INFORMATION TECHNOLOGY (IT) CONTRACT BETWEEN THE STATE OF WYOMING, DEPARTMENT OF HEALTH, DIVISION OF HEALTHCARE FINANCING AND MAXIMUS HEALTH SERVICES, INC. 1. Parties. The parties to this Contract are the State of Wyoming, Department of Health. Division of Healthcare Financing (Agency), whose address is 6101 Yellowstone, Rd. Suite 210 Cheyenne. WY 82002, and Maximus Health Services, Inc. (Contractor), whose address is 1891 Metro Center Drive Reston, VA 20190. 2. Purpose of Contract. The purpose of this Contract is to set forth the terms and conditions by which the Contractor shall provide and operate a Medicaideid Care CHIP Customer Service Center. These services are more fully described in Attachment A. Statement of Work, Attachment B, Request for Proposal (RFP) (Final Amended Version), Attachment C, Contractor?s Technical Proposal and Attachment D, Business Associate Agreement (BAA), all herein made part of this Contract. 3. Term of Contract and Required Approvals. This Contract is effective July I, 2016, or the last date by which parties have executed it and all required approvals have been granted (Effective Date), whichever is later. The term of the Contract is from the Effective Date through September 30, 2020. All services will be completed during this term. This Contract may be renewed twice with each renewal being for two years (for a maximum of eight years) by agreement of both parties in writing and subject to the required approvals. There is no right or expectation of renewal and any renewal will be determined at the discretion of the Agency. By law, contracts for professional or other services must be approved by the Attorney General and Procurement, Wyo. Stat. 9-1-403 and all contracts for services costing over $1,500.00 must be approved by the Governor or his designee as well. Wyo. Stat. 4. Payment. Agency agrees to pay Contractor for the services described in Attachment A, Statement of Work. The total payment under this Contract will not exceed nineteen million, three hundred eighty?one thousand, four hundred sixty-six dollars and forty cents Eighteen million, one hundred thirteen thousand, ?ve hundred twenty dollars will be paid for deliverables and Operations and Maintenance costs, unless penalties are assessed per Attachment A, Statement of Work. The remaining one million, two hundred sixty-seven thousand, nine hundred forty-six dollars and forty cents may be paid as adjustable incentive payments based on performance, as set forth in the Statement of Work. Payment shall be made Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 1 of IS U1 upon submission of invoice pursuant to Wyo. Stat. 16?6?602. No payment shall be made for work performed before the Effective Date of this Contract. Contractor shall submit invoices in suf?cient detail to ensure that payments may be made in conformance with this Contract. Should the Contractor fail to perform in a manner consistent with the terms and conditions set forth in this Contract, payment under this Contract may be withheld until such time as the Contractor performs its duties and responsibilities to the satisfaction of Agency. Except as otherwise provided in this Contract, the Contractor shall pay all costs and expenses incurred by Contractor or on its behalf in connection with Contractor?s performance and compliance with all Contractor?s obligations under this Contract. The Agency will remit payment of invoices to the Contractor in accordance with Attachment A, Statement of Work. Payments of invoices will be based upon the Contractor meeting the stated deadlines and upon the State's acceptance of the deliverables. Should the Contractor fail to comply with the provisions of the Contract, payment for portions of the Contract will be withheld until such time as the Contract terms have been implemented. Responsibilities of Contractor. The Contractor agrees to perform services in accordance with the following: Attachment A-Statement of Work, Attachment B-RFP (Final Amended Version) and Attachment C?Contractor?s Technical Proposal. Responsibilities of Agency. The responsibilities of the Agency are described in Attachment A, Statement of Work, and the RFP (Final Amended Version). Special Provisions A. Change Control Management. The Contractor must maintain a change control process with all changes and must be approved through the Agency?s change control board. The change control process will include the reason for the change, a complete description of work to be performed, an estimate of time and cost to complete the change, a completion date for the change and an impact analysis indicating rami?cations or impact to the project. If unforeseen circumstances arise where a dispute occurs, Contractor will submit in writing a description of the problem and proposed resolution to the Agency Project Representative for consideration. If change orders are needed, the Contractor agrees to continue at the hourly rate specified in Attachment A, Statement of Work. Changes include, without limitation: changes in laws, regulations, processes, or procedures that affect the cost time, or other material factors for performance of the work, Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 2 of 15 (ii) delays caused by the Agency or the State or their respective of?cers, employees, agents, vendors, and contractors. Contractors will notify the Agency of any changes and delays and shall take good faith reasonable steps to mitigate the impacts of the change or delay. In the event it is determined that a change to Attachment A, Statement of Work, is required, a Contract amendment will be made to the Contract in accordance with the Contract. The change request will be used by the Contractor as the justi?cation for a change to the Statement of Work. Con?icting Language. Contract language in this document shall have precedence and control over any con?icting language with Attachment A, the Statement of Work, Attachment B, RFP (Final Amended Version), and Attachment C, Contractor?s Technical Proposal. Language contained within Attachment D, the Business Associate Agreement, shall take precedence over any con?icting language which may exist in the Contract or any other attachment or document incorporated by reference herein. In case of con?ict, any clari?cation must be mutually agreed upon in writing and will govern the contractual relationship between the parties. Con?icts of Interest. Contractor shall not engage in providing consultation or representation of clients, agencies, or ?rms which may constitute a con?ict of interest which results in a disadvantage to the Agency or a disclosure which would adversely affect the interests of the Agency. Contractor shall notify the Agency of any potential or actual con?icts of interest arising during the course of the Contractor?s performance under this Contract. This Contract may be terminated in the event a con?ict of interest arises. Termination of the Contract will be subject to a mutual settlement of accounts. In the event the Contract is terminated under this provision, the Contractor shall take steps to ensure that the documents, data, compilations, reports, photographs, and other work provided to or produced by the Contractor for the Agency in the performance of this Contract are provided to the Agency or its designee in accordance with Section SS, Ownership of of the Contract. This does not prohibit or affect the Contractor?s ability to engage in consultations, evaluations, or representation under agreement with other agencies, ?rms, facilities, or attorneys so long as no con?ict exists. Kickbacks. Contractor certi?es and warrants that no gratuities, kickbacks, or contingency fees were paid in connection with this Contract, nor were any fees, commissions, gifts, or other considerations made contingent upon the award of this Contract. If Contractor breaches or violates this warranty, Agency may, at its discretion, terminate this Contract without liability to Agency, or deduct from the agreed upon price or consideration, or otherwise recover, the full amount of any commission, percentage, brokerage, or contingency fee. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 3 of IS Monitor Activities. The Agency shall have the right to monitor all Contract related activities of the Contractor and all subcontractors. This will include, but not be limited to, the right to make site inspections at any time, to bring experts and consultants on site to examine or evaluate completed work or work in progress, and to observe all Contractor personnel in every phase of performance of Contract related work. The Agency will exercise due care to minimize any delays or disruptions to the Contractor. No Finder?s Fees. No ?nder's fee, employment agency fee, or other such fee related to the procurement of this Contract will be paid by either party. Project Representative. All project management and coordination for the Agency shall be through a single point of contact designated as the Project Representative. The Agency Project Representative for this project is Penny Davis, Eligibility Vendor and Contract Manager. Any and all work performed under this Contract will be subject to approval and acceptance by the Agency Project Representative. In no instance will the Contractor?s staff refer any matters to any Agency Director or Deputy Directors or any other of?cial in Wyoming unless initial contact, both verbal and in writing, regarding the matter has ?rst been presented to the Agency Project Representative. This does not prevent the Contractor from communicating with the Agency?s Executive Leadership within the Governor?s of?ce with appropriate coordination with the Agency Project Representative. All correspondence from the Contractor shall be addressed directly to the Agency Project Representative. The Agency Project Representative or his designee shall be responsible for corresponding and arranging meetings with Agency personnel and outside Agencies and associations. The Agency Project Representative shall document performance of the Contractor as to the satisfaction of any deliverables required to meet the requirements of the Contract. The Contractor will be required to perform its work in compliance with Agency technology standards, policies, and procedures, as well as any applicable Federal guidelines. Use of Subcontractors. The Contractor shall be wholly responsible for performance of the entire Contract whether or not subcontractors are used. The Agency reserves the right to reject any named subcontractor or any subcontractor relationship. The Contractor shall not enter into any subcontracts or joint venture arrangement for any of the work proposed under this Contract without prior written acceptance from the Agency. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 4 of 15 General Provisions A. Amendments. Any changes, modi?cations, revisions, or amendments to this Contract which are mutually agreed upon by the parties to this Contract shall be incorporated by written instrument, executed and signed by all parties to this Contract. Applicable Law/Venue. The construction, interpretation, and enforcement of this Contract will be governed by the laws of the State of Wyoming. The Courts of the State of Wyoming shall have jurisdiction over this Contract and the parties, and the venue will be the First Judicial District, Laramie County, Wyoming. Assignment/Contract Not Used as Collateral. Neither party shall assign or otherwise transfer any of the rights or delegate any of the duties set forth in this Contract without the prior written consent of the other party. The Contractor shall not use this Contract, or any portion thereof, for collateral for any ?nancial obligation without the prior written permission of the Agency. Audit/Access to Records. The Agency and any of its representatives shall have access to any books, documents, papers, and records of the Contractor which are pertinent to this Contract. The Contractor shall. immediately upon receiving written instruction from the Agency, provide to any independent auditor, accountant, or accounting firm, all books. documents, papers. and records of the Contractor which are pertinent to this Contract. The Contractor shall cooperate fully with the independent auditor, accountant, or accounting ?rm during the entire course of any audit authorized by the Agency. Availability of Funds. Each payment obligation of the Agency is conditioned upon the availability of government funds which are appropriated or allocated for the payment of this obligation. If funds are not allocated and available for the continuance of the services performed by the Contractor, the Contract may be terminated by the Agency at the end of the period for which the funds are available. The Agency shall notify the Contractor at the earliest possible time of the services which will or may be affected by a shortage of funds. No penalty will accrue to the Agency in the event this provision is exercised, and the Agency will not be obligated or liable for any future payments due or for any damages as a result of termination under this section. This provision will not be construed to permit the Agency to terminate this Contract to acquire similar services from another party. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 5 of 15 Award of Related Contracts. The Agency may award supplemental or successor contracts for work related to this Contract. The Contractor shall cooperate fully with other contractors and the Agency in all such cases. Certi?cate of Good Standing. Contractor shall provide to Agency Certi?cate of Good Standing verifying compliance with the unemployment insurance and workers' compensation programs before and during performing work under this Contract, if applicable. Compliance with Laws. The Contractor shall keep informed of and comply with all applicable federal, state, and local laws and regulations in the performance of this Contract. Con?dentiality of Information. All documents, data compilations, reports, computer programs, photographs, and any other work provided to or produced by the Contractor in the performance of this Contract will be kept con?dential by the Contractor until publicly released by the Agency or until written permission is granted by the Agency for its release. If the Contractor receives a request for information subject to this Contract, Contractor shall notify Agency within ten days of such request and not release such information to a third party unless directed to do so by Agency. Notwithstanding any con?icting provision in this Contract or any attached or incorporated documents, all records and other information pertinent to this Contract are subject to the Wyoming?s Public Records Act, Wyo. Stat.? 16-4-201 et seq. To the extent permitted by law, the custodian of such records may deny access to records in accordance with Wyo. Stat. Entirety of Contract. This Contract, consisting of ?fteen (15) pages, Attachment A, Statement of Work, consisting of forty-eight (48) pages, Attachment B, RFP No. (Final Amended Version), consisting of one hundred ?fty (150) pages, Attachment C, Contractor?s Technical Proposal, consisting of one hundred eighty-?ve (185) pages, and Attachment D, the Business Associate Agreement (BAA), consisting of six (6) pages, represent(s) the entire and integrated agreement between the parties and supersede(s) all prior negotiations, representations, and agreements, whether written or oral. In the event of con?ict in language contained in this Contract and any attachment or other supporting documents, the language in the Contract shall control, with the exception of that contained in Attachment D, the Business Associate Agreement. Ethics. Contractor shall keep informed of and comply with the Wyoming Ethics and Disclosure Act (Wyo. Stat. 9-13-10], et seq), and any and all ethical standards governing Contractor?s profession. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 6 of 15 Extensions/Renewals. Nothing in this Contract will be interpreted or deemed to create an expectation that this Contract will be extended beyond the term described herein. Force Majeure. Neither party shall be liable for failure to perform under this Contract if such failure to perform arises out of causes beyond the control and without the fault or negligence of the nonperforming party. Such causes may include, but are not limited to, acts of God or the public enemy, ?res, ?oods, epidemics, quarantine restrictions, freight embargoes, and unusually severe weather. This provision will become effective only if the party failing to perform immediately noti?es the other party of the extent and nature of the problem, limits delay in performance to that required by the event, and takes all reasonable steps to minimize delays. This provision will not be effective unless the failure to perform is beyond the control and without the fault or negligence of the nonperforming party. Indemni?cation. The Contractor shall indemnify, release, protect, and hold harmless the State of Wyoming, the Agency, and all of their of?cers, agents, and employees from: Any claims for damages or losses arising from services rendered by any subcontractor, person, or ?rm performing or supplying services, materials, or supplies to Contractor in connection with the performance of this Contract. (ii) Any claims for damages or losses caused by negligent acts or willful misconduct, including disregard of State or federal statutes or regulations, by the Contractor, its of?cers, employees, or subcontractors, in the performance of the Contract. Any claims for damages or losses caused by the Contractor, its of?cers, employees, or subcontractors by the publication, translation, reproduction, delivery, performance, use, or disposition of any data processed under the Contract in a manner not authorized by this Contract or by federal or State regulations or statutes. (iv) Any failure of the Contractor, its of?cers, employees, or subcontractors to observe federal or State laws, including, but not limited to, labor laws and minimum wage laws. Any claims for damages, losses, or costs associated with legal expenses and reasonable attorneys? fees, including, but not limited to, those incurred by or on behalf of the State in connection with the defense of claims for such injuries, losses, claims, or damages speci?ed above. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 7 of 15 (vi) Any causes of action or claims or demands arising out of the performance of this Contract by the Contractor, including third party claims. Contractor shall not be responsible for any claim, damage, loss, liability, cost or expense to the extent caused by the negligence or willful misconduct of State of Wyoming, the Agency, or their of?cers, agents, and employees. Independent Contractor. The Contractor shall function as an independent contractor for the purposes of this Contract, and shall not be considered an employee of the State of Wyoming for any purpose. Consistent with the express terms of this Contract, the Contractor shall be free from control or direction over the details of the performance of services under this Contract. The Contractor shall assume sole responsibility for any debts or liabilities that may be incurred by the Contractor in ml?lling the terms of this Contract, and shall be solely responsible for the payment of all federal. state and local taxes which may accrue because of this Contract. Nothing in this Contract will be interpreted as authorizing the Contractor or its agents and/or employees to act as an agent or representative for or on behalf of the State of Wyoming or the Agency, or to incur any obligation of any kind on the behalf of the State of Wyoming or the Agency. The Contractor agrees that no health/hospitalization bene?ts, workers? compensation ands?or similar bene?ts available to State of Wyoming employees will inure to the bene?t of the Contractor or the Contractor's agents and/or employees as a result of this Contract. Nondiscrimination. The Contractor shall comply with the Civil Rights Act of 1964, the Wyoming Fair Employment Practices Act (Wyo. Stat. 27-9-105 et seq.), the Americans with Disabilities Act (ADA), 42 U.S.C. 12101 et seq., and the Age Discrimination Act of 1975 andr?or any properly promulgated rules and regulations thereto and shall not discriminate against any individual on the grounds of age, sex, color, race, religion, national origin, or disability in connection with the performance under this Contract. Notices. All notices arising out of, or from, the provisions of this Contract shall be in writing and given to the parties at the address provided under this Contract. either by regular mail or delivery in person. Information provided by e-mail will be delivered as follows: Agency: Jan Stall Eligibility and Operations Administrator Wyoming Department of Health, Division of Healthcare Financing ian.stall@wvo.gov Phone: 307-777-5472 Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 8 of 15 Contractor: John Crouse Vice President Maximus Health Care Service, Inc. 1515 Wynkoop Street, Suite 400 Denver, CO 80202 iohncrouse@maximus.com Of?ce: 303.285.7168 Mobile: 303.475.4916 With a copy to: Charles K. Sweeney 11, Vice President and Assistant General Counsel Maximus Health Care Services, Inc. 1515 Wynkoop Street, Suite 400 Denver, CO 80202 charlesksweeney??maximus.com Of?ce: 303.285.7557 Mobile: 303.883.8308 Notice and Approval of Proposed Sale or Transfer. The Contractor shall provide the Agency with the earliest possible advance notice of any proposed sale or transfer or any proposed merger or consolidation of the assets of the Contractor. Such notice will be provided in accordance with the notices provision of this Contract. If the Agency determines that the proposed merger, consolidation, sale, or transfer of assets is not consistent with the continued satisfactory performance of the Contractor's obligations under this Contract, then the Agency may, at its option, terminate or renegotiate the Contract. Ownership of Agency owns all documents, data compilations, reports, computer programs (if specified as a deliverable to the Agency, but not including Contractor owned or licensed tools for delivery of the Services, such as but not limited to, the Contractor?s CRM and IVR solutions and tools), photographs, data and other work provided to or produced by the Contractor in the performance of this Contract. Upon termination of services, for any reason, Contractor agrees to return all such original and derivative inforrnation/documents to the Agency in a useable format. In the case of electronic transmission, such transmission will be secured. The return of information by any other means will be by a parcel service that utilizes tracking numbers. Upon Agency?s veri?ed receipt of such information, Contractor agrees to physically and electronically destroy any residual Agency- owned data, regardless of format, and any other storage media or areas containing Such information. Contractor agrees to provide written notice to Agency Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 9 of 15 con?rming the destruction of any such residual Agency-owned data. The foregoing provision does not apply to third party works, products, or materials, or to Contractor Materials. Contractor will retain exclusive ownership of, and all right, title, and interest in and to, all Contractor Materials. ?Contractor Materials? means all discoveries, concepts, and ideas, whether or not they can be registered under patent, copyright, or similar statutes, including without limitation, patents, copyrights, trademarks, trade secrets, processes, methods, formulae, techniques, tools, solutions, programs, data and documentation, and related modi?cations, improvements, and know how, that the Contractor, alone, or jointly with others, its agents or employees, conceives, makes, develops, acquires, or obtains knowledge of at any time before, after, or during the term of the Agreement. If Contractor Materials are included in any deliverables, the Contractor grants the Agency a perpetual, irrevocable, nonexclusive, worldwide, royalty free license to use, execute, reproduce, display, perform, distribute internally, and prepare for Agency?s internal use ?derivative works? as de?ned in the Copyright Act, 17 U.S.C. 101, based upon Contractor Materials. Patent or Copyright Protection. The Contractor recognizes that certain proprietary matters or techniques may be subject to patent, trademark, copyright, license, or other similar restrictions, and warrants that no work performed by the Contractor or its subcontractors will violate any such restriction. The Contractor shall defend and indemnify the Agency for any violation or alleged Contractor violation of such patent, trademark, copyright, license, or other restrictions. The Contractor is not responsible for any infringing materials provided by the Agency or any third party, or for any infringement by the Agency or any third party. Prior Approval. This Contract shall not be binding upon either party, no services shall be performed under the terms of this Contract, and the Wyoming State Auditor shall not draw warrants for payment on this Contract until this Contract has been reduced to writing, approved as to form by the Of?ce of the Attorney General, ?led with and approved by Procurement, and approved by the Governor of the State of Wyoming, or his designee, if required by Wyo. Stat. Proof of Insurance. The Contractor shall not commence work under this Contract until it has obtained all the insurance required below and the certi?cate of insurance has been approved by the Agency and the State. Approval of the certi?cate of insurance by the Agency and the State shall not relieve or decrease the liability of the Contractor. The Contractor shall ?le a Certi?cate of Insurance with the Agency evidencing each type of coverage required. Workers? Compensation and Employer?s Liability Insurance. The Contractor shall provide Agency with a Certi?cate of Good Standing or other proof of workers? compensation coverage for all its employees who are to work on the project described in this Contract. Contractor?s Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 10 of 15 coverage will be under the Wyoming Department of Workforce Services? workers? compensation program if statutorily required or such other private workers? compensation insurance, as appropriate. Non?Wyoming Contractor?s insurance coverage will also include Employer?s Liability ?Stop Gap? coverage, in an amount not less $500,000 per employee for each accident and disease. Any subcontractors used shall also maintain worker?s compensation insurance as is stated herein, and a certi?cate of insurance as evidence submitted. (ii) Commercial General Liability Insurance. The Contractor shall provide commercial general liability insurance coverage, during the entire term of this Contract, against claims arising out of bodily injury, death, damage to or destruction of the property of others, and products and completed operations, premises operations, contractual liability, and personal and advertising injury in an amount not less than $500,000.00 per occurrence and $1,000,000.00 general aggregate. Business Automobile Liability Insurance. The Contractor shall maintain during the entire term of this Contract automobile liability insurance in an amount not less than $500,000.00 per occurrence. (iv) Commercial Crime Insurance. The Contractor shall maintain during the entire term of this Contract commercial crime insurance in an amount not less than $1,000,000.00. Unemployment Insurance. The Contractor shall be duly registered with the Department of Workforce Services and obtain such unemployment insurance coverage as required. Such coverage will be maintained throughout the duration of this Contract. The Contractor shall supply Agency with a Certi?cate of Good Standing or other proof of unemployment insurance coverage for itself. Any subcontractors used shall obtain unemployment insurance as required herein, and proof thereof submitted. (vi) Payment of Premiums and Notice of Revocation. All policies required under this Contract will be in effect for the duration of this Contract. All policies will be primary and not contributory. Contractor shall pay the premiums on all insurance policies which must include a provision for thirty (30) days advance written notice to the Agency of cancellation or non-renewal, except for the professional liability policy. Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. (vii) Agency?s/State?s Right to Reject. The State reserves the right to reject a certi?cate of insurance if the Contractor?s insurance company is widely regarded in the insurance industry as ?nancially unstable. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page of 15 AA. (vii) Subcontractors. The insurance requirements set out above apply to all subcontractors. It is the Contractor?s responsibility to require that its subcontractors meet these insurance requirements. The Agency has the right to review the insurance certi?cates of any and all subcontractors used by the Contractor. (ix) Professional Liability or Errors and Omissions Liability Insurance. The Contractor shall provide a certi?cate of insurance evidencing professional liability insurance or errors and omissions liability insurance for covered claims arising from the Contractor?s alleged or real professional errors, omissions or mistakes in the performance of Contractor?s professional duties under this Contract in an amount not less than $5,000,000. If the policy is a ?claims made? policy instead of an ?occurrence? policy, the retroactive date must precede the start date of this Contract and be maintained continually, or if the policy is not renewed or cancelled, tail coverage shall be obtained and maintained for three (3) years after the Contract expiration date. Publicity. Any publicity given to the projects, programs or services provided herein, including, but not limited to, notices, information, pamphlets, press releases, research, reports, signs, and similar public notices in whatever form, prepared by or for the Contractor, will identify the Agency as the sponsoring agency and will not be released without prior written approval from the Agency. Severability. Should any portion of this Contract be judicially determined to be illegal or unenforceable, the remainder of the Contract will continue in full force and effect, and the parties may renegotiate the terms affected by the severance. Sovereign Immunity. The State of Wyoming and Agency do not waive sovereign immunity by entering into this Contract and speci?cally retain all immunities and defenses available to them as sovereigns pursuant to Wyo. Stat. 1-39-104(a) and all other applicable law. Designations of venue, choice of law. enforcement actions, and similar provisions should not be construed as a waiver of sovereign immunity. The parties agree that any ambiguity in this Contract will not be strictly construed, either against or for either party, except that any ambiguity as to sovereign immunity will be construed in favor of sovereign immunity. Taxes. The Contractor shall pay all taxes and other such amounts required by federal, state and local law, including but not limited to federal and social security taxes, workers' compensation, unemployment insurance and sales taxes. Termination of Contract. This Contract may be terminated, without cause, by the Agency upon 30 days written notice. In the case of a termination without cause, the Agency shall pay the Contractor for all services and deliverables Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 12 of 15 BB. CC. DD. EE. GG. provided through the effective date of the termination, including work in progress and partially completed work; and (ii) any termination related services or deliverables directed or approved by the Agency. Contractor shall not be entitled to payment for work not done, or expenses or costs not incurred; or (ii) for lost pro?ts on the terminated portion of the Contract. If at any time during the performance of this Contract, the work is not progressing satisfactorily or within the terms of this Contract, or the Contractor fails to perform in accordance with the Contract, then at the discretion of the Agency, and after written notice to the Contractor, the Agency may terminate this Contract or any part of it. The notice shall state the defects or de?ciencies in the Contractor?s performance with reasonable speci?city and provide the Contractor with thirty (30) days to cure. If the Contractor cures the defects or de?ciencies within this period, the Contract shall not be terminated. The Contractor will be entitled to a pro rata payment for all deliverables accepted by the Agency as of the termination date; however, the Contractor shall be liable to the Agency for the reasonable additional incremental cost of replacement services above the Contractor?s price if any, for the duration of the Contract term. The Agency shall act diligently and in good faith to mitigate the cost of the replacement services. Third Party Bene?ciary Rights. The parties do not intend to create in any other individual or entity the status of third party bene?ciary, and this Contract will not be construed so as to create such status. The rights, duties and obligations contained in this Contract will operate only between the parties to this Contract, and will inure solely to the bene?t of the parties to this Contract. The provisions of this Contract are intended only to assist the parties in determining and performing their obligations under this Contract. Time is of the Essence. Time is of the essence in all provisions of the Contract. Titles Not Controlling. Titles of sections and subsections are for reference only and will not be used to construe the language in this Contract. Waiver. The waiver of any breach of any term or condition in this Contract will not be deemed a waiver of any prior or subsequent breach. Failure to object to a breach will not constitute a waiver. Performance Measurements. Performance measurements applicable to Contractor under this Contract will not include delays, interruptions, or fault attributable to events of force majeure as de?ned in Contract Section 8.M Force Majeure; (ii) delays or interruptions caused by the Agency or the State, its employees, agents, vendors, or other contractors; or planned outages or downtime for maintenance, repairs, upgrades, and similar circumstances. Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 13 of IS FF. Limitation on Liability. Neither party shall be liable to the other for any damages that were not reasonably foreseeable at the time the parties entered into this Contract or for special, indirect, incidental, consequential or punitive damages. The total liability of the Contractor to the Agency resulting from the Contractor?s breach or non-performance of this Contract is limited to two times the contract price expressed in Attachment A, Statement of Work. The limitation on the Contractor?s total liability shall not apply to indemnity under Section 8N. REMAIN DER OF PAGE INTENTIONALLY LEFT BLANK Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 14 of 15 Signatures. The parties to this Contract, either personally or through their duly authorized representatives, have executed this Contract on the dates set out below, and certify that they have read, understood, and agreed to the terms and conditions of this Contract. This Contract is not binding on either party until approved by the Procurement Services Division of the Department of Administration and Information and the Governor of the State of Wyoming or his designee, if required by Wyo. Stat. 9-2-1016(b) The effective date of this Contract is the date of the signature last af?xed to this page. THE STATE OF WYOMING, DEPA MENT OF HEALTH, DIVISI OF HEALTHCARE FINANCING a/z7/a Dan! a Dat? I org/?L, Geri Green?late Medicaid Agent Date MAXIMUS HEALTH SERVICES, INC. MKWI: area-lav Charles K. Sweeney II, Vice Prebident - Legal Counsel Date ATTORNEY OFFICE APPROVAL AS TO FORM f?M 17f?_ Semor Assistant Att ey General Date information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 15 of 15 MAXIMUS STATEMENT OF WORK May 12, 2016 ATTACHMENT A Maximus Health Services, Inc. Statement of Work Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Provided by: MAXIMUS Health Services, Inc. MAXIMUS Health Services, Inc. 1891 Metro Center Drive Reston, VA 20190 303.285. 