedicated line for contacting the
Contractor; when members and individuals call in, they are automatically assigned to the next
available Contractor agent. This dedicated line should also have technology in place to
provide data, at a minimum, on the number of calls received, the average wait time and the
number of abandoned calls. Call Centers can be as small as 2 Contractor staff and as large as
100 or more Contractor staff answering calls.
1.1.6. Child Health Plan Plus (CHP+) - public low-cost health insurance for certain children and
pregnant women.
1.1.7. Compliance - these measures are tied to contracts or to ensure Colorado does not fall below
expected federal or state standards.
1.1.8. COGNOS/Decision Support System 01 (DSS01) - the Department’s data reporting systems
that use information from the Colorado Benefits Management System (CBMS).
1.1.9. Colorado Benefits Management System (CBMS) - the State’s eligibility determination
system.
1.1.10. Colorado interChange (interChange) - the State’s claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collects and analyzes data
related to those payments.
1.1.11. Corrective Action Plan (CAP) - A formal plan implemented with Department technical
assistance to address non-compliance and/or performance as defined in 10 CCR 2505-5
1.020.11.
1.1.12. County Administration website - the Department’s public-facing website where contract
documentation is kept for the County Incentives Program
(http://www.colorado.gov/hcpf/county-admin).
1.1.13. County Financial Management System (CFMS) - the accounting system utilized by the
Contractor to record expenditures against county administration funding for Colorado’s
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Medical Assistance Program. The system is also used to issue Performance Incentive
Payments to eligible Contractors.
1.1.14. County Incentives Program - program that provides specific funding to county departments
of human/social services for meeting Medicaid-related Performance Incentive Standards in
their counties. Also referenced as Performance Incentive Standard Program throughout this
Agreement.
1.1.15. Determination - The act of using CBMS to determine if an Applicant is eligible for the
Colorado Medical Assistance Program based on information submitted on a new application,
a redetermination or a change in member circumstance.
1.1.16. Disenroll or Disenrollment - The act of processing a change in circumstance that affects a
member’s eligibility and makes them ineligible for coverage within Health First Colorado or
Child Health Plan Plus.
1.1.17. Eligibility Quality Assurance (EQA) Program - EQA conducts monthly case reviews to
monitor the accuracy and timeliness of eligibility determinations for Medical Assistance
made by the Contractor, with cases pulled monthly for quality review. Results of the EQA
reviews are displayed on the MAP Accuracy Dashboard.
1.1.18. HCPF Memo Series - The Department’s policy, operational and informational
communications that are utilized to provide contract clarifications, provide data and
operational guidance and share information pertaining to the County Incentives Program
(https://hcpf.colorado.gov/memo-series).
1.1.19. Health First Colorado – the member-facing name for Colorado's Medical Assistance
Program, which includes all programs that use the Modified Adjusted Gross Income (MAGI)
methodology.
1.1.20. Home and Community-Based Services (HCBS) - HCBS waiver programs provide additional
benefits and services to eligible populations in addition to the standard benefit package
offered to all members.
1.1.21. Improvement Action Plan (IAP) - An informal plan implemented with technical assistance
to address non-compliance and/or performance that may lead to noncompliance.
1.1.22. Long Term Care (LTC) - Long-Term Care is a Medical Assistance program that provides
nursing-home care, home-health care, personal or adult day care for individuals aged at least
65 years or with a chronic or disabling condition.
1.1.23. Management Decision Letter (MDL) -A formal notification issued by the Department,
through a letter that details areas and findings of noncompliance by the Contractor. An MDL
can be issued for not meeting performance targets on the MAP Dashboard.
1.1.24. MCC – Health First Colorado Member Contact Center
1.1.25. Member – An individual who is eligible for the Colorado Medical Assistance Program. Also
known as a client.
1.1.26. Medical Assistance Performance (MAP) Dashboards - a graphic representation of essential
information regarding performance measures, targets and benchmarks and the county’s actual
performance. The MAP Dashboards highlights each county’s performance and quality.
1.1.27. Performance Measure - A quantification that provides objective evidence of the degree to
which a performance result (goal) is occurring over time.
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1.1.28. Program for the All-Inclusive Care for the Elderly (PACE) – Program provides
comprehensive medical and social support services to certain frail individuals 55 years of age
and over. The goal of PACE is to keep individuals in their homes and communities through
comprehensive care coordination.
1.1.29. PuMP - Performance Measurement Process developed by Stacey Barr.
1.1.30. Reporting Period - The period of time for each performance standard used to measure whether
the Contractor is meeting the requirements of each specific Performance Incentive Standard,
including performance targets and/or deliverables.
1.1.30.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1.30.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and end on
June 30 of that SFY.
1.1.31. Redetermination - A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.32. State Fiscal Year (SFY) - The period beginning July 1 of each calendar year and ending on
June 30 of the following calendar year. Also referred to as fiscal year in this Exhibit.
1.1.33. Status Report - a communication to the Contractor that details which Performance Incentive
Standards were met for each Reporting Period.
1.1.34. Tableau – is an interactive data visualization software focused on business intelligence;
provides a graphic representation of essential information regarding performance measures,
targets and benchmarks and the county’s actual performance.
1.1.35. Timely Determination - Any Determination that is completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.36. Timely Disenrollment - Processing a change in a member’s circumstance and making a
determination within fifteen (15) calendar days.
1.1.37. Timely Redetermination - Any Redetermination that is completed by the last day of the month
prior to the month in which the member’s new annual enrollment period begins.
1.1.38. Target - Degree of performance we are aiming to achieve (i.e. 95% Timeliness)
1.1.39. Untimely Determination – Any Determination that is not completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.40. Untimely Redetermination – Any Redetermination that is not completed by the last day of
the month prior to the month in which the member’s new annual enrollment period begins.
This is based on the CBMS RRR Due Date.
1.1.41. Voice of the Customer - Voice of the Customer (VoC) is a series of different methods that is
used to collect customer feedback. A VoC program can help the Contractor capture how
customers feel about the experience of accessing services at the Contractor, and can produce
insights that can help the Contractor create a stronger customer experience.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility-related work within the Contractor’s
county, required under C.R.S. §25.5-1-101 et seq. The Department and the Contractor share the
costs of this work performed by the Contractor as defined in those statutes and this Contract shall
not impact the allocated amount of that cost sharing.
