"

EXECUTIVE DOCUMENT SUMMARY..
State Form 41221 (R101'4-06)
'nsI1uctions "" COO ..... ,. ..... EDS

- .- ,
•

~te1Ved
16, Address:

1. Ptease read the guidelines on the back of this fon'n.

''''o"".tio,,-

JAN-. 1 5 2016

2. Please type ..
3. Check all boxes that apply,
.4. For amendments I renewals, attach original contract.

FSSA.. OfficeofMedk:aid
402 W WASHINGTON ST W374
INDIANAPOLIS. IN 46204

I

1

Mn

mOA COntracts

5.

-Gram
Lease
-

AItomey

_

MOU

PO BOX 791188
BAlTIMORE. Me 2127~1188

10. New toIaI amount for each fiscal year :
Year 2018

Yea<

=
-,,20,,',,-7__

Year 2018

Secrcu:ry of State? (QuI ofState

~Yes

$? 5Q5 277 56

29. Primary Vendor: MlWBEIIN-Veted

,'S.S.M:W

Minaritv:

Yes

Women:

X

No

x

No
No

IN-Vc:tcnm

1S.2 %

32. Ifves. liSl the ~~:
Mioority,
_ _-,'",0..:..'
10.5
Women:

31. Sub Vendor: MlWBEIIN-VdCrim
~ Yes
Minority:
No

Womc:o:
IN-Vc:teraD

13. Med.:Id of SOlQ1:le sdcction:
_ _ Bid.Quolation

~ R.FPIII

_ _ """'-'"

15-036

~ Yes

_ _ No

X

_ _ Negotiated

,.

33. Is tbcrc: Rcnc:waIlanguagc

__ SpoQaI_

_ _ 0dJa- (.fpeCify)

x y.,

No
30. PrimaIy Vcodor- Paccntages

%
~,

IN- Vetenm

---'i4 .TZ

34. Is there a

-rcmrioarion for

%

Convcnic:nce" clause in the
dnn........,? X
Yes

No

No

Yes: lOT"" 0eJepte bas siped ofron contract
36. Starutory Auzhorily

rcjl~

applicable Inchano or Fedrrol Code$):

NlA

37. Descriplioo of w<d: mel juaificarioo for spending UJODey.

(PJ~ giw

a bn~f Ikscnpllon of ,he scope of wont mduded in ,Ins agreemrm)

This CantmaDr sball provide EnrolIIIlCQ1 Bmka- scMca Cor the S1ate's Medicaid manapd care program!l_ Tho!: COIIIrad l$ jUSlified ba:au$e it ~ die State's
Medi"Mt...tigibie popWmon about the IJWIa80d CIIre plans available and faciliGus their enrollment inlO !he besHuiIo:I prosram in a timely f'uhiola.

38. Justificarion of vmdor selection and ddenninarioo of price reasonabIcncss:
An RFP was COPduc:tcd mil two vendors responded. After oral pre5It!rItI:bon cblrific:ations. and: BAfO's, MP;imus canbined cast aDd ~ IIUCSSInmt and q.q.lify

JAN 2 0 2016

'MAQ) _ _ "''''_~,."""""",

39. Iflhis comrac:t is submitted

OAG-ADVISORY

fmmAG

47. Date Appro.... ed

90990-000

 r

PROFESSIONAL SERVICES CONTRACT
INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION
CONTRACT WITH: Maximus Health Service, Inc.
EDS # MD29-6-99-16cLF-0725

between

This Contract ("this Contract"), entered into by and
indiana Family and Social services
Administration (FSSSA) (the "State") and Maximns Health Serv;ce, Inc. (the "Contractor"), is
executed pursuant to the tenns and conditions set forth herein. In consideration of those mutual
undertakings and covenants, the parties agree as follows:
.1. DudesorCoutractor.
The Contractor shaH provide the following services relative to this Contract:
The Contractor. shall provide Enrollment Broker services for the State's Medicaid managed care programs
which eduCates the State's Medicaid eligible population about the mariaged care plans available and
facilitates their enrollment into the best-suited program in a timely fashion.
A. The Contractor shall provide services set forth in Exhibit 1 - Statement or Work attached hereto
-and incorporated herein.
B. The Contractor shall comply with the Perfonnance Standards set forth in Exbibit 2 - Enrollment
.Broker Services Performance Standards, which outlines Consequential Damages and Service
Level Agreements, is attached hereto and incorporated herein.
.
C. The Contractor shall comply with the budget set forth in Exbibit 3 - Contract Budget attached
. hereto and incorporated herein.

2. Consideration.
The Contractor will be paid at the rate set forth in Attacbment A, which is attached hereto and
incorporated herein for perfonning the duties set forth above. Total remuneration under this Contract
shall not exceed S 10,198,121.24
3. Term.
This Contract shall be effective for a period of 48 montbs. It shall commence on January 1,2016 and
shall remain in effect through December 31,2019.
4. Access to Records.
The Contractor and its subcontractors, if any, shall maintain all books, documents, papers, accounting
records, and other evidence pertaining to all costs incurred under this Contract. They shall make such
materials available at their respective offices at all reasonable times during this Contract and for three (3)
years fromthe date of final payment under this Contract, for inspection by the State or its authorized
designees. Copies shall be furnished at no cost to the State if requested.

l

 EDS# MD29-6-99-16-:-LF -0725
5_ Assignment; Successors.
The Contractor binds its successors and assignees to all,the tenns and conditions of this Contract. The
Contractor shall not assign or subcontract the whole or any part of this Contract without the'State's prior
written consent. The Contractor may assign its right to receive payments to such,thinl partiesas the
Contractor may desire without the prior written consent of the State, provided that the Contractor gives
written notice (including evidence of such assignment) to the State thirty (30) days in advance of any
payment so assigned. The assignment shall cover all unpaid amounts under this Contract and shall not be
made to more than one party.

6. Assignment of Antitrust Claims.
As part of the consideration for the award of this Contract, the Contractor assigns to the State all right,
title and interest in and to any claims the Contractor now has, or may acquire, under state or feden"
antitriist laws relating to the products or services which'3J"e the subject ofthis Contract.
7. Audits.

The Contractor acknowledges that it may be required to submit to an audit of funds paid through this
Contract.' Any such audit shall be conducted in accordance with IC §5-11-1, el seq., and audit guidelines
specified by the State.
The State considers the Contractor to be a "Contractor" under 2 C.F.R. 200.330 for purposes of this
Contract. However, if required by applicable provisions of 2 C.F.R. 200 (Unifonn Administrative
Requirements, Cost Principles, and Audit Requirements), Contractor shall arrange for a financial and
compliance'audit, which complies with 2 C.F.R. 200.500 el seq.
8. Anthority to Bind Contractor.
The signatory for the Contractor represents that he/she has been duly authorized to execute this Contract'
on behalf of the Contractor and has obtained all necessary or applicable approvals to make this Contract
fully binding upon the Contractor when his/her signature is affixed, and accepted by the State.
9. Changes in Work.

The Contractor shall not commence any additional work or change the scope of the work until authorized
in writing by the State. The Contractor shall make no claim for additional compensation in the absence of
a prior written approval and amendment executed by all signatories hereto. This Contract may only be
amended, supplemented or modified by a written document executed in the same manner as this Contract.
10. Compliance with Laws.
A. The Contractor shall comply with all applicable federal, state, and local laws, rules, regulations, and
ordinances, and all provisions required thereby to be included herein are hereby incorporated by
reference. The enactment or modification of any applicable state or federal statute or the promulgation of
rules or regulaiions thereunder after execution of this Contract shall be reviewed by the State and the
Contractor to detennine whether the provisions of this Contract require fonnal modification.
B. The Contractor and its agents shall abide by all ethical requirements that apply to persons who have a
business relationship with the State as set forth in IC §4-2-6, el seq., IC §4-2-7, et seq. and the regulations
promulgated thereunder. If the Contractor bas knowledge, or would have acquired knowledge with

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reasonable inquiry, tbat a state officer, employee, or special state appointee, as tbose terms are
defined in IC 4-2-6-1, bas a financial interest in t'be Contract. tbe Contractor sball ensure
compliance witb tbe diselosure requirements in IC 4-2-6-10.5 prior to tbe execution oftbis
contract. If the Contractor is not familiar with these, ethical requirements, the Contractor should refer any
questions to the Indiana State Ethics Commission, or visit the Inspector General's website at ,
http://www.in.gov/ig!. If the Contractor or its agents violate any applicable ethical standards, the State
may, 'in its sole disCretion, terminate this Contract immediately upon notice to the Contractor. In addition,
the Contractor may be subjeci.to penalties under IC §§4-2-6, 4-2-7, 35-44.1-1-4. and under any other
applicable laws.
C. The Contractor certifies by entering into this Contract thaineither it nor its principal(s) is presently in
arrears in payment of taxes, permit fees or other statutory, regUlatory or judicially required payments to
the State of Indiana. The Contractor agrees that any payments currently due to the State of Indiana may
be withheld from payments due to the Contractor. Additionally, further work or payments may be
- withheld, delayed, or denied and/or this Contract suspended until the Contractor is current in its payments,' .
and has submitted proof of such payment to the State:
"

D. The Contractor warrants that it has no current, pending or outstanding criminal, civil, or enforcement
actions initiated by the State, and agrees that it will immediately notifY the State of any such actions.
During the term of such actions, the Contractor agrees that the State may delay, withhold, or deny work
under any supplement, amendment, change order or other contractual device issued pursuant to this
Contract.
E. If a valid dispute exists as to the Contractor's liability or guilt in any action initiated by the State or its
agencies, and the State decides to delay, withhold, or deny work to the Contractor, the Contractor may
request that it be allowed to continue, or receive work, without delay. The Contractor must submit, in
writing, a request for review to the Indiana Department of Administration (IDOA) following the
procedures for disputes outlined herein. A determination by IDOA shall be binding on the parties. Any
payments that the State may delay, withhold, deny, or apply under this section shall not be subject to
penalty or interest, except as permitted by IC §5-17-5.
F. The Contractor warrants that the Contractor and its subcontractors, if any, shall obtain and maintain all
required permits, licenses, registrations, and approvals, and shall comply with all health, safety, and
environmental statutes, rules, or regulations in the performance of work activities for the State. Failure to
do so may be deemed a material breach of this Contract and grounds for immediate termination and
denial of further work with the State.
G. The Contractor affirms that, if it is an entity described in IC Title 23, it is properly registered and owes
no outstanding reports to the Indiana Secretary of State.
H. As required by IC §5-22-3-7:
(I) The Contractor and any principals of the Contractor certifY that:

(A) the Contractor, except for de minimis and nonsystematic violations, has not
violated the terms of:
(i) IC §24-4.7 [Telephone Solicitation Of Consumers];
(ii) IC §24-5-12 [Telephone Solicitations]; or
(iii)IC §24-5-14 [Regulation of Automatic Dialing Machines];
in the previous three hundred sixty-five (365) days, even if IC §24-4.7 is preempted
by federal law; and
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(B) the Contractor will not violate the terms ofIC §24-4.7 for the duration of the
Contract, even ifIC §24-4.7 is preempted by federal law.
(2) The Contractor and any principals of the Contractor certify that an affiliate or principal of
the Contractor and any agent acting on behalf of the Contractor or on behalf of an
affiliate or principal of the Contractor, except for de minimis'and nonsystematic
violations, .
(A) has not violated the terms oflC §24-4.7 in the previous tJuh, hundred sixty-five
(365) days, even iflC §24-4.7 is preempted by federal. law; and
(B) will not violate the terms of IC §24-4.7 for the duration ofthl: Contract, even if
1C.§24-4.7 is preempted by federal law.

11. Condition of Payment
All services provided by the Contractor under this Contract must be performed to the State's reasonable
satisfaction, as determined at the discretion of the undersigned State representative and in accordance
with all applicable federal, state, local laws, ordinances, rules and regulations. The State shall not be
required to pay for work found to be unsatisfactory, inconsistent with this Contract or performed in
violation of any federal, state or local statute, ordinance, rule or regulation.

12. Confidentiality, Security and Privacy of Client Personal Information
A. Terms used, but otherwise not defined in this Contract shall have the same meaning as those
found in 45 CFR Parts 160, 162, and 164.
B. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996 (sections 1171
through 1179 of the Social Security Act), including any subsequent amendments to such Act.

C. "HIPAA Rules" mean the rules adopted by and promulgated by the US Department of Health and
Human Services ("HHS") under HIPAA and other relevant federal laws currently in force or
subsequently made, such as the Health Information Technology for Economic and Clinical Heath
Act ("HITECH"), as enumerated under 45 CFR Parts 160, 162, and 164, including without
limitation any and all additional or modified regulations thereof. Subsets of the HIPAA Rules
include:
I) "HIPAA Enforcement Rule" as defined in 45 CFR Part 160;
2) "HIPAA Security Rule" as defined in 45 CFR Part 164, Subparts A and C;
3) "HIPAA Breach Rule" as defined in 45 CFR Part 164, Subparts A and D; and
4) "HlP AA Privacy Rule" as defined in 45 CFR Part 164, Subparts A and E.
D. If Contractor is deemed a Business Associate to the State, Contractor is hereby authorized by the
State to create, receive, maintain, and/or transmit Protected Health Information ("Pill') and other
Personally Identifiable Information (meaning personal information as collectively defined in IC
4-1-6-1 and IC 4-1-11-3, "PIF) on the State's behalf pursuant to and consistent with the Services
performed by Contractor under this Contract.
E. Contractor agrees that as a Business Associate to the State it is obligated to comply with the
HIPAA Rules, as such Rules apply to Business Associates, throughout the term of this Contract
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and thereafter as may be required by federal law and such compliance will be at Contractor's sole
expense. Further:
.
I) Contractor will not use or further disclose PHI or PH except as expressly permitted by this
Contract or as required by law; provided, however, nothing in this Contract shall be construed
to permit Contractor use or disclose PHI in a manner that would violate the provisions of the
HIPAA Privacy Rule as such Rule applies to the State with regard to the Services performed
by Contractor under this Contract or otherwise cause the State to be non-compliant with the
HIPAA Privacy Rule.
2) Contractor understands it must fully comply with the H1PAA Security Rule and will employ'
appropriate and compliant safeguards to reasonably prevent the use or disclosure of PHI and
PH other than as permitted by this Contract or required by the HIPAA Privacy Rule. Such
safeguards will be designed, implemented, operated, and managed by Coritractor at
Contractor's sole expense and following the Contractor's best professional judgment
regarding such safeguards. Upon the Siate's reasonable request, Contractor will review such,
safeguards with the State. Contractor will implement the following HIPAA requirements for
any forms of PHI or PH that the Contractor receives, maintains; or transmits on behalf of the
State:
a) Administrative safeguards under 45 CFR § 164.308;
b) Physical safeguards under 45 CFR § 164.310;
c) Technical safeguards under 45 CFR § 164.312; and
d) Policies and procedures and documentation requirements under 45 CFR § 164.316
3) Contractor understands that it is subject to the HIPAA Enforcement Rule under which

Contractor may be subject to criminal and civil penalties for violations of and noncompliance with the H1PAA Rules.
F. Improper Disclosure, Securitv Incident, and Breach Notification.
I) Contractor understands that it is subject to the HIPAA Breach Rule.
2) For the purposes of this Contract, the term Breach has the same meaning as defined in the
HIPAA Breach Rule. The term "Security Incident'" shall mean an action or event that has
resulted in the improper use or disclosure of PHI or PH in Contractor's safekeeping (in
violation of this Contract and/or in violation of the HIPAA Privacy Rule), the reasonable
possibility or suspected possibility that an improper use or disclosure of PHI or PH may have
occurred, or circumstances in which PHI or PH has been exposed to an opportunity for
improper use or disclosure.
3) If a Security Incident occurs or if Contractor suspects that a Security Incident may have

occurred with respect to PHI and/or PH in Contractor's safekeeping:
a) Contractor shall notify the State of the Security Incident within one (I) business day of
when Contractor discovered the Security Incident; such notification shall be made to the
FSSA Privacy Office in a manner reasonably prescribed by the FSSA Privacy Officer and
shall include as much detail as the Contractor reasonably may be able to acquire within
the one ( I ) business day.

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b) For the purposes of such Security Incidents, "discovered~ and "discovery" shall mean the
first day on which such Security Incident is known to the Contractor or, by exercising
reasonable diligence, would have been known to the Contractor. Regardless of whether
the Contractor failed to exercise reasonable diligence, improperly delaying the _
notification of discovery beyond the one day requirement, the Contractor will notifY the
FSSA Privacy Office within one day of gaining actual knowledge of a breach.
c) In collaboration with the FSSA Privacy Office. Contractor shall undertake all
commercially reasonable efforts necessary to thoroughly investigate the Security Incident
and to provide all results of such investigation to the FSSA Privacy Office, including but
not limited to Contractor personnel involved, source and cause of the Security Incident,
specific information disclosed, disclosure victims (those whose PHIIPII was disclosed),
disclosure recipients, supporting materials, actions taken to mitigate or stop the Security
Incident, and similar details.
-

-.

d) Contractor's investigation must be undertaken expeditiously and completed to the ext!!nt
that a determination of whether a Breach has occurred can be reasonably made, inCluding
the identification of the victims or likely victims, within a reasonable timeframe as .
mutually agreed upon with the FSSA Privacy Office, from the date of discovery of the
Security Incident. Contractor shall provide details of its investigation to the FSSA
Privacy Office on an ongoing basis until the investigation is complete.
e) Contractor and the FSSA Privacy Office will collaborate on the results of Contractor's
investigation; the determination as to whether a Breach has occurred rests solely with the
FSSA Privacy Office.
f)

If it is determined by the FSSA Privacy Office that a Breach has occurred:
I.

Contractor agrees that it shall be responsible for, including all costs with respect
to, fulfilling the State's andlor Contractor's obligations for notice to all of the
known and suspected victims of the Breach. Such notice shall comply with the
HIPAA Breach Rule notification requirements andlor applicable notification
requirements under State law.

Contractor further agrees that such notification will be made under its name,
unless otherwise specified by the FSSA Privacy Office. Contractor will
coordinate its Breach notification efforts with the FSSA Privacy Office; the
FSSA Privacy Office will approve Contractor's Breach notification procedures and
plans. including the format and content of the notice(s) prior to such
notification being made.

II.

III.

Contractor accepts full responsibility for the Breach and any resulting losses or
damages incurred by the State or any victim of the Breach.

IV.

Contractor will undertake all commercially reasonable efforts necessary to
mitigate any deleterious effects of the Breach for the known and suspected
victims of the Breach.
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v.

The State, through the FSSA Privacy Office, will make the appropriate
notifications to HHS andlor the applicable State agencies with respect to the
Breach, unless the Contractor is directed to do so by the FSSA Privacy Office.'

g) Contractor will undertake commercially reasonable corrective actions to eliminate or
minimize to the greatest degree possible the opportunity for an identified Security
Incident to reoccur and provide the FSSA Privacy Office with its plans, status updates,
and wrinen certification of completion regarding such corrective actions.
G. Subcontractors. Contractor agrees that iIi accordance with the HIPAA Privacy Rule any
subcontractors engaged by Contractor (in compliance with this Contract) that will create, receive,
maintain, or transmit State PHIIPH on Contractor's behalf will contractually agree to the same
restrictions, conditions, and requirements that apply to Contractor with respect to such PHllPII.,
H. Access by Individuals to their PHI. Contractor acknowledges that in accordance with the HIPAA
Privacy Rule individuals for whom Contractor has direct possession of their PHI on the State's
behalf have the right to inspect and amend their PHI, and have the right for an accounting of uses
and disclosures of such PHI, except as otherwise provided therein. Contractor shall provide such
"
right of inspection, amendment, and accounting of disclosures to such individuals upon
reasonable request by the State (or by such individuals if the State directly refers such individ~als
to Contractor). In situations in which Contractor does not have direct possession of such PHI;
then the State shall be responsible for such inspection, amendment. and accounting of disclosures
rights by individuals.
I.

Access to Records. Contractor shall make available to HHS andlor the State, Contractor's
internal practices. books, and records relating to the use and disclosure of PHI and PH provided to
Contractor by the State or created, received, maintained, or transmined by Contractor on the
State's behalf. Contractor shall promptly inform the State by giving notice to the FSSA Privacy
Office of any request by HHS (or its designee) for such internal practices, books, andlor records
and shall provide the State with copies of any materials or other information made available to
HHS.

J.

