indicate satisfied or very satisfied Time over which standard is measured: Quarter Pre-admission 95% of members Documentation of 1.00% of fees if outreach call meeting criteria for outbound call. performance is receiving a less than preadmission outreach standards. call will receive a call. Disease 95% of members Documentation of 1.50% of fees if Management meeting criteria for attempted performance is Outreach Call receiving an outreach member contact. less than call (and have a standards. telephone number in the eligibility system) will have documentation of all outreach call attempts. Complex Case 95% of member Documentation of 1.00% of fees if Management meeting criteria for attempted performance is Program participation in the contacts. less than complex case standards. management program will have document of attempted member and physician contact. Provision of Draft Draft Plan Document Receipt date as $500 per day for Plan Documents documented by the first three (Certificate/Evidence of vendor and calendar days Certificate/ Coverage or Summary confirmed by State that the draft Evidence of Plan Description as document is not Coverage for appropriate by plan) received. plans and including all required Summary Plan updates is provided to $1,000 per Description for the the State at least three calendar day for fully-insured plans months prior to the first each day the draft day of the plan year. document is not For example if the plan received for the year effective date fourth calendar January 1st, the vendor day and beyond. must provide the State the draft by October 1st of the prior year. Provision of Final Final Plan Document Receipt date as $500 per day for Plan Documents documented by each calendar day (Certificate/Evidence of vendor and the draft plan Coverage or Summary
indicate satisfied or very satisfied Time over which standard is measured: Quarter Pre-admission outreach call 95% of members meeting criteria for receiving a preadmission outreach call will receive a call. Documentation of outbound call. 1.00% of fees if performance is less than standards. Disease Management Outreach Call 95% of members meeting criteria for receiving an outreach call (and have a telephone number in the eligibility system) will have documentation of all outreach call attempts. Documentation of attempted member contact. 1.50% of fees if performance is less than standards. Complex Case Management Program 95% of member meeting criteria for participation in the complex case management program will have document of attempted member and physician contact. Documentation of attempted contacts. 1.00% of fees if performance is less than standards. Provision of Draft Plan Documents Certificate/ Evidence of Coverage for plans and Summary Plan Description for the fully-insured plans Draft Plan Document (Certificate/Evidence of Coverage or Summary Plan Description as appropriate by plan) including all required updates is provided to the State at least three months prior to the first day of the plan year. For example if the plan year effective date January 1st, the vendor must provide the State the draft by October 1st of the prior year. Receipt date as documented by vendor and confirmed by State $500 per day for the first three calendar days that the draft document is not received. $1,000 per calendar day for each day the draft document is not received for the fourth calendar day and beyond. Provision of Final Plan Documents Final Plan Document (Certificate/Evidence of Coverage or Summary Receipt date as documented by vendor and $500 per day for each calendar day the draft plan
F10B3400022-AttachmentS-PPO-SF.docx