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3. SYSTEMS USED TO DETERMINE COMPLIANCE WITH PERFORMANCE
INCENTIVES STANDARDS
3.1. Systems Utilized to Determine Compliance
3.1.1. To determine whether the Contractor met any or all the Performance Incentives Standards
when completing determinations and redeterminations within the Contractor’s county, the
Department will utilize the COGNOS/DSS01 and MAP Dashboard systems to pull data
tracking and reports that track the Contractor’s compliance with certain Performance
Incentive Standards. This data will be visualized on each county’s MAP Dashboards.
3.1.2. To determine whether the Contractor met any or all the Performance Incentives Standards
when working with Medicaid populations within the Contractor’s county, the Department
may utilize data from the Colorado interChange system.
3.1.3. The above list of systems is not all-inclusive and the Department will, at its discretion, utilize
additional data and reports from the COGNOS/DSS01, interChange, and/or other systems to
determine whether the Contractor met any or all the Performance Incentives Standards.
3.1.4. The date the data or reports will be pulled from the COGNOS/DSS01, interChange, and/or
other systems published on the MAP Dashboard will be defined in each applicable
Performance Incentive Standard and/or the PuMP template for those performance measures.
3.1.5. The Contractor should utilize policy, operational and informational guidance provided in this
Exhibit and through the HCPF Memo Series for each Performance Incentives Standard to
assist with implementing the Performance Incentives Standard and pulling applicable data
and reports to determine the Contractor’s compliance with any or all the Performance
Incentives Standards.
3.2. Communications Utilized to Determine Compliance
3.2.1. To fulfill the requirements in Exhibit A Statement of Work and earn a Performance Incentive
Payment, the Contractor shall utilize and comply with guidance issued through the HCPF
Memo Series.
3.2.2. The Contractor will utilize the HCPF Memo Series to find any forms, templates, program
contacts or additional information needed to operationalize the Performance Incentives
Standard Program referenced throughout this Agreement.
3.2.3. If additional guidance or contract clarification is needed, the Department may release
additional guidance to the Contractor through the HCPF Memo Series.
4. PERFORMANCE INCENTIVES STANDARD PROGRAM
4.1. The Contractor may earn Performance Incentive Payments to reimburse it for a portion of its cost
sharing as described in Section 2.
4.2. Accuracy Performance Incentive Standard
4.2.1. The Contractor may earn the Accuracy Performance Incentive Payment by meeting the
Accuracy targets at the end of the Second Reporting Period. To earn the entire Accuracy
Performance Incentive Payment, the Contractor must meet both targets as specified in section
4.2.1.1, which includes (1) Target for Inaccurate Eligibility Determination Rate and (2)
Target for Errors that do not Impact Eligibility. If the Contractor only meets one target, the
Accuracy Performance Incentive Payment will be 50% of the total amount for this
Performance Incentive.
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4.2.1.1. Accuracy Targets
4.2.1.1.1. The Inaccurate Eligibility Determination Rate target is used to determine how many
individuals in the sample had an incorrect determination.
4.2.1.1.1.1. The Inaccurate Eligibility Determination Rate is calculated as the number of
individuals that were incorrectly approved, denied, or terminated divided by the
total number of individuals in the sample (%), monthly (includes applications,
redeterminations, and case changes).
4.2.1.1.2. The Errors that do not Impact Eligibility target is used to determine how many
individuals in the sample had a correct determination with errors that did not impact
eligibility.
4.2.1.1.2.1. The Errors that do not Impact Eligibility is calculated as the number of individuals
with error(s) that did not impact eligibility divided by number of individuals in
the sample, monthly (includes applications, redeterminations, and case changes).
4.2.1.2. HCPF Eligibility Quality Assurance Program and Medical Assistance Performance
(MAP) Accuracy Dashboard
4.2.1.2.1. The Contractor shall comply with the HCPF Eligibility Quality Assurance Program,
per 10 CCR 2505-5 1.020.10.2 and HCPF Operational Memo (OM) 21-057, or
whichever later Operational Memo supersedes OM 21-057, which specifies the
Contractor’s role in the state quality assurance (QA) case review process.
4.2.1.2.1.1. The QA case reviews occur monthly.
4.2.1.2.1.2. The QA case review process is to monitor the accuracy and quality of eligibility
determinations for Medical Assistance made by the Contractor.
4.2.1.2.1.3. The Contractor must respond to documentation requests and error findings within
ten (10) business days of the request to ensure QA case reviews are completed
timely.
4.2.1.2.1.4. The Contractor must respond to the Department’s QA case review error findings
by using the two options, 1) Agree/Concur or 2) Disagree/R ebut within ten (10)
business days.
4.2.1.2.1.5. If additional or revised guidance on the state quality assurance case review
process is issued, then the Contractor shall comply with the most current, recent
information issued through the HCPF Memo Series.
4.2.1.2.2 The Department shall utilize the Medical Assistance Performance (MAP) Accuracy
Dashboard to publish the results of the quality assurance case review findings on a
monthly basis and sends the results to the County Directors and County
Commissioners.
4.2.1.3. Setting Accuracy Targets and Benchmarks
4.2.1.3.1. The Department shall use the most recent twelve (12) months of cumulative data on
the MAP Accuracy Dashboard, to set the Second Reporting Period targets and
quarterly benchmarks. The Department shall communicate through HCPF Memo
Series the targets and benchmarks the Contractor is required to meet at the conclusion
of the Second Reporting Period to earn the Accuracy Performance Incentive payment.
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4.2.1.4. Determining Compliance with the Accuracy Performance Incentives Standards
4.2.1.4.1. The MAP Accuracy Dashboard will be available monthly to the Contractor to
determine the Contractor’s performance over the fiscal year. To determine
compliance with the Accuracy Performance Incentive, the Department will utilize the
most recent twelve (12) months of cumulative data MAP Accuracy Dashboard, to
determine whether the Contractor met or exceeded the specified Accuracy target.