Return of Protected Health Information. Upon request by the State or upon termination of this
Contract, Contractor will, at the State's sole option, either return or destroy all copies of any PHI
or PH provided to Contractor by the State, including PHI or PH created, received, maintained, or
transmined by Contractor on the State's behalf and Contractor shall warrant in writing that it has
returned or destroyed such PHI andlor PlI. Further, upon termination of this agreement
Contractor will not retain any copies of any such PHI and PH and shall warrant same in writing.

K. At the sole discretion of the State, the State may terminate this Contract for Contractor's material'
breach of this Section 12.
L. Contractor agrees to participate in a disaster recovery plan, as appropriate to the Contractor's
Services, as determined by the State to be necessary to uphold integral business functions in the
event of an unforeseen disaster.
M. Drug and Alcohol Records. In the performance of the Services under this Contract, Contractor
may have access to confidential information regarding alcohol and drug abuse patient records.
Contractor agrees that such information is confidential and protected information and promises
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and assures that any such infonnation, regardless of fonn, disclosed to Contractor for the
purposes of this Contract will not be disclosed or discussed with others without the prior written
consent of the State. The Contractor and the State will comply with the applicable requirements
of 42 CFR Part 2 and any other applicable federal or state law or regulatory requirement
concerning such infonnation. The Contractor, will report any unauthorized disclosures of such
infonnation in compliance with Section I2.F.
N. Confidentiality of State Infonnation. The Contractor understands and agrees that data, materials.,
and infonnation disclosed to the Contractor may contain confidential and protected infonnation.
The Contractor covenants that data, material and infonnation gathered, based upon or disclosed to
the Contractor for the purpose of this Contract, will not be disclosed to or discussed with third
parties without the prior written consent of the State.
The parties acknowledge that the services to be perfonned by Contractor for the State under this
contract may require or allow access to data, materials, and infonnation containing Socia! Security
numbers maintained by the State in its computer system or other records. In addition to the covenant
made above in this section and pursuant to 10 lAC 5-3~1(4), the Contractor and the State agree to
comply with the provisions of IC 4-1- \0 and IC 4-1-11. If any Social Security number(s) is/are
disclosed by Contractor, Contractor agrees to pay the cost of the notice of disclosure of a breach of
the security of the system in addition to any other claims and expenses for which it is'liable under the
tenns of this contract. The Contractor shall report any unauthorized disclosures of Social Security
numbers to the FSSA HIPAA Compliance Office within one (I) business day of the date of
discovery.
O. Contractor will indemnifY and hold the State harmless from any loss, damage, costs., expense,
judgment, sanction or liability, including, but not limited to, attorneys' fees and costs, that the
State incurs or is subject to, as a result of a breach of this Section by the Contractor or any
subcontractor, agent or person under Contractor's control. In the event a claim is made against the
State for any such claim, cause of action, liability, damage, cost or expense, State may, at its sole
option: (i) tender the defense to Contractor, who shall provide qualified and competent counsel to
represent the State interest at Contractor's expense; or (ii) undertake its own defense, utilizing
such professionals as it deems reasonably necessary, holding Contractor responsible for all
reasonable costs thereof. In any event, State shall have the sole right to control and approve any
settlement or other compromise of any claim brought against it that is covered by this Section.

13. Continuity of Services.
A. The Contractor recognizes that the service(s) to be perfonned under this Contract are vital to the State
and must be continued without interruption and thal upon Contract expiration, a successor, either the
State or another contractor, may continue them. The Contractor agrees to:
I.
Furnish phase-in training; and .
2.
Exercise its best efforts and cooperation to effect an orderly and efficient transition to a
successor.
B. The Contractor shall, upon tJie State's written notice:
I. Furnish phase-in, phase-<lut services for up to sixty (60) days after this Contract expires;
and
2. Negotiate in good faith a plan with a successor to detennine the nature and extent of
phase-in, phase-<lut services required. The plan shall specifY a training program and a
date for transferring responsibilities for each division of work described in the plan, and
shall bc subject to the State's approval. The Contractor shall provide sufficient
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 EDS# MD29-6-99-16-LF-0725
experienced personnel during the phase-in, phase-out period to ensure that the services
called for by this Contract are maintained at the required level of proficiency.
C. The Contractor shall allow as many personnel as practicable to remain on the job to help the successor
maintain the continuity and consistency of the services required by this Contract. The Contractor also
shall disclose necessary personnel records and allow the successor to conduct on-site interviews with
these employees. If selected employees are agreeable to the change, the Contractor shall release them at a
mutually agreeable date and negotiate transfer of their earned fringe benefits to the successor.
D,. The Contractor shall be reimbursed for all reasonable phase-in, phase-out costs (i.e., costS incurred
within the agreed period after contract expiration that result from phase-in, phase-out operations).

14. Debarment and suspension.
A. The Contractor certifies by entering into this Contract that neither it nor its principals nor any of its
subcontractors are presently debarred, suspended, proposed for debarment, declared ineligible Or
voluntarily excluded from entering into this Contract by any federal agency or by any department, agency
~r political subdivision of the State of Indiana. The term "principal" for purposes of this Contract means
an officer, director, owner, partner, key employee or other person with primary management or
supervisory responsibilities, or a person who has a critical influence on or substantive control over the
operations of the Contractor.
B. The Contractor certifies that it has verified the state and federal suspension and debarment status for,·
all subcontractors receiving funds under this Contract and shall be solely responsible for any recoupment,
penalties or costs that might arise from use of a suspended or debarred subcontractor. The Contractor
shall immediately notifY the State if any subcontractor becomes debarred or suspended, and shall, at the
State's request, take all steps required by the State to terminate its contractual relationship with the
subcontractor for work to be performed under this Contract.

IS. Default by State.
-

If the State. sixty (60) days after receipt of written notice, fails to correct or cure any material breach of
this Contract, the Contractor may cancel and terminate this Contract and institute measures to collect
monies due up to and including the date of termination.
16. Disputes.
A. Should any disputes arise with respect to this Contract, the Contractor and the State agree to act
immediately to resolve such disputes. Time is of the essence in the resolution of disputes.
B. The Contractor agrees that,.the existence ofa dispute notwithstanding, it will continue without delay
to carry out all of its responsibilities under this Contract that are not affected by the dispute. Should the
Contractor fail to continue to perform its responsibilities regarding all non-disputed work, without delay,
any additional costs incurred by the State or the Contractor as a result of such failure to proceed shall be
borne by the Contractor. and the Contractor shall make no claim against the State for such costs.

C. If the parties are unable to resolve a contract dispute between them after good faith attempts to do so, a
dissatisfied party shall submilthe dispute to theCommissionerofthe Indiana Department of
Administration for resolution. The dissatisfied party shall give written notice to the Commissioner and
the other party. The notice shall include (I) a description of the disputed issues, (2) the efforts made to
resolve the dispute, and (3) a proposed resolution. The Commissioner shall promptly issue a Notice
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setting out documents and materials to be submitted to ihe Commissioner in order to resolve the dispute;
the Notice may also afford the parties the opportunity to make presentations and enter into further
negotiations. Within 30 business days of the conclusion of the final presentations, the Commissioner
shall issue a written decision and furnish it to both parties. The Commissioner's decision shall be the
final and conclusive administrative decision unless either party serves on the Commissioner and the other
party, within ten business days after receipt of the Commissioner's decision, a written request for
reconsideration and modification of the written decision. If the Commissioner does not modify the
written decision within 30 business days, either party may take such other action helpful to resolving the
dispute, including submitting the dispute to an Indiana court of competent jurisdiction. If the parties .
accept the Commissioner's decision, it may be memorialized as a Written Amendment to this Contract if
appropriate.
D. The State may withhold payments on disputed items pending resolution of the dispute. The
unintentional nonpayment by the State to the Contractor of one 'or more invoices not in dispute in
accordance with the terms of this Contract will not be cause for the Contractor to terminate this Contract, .
and the Contractor may bring suit to collect these amounts without following the disputes procedure
. contained herein.
E. With the written approval of the Commissioner of the Indiana Department of Administration, the
parties may agree to forego the process described in subdivision C. relating to submission of the dispute
to the Commissioner.
F. This paragraph shall not be construed to abrogate provisions oflnd. Code 4-6-2-11 in situations where
dispute resolution efforts lead to a compromise of claims in favor ofthe State as described in that
statute. In particular, releases or settlement agreements involving releases of legal claims or potential
legal claims of the state should be processed consistent with Ind. Code 4-6-2-11, which requires approval
of the Governor and Attorney General.
17. Drug-Free Workplace Certification.
As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of [ndiana, the
Contractor hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free
workplace. The Contractor will give written notice to the State within ten (10) days after receiving actual
notice that the Contractor, or an employee of the Contractor in the State of Indiana, has been convicted of·
a criminal drug violation occurring in the workplace. False certification or violation of this certification
may result in sanctions including, but not limited to, suspension of contract payments, termination of this
Contract and/or debarment of contracting opportunities with the State for up to three (3) years.
[n addition to the provisions of the above paragraph, if the total amount set forth in this Contract is in
excess of $25,000.00, the Contractor certifies and agrees that it will provide a drug-free workplace by:
A. Publishing and providing to all of its employees a statement notifying them that the unlawful
manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the
Contractor's workplace, and specifYing the actions that will be taken against employees for violations
of such prohibition;
B. Establishing a drug-free awareness program to inform its employees of (I) the dangers of drug abuse

in the workplace; (2) the Contractor's policy of maintaining a drug-free workplace; (3) any avai[able
drug counseling, rehabilitation and employee assistance programs; and (4) the penalties that may be
imposed upon an employee for drug abuse violations occurring in the workplace;

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C. NotifYing all employees in the statement required by subparagraph (A) above that as a condition of
. continued employment, the employee will (I) abide by the terms of the statement; and (2) notifY the
Contractor of any criminal drug statute conviction for a violation occurring in the workplace no later
than five (5) days after such conviction;
D. NotifYing the State in writing within ten (10) days after receiving notice from an employee under
subdivision (C)(2) above. or otherwise receiving actual notice of such c o n v i c t i o n ; '
E. Within thirty (30) days after receiving notice under subdivision (C)(2) above of a conviction,
imposing the following sanctions or remedial measures on any employee who is convicted of drug ,
abuse violations occurring in the workplace: (I) taking appropriate personnel action against the
employee, up to and including termination; or (2) requiring such employee to satisfactorily participate
in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state. or
local health, law enforcement, or other appropriate agency; and

F. Making a good faith effort to maintain a drug-free workplace through the implementation of
subparagraphs (A) through (E) above.

18. Employment Eligibility Verification.
As required by IC §22-5-1.7, the Contractor swears or affirms under the penalties ofpe!jury that the
Contractor does not knowingly employ an unauthorized alien. The Contractor further agrees that:
A. The Contractor shall enroll in and verifY the work eligibility status of all hislher/its newly hired
employees through the E-VerifY program as defined in IC §22-5-1.7-3. The Contractor is not required to
participate should the E-VerifY program cease to exist. Additionally, the Contractor is not required to
participate if the Contractor is self-employed and does not employ any employees.
B. The Contractor shall not knowingly employ or contract with an unauthorized alien. The Contractor
shall not retain an employee or contract with a person that the Contractor subsequently learns is an
unauthorized alien.

C. The Contractor shall require hislher/its subcontractors, who perform work under this Contract, to
certifY to the Contractor that the subcontractor does not knowingly employ or contract with an
unauthorized alien and that the subcontractor has enrolled and is participating in the E-VerifY program:
The Contractor agrees to maintain this certification throughout the duration of the term ofa contract with
a subcontractor.

The State may terminate for default if the Contractor fails to cure a breach of this provision no later than
thirty (30) days after being notified by the State.

19. Employment Option.
If the State determines that it would be in the State's best interest to hire an employee of the Contractor,
the Contractor will release the selected employee from any non-eompetition agreements that may be in·.
effect. This release will be at no cost to the State or the employee.
20. Force Majeure.
In the event that either party is unable to perform any of its obligations under this Contract or to enjoy any
of its benefits because of natural disaster or decrees of governmental bodies not the fault of the affected
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party (hereinafter referred to as a "Force Majeure Event"), the party who has been so affected shall

immediately or as soon as is reasonably possible under the circumstances give notice to the other
party and shall do everything possible to resume performance. Upon receipt of such notice, all
obligations under this Contract shall be immediately suspended. If the period of nonperformance exceeds
thirtY (30) days from the receipt of notice of the Force Majeure Event, the party whose ability to perform
has not been so affected may, by giving written notice, terminate this Contract.
21. Funding Cancellation.
When the Director of the State Budget Agency makes a written determination that funds are not
appropriated or otherwise available to support continuation of performance of this Contract, this Contract
shall be canceled. A determination by the Director of State Budget Agency that funds are not
appropriated or otherwise available to support continuation of performance shall be final and conclusive.
22. 'Governing Law.
This Contract shall be governed, construed, and enforced in accordance with the laws of the State of
Indiana, without regard to its conflict of laws rules. Suit, if any, must be brought in the State of Indiana.
23. HlPAA Compliance.
This information has been incorporated in Clause 12.
24. Indemnification.
The Contractor agrees to indemnify, defend, and hold harmless the State. its agents, officials, and
employees from all third party claims and suits including court costs, attorney's fees. and other expenses
caused by any act or omission of the Contractor and/or its subcontractors, if any, in the performance of
this Contract. The State shall not provide such indemnification to the Contractor.
25. Independent Contractor; Workers' Compensation Insurance.
The Contractor is performing as an independent entity under this Contract. No part of this Contract shall
be construed to represent the creation of an employment, agency, partnership or joint venture agreement
between the parties. Neither party will assume liability for any injury (including death) to any persons, or
damage to any property, arising out of the acts or omissions of the agents, employees or subcontractors of
the other party. The Contractor shall provide all necessary unemployment and workers' compensation
insurance for the Contractor's employees, and shall provide the State with a Certificate of Insurance
evidencing such coverage prior to starting work under this Contract.
26. Information Technology Enterprise Architecture Requirements.
If the Contractor provides any information technology related products or services to the State, the
Contractor shall comply with all lOT standards, policies and guidelines, which are online at
http://iot.in.gov/architecture/. The Contractor specifically agrees that all hardware, software and services
provided to or purchased by the State shall be compatible with the principles and goals contained in the
electronic and information technology accessibility standards adopted under Section 508 of the Federal
Rehabilitation Act of 1973 (29 V.S.c. 794d) and IC §4-I3.I-3. Any deviation from these architecture
requirements must be approved in writing by lOT in advance. The State may terminate this Contract for
default if the Contractor fails to cure a breach of this provision within a reasonable time.

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27. Insurance.
A. The Contractor and their subcontractors ( if any) shall secure and keep in force during the tenn of this
Contract the following insurance coverages (if applicable) covering the Contractor for any and all claims
of any nature which may in any manner arise out of or result from Contractor's perfonnance under this
Contract:
I. Commercial general liability, including contractual coverage, and products or

completed operations coverage (if applicable), with minimum liability limits not less than
$700,000 per person and $5,000,000 per occurrence unless additionHt coverage is required by the
State. The State is to be named as an additional insured on a prilIllll)', non-contributory basis for
any liability arising directly or indirectly under or in connection with this Contract.
2. Automobile liability for owned, non-owned and hired autos with minimum liability limits of
$700,000 per person and $5,000,000 per occurrence. The State is to be named as an additional
insured on a primary, non-contributory basis.
3. Errors and Omissions liability with minimum liability limits of$I,OOO,OOO per claim and
in the aggregate. Coverage for the benefit ofthe State shall continue for a period of two
(2) years after the date of service provided under this Contract.
4. Fiduciary Liability is required if the Contractor is responsible for the management and oversight of
various employee benefit plans and programs such as pensions, profit-sharing and savings, among
others. These contractors face potential claims for mismanagement brought by plan
members. Limits should be no less than $700,000 per cause of action and $5,000,000 per
occurrence.

5. Valuable Papers coverage, available under an Inland Marine policy, is required when any plans,
drawings, media, data, records, reports, billings and other documents are produced or used under
this agreement. Insurance must have limits sufficient to pay for the re-creation and reconstruction
of such records.
6. The Contractor shall secure the appropriate Surety or Fidelity Bond(s) as required by the state
. department served or by applicable statute.
7. The Contractor shall provide proof of such insurance coverage by tendering to the undersigned
State representative a certificate of insurance prior to the commencement of this Contract and
proof of workers' compensation coverage meeting all statutory requirements of IC §22-3-2. In
addition, proof of an "all states endorsement" covering claims occurring outside the State is
required if any of the services provided under this Contract involve work outside of Indiana.
B. The Contractor's insurance coverage must meet the following additional requirements:

I. The insurer must have a certificate of authority or other appropriate authorization to operate in the
state in which the policy was issued.
2. Any deductible or self-insured retentio~ amount or other similar obligation under the insurance
policies shall be the sole obligation of the Contractor.

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3. The State will be defended, indemnified and held haooless to the fuli extent of any coverage
actually secured by the Contractor in excess of the minimum requirements set forth above. The
duty to indemnifY the State under this Contract shall not be limited by the insurance required in
this Contract.
4. The insurance required in this Contract, through a policy or endorsemeiJt{s), shall include a
provision that the policy and endorseinents may not be canceled or modified without thirty (30)
days' prior written notice to the undersigned State agency.
5.

The Contractor waives and agnies to require their insurer to waive th~ir rights of subrogation
against the State of Indiana. .

C. Failure to provide insurance as required inthis Contract may be deemed a material breai:h of contract
entitling the State to immediately tenninate this Contract. The Contractor shallfumish a certificate of
insurance and all endorsements to the State befure the commencement of this Contract.
28. Key Person(s).
A. If both parties have designated that certain individual(s) are essential to the services offered, the
parties agree that should such individual(s) leave their employment during the teoo ofthis Contract for
whatever reason, the State shall have the right to teooinate this Contract upon thirty (30) days' prior
written notice.

B. In the event that the Contractor is an individual, that individual shall be considered a key person and,
as such, essential to this Contract. Substitution of another for the Contractor shall not be peooitted
without express written consent of the State.
Nothing in sections A and B, above shall be construed to prevent the Contractor from using the services
of others to perfooo tasks ancillary to those tasks which directly require the expertise of the key person.
Examples of such ancillary tasks include secretarial, clerical, and common labor duties. The Contractor
shall, at all times, remain responsible for the perfoooance of all necessary tasks, whether perfoooed by a
key person or others.
Key person(s) to this Contract is/are Sharon Reynolds - Project Manager and Natalie SmithOperations Manager
29. Licensing Standards.
The Contractor, its employees and subcontractors shall comply with all applicable licensing standards,
certification standards, accrediting standards and any other laws, rules, or regulations governing services
to be provided by the Contractor pursuant to this Contract. The State will not pay the Contractor for any
services perfoooed when the Contractor, its employees or subcontractors are not in compliance with such
applicable standards, laws, rules, or regulations. If any license. certification or accreditation expires or is
revoked. or any disciplinary action is taken against an applicable license, certification, or accreditation.
the Contractor shall notifY the State immediately and the State, at its option. may immediately teooinate
this Contract.
.
30. Merger & Modification.
This Contract constitutes the entire agreement between the parties. No understandings, agreements, or
representations, oral or written, not specified within this Contract will be valid provisions of this Contract.
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MD29-6-99-16~LF-0725

This Contract may not be modified, supplemented, or amended, except by written agreement signed by all
necessary parties.
'

31. Minority and Women's Business Enterprises CompUance.
Award of this Contract was based, in part, on the MBEJWBE participation plan. The following certified
MBE or WBE subcontractors will be participating in this Contract:
MBEJWBE

WBE
MBE
MBE
MBE

PHONE

COMPANY NAME

260.434.0990
317.872.4490
765.459.8262
317.423.8980

SCOPE OF PRODUcrs and/or SERVICES

Briljent LLC
Fineline Printing Group
Rite Quality Office Supplies
Bucber & Cbristian Consulting

tmLIZATION

DATE

PERCENT

1/112016 10.48%
1/112016
5.19%
11112016
.38%
1/112016 4.55%

A copy of each subcontractor agreement must be submitted to IDOA's MBElWBE Division within thirty
(30) days of the effective date of this Contract, .Failureto provide a copy of any subcontractor,agreement
will be deemed a violation of the rules governing MBElWBE procurement, and may result in sanctions
allowable under 25 lAC 5-7-8. Failure to provide any subcontractor agreement may also be considered a
material breach of this Contract. The Contractor must obtain approval from IDOA's MBElWBEDivision'
before changing the participation plan submitted in connection with this ContracL
The Contractor shall report payments made to MBElWBE Division subcontractors under this Contract on
a monthly basis. Monthly reports shall be made using the online audit tool, commonly referred to as "Pay
Audit,~ MBEJWBE Division subcontractor payments shall also be reported to the Division as reasonably.
requested and in a format to be determined by Division:

32. Nondiscrimination:
Pursuant to the Indiana Civil Rights Law, specifically including IC §22-9-1-1 0, and in keeping with the
purposes of the federal Civil Rights Act of 1964, the Age Discrimination in Employment Act, and the
Americans with Disabilities Act, the Contractor covenants that it shall not discriminate against any
employee or applicant for employment relating to this Contract with respect to the hire, tenure, terms,
conditions or privileges of employment or any matter directly or indirectly related to employment,
because of the employee's or applicant's race, color, national origin, religion, sex, age, disability,
ancestry, status as a veteran, or any other characteristic protected by federal, state, or local law
("Protected Characteristics~). Contractor certifies compliance with applicable federal laws, regulations,
and executive orders prohibiting discrimination based on the Protected Characteristics in the provision of
services. Breach of this paragraph may be regarded as a material breach of this Contract, but nothing in
this paragraph shall be construed to imply or establish an employment relationship between the State and
any applicant or employee of the Contractor or any subcontractor.
The State is a recipient of federal funds, and therefore, where applicable, Contractor and any,
subcontractors shall comply with requisite affirmative action requirements, including reporting; pursuant
to 41 CFR Chapter 60, as amended, and Section 202 of Executive Order 11246 as amended by
Executive Order 13672.