7168 This document is a Statement of Work (SOW) to identify and describe important milestones, deliverables and payment structure for the Wyoming Department of Health Customer Service Center (CSC) Contract. The scope includes: 0 Provide Transition Services: The Contractor will work with the Incumbent Contractor to successfully transition the CSC services, any CSC systems owned by the state, documentation, knowledge, and training needs. . Provide CSC Staff and Infrastructure: The Contractor will develop its resource plan and staff the CSC with qualified representatives and management, and provide the hardware and software, such as the Interactive Voice Response (IVR) and Customer Relationship Management (CRM), required to meet RFP Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 1 of 48 MAXIMUS STATEMENT OF WORK requirements and performance expectations. The Contractor will also work with the WES Contractor to integrate required tools and obtain necessary system documentation, training, and assistance. The Agency requires that the Maximus maintain an in-person service location with mailroom operations in a facility located in Cheyenne, WY with overflow call center operations offsite including some part time staff including the policy analyst and the IT specialist. Provide Robust Training and Support for CSC Representatives: The Agency and WES Contractor will work with CSC Contractor trainers to identify the necessary system and policy training components for CSC representative training. The CSC Contractor trainers will be responsible for regular staff training and will also provide staff with the necessary tools and documentation to quickly access system, process, program, and policy information. The CSC Contractor will also be responsible for delivering a comprehensive Knowledge Management (KM) solution that will provide CSC staff access to CSC training materials, WDH policy information, and other pertinent knowledge to facilitate business processes. Provide Customer Service and Eligibility Determination Processing Services: The Contractor will provide call support, disseminate program information to clients, provide application assistance, process applications, renewals, and client changes in the WES, and provide ongoing case maintenance for Medicaid and Kid Care CHIP clients. Due to the complexities of the LTC program, the Agency will maintain the LTC applications and cases throughout the contract, unless new contract terms are negotiated. The CSC Contractor will triage LTC cases to the State LTC Unit for management. Provide Mailroom and Scanning Support: The Contractor will manage all eligibility-related inbound and outbound mail. The CSC will be responsible for triaging requests and scanning documentation into the Agency's integrated EDMS and linked to the appropriate electronic case file reducing paper documentation. All records will be maintained in accordance with record retention requirements. Provide Ongoing Security Management: The Contractor will provide ongoing security management and maintenance related to the CSC, its staff and its use of WES and related components to ensure compliance with Federal and State security rules, including but not limited to HIPAA and HITECH. Provide Business Continuity and Disaster Recovery services: The Contractor will provide business continuity and disaster recovery services for the appropriate systems and tools, in accordance to the agreed upon performance expectations. May 12, 2016 Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 2 of 48 MAXIMUS STATEMENT OF WORK Provide Performance Monitoring: The Contractor will provide performance management and reporting in accordance to the agreed upon performance expectations. Collaborate with the Agency and Designated WES Contractor to Improve the WES: As indicated in earlier sections, the Agency has identified several defects and enhancements to the current WES that will be resolved by the WES Contractor. The Agency expects the CSC Contractor to collaborate with the WES Contractor and Agency to regularly review identified defects impacting the CSC and develop short-term workarounds for issues until they are fully resolved in the system. Partner with the Agency and WES Contractor to Assist in CMS Compliance Needs: The Contractor will meet regularly and collaborate with the Agency and WES Contractor to review status, issues, and potential risks with service delivery and compliance. Work with the Agency as directed to support CMS compliance needs. Assist the Agency in Interpreting Future Federal Policies and Requirements: The Contractor will provide consultation and expertise to Agency liaisons and assist in interpreting future polices and regulations; as well as their impact on the current system and service model. May 12. 2016 Attachment A To the Information Technology (lT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 3 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 The following table shows specific tasks, milestones, completion dates, and estimated prices. Contractor will perform forty-eight (48) months of CSC Operations with a contract end date of September 30, 2020. This includes work to transition and operate the CSC. The Contractor will pursue all options to complete this project on schedule and within the quoted costs. Payments of invoices will be based upon the Contractor meeting the stated deadlines for deliverables and upon the Agency?s acceptance of the proposed deliverables. All dates in this Statement of Work assume a Contract award and a Contract Effective date not later than July 1, 2016. If either the Contract award or the Contract Effective Date is after July 1, 2016, all dates will be extended day for day for the delay, unless the parties othenivise agree in writing. ESTI MAT- ER I IN EN RITE DELIV ABLE ED DATE PR ERAL ACCEP ANCEC RA Kick-Off Meeting The CSC Contractor will participate in a kick- Agency participation in kick-off meeting and off meeting that will focus on the way to 715/2016 $0.00 agreed upon approach to speci?ed Items. successfully the CSC and effective Deliverables acceptance form Signed off after use the WES system using appropriate call successful meeting. center and IT technology practices. Agency review of the Project Plan in accordance with the de?ned required content that is reasonable and creates a strategy for meeting the scope of work for the project. Project Management Tools and Plans The CSC contractor will document how they will successfully manage and execute the 7/11/2016 $0.00 Any mutually agreed approaches and/or scope of work including the development of changes have been implemented. Any Sta rt-Up a CSC speci?c transition baseline and approach and/or changes not accepted by the Phase operations related resource plan, Agency have been removed. Deliverables communication plan, risk management plan acceptance form signed off. and quality assurance plan Overall process for the development and submission of deliverables that meet the needs of the project including review times. Contents to be de?ned during the startup Deliverable Review and Acceptance Procedures 7111/2016 $0'00 phase. Each deliverable will have a relevant Overall process for the development and evrew of speCI?c acceptance cntena submission of deliverables that meet the developed by the Contractor. After needs of the project. review, acceptance form signed off. Review design and frequency for project communication. ls easy to read both Status Reports 7/1 ?2016 $000 electronically as well as hardcopy. Especially important is transition related activities and Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, inc. Page 4 of 48 MAXIMUS STATEMENT OF WORK May 12. 2016 . . . impediments that quickly need to be Provude regular status reports and transutlon . . . . . addressed. After successful revrew, actuvrties, during the transition phase. acceptance form signed off. Start-up Related Meetings Attend and participate in all start-up related It -- meetings as requested by the Agency to aid 7/11/2016 $0.00 As nec ssary to success transution the . . ystem. in the collaboration between all relevant parties Review of C50 Related System Documentation Provide an update and identi?cation of Review of current system documentation 7/25/2016 $0 00 existing resources that could be re-used. After review current user training, WES Wise meeting and successful review, acceptance documentation and state policies to clarify form signed off. de?ciencies. All Acceptance Documents Completed and End of Start up Phase 7I25I2016 $0.00 signed off DELIVERABLE ESEXTAETED GENERAL ACCEPTANCE CRITERIA Transition Plan Develop a detail transition plan that shall include the following: Approach and timeline for transition; Approach for conducting a WES 8/6/2016 $0 00 Complete and detailed plan. After successful knowledge transfer from the Incumbent review, acceptance form signed off. Contractor to the new Contractor; Tasks and activities for transition; Transition milestones (e Transition of policy knowledge Infrastructure Plan Completed plan After successful review Transition Document the technical infrastructure and 8/5/2016 $0.00 acceptance form signed off. locations of the Infrastructure Phase Collaboration Plan Develop methodologies for collaboration and 8/6/2016 $0 00 Completed plan. After successful review, sharing of knowledge between the Agency acceptance form signed off. and the WES Contractor. Technical and Functional Collaboration Meetings. Participate in functional collaboration All notes are captured, maintained and meetings as requested by either the Agency On-going in distributed. Notes become part of the project or the WES Contractor. The purpose of Transition $0.00 communication. First meeting should be held these meetings is to quickly resolve key Phase no later than August 6, 2016. After successful technical issues that arise by assembling the review, acceptance form signed off. appropriate Agency and Contractor staff to understand and resolve the issue. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, inc. Page 5 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Establish Facilities and Install CSC Tools 8/13/2016 $0 00 Review of plan. After successful review, IVR, CRM, KM and other tools acceptance form signed off. CSC Transition System Testing Plan Docufment thelapproach to CSC swim and Report to the Agency the results of all CSC ?Wt/0m Prepai?"?" 0i 8/20/2016 $0.00 System and functional tests. After successful transmon. Operational Readiness and review acceptance form signed off. Operability Testing including objective measures to determine readiness for CSC transition. WES Contractor Train the Trainer 5955?" Attendance Provide a list of trainings and attendees with Provide functional Agency and CSC users 9/16/2016 $0.00 training materials, PowerPoints, etc used for with appropriate training to be able to the session. navigate and ef?ciently use WES. The necessary existing CSC documentation and any newly created CSC operational Staff Training Materials, guidance shall be created, reviewed and Orientation and Final Training 9/16/2016 $000 training on the speci?cs of the operations of the CSC should be complete and documented. Completion of the knowledge management Knowledge Management Implementation, 9/16/2016 $0 00 implementation and any data conversion from Data Conversion and Testing the incumbent/current system documented in a report. Operational Readiness Conduct with the Agency the Operational Readiness Successful . . . completion of the will provide Develop comprehensrve readiness CheCkl'St 9/23/2016 $0.00 acceptance to transition on September 30, and 99mm with the Agemyt .599 by Step 2016 and the end of the Transition Phase. demonstration Of all items. Agency will approve checklist and operational readiness results. Conclusion of the hand-off of all in-process Hand-off of Pending Client Activities 9/30/2016 $0.00 work and prompt noti?cation of the Agency via email. End of Transition Phase 9I30I2016 $0.00 ??mp'eted and srgned off DELIVERABLE ESTIMATED GENERAL ACCEPTANCE CRITERIA DATE Operations and Maintenance Status Operations Report Provide CSC operations and maintenance and Maintain confidentiality of citizen data and Ongoing $240,000.00 that demonstrates compliance with Maintenance the integrity and availability of the CSC Service Level Agreements. implemented tools in compliance with the Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 6 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 SLAs Completion of the operation plan of the CSC . in compliance with Wyoming policies, in Operational Procedures Plan 10/1/16 $100,000.00 alignment with WES functions, and with Service Level Agreements. Operational Manual and Process Guides Manual Will have suf?CIent detail to allow the productive use of the system. Manuals are to be updated no less than in the event Ongoing $250,000.00 of a functional change. Manual updates will be reviewed and the Agency sign the acceptance form when the manual is appropriately updated CSC Operations Ongoing $15,733,520.00 Operations in compliance with the SLAs. Reporting Provide the required reporting timely, as Provide the reports speci?ed in the RFP Ongoing $735,000.00 needed by the Agency, and in compliance under Operations. with the SLAs. Proof of the establishment or usage of an Establish Toll-free Telephone Line Ongoing $500,000.00 existing telephone line and continuous availability. Implement Customer Satisfaction Ongoing $55,000.00 Demonstration of the Implementation of Surveys customer satisfaction surveys. Corrective Action Plan Issues affecting CSC should be identi?ed and Continuously monitor for issues/defects and Ongoing $250,000.00 a corrective action plan created when correct defects identi?ed by the Agency negative impacts are evident in the CSC. and/or Contractor. Contractor shall look for ways to maximize the effectiveness of all of the CSC operations to . . . . $250,000.00 equate a higher service performance level of CSC Optimization Assessment Ongorng state citizen. Written recommendations for review by the Agency with corresponding level of effort and impacts for implementation. End of Operations and Maintenance 9130/2020 $18,113,520.00 Amman? D9cuments ?mm? and signed off Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 7 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 PHASE DELIVERABLE GENERAL ACCEPTANCE CRITERIA Development of a detailed system turnover Turnover System Turnover Plan Ongoing $0.00 plan. After successful review acceptance form Phase signed off. Supply to the Agency all CSC documentation, including functional speci?cations, operational CSC data and all current documentation Ongoing $0.00 procedures and implementation details of CSC tools. After successful review acceptance form signed off. Agency staff training, to include a) CSRC processes and procedures; Schedule and documentation of all CSR Administrative processes and procedures; Ongoing $0.00 process and procedures. After successful and Review of application backlog and plan review acceptance form signed off. to resolve, if applicable All Acceptance Documents Completed and End of Turnover 9/30/2020 $0.00 signed off Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 8 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 The total payment under this Contract will not exceed nineteen million, three hundred and eighty-one thousand, four hundred and sixty-six dollars The base contract amount is eighteen million one hundred thirteen thousand, five hundred and twenty dollars with the difference of one million two hundred sixty-seven thousand, nine hundred forty-six dollars of potential incentive payments based on all SLAs are meet and exceeding those SLAs identi?ed for the incentive. Payment will not begin until the Contractor enters the Operations Phase. Upon entering the Operations Phase, Contractor will be paid a fixed amount dependent upon the Contract meeting performance measures (penalties) and any incentive if applicable. This is a ?rm fixed price contract. That does not allow for adjustment unless there are material changes to scope and/or volume. For example, if the call volume falls below 8,000 calls per month for a period of 6 months based on actual volume not averaged volume or the call volume is 12,000 calls per month or more for a period of 6 months based on actual volume, not averaged volume, the Agency and Maximus will re-evaluate the relevant pricing for such metrics. The Agency anticipates application volumes to be between 1,000 - 2,000 per month; include paper, phone and walk-in applications. The Contract shall be renegotiated if the volume changes by 20% or more for a period of six (6) consecutive months. The Agency anticipates the renewal volumes to fall between 2,000 3,000 per month; include paper, phone and walk-in applications to renew. The Contract shall be renegotiated if the volume changes by 20% or more for a period of six (6) consecutive monthsPricing. Elements Transition Transition Price $0.00 00-.0 .0 . -. .o ?00- Pricijg? Elements Year 1 Year 2 Year 3 Year 4 Fixed Price $377,365 $377,365 $377,365 $377,365 Annual Fixed Price $4,528,380 $4,528,380 $4,528,380 $4,528,380 - 3 - 0-0 . - Pricing Elements Year 1 Year 2 Year 3 Year 4 All Inclusive Bended $65 $65 $65 $65 Hourl Rate for Chan- Total (excluding incentive Payments) Total $18,113,520 Possible Incentive Payments Year 2 Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 9 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 $316,986.48 $316,986.48 $316,986.48 $316,986.48 [mm??l'iirezia 17-49? .1911 if 1111831800 [313.52% ll 81301183330102 Draft Estimated Invoicing Schedule (Not including Potential Incentive) '1 Emir-.1215; 1291:: 7.1371 . 1 10/1/2015 $100,000.00 Operational Procedures Plan 1 $100,000.00 CSC erations and Maintenance Billin 2016/2017 $4,428,380.00 Oct Sec 2016/13" Sep 2017 (X) 2 to 13 $369,031.67 CSC Operations and Maintenance Billing Oct - Dec 2017/Jan - Sep 2018 (X) CSC Operations and Maintenance Billing Oct - Dec 2018/Jan - Sep 2019 (X) CSC Operations and Maintenance Billing Oct - Dec 2019/ Jan - Sep 2020 (X) 2017/2018 $4,528,380.00 14 to 25 $377,365.00 2018/2019 $4,528,380.00 26 to 37 $377,365.00 38 to 49 $377,365.00 2019/2020 $4,528,380.00 7 IV .1390? Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 10 01?48 MAXIMUS If Maximus meets all SLAs defined in the SOW, Maximus will receive an incentive payment if Maximus also exceeds the average criteria defined for SLAs 15set forth in the Incentive SLAs table below. The incentive percentage will be determined by the Incentive Payment Matrix table below and based on the invoice amount excluding specific deliverables (Operations Plan) and is not applicable to project change orders. The Contractor will receive the incentive payment each month if all SLA requirements are met and the identi?ed SLAs are exceeded by the necessary STATEMENT OF WORK margin for that month. Incentive SLAs Qualifying Excellence Criteria May 12, 2016 SLA ID Description Minimum Excellence Criteria 15 Training 85% score Greater than 90% 33 Call Wait Times(Speed Less then (10) minutes Six (6) minutes or less to Answer) for more than 95% of for more than 95% of calls calls 39 First CSR Contact 75% Greater than 83% Resolution hence not requiring any additional interaction to meet the clients need. 43 Client Satisfaction 80% of respondent 88% client satisfaction Assessment client satisfaction rating rating 4 or higher 4 or higher 88% report that they 80% of Respondents connect with a CSR on report that they connect the ?rst call with a CSR on the ?rst call 55 Security Incidents 1O incidents per year related to reportable to affecting no more than PII and PHI as de?ned in 15 people. 0 incidents per month. BAA. Incentive Payment Matrix Incentive One SLA Two SLAs Three SLAs Four SLAs Five SLAs Eligibility Meets Meet Meet Meet Meet Excellence Excellence Excellence Excellence Excellence Criteria Criteria Criteria Criteria Criteria Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 11 of 48 MAXIMUS STATEMENT OF WORK May 12,2016 Service Level Agreements and associated penalty relevant to transition are in effect at the execution of the Contract. Service Level Agreements and associated penalty, with the exception of SLAs related to availability and security, will not be in force until January 1, 2017. Total penalties in any month shall not exceed 10% of the amounts payable to Contractor in that month. This limit shall apply beginning with the first full month of operations. 1 Transition "Transition Work closely and participate in at least two (2) meetings a week with the Agency, Incumbent Contractor, and C80 Contractor to broker through issues. Meetings may be required more frequently if determined necessary by the parties. $100000 penalty per missed meeting applicable to the defined two meetings per week. The penalties are not applicable if parties agree to cancel a meeting. Contractor personnel may attend meetings via phone. 