4.2.1.4.2. The Department will take the Contractor’s final actual performance on the MAP
Accuracy Dashboard in comparison to the Contractor’s Accuracy targets at the end
of the fiscal year to determine if the Contractor’s actual performance has met and/or
exceeded the Accuracy targets to earn an Accuracy Performance Incentive Payment.
The percentage calculation has one (1) decimal place and will not be rounded.
4.2.1.5. Review Sample Size Exemptions
4.2.1.5.1. If the Contractor has a review sample size, as defined in section 4.2.1.5.2, performed
by HCPF EQA, the Contractor may be eligible for the Review Sample Size
Exemption.
4.2.1.5.2. Definition of Review Sample Size
4.2.1.5.2.1. The Contractor with twenty (20) or fewer quality assurance case reviews per fiscal
year would qualify for a Review Sample Size Exemption. The Contractor with a
review sample size that does not meet one or both of the Accuracy Incentive
targets as defined in section 4.2.1.1 may be eligible for the Review Sample Size
Exemption:
i. Inaccurate Eligibility Rate and/or,
ii. Errors that do not impact Eligibility.
4.2.1.5.3. Determining Targets percentage (%) for Potential Review Sample Size Exemptions
4.2.1.5.3.1. The Department shall have two tier target percentages for the Accuracy Targets:
4.2.1.5.3.1.1. Tier 1 target percentage (%): The Contractor with twenty (20) or more quality
assurance case reviews.
4.2.1.5.3.1.2. Tier 2 target percentage (%): The Contractor with fewer than twenty (20)
quality assurance case reviews.
4.2.1.5.3.2. The Department shall set the two-tier targets percentage based on the most recent
twelve (12) months of cumulative data for the Accuracy Incentive.
4.2.1.5.3.2.1. The finalized targets percentage will be communicated through the HCPF
Memo Series.
4.2.1.5.4. Review Sample Size Exemption Process
4.2.1.5.4.1. The Department shall follow Exhibit D for the Review Sample Size Exemption
Process.
4.2.1.5.4.2. Definition of Similar Error(s)
4.2.1.5.4.2.1. The MAP Accuracy Dashboard identifies the accuracy rates for each
Contractor; HCPF EQA provides the Contractor with those errors caused by
the Contractor that impact accuracy rates. This allows the Contractor to
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address the root cause of errors to prevent similar errors going forward. If
errors are not addressed by the Contractor and they repeat in future months,
the errors will be considered similar errors.
4.2.1.5.4.3. If the Contractor meets only one target with less than twenty (20) reviews, the
Review Sample Size Exemption Process will be applied only to the one target not
met by the Contractor.
4.2.1.5.4.4. The Contractor that does not meet both targets with less than twenty (20) reviews,
exemption will be applied to both targets.
4.2.1.5.5. Notification of Review Sample Size Exemption
4.2.1.5.5.1. If the Contractor does not meet the Accuracy Incentive Targets per section
4.2.1.5.3, they will be notified through the Status Report of the Second Reporting
Period.
4.2.1.5.5.2. The Contractor that does not meet the Accuracy Incentive Targets but qualifies
for the exemption process per section 4.2.1.5.4 will be notified through the Status
Report.
4.2.1.5.5.2.1. If the Contractor qualifies for the Review Sample Size Exemption Process,
the Department shall review previously submitted documentation from the
Contractor based on their MAP Accuracy Dashboard and may request
additional documentation as specified in section 4.2.1.5.6.
4.2.1.5.5.2.2. The Contractor shall submit any additional documentation requested for the
exemption process to the County Relations webform
(https://hcpfdev.secure.force.com/HCPFCountyRelations) or email
HCPFCountyRelations@state.co.us within ten (10) business days from the
day of notification.
4.2.1.5.6. Review Sample Size Exemption Process and Accuracy Performance Incentive
Payment
4.2.1.5.6.1. The Contractor shall earn the entire Accuracy Performance Incentive Payment if
both Accuracy Targets defined at sections 4.2.1.1.1 and 4.2.1.1.2 are met after
eligible exemption(s) are applied. If only one target is met, 50% of the Accuracy
Performance Incentive Payment will be earned. If both targets are not met, no
Accuracy Performance Incentive Payment is earned.
4.2.2. BENCHMARKS: Individualized, Contractor-specific accuracy targets for Inaccurate
Eligibility Determinations and Errors That Do Not impact Eligibility.
4.3. Performance Compliance Performance Incentive Standard
4.3.1. The Contractor shall comply monthly with the Director-level MAP Dashboard measures. The
performance measures include timeliness of applications/redeterminations, timeliness of
long-term services and supports (LTSS) applications/redeterminations, timeliness of case
changes, etc.
4.3.1.1. The specific Director-level measures to be included in the Performance Compliance
Performance Incentives Standard shall be communicated through HCPF Memo Series.
4.3.1.1.1. The Department reserves the right to remove and/or add additional measures as it is
appropriate.
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4.3.1.1.1.1. If adding or revising MAP Dashboard measures, the Department shall apply the
PuMP process and the Contractor shall have an opportunity to provide feedback.
4.3.1.1.2. Department Monitoring of MAP Dashboards
4.3.1.1.2.1. The Department updates the MAP Dashboards monthly, which are accessible to
the Contractor through the Department’s MAP Dashboard SharePoint Page and
Tableau; copies of these Dashboards are also emailed to Contractor leadership
monthly.
4.3.1.1.3. Contractor Monitoring of MAP Dashboards
4.3.1.1.3.1. The Contractor must monitor the monthly published MAP Dashboards to ensure
targets are met.
4.3.1.1.3.2. The Contractor shall designate MAP Dashboard performance owners to access
the MAP Dashboards and follow the Standard Operating Procedure (SOP) that is
available on the Department SharePoint Page to ensure targets are met and to take
action if necessary.
4.3.1.1.3.3. The Contractor shall review and investigate the root causes for not achieving the
target(s).
4.3.1.1.3.4. If requested, the Contractor shall respond to the Department with the outcome of
the investigation for not meeting the target based on the established MAP
Dashboard process.
4.3.1.1.3.5. The Contractor shall follow guidance regarding the MAP Dashboard process as
issued through the MAP Dashboard SOP, trainings and HCPF Memo Series.