33. Notice to Parties,
Whenever any notice, statement or other communication is required under this Contract, it shall be sent
by first class mail or via an established courier I delivery service to the following addresses, unless
otherwise specifically advised.
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A. Notices to the State shall be sent to: (Include contact name and/or title, name of agency & address)
Doug Montgomery
402 West Washington Street
Indianapolis, IN. 46204-2739

B."Notices to the Contractor shall be sent to: (Include contact name and/or title, name of vendor &"
address)
Bruce Caswell
PO Box 791188
Baltimore, MD. 21278-1188

," .
As required by IC §4-\3-2-14.8, payments to the Contractor shall be made via electronic funds transfer. in
acCordance with instructions filed by the Contractor with the Indiana Auditor of State.
34. Order of Precedence; Incorporation by Reference.
Any inconsistency or ambiguity in this Contract shall be resolved by giving precedence in the following
order: (I) this Contract, (2) attachments and exhibits prepared by the State, (3) RFP# I 5-036, (4)
Contractor's response to RFP#15-036, and (5) attachments prepared by the Contractor. All attachments,
and all documents referred to in this paragraph, are hereby incorporated fully by reference.
35. Ownership of Documents and Materials.
A. All documents, records, programs, applications, data, algorithms, film, tape, articles, memoranda, and
other materials (the "Materials") not developed or licensed by the Contractor prior to execution of this
Contract, but specifically developed under this Contract shall be considered "work for hire" and the
Contractor hereby transfers and assigns any ownership claims to the State so that all Materials will be the
property of the Stale. If ownership inlerest in the Malerials cannot be assigned to the State, the Contractor
grants the Stale a non-exclusive, non-cancelable, perpetual, worldwide royalty-free license 10 use the
Materials and 10 use, modifY, copy and create derivative works of the Malerials.

B. Use oflhe Malerials, olher than related to contract performance by Ihe Contractor, without the prior
written consent of the State, is prohibited. During the performance oflhis Contract, the Contractor shall
be responsible for any loss of or damage 10 the Materials developed for or supplied by the Stale and used
to develop or assist in the services provided while the Malerials are in the possession of the Contractor.
Any loss or damage thereto shall be restored at the Contractor's expense. The Contraclor shall provide
the Stale full, immediate, and unrestricted access to the Materials and to Contractor's work product during
the term of this Contract.
36. Payments.
A. All payments shall be made 35 days in arrears in conformance with State fiscal policies and
procedures and. as required by IC§4-13-2-14.8, the direcl deposit by electronic funds transfer to the
financial institution designated by the Contraclor in wriling unless a specific waiver has been obtained
from the Indiana Auditor of Stale. No payments will be made in advance of receipt of the goods or
services thaI are Ihe subjecl of this Contracl except as permitted by IC §4-13-2-20.

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B. The State Budget Agency and the Contractor acknowledge that Contractor is being paid in advance for
the maintenance of equipment and / or software. Pursuant to IC §4-13-2-20(b)( 14), Contractor agrees that
if it fails to perform the maintenance required under this Contract, upon receipt of written notice from the
State, it shall promptly refund the consideration paid; pro-rated through the date of non-performance.

CAt the time that the final claim is submitted, all reconciliation issues must be resolved including the
return of any incorrectly reimbursed monies or credits received for expenses previously reimbursed.
Incorrectly reimbursed funds or credits received for expenses reimbursed will be returned immediately
upon discovery as a direct payment, not credit, to the "State of Indiana:' Each return of funds will be
accompanied with a completed FSSA Contract Claim Reimbursement Form identifYing specific
Components to be credited (negative) and each associated month reported on the original reimburSement
request. Payments and FSSA Contract Claim Reimbursement Forms will be submitted to FSSA
Administrative Services using the address provided on the reimbursement form.
D. Claims must be submitted with accompanying supportive documentation, as designated by. the State. '.
Incomplete claims submitted or claims submitted without supportive documentation will be returned to
the Contractor andlor Grantee and not processed for payment. Failure to successfully perform orexecute
the policies andlor provisions made in this contract may result in the denial andlor partial payment of
claims submitted for reimbursement.
E. The State Budget Agency and the Contractor acknowledge that Contractor is being paid in advance for
the maintenance of equipment and / or software. Pursuant to IC 4-13-2-20(b)( 14), Contractor agrees that
if it fails to perform the maintenance required under this Contract, upon receipt of written notice from the
State, it shall promptly refund the consideration paid, pro-rated through the date of non-performance.
37. PeoaltieslloterestlAttorney's Fees.
The State will in good faith perform its required obligations hereunder and does not agree to pay any
penalties, liquidated damages, interest or attomey·s fees, except as permitted by Indiana law, in part, IC
§S-17-S, IC §34-S4-8. IC §34-13-1 and IC § 34-S2-2-3.
Notwithstanding the provisions contained in IC §S-17-S, any liability resulting from the State's failure to
make prompt payment shall be based solely on the amount of funding originating from the State and shall
not be based on funding from federal or other sources.
38. Progress Reports.
The Contractor shall submit progress reports to the State upon request. The report shall be oral, unless the
State, upon receipt of the oral report. should deem it necessary to have it in written form. The progress
reports shall serve the purpose of assuring the State that work is progressing in line with the schedule, and
that completion can be reasonably assured on the scheduled date.
39. Public Record.
The Contractor acknowledges that the State will not treat this Contract as containing confidential
information, and will post this Contract on its website as required by Executive Order OS-07. Use by the
public of the information contained in this Contract shall not be considered an act of the State.

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40. Renewal Option.
This Contract may be renewed under the same terms and conditions, subject to the approval of the
Commissioner of the Department of Administration and the State Budget Director in compliance with IC
§5-22-17-4. The term of the renewed contract may not be longer than the term of the original contract.

41. Severability.
The invalidity of any section, subsection, clause or provision of this Contract shall not affect the .validity
of the remaining sections, subsections, clauses or provisions of this Contract.

42. Substantial Perfonnance.
This Contract shall be deemed to be substantially performed only when fully performed according to its
terms and conditions and any written amendments or supplements.

43. Taxes.
The State is exempt from most state and local taxes and many federal taxes. The State will not be
responsible for any taxes levied on the Contractor as a result of this Contract.

44. Tennination for Convenience.
This Contract may be terminated, in whole or in part, by the State, which shall include and is not limited
to the Indiana Department of Administration and the State Budget Agency whenever, for any reason, the
State determines that such termination is in its best interest. Termination of services shall be effected by
delivery to the Contractor of a Termination Notice at least thirty (30) days prior to the termination
effective date, specifYing the extent to which performance of services under such termination becomes
effective. The Contractor shall be compensated for services properly rendered prior to the effective date
of termination. The State will not be liable for services performed after the effective date of termination.
The Contractor shall be compensated for services herein provided but in no case shall total payment made
to the Contractor exceed the original contract price or shall any price increase be allowed on individual
line items if canceled only in part prior to the original termination date. For the purposes of this
paragraph, the parties stipulate and agree that the Indiana Department of Administration shall be deemed
to be a party to this agreement with authority to terminate the same for convenience when silch
termination is determined by the Commissioner of IDOA to be in the best interests of the State.

45. Tennination for Default.
A. With the provision of thirty (30) days' notice to the Contractor, the State may terminate this ConF<'ct
in whole or in part if the Contractor fails to:
I. Correct or cure any breach of this Contract; the time to correct or cure the breach may be
extended beyond thirty (30) days if the State determines progress is being made and the extension
is agreed to by the parties;
2. Deliver the supplies or perform the services within the time specified in this Contract or any
extension;

3.
4.

Make progress so as to endanger performance of this Contract; or
Perform any of the other provisions of this Contract.

B. If the State terminates this Contract in whole or in part due to Contractor's breach or default, it may
acquire supplies or services substantially similar to those terminated and within the scope of the Contract,
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~d the Contractor will be liable to the State for reasonable excess costs for those supplies or services.
However, the Contractor shall continue the work not terminated.

C. The State shall pay the contract price for completed supplies delivered and services accepted. The
Contractor and the State shall agree on the amount of payment for manufacturing materials delivered and
ateepted and for the protection and preservation of the property. Failure to agree will be a dispute under
tJie Disputes clause. The State may withhold from these amounts any sum the State determines to be
necessary to protect the State against loss because of outstanding liens or claims of former lien holders.
D. The rights and remedies of the State in this clause are in addition to any other rights and remedies
provided by law or equity or under this Contract.

46. Travel.
No expenses for travel will be reimbursed unless specifically'permitted under the scope of services or
consideration provisions. Expenditures made by the Contractor for travel will be reimbursed at the
current rate paid by the State and in accordance with the State Travel Policies and Procedures as specified
in the current Financial Management Circular. Out-of-state travel requests must be reviewed by the State
for avai lability of funds and for appropriateness per Circular guidelines.

47. Indiana Veteran's Business Enterprise Compliance.
Award of this Contract was based, in part, on the Indiana Veteran's Business Enterprise ("IVBE~)
participation plan. The following IVBE subcontractors will be participating in this Contract:
VBE

PHONE

VBE

317.297.7842

COMPANY NAME

SCOPE OF PRODUCTS andIor SERVICES

MBCGroup

UTILIZATION

DATE

PERCENT

1/112016

4.23%

A copy of each subcontractor agreement shall be submitted to IDOA within thirty (30) days of the
request. Failure to provide any subcontractor agreement may also be considered a material breach of this
. Contract. The Contractor must obtain approval from looA before changing the IVBE participation plan
submitted in connection with this Contract.
The Contractor shall report payments made to IYBE subcontractors under this Contract on a monthly
basis. Monthly reports shall be made using the online audit tool, commonly referred to as "Pay Audit."
IVBE subcontractor payments shall also be reported to looA as reasonably requested and in a format to
be determined by looA.

48_ Waiver of Rights.
No right conferred on either party under this Contract shall be deemed waived, and no breach of this
Contract excused, unless such waiver is in writing and signed by the party claimed to have waived such
right. Neither the State's review, approval or acceptance of, nor payment for, the services required under
this Contract shall be construed to operate as a waiver of any rights under this Contract or of any cause of
action arising out of the performance of this Contract, arid the Contractor shall be and remain liable to the
State in accordance with applicable law for all damages to the State caused by the Contractor's negligent
performance of any of the services furnished under this Contract.

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49. Work Standards.
The Contractor shall execute its responsibilities by following and applying at all times the highest
professional and technical guidelines and standards. If the State becomes dissatisfied with the work
·product of or the working relationship with those individuals assigned to work on this Contract, the State
may request in writing the replacement of any or all such individuals, and the Contractor shall grant such
request.

50. Prevention of Fraud and Abuse.
In accordance with 42 U.S.c. 1396a(aX68), Contractor shall establish and disseminate, to its employees
(including management), subcontractors, and agents, written policies that provide detailed information
about federal and state False Claims Acts, whistleblower protections, and Contractor policies and
procedures for preventing and detecting fraud and abuse. The written policies described in this paragraph
may be on paper or in electric form and must be adopted by the. subcontractors and agents of the
_.
Contractor. If Contractor maintains an employee handbook, the Contractor shall provide the described
information specifically in the employee handbook.
In any inspection, review, or audit of the Contractor by (or at the behest of) the State or federal
government, the Contractor shall provide upon request copies of its written policies regarding fraud,
waste, and abuse. Contractor shall submit to OM PP a corrective action plan within sixty days (60) if the
Contractor is found not to be in compliance with any part of the requirements stated in this paragraph. If
Contractor is required to submit a corrective action plan and does not do so within sixty (60) days, the
state may withhold payment to the Contractor until a corrective action plan is received.

51. Assurance of Compliance with Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of
1973 and the Age Discrimination Act of 1975, the Americans with Disabilities Act of 1990 and Title
IX of the Education Amendments of 1972.
The Contractor 3/,>TeeS that it, and all of its subcontractors and providers, will comply with the following:
A.

Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by
or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80), to
the end thaI, in accordance with Title VI of that Act and the Regulation, no person in the United States
shall on the ground of race, color, or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under any program or activity for which the
Contractor receives Federal financial assistance under this Contract.

B. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements
imposed by or pursuant to the Regulation ofthe Department of Health and Human Services (45 C.F.R.
Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise
qualified handicapped individual in the United States shall, solely by reason ofhislher handicap, be
excluded from participation in, be denied the benefits of, or be subjected to discrimination under any
program or activity for which the Contractor receives Federal financial assistance under this Contract.
C.

The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91), to the
end thaI, in accordance with the Act and the Regulation, no person in the United States shall, on the basis
of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination
under any program or activity for which the Contractor receives Federal fmancial assistance under this
Contract.

D.

The Americans with Disabilities Act of 1990 (Pub. L. 101-336), as amended, and all requirements
imposed by or pursuant to the Regulation of the Department of Justice (28 C.F.R. 35.101 et seq.), to the
end that in accordance with the Act and Regulation, no person in the United States with a disability shall,
Page ZO of Z3

07/15

 EDS# MD29-6-99-16-LF-0725

on the basis of the disability, be excluded from participation in, be denied the benefits of, or otherwise be
subjected to discrimination under any program or activity for which the Contractor receives Federal
financial assistance under this Contract.
E.

Title IX of the Education Amendments of 1972, as amended (20 U.S.c. §§ 1681, 1683, and 1685-1686),
and all requirements imposed by or pursuant to regulation, to the end that, in accordance with the
Amendments, no person in the United States shall, on the basis of sex, be excluded from participation in,
be denied the benefrts of, or otherwise be subjected to discrimination under any program or activity for .
which the Contractor receives Federal fmancial assistance under this Contract.

The Contractor agrees that coinpliance with this assurance constitutes a condition of continued receipt of
Federal fmancial assistance, and that it is binding upon the Contractor, its successors, transferees and
assignees for the period during which such assistance is provided. The Contractor further recognizes that the
United States shall have the right to seek judicial enforcement of this assurance.

52. Conveyance of Documents and Continuation of Existing Activity•.
Should the Contract for whatever reason, (i.e. completion of a contract with no renewal, or termination of
service by either party), be discontinued and the activities as provided for' in the Contract for services cease,
the Contractor and any subcontractors employed by the terminating Contractor in the performance of the
duties of the Contract shall promptly convey to the State of Indiana, copies of all vendor working papers, data
collection forms, reports, charts, programs, cost records and all other material related to work performed on
this Contract. The Contractor and the Office shall convene immediately upon notification of termination or
non·renewal of the Contract to determine what work shall be suspended, what work shall be completed, and
the time frame for completion and conveyance. The Office will then provide the Contractor with a written
schedule of the completion and conveyance activities associated with termination. Documents/materials
associated with suspended activities shall be conveyed by the Contractor to the State of Indiana upon five
days' notice from the State of Indiana. Upon completion of those remaining activities noted on the written
schedule, the Contractor shall also convey all documents and materials to the State of Indiana upon five days'
notice from the State oflndiana

53. Environmental Standards.
If the contract amount set forth in this Contract is in excess of $1 00,000, the Contractor shall comply with all
applicable standards, orders, or requirements issued under section 306 of the Clean Air Act (42 U.S.c.
§ 7606), section 508 ofthe Clean Water Act (33 U.S.c. § 1368), Executive Order 11738, and Environmental
Protection Agency regulations (2 C.F.R. Part 1532), which prohibit the use under non-exempt Federal
contracts offacilities included on the EPA List of Violating Facilities. The Contractor shall report any
violations of this paragraph to the State of Indiana and to the United States Environmental Protection Agency
Assistant Administrator for Enforcement.

54. Lobbying Activities.
Pursuant to 31 U.s.c. § 1352, and any regulations promulgated thereunder, the Contractor hereby assures and
certifies that no federally appropriated funds have been paid, or will be paid, by or on behalf of the
Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, a
member of Congress, an officer or employee of Congress, or an employee of a member of Congress, in
connection with the awarding of any federal contract, the making of any federal grant, the making of any
federal loan, the entering into of any cooperative contract, and the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan or cooperative contract. If any funds other
than federally appropriated funds have been paid or will be paid to any person for influencing or attempting
to influence an officer or employee of any agency, a member of Congress, an officer or employee of
Congress, or an employee of a member of Congress in connection with this Contract, the Contractor shall

Page 21 of 23
07/15

 EDS# MD29-6-99-I6-LF-0725
complete and submit Standard Fonn-LLL, "Disclosme Fonn to Report Lobbying", in accordance with its
instructions.

55. Financial Disclosu reo
The Contractor agrees that it has disclosed, and shall as necessary in the future disclose to the State the
name and address of each person with an ownership or controlling interest in the disclosing entity or in
any subcontractor in which the disclosing entity has a direct or indirect ownership interest of 5 percent or
more. If the Contractor is not subject to periodic survey under § 455.1 04(b)(2) it must disclose to the
State, prior to enrolling, the name and address of each person with an oWnership or controlling interest in
the diSclosing entity or in any subcontractor in which the disclosing entity has direCt or. iildirect
ownership interest of 5 percent or more. Additionally, under § 455.1 04(a)(2), the Contractor. must disclose .
whether any of the named persons is relatcid to another as spouse, parent, child, or sibling. Moreover, .
pursuant to the requirements of § 455.1 04(a)(3), the Contractor shall disclose the name of any other
disclosing entity in which a person with an ownership or controlling interest in the disclosing entity has
. an ownership or controlling interest.

a

56. Limitation of Liability.
The State agrees that Contractor's total liability to ihe State for any and all damages whatsoever. arising
out of or in any way related to the Contract from any cause, including but not limited to negligence,
errors, omissions, strict liability, breach of contract or breach of warranty shall not, in the aggregate,
exceed four (4) times the value of the Contract for the Contractor's initial tenn.
In no event shall either party be liable for special, indirect, incidental economic, consequential or punitive
damages, including but not limited to lost revenue, lost profits, replacement goods, loss of technology
rights or services, loss of data, or interruption, or loss of use of software or any portion thereof regardless .
of the legal theory under which such damages are south even if a party has been advised of the likelihood'
of such damages and notwithstanding any failure of essential purpose of any limited remedy.

57. Cbanges in Circumstances.
In the event of unanticipated shifts in monthly volumes (below 30.000 or above 50,000 calls for more
than a 2 month period) or program changes that impact enrollment broker functions which impact the
costs of Contractor provided services, the Contractor shall submit a change request to the State which will
include a cost proposal. The parties will thereafter negotiate a reasonable and equitable adjustment to
price, service levels or both.