2 RESERVED 3 Transition Deliver weekly status reports detailing all changes, issues, hours and questions regarding the Incumbent Contractor and its operation of WES and current 080 (per the requirements in RFP Appendix A). Due the Monday morning the following week by noon. If Monday is a holiday then by noon the next day, Tuesday. $500.00 penalty per occurrence. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 12 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 4 Transition Track and provide a weekly transition report and a Final Report for Agency approval. As defined in the RFP, the report will include status of all Transition milestones, hours expended and staff available for Contractor's transition activities. Due the Monday morning the following week by noon. If Monday is a holiday then by noon the next day, Tuesday. $100.00 penalty per missed occurrence. 5 Transition Successful completion of the Operational Readiness criteria by close of business 90 Days from Contract Effective Date or Contract award date, whichever is later (the ?Completion Date?). Penalties will not be assessed if the Operation Readiness criteria are not successfully completed on Day 1 and Day 2 after the Completion Date. After Day 2, a $10,000.00 per day penalty will be assessed until the Operational Readiness criteria are successfully completed. The Contractor will develop the Operational Readiness criteria, subject to Agency approval. If the Contractor does not begin providing the Services as scheduled, the payments to the Contractor will be reduced pro-rata on a daily basis for each day of delay, unless othenivise agreed in writing. 6 RESERVED i?a-r .- Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 13 of 48 MAXIMUS Availability STATEMENT OF WORK 99% excluding planned downtime $1,000.00 penalty per tool if average availability falls below 99%. This penalty is not applicable if the availability is not met due to factors outside of the Contractor?s network or control. May 12, 2016 Maximum Down Time and Updates 1% excluding planned downtime. See SLA 7 IVR Data Response Time Data received from IVR will be user accessible within three (3) seconds at least 99% of the time. $1,000.00 penalty if average user accessibility falls below 99%. This penalty is not applicable if the response times are not met due to factors outside of the Contractor?s network or control. The parties will agree on a reasonable method to measure IVR Data Response Time. 10 CRM Response Time Data received from CRM will be user accessible within three (3) seconds at least 99% of the time. CRM response time must average two (2) seconds or less. No individual response shall exceed ten (10) seconds. $1,000.00 penalty per month if average user accessibility falls below 99%. This penalty is not applicable if the accessibility times are not met due to factors outside of the Contractor?s network or control. The parties will agree on a reasonable method to measure accessibility. $500.00 penalty per day, if CRM average response time is above 3 seconds or individual responses are taking more than 11 seconds. 11 CRM Database Response Time Response time for adding, updating, or deleting data shall not $500.00 penalty per day if response time exceeds 4seconds. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 14 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK exceed three (3) seconds. This penalty is not applicable if the response times are not met due to factors outside of the Contractor's network or control. The parties will agree on a reasonable method to measure response times. May 12, 2016 12 Planned Down Time for CSC Tools (IVR, CRM, KM) Updates shall be made outside of normal working hours, which are 7:00 AM to 6:00 PM, MT, Monday through Friday, with the exception of State Observed Holidays, or at times agreed to by the Agency. Planned downtime shall not exceed five (5) hours per month. See SLA 7 all planned downtime time must be approved. 13 Noti?cation of Downtime for CSC Tools Planned downtime due to scheduled upgrades or routine maintenance shall be communicated to WDH Vendor and Contract Manager, via email, seven (7) business days prior to downtime. Notifications will be sent to Agency users, via email, five (5) business days prior to the planned outage notifying them of the planned downtime. Notifications will be provided to the WES Contractor to be posted on the Client Web Portal users ?ve (5) business days prior to the planned outage notifying them of the planned downtime. All planned downtime will be arranged and approved in advance. $500.00 penalty per day if users are not notified per the SLA. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 15 of 48 MAXIMUS STATEMENT OF WORK The foregoing SLA does not apply to emergency repairs. May 12. 2016 14 Training 100% of CSRs will be tested on general policy and workflow knowledge and receive a score of 85% or h_igher. Approval of policy test by the Agency. This does not have associated penalties however is a critical factor in incentive payments. 15 16 Reporting Mailing CSC Standardized Reporting from CSC tools will be available 99.9% of the time. CSC Reports templates from CSC tools and creation of ad hoc reporting will be available 99.9% of the time. All notices queued and received by Contractor not later than 8 AM Mountain Time from the previous day?s activities shall be printed and mailed by the following business day. $100 penalty per report for any reports that are not provided by the date due as agreed by the parties. The parties will agree on details of each hoc report. Agency will allow Contractor to shift resources from other work and provide relief from other contract requirements as necessary to allow timely responses to ad hoc reports. Contractor will provide Agency the estimated time to respond based on technical limits and constraints. lf notices are queued and available for printing and the CSC equipment, network or other factor prevents the printing of the notices a penalty of $500.00 per batch ?le will be assessed. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 16 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK May 12, 2016 Closure Notification must be mailed fifteen (15) days prior to the end of the month Renewal Notification must be mailed forty-five (45) days prior to the renewal date 17 Document Imaging 95% of all documents The penalty assessed for received must be not meeting the 95% scanned into the scanning requirements will system within one (1) be $500.00 per late business day. The scanning occurrence. remaining 5% of documents must be scanned within two (2) business days. Scanning accuracy must be verified within 1 days of scanning. 18 Disaster Recovery The IVR, ACD, and $5,000.00 penalty per day CRM will be available if CSC tools are not using an Agency- available for use within approved disaster twenty-four (24) hours. recovery site, within twenty-four (24) hours. This penalty shall not apply if the Agency-approved disaster recovery site is not available due to a disaster. 19 Annual Disaster Executive-level test $500.00 penalty per each Recovery Plan results summary shall day late. Testing be submitted to the Agency within ten (10) days of test completion. Commencement of testing will be agreed by the parties. 20 Backup and Retention 99% of backups and $1,000.00 penalty per day Expectations for CSC retention standards until correct backup is Tools shall be performed completed, if backups are accurately and as not created and retained as scheduled. scheduled. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 17 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK Daily backups with retention of sixty-one (61) days. Weekly backups with retention of nine (9) weeks. backups with retention of eighteen (18) months. Annual backups with retention of seven (7) years or contract termination, whichever comes first. May 12. 2016 21 EmergencyICritical Priority Issues: Multi- agency outages or critical Agency outage. Severe security andlor financial implications to the Related to CSC Tools only. Communication to Agency: 0 Thirty (30) minutes Resolution or plan for resolution: One (1) Hour Contractor to document emergency services and service restoration order. A CSC Designee to document updates. CSC Manager will provide Agency with updates, status reports, and notification of expected delays. The CSC Designee?s documentation suspended until resolution. Contractor shall notify Agency. Agency emergency requests require that an Agency contact be available to Contractor at all times. Updates to Agency every hour, or as Agency requests. $5,000.00 penalty per day after day one (1 if emergency issues are not mitigated or resolved per the SLA. Attachment A To the information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 18 of48 MAXIMUS STATEMENT OF WORK 100% Emergency lssues will be mitigated within two (2) hours of communication of issue to the Agency. May 12. 2016 22 Urgent Priority Issue Resolution Related to CSC Tools only. Serious disruption to Agency business that affects up to 15% of the Agency/CSC users. Serious security and/or financial implications to the Agency/State is defined as a HIPAA Breach affecting fifteen (15) or more individuals or estimated financial impact costing more than $5,000.00 dollars. Communication to Agency: One (1) hour Resolution or plan for resolution: Four (4) hours CSC Designee to document updates to CSC Manager. CSC Manager will provide Agency with updates, status reports, and notification of expected delays. Agency notification by CSC Manager. Updates to Agency every two (2) hours or as Agency requests. 90% of Urgent Priority issues will be resolved within four (4) hours of communication of issue to the Agency. $3,000.00 penalty per four (4) hours if urgent priority issues are not resolved. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 19 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS 23 Normal Priority Issue Resolution Related to CSC Tools only STATEMENT OF WORK Affects small number of users. Causes inconvenience for an Agency or delays agency business without significant loss of productivity, were there is a workaround and it affects less than 15% of the Agency/CSC users. Prevents use of a fully supported service by the Agency or individual. Communication to Agency: Within four (4) hours Resolution or plan for resolution: Three (3) business days 85% of Medium Priority issues will be resolved within three (3) business days of creation. $500.00 penalty per business day after day three (3) if medium priority issues are not resolved. $500.00 penalty per day four (4) through seven (7) and $1,000.00 each day after day seven (7). May 12. 2016 24 Low Priority Issue Resolution Related to CSC Tools only Related to CSC Tools only Problem concerning minor items, i.e. document formatting. Prevents use of non- supported service by the Agency or individual. Communication to Agency: One (1) business day Resolution or plan for resolution: Five (5) business days. 85% of Low Priority issues will be resolved within ten (10) business days of creation or receipt. $500.00 penalty per business day after day ten (10) if low priority issues are not resolved. $1,000.00 penalty per day after day twenty (20). Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 20 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 25 Call Response Times Time to AnswerIAbandonment A maximum abandonment rate of Abandonment rate is defined as the percentage of users who after making the selection from the IVR menu to speak with an agent, disconnect the call prior to CSC interaction. Confirm IVR selection to talk to a person and not self- service options. An individual or electronic device answers 100% of calls, without receiving a busy signal, within three (3) telephone ?ngs. If abandonment rate is above 5% but less than 9% based on an average calculation the vendor will be assessed a $2,500.00 penalty per month. If abandonment is above 9% then the penalty will be $5,000.00 per month. 26 Call Wait Time Message The IVR shall provide a message prompt when call wait time exceeds 240 seconds (four (4) minutes) on greater than 99% of calls. Message prompt will notify the caller of the expected wait time. No penalty. 27 Call Wait Times (Speed to Answer) Call wait times, speed to answer, shall not exceed ten (10) minutes for more than 95% of calls. If 5% or more of the calls exceed ten (10) minutes, a $5,000.00 penalty will be assessed per month. 28 Placed on Hold Call Times 100% of calls placed on hold by CSC staff will not exceed four (4) minutes. The maximum time a caller is put on hold before CSR checks back with the caller is four (4) No penalty. Attachment A To the information Technology (IT) Contract between the State of Wyoming, Department of Page 21 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK minutes for greater than 99% of calls. May 12, 2016 29 Average Handle Time (AHT) Using the first three (3) months of AHT as a benchmark, the average CSR AHT shall not increase more than 10%. Any exceptions due to addition of new programs or processes requiring a discussion with the client for consideration of approval by the Agency. . Pre- approval is not always obtainable. AHT (Total Talk Time Total Hold Time Total After Call Work) Divided Number of Calls Handled $100.00 penalty per day after the 3rd day if the average handle time exceeds the calculated average handle time. 30 Client?s Voice Mail Returns 95% of the time Contractor Staff will return calls within (1) business days of receipt which will be documented in the CRM. The 080 will make a total of two (2) attempts to reach the client or leave a message. $500.00 penalty per occurrence when 15't attempt is not made within one (1) business day. 31 First CSR Contact Resolution Client questions and concerns are resolved 75% of the time upon first contact with the CSR. Critical to incentive payment, 75% ?rst time contact. The parties will mutually agree on reasonable measurement method Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 22 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK during startup. May 12, 2016 32 Call Documentation 99% of all calls are documented in the CRM as validated by the QA sample. No penalty. 33 Quality Metrics and State Policy Accuracy All eligibility determinations by the Contractor shall maintain a 99% policy and procedure accuracy. Monitor the process as defined in the CSC Contractor?s Quality Assurance lQuality Monitoring Plan. The Contractor?s Quality Assurance [Quality Monitoring Plan shall address the following CSR responsibilities: Properly update system Case log and addresses; Provide accurate information to clients or to the Agency staff; Properly redirect callers; or Print and mail materials within twenty-four (24) hours of triggering a notification. . Follow State policy to accurately determine eligibility. $1,000.00 penalty per incorrect eligibility determination below the 99% level based upon CSC QC statistics, Medicaid QC Units statistics or Agency. 34 Client Satisfaction Assessment Survey no less then every ?10th caller to rate the quality, timeliness, and other service delivery elements carried out by the Critical to incentive payment. $1,000.00 penalty per month when the average satisfaction score falls To the Information Technology (lT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Attachment A Page 23 of 48 MAXIMUS 36 Ability to Speak with CSC Representative on First Attempt Calls Escalated to Agency STATEMENT OF WORK CSC. Greater than an average 80% of client responses shall rate the CSC four (4) or higher in all categories. Customer quality satisfaction criteria is rated on a scale of one 1) to five (5) where one (1) being least satisfied and five (5) being most satisfied. 80% of client responses shall report that they were able to speak to a CSC Representative the first time that they called. The ratio of calls escalated to the Agency with a complaint or problem that a CSC supervisor couldn?t address should not exceed ten (10) calls per month, unless it is within 1 month of a significant (affects more than one program or more than 1,000 clients) policy change. Applies to complaints or problems that Contractor should below four (4). Penalties shall not apply to the first 4 months of operations during which the Contractor will ramp up its processes. May 12, 2016 $1,000.00 penalty per month when average percentage for the survey question ?was the client unable to speak to a CSC Representative the first time they called,? falls below 80%. Penalties shall not apply to the first 4 months of operations during which the Contractor will ramp up its processes. After the first six (6) month period of Operations, the Agency reserves the right to implement a consulting fee of $150.00 per occurrence when required to assist the CSC with resolving complaints or problems related to eligibility. This fee will be deducted from the invoice in which the case was finally resolved. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 24 of 48 MAXIMUS STATEMENT OF WORK have been able to answer based on its training and procedures. May 12, 2016 37 In Person Wait Times Clients are greeted in less than two (2) minutes and signed in If the sign-in area is crowded, Clients will be offered the option to wait or to return at a later time. Clients meet with a CSR 15 minutes or less from the time of sign-in. $1,000.00 penalty per month when the average wait exceeds fifteen (15) minutes. 38 Distribute Long Term Care Documents 99% of the time Contractor Staff will deliver all LTC documents to the LTC Unit within two (2) business days of receipt. $500.00 penalty per day, after the second day, for any late delivery of documents to the LTC Unit. 39 Process Applications 99% of applications will be processed within thirty (30) days of receipt, when all applicant?required fields are complete and all verifications are included for processing. For applications requiring additional information the CSC will be given an additional ?fteen (15) days from the time the missing information is provided by the client. $500.00 penalty per application for any application not processed within 30 days of receipt, if no additional information is necessary for the processing. $500.00 penalty per application for applications not processed within fifteen (15) days of receipt of missing information. Cumulative penalties under SLA 39 will not exceed $5,000 per month. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 25 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS 40 Process Renewals STATEMENT OF WORK 99% of renewals will be processed at least sixteen (16) calendar days before the end of the month when the renewal and necessary verifications are received by the 5th calendar day of the month. For renewals requiring additional information, the CSC will be given an additional ten (10) days from the time the missing information is provided. May 12. 