4.3.1.1.4. Determining Compliance with Performance Compliance Performance Incentives
Standard
4.3.1.1.4.1. The Contractor will be deemed out of compliance for specific Director-level
measures when the Contractor has not met the target(s) after a short- or long-run
of performance.
4.3.1.1.4.1.1. The Contractor shall refer the MAP Dashboard SOP and HCPF Memo Series
for guidance on what constitutes a short- or long-run of performance.
4.3.1.1.4.1.2. A Management Decision Letter (MDL), requiring the Contractor to create an
Improvement Action Plan (IAP) or Corrective Action Plan (CAP), will be
issued to the Contractor to address the short- or long-run of performance.
4.3.1.1.4.1.2.1. The Contractor shall refer to HCPF OM 21-078 for guidance on MDLs,
IAPs and CAPs.
4.3.1.1.4.1.2.1.1. If additional guidance or clarification on MDLs, IAPs and CAPs is
issued by the Department, the Contractor shall comply with the most
current, recent information issued through the HCPF Memo Series.
4.3.1.1.4.1.2.2. The issuance of the MDL on a specific Director-level measure signifies
that measure as being out-of-compliance. A Management Decision Letter
decreases the county’s compliance percentage, thereby impacting the
county’s ability to earn the Performance Compliance Incentive. Only
Director-level performance measures that the county did not receive an
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MDL for any time throughout the fiscal year will be considered in-
compliance.
4.3.1.1.4.1.2.2.1. The Contractor shall refer to HCPF OM 21-079 for guidance on
calculation of target for the Performance Compliance Incentive. If
additional or revised guidance is issued, then the Contractor shall
comply with the most current, recent information issued through the
HCPF Memo Series.
4.3.1.1.4.2. The Contractor may earn the Performance Compliance Performance Incentive
Payment by ensuring that a certain number of Director-level measures maintain
compliance with the performance targets and are not issued an MDL.
4.3.1.1.4.2.1. The specific number of Director-level measures that the Contractor must
maintain compliance with shall be communicated through the HCPF Memo
Series.
4.3.2. BENCHMARK: The Contractor shall maintain compliance with a certain percentage of
Director-level measures out of the total number of Director-level measures reported on the
MAP Dashboard.
4.4. Customer Service Performance Incentive Standard
4.4.1. The Contractor may earn one Customer Service Performance Incentive Payment at the end
of the Second Reporting Period in which the Contractor submits the required deliverable(s)
for both Reporting Periods relating to improving customer service through the monitoring of
metrics and the development of improvement plans that demonstrate the Contractor is
actively implementing the rule 10 CCR 2505-5 1.020.3.4, which requires the county director
to implement administrative internal controls that ensure the Contractor provides timely,
respectful and culturally-appropriate customer service to Medical Assistance applicants and
members.
4.4.1.1. Contractor Customer Service Tier
4.4.1.2. The Department shall assign the Contractor to a Customer Service Tier by September 30,
2022. The Customer Service Tier determines which customer service metrics,
benchmarks and deliverables the Contractor must meet and/or submit to earn a Customer
Service Performance Incentive Payment.
4.4.1.2.1. Customer Service Tier Reclassification
4.4.1.2.1.1. The Department may, in consultation with the Contractor, amend its initial
classification and reclassify the Contractor to a different Customer Service Tier.
4.4.1.2.1.2. Any reclassification approved by the Department, in consultation with the
Contractor, shall take effect the following Reporting Period.
4.4.1.2.1.3. Only Contractor reclassifications from Tier 2 to Tier 1A or 1B are allowable.
4.4.2. Customer Service Tier 1
4.4.2.1. If the Contractor is assigned to the Customer Service Tier 1 category, the Department
shall classify the Contractor as Tier 1A, Tier 1B and Tier 1C to determine what the
Contractor’s required metrics, benchmarks and deliverables are.
4.4.2.1.1. Customer Service Tier 1A
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4.4.2.1.1.1. If the Contractor is classified as Tier 1A, the Contractor is understood to have an
active call center operation, which can be as small as two Contractor staff or as
large as 100 or more Contractor staff members answering calls, with a dedicated
line which has the technology in place to provide data, at a minimum, on the
number of calls received, the average wait time and the number of abandoned
calls.
4.4.2.1.1.2. If the Contractor is classified as Tier 1A, the Contractor shall:
4.4.2.1.1.2.1. Submit to the Department monthly Call Center reporting from the
Contractor’s available data that complies with the Call Center data reporting
requirements determined by Department.
4.4.2.1.1.2.1.1. Monthly reporting will be due on the 10th of each month and sent
electronically to the County Relations webform
(https://hcpfdev.secure.force.com/HCPFCountyRelations) or email
HCPF_CountyRelations@state.co.us. Monthly reporting must begin in
October 2022, unless the Department and the Contractor agree on a later
date, not to exceed December 31, 2022.
4.4.2.1.1.2.1.2. Data elements required to be submitted by the Contractor shall be issued
via HCPF Memo Series and will be available no later than September 30,
2022.
4.4.2.1.1.2.1.3. If certain data elements required by the Department are not available in
the Contractor’s data, the Contractor shall propose an alternate data set,
which shall be reviewed and approved by the Department.
4.4.2.1.1.2.2. Meet and/or exceed a service-level performance target for the Contractor’s
Call Center Average Speed to Answer (ASA) b y the Second Semi-Annual
Due Date, June 16, 2023.
4.4.2.1.1.2.2.1. The service-level performance target for the Contractor’s ASA shall be
jointly determined by the Department and the Contractor and shall be
based on the most recent six (6) months of ASA performance data
provided by the Contractor.
4.4.2.1.1.2.2.2. The service-level performance target shall be jointly determined by the
Department and Contractor no later than December 15, 2022.
4.4.2.1.1.2.3. Attend one, two-hour technical assistance and learning session with the
Department’s MCC Operations staff before June 30, 2023.
4.4.2.1.1.2.3.1. The date, time and location of the technical assistance and learning session
will be jointly agreed-upon by the Department and the Contractor.
4.4.2.1.1.2.3.2. The session can be scheduled in a different time format, if agreed upon by
the Department and the Contractor.