58. FSSA Medicaid Boilerplate Affirmation Clause.
I swear or affinn under the penalties of perjury that I have not altered, modified, changed or deleted the
2015 FSSA Medicaid Boilerplate contract clauses in any way except for the following clauses which are
named below:

Paragrapb 45.B - Termination for Default - modified
Paragrapb 56 - Limitation of Liability - added in its entirety
Paragrapb 57 - Changes in Circumstances ~ added in its entirety

Page 22 of 23

07/15

 EDS# MD29-6-99-l6-LF-0725
Non-CoUusioo and Acceptance
The undersigned attests, subject in the penalties for perjillY. that !he undersigned is the Contractor, or that
the undersigned is the properly authorized representative, agent, member or officer oflbe
ContraClor. Further, to the underSigned's knowledge, neither the undersigned nor any other member,
employee, representative, agent or officer of the Contractor, directly or indirectly, has entered into or been
offured any sum of money or ~ther consideratiOD for the execution of this Contract other than that which
appears upon the face hereof. Furthermore, if the nndersigned bas kDowledge that a state officer,
employee, or special state appointee, as those terms are defined in IC 4-2+1, bas a financial
interest in the Contract, the Coiltractorattests to compliance with the disclosnre requirements in
IC 4-2-6-10.5.
.
In Witness Whereof, Contractor and the State have, through their duly anthorized representatives,
entered into this Contract. The parties, having read and understood the foregoing terms iiftbis Contract,
do by therr respective signatures' dated below.agree to the terms thereof.
Maximns Health Service,Inc,

Family and Social Servil:es Administration

,~/.e

By:

~ce of Medicaid Policy and Planning

~~[~~q;.1 lie Ljik;)GcJ,- J~ ~~,a. f/ It j, 5
Date:

Approved by:
State Budget Agency

Approved by:
Indiana Department of Administration

~A"'~

By:
Jessica Robertson, Commls IODer

(for)

tire {2-D/ {,

Date:

:~~~
Date:

APPROVED as to Form and Legality:
Office of the Attorney General

~Att~eral

Gregory
Date:

(for)

1/~11t,
r
/

Indiana Office of Technology

By

y.J. d

(for)

D6JiIIld Neely, Chief Information Officer
Date:

fl.\ 7- 5/ 1-5
Page 230123

07/15

{I Jet 12-01 (.,

(for)

 ATTACHMENT DOCUMENT SUMMARY
11/18/2015

VENDOR INFORMATION:
LEGAL NAME: .

ATTACHMENT:
AGREEMENT #:
AGREEMENT TERM:

A
99-16-LF-onS
01/01/2016-12/31/2019

MAXlMUS HEAlTH SERVICE

MAIUNG ADDRESS:

PO BOX 791188
.
BAlTIMORE, MD 21278-1188

CONTACT NAME:
EMAIl: ADDRESS:

BRUCE CASWEU
brucecaswell@maximus.rom .

TELEPHONE NUMBER:
FAX NUMBER:

(BOO) 368-21S2
(703) 2S1-824O

FSSA CONTRACT CONTACT:
EMAIL ADDRESS:

Ankenbruck, Brenda (317) 234444S
Brenda.Ankenbruck@fssa.IN:gov

FID/SSN:
PS VendOr ID:

XX-XXX7682
0000223037

CHANGE NUMBER:

ORIG

"

FINANCIAL SUMMARY:
ClAIM PROG ID
99-16-LF-onS-o1

SERVICE
CODE
PROGRAM
4012A
Medicaid Admini

EFFECTIVE DATES
01/01/2016-06/30/2016

AWARD
AMOUNT
$1,242,813.91

99-16-LF-onS-o2

4012A

Medicaid Admini

07/01/2016-06/30/2017

$2,50S,2n.56

99-16-LF-onS-o3

4012A

Medicaid Admini

07/01/2017-06/30/2018

$2,54S,4S0.34

99-16-LF-on5-04

4012A

Medicaid Admini

07/01/2018-06/30/2019

$2,586,622.56

99-16-LF-onS-oS

4012A

Medicaid Admini

07/01/2019-12/31/2019

$1,317,961.87

TOTAL DOLlAR AMOUNT:

$10,198,121.24

Pagel 016

~~

 ATTACHMENT DOCUMENT DETAIL

ATTACHMENT:
AGREEMENT #:
AGREEMENT TERM:

11/18/2015

A
99-16-LF-D72S
01/01/2016-12/31/2019

LEGAL NAME:
CLAIM PROGRAM ID:
PROGRAM 'TOTAL:

MAXIMUS HEAlTH
SERVICE

PS VENDOR ID:

0000223037

99-16-LF-072S-D1
1,242,813.91

DUNS#:
REGION:

n/a
Statewide

FUND DESCRIPTION:

Medicaid Administration
SFY 16

CFDA NUMBER:

93.767

FEDERAL YEAR:
EFFECTIVE DATES:

2016
01/01/2016-06/30/2016

STATE YEAR: .
CLOSE OUT DATE:

2016
08/29/2016

SERVICE. INFORMATION:
SERVICE EFF DATES:
COMPONENT DESCRIPTION

4012A ENROLLMENT BROKER

.SSA

1/01/16-6/30/16
1/01/16-6/30/16
1/01/16-6/30/16
1/01/16-6/30/16
1/01/16-6/30/16
1/01/16-6/30/16

PRINTED MAlERIALS

.62A

PERFORMANCE W/H-HCC AUTO
.628
PERFORMANCE W/H-REPORlS
.1
HELPUNE
.6
INFORMATION SYSlEMS
.73
OTHER TASKS
SERVICE TOTAL:

1/1/201~6/30/2016

COMPONENT DATES

.UNITS
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST

SPECIAl CONDITIONS I CPID NOTES:

Payments will be made in accordance with the Statement of Work and Exhibit 3

Page 2of6

II

RATE AWARDAMT
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000

0.00
0.00
0.00
0.00
0.00
0.00
1,242,813.91

 ATTACHMENT:
A
ATTACHMENT DOCUMENT DETAIL
11/18/2015
AGREEMENT #:
9!H6-Lf-072S
--",~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _-",A..,G",RE~EM~ENT~~IE"'RM......,:'---~0..,1/~0112016-12/31/2019
-

"
LEGAL NAME:
CLAIM PROGRAM ID:
PROGRAM TOTAL:
FUND DESCRIPTION:
FEDERAL YEAR:
EFFECTlVE DATES:

MAXlMUS HEALTH
SERVICE
99-16-LF-072S-o2
2,505,272.56
Medicaid Administration
SFY 17
2016
07/01/2016-06/30/2017

SERVICE INFORMATION:
SERVICE EFF DATES:
COMPONENT DESCRIPTION
.SSA
PRINTED MATERlALS
.62A
PERFORMANCE W/H-HCC AUTO
.628
PERFORMANCE W/H-REPOR15
.1
HEL.PI.lNE
.6
INFORMATION SYSTEMS
.73
OTHER TASKS
SERVICE TOTAL:

PS VENDOR ID:
DUNS#:
REGION:

0000223037
n/a
statewide

CFDA NUMBER: -

93.767

STATE YEAR:
CLOSE OUT DATE:

2017
08/29/2017

4012A ENROLLMENT BROKER
7/1/2016M6/30/2017
COMPONENT DATES
UNITS
ACTUAL COST
7/01/16-6/30/17
ACTUAL COST
7/01/16-6/30/17
ACTUAL COST
7/01/16-6/30/17
ACTUAL COST
7/01/16-6/30/17
ACTUAL COST
7/01/16-6/30/17
ACTUAL COST
7/01/16-6/30/17

RATE AWARDAMT
0.00
1.0000
0.00
1.0000
0.00
1.0000
0.00
0.00
1.0000
1.0000
0.00
2,505,272.56

1.0000

SPEClALCONDITIONSl~C~P~I~D~N~O~TES~~:__~~~~~____~~~~~~~~~_________

Payments will be made in accordance with the Statement of Work and Exhibit 3

Page3of6

 ATTACHMENT DOCUMENT DETAIL
11/18/2015

LEGAL NAME:

CLAIMPROG.RAM ID:
PROGRAM TOTAL:

ATTACHMENT:
AGREEMENT #:
AGREEMENT TERM:

A
99-16-lHl72S
01/01/2016-12/31/2019

MAXIMUS HEAlTH
SERVICE

PS VENDOR ID:

0000223037

99-16-lF-072S-D3

DUNS #:

n/a

~==~======~~__~2,~~~~4~S~0'~~~~~~__'~RE~G~IO~N~:~__________~S~~~~'de~__________
FUND DESCRIPTION:
Medicaid Administration
SFY 18
CFDA NUMBER:
93.767

FEDERAL YEAR:
EFFECTIVE DATES:

2017
07/01/2017-06/30/2018

SERVICE INFORMATION:
SERVICE EFF DATES:
COMPONENT DESCRIPTION
.SSA
.62A

.628
.1
.6
.73

PRINTED MATER1ALS
PERFORMANCE W/H-HCC AUTO
PERFORMANCE W/H-REPORT5
HElPllNE
INFORMATION SYSTEMS
OTHER TASKS

STATE YEAR:
CLOSE OUT DATE:

2018
08/29/2018

4012A.ENROLLMENT BROKER.
7/1/2017-6/30/2018
COMPONENT DATES
UNITS
ACTUAl COST
7/01/17-6/30/18
ACTUAl COST
7/01/17-6/30/18
ACTUAl COST
7/01/17-6/30/18
ACTUAl COST
7/01/17-6/30/18
ACTUAL COST
7/01/17-6/30/18
ACTUAL COST
7/01/17-6/30/18

..

RATE

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
2,~S,450.~

SERVICE TOTAL:

SPECIAL CONDmONS / CPID NOTES:

Payments will be made in accordance with the. Statement of Work and Exhibit 3

Page4of6

 ~. ATTACHMENT DOCUMENT DETAIL

¥

11/18/2015

ATTACHMENT:
AGREEMENT #:
AGREEMENT TERM:

A
99-16-LF-Q72S
01/oi/2016-12/31/2019

MAXIM US HEALTH
lEGAl NAME:
CLAIM PROGRAM ID:
SERVICE
PS VENDOR ID:
0000223037
99-16-LF-Q72S-<l4
DUNS #:
n/a
PROGRAM TOTAL:
-==::-=::====:-:-_-:,2,S86,622=-.S"..6~-:-c-;-_---,!RE=GI=O",N,,-:_ _ _ _ _---'S"'ta"..tew=i"'de"--_ _ _ __
FUND DESCRIPTION:
Medicaid Administration
SFY 19
93;767
. CFDA NUMBER:
2018
FEDERAL YEAR:
EFFECTIVE DATES:
STATE YEAR:
07/01/2018-06/30/2019
2019
CLOSE OUT DATE:
08/29/2019

SERVICE INFORMATION:
SERVICE EFF DATES:
COMPONENT DESCRIPTION

.SSA
.62A
.628
.1
.6

4012A ENROLlMENT BROKER

7/1/2018H&/30/2019
COMPONENT DATES

PRINTED MATERIAlS
PERFORMANCE W/H-HCC AUTO
PERFORMANCE W/H-REPORTS

7/01/18~/30/l9
7/01/18~/30/l9
7/01/18~/30/l9

HElPlINE

7/01/1~/30/l9
7/01/l8~/30/19
7/01/18~/30/19

INFORMATION SYSTEMS

.73
OTHER TASKS
SERVICE TOTAL:

UNITS
ACTIJAlCOST
ACTIJAlCOST
ACTIJAlCOST
ACTIJAlCOST
ACTIJAlCOST
ACTIJAlCOST

RATE

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
2,586,622.56 .

SPECIAL CONDmONS 1 CPID NOTES:

Payments will be made in accordance with the .Statement of Work and Exhibit 3
-'"

Page 5of6

 AtTACHMENT DOCUMENT DETAIL

AtTACHMENT:
AGREEMENT"#:

'._ . 11/18/2015

A

99-16-lHI72S
......"=::...._-'-_ _ _ _ _ _ _ _ _ _ _ _ _ _--"A"'G""RE"""EM"""ENT~_"'lE"'RM="':'_____0"."cl/r.=0I.L2016-12/31/2019
"

LEGAL NAME:
CLAIM PROGRAM 10:
PROGRAM TOTAL:

MAXIMUS HEALlli
SERVICE

99-16-lHl72S-oS
1,317,961.87

FUND DESCRIPTION:

Medicaid Administration

FEDERAL YEAR:
EFFECTIVE DATES:

SFY20
2019
07/01/2019-12/31/2019

Statewide

CFDA NUMBER:

n/a

STAlE YEAR:
CLOSE OUT DAlE:

2020
02/29/2020

SERVICE INFORMA110N:
SERVICE EFF DATES:
COMPONENT DESCRIPTION

4012A ENROllMENT BROKER

.SSA

7/01/19-12/31/19
7/01/19-12/31/19
7/01/19-12/31/19
7/01/19-12/31/19
7/01/19-12/31/19
7/01/19-12/31/19
7/01/19-12/31/19

PRINTED MATERlALS

.62A

PERFORMANCE W/H-HCC AUTO
PERFORMANCE W/H-REPORTS
HELPUNE
INFORMATION SYSTEMS
OlliER TASKS
OUTGOING TRANSITION
SERVICE TOTAL:

.628
.1
.6
.73
.74

0000223037

PS VENDOR ID:
DUNS#:'
REGION:

n/a

7/1/2019-12/31/2019
COMPONENT DATES

UNn5
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST
ACTUAL COST

RAlE

1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1,317,961.87

SPEOAl CONDmONS / CPID NOTES:

Payments will be made in accordance with the Statement of Work and Exhibit 3

Page6of6

 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-I6-LF-0725

I. Overview
The Contractor will serve the Medicaid managed care programs, which include Hoosier Healthwise,
the Healthy Indiana Plan 2.0 (HIP). and Hoosier Care Connect programs. In addition, the Contractor
will serve the HIP Employer Benefit Link (HIP Link) program, which is an optional defined
contribution premium assistance program for HIP eligible individuals with aCcess to employer
sponsored health insurance. The Contractor shall establish a positive and collaborative working
relationship with other State contractors associated with the Indiana Health Coverage Programs
(IHCP), i.e., the Managed Care Entities (MCEs), the Fiscal Agent, the Eligibility Vendor, and the
monitoring contractor. The Contractor must coordinate with these contractors when necessary.

1.1. Programs Covered Under Tbis Contract
1.1.1. Hoosier Healthwise and tbe Healthy Indiana Plan 2.0 (HIP)
Hoosier Healthwise is a health care program for low-income families, pregnant women, and
children in the state of Indiana. Hoosier Healthwise is a federally-approved program
administered by the Indiana Family and Social Services Administration (FSSA) to provide
reimbursement for reasonable and necessary medical care for perSons meeting financial
eligibility requirements.
HIP is a program created to provide health care coverage to low-income adults. Indiana
offers HIP members a comprehensive benefit package through a deductible health plan
paired with a personal health care account called a POWER (Personal Wellness and
Responsibility) Account. HIP members will receive services through an MCE and will have
access to one ofthree HIP benefit packages depending on eligibility and other factors: HIP
Plus, HIP Basic, and HIP State Plan.
HIP Link is a new HIP program component. HIP Link will provide a defined
contribution that can be used for premiums and other out of pocket expenses associated
with Employer Sponsored Insurance (ESI). Individuals participating in HIP Link will
enroll in their ESI plan instead of HIP and receive up to four thousand dollars
($4,000.00) to help pay for a portion of the premium and other out of pocket health care
expenses. Employed applicants can elect to participate in the HIP Link program as an
alternative to HIP via a checkbox on the application.
The design and goals of these programs are to ensure access to primary and preventive
health care services, improve access to care, and encourage quality and continuity of
care. Individuals will be able to select a Managed Care Entity (MCE) on the application
for both Hoosier Healthwise and HIP. Also, members will be linked to a Primary
Medical Provider (PMP) by their selected MCE. The contracted MCEs within Hoosier
Healthwise and HIP are currently Anthem, Managed Health Services, and MDwise. The
MCE will be responsible for coordinating the health care service needs of their
members.

Page 10f34

 Maximus Health Service, Inc.
Exhibit I - Statement of Work
EDS# MD29-6-99-16-LF-0725
1.1.2. Hoosier Care Connect

The Hoosier Care Connect program is a coordinated care program for Indiana's Medicaid
enrollees in the aged, blind and disabled categories. Enrollees will select an MCE responsible
for coordinating care with the member's medical providers. Hoosier Core ConneclmemberS .
will receive all Medicaid covered benefits in addition to care coordination services. Care
coordination services will be individualized based on the member's assessed level of need
detennined through a health screening conducted by the MCE.
The design will support the goals of the program which include improved quality outcomes
and consistency of care across the delivery system, enrollee choice, protections and access,
coordination of care across the delivery system and care continuum and flexible personcentered care.
Members will have the opportunity to select a health plan on the application for health care
coverage. Once determined eligible, this selection will be transmitted from DFR to the
Medicaid Management Information System (MMIS). Members not choosing a plan on the
application will receive a letterlbrochure from the Contractor explaining their eligibility and
the need to choose a health plan. Those members that do not select an MCE within sixty (60)
calendar days of the enrollment mailing will be auto-assigned. If the MCE decides to use a
PMP model, they will assign the member to a PMP within the plan.
1.2. Description of Enrollment Broker Tasks

1.2.1. Helpline Systems
The telephone Helplines will serve as a central point of information for the Medicaid
programs described in Section 1.1. The Contractor shaH maintain and manage the existing
Helplines for the Hoosier Heaithwise, HIP, HIP Link and Hoosier Care Connect programs to
address problems and answer questions that members and potential members have about the
programs. The Contractor shall also conduct member education, and shall track, monitor, and
report on various performance measures.
1.2.2. Live Chat
The Contractor will provide live chat services to the State of Indiana via software provided
by the Contractor and will reside on the State's website. Contractor helpline staff will
respond to chat requests directed to the Contractor from visitors of the HIP section of the
State's website who choose to use the chat function. Chat services will be available only
during normal business hours when the Contractor's helpline is open and available to callers.
The chat function may be shut down during times of extreme call volumes to the Helpline.

Chats will be restricted to general inquiries of the HIP and HIP Link programs and will not
include Protected Health Information (PHI). Should the chat initiator want specific detail on
their individual services or circumstances, the individual will be directed to call the HIP tollfree number for assistance.
The Contractor will work with FSSA to develop standard answers to anticipated questions.
These may be revised as experience and needs dictate.

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 Maximus Health Service, Inc.
Exhibit I - Statement of Work
EDS# MD29-6-99-16-LF-0725
The Contractor may be requested to add further program chats for other state programs such
as Hoosier Healthwise and Hoosier Care Connect in the future.

1.2.3. Educational Materials
As deemed appropriate by the State, the Contractor must develop and distribute various
educational materials. The Contractor must work with FSSA and other State contractors in
the development and distribution of member education materials developed by the
Contractor. Materials must be distributed within a timefrarne that enables the potential.
enrollee to use the information in choosing among available options.
1.2.4. Data Entry & Correspondence.
..
-Contractor Representatives shall enter all relevant information into the Contractor database
and MMIS, as well as perform extensive data entry, tracking, accuracy monitoring, and
database correction functions. The data entered by the Helpline Representatives is used for' "
monitoring and tracking purposes and reporting on the operations of the managed care
programs overall as well as the individual MCEs.
1.2.5. InfonnationlDatabase Systems
The Contractor shall develop and maintain a database that assists staff with processing
member enrollment, PMP andlor health plan selection, changes, and disenrollment; tracking
complaints and grievances, PMP and plan change reasons, disenrollment reasons; and
reporting of performance measures and program statistics.
The Contractor must have the capacity to interface with, and enter relevant information into
MMIS. All data provided to the Contractor, including the data contained in the Contractor
database, is the property of the State and may not me marketed or sold by the Contractor. All'
transactions must be compliant with the Health Insurance Portability and Accountability Act
(HIPAA).
Contractor must also have the capacity to prepare accurate and thorough written responses to
various inquires.

1.2.6. Administrative Tasks
The Contractor shall assist,the State with ongoing program operation, policy and procedures
development and review; participate in various meetings, such as monthly status meetings
with FSSA and related contractors, the monthly Managed Care Policy/Operations meeting,
and the monthly Quality Improvement Committee. The Contractor shall adhere to reporting
requirements included in this contract.
The Contractor shall maintain an office within fifteen (15) miles of the State Capitol in
Indianapolis. In general, the Contractor staff shall have:
• Knowledge of the health care needs of the various IHCP populations and the
skills for working with these populations;
• Knowledge and experience in Medicaid managed health care commercial health
care delivery systems;

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 Maximus Health service, Inc.
Exhibit 1- Statement of Work
EDS# MD29-6-99-16-LF-0725
o

o

o

The ability to develop, maintain, and use both an interactive, automated data
system and a telephone helpline system;
Exceptional interpersonal skills and the ability to work closely with physicians
and county caseworkers on member and provider issues and to educate both
members and providers effectively; and
Excellent conflict resolution and customer serVice skills.