2016 $500.00 penalty per renewal for any renewal not processed within sixteen (16) calendar days before the end of the month, if no additional information is necessary for the processing. Cumulative penalties for renewals under SLA 40 will not exceed $10,000 per month. $500.00 penalty per renewal for renewals not processed within ten (10) days of receipt of missing information. 41 Security Incidents No more than ten (10) incidents affecting no more than fifteen (15) clients per incident per State Fiscal Year. In the event that more than ten (10) incidents occur when fifteen (15) people or more are affected, the Contractor shall be responsible for associated costs such as call center costs, credit reporting, publications, and media centers. $1,000.00 penalty for each security incident caused by Contractor performance of the Contract that affects fifteen (15) people or more. For security incidents that affect less that ?fteen people, the penalties do not apply to the first 10 security incidents. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 26 of 48 MAXIMUS STATEMENT OF WORK 0% of aggregated security incidents affecting 500 or more clients per State Fiscal Year. For any Security incidents affecting population of 500 or more clients, the Contractor will receive sanctions, if any, determined by Of?ce Civil Rights (OCR) and be responsible for OCR and other associated costs such as call center costs, credit reporting, publications, and media centers. A security incident is defined as a Contractor failure to handle HIPAA Protected Health Information (PHI) in compliance with the following provisions of the Business Associate Agreement. 1) Section 3 A - Contractor shall not create, receive, maintain, or transmit protected health information in a manner that would violate any provision of the Privacy and Security Rules, or other applicable federal, state, or local law. 2) Section 3 - Contractor shall establish, use, and maintain administrative, May 12, 2016 Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 27 of 48 MAXIMUS STATEMENT OF WORK physical, and technical safeguards to protect the confidentiality, integrity, and availability of all protected health information that the Business Associate creates, receives, maintains, or transmits on behalf of the Agency and to prevent any use or disclosure of protected health information as provided by this attachment. 3) Section 3 Contractor shall comply with Subpart of 45 CFR Part 164 with respect to electronic protected health information. For purposes of this SLA and reporting, a security incident does not include any attempted unauthorized access that was not successful. May 12, 2016 42 Audit Records Review 50% of all security- related logs must be audited annually by the Contractor, and provide the results to the Agency. $5,000.00 penalty will be assessed when less than 50% of all security-related logs are audited annually. The parties will agree on reasonable audit processes during the startup phase. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 28 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS 43 Audit Records Related to an Incident STATEMENT OF WORK 99% of related logs to an incident must be reviewed. If 99% of logs related to an incident are not reviewed and a summary of what logs were reviewed and findings within thirty (30) calendar days a penalty of $2,500.00 will be assessed. The parties will agree on reasonable audit processes during the startup phase. 44 Compliance with Applicable Regulations 100% compliance with all applicable State and Federal rules, regulations, and policies on which the Contractor has been trained by the Agency. $200.00 penalty per occurrence based upon CSC QC statistics, Medicaid QC Units statistics and Agency review. 45 Risk Assessment (POAM) 0% of vulnerabilities without documented mitigation or Agency approved risk acceptance. All vulnerabilities of a critical or major impact must be shared with the Agency through a Plan of Actions and Milestones (POAM) quarterly by the 5th day of the ending month of the quarter. $1,000.00 penalty for late receipt of the POAM. 46 Physical Security Incidents 0% of incidents where unauthorized access to secure areas is gained. $1,000.00 penalty per occurrence. 47 Training Conduct HIPAA training with all new hires prior to working with client data. New hires are not permitted to work with client until trained. $5,000.00 penalty per occurrence of new Contractor employees having access to client data before successful completion of HIPAA and security training. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 29 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, inc. MAXIMUS STATEMENT OF WORK Conduct annual ongoing HIPAA and security training with Contract staff. Training materials must be approved by the Agency. $1,000.00 penalty per Contractor employee per day late receiving annual HIPPA and security training. The 13th month is excluded from the penalty. May 12. 2016 - 48 State Deadlines Tasks must be $500.00 per day if tasks completed by Agency are not completed by imposed deadlines agreed deadlines. including, but not limited to, additional The parties will agree on spreadsheets, tracking details of each Task. mechanisms, and Agency will allow reporting. Contractor to shift resources from other work and provide relief from other contract requirements as necessary to allow timely responses to Task requirements. Contractor will provide the Agency estimated time to respond based on technical restraints. Work will be delivered by the mutually agreed upon milestones provided in the Project (Work) Plan. 49 Status Reports $500.00 penalty per day if status reports a status report is delivered five (5) delivered after the fifth business days prior to business day. the scheduled status meeting. 50 Accurate Billing 100% of invoices are $200.00 per occurrence of billed accurately meaning that they accurately represent the agreed upon incorrect invoice. No pena?y Attachment A To the Information Technology (lT) Contract between the State of Wyoming, Department of Page 30 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services. inc. MAXIMUS STATEMENT OF WORK invoices per the Contract and accepted by the Agency. May 12. 2016 51 Staff Resource Management No more than two (2) staff turnover for the Operations Manager position per year. A qualified interim substitute must be in place within two (2) weeks after the termination date. The definition of a qualified substitute is having experience in the position, meeting the requirements of the position and understanding of the Wyoming Customer Service Center. Contractor shall have 60 days to fill the Operations Manager position. $2,500.00 penalty per occurrence if the interim Operations Manager position is un?lled for more than two (2) weeks. 52 Staff Resource Management Any Key Personnel position may not be open for more than two (2) weeks without a qualified interim substitute. A qualified interim substitute must be in place within two (2) weeks after the separation date. The definition of a qualified interim substitute is having experience in the position, meeting the requirements of the position and understanding of the Wyoming Customer Service Center. $1500 penalty per occurrence of an open Key Personnel position that is not filled with an interim person within two (2) weeks. Contractor shall have 60 days to fill the Key Personnel position. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 31 of 48 MAXIMUS STATEMENT OF WORK Key Personnel positions are Training Manager, IT Specialist, Manager, Reporting Analyst, Consulting Policy Analyst and Mailroom Lead. May 12, 2016 53 CSC Management Availability by Person 100% during emergencies, with a two (2) hour expectation for response. $500.00 penalty per occurrence when emergency response time exceeds two (2) hours. Agency must use the call escalation list provided by Contractor. 54 Response to Agency Requests 100% of the time CSC Contractor Staff will respond to written via email or hard copy) inquiries/requests coming from Agency to the CSC Manager and Project Manager, within two (2) business days; responses will include information informing the Agency that the request has been received and the length of time it will take to process. $500.00 per occurrence of failure to respond in writing within two (2) business days. 55 Response to Other Written Requests 95% of the time Contractor Staff will research and respond by email or phone call to written email or hardcopy) correspondence coming from Providers, Clients, Client Advocates or DFS Of?ces within two (2) business days of the CSC receiving the correspondence. Vendor will maintain a log of all written $500.00 per occurrence when response exceeds two (2) business days. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 32 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK requests and provide to Agency upon request. May 12, 2015 56 Medicaid Hearing Response Respond to Medicaid Hearing requests for research and information, including accuracy of determination decision and escalate to State staff within forty-eight (48) hours of the request. $500.00 penalty will be assessed per occurrence if response exceeds forty- eight (48) hours. Attachment A To the information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 33 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Below is a list of terms and definitions that apply to the WES project. Term De?nition ABD Age, Blind or Disabled ACA Patient Protection and Affordable Care Act Agency Wyoming Department of Health American Recovery and The American Recovery and Reinvestment Act of 2009, Reinvestment Act (ARRA) Pub. L. No. 111-5. Americans With Disabilities Act The Americans With Disabilities Act of 1990, 42 U.S.C. (ADA) ?12101 et. seq. Breach Definition 1: Failure to meet the SLA. Definition 2: as in security breach. Violation or unintended release of data. CAB Change Advisory Board See also CCB 008 Change Control Board See also CCB Centers for Medicare and An agency of the United States Department of Health and Medicaid Services (CMS) Human Services that provides federal oversight of the Medicaid program. CES CHIP Eligibility System Change Management or A process that facilitates the organized planning, Change Management Process development, and execution of modifications and Enhancements to the WES so that changes to the System are introduced in a controlled and coordinated manner, and the possibility that unnecessary changes will be introduced to a system without proper planningiireduced. CHIP Children's Health Insurance Program Claim A bill for services that is appropriate for the provider type and type of service(s), whether submitted as a paper claim or electronically, and identified by a unique claim control number. A single claim is defined as a billing comprised of a single beneficiary with the same Date of Service (or range of dates for service), submitted by a single billing provider which may include one or more service(s) or document(s). Client Refers to Wyoming citizens seeking services from the Agency or other State agencies (applicants), or citizens already receiving State benefits. CMPPA Computer Matching and Privacy Protection Act of 1988 CMS Centers for Medicare and Medicaid Services Commercial Off-The-Shelf A product that is sold in substantial quantities in the (COTS) commercial marketplace that does not require additional software or hardware development or Customization for Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 34 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Term De?nition general use. ConfigurabIe/Configuration Modification of system functionality, which does not require development changes to the software and can be modified by non-technical non-programmer or developer) staff. COTS *See Commercial Off-The-Shelf CSR Client Service Representative Customer Relationship A software or system used the Contractor to organize, Management (CRM) automate and customer service and technical support. Customization Customization -functionallty and that requires dedicated technical staff a prog?mmer or developer). Data Dictionary A centralized repository of information about data such as meaning, valid values, relationships to other data, origin, usage and format. Data Warehouse (DW) A database used for reporting and analysis. Defect An error, flaw, failure, or fault in a computer program or system that causes it to produce an incorrect or unexpected result, or to behave in unintended ways. See also Inherited Defect DFS Department of Family Services DHS Department of Homeland Security Dispute Process The process described in the Contract for the Contractor and the Department to follow to resolve all debates or disagreements between the Department and Contractor. ECOM Medicaid Eligibility Online Manual Electronic Document Management System (EDMS) Software that manages documents for electronic publishing. EMTLA Emergency Medical Treatment Labor Act Enhancement An enhancement is any system change or upgrade that increases hardware or software requirements beyond the original requirements. ETS The Department of Enterprise Technology Services (formerly the Office of the Chief Information Officer FDSH Federal Data Services Hub FFM Federally Facilitated Marketplace Federal Financial Participation (FFP) Federal matching funds for State expenditures relating to assistance payments for certain social services, and State medical and medical insurance expenditures. Fee-For-Service (F FS) A payment model where services are unbundled and paid for separately. FFY Federal Fiscal Year FIPS Federal Information Processing Standards Fiscal Agent (FA) An entity that acts on behalf of the State Medicaid agency in respect to claims processing, Provider Enrollment and relations, utilization review, and other functions. Fiscal Year (FY) A period used for calculating annual financial statements in Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 35 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Term De?nition businesses and other organizations. FISMA Federal Information Security Management Act FOIA Freedom of Information Act Full Time Equivalent (FTE) A unit of measure that equates to the workload of an individual who works a full time schedule, regardless of the actual number of individuals who perform that work or the actual number of hours worked by those individuals. Global Providing services that are performed by workers located in foreign countries, whether the workers are employees of USA or foreign companies. Health Information Technology for Economic and Clinical The Health Information Technology for Economic and Clinical Health Act provisions of ARRA. Health Act (HITECH) HIEES Health Insurance Eligibility and Enrollment System HIPAA Health Insurance Portability and Accountability Act of 1996 HITECH Health Insurance Technology for Economic and Clinical Health Act HIX Health Insurance Exchange Incumbent Contractor The current contractor and developer of the WES. Inherited Defect(s) An inherited defect is a WES system defect resulting in an unfulfilled contract requirement(s). This includes any functionality that was not completed by the Incumbent Contractor. See also Defect. Interactive Voice Response (IVR) A technology that allows a computer to interact with humans through the use of voice and Dual~tone multi-frequency tones input via keypad. Interoperability The ability to exchange and use information from multiple machines from multiple different entities. Key Personnel The position or positions that are specifically designated as such in this Contract. Kid Care CHIP Wyoming?s Children Health Insurance Program (CHIP). MCI Master Client Index Milestone A significant point, event or achievement that reflects progress toward completion of a process, phase or project. Medicaid The Medical assistance program authorized under Title XIX of the Social Security Act. Medicaid Information Technology Architecture (MITA) A national initiative, overseen by CMS, that is intended to foster integrated business and IT transformation across the Medicaid Enterprise to improve the administration of the Medicaid program. Medicaid Management Information System (MMIS) A collection of services and automated claims processing that fulfills, at a minimum, the federal requirements specified in Part II of the State Medicaid Manual (CMS Publication 45), program directives and memos, policy statements, and the like that serve as the basis for CMS certification and is Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 36 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Term De?nition compliant with HIPAA requirements, as modified. Medicare A health insurance program for the aged and disabled under Title of the Social Security Act. MEQC Medicaid Eligibility Quality Control MITA Medicaid Information Technology Architecture MMIS Medicaid Management Information System MOU Memorandum of Understanding NIST National Institute of Standards and Technology Open Source Software Software that incorporates or has embedded in it any source, object or other software code subject to an "open source", "copy left" or other similar type of license terms . Operations Project phase in which business processes are operational, but issues are continually identified and resolved. Optical Character Recognition (OCR) The mechanical or electronic conversion of scanned images of handwritten, typewritten or printed text into machine- encoded text for the purpose of electronically searching, storing more compactly, on-line display, and text mining. Optimization A component of the Operations phase in which the CSC Tools and staff have satisfied exit criteria for Transition and is encouraged to assess business processes and propose recommendations and identify value-added opportunities for improvements. PCR Program Change Request(s) PE Presumptive Eligibility PERM Payment Error Rate Measurement PII Personally Identifiable Information Planned Downtime Planned downtime is a system outage that is planned and agreed to by the Agency for normal system maintenance and upgrades. Problem A Defect, operational issue or situation regarded as unwelcome or harmful and needing to be dealt with and overcome. Protected Health Information (PHI) Individually identifiable health information or health information with data items that reasonably could be expected to allow individual identification. Ql Qualified Individuals. A Federally-funded program to assist Medicare beneficiaries of modest means pay for Medicare premiums. QMB Qualified Medicare Beneficiaries. A Federally-funded program to assist Medicare beneficiaries of modest means pay for Medicare premiums, co-payments and deductibles. Quality Assurance (QA) The planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled. SaaS Software as a Service SAS-70 Statement on Auditing Standards No. 70 SFY State Fiscal Year Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 37 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Term De?nition SLA Service Level Agreement SLMB Specified Low-Income Medicare Beneficiaries. A Federally- funded program to assist Medicare beneficiaries of modest means pay for Medicare premiums. SNAP Supplemental Nutrition Assistance Program SOA Service Oriented Architecture Software A set of programs, procedures, algorithms and its documentation concerned with the operation of a data processing system. Specification A detailed, exact statement of particulars such as a statement prescribing materials, dimensions and quality of work. SSA Social Security Administration SSI Supplemental Security Income SSL Security Sockets Layer Stabilization A component of the Transition phase in which the CSC Tools and business processes are fully supported by the Contractor. State Fiscal Year (SFY) The twelve (12) month period beginning on July of a year and ending on June 30th of the following year. State health insurance Includes Medicaid and Kid Care CHIP programs programs Systems Development Life A process of creating or altering information systems, and Cycle (SDLC) the models and methodologies that are used to develop these systems. The methodologies form the framework for planning and controlling the creation of an information system. TANF Temporary Assistance for Needy Families Transition Project phase during which the Incumbent Contractor continues to work toward meeting contractual obligations while also communicating future needs to the incoming Contractor. User Acceptance Testing (UAT) The process to obtain confirmation that a system meets mutually agreed-upon requirements prior to the Department's acceptance of the System or changes to the System. Users Defined as State and or Agency clients accessing and using the WES. VPN Virtual Private Networks Warm Transfer If a Representative is unable to assist a client or applicant, this processes ensures that clients are connected and introduced to a resource that can assist them. Work The tasks and activities the Contractor is required to perform to fulfill its obligations under the Contract, including the performance of any services and delivery of any goods. Work Products Includes finished or unfinished source code, documents, data, or reports resulting from the HIEES contract. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 38 of 48 MAXIMUS STATEMENT OF WORK May 12. 2016 Term De?nition ?Real-time? eligibility Automated eligibility determination process where clients can apply online and receive their eligibility determination within an average of 15-20 minutes of initiating the application. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 39 of48 MAXIMUS STATEMENT OF WORK May 12. 2016 Contractor shall comply with the executed contract and all attachments, all requirements and standards defined in this document, all requirements and standards defined in the Request For Proposal and the Maximus Technical Proposal. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 40 of 48 MAXIMUS STATEMENT OF WORK May 12. 2016 Contractor will rely on the Agency to provide assistance with contact information, review of milestones as they are completed, and general responsiveness to project needs and questions as they arise. Contractor appreciates any input and/or critiques, and will work closely with the primary point of contact to ensure all goals and requirements of this project are met. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, inc. Page 41 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 INTRODUCTION This Change Management Plan describes the change management process which applies to all hardware and software related to the Operation of the WES Customer Service Center and their related environments. The Wyoming Department of Health (WDH) will work with Maximus to establish a single WES Change Control Board (CCB) to review, assess, and authorize CSC related functionality, defects and changes. It is anticipated because of the closely associated role that Maximus will have with the Wyoming Eligibility System; there may be times when WDH requires Maximus to participate in the WES Change Control Board meeting related to system functionality, defects or enhancements. Change Management Scope The goal of the WES CSC Change Management Plan is to ensure the availability and reliability of the CSC infrastructure and tools by providing a structured process to control and document changes to the environment. Change Management provides a process to review, approve or reject proposed changes; provide approved changes to management for scheduling and implementation; verify that the change was completed; document changes to the environment; and notification. Access to the environment to apply changes is restricted to authorized WES CSC staff. Changes to the WES CSC tools and infrastructure are under formal WES CSC Change Management and shall follow the guidelines in this document. The WES CSC infrastructure is de?ned as all production and non-production environments including the JIRA and other relevant tools both integrated into the WES CSC and by use in the CSC. WES CSC CHANGE CONTROL BOARD The WES CSC will established a single Change Control Board to review, assess and authorize changes. WES CSC Change Management Authority The WES CSC Configuration Manager, a Maximus resource, will manage and facilitate the change management process and arbitrate any conflicts that may result from the Change Approval Process to ensure the stability of the WES CSC. The WES CSC Configuration Manager serves as the Change Manager and is responsible for ensuring that CSC Change Management policies are followed. At the discretion of the CCB, additional expert advice may be sought from vendor technical representatives, application owners, and other business subject manager experts. These groups will be represented at CCB meetings as necessary. The Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Heaith Services. Inc. Page 42 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Configuration Manager will function as the CCB Secretary and will be responsible for identifying changes to be reviewed by the CCB, scheduling meetings, and keeping meeting minutes. Change Authority The CCB has the direct authority over changes to the following: I CSC related Hardware changes I CSC ooperating system changes (versions and patches) I Operating system configuration (operational and security) I Vendor software changes (versions and patches) I CSC Application software deployment and changes I CSC nnetworks, including ?rewall, switch, and router hardware, software and configuration protocols, ports) I CSC Tools, as implemented for the use of the CSC Contractor. Enforcement Authority WDH has the authority to enforce the Change Management Plan. The goal is to ensure all personnel involved in the CSC Change Management process follow the policy requirements and do not take actions to circumvent these policies. Change Control Board Membership The CSC CCB exists to review and authorize changes to CSC con?guration items and to assist in CSC Change Management in the assessment and prioritization of defects and change requests. The CCB forum is facilitated by CSC Change Management and reviews change requests from a business and technical perspective. To achieve this, the CCB comprises WES business owners, end users, technical support personnel, related service support and service delivery process representatives. CCB attendees will be called upon for their particular expertise in assessing, authorizing, and scheduling change requests. The CSC CCB will meet at a mutually agreed upon cadence as necessitated by the Project. The cutoff to have a Request reviewed in the CCB is 24 hour prior to allow analysis to be performed. The Request must have received technical assessment in order to be reviewed in the CCB. A sample CCB meeting agenda is presented as Appendix A. The three main permanent roles represented in the WES CSC CCB process are: Change Management, Key Participants and Required Attendees. Change Management is represented in CCB by: I CCB Facilitator (Project Management) I CCB Scribe (Configuration Manager) Attachment A To the Information Technology (iT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 43 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Key Participants are permanent advisory members of the CSC CCB and as such are required to attend all CCB meetings or designate a proxy to attend in their place. Key Participants are representative of the following WES Business and IT units: WDH Management WES Project Management CSC Software Development CSC Operations CSC Security Required Attendees attend CSC CCB Meetings to assist in the representation, risk and impact assessment, and scheduling of change requests. Required Attendees may request that a change be placed on hold based on reasonable business or technical justification. Change Control Board Responsibilities The WES CCB responsibilities are detailed in the below table. Action Owner Run CCB Review in JIRA 24 hours prior to meeting to 1 determine JIRA tickets ready for CCB review. Change Management Review all submitted changes for completeness and 2 accuracy Change Management 3 fSend CCB InVItatIon and Change Requests scheduled Change Management or revnew 4 the Bridge Line Call at the announced meeting CCB Facilitator Take Roll Call to ensure Key Participant Attendance. A quorum for holding a CCB is the WDH Management 5 and WES (Contractor) Project Management CCB Facilitator representative who agree to adjudicate tickets with Change Management to act as facilitator/scribe. . . CCB Facilitator, Key 6 ixegtdeixES CSC CCB Agenda as detailed in Participants, Required pp Attendees 7 Record outcome of Problem Reports on agenda CCB Scribe 8 Adjourn Meeting CCB Facilitator Document in the Problem Reports the outcome of the 9 CCB Review within 24 hours Change Management Change Management, 10 Complete any ad hoc CCB Follow Up Action Items Key Participants, Required Attendees Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and MAXIMUS Health Services, lnc. Page 44 of 48 MAXIMUS STATEMENT OF WORK May 12, 2016 Publish WES Meeting Minutes to the WES Document 11 Library and send URL link to the CCB Attendees Change Management within 24 hours CCB Roles and Responsibilities WES Change Advisory Board Change Advisory Board Overview The CSC Change Advisory Board (CAB) is a programmatic group that reviews CSC Project Change Requests (PCRs), their associated Change Requests (CRs) and Decision Information Requests (Dle) as their primary function. The CAB also discusses and adjudicates any out of scope tasking, tickets reviewed at the CCB that cannot be agreed upon or a major problem or event of a high urgency, risk, and impact that does not allow for the normal CSC CCB Procedure. The CSC CAB is the decision-making authority in emergency change situations. The CAB is responsible for determining on a case-by-case basis whether to authorize emergency change requests to the CSC environments. This procedure defines the agreed upon criteria. Change Advisory Board Scope The scope of the CSC CAB from a change management aspect is to review, assess and authorize or decline CSC changes not resolved in the CSC CCB and emergency change requests escalated to them Change Advisory Board Roles The CSC CAB is initiated, expedited, and facilitated by WES CSC Change Management. The CAB is comprised of the following Senior WES and WDH Leaders: I WDH Eligibility Vendor Contract Manager I WDH WES Project Manager I WDH Eligibility Operations Administrator I Maximus Project Manager I Maximus Operations Manager I Maximus Technical Manager I Maximus Security Manager All CAB members are required voting members and therefore are required to designate a proxy to Change Management in the event that they are not available in an emergency situation. Change Management will accept either verbal or written authorization for emergency changes and note approvals for CAB Members in the change request. CAB Members are required to follow up a verbal approval written confirmation in the JIRA ticket that is the basis for the emergency change within 24 business hours. Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 45 of 48 MAXIMUS STATEMENT OF WORK May 12. 2016 If a change requires multi-organizational input then the change management process, through Deloitte, Maximus or WDH Management, will engage the emergency change requestor, application Business Owner and any necessary Subject Matter Experts (SME) to supply information to the WES CSC CAB regarding the business justification, technical specifics, risk and impact of the proposed change. CAB Procedure The CSC CAB responsibilities when executed for an emergency change request are detailed the below table. Action Owner Change Management receives notification of a new discuss Lessons Learned 1 emergency change or unresolved CCB issue Change Management Change Management reviews the request and 2 determines that a CAB should be convened or to Change Management follow the CSC Change Control Board Procedure. Change Management initiates a conference call and 3 contacts all CAB members or designated proxies, the Chan Mana ement emergency change requestor and any necessary 9 SMEs 4 Execute CSC CAB Agenda All 5 Document Emergency Change Authorization or CCB CAB Members, Change issue resolution by the CAB Management Document in the Change Requests the business or 6 technical justification for the emergency and any Change Management pertinent information within 2 hours in JIRA 7 i(?tleorrissplete any reqUIred notification or follow up action Change Management, All 8 Place change on agenda for next CAB Meeting to Change Management Change Advisory Board Roles and Responsibilities for Emergency Releases Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Page 46 of 48 Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. MAXIMUS STATEMENT OF WORK May 12. 2016 WES CHANGE MANAGEMENT IMPLEMENTATION Only approved changes to WES are installed. Change Management Request Process The detailed process flow for WES change tickets is illustrated in Figures 3-1 and 3-2. The process applies to problem reports, change requests and defects and is outlined in the following sections. Submission Process All changes to the environments are submitted to CM by an individual requestor. The change requestor is responsible for completing the JIRA ticket, which must include the following information: Project, Issue Type, Summary of the request, initial priority, initial severity, and a detailed description to include case number and screen shots if applicable. Change Review and Approval All submitted JIRA tickets are reviewed by the appropriate functional lead for completeness and assessed for technical impact (triage). The 080 Configuration Manager will document the NG recommendation and is responsible for facilitating the review and approval process ensuring that an adequate assessment and (as needed) security review are performed prior to assigning to a board agenda. The CCB and CAB boards are responsible for adjudicating the changes at the meetings. CCB Review/Approval Process The scope of the CCB is to review and authorize changes to CSC configuration items, ensure impact assessments across the WES and related systems are considered, and to gain visibility into problem reports (non-changes) within the production environment. The technical assessors assigned to review the change request will verify or update the requirements for each JIRA defect or change request submitted or determine that this is a new requirement. The objective of the CCB is to ensure that all changes are ef?ciently processed via standardized procedures in an attempt to minimize the impact of change-related incidents within the environment. In addition, the CCB will be ensuring that high?risk changes have visibility, are effectively communicated, appropriately scheduled and any necessary additional coordination efforts are obtained prior to their execution. Scheduling and Implementation A defect or change request approved by a change board may be directed to be implemented in the WES environment per a Standard or Emergency basis. WES Issue Ticket Types The JIRA ticketing system used by the 080 can create a variety of ticket types for Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 47 of 48 MAXIMUS STATEMENT OF WORK change and program management purposes. Ticket types that are brought to the CSC CCB are as follows: 1. Problem Report A Problem may be found anywhere on the program. The first step is to report them to the Help Desk where they initially start as a JIRA Problem Report. If the Help Desk can address the problem, it is resolved with the reporter and closed. If the Help Desk cannot resolve the issue the Problem Report is escalated to CSC Configuration/Change Management to review and assign for analysis. If it is determined that the Problem Report is not a code, data or requirements issue it is addressed by Tier ll/development and returned to the Help Desk for the submitter to close. If the problem is determined to be a code, data or requirements issue Change Management revises the Problem Report ticket type as appropriate and processes accordingly. Defect - When a ticket is determined to be a non-compliance with a system requirement it is logged as a Defect. Defects are assigned to the appropriate development team to analyze and if approved by the CCB create a Data Defect A ticket may be submitted when there are errors in data that a user cannot address and require a database analyst to go into the database and correct. Data Defects are assigned to the appropriate DBA team to analyze and if approved by the CCB correct the data. Database Change Request - When a ticket is determined to require a change to ta database structure or internal jobs, it is processed as a Database Change Request. Database Change Requests are assigned to the DBA team to analyze and if approved by the CCB make the fix to the database. Service Request - A request from a user for information that does not impact a configuration item such as a password reset or to run an ad hoc report. Service Requests are submitted and processed through the JIRA system but do not go through the CCB. They are reviewed by CM to ensure they meet the definition and then assigned to the group responsible for completing the action. Change Request When a ticket is determined to be a change to the CSC requirements, either hardware or software, it is processed as a Change Request. Change Requests may be determined to be cost or no~cost. No-cost Change Requests are routine actions such as software patching. Cost Change Requests are modifications outside the scope of the Contract such as changes to accepted requirements and require the Contractor to submit a Project Change Request (PCR). Project Change Request -- Change Requests with significant cost associated with the change or modifications outside the scope of the Contract require the Contractor to submit a Project Change Request (PCR). After assessing that a Change Request requires a PCR the contractor will prepare the level of effort and cost documents. The fully completed PCR is submitted and reviewed at the CAB level for WDH acceptance and approval