4.4.2.1.1.2.3.3. The Contractor can request additional support, beyond the required
session detailed 4.4.2.1.1.2.3, from the MCC Operations staff to improve
its ASA performance by contacting the County Relations webform
(https://hcpfdev.secure.force.com/HCPFCountyRelations) or email
HCPF_CountyRelations@state.co.us.
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4.4.2.1.1.2.4. The Contractor assigned to Customer Service Tier 1A must comply with the
provisions in sections 4.4.2.1.1.2.1, 4.4.2.1.1.2.2 and 4.4.2.1.1.2.3 to earn a
Customer Service Performance Incentive Payment.
4.4.2.1.2. Customer Service Tier 1B
4.4.2.1.2.1. If the Contractor is classified as Tier 1B, the Contractor is understood to not have
an active call center operation, which includes at least two or more staff members
answering a dedicated line and to not have the technology in place, at a minimum,
on the number of calls received, the average wait time and the number of
abandoned calls. However, the Contractor classified as Tier 1B is actively and
currently working to implement active call center operations within the contract
period.
4.4.2.1.2.2. If the Contractor is classified as Tier 1B, the Contractor shall:
4.4.2.1.2.2.1. Submit to the Department monthly Call Center reporting from the
Contractor’s available data that complies with the Call Center data reporting
requirements determined by Department.
4.4.2.1.2.2.2. Monthly reporting will be due on the 10th of each month and sent
electronically to the County Relations webform
(https://hcpfdev.secure.force.com/HCPFCountyRelations) or email
HCPF_CountyRelations@state.co.us. Monthly reporting must begin in
October 2022, unless the Department and the Contractor agree on a later date,
not to exceed December 31, 2022.
4.4.2.1.2.2.3. Data elements required to be submitted by the Contractor shall be issued via
HCPF Memo Series and will be available no later than September 30, 2022.
4.4.2.1.2.2.4. If certain data elements required by the Department are not available in the
Contractor’s data, the Contractor shall propose an alternate data set, which
shall be reviewed and approved by the Department.
4.4.2.1.3. Customer Service Tier 1C
4.4.2.1.3.1. If the Contractor is classified as Tier 1C, the Contractor is understood to not have
an active call center operation and does not anticipate implementing an active call
center before the contract expiration date. A Contractor classified as Tier 1C may
have sufficient volume for an active call center but does not currently have the
processes or funding in order to implement the active call center.
4.4.2.1.3.2. If the Contractor does not anticipate implementing active call center operations
prior to the end of the contract expiration date, the Contractor shall be re-classified
by the Department as Tier 2B for the purposes of determining the Contractor’s
required metrics, benchmarks and deliverables.
4.4.2.1.3.2.1. Requirements for Tier 2B can be found in section 4.4.3.
4.4.2.1.3.3. If the Contractor does have available call center reporting from existing systems,
the Contractor shall also follow the call center reporting requirements as detailed
in section 4.4.2.1.2.2.1.
4.4.3. Customer Service Tier 2
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4.4.3.1. If the Contractor is assigned to the Customer Service Tier 2 category, the Department
shall classify the Contractor as Tier 2A or Tier 2B to determine what the Contractor’s
required metrics, benchmarks and deliverables are.
4.4.3.2. If the Contractor is classified as Tier 2A or 2B, the Contractor is understood to be small
enough in operations and workload where a call center (defined as at least two or more
staff members answering a dedicated line and to not have the technology in place, at a
minimum, on the number of calls received, the average wait time and the number of
abandoned calls) is cost-prohibitive or not supportable under existing funding or staffing
allocations.
4.4.3.3. If the Contractor is classified as Tier 2A, the Contractor shall:
4.4.3.3.1. Submit to the Department a Customer Service Survey Outreach Plan no later than the
Semi-Annual Due Date on June 16, 2023. The Customer Service Outreach Plan shall
be submitted via the County Relations webform.
4.4.3.3.1.1. The Customer Service Survey is managed by the Department and does not require
any action from the Contractor.
4.4.3.3.1.2. The Contractor’s baseline for the Customer Service Survey will be determined
prior to the Semi-Annual Due Date to allow for the Contractor to integrate that
data into its Customer Service Outreach Plan. The Contractor’s baseline is used
to determine what percentage of survey participation rate that must be increased
in the following contract cycle.
4.4.3.3.1.3. The Customer Service Survey Outreach Plan shall include the Contractor’s
methodologies and strategies for increasing applicant and member p articipation
in the Department’s Customer Service Survey in the following contract cycle.
4.4.3.3.1.3.1. The Customer Service Outreach Plan will include, at minimum, the following:
4.4.3.3.1.3.1.1. Who is responsible for the Contractor’s Outreach Plan
4.4.3.3.1.3.1.2. What communications, methodologies and strategies will be used to
engage with applicants and members to increase participation in the
survey
4.4.3.3.1.3.1.3. How the Contractor will ensure that negative action is not taken against
applicants and members who decline to participate in the Customer
Service Survey
4.4.3.3.1.3.1.4. How the Contractor tracks and monitors its participation rate based on
Department-provided data
4.4.3.3.1.3.1.5. No template is provided to the Contractor; the Contractor’s Outreach Plan
shall be detailed on the Contractor’s letterhead.
4.4.3.4. If the Contractor is classified as Tier 2B, the Contractor shall:
4.4.3.4.1. Submit to the Department a Customer Service Improvement Plan (CSIP) no later than
the Semi-Annual Due Date on June 16, 2023.
4.4.3.4.1.1. The CSIP shall:
4.4.3.4.1.1.1. Does not require a standardized template, but must be written on the
Contractor’s formal letterhead, approved by the Contractor’s director and
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include each of the required elements listed from 4.4.3.4.1.1.2, 4.4.3.4.1.1.3,
and 4.4.3.4.1.1.4.
4.4.3.4.1.1.2. Voice of the Customer
4.4.3.4.1.1.2.1. Address how the Contractor hears from customers on a regular basis
through regular and ongoing data and information collection. If the
Contractor does not have active processes in place to integrate the Voice
of the Customer, the CSIP must include how the Contractor is rectifying
the lack of information on customer satisfaction.