The Contractor shall be knowledgeable about all of the Indiana Health Coverage Programs. It
is essential for the Contractor to understand the differences and the unique characteristics of
each of the populations served under the Indiana Health Coverage Programs.
1.2.7. Quality Improvement
The Contractor shall track and resolve quality issues;participate in meetings such as the
Quality Improvement Committee (QIC) and other aspects of the State's quality strategy, as
appropriate.

1.3. State and Federal Requirements
The Contractor is required to comply with all applicable state and federal laws and regulations,
including the American with Disabilities Act (ADA), the Balanced Budget Act (BBA) of 1997
Subtitle H, and the Medicaid Managed Care rules, 42 CFR 438. The Contractor must be
compliant with HIPAA. In addition to these federal regulations and statutes, federal civil rights
laws will also govern the principles of this procurement.
In accordance with 42 CFR 438.810 and SSA 1903 (b)(4), the Contractor and its subcontractors
must meet the following criteria:
I) Independence - The Contractor and its subcontractors are independent of any MCE or
other health care provider in the State in which they provide enrollment activities. A
broker or subcontractor is not considered "independent" if ito Is an MCE, PCCM or other health care provider in the State;
o Is owned or controlled by an MCE, PCCM, or oth,er health care provider in the State;
or
o Owns or controls an MCE, PCCM or other health care provider in the State.
2) Freedom from conflict of interest - No person who is an owner, employee"consultant, or
has a contract with the broker either has any direct or indirect financial interest with such
an entity or health care provider or has been excluded from participation in the program
under title XVIII or title XIX, debarred by any Federal agency, or subject to a civil
money penalty under this Act.
3) Approval by CMS - In accordance with 42 CFR 439.6 (d)(I), (3), and (4), SSA
1903(m)(2)(A)(v), and SMM 2090.4, the Contractor will carryout its choice counseling
and enrollment activities in a way that does not promote enrollment discrimination
consistent with the regulation requirements listed below:
o The Contractor will ensure that the MCE, PCCM or other health care provider
accepts individuals in the order in which they apply without restriction, (unless
authorized by the Regional Administrator), up to the limits set under their contract.

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Exhibit 1- Statement of Work
EDS# MD29-6-99-16-LF-0725 '
• The Contractor will not discriminate against individuals eligible to be covered under
contract on the basis of health status or need for health services.
• The Contractor will not allow the MCE, PCCM or other health care provider to
discriminate against individuals eligible to enroll on the basis of race, color, or
national origin, and will not use any policy or practieethat has the effect of
discriminating on the basis of race, color, or national origin.

-.
2. Hoosier Healthwise, HIP and HIP Link-Specific Contractor Tasks
2.1. Enrollment Broker Helpline Services
2.1.1. Helpline Maintenance and Management
The Contractor shall maintain and manage the existing toll-free Hoosier Healthwise Helpline
number as well as the appropriate prompts feeding from the state's toll-free number for HlP,
which includes a HIP Link specific prompt. The Contractor will staff the Hoosier
Healthwise. HIP and HIP Link Helplines that serve as the central point of information on all
aspects of the programs. The Contractor must have an appropriate system in place to allow
receipt of incoming call traffic, sophistication to route calls to designated resources,
management software for monitoring and oversight of the staff and system, and robust
reporting capabilities. The Contractor shall provide adequate staffing for the Enrollment
Broker Helplines to ensure that member inquiries and complaints are resolved in a timely
manner and that vital program functions such as education and enrollment are provided
efficiently and effectively. The Contractor must staff the Helplines to provide sufficient "live
voice" access to its members during, at a minimum, fifty-five (55) hours a week, Monday
through Friday 8:00 AM to 7:00 PM Eastern Time zone. The general public, members and
potential members, physicians including both PMPs and non-PMPs, ancillary providers,
MCEs, and community agencies all use the current Helpline as their basic source of
information regarding the Indiana Medicaid programs described in Section 1.1. For HIP Link,
participating employers and employers who are interested in partiCipating in the program
should be directed to the State's Fiscal Agent's call center for employer specific information
related to the HIP Link program. The Contractor must have the ability to transfer callers to
other \HCP contractors including MCEs, the Eligibility Vendor, and the Fiscal Agent when
necessary and appropriate. Helpline services are subject to performance standards listed in
Section 6.1.1 of this document.
2.1.2. Tracking and Reporting
The Contractor shall enter all relevant information into the Contractor database in accordance
with Section 4.1 and perform extensive data entry, tracking, and database correction
functions. Member issues, complaints, grievances, referrals and follow-ups are entered and
tracked via the database. The Contractor shall record the enrollee's request for counseling
and document the enrollee's choice in the Contractor's call tracking system. The Contractor's
database shall be capable of separately identif'ying and tracking enrollees seeking HIP Link
options counseling who are medically frail or indicated that they may be medically frail. The
Contractor's database shall also be capable of collecting information from potential HlP Link
eligible caller's whose employer does not participate in HIP Link, and share such information
with the State on at least a weekly basis.
Page 5 of 34

"

 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
All data entered by the Helpline Representatives is used for monitoring and tracking purposes
and reporting on the operations of the managed care programs overall aswell as the
of the
individual MCEs. The Contractor shall
evaluate the adequacy and effectiveness
.
.
Helpline coverage on a daily basis by gathering statistics related to the operation of the
Helpline and preparing regular reports to the State as defined in Section 6.2 and submitting
those reports at the times required per. each report definition.
.

2.2. Hoosier Heaithwise and HIP-Specific Member Education
2.2.1. Managed Care Enrollment Edlication
The Helpline staffwill provide potential members with information on the managed care
programs over the phone. All enrollee education, including call scripts: must be developed by .
the Contractor and approved by FSSA. In accordance with 42 CFR 438. \O(e)(I) and (2),
enrollment education must include; but not necessarily be limited to the items noted below:
• Basic features of managed care;
• How to access the Medicaid health care system appropriately (i.e., keeping
appointments, appropriate use of the emergency room, prior authorization
requirements, understanding MCE rules, how to file a grievance, etc.);
• The importance of primary and preventive care and other health promotion services
• Detailed, unbiased information about the MCEs (to be developed in concert with the
MCEs and FSSA); and
• Where appl icable, how to access the transportation benefits within the MCEs rules.
In the telephone interview with potential enrollees, the enrollee shall have the opportunity to
ask questions and must be given the Helpline number and shall be encouraged to call again if
they have further questions. The Contractor is not required to maintain a provider list, but
must be able to direct the member to such information when necessary. The Contractor must
develop and maintain a MCE Summary sheet which must be available for the member to
easily compare the MCEs. The Contractor shall make oral interpretation services available to
the visually-impaired and to enrollees in languages other than English (Spanish is the current
prevalent second language). The Contractor must notify current and potential enrollees of
availability of oral interpretation of written materials, as well as information in alternative
formats and languages, and how to access those services. All information must meet the
requirements of 42 CFR 438.10 as amended from time to time.
Participation in the national efforts to ensure that Medicaid-eligible children enroll in the
program will also be required.
2.2.2. Cboice Counseling
The Contractor shall provide each member with unbiased information to assist them in the
selection of an MCE. The Contractor shall, at a minimum, supply the member with the
following two items of information:
• Detail on each of the MCEs available in the member's county via the MCE summary;
and

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Exhibit 1 - Statement of Work
EDS# MD29-6-99-1~LF-0725
• Detail on providers and PMPs available in the member's county. Members shall be
directed to information containing a provider listing and PMPs available in the
member's county ifthey so choose,
The Contractor may propose other methods to effectively educate current and potential
managed care members and implement these methods as approved by the State.

2.2.3. Member Materials
The Contractor must update/revise existing materials, develop new materials when necessary;
and distribute those materials as appropriate, to be used .in conjunction with the Contractor's
member education and enrollment facilitation responsibilities. All materials are the property
of the State and must be sent to FSSA for review and approval. Member materials must be
written at an appropriate reading level (i.e., fifth grade). Alternative formats that take into
account the special needs of those who, for example, may be visually limited or have limited
English proficiency, shall be made available. Materials must be translated into Spanish. The·
Contractor must have policies and procedures in place to ensure that materials are accurate in
content, accurate in translation relevant to language or alternate formats and do not defraud,
mislead or confuse the member. The Contractor must develop and include a Contractordesignated inventory control number on all member promotional, education, training or
outreach materials with a date issued or date revised clearly marked. The purpose of this
inventory control number is to facilitate FSSA's review and approval of member materials
and document its receipt and approval of original and revised documents. Annually, as part of
its Quality Management and Improvement Plan Summary Report, the Contractor must submit
a list of all member education and outreach materials it has used during the previous year and
anticipates using in the upcoming year.
The Contractor shall notiry enrollees:
• That oral interpretation is available for any language, including Spanish;
• That written information is available in prevalent languages (currently Spanish); and
• How to access the interpretation services and written information.
Upon request by the member, the Contractor shall send out electronic brochures and
educational information to current and potential members via e-mail to reduce the volume of
mailings.
Member materials may include the following:

2.2.3.1. Member Brocbures
While the Contractor does not currently mail brochures to potential Hoosier Healthwise
members, the State may request that the Contractor resume this mailing in the future. If
requested, the Contractor will ensure the member brochures include general information
that facilitates the member's understanding of the Hoosier Healthwise program and must
be updated, revised, and distributed as needed. The brochures must be written at the fifth
grade reading level. The Contractor is required to produce and distribute brochures

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 Maximus Health Service, Inc.
Exhibit I - Statement of Work
EDS# MD29-6-99-16-LF-0725
containing infonnation requested by the State and brochures that may contain the
following infonnation:
• How to enroll;
• How to choose an MCE;
• How to use the Helpline; and
• How to obtain services appropriately.
The State may request that the Contractor produce other brochures that may contain the
following infonnation:
• The basic features of managed care;
• Which populations are excluded from enrollment, subject to mandatory enrollment,
or free to enroll voluntarily in the program; and
.
• MCE responsibilities for coordination of enrollee care.
2.2.3.2. MCE Summaries
The Contractor shall collaborate with MCEs to create the MCE Summary sheets, update
them as necessary, and print and distribute them. The MCE Summary sheets provide
comparative MCE infonnation for potential enrollees, as required by 42 CFR
438.IO(e)(2)(ii).
The Contractor must provide infonnation specific to each MCE program operating in
. potential enrollee's service area, such as:
• Benefits covered;
• Cost sharing, if any;
• Service area; and
• Benefits that are available under the State plan but are not covered under the contract,
including how and where the enrollee may obtain those benefits, any cost sharing,
and, if applicable, how transportation is provided. For a counseling or referral service
that the MCE does not cover because of moral or religious objections, the State must
provide infonnation about where and how to obtain the service.
2.2.3.3. Provider Lists
The Contractor is not required to provide printed provider and PMP lists. MCEs are
required to develop provider directories and make printed copies available to members
upon request. The Contractor must have policies and procedures in place to refer
members to the MCEs, when requested, to obtain provider directories and infonnation to
assist in an enrollee's selection of an MCE.
2.2.3.4. Other Materials
The Contractor shall also produce, update, print and distribute materials which provide
infonnation on specific topics, including, but not limited to, appropriate emergency room
use, pharmacy use, the importance of keeping scheduled appointments, the importance of
a medical home, and procedures for filing grievances. The topics and the distribution of
the material will be developed at the direction of FSSA in conjunction with the MCEs.

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
2.2.4. Correspondence
Contractor must have the capacity to prepare accurate and thorough written responses to
various inquires. The Contractor must respond to ninety-eight percent (98%) of all written
provider and recipient correspondence (inquiries) within ten (10) business days of receipt of
the written correspondence by the Contractor. The Contractor must respond to the remainder
within fifteen (15) business days of receipt. This may involve coordination with other
contractorS. Written responses must be technically and grammatically accurate. The
Contractor shall refer all questions from State and Federal legislators, the Governor, the
FSSA Sec.retary, or news media inquiries to the Director of Support Services or delegate.

2.3. HIP Link Member Edncation
2.3.1. HIP Link Enrollment Education
The Helpline staff will provide potential members with general program education and will
offer choice counseling to assist members and potential members in deciding whether HIP
Link is right for them. Helpline staff will also provide general information about health and
outreach services available to members and potential members under both the HIP and HIP
Link programs, including assisting members understand and utilize their HIP Link member
handbook.
The Helpline staff will provide members and potential members with information on the HIP
and HlP Link programs over the phone. To assist the Contractor, the State will provide the
Contractor with HIP Link program training materials and a step by step enrollment
counseling guide. All enrollee education, including call scripts, developed by the Contractor
must be approved by FSSA. HIP Link enrollment education must include, but not necessarily
be limited to the items noted below:
• Basic features of HIP Link, including but not limited to an explanation that it is an
optional program for individuals otherwise eligible for HIP;
• Detailed, unbiased information comparing HIP and HIP Link, including
individualized counseling specific to the individual's ESI health plan compared to the
HIP managed care option available to that individual;
o
For purposes of clarification, individuals who, based on their case records or selfattestation, are (or likely are) medically frail or who are eligible for HIP pursuant
to Section 1931 or transitional medical assistance will receive information
comparing the differences between the benefits available under their HIP Link
approved ESI plan(s) and the HIP State Plan benefits (rather than the standard
HIP benefits).
• The importance of primary and preventive care and other health promotion services,
as well as information regarding the HIP and HIP Link rollover incentives; and
• Where applicable, how to access the health care system appropriately (i.e., keeping
appointments, appropriate use of the emergency room, prior authorization
requirements, understanding health plan rules, etc.).
In the telephone interview with potential HIP Link members, the individual shall have the
opportunity to ask questions about the program and/or the member handbook and must be
given the Helpline number to ask further questions and shall be encouraged to call again if
they have further questions. The Contractor must be equipped to provide basic information
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Exbibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
regarding the individual's specific ESt plan; provided, however, the applicable health plan
sponsor is an approved HIP Link enrolled employer. The State (or its contractor) shall
provide the Contractor access to the summary of benefits information provided by the HIP
Link approved employer during the employer application process, as well as the HIP Link
Employer Counseling Team's (ECT) plan review notes of each HIP Link approved health
plan.
In the event a potential HIP Link member's employer is not an approved HIP Link enrolled .
employer, the Contractor shall provide the caller with general information regarding how
employers may enroll, and collect contact information from the caller including the
employer's company name and contact information for targeted ECT outreach. In addition,
the Contractor shall provide the caller with information about the HIP managed care _
program, which may be accessed by eligible individuals prior to HIP Link enrollment. More
information about this process is available in the enrollment counseling guide provided by
the State to the Contractor.

The Contractor shall make oral interpretation services available to members in languages
other than English (Spanish is the current prevalent second language). All information must
meet the requirements of 42 CFR 438.10 as amended from time to time.
2.3.2, Choice Counseling
The Contractor shall provide each member with unbiased information to assist them in the
selection of HIP or HIP Link. As part of the HIP Link choice counseling services, the
Contractor shall be equipped to provide members and potential members with a description
of general benefits covered under the individual's specific ESI plan.
If the potential HIP Link member has access to multiple HIP Link approved health plans, the
Contractor shall also provide the individual with unbiased information to assist them in the
selection of a specific HIP Link eligible plan. As part of the HIP Link choice counseling
services, the Contractor shall be equipped to provide members and potential members with a
description of general benefits covered and out-of-pocket expenses under the individual's
specific ESI plan. The Contractor shall only be responsible for counseling based on the
information provided to the Contractor by the State, which will include the summary of
benefits provided by the employer, as well as the ECTs plan review notes. If a potential
member asks more detailed questions during the telephone interview, the Contractor shall
direct the potential member to contact their employer's Human Resources representative for
more information on the ESt plan's covered benefits and services.
The Contractor shall, at a minimum, supply the member with the following information:
• Detail on the HIP Link program, including:
o Defined contribution to HIP Link POWER account to pay for costs of
premium and other cost-sharing responsibilities of the ESI plan;
o Cost sharing requirements; and
o If requested, provide counseling services comparing HIP Link eligible
ESI plan(s) to the HIP plan that the member is eligible for or likely to be
eligible for based on household income and current health conditions.

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Exbibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
•

•

•

•

Detail on the HIP managed care program,'inc1uding:
o General covered services of the HIP program;
o Cost sharing requirements; and
o If requested, provide the counseling services described in Section 2.2.2
regarding a comparison of available MCEs.
Enrolled providers available in the member's county. Members shall be directed
to information containing a provider listing available in the member's county if
they so choose. In addition"the Contractor shall also:
o Provide access to the provider lists described in Section 2.2.3.3.
o Advise individuals of the importance of locating providers that are both
in-network with the applicable ESI plan and enrolled in Medicaid, and, if
requested:
• Refer individuals to their ESI plan provider directory to identifY
in-network providers; and
• Assist individuals determine if identified providers are enrolled in
Medicaid.
Detail on transferring from HIP Link, specifically providing information that once
'
they are enrolled in HIP Link they may only transfer to HIP during open
enrollment or following a qualifYing event as described in Section 2.4.5.
Assist individual assess the HIP Link eligible ESI plan(s) using the affordability
table(s) provided by the State.

The Contractor may propose other methods to effectively educate current and potential HIP
Link members and implement these methods as approved by the State.

2.3.3. Member Materials
The Contractor may be required to produce, update, print and distribute written materials
which provide information on HIP Link specific topics, as needed. The topics and the
distribution ofthe material will be developed at the direction of FSSA in accordance with
Section 2.2.3.
2.2.4. Correspondence
The Contractor must have the capacity to prepare accurate and thorough written responses to
various inquires. The Contractor must respond to ninety-eight percent (98%) of all written
provider and recipienteorrespondence (inquiries) within ten (10) business days of receipt of
the written correspondence by the Contractor. The Contractor must respond to the remainder
within fifteen (15) business days of receipt. This may involve coordination with other
contractors. Written responses must be technically and grammatically accurate. The
Contractor shall refer all questions from State and Federal legislators, the Governor, the
FSSA Secretary, or news media inquiries to the Director of Support Services or delegate.
2.4. Member Enrollment and Disenrollment in Hoosier HeaJlhwise, HIP and HIP Link
The Contractor shall assist in' member enrollment and disenrollment.

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Exbibit I - Statement of Work
EDS# MD29-6-99-16-LF-0725
2.4.1. Member Enrollment
After the member has been educated by the Helpline Representative, the Contractor shall
record the program and/or MCE selection (as applicable) and. the results of the conversation
in the Contractor database as set forth in Section 4.1. The Contractor must then ensure that
the selection is also recorded in MMIS. In Hoosier Heallhwise, MCE selections for newly
eligible potential enrollees are effective on either the 1st or the 15th of each month, depending
on when the selection is recorded in MMIS. Selections entered into MMIS between the 25th
of one month and the 12· of the second month will be effective on the 15th of that second
month. Selections entered between the 13· and the 24" of one month will be effective on the
1st of the next month. For example, selections entered between April 25" and May 12" will be
effective on May 15". Selections entered between May 13" and May 24thth will be effective on
June I st. For HIP and HIP Link enrolled members, new selections are always effective on.the
1st of the month.
2.4.2. Presumptive Eligibility (PE)
The Contractor shall accept calls from pregnant women determined presumptively eligible by
a Qualified Provider (QP). Upon selection of an MCE, the Contractor shall enter the
presumptively eligible member's MCE selection into the HP Web interchange system. The
presumptively eligible member must make an MCE selection in order for their PE application
to be considered complete. The member may also provide a PMP selection to the Contractor
or the MCE will contact the member for a PMP selection.
2.4.3. Open Enrollment Function
The Contractor shall process enrollments for Hoosier Heallhwise members, including
presumptively eligible pregnant women, to remain enrolled with an MCE pursuant to the
requirements of the Open Enrollment policies.
2.4.4. MCE and PMP Cbanges
In the managed care programs, disenrollment from a PMP or MCE is typically the result of a
PMP or MCE change, not a disenrollment from the managed care programs altogether. The
following seven circumstances are some of the events that may result in a MCE and/or PMP
change but do not end managed care coverage:
I) PMP disenrolls from the program or from a particular MCE;
2) Membermoves and current PMP is not easily accessible [42 CFR 438.56
(d)(2)(i)];
3) PMP's scope of practice does not meet the member's current health care needs
[42 CFR 438.56 (d)(2)(iv)];
4) Poor quality of care [42 CFR 438.56 (d)(2)(iv)];
5) Lack of access to services covered in the contract [42 CFR 438.56 (d)(2)(iv)];
6) The MCE does not, because of moral or religious objections, cover the service the
member seeks [42 CFR 438.56 (d)(2)(ii)]; or
7) The member needs related services (for example a cesarean section and a tubal
ligation) to be performed at the same time; not all related services are available
within the MCE; and the member's primary care provider or another provider
determines that receiving the services separately would subject the member to
unnecessary risk [42 CFR 438.56 (d)(2)(iii)].