before the Change Request is processed and approved by the CAB. May 12, 2016 Attachment A To the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and MAXIMUS Health Services, Inc. Page 48 of 48 ATTACHMENT STATE OF WYOMING DEPARTMENT OF ADMINISTRATION AND INFORMATION PROCUREMENT SECTION 700 W. 215t Street CHEYENNE, WY 82002 Final Amended Version REQUEST FOR PROPOSAL NO. 0175-A WYOMING DEPARTMENT OF HEALTH DIVISION OF HEALTHCARE FINANCING Wyoming Department of Health Customer Service Center Procurement OPENING DATE AND TIME MARCH 25, 2016 2:00 P.M. (MDT) PURCHASING REPRESENTATIVE: Mandy Gershmel E-mail: mandv.gershmel1@wvo.gov Phone: 307-777-6718 DIVISION OF HEALTHCARE FINANCING REPRESENTATIVE: Jan Stall TELEPHONE NO.: 307-777-5472 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 1 of 150 TABLE OF CONTENTS SECTION 1: REQUEST FOR PROPOSAL 4 1.1 SUBMISSION OF PROPOSALS: 4 1.2 MODIFICATIONS OR WITHDRAWAL OF PROPOSALS: 4 1.3 PREPARATION OF PROPOSALS: 4 1.4 AWARD AND CONTRACT INFORMATION: 5 SECTION 3: SPECIAL PROVISIONS INFORMATION 7 3.1 STATE PARTIES: 7 3.2 CONTENT AND PROCUREMENT POINTS OF CONTACT: 7 3.3 RESTRICTIONS ON COMMUNICATIONS WITH STATE STAFF: 8 3.4 PRE-PROPOSAL CONFERENCE: 8 3.5 ORAL PRESENTATIONS: 8 3.6 PROPOSAL RESPONSE SEQUENTIAL ORDER: 9 3.7 EFFECTIVE DATES OF PROPOSAL: 9 3.8 ADVERTISING AWARD CONDITIONS: 9 3.9 CONTRACT NEGOTIATIONS: 9 3.10 BEGINNING WORK: 10 3.11 NON-APPROPRIATION OF FUNDS: 10 3.12 COPYRIGHT INFRINGEMENT: 10 3.13 COST OF PREPARING PROPOSALS: 11 3.14 PROPOSAL EVALUATION: 11 3.15 RISKS AND LIABILITY: 11 3.16 ADDENDUM TO THE RFP: 11 3.17 PROPERTY DAMAGE AND LIABILITY INSURANCE: 11 3.18 MISREPRESENTATION OF INFORMATION: 11 3.19 DISPOSITION OF PROPOSALS: 12 3.20 LEGAL CONSIDERATIONS: 12 3.21 PROPOSER RELATIONSHIP WITH STATE: 12 SECTION 4: SCHEDULE OF EVENTS 13 4.1 KEY DATES (SCHEDULE OF EVENTS): 13 SECTION 5: ADMINISTRATIVE INFORMATION 14 5.1 INTRODUCTION AND BACKGROUND: 14 5.2 PROGRAM BACKGROUND 15 5.3 PURPOSE AND INTENT: 21 5.4 STAKEHOLDERS: 21 5.5 RFP REQUIREMENTS: 23 SECTION 6: RE UIREMENTS SPECIFICATIONS- RESPONSIBILITIES OF CONTRACTOR 24 6.1 SCOPE OF PROJECT: 24 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 2 of 150 6.2 RELEVANT EXPERIENCE: 26 6.3 SCOPE OF SERVICES: PHASE SPECIFIC REQUIREMENTS 26 6.4 GENERAL REQUIREMENTS: 33 6.5 SYSTEM OR WYOMING IT STANDARDS: 36 6.6 TECHNOLOGY AND SPECIFICATIONS: 38 6.7 HOSTING: 39 6.8 CONTRACTOR QUALIFICATIONS: 39 6.9 PROJECT MANAGEMENT AND REPORTING: 40 6.10 TRAINING AND KNOWLEDGE TRANSFER PLAN: 40 6.11 OPERATIONAL READINESS AND OPERABILITY TESTING: 40 6.12 MAINTENANCE AND SUPPORT REQUIREMENTS: 40 6.13 QUALITY ASSURANCE AND QUALITY CONTROL: 41 6.14 CHANGE CONTROL MANAGEMENT: 41 6.15 DELIVERABLES AND MILESTONES: 41 SECTION 7: PROPOSAL SUBMISSION REQUIREMENTS - SEQUENTIAL ORDER 43 7.1 TECHNICAL PROPOSAL, FORMAT AND CONTENTS: 43 7.2 COST PROPOSAL FORMAT AND CONTENT: 52 SECTION 8: EVALUATION METHODOLOGY 55 8.1 OVERVIEW: 55 8.2 COMPLIANCE WITH MANDATORY REQUIREMENTS: 55 8.3 TECHNICAL SCORING AND RANKING: 55 8.4 ORAL SCORING AND RANKING: 56 8.5 COST SCORING AND RANKING: 56 8.6 EVALUATION POINT SUMMARY: 57 8.7 FINAL RANKINGS OF PROPOSALS: 58 SECTION 9: PAYMENT TERMS 59 9.1 TIME 59 9.2 CONTRACT INCENTIVE PAYMENTS 59 SECTION 10: PROPOSAL PRICE SHEET AND SIGNATURE PAGE BOOKMARK NOT DEFINED. SECTION 11: SAMPLE IT CONTRACT BOOKMARK NOT DEFINED. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 3 of 150 SECTION 1: REQUEST FOR PROPOSAL 1.1 SUBMISSION OF PROPOSALS: Proposals will be received for providing operation and expansion of the Wyoming Department of Health Customer Services Center (CSC) that supports client services for the State of Wyoming, Department of Health, Division of Healthcare Financing, (Agency) through the Public Purchase online bidding system until March 25, 2016 2:00 PM. (MT). Proposals must include: 1.1.1.1 The technical proposal and cost proposal which must be uploaded as separate documents and identified as such. 1.1.1.2 No proposal will be considered which is not accompanied by the attached Proposal Price Sheet and signed by the proper official of the firm. Fax or email submission of proposals will not be accepted. 1.1.1.3 As specified in Section 7.1, Proposers must submit one electronic copy of both the technical and cost proposal through the Public Purchase online bidding system on or before the time and date specified. Additionally, the Agency is requesting ten (10) hard copies of the technical and cost proposals to support the proposal evaluation process. Hard copies must be delivered in person or mailed to the Agency as specified further in Section 7.1. Proposals received after the time specified will not be considered. 1.1.1.4 Proposal information is restricted and not publicly available until after the award of the Contract by the Procurement Section. Once a contract has been fully signed and submitted to the A and Procurement Office the award process will be complete. 1.1.1.4.1 Additional proposal submission requirements are included in Section 7. 1.2 MODIFICATIONS OR WITHDRAWAL OF PROPOSALS: 1.2.1.1 A proposal may be altered through the Public Purchase online bidding system prior to the specified date and time of the opening contained in this document. 1.2.1.2 A proposal may be withdrawn through the Public Purchase online bidding system by the Proposer up to the time of the opening. Failure of the successful Proposer to furnish the service awarded as a result of this advertisement shall eliminate the Proposer from the active Contractors list for a period of time as determined by the Procurement Section. 1.3 PREPARATION OF PROPOSALS: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 4 of 150 1.3.1.1 1.3.1.2 1.3.1.3 Proposals must address and adhere to the requirements included in this Request for Proposal (RFP). Proposers shall document any recommended modifications to the included provisions or specifications and discuss how they are advantageous to the Contract. The State will consider reasonable adjustments in final contract negotiations. In case of error in the extension of prices in the proposal, unit prices will govern. Proposers are expected to examine special provisions, specifications, schedules and instructions included in this Request. Failure to do so will be at the Proposer?s risk. 1.4- AWARD AND CONTRACT INFORMATION: 1.4.1.1 1.4.1.2 1.4.1.3 1.4.1.4 1.4.1.5 The State of Wyoming hereby notifies all proposers that it will affirmatively insure that minority business enterprises will be afforded full opportunity to submit proposals in response to this invitation and will not be discriminated against on the grounds of age, race, color, sex, creed, national origin, or disability. The proposer, also, agrees that should this firm be awarded a Contract that the firm will not discriminate against any person who performs work there under because of age, race, color, sex, creed, national origin, or disability. The Proposer expressly warrants to the State that it has the ability and expertise to perform its responsibilities hereunder and in doing so shall use the highest standards of professional workmanship in accordance to the agreed upon requirements and service level agreements (SLAs). The State of Wyoming reserves the right to reject any or all proposals, to waive any informality or technical defect in the proposals, or to award the contract in whole or in part, if deemed to be in the best interest of the State to do so. The Department of Administration and Information, Procurement Section will award this contract to the firm, determined by the Wyoming Department of Health, Division of Healthcare Financing the most responsive and responsible offer, based on criteria specified herein. This Request for Proposal shall become part of the Contract and will be in effect for the duration of the Contract period. In the event of a conflict between the Contract, Statement of Work (Attachment A), the RFP No. 0175-A or any other document incorporated by reference, the following order of documents shall govern, in the order listed: (1) the Contract, (2) Statement of Work (Attachment A), then (3) RFP No. 0175-A including amendments and Questions and Answers then (4) Proposal Response, then any other document incorporated by reference. In case of conflict any clarification must be mutually agreed upon in writing and will govern the contractual relationship between the parties. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 5 of 150 1.4.1.6 The successful proposer will be required to enter into and sign a formal Contract with the State with reasonable adjustments acceptable to the State. The agreement will become a part of the Contract and will be in effect for the duration of the contract period. The contract language will control over any language contained within this RFP that conflicts with the signed and fully executed Contract. 1.4.1.7 The successful Proposer will also be required to enter into and sign a Business Associates Agreement (BAA) in compliance with the Privacy and Security provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This is an agreement to protect personal or sensitive information. A sample BAA is included in Appendix K. 1.4.1.8 The Successful proposer shall comply with the Americans with Disabilities Act and Wyoming Fair Employment Practices Act. (W. S. 27-9-105 et. seq.). DATED THIS 25th Day of January, 2016 STATE or WYOMING Lori Galles, Manager Procurement Section Assigned Buyer: Mandy Gershmel Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 6 of 150 SECTION 3: SPECIAL PROVISIONS INFORMATION PROPOSALS MUST BE SUBMITTED THROUGH THE PUBLIC PURCHASE ONLINE BIDDING SYSTEM BY 2:00 P.M. (MT) on MARCH 25, 2016. PROPOSALS RECEIVED AFTER THE TIME AND DATE SPECIFIED WILL NOT BE CONSIDERED. It is the responsibility of the Proposer to clearly identify all information that is considered confidential in accordance with the Wyoming Public Records Act, W.S. 16?4-201 through 16-4?205. Please identify each confidential page with the word in capital, bold letters centered at the bottom of each page. Information not clearly marked may be considered public. 3.1 3.2 STATE PARTIES: 3.1.1 3.1.2 3.1.3 3.1.4- This Request for Proposal (RFP) is issued by the Wyoming Department of Administration and Information, Procurement Section, on behalf of the Wyoming Department of Health (Agency). Throughout this document and others in connection with this project, various references are made, or will be made to the "State". Generally, whenever this reference appears, the term ?State" incorporates all parties to the RFP as cooperative state agencies that will be working on this project as a cohesive state unit. It should be understood that the Director of Wyoming Department of Health is empowered to be the signatory on all contracts, agreements, or modifications pertaining to this project. Such agreements, etc., not bearing this signature or that of a designee are invalid insofar as contractual relations between the State and Contractor are concerned. The names and address of the State parties are: Thomas 0. Forslund Wyoming Department of Health Director 2300 Capital Ave. 401 Hathaway Building Cheyenne, WY 82002 Mandy Gershmel, Buyer Wyoming Department of Administration and Information Procurement Section 700 W. let Street Cheyenne, WY 82002 Telephone: (307) 777-6718 E-mail: mandygershmelleyogov CONTENT AND PROCUREMENT POINTS OF CONTACT: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 7 of 150 3.3 3.4 3.5 3.6 3.2.1.1 The Department of Administration and Information, Procurement Section, is the primary point of contact from the date of release of the RFP until the Contract is fully executed and signed. Any attempt to contact any State employees, other than those named below, regarding this procurement may cause rejection of any proposal submitted by that party. 3.2.1.2 Questions must be submitted through the Public Purchase online bidding system until 2:00 PM. (MT) on February 12, 2016. 3.2.1.3 Written questions in regarding RFP material or the procurement process shall be submitted though the Public Purchase online bidding system. No telephone calls or faxes will be accepted. 3.2.1.4 Written responses will be available under each question through the Public Purchase bidding system. Responses will not identify the firm that submitted the question. All parties should clearly understand that only the written answers issued by the Agency are the official position on an issue, and these answers shall become part ofthe RFP and, by incorporation, any subsequent Contract. RESTRICTIONS ON COMMUNICATIONS WITH STATE STAFF: From the issuance date of this RFP until a Proposer is selected and the selection is announced, Proposers are not allowed to communicate with State staff except: Procurement Section;State Representative during Pre-Proposal Conference [if applicable) and/ or Oral Presentations (if applicable] or in response to questions during the selection process; and 3.4.1.1.1 Via written questions. 3.4.1.2 For violation of this provision, the State reserves the right to reject the proposal. PRE-PROPOSAL CONFERENCE: 3.5.1.1 A Pre-Proposal Conference will not be held in connection with this RFP. ORAL PRESENTATIONS: 3.6.1.1 Proposers with the top three (3) technical scores may be requested to make an oral presentation to clarify and/or demonstrate any particular points about their proposals or to discuss any changes to their technical proposals which might be advantageous to the State. The procurement timetable (See Section 4: Schedule Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 8 of 150 of Events) will indicate the period when oral presentations may be requested. If so requested, Proposers will be provided a one-week notification of the time scheduled for the presentation. The Evaluation Team members will address questions to the Proposers pertaining to their ability to complete this project. The Proposer is responsible for the payment of all costs involved in any oral presentations and shall not be reimbursed by the State for these costs. If held, Oral Presentation will be used to clarify Technical Pr0posa content and may result in modifications to the original Technical Proposal scoring, as further detailed in Section 8, Evaluation Methodology. 3.6.1.2 Such presentations are for the purpose of explaining or clarifying any significant elements of the proposal and/or displaying software/hardware capabilities to assist the Evaluation Team in further evaluating the proposal. At the option of the State, presentations may be attended by others in addition to the Evaluation Team members. 3.7 PROPOSAL RESPONSE SEQUENTIAL ORDER: 3.7.1.1 Proposers are required to keep their proposal response in the same sequential order that is referenced in Section 7, Proposal Submission Requirements. 3.8 EFFECTIVE DATES OF PROPOSAL: 3.8.1.1 All terms, conditions and costs quoted in the Proposer's reSponse will be binding on the Proposer for 180 days from the effective date of the proposal. 3.9 ADVERTISING AWARD CONDITIONS: 3.9.1.1 A fully executed contract must be made and written approval from the State before the successful Proposer may advertise the award of the contract or the services being provided after the contract begins. The Proposer must agree not to refer to awards in commercial advertising in such a manner as to state or imply that the firm or its services are endorsed or preferred by the State of Wyoming. 3.10 CONTRACT NEGOTIATIONS: 3.10.1.1 The State will notify the successful Proposer and negotiate a contract under the procedures of the State of Wyoming, Department of Administration and Information, Procurement Section and the Wyoming Attorney General?s contract guidelines. A sample IT Contract can be found on the Department of Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 9 of 150 Enterprise Technology Services Resources Webpage. Proposers should submit as part of their proposal, suggested Contract language that relates to software licensing, maintenance services, and any patented or copyrighted products owned by the Contractor that will be used in meeting the RFP specifications. Except for clauses related to software licensing, maintenance services, and any patented or copyrighted products owned by the Contractor that will be used in meeting the RFP specifications, the successful Proposer shall be expected to sign a contract containing substantially the same terms and conditions as set forth in the draft contract. The successful Contractor will be required to enter into and sign a formal Contract with the State. 3.10.1.2 This RFP, the proposal, oral presentation and any agreements entered into as part of the Contract award will become a part of the Contract and will be in effect for the duration of the Contract period. The Contract language will take precedence over any language contained within this RFP that may conflict with the signed and fully executed Contract. A proforma Contract for the Proposer?s review is contained in Section 11, Attachment A. 3.11 BEGINNING WORK: 3.11.1.1 The successful Proposer must not commence any work that could be billed until a valid contract has been executed. The State will not pay for any work by the Proposer prior to execution of the Contract. 3.12 NON-APPROPRIATION OF FUNDS: 3.12.1.1 Obligations of the State shall cease immediately if the Wyoming State Legislature fails to appropriate, or othenrvise make available funds for the contract. The State will use its best efforts to secure sufficient funding to cover the proposed contract, and notify the Proposer immediately of any funding insufficiency. 3.13 COPYRIGHT INFRINGEMENT: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 10 of 150 3.14- 3.15 3.16 3.17 3.18 3.19 3.13.1.1 The Proposer shall warrant that all materials and/or Products produced hereunder will not infringe upon or violate any patent, copyright, trade secret, or other prOprietary right of any third party. In the event of a claim by any third party against the State, the State shall notify the Proposer, and the Proposer shall defend such claim and the State?s name. The defense of such claim will be at the Proposer?s expense. COST OF PREPARING PROPOSALS: 3.14.1.1 All costs incurred for the preparation of this proposal and for other procurement related activities are solely the responsibility of the Proposer. The State of Wyoming will not provide reimbursement for such costs. PROPOSAL EVALUATION: 3.15.1.1 All Proposers must meet the minimum qualifications set forth in the Proposal Requirements and Review Process in order to be considered and ranked pursuant to the criteria set forth in this RFP. RISKS AND LIABILITY: 3.16.1.1 By submitting a proposal, a Proposer specifically assumes any and all risks and liability associated with information marked confidential in the proposal and the release of the information. All costs incurred in preparing a response to the RFP are the responsibility of the Proposer. ADDENDUM TO THE RFP: 3.17.1.1 The State reserves the right to amend the RFP prior to the date for proposal submission. Addendum will be uploaded through the Public Purchase online bidding system to the corresponding RFP. PROPERTY DAMAGE AND LIABILITY INSURANCE: 3.18.1.1 The Proposer may be required to furnish proof of property damage liability insurance in the amount deemed necessary by the Agency for the project, if applicable. MISREPRESENTATION OF INFORMATION: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 11 of 150 3.19.1.1 Misrepresentation of a Proposer?s status, experience, or capability in the proposal may result in disqualification of that Proposer from the selection process. Discovery of litigation or investigations in a similar area of endeavor may, at the discretion of the State and after consultation with the Procurement Services Section, preclude the Contractor from the selection process. 