4.4.3.4.1.1.2.2. Address how the Contractor is or isn’t using data to determine customer
satisfaction
4.4.3.4.1.1.2.3. Include how the Contractor is actively implementing processes that
integrate the Voice of the Customer.
4.4.3.4.1.1.2.4. Include how the Contractor, through its customer service processes,
provides supports to underserved and/or at-risk populations and
communities.
4.4.3.4.1.1.3. Complaints and Negative Feedback
4.4.3.4.1.1.3.1. Detail how the Contractor works to ensure timely responses and requests
for support from the customer, to avoid complaints where possible.
4.4.3.4.1.1.3.2. If a complaint is submitted, the CSIP shall include how the Contractor
addresses positive and negative feedback received through process
improvement, training and coaching, positive reinforcement with staff or
other methods.
4.4.3.4.1.1.3.3. Prescribe how the Contractor’s processes integrate or align with the
Department’s centralized complaint process as issued in HCPF Memo
Series.
4.4.3.4.1.1.4. Data Collection
4.4.3.4.1.1.4.1. Detail what data is collected, how the data is collected ongoing and what
tracking mechanisms are in place.
4.4.3.4.1.1.4.2. Include what steps the Contractor takes when actionable data on customer
service satisfaction is collected.
4.4.3.4.1.1.4.3. Describe what tools the Contractor uses, if any, to collect its data and
inform its process improvements.
4.4.4. Customer Service Performance Incentive Standard Exemptions for Unusual Circumstances
4.4.4.1. The Contractor may request an exemption for unusual circumstances for failure to meet
the service-level performance targets as detailed in section 4.4.5.1, if the Contractor was
classified by the Department as Customer Service Tier 1A or 1B.
4.4.4.2. No exemptions for unusual circumstances are allowed for deliverables as detailed in
section 4.4.5.2 for Contractors classified as Customer Service Tier 1A, 1B, 1C or Tier 2.
4.4.4.3. The exemption process for unusual circumstances is described in section 6, Exemptions;
only Contractor exemption requests that follow the process and meet the requirements as
outlined in section 6 will be considered by the Department.
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4.4.5. PERFORMANCE BENCHMARK:
4.4.5.1. Tier 1: Meet or exceed customized Average Speed to Answer by end of Second Reporting
Period and complete required participation in technical assistance sessions with MCC.
Customer Service survey response rates to increase by the customized target for the
Contractor. Deliverable is measured by increase in number of responses to be released in
HCPF Memo Series.
4.4.5.2. Tier 2: Customer Service survey response rates to increase by the customized target for
the Contractor. Deliverable is measured by increase in number of responses to be released
in HCPF Memo Series.
5. SEMI-ANNUAL REPORTING
5.1. The Contractor shall submit documentation to the Department to verify the Contractor’s
compliance with each Performance Incentive Standard and will submit such documentation on a
semi-annual basis as required. The Contractor must submit documentation to the County
Relations webform (https://hcpfdev.secure.force.com/HCPFCountyRelations) or email
HCPF_CountyRelations@state.co.us, unless otherwise specified through the HCPF Memo
Series.
5.1.1. For the Second Reporting Period, the Contractor shall submit the following documentation:
5.1.1.1. Any Accuracy Performance Incentive Standard Review Sample Size Exemption Process
documentation for the fiscal year if the Contractor failed to meet specified target(s). The
Contractor shall only submit documentation upon the Department’s request.
5.1.1.1.1. Any Customer Service Performance Incentive Standard Plans or other documents
listed as deliverables under this agreement or specified through the HCPF Memo
Series.
5.1.1.1.2. DUE DATE: June 16, 2023
6. EXEMPTIONS
6.1. The Contractor may request an exemption for unusual circumstances for specific Performance
Incentive Standards by following the process as outlined in section 6.
6.1.1. Based on the Department’s review of the Contractor’s request, partial payment of the
Performance Incentive Standard Payments may be made at the Department’s discretion,
which is not subject to exemption request or dispute. The Department’s decision on partial
payment is final and Performance Incentive Payments made based on the Department’s
determination.
6.2. Definition of Unusual Circumstances
6.2.1. Unusual circumstances are defined as uncommon, rare or sudden events over which the
Contractor had no direct control and which directly result in the failure to act in accordance
with or meet the requirements of the specific Performance Incentive Standard.
6.2.2. Unusual circumstances for which the Contractor can request exemption include the
anticipated end of the federal COVID-19 Public Health Emergency or other circumstances
that cause a large, sustained increase in workload.
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6.2.3. Unusual circumstances do not include circumstances for which the Contractor had direct
knowledge or control over, including the Contractor’s clear and demonstrated failure to act
in accordance with or meet the requirements of the specific Performance Incentive Standard
is evident.
6.2.4. The Department’s determination of whether the Contractor’s request meets the definition of
unusual circumstances is final.
6.3. Process for Unusual Circumstances Exemption Requests
6.3.1. The process for the Contractor to submit an exemption request shall be communicated via
the HCPF Memo Series for each Performance Incentive Standard.
6.3.2. Unusual circumstances exemption requests must include thorough supporting documentation
from the Contractor, and the Contractor shall be responsible for timely submission of any
additional documentation requested by the Department for the exemption process.
6.3.3. General questions on unusual circumstances exemption requests should be submitted to the
County Relations webform (https://hcpfdev.secure.force.com/HCPFCountyRelations) or
email HCPF_CountyRelations@state.co.us.
6.4. Department Review and Approval of Exemption Requests
6.4.1. Based on the Contractor’s unusual circumstances exemption request and supporting
documentation, the Department will provide the Contractor with an approval or denial of the
request on the Final Status Report.
6.4.2. If the Department approves the unusual circumstances exemption request, partial payment
may be made to the Contractor for the Performance Incentive Standard the Contractor
requested exemption for.
6.4.2.1. The Department has the sole authority to determine the amount of partial payment, which
is not subject to dispute by the Contractor.
6.4.2.2. If partial payment is made based on the Contractor’s unusual circumstances exemption
request, the Department will provide the actual amount of the partial payment on the Final
Status Report.
6.4.3. If the Department denies the unusual circumstances exemption request, the Performance
Incentives Payments issued are final and are not subject to further dispute or appeal
6.4.4. The Department may approve or reject any request for unusual circumstances exemptions
and may limit the total number of approved exemptions for all Performance Incentive
Standards.