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Exbibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
The MCE is responsible for conducting PMP changes for their members. In the case that a
member contacts the Contractor for a PMP change, the Contractor shall re-direct the call to
the MCE's member services department.
If a member wishes to change MCEs, the Contractor shall process this request subject to the
limitations outlined in this section. After the request has been placed, the MCE that the
member has switched to will process that member's PMP assignment.
2.4.4.1. Hoosier Healthwise Member MCE Changes
Hoosier Healthwise members can only change MCEs at the following times:
• Anytime during their first ninety (90) calendar days enrolled with a new MCE; this is
referred to as the free change period
• Annually during their Open Enrollment period
• Anytime there is 'just cause." The Contractor must obtain FSSA approval before
authorizing any 'just cause" change.
Hoosier Healthwise Open Enrollment statuses include the following:
• No Status: Contractor may make the initial self-selection MCE assignments for a
member.
• 0 - Open Status: Contractor may make an MCE assignment change. A date segment
will accompany this status indicating when the member is in his or her ninety (90)
calendar day free change period.
• C - Closed Status: Contractor may not make an MCE assignment change without just
cause or household member MCE assignment change. A date segment will
accompany the closed status indicating when the member became assigned to the
MCE and when the assignment period ends with his or her chosen MCE at the close
of their 12-month enrollment. With the closed status, the Contractor may take a
future date assignment for the upcoming annual open enrollment period when the
member is nearing sixty to ninety (60-90) calendar days to the end of their closed
status. A date segment will accompany the status sent by the Contractor to assist with
making this future date assignment.
2.4.4.2. HIP Member MCE Changes
An individual may change their HlP MCE selection at any time before making their first
POWER Account contribution. Also, HIP members will have the opportunity to change
MCEs during the redetermination process at the end of each l2-rrionth coverage term.
Ninety (90) calendar days prior to the end of the coverage term, the State will send a
notice to the member about redetermination and the member's right to change MCEs
during redetermination. If the member does not contact the Contractor to change MCEs,
the member will be reassigned to their original MCE. If the member contacts the
Contractor and selects a new MCE, the Contractor must update MMlS according to
established procedures. MMlS will process the MCE change effective the first day of the
member's new coverage term.

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
2.4.4.3. MCE Changes for Just Cause
A member may request to change MCEs for cause at any time after exhausting their
MCE's internal grievance and appeals process. "For cause" is defined as receiving poor
quality care coverage and includes the following:
• Receiving poor quality of care;
• Failure to provide covered services;
• Failure of the MCE to comply with established standards of medical care
administration;
• Lack of access to providers experienced in dealing with the member's health
care needs;
..
.
• Significant language or cultural barriers;
• Corrective action levied against the MCE by the State;
• Limited access to a primary care clinic or other health services within
reasonable proximity to amember's residence;
• A determination that another MCE's formulary is more consistent with a new
member's existing health care needs;
• Lack of access to medically necessary services covered under the MCE's
contract with the State;
• A service is not covered by the Contractor for moral or religious objections;
• Related services are required to be performed at the same time and not all
related services are available within the MCE's network, and the member's
provider determines that receiving the services separately will subject the
member to unnecessary risk;
• The member's primary healthcare provider disenrolls from the member's
current MCE and reenrolls with another MCE; or
• Other circumstances determined by FSSA or its designee to constitute poor
quality of health care coverage.
Before the member contacts the .Contractor, the member must first contact his or her
MCE so the MCE can attempt to resolve the concern. If the member remains dissatisfied
with the outcome, the member can contact the Contractor to request disenrollment. The
Contractor must review the request and make a disenrollment determination.
The Contractor must request a copy of the member's grievance and appeals record ITom
the MCE. The MCE will be expected to respond to the Contractor's request within three
(3) business days .
. After the Contractor receives a copy of the member's grievance and appeals record from
the MCE, it must review the record to confirm that the grievance and appeals process was
exhausted. It must also review the record to make a preliminary recommendation to
FSSA as to whether the member's request should be approved or denied. The Contractor
must make the recommendation within seven (7) business days of receiving the record.
FSSA then determines final approval. .

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 Maximus Health Service, Inc.
Exhibit 1- Statement of Work
EDS# MD29-6-99-16-LF-0725
If the member's request is approved, the Contractor must notify the State's fiscal agent
about the member's disenrollment and new eiJrollment,
2.4,5. HIP and HIP Link Transfers
HIP Link members may only voluntarily transfer to HIP during their redetermination period
(which will also align with their employer's open enrollment period), or following the
occurrence of one of the following criteria:
I) The HIP Link member beComes pregnant.
2) The HIP Link member attests to be medicallY frail under 405 lAC 10-11-5(f).
3) The HIP Link member meets the defmition of Section 1931 parent and caretaker
relative under 405 lAC 10-2-1(46).
4) The HIP Link member meets the definition of transitional medical assistance
under 405 lAC 10-2-1(48).
5) The HIP Link member exhausts the member's POWER account and the
member's out-of-pocket contributions reach or exceed five percent'(5%) of the
member's household income as defined in 405 lAC 10-2-1(6) on a quarterly
basis.

A HIP Link member will be automatically disenrolled from HIP Link and enrolled in HIP in
the following circumstances: (i) the ESI plan is determined to no longer meet the eligibility
requirements; (ii) the member no longer meets the eligibility criteria for HIP Link but
remains eligible for HIP; or (iii) the HIP Link participating employer withdraws from the
program.
A HIP member may transfer to HIP Link during their redetermination period, or at any time
during a special enrollment period. However, an individual shall only be allowed one
opportunity to enroll in HIP Link during a special enrollment period every two (2) years.
The Contractor will not be responsible for managing HIP and HIP Link transfers. In the event
that a member contacts the Contractor for such a transfer, the Contractor shall offer the
choice counseling services described in Section 2, and then re-direct the call to the Division
of Family Resources (DFR) for the individual to submit the change request,
2.4.6. Member Disenrol\ment from Managed Care Program
There are a number of reasons why a member may be disenrolled from the managed care
programs. Some of these disenrollments are processed by the MMIS system and some are
processed by the Contractor.
Disenrollments systematically processed by the MMIS system may include the following five
reasons:
I) Member loses eligibility in IHCP;
2) Change in aid category causes enrolled member to become ineligible;
3) Member meets long-term level of care criteria as determined by the Indiana PreAdmission Screening and the Federal Pre-Admission Screening (IPASIPASRR)
processes or the Home and Community Based Services (HCBS) Waiver program.
Data entry of the level of care into MMIS automatically closes managed care
segment;

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 MaximusHealth Service, Inc.
Exhibit I - Statement of Work
EDS# MD29-6-99-I6-LF-0725
4) Enrolled member becomes eligible for Medicare; or.
5) Member was enrolled inappropriately or mistakenly enrolled, for example due to
the result of a data entry error or a change in eligibilitY information
The above information will be passed to the Contractor from MMIS. The Contractor will
manage disenrollments when the member elects to disenroll from the program or the member
is determined to be ineligible for the program under the terms of the State of Indiana's
applicable waivers for reasons such as the following:
I) Member is determined eligible for and enrolls in a HCBS waiver program. The
Division of Disability and Rehabilitative Services (DDRS) waiver unit will notifY
the Contractor via email when a managed care-enrolled member has been
approved for a waiver but has not had a level of care. entered into MMIS. The
email notification is system-generated and sent to
email address specifically
designated by the Contactor for this purpose. These members are to be
disenrolled from managed care and/or removed from· the potential list. This action .
must be processed within one (I) business day of receipt of email notification.
The Fiscal Agent and MCE must be notified if the deletion occurs outside of the
deletion period. (Deletion period: the period oftime when a PMP segment has
been assigned in MMIS with a future effective date.and the Contractor can delete.
it from the system ·before it generates a roster or any capitation payments).
2) Enrolled member becomes eligible for and enrolls in the IHCP Hospice program.
The hospice analyst in the prior authorization department will notifY the
Contractor ofa member's election and eligibility for hospice services. The
Contractor shall immediately disenroll the member.
3) Disenrollments approved by FSSA due to circumstances which, in the judgment
of FSSA, are justified and documented. An example of this may be when a MCE
has a violent, unmanageable member and requests FSSA allow the MCEs to
release the member into the IHCP fee-for-service program.
4) Disenrollments to fee for service coverage for American Indian/Alaska Native
(AllAN) member who elects to disenroll from managed care.

an

The effective date of an approved disenrollment must be no later than the first day of the next
month following the month in which the enrollee or the MCE files the request (42 CFR
438.56). Contractor must notifY the requestor of a decision to deny a disenrollment request
and the reason for the denial by phone. The call must be followed by a denial letter that gives
the member his or her appeal rights.
2:4.7. Data Entry
The Contractor shall process MCE selection, change requests, and disenrollments for
members enrolled in the managed care programs. This information shall be entered and
maintained in the Contractor database and MMIS. The Contractor must have the capacity to
interface with, and record relevant information in to MMIS. The data contained in the
Contractor database is the property of the State. All transactions must be HIPAA-compliant.

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 Maximus Health Service, Inc.
ExhibiU - Statement of Work
EDS# MD29-6-99-16-LF-0725

3. Hoosier Care Connect-Specific Contractor Tasks
3.1. Enrollment Broker Helpline Services
3.1.1. Helpline Maintenance and Management
The Contractor must maintain and manage the existing statewide toll-free telephone Helpline
to assist members with MCE selections or MCE change requests, questions, concerns or
complaints. The Contractor's Helpline staff must be prepared to respond to member and
potential member concerns or issues including, but not limited to the following:
• Access to health care services
• Identification or explanation bfcovered services
• Special health care needs
• Disease management services
• Behavioral health
• Care management
• Procedures for submitting a member grievance or appeal
• Potential fraud or abuse
• Changing MCEs
• Moving into or out of the Hoosier Care Connect program
The Contractor must staff the Helpline to provide sufficient "live voice" access to its
members during, at a minimum, fifty-five (55) hours a week, Monday through Friday 8:00
AM to 7:00 PM and in the Eastem Time zone. The Helpline must offer language translation
services for members whose primary language is not English and must offer automated
telephone menu options in English and Spanish. A messaging option must be available after
business hours in English and Spanish and member services staff must respond to all member
messages by the end of the next business day. The Contractor must provide members oral
interpreter services, either through interpreters or telephone services. For example, the
Contractor must provide Telecommunications Device for the Deaf (TOO) services for
hearing impaired members, oral interpreters and signers.
The Contractor must maintain a system for tracking and reporting the number and type of
members' calls and inquiries it receives during business hours and non-business hours. The
Contractor must monitor its Helpline service and report its telephone service level
performance to FSSA each month.
The Hoosier Care Connect Helpline services will be subject to performance standards listed
in Section 6.1.1 of this document.

3.1.2. Tracking and Reporting
Hoosier Care Connect Helpline Representatives shall enter all relevant information into the
Contractor database and perform extensive data entry, tracking, and database correction
functions. Member issues, complaints, grievances, referrals and follow-ups are entered and
tracked via the database. The data entered by the Hoosier Care Connect Helpline
Representatives is used for monitoring and tracking purposes and reporting on the operations
of the Hoosier Care Connect program overall. The Contractor shall evaluate the adequacy
and effectiveness of the Hoosier Care Connect Helpline coverage on a daily basis by

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
gathering statistics related to the operation of the Hoosier Care Connect Helpline and
preparing regular reports to the State as defined in Section 6.2 and submitting those reports at
the times required per each report definition.

3.2. Member Education
3.2.1. Enrollment Education
The Contractor will provide Hoosier Care Connect members and potential members with
infonnation on Hoosier Care Connect. In accordance with 42 CFR 438JO(e)(I) and (2),
enrollment education must include, but not necessarily be limited to the items noted below:
• How to access the health care system appropriately (i.e., keeping appointments, use
of the emergency room, which Services need PMP approval, how to file a grievance,
..
etc.);
• The importance of primary and preventive care and other health promotion services;
• The importance of choosing a PMP and having a medical home;
• Detailed, unbiased infonnation about the MCEs and PMPs; and
• The differences between the traditional IHCP fee-for-service program they were
previously in and the new Hoosier Care Connect disease management program.
The Contractor must attempt to conduct a telephone interview with enrollees, during which'
time the enrollee must have a chance to ask questions. During the interview, the enrollee
shall be given the Helpline number and shall be encouraged to call again if they have further
questions.
The Contractor must make oral interpretation services available to enrollees in languages
other than English. Oral interpretation/reading services must also be available for blind
enrollees. The Contractor must notify enrollees and potential enrollees that oral interpretation
and written infonnation in other languages are available and how they can access those
servIces.

3.2.1.1. Program Enrollment
Participation in the Hoosier Care Connect program is mandatory for all members in
the following aid categories:
• Aged
• Blind
• Disabled
• MASI
• MEDWorks
Members may select an MCE on the application. Those members who do not make a
selection on the application will be targeted for outreach, education and assistance in
choosing a health plan by the Contractor.

3.2.2. Choice Counseling
Hoosier Care Connect MCEs set their PMP policies, with State approval. When a Hoosier
Care Connect member indicates to the Contractor he or she would like to see a specific
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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
healthcare provider, the Contractor shall determine if the requested provider is available in an
MCE network(s), either as a specialist, PMP or other provider type. The Contractor shall
inform the member of the provider's contracting status with each MCE and indicate the MCE
will assist the member with seeing their chosen healthcare provider once the MCE
assignment is effective. If the requested provider is not contracted with any Hoosier Care
Connect MCE, the Contractor shall inform the member the provider is not enrolled with any
MCE. If the member indicates he or she wants to postpone an MCE selection until the
provider joins the network, the Contractor shall advise the member this is permissible and
shall provide instructions for calling the Contractor back to make an MCE selection. The
Contractor shall also advise the member of the timeline in which an MCE selection must be
made to avoid being auto-assigned. Further, the Contractor shall encourage the member to
also contact the requested provider to see ifhe or she would be willing to contract with aJ1
MCL
3.2.3. Member Materials
The Contractor must work with the MCEs to update/revise existing member materials,
develop new materials when necessary, and distribute those materials as appropriate, to be
used in conjunction with the Contractor's member education and enrollment facilitation
responsibilities. All materials are the property of the State and are subject to FSSA's review
and approval. Member materials must be written at an appropriate reading level (i.e., fifth
grade). Alternative formats must be available; these formats must take into account the
requirements of the Americans with Disabilities Act and the special needs of those who, for
example, may be visually limited or have limited English proficiency. Materials must be
translated into Spanish. The Contractor must have policies and procedures in place to ensure
that materials are accurate in content, accurate in translation relevant to language or alternate
formats, and do not defraud, mislead or confuse the member. The Contractor must develop
and include a Contractor-designated inventory control number on all member promotional,
education, training or outreach materials with a date issued or date revised clearly marked.
The purpose ofthis inventory control number is to facilitate FSSA"s review and approval of
member materials and document its receipt and approval of original and revised documents.
Annually, as part of its Quality Management and Improvement Plan Summary Report, the
Contractor must submit a list of all member education and outreach materials it has used
during the previous year and anticipates using in the upcoming year.
The Contractor shall notity enrollees:
• That oral interpretation is available for any language, including Spanish;
• That written information is available in prevalent languages (currently Spanish); and
• How to access the interpretation services and written information.
Upon request by the member, the Contractor shall send out electronic brochures and
educational information that have been developed by the Contractor to current and potential
members via e-mail to reduce the volume of mailings. Member materials include the
following:

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
3.2.3.1. Member Brocbures
The member brochures include general information that facilitates the potential member's
understanding of the Hoosier Care Connect program and must be updated, revised, and.
distributed as needed. The brochures must be Written at the fifth grade reading level. The
Contractor is required to produce and distribute a brochure or brochures addressing the
following:
• How to enroll;
• How to choose an MCE;
• How to use the Helpline; and
• How to obtain Services appropriately.
The State may request that the Contractor produCe other brochures containing
information requested by the State or brochures that may contain the following
information:
• The basic features of managed care and Indiana Medicaid;
• Which populations are excluded from enrollment, subject to mandatory enrollment,·
or free to enroll voluntarily in the program; and
• MCE responsibilities for coordination of enrollee care.
3.2.3.2. MCE Summaries
The Contractor is responsible for creating the MCE Health Plan Summary sheets that
compare the Hoosier Care Connect MCEs, Updating them as necessary, printing and
distributing them to members. The MCE Summary sheets provide comparative MCE
information for the enrollees, as required by the 42 CFR 438.10(e)(2)(ii).
The Contractor must provide information specific to each MCE program operating in
potential enrollee's service area, such as:
• Benefits covered;
• Cost sharing, if any; and
• Service area.
3.2.3.3. Provider Lists
MCEs are required to develop provider directories and make printed copies available to
members upon request. The Contractor must have policies and procedures in place to
refer members to the MCEs, when. requested, to obtain provider directories and
information to assist in an enrollee's selection of an !'ACE: The Contractor is not required
to provide printed provider and PMP lists.
3.2.3.4. Otber Materials
The Contractor shall also be responsible to update, print and distribute materials that
provide information on specific topics, as requested by the State.
3.2.4. Correspondence
The Contractor must have the capacity to prepare accurate and thorough written responses to
various inquires. The Contractor shall respond to ninety-eight percent (98%) of all written
provider and recipient correspondence (inquiries) within ten (10) business days of receipt of
the written correspondence by the Contractor. The Contractor must respond to the remainder
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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
within fifteen (15) business days of receipt. This may involve coordination with other
contractors. Written responses must be technically and grammatically proficient. The
Contractor shall refer all questions from State and Federal legislators, the Governor, the
FSSA Secretary, or news media inquiries to the Director of Support Services or delegate.

3.3. Member Enrollment and Disenrollment
3.3.1. Member Enrollment
After the member has been educated by the Helpline Representative, the Contractor must
record the MCE selection and the results of the conversation in the Contractor database. The
MCE will then assist the member in PMP selection and report the result to the Contractor.
The Contractor must then ensure that the PMP selection is recorded in MMlS. PMP
selections for newly eligible enrollees entered into MMIS between the 25th of one month and
the 12th of the second month will be effective on the I 5th of that second month. PMP
selections entered between the 13th and the 24th will be effective the I st of the next month. For
. example, selections entered between April 25th and May 12th will be effective on May 15th.
Selections entered between May 13th and May 24th will be effective on June lSI.
3.3.2. PMP Cbanges or MCE Cbanges
Hoosier Care Connect does not require MCEs to have a PMP model. FSSA shall inform the
Contractor which MCEs have elected to utilize a PMP model. If an MCE has opted to
implement a PMP model, policies for changing PMPs, including but not limited to allowable
frequency of changes, are determined by the MCE, with State approval. Any requirements or
requests to change providers within the MCE will be handled by the MCE.
Members may change MCEs within the first ninety (90) calendar days of assignment to an
MCE, during their open enrollment period or with a just cause. Members will also be
allowed to follow their PMP to a new MCE if that provider moves. The Contractor shall only
be responsible for linking members to an MCE. The Contractor shall refer members to their
MCE for requested PMP changes and all other PMP·related inquiries.
If a member choses to change MCEs, the Contractor shall process the request. After the
request has been placed, the MCE that the member has switched to will work with the
member on a PMP selection, if applicable. MCE changes are only effective on the first of the
next month. MCE changes processed after the 24th of the month will not take effect until the
1st of the second month. The Contractor shall advise members of the timeframe in which
their MCE change will be effective.

3.3.3. Member Disenrollment
Members may be automatically disenrolled from the Hoosier Care Connect program. These
automatic disenrollments are processed by the MMIS system.
Disenrollments processed by the MMIS system may include the following reasons:
I) Member loses eligibility in IHCP
2) Change in aid category causes enrolled member to become ineligible for Hoosier
Care Connect

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
3) Member was enrolled inappropriately or mistakenly enrolled, such as the result ofa
data entry error or a change in eligibility information.
'
This information will be passed to the Contractor from MMIS.
The Contractor will manage disenrollments when an enrolled member becomes eligible for
and enrolls in the ll-ICP Hospice program. The hospice analyst in the prior authorization
department will notify the Contractor of a member's election and eligibility for hospice
services. The Contractor shall immediately di,senroll the member.