6.4.5. Non-Allowable Exemption Reasons
6.4.5.1. The Department will deny unusual circumstances exemption requests that are determined
as due to the fault of the Contractor, where unusual circumstances truly did not exist,
and/or any exemption requests based on the following:
6.4.5.1.1. The Contractor failed to meet contractually-specified requirements relating to the
content of submission of deliverables and the timely submission of deliverables.
6.4.5.1.2. The Contractor failed to meet contractually-specified requirements relating to
performance benchmarks of any Performance Incentive Standards eligible for
exemption requests.
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6.4.5.1.3. The Contractor’s failure to review and utilize County Administration regulations at
10 CCR 2505-5 1.020 and County Incentives Program documentation, including
policy, informational, and operational guidance issued through the HCPF Memo
Series, that resulted in the Contractor failing to meet performance benchmarks and
deliverables relating to any Performance Incentive Standard.
6.4.5.1.4. The Department’s final determination of the Contractor’s exemption request(s) for
the Accuracy Performance Incentive Standard.
6.4.5.1.5. The Contractor’s failure to use the MAP Dashboards for the purposes of fulfilling
Exhibit A, Statement of Work.
6.4.5.1.6. The Contractor’s failure to use EQA case review results for the purposes of fulfilling
Exhibit A, Statement of Work. The reasons for denial of an exemption as stated in
section 6 are not all-inclusive and the Department reserves the right to deny any
exemption for reasons not stated in section 6.
6.4.6. Prior to denying an exemption for reasons beyond those stated in section 6, the Department
may, at its discretion, request further information from the Contractor to determine whether
the request for exemption meets the exemption standards as stated in section 6, Exemptions.
6.5. Performance Incentive Standards Eligibility for Unusual Circumstances Exemption Requests.
6.5.1. Unusual circumstances exemption requests will be considered for any Performance Incentive
Standard listed under section 6.5.1.
6.5.1.1. Customer Service Performance Incentive Standard
6.5.1.2. Accuracy Performance Incentive Standard
6.5.2. Unusual circumstances exemptions requests will not be considered for any Performance
Incentive Standard listed under 6.5.2.
6.5.2.1. Performance Compliance Performance Incentive Standard
6.5.3. The Contractor’s performance and compliance with the Performance Incentive Standards
listed under section 6.5.2 will be deemed final, as determined by the Department, and
Performance Incentive Payments made without the opportunity to submit an exemption.
7. NOTIFICATIONS
7.1. After each Reporting Period, the Contractor will be provided a Status Report that details which
Performance Incentive Standards were met.
7.1.1. The Contractor’s Reporting Period Status Report will only detail which Performance
Incentive Standards were met for the Reporting Period in question. Funding amounts will
not be provided until the conclusion of the fiscal year.
7.1.2. If the Contractor has more than one Reporting Period in the fiscal year to meet any
Performance Incentive Standards, the Reporting Period Status Report will not include the
Contractor’s performance in those Performance Incentive Standards.
7.2. After the conclusion of the fiscal year, the Department will provide the Contractor a final Status
Report that details which Performance Incentive Standards were not met and met and how much
Performance Incentive Payments were earned by the Contractor.
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7.2.1. The final Status Report cannot be disputed; if the Contractor disagreed with the Department’s
determination of compliance with any Performance Incentive Standard, the Contractor must
have disputed that result based on the Reporting Period Status Report.
7.3. Each Reporting Period Status Report and the final Status Report will be sent to the county
human/social services director and will act as the official notification of the Contractor’s
compliance with the Performance Incentives Standards.
7.4. Status Reports for each Reporting Period will be sent within ten (10) calendar days after the
Semi-Annual Reporting due date for each Reporting Period as found in Section 5, Semi-Annual
Reporting. The date on which the Status Report for each Reporting Period is sent to the
Contractor will be considered the Status Report Date.
7.4.1. If unusual circumstances have delayed the Contractor’s Reporting Period or final Status
Reports, the Department will inform the Contractor of the delay and an anticipated date of
resolution.
7.5. The final Status Report will be sent upon the Department’s determination of final Performance
Incentive Payment amounts.
7.6. The Contractor will have the opportunity to dispute the Status Report results as defined in section
8, Dispute Resolution.
8. DISPUTE RESOLUTION
8.1. Opportunity and Timeframe for Dispute Resolution
8.1.1. In the event the Contractor disagrees with the findings of the official notification as found in
section 7, Notifications, the Contractor will have the opportunity to dispute the Reporting
Period Status Report for the Reporting Period in question.
8.1.1.1. The final Status Report cannot be disputed per section 7.2.1.
8.1.1.1.1. The Contractor will have seven (7) calendar days from the Status Report Date to
review each Reporting Period Status Report and dispute the results.
8.1.1.1.1.1. If the Contractor fails to dispute the Reporting Period Status Report within seven
(7) calendar days from the Status Report Date, the Status Report results will be
deemed final. No further disputes will be allowed, and compensation will be
made per section 9 based on the results of the non-disputed Status Report.
8.2. Allowable Disputes
8.2.1. The Contractor will be allowed to dispute the results of the Status Report based on the
following reasons:
8.2.1.1. The Contractor submitted documentation that was required for a Performance Incentive
Standard, so long as the Contractor has proof that the required documentation was
submitted on or before the contractually-required due date.
8.2.1.2. The Contractor requests a re-review of the Contractor’s submitted documentation that
was used to determine compliance with any Performance Incentive Standard.
8.2.1.3. The Contractor has available data, such as systems reports or other tracking
methodologies, that conflicts with the Department’s available data that will utilized to
determine compliance with a Performance Incentive Standard.
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8.2.1.3.1. The Contractor will be responsible for providing all necessary and relevant data
available to the Department in order to determine if the Contractor’s data actually
conflicts with the Department’s data.
8.2.1.3.2. The Department will make the final determination when a conflict of data occurs and
will make Performance Incentive Standard Payments based on its final determination.
8.2.2. The Department reserves the right to add additional allowable dispute reasons throughout the
fiscal year based on additional information made available from the Department and/or
Contractor. These additional allowable dispute reasons will be considered on a case-by-case
basis, and the Department’s determination of additional allowable dispute reasons are final
and not subject to the Dispute Resolution process as outlined in section 8.
8.3. Nonallowable Disputes
8.3.1. The Contractor will not be allowed to dispute the results of the Status Report based on the
following reasons:
8.3.1.1. The Contractor failed to meet contractually-specified requirements relating to the content
of submission of deliverables and the timely submission of deliverables.
8.3.1.2. The Contractor failed to meet contractually-specified requirements relating to
performance benchmarks of any Performance Incentive Standard.
8.3.1.3. The Contractor’s failure to review and utilize County Incentives Program documentation,
including policy, informational, and operational guidance issued through the HCPF
Memo Series, that resulted in the Contractor failing to meet performance benchmarks and
deliverables relating to any Performance Incentive Standard.
8.3.1.4. The Department’s final determination of the Contractor’s exemption request(s) for the
Accuracy Performance Incentive Standard.
8.3.2. The Department reserves the right to deny a Contractor’s dispute based on any reason not
included under section 8.3.1. The Department’s determination is final and is not subject to
dispute or appeal.
9. COMPENSATION
9.1. Compensation
9.1.1. Performance Incentive Payment
9.1.1.1. The Department shall pay the Contractor, after the end of the fiscal year in which the
work was performed, a Performance Incentive Payment for each Performance Incentive
Standard it meets during the applicable Reporting Period as follows:
9.1.1.1.1. The Department shall pay the Contractor an Accuracy Performance Incentive
Payment, if applicable, as shown in Exhibit B at the conclusion of the Second
Reporting Period if the Contractor meets the requirements for that Performance
Incentive Standard. (To earn the entire Accuracy Performance Incentive Payment, the
Contractor must meet both targets as specified in section 4.2.1.1, which includes (1)
Target for Inaccurate Eligibility Determination Rate and (2) Target for Errors that do
not Impact Eligibility. If the Contractor only meets one target, the Accuracy
Performance Incentive Payment will be 50% of the total amount for this Performance
Incentive.)
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9.1.1.1.2. The Department shall pay the Contractor a Performance Compliance Performance
Incentive Payment as shown in Exhibit B at the conclusion of the Second Reporting
Period if the Contractor meets the requirements for that Performance Incentive
Standard.
9.1.1.1.3. The Department shall pay the Contractor a Customer Service Performance Incentive
Payment as shown in Exhibit B at the conclusion of the Second Reporting Period if
the Contractor meets the requirements for that Performance Incentive Standard.
9.1.2. Remaining Funds Incentive Pool Payment
9.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
9.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
9.1.2.1.1.1. The total amount of all base Performance Incentive Payments allocated to any
Contractor that selected to not participate in the Performance Incentive Standards
Program for that SFY.
9.1.2.1.1.2. Each of the Performance Incentive Payments the Accuracy Performance Incentive
Standard, Performance Compliance Performance Incentive Standard, the
Customer Service Performance Incentive Standard and the Continuous Coverage
Performance Incentive Standard that were not earned by the Contractor during a
Reporting Period in that SFY.
9.1.2.1.1.2.1. The Contractor shall be eligible for Remaining Funds Incentive Pool
payments.
9.1.2.1.2. If the Remaining Funds Incentive Pool is zero dollars ($0.00) for any SFY, the
Contractor shall not receive a Remaining Funds Incentive Pool Payment for that SFY.
9.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
9.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds Incentive
Pool based on the dollar amount of Incentives met during that SFY.
9.1.2.2.2. Based on the proportion of total Incentive funds that the Contractor is eligible to be
paid in each SFY, the Contractor shall receive the same proportion of funds from the
Remaining Funds Incentive Pool.
9.1.2.2.3. The Contractor’s payment of funds from the Remaining Funds Incentive Pool shall
never exceed the county’s share of Medicaid expenditure, as specified in Section 2,
County Determinations.
9.2. Payment Procedures
9.2.1. The Contractor shall receive Performance Incentive Payments at the end of the Second
Reporting Period within ninety days (90) days following the end of the fiscal year in which
the Performance Incentive Standards were met. This allocation will reflect the maximum the
Contractor can earn for each Performance Incentive Standard per Reporting Period.
9.2.1.1. If the Contractor’s county administration line item is over-expended during the county
administration closeout process, Settlement Accounting and the Department may utilize
the Contractor’s earned Performance Incentive Payments during the closeout process.
9.2.2. Actual Performance Incentive Payment maximums are dependent on the Contractor’s share
of Medicaid county administration expenditure. In no event shall the Contractor be paid more
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Exhibit A-1, SOW Page 20 of 20
than the Contractor’s county share of Medicaid county administration expenditure in any
Reporting Period or fiscal year.
9.2.3. The Department may add any unearned funds from the First Reporting Period into the Second
Reporting Period allocation for any SFY.
9.2.4. The Contractor shall be paid the Performance Incentive Payments through the County
Financial Management System (CFMS).
9.2.5. The Department may use any unearned Second Reporting Period Performance Incentive
Payments during the county administration close out process.
9.2.5.1. The Incentive Payment earned is unrestricted, and the Contractor may utilize the fund per
the Contractors discretion.
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Exhibit B-1, Rates Page 1 of 1
EXHIBIT B-1, RATES
SFY 2022-23 Incentives Payment Table
To earn the entire Accuracy Performance Incentive Payment, the Contractor must meet both targets as specified in
section 4.2.1.1, which includes (1) Target for Inaccurate Eligibility Determination Rate and (2) Target for Errors
that do not Impact Eligibility. If the Contractor only meets one target, the Accuracy Performance Incentive Payment
will be 50% of the total amount for this Performance Incentive.
Incentive Payment Name % of Funding Payment
Amount
Accuracy Performance
Incentive Payment
40% $14,360.40
Performance Compliance
Performance Incentive
Payment
30% $10,770.30
Customer Service
Incentive Payment
30% $10,770.30
Total $35,901.01
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Exhibit D, Review Sample Size Exemption Process Flow Page 1 of 1
DocuSign Envelope ID: B83738F4-A431-47B6-9479-3EE364E4F7E5