3.3.4. Data Entry
The Contractor shall process MCE selections and change requests for members enrolled in
Hoosier Care Connect and enter relevant information in the Contractor database. The
Contractor must be able to interface with and record relevant information ,in MMIS. The data
contained in the Contractor database is the property of the State.
The Contractor should make referrals to other FSSA contractors as necessary.

4. Information System Requirements
4.1. Enrollment Broker Database
The Contractor must develop and maintain a database that identifies member and provider
information in the following areas:
I. General information about each member, such as demographic data, member
phone number, date of phone contact, and to which program and PMP he/she is
assigned.
2. Information for tracking and status updates of those members needing assistance
with service delivery, such as members with access problems or special needs
andlor choosing a PMP before the end of the thirty (30) calendar days.
3. Information for tracking those members with complaints and grievances about the
care they are receiving and the time required to resolve registered complaints and
grievances that have been filed. See Section 6.3 of this document for additional
details.
4. Information about PMPs necessary to generate the PMP lists, such as address,
specialty, and hospital affiliation.
S. Ability to accept, store and send plan and PMP selections to the MMIS for
processing.
6. Information about enrollees! potential enrollees who have received HIP/HIP Link
enrollment counseling. Information tracked should also separately identify how
many from this total are:
a. Medically frail (or indicate they may have a condition that qualifies them
as medically frail);
b. Section 1931; or
c. TMA.

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-~99-1~LF-0725
7. Out of the total enrollees or pOtential enrollees who receive HIP and HIP Link
enrollment counseling (as described in item six above). how many indicated that
they would likely choose to enroll in HIP Link.
8. Tracking the name and contact information of the employer of individuals who
call and are interested in enrolling in HIP Link but are not eligible because their
employer is not enrolled as a HIP Link employer.

4.1.1. Right Choices Program Tracking
One of the tools that the State has to ensure program integrity and to enforce appropriate use
of Medicaid services is the Right Choices Prograin, This program relies on utilization
reviews conducted by IHCP contractors and provider reporting of member habits when they
engage in the following_behaviors:
• Drug-seeking behavior
• Frequent, inappropriate utilization of the emergency room
_. Duplication of services by multiple providers or practices, of the same specialty
• Frequent changes of primary care physicians
When the State confirms a member has used Medicaid inappropriately, that member is
restricted to receive non-emergency services through one physician, one pharmacy, and one
hospital. These requirements promote continuity of medical care and medication
management. For a restricted member to receive treatment from providers other than the
assigned providers requires a written referral.
The Contractor shall receive information on restricted members from FSSA and other IHCP
contractors, including but not limited to the MCEs, track the members in its database, provide
the mechanism for the-information to be entered into MMIS and forward any member
concern phone calls to the appropriate entity. The Contractor will not accept/process plan
changes for members in the Right Choices Program unless directed to by the State.

4.2. Information System Requirements
The Contractor is required to maintain an information systems security policy and conform to the
State's information systems security policy. In addition, the State's Fiscal Agent will provide the
Contractor with appropriate access to MMIS, the State's claims processing system, to retrieve
member eligibility and enrollment information and provider demographics. The Contractor shall
enter member enrollment llIId PMPlhealth plan change information into MMIS and may receive
ongoing file transfers frOm the Fiscal Agent to update the Contractor's database. The data entered
into and maintained in the Contractor's database related to this contract remains the property of
the State. The MMIS system currently runs in a UNIXJOracle environment. It is a database
system that is accessed through a Powerbuilder GUI front-end hosted through the State's Citrix
environment. The Powerbuilder application code is downloaded to the State's Citrix servers as
new releases are made available (currently on a monthly basis). Connectivity to MMIS may be
provided by the State directly through its Citrix environment in order to facilitate required data
transfers through secure method.
Alternatively, if the Contractor prefers to manage the connectivity to the local Fiscal Agent site,
all connectivity and access must meet the requirements of FSSA. The Contractor will be required

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 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
to consult with the Fiscal Agent prior to making any local network, system, and/or workstation
configuration changes. Changes made without the approval and consent of both FSSA and the
Fiscal Agent could result in the loss of access and connectivity as a result of incompatibility of
software applications. The Contractor must ensun; that its system is in working order and is
available ninety-nine percent (99%) of the hours of operation. Scheduled maintenance must occur
only during non-operation hours. Acts of God and emergency maintenance will count against the
ninety-nine percent (99%) requirement. The Contractor must have a disaster recovery plan that
has been approved by FSSA, upon contract implementation. At a.minimum, the disaster recovery.
plan shall show how the Contractor will continue business in the event of disaster. The disaster
recovery plan must specify an off-site recovery location and must be regularly tested.
In addition, at a future date.to be determined by the State, the State will provide the Contractor
direct access to the HIP Link Employer Portal (Portal). Through the Portal or MMIS, the
Contractor will be able to access information regarding the HIP Link employer status, HIP Link
employer 10 number (if available), all plan documents submitted to the State by the employer,
and the ECT team review notes, including benefit review table and the plan affordability table.
However, until such time that the Portal access is finalized, the above listed information will be
available via MMIS, other than the benefit review table and plan affordability table, which will
be sent directly to the Contractor via email to an address to be provided by the Contractor. The
Contractor shall establish a process to store the documents in a searchable format by employer
name for use by the Helpline Representatives.
Note, at all times the Contractor must meet the minimum requirements needed to interface with
all necessary State systems and the systems of other State contractors as designated from time to
time by the State.

5. Administrative Tasks
5.1. Staffing Requirements
Key Staff
Contract Manager - The Contractor must employ a Contract Manager who is dedicated
full-time to the contract. This individual shall be the primary liaison with the State (or its
designees) to facilitate communications between FSSA, the State's contractors and the
Contractor's executive leadership and staff. This individual must maintain a current
knowledge of Federal and State legislation, legislative initiatives, and regulations that may
impact Hoosier Healthwise, HIP. HIP Link or the Hoosier Care Connect program. The
Contract Manager, in close coordination with other key staff, shall ensure all Contractor
functions are in compliance with the terms of the contract. Contractor shall give FSSA the
right to approve the candidate who will fill this position.
Operations Manager - The Contractor shall employ an Operations Manager who is
dedicated full-time to the contract. This Manager must, at a minimum, be responsible for
directing the activities of the Contractor's member services, Helpline telephone performance,

Page 24 of 34

 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-072S
member education and member materials development, approval and distribution and serve
as the primary interface with FSSA, the State's Fiscal Agent, and MCEs regarding such
issues as member enrollment, disenrollment, and eligibility. This Manager must provide an
orientation and on-going training for Contractor representatives, at a minimum, to support
accurately infonning members of how the programs operate, availability covered services,
benefit limitations, emergency services, PMP assignment, specialty provider referrals, selfreferral services, preventive and enhanced services, well-child services '!lid member
grievances and appeals procedures. The Operations Manager, in close coordination with
other key staff, shall ensure all of the Contractor's member services operations are in
compliance with the tenns of the Contractor's contract with the State. Contractor shall give
FSSA the right to approve the candidate who will fill this position.

of

Information Systems Coordinator - The Contractor shall employ an Infonnation Systems
Coordinator who is dedicated full~time to the contract. This individual will oversee the
Contractor's database and phone systems and serve as a liaison between the Contractor and
the State's other contractors regarding data transmission interface, phone connectivity,
HIPAA requirements, reporting and data management issues. The Infonnation Systems
Coordinator, in close coordination with other key staff, shall ensure all program data
transactions are in compliance with the tenns of the Contractor's contract with the State.
Contractor shall give FSSA the right to approve the candidate who ~ill fill this position.
The Contractor shall provide written notification to FSSA' s Managed Care Programs Manager of
anticipated vacancies of key staff within five (S) business days of receiving the key staff person's
notice to tenninate employment or five (S) business days before the vacancy occurs, whichever
occurs first. At that time, the Contractor must present FSSA's Managed Care Director with an
interim plan to cover the responsibilities created by the key staff vacancy. Likewise, the
Contractor must notify FSSA's Managed Care Director within five (S) business days after a
candidate's acceptance to fill a key staff position or five (S) business days prior to the candidate's
start date, whichever occurs first. All key staff must reside in the state of Indiana and maintain an
office within fifteen (IS) miles of the State CapitoL Key staff must also be accessible in-person at
the State's request. FSSA reserves the right to approve candidates who will fill vacant key staff
positions.
All key staff must be accessible to FSSA and its other program subcontractors via phone and
electronic mail systems. As part of its annual Quality Management and Improvement Plan, the
Contractor must submit to FSSA an updated organizational chart including email addresses and
phone numbers for key staff.
Otber Staff Positions
Quality Coordinator - The Contractor shall employ a Quality Coordinator to investigate
and coordinate responses to resolve member and provider grievances and appeals against the
Contractor, and interface with FSSA Hearings and Appeals Office. The Quality Coordinator
shall also lead the Contractor's quality improvement efforts.

Page 25 of 34

 Maxim~.s

Health Service, Inc.
Exhibit I - Statement of Work
EDS# MD29-6-99-16-LF-0725
The remaining staff po.sitio.ns listed in the sectio.n belo.w are provided as a general guideline.
FSSA expects the Co.ntracto.r to. emplo.y the staff necessary to. comply with the State's
perfo.rmance requirements, which may include but no.t be limited to., the fo.lIo.wing:
• Executive management to. interface with FSSA leadership, to. coordinate and co.nfer
with the State o.n matters related to. the Co.ntracto.r's responsibilities and participatio.n
in the Medicaid managed care.programs;
.
• Sufficient technical support services staff to. ensure the timely and accurate
processing o.f support services, reports and requests (including but no.t limited to.
telepho.ne systems and info.rmatio.n systems);
• A sufficient number o.f custo.mer services representatives to. perfo.rm the Helpline
functio.ns; and
• A sufficient number o.fHelpline Representatives specificaUy trained in HIP Link to.
perfo.rm educatio.n and cho.ice co.unseling functio.ns related to. the member o.r potential
member's HIP Link eligible commercial ESI plan.
The Co.ntracto.r shall remo.ve o.r reassign, upon written request fro.m the State, any emplo.yee
o.r subco.ntracto.r that the State deems unacceptable.
5,2. Subcontracton
The term "subco.ntract(s)" includes contractual agreements between the Co.ntracto.r and any entity
that perfo.rms delegated activities related to. the State Enrollment Broker co.ntract.
.
FSSA will appro.ve all subco.ntracto.rs and any change in subco.ntracto.rs o.r material change to.
subco.ntracting arrangements. All subco.ntracts will be appro.ved by FSSA prio.r to. being signed
by the subco.ntracto.r and must include acceptable HIPAA language. The State enco.urages the
Co.ntracto.r to. subco.ntract with entities that are located in the State o.f Indiana.
The Co.ntracto.r is responsible fo.r the perfo.rmance o.f any o.bligatio.ns that may result from this
co.ntract. Subco.ntracto.r agreements do. no.t terminate the legal responsibility o.f the Co.ntracto.r to.
the State to. ensure that all activities under the co.ntract are carried o.ut. The Co.ntracto.r must
o.versee subco.ntracto.r activities and submit an annual report o.n its subco.ntractors' co.mpliance,
co.rrective actio.ns and o.utco.mes o.fthe Contracto.r's mo.nito.ring activities. The Co.ntractor will be
held acco.untable fo.r any functio.ns and responsibilities that it delegates.
The Co.ntracto.r must co.mply with 42 CFR 438.230 and the fo.llo.wing subco.ntracting
requirements:
• The Co.ntracto.r must o.btain FSSA's approval befo.re subcontracting any portio.n o.f
the project's requirements. This approval shall include detailed review o.f any
subco.ntracto.r agreements. The Co.ntracto.r must submit a written request and a draft
subco.ntract to. FSSA at least sixty (60) calendar days prio.r to. the use o.f a
subco.ntracto.r. The Co.ntracto.r shall o.btain FSSA's approval o.fthe subco.ntract befo.re
using it with any subco.ntracto.rs. If the Co.ntracto.r makes subsequent changes to. the
duties included in its subco.ntracts, it must no.tify FSSA sixty (60) calendar days prio.r
to. the revised co.ntract effective date and submit the amendment fo.r review and
approval. FSSA must approve changes befo.re the Co.ntracto.r modifies any previo.usly
approved subco.ntracts.

Page 26 o.f 34

 Maximus Health Service, Inc.
Exhibit 1- Statement of Work
EDS# MD29-6-99-16-LF-0725
• The Contractor must evaluate prospective subcontractors' abilities to perform
delegated activities prior to contracting. with the subcontractor to perform services
associated with Hoosier HeaJthwise, HIP, HIP Link and Hoosier Care Connect.
• The Contractor must have a written agreement in place that specifies the
subcontractor's responsibilities and provides an option for revoking delegation or
imposing other sanctions if performance is inadequate. The wrinen agreement must
be in compliance with all State of Indiana statutes, and will be subject to the
provisions thereof. The subcontract cannot extend beyond the term ofthe·State~s
contract with the Contractor.
• The Contractor must collect performance and financial data from its subcontractors
and monitor delegated performance on an ongoing basis and conduct formal, periodic
and random reviews, as directed by FSSA. The Contractor shall monitor
subcontractor performance against the requirements of the False Claims Act. The
Contractor must incorporate all subcontractors' data into the Contractor's
performance and financial data for a comprehensive evaluation of the Contractor's
performance compliance and identify areas for its subcontractors' improvement when
appropriate. The Contractor must take corrective action if deficiencies are identified
during the review.
• All subcontractors must fulfill all State and Federal requirements appropriate to the
services or activities delegated under the subcontract. In addition, all subcontractors
must fulfill the requirements of the State's contract with the Contractor (and any
relevant amendments) that are appropriate to any service or activity delegated under
the subcontract.
• FSSA may waive its right to review subcontracts. Such waiver shall not constitute a
waiver of any subcontract requirement. In accordance with IC 12-15-30-5(b), any
subcontract agreements terminate when the Enrollment Broker's contract with the
State terminates.
The Contractor must have policies and procedures addressing auditing and monitoring
subcontractors' data, data submissions and performance. The Contractor must integrate
subcontractors' financial and performance data (as appropriate) into the Contractor's information
system to accurately and completely report Contractor performance and confirm contract
compliance.
FSSA reserves the right to audit the Contractor's subcontractors' self-reported data and change
reporting requirements at any time with reasonable notice. The Contractor is responsible for any
additional costs associated with on-site audits or other oversight activities that result when
required systems are located outside of the State.
If the Contractor uses subcontractors to provide direct services to members, the subcontractors
muSt meet the same requirements as the Contractor, and the Contractor must demonstrate its
oversight and monitoring of the subcontractor's compliance with these requirements. The
Contractor must require subcontractors providing direct services to have quality improvement
goals and performance improvement activities specific to the types of services provided by thesubcontractors.

Page 27 of 34

 Maximus Healtb Service, Inc.
Exbibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
5.3. Policy Oversigbt
The Contractor is responsible for maintaining and keeping up to date the existing written policies
. and procedures for all of the Contractor functional areas. The Contractor shall also assist the
State with ongoing program operation, policy and procedure development and review. The
Contractor shall incorporate revised policies and procedures, as appropriate, into the revisions of
all materials such as the member letters and brochures. The Contractor shall make available to
FSSA copies of all policies and procedures in both electronic and hard copy format.
5.4. Administrative Plan Development and Execution
The State may request that the Contractor produce and present a detailed administrative plari that
describes the resources and supplies needed to complete the member education and enrollment, .
Helpline maintenance and management, database development and management, and quality
improvement activities described in this contract. The plan shall include an organizational chart
and contact information (i.e., phone numbers and email addresses) for key personnel.
The Contractor must promptly provide written notification to FSSA ofany vacancies of key
positions and must make every effort to fill vacancies in all key positions with qualified persons
approved by FSSA.
5.5. Meetings Requirements
Key personnel are required to actively participate in several regularly scheduled meetings each
month, which are listed in this section of the Scope of Work. These meetings are necessary to
coordinate with the other FSSA contractors and to ensure the smooth operation of the program.
In addition, participation in ad hoc meetings with other FSSA contractors, state offices (e.g.,
DFR) or other entities may also be required. Most meetings are held at the Indiana Government
Center, South Building (IGCS).
5.5.1. Status Meetings
Contractor status meetings will be held with FSSA to discuss program policies, provide
updates on ongoing projects, resolve challenges, and discuss progress on work plans and
action plans. The Contractor shall develop the agenda, and provide the agenda and status
report to FSSA one (I) business day prior to the meeting. The Contractor shall record and
prepare meeting minutes, and provide minutes to FSSA within two weeks after the meeting.
The agenda and minutes are subject to FSSA review and approval. Monthly managed care
status meetings will be held with FSSA and the Fiscal Agent to discuss program policies and
operations, projects and challenges that involve other contractors.
5.5.2. Managed Care Policy/Operations Meeting
If requested, the Contractor shall attend and participate in the managed care policy/operations
meetings with representatives from FSSA and the various contracted parties affiliated with
the Hoosier Healthwise, HIP, HIP Link and Hoosier Care Connect programs. The Contractor
must revise its policies and procedures to incorporate policy changes and clarifications, and
new policies agreed upon in these meetings.

Page 28 of 34

 Maximus Health Service. Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
5.5.3. Quality Improvement Committee
The Contractor shall participate in the meetings of the Quality Improvement Committee.
Participation includes meeting attendance and submission of requested data.
5.6 Training Requirements
The Contractor shall provide appropriate training to its staff incl.uding: program orientition and
updates, cultural sensitivity, program policies and procedures, relevant information regarding all
Health Plans available to potential enrollees and other topics as requested by the State.
Training on enrollment broker functions shall be delivered to State staff upon request, at any time
with reasonable advance notice. All training provided to State staff shall be at the Contractor's
sole expense.

6. Quality Management
6.1. Performance Standards
The following performance standards apply to Hoosier Healthwise, HIP, HIP Link and Hoosier
Care Connect programs, unless otherwise indicated.

6.1.1. Helpline Performance Standards
The Contractor is encouraged to perform at a level exceeding the minimum performance
standards listed below. The State reserves the right to amend or delete any of these standards
or add additional standards without notice. For purposes of these standards, the Helpline
means the Hoosier Healthwise, HIP, HIP Link and Hoosier Care Connect Helplines and
includes all calls received through that line from providers, members and the general public.
With the exception of the holidays listed below, the staff must be available to provide
sufficient "live voice" access to members during (at a minimum) fifty-five (55) hours a week,
Monday through Friday 8:00 AM to 7:00 PM. Voice mail or an answering service must be
available after hours. All after-hours calls must be returned the next business day.
The member Helpline may be closed on the following holidays:
•
•
•
•
•
•
•

New Year's Day;
Martin Luther King, Jr. Day;
Memorial Day;
Independence Day (July 4th);
Labor Day;
Thanksgiving; and
Christmas.

The Contractor may request that additional days, such as the day before Thanksgiving, be
authorized for limited staff attendance. This request must be submitted to FSSA at least
thirty (30) calendar days in advance of the date being requested for limited staff attendance

Page 29 of 34

 Maxiinus Healtb Service, Inc.
Exbibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
and must be approved by FSSA. Call center closures, limited staffing or early closures shall
.
.
not burden a member's access to the Contractor's services.
The call center must be located within sixty miles of downtown Indianapolis. The call· center
must be staffed so that a capacity of at least 40,000 calls per month can be handled. However,
when call volume exceeds capacity, the Contractor may use additional offsite call cenier
capacity to maintain Helpline service standards. The offsite call.center may be.located within
the continental United States. Non-complianee with standards (a) through (h) below shall be
subject to non-compliance remedies, as described in Attachment I - Performance Standards:
a) One hundred percent (100 %) of all calls shall reach the Helpline menu on or
within three (3) rings or fewer.
b) Average speed to answer calls shall not exceed 60 seconds..
c) The busy rate shall not exceed zero percent (0%).
d) The lost call (abandonment) rate shall not exceed seven percent (7%).
e) An answering machine, voice mail or answering service must be available for
after-hours calls. One hundred percent (100%) of after-hours calls must be
returned within the next business day.
' .
f) The Helpline must be equipped with the appropriate technology to accept calls
from all members. The Contractor is responsible for ensuring that people with
limited English proficiency and those who are deaf, hearing impaired or have
other special needs have access to communication services that enable all
.
members to utilize the Helpline.
g) Eighty-five percent (85%) of all issues from callers should be resolved on the
call. If information cannot be provided to a caller in a timely manner, the
Helpline representative should request a name, phone number and/or addresses (if
necessary) and respond to the caller within one (I) business day from the time of
contact.
h) The Contractor must immediately report any failure of Helpline operations to
FSSA.

6.1.2. Member Education Performance Standards
Non-compliance with standards below shall be subject to non-compliance remedies, as
described in Attachment I - Performance Standards:
a) Ninety percent (90%) of new managed care members (including those Hoosier
Healthwise members that have not selected a MCE on their application) must be .
educated within fourteen (14) calendar days of being determined eligible for
managed care.
b) The Contractor shall ensure the default auto-assignment rate does not exceed
fifteen percent (15%) for members in the Hoosier Care Connect program.
c) Relevant information must be entered into MMIS within three (3) business days
with ninety-eight percent (98%) accuracy.
d) The Contractor must respond to ninety-eight percent (98%) of all written provider
and recipient correspondence (inquiries) within ten (10) business days of receipt
of the provider's correspondence by the Contractor. The Contractor must respond
to the remainder within fifteen (15) business days of receipt.
e) All written educational and outreach materials must be approved by FSSA prior
to distribution.
Page 30 of 34

 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
f)

Ifrequested by the State, the Contractor will submit an annual workplan forty
five (45) calendar days prior to the start of a calendar year. The plan will detail
the education and outreach plan for the coming year. At this time the Contractor
will also submit to FSSA an additional report documenting the results of the
previous year's work plan.

6.2. Data Reporting and Monitoring
The Contractor is responsible for monitoring of the Hoosier Healthwise, HIP, HIP Link and
Hoosier Care Connect Helplines for fraud prevention and data gathering purposes. The
Contractor shall immediately report to FSSA any suspected fraud and abuse or misconduct
associated with any service or function provided for by this Contract, or suspected abuse or
misconduct by a potential enrollee, provider, Contractor staff, or subcontractor. In addition, the
Contractor will collect data on a monthly basis and will use it to monitor the success of the
Medicaid managed care programs. Contractor performance and quality improvement data will be
submitted to FSSA. The data will be reviewed to determine what changes may be necessary to
improve the quality of services to members and providers. A summary of the required reports are
listed below.
6.2.1. Report Submission Requirements
The Contractor shall provide FSSA with the reports listed below as well as any reports
requested by the State:
a) Monthly Status Report: The Contractor shall submit to FSSA an updated status
report. This report contains the current status regarding the Contractor's Hoosier
Healthwise, HIP, HIP Link and Hoosier Care Connect program operations and
outstanding issues and action items.
b) Monthly Program Data: The Contractor shall submit to FSSA monthly reports of
program data and performance measures. These reports shall include any
information deemed necessary by the State. Currently, these reports include the
Contractor's performance measures and statistics regarding its efficiency and.
overall operations. The Helpline call statistics, the number of member
enrollments, disenrollments by reason, auto-assignment rate, and grievance data
are examples of the types of data reports that the Contractor must submit to FSSA
on a monthly basis. The Contractor must be able to stratifY the data, for example, .
by county, and/or MCE.
c) Monthly Usage Volume Report: The Contractor shall submit to FSSA a monthly
usage volume report, which states the Contractor's actual usage volumes for items
billed to the State for the preceding month and projected usage volumes for the
following month.
d) Monthly Report: Reports shall update the progress achieved relative to the annual·
work plan submitted for each functional area as well as selected program data,
including complaint reports.
e) Annual Report: These reports provide, for each functional area, the annual
workplan proposed for the coming year and performance reviews from the past
year. The annual reports are submitted with the fourth quarter reports.
f) Quality Management and Improvement Work Plan Requirements: The quality
improvement program shall be based on a written plan, which includes goals,

Page 31 of 34

 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
structure, authority, responsibilities, scope, and methods of evaluation. The
Contractor shall develop an annual Quality Improvement Plan, which is
submitted to FSSA thirty (30) calendar days after the end of the calendar year.
g) Quality Management and Improvement Progress Report: The progress reports
must be submitted quarterly and shall update the progress achieved relative to the
Quality Management and Improvement workplan.
h) Business Continuity Plan: Thirty (30)calendar days prior to enrollment, the
Contractor shall provide a business continuity plan that details the Contractor's
plan to maintain service standards in the evenfofan outage or failure in the
Contractor's communication or technical support systems. In addition, the
Contractor will detail how it will guarantee the State full access to all of the
Contractor's information systems in order. to guarantee the services of the
contract in the event the Contractor is unable to provide the required contract
services in the future. Subsequently, this business continuity plan shall be updated
annually and submitted to the State within,thirty (30) calendar days following
each year of the contract.
6.2.2. Performance Standards for Report Submissions
a) Provide status reports to FSSA at least one (I) business day prior to each status
meeting, to allow for FSSA review before the meeting and to aid the discussion
during the status meeting.
b) Submit monthly program data reports to FSSA within ten (10) business days of
the end ofthe previous month.
c) Submit quarterly reports within thirty (30) calendar days after the end of each
calendar quarter.
d) Submit annual reports within thirty (30) calendar days after the end of the
calendar year.
6.3. Complaints and Grievances
There are two types of grievances that may be received by the Contractor: grievance about an
MCE, or grievances about the Contractor services.
I) If the member is calling with a concern about his or her MCE, the Contractor should
help him or her initiate the plan's grievance process. Ifthe member has not already
done this, the Contractor should direct the member to Call the health plan's member
services number.
2) The Contractor shall develop and maintain policies and procedures to manage
complaints and grievances as required by the State. FSSA must approve these
policies and procedures and may require updates or changes to them at its discretion.
Grievance data reporting is required in the monthly program reports submitted to
FSSA and in the quarterly reports.
Grievances are received through the Enrollment Broker Helpline. This information is captured,
tracked and reported through the Contractor's database. Grievance data reporting is required in
the monthly program reports submitted to FSSA.

Page 32 of 34

 Maximus Health Service, Inc.
Exhibit 1 - Statement of Work
EDS# MD29-6-99-16-LF-0725
7. Start Up and Transition Activities
7.1. Incoming Transition Activities
The Contractor shall be solely responsible for all costs related to incoming transition activities..
The Contractor shall submit a plan for incoming transition activities demonstrating that the
Contractor understands the scope and complexity of the incoming transition activities for the
Scope of Work. The Contractor shall be able to make revisions to this transition plan, but any
requests for revisions shall be submitted in writing to the State for approval. These revisions shall
in no way negatively affect the quality of the transition services. The Contractor shall provide a
high-level description of the plan for incoming transition activities for the Scope of Work which
~ontains but is not limited tli the following information:
• Identification of Contractor's needs for new staff knowledge, skills, and abilities that
will be required to successfully implement the incoming transition services.
7.1.1
Removed by mutual agreement of both parties.
7.1.2 Readiness Review
If required by the State, the Contractor shall participate in a readiness review at a mutually
agreed upon time prior to assuming the responsibilities of the contract so that FSSA can
confirm that the Contractor meets contract and operational requirements. The Contractor and
its subcontractors, ifany, shall submit documentation that demonstrates the Contractor's
readiness to serve members. This should include documentation showing that the project is
fully staffed, staff are adequately trained, and the Contractor's facilities are ready to begin
operations. FSSA may, at its discretion, also request additional documentation to verify the
Contractor's readiness to serve members and conduct on-site reviews of the Contractor and
its sub-contractors, if any. The Contractor shall provide all necessary documentation related
to the readiness review thirty (30) calendar days prior to scheduled member enrollment.
If for any reason the Contractor does not pass the readiness review by the contract start date
and there is a delay in the operational start date, the Contractor shall be subject to
consequential damages and corrective actions as described in Attachment I - Performance
Standards.
7.2 Outgoing Transition Activities
The Contractor shall be reimbursed for Outgoing Transition Activity costs up to the not-toexceed pricing agreed upon from the Cost Proposal. The Contractor shall submit a plan for
outgoing transition activities that demonstrates the Contractor understands the scope and
complexity of the outgoing transition activities for the Scope of Work. The Contractor shall
provide a high-level description of the plan for outgoing transition activities for the Scope of
Work which contains but is not limited to the following information:
• Explanation of the planned steps to transition activities from the Contractor to the
incoming vendor.

Page 33 of 34

 Maximus Health Service, Inc.
Exhibit 1- Statement of Work
EDS# MD29-6-99-16-LF-0725
• Explanation of the planned approach to coordination between the State, the
Contractor, and the incoming vendor.
• A description of staffing requirements for the outgoing transition and how the staff
will support the outgoing transition of services.
• The Contractor's skills and abilities that will enable a successful outgoing transition
of services including past experience with other states transitioning out the~ services.
'The State recognizes that the Contractor may not possess all the information needed for a
complete and detailed plan for outgoing transition activities, but the plan for outgoing activities
submitted should be as accurate and comprehensive as possible.
Upon notice ofthe termination of the contract for any reason, the Contractor shall within five (5).
business days submit a transition plan for FSSA's review and approvaL The transition plan will
be implemented to ensure a smooth transition of activities and responsibilities to the
succeeding contractor with the leaSt amount of disruption possible. The transition plan should
include:
• The conveyance of documents and other materials to the succeeding contractor.
These materials may contain, but are not limited to policies, standard operating
.
procedures, training manuals, educational materials, promotional items, and all other
materials associated with the contract.
• The coordination of activities to be ceased by the Contractor and commenced by the
succeeding contractor, including Helpline management and MMIS access.
• Listing of key activities to be conducted during the transition, the staff responsible,
and target dates for completion. This should also list the staff person who will lead
the communication with the succeeding contractor. The Contractor must respond to
all communication via voice, written, or electronic means from the succeeding
contractor within twenty-four hours.
Transition at the end of the contract period will be managed the same as above, except that the
transition plan will be submitted twelve (12) months in advance of the end of the contract period
for FSSA's review and approval.
7.2.1 Transition Period
The Contractor is also required to participate in the Transition Period during the outgoing
phase of the transition. The Transition Period begins one hundred twenty (120) calendar days
prior to the end of the Contract, during which the Contractor shall work in conjunction with
the State and the newly awarded Contractor, to finalize a transition plan of services and
support for the Scope of Work. The primary goal of this Transition Period is to ensure that
there is no disruption to the performance of the required services. The transition to the
awarded Contractor's staff shall be as orderly and as transparent as possible to the State.

Page 34 of 34

 Maximus Health Service, Inc.
Exhibit 2 - Enrollment Broker Services Performance Standards
EDS# MD29-6-99-16-LF-0725

I.

Consequential Damages - Failure to Meet Contract Requirements

It is expressly agreed by the State and the Contractor- that, in the event of a failure to meet
the perfonnance requirements listed below, damage shall be sustained by the State, and
the Contractor shall pay to the State itS actual damages according to the following
subsections. Written notice of said failure to perfonn shall be provided to the Contractor,
by the State.

I. Operational Start Date - Damages
If, for any reason, the Contractor fails to pass the readiness review as stipulated in
Section 7.1.2 of the Scope of Work and does not meet the anticipated agreed upon
operational start date for the contract and a contract amendment delaying this date or _
start-up of a portion of the enrollment broker services requirements listed has not been
approved, then the Contractor shall be liable for costs incurred by the State to continue
.;', current operations and to complete the transition efforts. The Contractor shall forfeit any
claims to reimbursement until the State approves operational readiness through the
readiness review.

II.

Service Level Agreements - Failure to Meet Performance Requirements

I. Areas of Non-Compliance
The State monitors certain quality and perfonnance standards, and holds the Contractor
accountable for delivering the scope of work and being in compliance with contract
tenns. The State accomplishes this by working collaboratively with the Contractor to
maintain and improve programs, and not to impair Contractor stability. The State may
enforce any of the remedies listed in Section 11.3 of this Attachment if the Contractor is
non-compliant with the contract.
a. Non-compliance with General Contract Provisions
The objective of this requirement is to provide the State with an administrative
procedure to address issues where the Contractor is not compliant with the .
contract. Through routine monitoring, the State may identifY contract noncompliance issues. If this occurs, the State will notify the Contractor in
writing of the nature of the non-perfonnance issue. The State will establish a
reasonable periOd oftime, but not more than ten (10) business days nor less
than five (5) business days, during which the Contractor must provide a
- written response to the notification. If the Contractor does not correct the nonperfonnance issue within the time specified in the notice, the State may
. enforce any of the remedies listed in Section 11.3 of this Attachment.
b. Non-compliance with Reporting Requirements

I

 Maximus Health Service, Inc.
Exhibit 2 - Enrollment Broker Services Performance Standards
EDS# MD29-6-99-I6-LF-072S
The State may change the frequency of required reports, or may require
additional reports, at the State's reasonable discretion. Reports submitted
incorrectly or not delivered complete, on time, and in the correct reporting
formats constitute contractual non-compliance, as defmed in Section 6.2 of the
Scope of Work.
c. Non-Compliance with Helpline Performance Standards
The Contractor must ensure that Helpline Performance Standards are met in
full under this contract. The State may enforce any of the remedies listed in
Section 11.3 of this attachment if the Contractor remains out of compliance
with any of the standards in Section 6.1.1 of the Scope of Work. The State
may waive such remedies for the first three months of operation (the ramp-up
period). However, ifit is determined by the State that the Contractor's noncompliance with the standards for a certain month was caused by extenuating
circumstances outside of the Contractor's control, nori-compliance for that
month will be waived.
d. Non-Compliance with Member Education Performance Standards
The Contractor must ensure that the Member Education services under this
contract are met in full as listed in Section 6.1.2 of the Scope of Work.
2. Non-compliance Remedies
In the event that the Contractor fails to meet performance requirements or reporting
standards set forth in the RFP, any Attachment to the RFP, the contract or other standards
established by the State, the State will provide the Contractor with a written notice of
non-compliance and may require any of the corrective actions or remedies discussed in
Section 11.3 below. The State will provide written notice of non-compliance to the
Contractor within sixty (60) calendar days of the State's discovery of such noncompliance.

If the State elects not to exercise a corrective action clause contained anywhere in the
RFP, any Attachment to the RFP or contract in a particular instance, this decision must
not be construed as a waiver of the State's right to pursue future assessment of that
performance requirement and associated damages, including damages that, under the
terms of the RFP, any Attachment to the RFP or contract, may be retroactively assessed.
3. Corrective Actions
The State may require corrective action(s) when the Contractor has failed to provide the
requested services. The nature of the corrective action(s) will depend upon the nature,
severity and duration of the deficiency and repeated nature of the non-compliance. The

2

 Maximus Health Service, Inc.
Exhibit 2 - Enrollment Broker Services Performance Standards
EDS# MD29-6-99-16-LF-0725
written notice of non-compliance corrective actions may be instituted in any sequence
and include, but are not limited to, any of the following:
•
•

•

•
•

•

•

Written Warning: The State may issue a written warning and solicit a response
regarding the Contractor's corrective action.
Formal Corrective Action Plan: The State may require the Contractor to develop a
formal corrective action plan to remedy the breach. The corrective action plan
must be submitted under the signature. of the Contractor's chief executive and
must be approved by the State. If the corrective action plan is not acceptable, the
State may provide suggestions and direction to bring the Contractor into
compliance.
Withholding Full or Partial Invoice Pavrnents: The State may suspend full or
partial invoice payments for one or more months when the State determines that
the Contractor is non-compliant. The State must give the Contractor written notice
ten (10) business days prior to the suspension of invoice payments and specific
reasons for non-compliance that result in suspension of payments. The State may
continue to suspend all invoice payments until non-compliance issues are
corrected. However, the State may not return a portion of or all invoice payments
withheld in the event that there is a lost value of services that the State did not
receive from the Contractor.
Performance-Related Delayed Payments: Please see Section 11.4 of this document
for a description of Performance-Related Delayed Payments.
Assigning the Contractor's Responsibilities to Another Contractor: The State may
assign the Contractor's responsibilities to one or more other contractors that also
provide services for the Scope of Work, subject to consent by the contractor that
would gain that responsibility. The State must notifY the original Contractor in
writing of its intent to transfer its responsibilities to another Contractor at least ten
(10) business days prior to transferring any services.
Appointing Temporary Management of the Contractor: The State may assume
management of the Contractor or may assign temporary management of the
Contractor to the State's agent, if at any time the State determines that the
Contractor can no longer effectively manage the services for the Scope of Work.
Contract Termination: The State reserves the right to terminate the contract
pursuant to the contract termination clauses in the contract resulting from this

RFP.
4. Performance-Related Delayed Payments
The Contractor shall invoice to the State 95% of the total amount payable each period.
The remaining 5% shall be held back according to the vendor(s)'s demonstrated and
documented performance against the standards listed in this section. At the end of each
quarter, the State shall determine whether the vendor(s)'s performance was sufficient to
earn all or a portion of the performance-related delayed payments for the quarter. It is the
Contractor's responsibility to submit the proper documentation/reports to provide proof
regarding the Contractor's ability to have met the performance standard for the quarter. If
the State determines that payment of some or the entire withheld portion is due, the State

3

 Maximus Health Service. Inc.
Exhibit 2 - Enrollment Broker Services Performance Standards
EDS# MD29-6-99-I6-LF-0725
shall pay the Contractor the proper percentage of the portion withheld within thirty (30)
calendar days of the end of the quarter. Any withhold amounts not released reflect the
lost value of the services the State did not receive from the Contractor for the time period
measured and thus will not be payable to the Contractor. The State's decision to release
some of or the entire withheld amount shall be final.
The release of performance-related delayed payments shall be based on the autoassignment rate of Hoosier Care Connect for the quarter and the quantity of late
Contractor reports for the quarter, as outlined in Section 6.2.1 of the Scope of Work. Fifty
percent (50%) of performance-related delayed payments will be tied to the to the autoassignment rate of Hoosier Care Connect. The remaining fifty percent (50%) of
performance-related delayed payments will be tied to the reporting requirements.
The percentage payout of performance-related delayed payments shall be based on the
following two schedules:

Schedule I: Auto-Assignment Rate for Hoosier Care Connect (50% of Performance-

For example, if during the quarter, the auto-assignment rate for Hoosier Care Connect
were 8%, the Contractor would receive sixty percent (60%) of the performance-related
delayed payments held for the quarter allocated to the Hoosier Care Connect autoassignment rate. The remaining forty percent (40%) of performance-related delayed
payments for that quarter reflect the lost value of the services the State did not receive
from the Contractor during the quarter and will not be payable to the Contractor.

Schedule 2: Quantity of Late Reports (50% of Performance-Related Delayed

For example, if during the quarter, the Contractor turned in two (2) late reports, the
Contractor would receive none of the performance-related delayed payments held for the
quarter allocated to reporting requirements. The entire performance-related delayed

4

 Maximus Health Service, hic.
Exhibit 2 - Enrollment Broker Services Performance Standards
EDS# MD29-6-99-16-LF-0725
payments for that quarter reflect the lost value of the services the State did not receive
from the Contractor during the quarter and will not be payabJe" to the Contractor.

5

 ..... T....
2016
2017
2018

2019
2020
.. Calendar

------ -

_26
Helpline Services ICY 16)
Printed MateMIs. Posbge, et:c. ICY 16}
Information Systems (eY 16)
Other Tasks (tV 16)

-e-

M ......
M ......

_17
'-

,.,.",

fl61

1""""

"'I
; ICYI61

~ICYI7I

He!plineServiceo (CY 17)

Total NT£:

""""

1_""

-.

6
6
$13,424.40
6
$30,697.70
6
6
$0.00
TObiI Annual NR:

~:
iB2.78
;,881.

Helptine Services (ev 181
Printed Materals, PosUIB~. f!t:c. ICY 17)

Printed Materials, Po:sI:ap, etc. ICY 18)
Information Systems ICY 17)
Information Systems ICY 18)
OtherT~ ICY 17)
0ttIer Tasb ICY 181
Performance Withhold

M .....

Page 1 of 1

-

$943,984.65
$34,096.66

S80.54638
$184,l86..11
$0.00
$1 Wlnot

6
6
6

~H~

, '.67
~40

, '.ro

$0.00
12
Teal Annual NTE

---------Month>

2.586,622.56
1.317,961.87
10,198,.121.24

$_

$ 157,330.78
$5.682.78

,ICY161

'1~71

Y~ar

1.242,813.91

2.505,272..56
2.545,450.34

-

$159.soo.oo
6
$162,400.00
6
$S.B81.11
6
$6,086.36
6
$13,533.67
6
6
$13.645.23
$31.195.00
6
$31,700.36
6
$0.00
12
Total Annual NTt

$0.00

$$958,.800.00
$974,400.00
$35,286.64
$36,511.1"

$81.202.00
$81,871.37
$187,170.03

$190.202.18
$0.00
$Z"S45 4§0 14