3.20 DISPOSITION OF PROPOSALS: 3.20.1.1 All material submitted becomes the property of the State of Wyoming, which is under no obligation to return any of the material submitted in response to the RFP. The successful proposal shall be incorporated into the resulting contract. 3.21 LEGAL CONSIDERATIONS: 3.21.1.1 This RFP is issued under the provisions of Wyo. Stat. 9-2w1016 (1977), as amended and Wyo. Stat. 42-4-101 et seq. 3.21.1.2 Proposers are charged with presumptive knowledge of all requirements ofthe cited authorities. Any proposal submitted by Proposer that fails to meet all published requirements of the cited authorities may, at the option of the State, be rejected without further consideration. 3.22 PROPOSER RELATIONSHIP WITH STATE:Proposer staff will have an ongoing relationship with State staff that is based on trust, confidentiality, objectivity and integrity. The Proposer will be expected to operate at all times in the State's best interests and in a straightforward, trustworthy and professional manner. As part of the tasks described in this RFP, the Proposer shaH: 3.22.1.1 Work cooperatively with the staff of State and the State?s business partners whenever required in the course of performing the functions required by the RFP and resulting contract. 3.22.1.2 Proposer must work c00peratively with the staff of other Proposer whenever required in the course of performing the functions required by the RFP and resulting contract. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 12 of 150 SCHEDULE OF EVENTS 3.23 KEY DATES (SCHEDULE OF EVENTS): The following schedule of events is subject to change at the sole discretion of the Department of Health, Division of Healthcare Financing: Event Description Date Time (MT) ?l RFP Released January 26, 2016 Closing Date for Questions February 12, 2016 2:00 PM. Response to Questions Returned February 26, 2016 Proposal Submission Due Date March 25, 2016 2:00 PM. Oral Presentations (Optional) Contract Award Date Transition Phase Begins Date July 1, 2016 Operations Phase Begins Date October 1, 2016 *Based on Agency approval and operational performance, as further described in Section 6. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 13 of 150 SECTION 4-: ADMINISTRATIVE INFORMATION 4.1 INTRODUCTION AND BACKGROUND: The Wyoming Department of Health (Agency) is seeking a qualified contractor to maintain and enhance its Customer Service Center (CSC) that currently supports eligibility and enrollment business processes for State Funded health insurance programs. The Agency contracted with Northrup Grumman (Incumbent Contractor) in 2012 to implement and operate a centralized CSC to provide customer service and support eligibility determinations. The current contract is set to expire on September 30, 2016. The CSC acts as the primary processing point of contact for Medicaid and Kid Care CHIP as indicated in Table 5.2.1 below. The CSC is also responsible for the following high-level activities: Disseminating program information and materialsl; Answering customer inquiries regarding eligibility including program requirements; Screening clients for programs; Accepting telephone, mail, fax, email and Client Web Portal applications for processing; Conduct in-person interviews at the centralized location in Cheyenne, related to eligibility functions; Processing applications, renewals, and client changes, including verification of resources for some cases; Following up on needed client verifications; Answering basic questions regarding denials and closures of benefits; Performing other case management functions; Providing CSC staffing and training; Providing the CSC infrastructure and CSC-specific tools, including the NR and Providing quality assurance (QM/quality control (QC) of applications and cases; Managing the centralized mailroom through the use of the State's Electronic Document Management System and Providing CSC reporting. The CSC provides these services for all health insurance programs listed in Table 5.2.1 below, with the exception of Long Term Care (LTC), which are currently screened and forwarded by the 1 Note that the Agency is responsible for program outreach. The awarded Contractor will not be responsible for conducting program outreach services. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 14 of 150 4.2 CSC to the Agency's LTC Unit. More information on the service delivery model is included below. See Appendix for a full Glossary of Terms as they relate to the CSC service and Scope of Work. The CSC uses the State?s Wyoming Eligibility System (WES) to support application processing and eligibility determination services. The Agency is currently in the process of reprocuring a contractor to operate the WES and provide enhancement services to streamline business processes. The RFP was released on January 26, 2016. The awarded CSC Contractor must maintain a good working relationship with the awarded WES Contractor and will be integral in providing feedback on WES operations. The Agency recommends that all CSC Proposers review the WES RFP included in the procurement library [located at and Appendices to better understand the parallel project. Further details on the WES and CSC Contractor relationships are included in subsequent sections. PROGRAM BACKGROUND Wyoming Department of Health (Agency) is the single State agency for both Medicaid and Kid Care CHIP. Programs managed by the Agency include Medicaid, Kid Care CHIP, Prescription Drug Assistance Program (PDAP), State Funded Foster Care, State Licensed Shelter Care, and other health programs. Different rules are applicable for the various programs. The CSC and WES currently support eligibility determinations for all health insurance programs listed in Table 5.2.1 below, which includes a brief summary of each health insurance program, as well as basic program statistics. Note that Table 5.1.2 includes LTC related programs, which are supported by the WES but are outside the scope ofthe CSC. Medicaid specific policies, procedures and other program information is available upon request. The CSC may be expanded in the future to include the Medicaid enrollment and benefit services, as further described in subsequent sections. Table 5.2.1: Program Summary Table PROGRAM DESCRIPTION PROGRAM STATISTICS Medicaid- Includes: SFY2015 Caseloadz: Children 0 Family Care children (who 55,589 clients meet 1996 AFDC Guidelines) 0 Foster Care children in DFS average number of custody and children in eligibles: 43,000 subsidized adoption 0 MAGI children - Newborns born to a Medicaid 2 Total number of unduplicated eligibles throughout SFY. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 15 of 150 PROGRAM DESCRIPTION PROGRAM STATISTICS eligible mother Medicaid- Qualified Pregnant Women (who SFY2015 Caseload: Pregnant Women meet 1996 AFDC Guidelines) and Poverty Level Pregnant Women. 3,795 clients average number of eligibles: 2,200 Medicaid- Adults who are caretaker relatives SFY2015 Caseload: Family Care Adults that provides a home for and 10,274 clients takes care of the day?to-day needs of an eligible dependent child average number of under the age of 19. eligibles: 7,000 Medicaid- Includes Breast and Cervical SFY2015 Caseload: Special Groups Cancer, Tuberculosis Assistance, 528 clients and the Family Planning Waiver programs. average number of eligibles: 400 Medicaid- The EID program is an option that SFY2015 Caseload: Employed allows employed individuals 297 clients Individuals with who are disabled to Disabilities (EID) receive Medicaid by paying a average number of premium, as long as they eligibles: 250 are working and meet SSA disability guidelines. The disability determination can be made either through SSA or through the Wyoming Department of Health (using SSA guidelines). Medicaid- The Emergency Services program SFY2015 Caseload: Non Citizens with may be able to cover expenses for 724 clients Medical Emergencies Wyoming's residents who are either undocumented immigrants or ineligible immigrants. This is not a full medical assistance program. Benefits are limited to emergency services such as labor and delivery. Other emergency services may be covered from the time treatment is first given for a condition until that same condition is no longer considered an emergency. These services must be determined an emergency by Medicaid's fiscal average number of eligibles: 515 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 16 of 150 PROGRAM DESCRIPTION PROGRAM STATISTICS agent Medicare Savings Program Includes the Qualified Medicare Beneficiary (QMB) program, Specified Low-Income Medicare Beneficiary (SLMB) program and the Qualified Individual (QI) program. These programs help Medicare beneficiaries of modest means pay for Medicare expenses. The QMB program covers Medicare premiums, co- payments and deductibles, while the SLMB program covers Medicare premiums only. Individuals complete an application for most Medicare Savings programs, but individuals who have recently applied for a Low Income Subsidy for their Medicare Part premium, can have their application forwarded to the State, through an interface, for processing. SFY2015 Caseload: 4,918 clients average number of eligibles: 4,150 Medicaid- Aged, Blind or Disabled (ABD): SSI and SSI related cases only The CSC processes a subset of Medicaid ABD cases for Supplemental Security Income (SSI) and SSI Related programs. Other Medicaid ABD programs are handled by the LTC Unit, as detailed below. SSI eligibles are not required to submit an application and their eligibility information is received from the Social Security Administration (SSA). SFY2014 Caseload: 12,899 clients average number of eligibles: 11,300 State Supplemental Payment Program Provides cash payments to SSI recipients receiving full SSI payments from the SSA are entitled to a small supplemental payment from the State of Wyoming. SFY2015 Caseload: 4,484 clients average number of eligibles: 3,382 Children?s Health Provides coverage to uninsured SFY2015 Caseload: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 17 of 150 PROGRAM DESCRIPTION PROGRAM STATISTICS Insurance Program children under age 19. Families 8,483 clients (Kid Care CHIP) may be responsible for cost sharing depending on income and average number of Native American or Alaskan Indian eligibles: 3,500 ethnicity status. Benefits are delivered through a private health insurance Contract. Table 5.2.2: LTC Program Summary Table PROGRAM DESCRIPTION PROGRAM STATISTICS Medicaid- Institutionalized programs for SFY2014 Caseload: Aged, Blind or those individuals who need long 6,700 clients Disabled (ABD) term care and are unable to live in the community. average number of eligibles: Home and Community Based LTC: 5,864 Waiver programs for individuals who need a level of care provided in an institution, but wish to remain in the community and receive specialized services. 4.2.1 Current Service Delivery Model The CSC operates a single facility located in Cheyenne, Wyoming that provides multiple intake points for accessing health insurance coverage to accommodate the individual needs of the client. Applications are currently accepted online through a Client Web Portal or through the centralized CSC by telephone, mail, fax, email or in~person. When a client's eligibility cannot be determined through the Client Web Portal or a client prefers to contact the CSC, the client has several options to receive service: mail, fax, telephone, email, or in-person. Note that all LTC related contacts and service needs are currently screened to the Agency?s LTC Unit for processing. The CSC operates a centralized mail hub that manages all paper documents received through email, mail or fax related to health insurance programs and ensures the proper documentation is scanned, indexed and filed to the appropriate electronic case file. The CSC will leverage the WES and its integrated EDMS to support this business process. See additional information regarding the CSC Interaction with the State of Wyoming?s Central Mail provided in the procurement library [located at A client can also call the CSC or visit the CSC facility in-person to speak directly with a CSC representative regarding their application, renewal, case change, or other general assistance. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 18 of 150 CSC representatives heavily rely on the WES to help address issues and facilitate business processes. In addition to application and eligibility processing, the CSC provides customer service and case management services for Medicaid, Kid Care CHIP and State funded medical programs. The CSC also assists the Agency in renewal and change processing and quality control activities when requested. This could include Medicaid Eligibility Quality Control (MEQC), Payment Error Rate Measurement (PERM), and Quality Assurance reviews. The figure below illustrates the current workflow. Figure 5.2-1: Summary of Current CSC Warkflow I Tel-phone In Person TDYITDD at; IVR CSC Flaps CHM - LTC Transfer 3 i - Lch-uGtI-w' - ?168um - - I woman-mammalian . muons LTC Presently, the Agency has identified some defects and enhancements related to the Client Web Portal, which are currently impacting the current CSC staff, call volumes and workload. Currently, less than 1% of the client p0pulation exclusively uses the Client Web Portal for services. Once Client Web Portal updates are complete, the Agency anticipates that the Client Web Portal usage will increase and shift a portion of calls currently handled by the CSC to the self-service online Portal- resulting in a lower demand on the CSC in the future. The goal of the Agency is to have 25% of its clients using the Client Web Portal for services without contacting the CSC. Additional details on the current defects and anticipated resolutions is included in Appendix E. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 19 of 150 As indicated above, both the CSC and the LTC Unit heavily rely on the WES to support its business needs. The outstanding WES functionality and defect rate has impacted the projected call volumes and CSC workload- resulting in the Agency providing supplemental support to the CSC. The awarded Contractor will have a strong working relationship with the WES Contractor, and will be required to integrate some CSC components into the WES, as further described in Section 6.4. The Agency anticipates that both the WES and CSC will be transitioned in the same timeframe, requiring a collaborative partnership between the selected vendors and Agency to ensure a successful transition of services for the Agency's clients. Specific requirements for this vendor partnership are included in Appendix A. Once the CSC and WES projects have been successfully transitioned and stabilized, the awarded CSC Contractor will work with the Agency to identify ways to further streamline and enhance CSC processes and services to provide more efficient and effective services for its clients. 4.2.2 Future Program Integration With the exclusion of the LTC services in Table 5.2.2, the CSC is responsible for conducting eligibility determination and case maintenance services in the WES for individuals covered by the programs discussed in Table 5.2.1 above. The Agency envisions a single CSC to service all its clients? needs and to act as a "one stop shop? for its applicants and clients, which would include expanding the CSC to provide Medicaid enrollment and benefit information. Enrollment and benefit assistance is currently managed by the State?s fiscal agent, which is in the process of being reprocured as part of the Agency?s Wyoming Integrated Next Generation System (WINGS) project. The WINGS project is the Agency?s alternative approach to procuring a traditional MMIS. Instead of procuring one vendor to act as Wyoming's fiscal agent, the Agency is procuring multiple vendors to operate its MMIS with a service-based model. Integration of these future client support activities would require a contract amendment. 4.2.3 Business Needs As stated above, the Agency is seeking a vendor to maintain and enhance its CSC that currently supports application and eligibility determination processes. In addition, the Agency has identified additional business needs forthe CSC, including: Table 5.2.3: Summary of Business Needs AREA OF NEED DESCRIPTION increase effectiveness and Updates to the CSC model and tools will increase effectiveness efficiency and efficiency in service delivery. Improve CSC training and Implement a more robust training and knowledge dissemination knowledge dissemination requirement set that will require the Contractor to take a more proactive role in resolving caller needs. Improve reporting Improvements to the current reporting capabilities will allow the capabilities State the flexible and robust reporting capability originally intended with the CSC. Implement a The reprocurement will allow the Agency the ability to review performance-based the current contract, performance expectations, and implement payment model a performance-based payment model. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 20 of 150 43 $4 PURPOSEANDINTENT: The purpose of this Request for Proposal (RFP) is to solicit competitive proposals from Proposers who can operate the CSC in accordance to Agency?s needs and expectations, as described within this RFP, and further optimize the current services and programs to provide its clients with an effective ?one stop shop? for Medicaid assistance. Based on the current CSC contract, all work and services must be successfully transitioned to the awarded CSC Contractor by September 30, 2016 for start of operations on October 1, 2016. The interdependencies between WES operations and CSC performance will be a consideration when the Agency reviews performance expectation that rely on WES functionality. In addition to WES, the WES hosting vendor also impacts the CSC through its ability to provide uninterrupted hosting services to WES. The comprehensive list of stakeholders that will result from this procurement are described in the table below. Table 5.4.1: Summary of Stakeholders Stakeholder DESCRIPTION BENEFITS WDH (Agency) WDH will be primarily responsible for the CSC reprocurement project, and the day-to-day project management related to the transition and operations of CSC services. The Agency will be responsible for overseeing the awarded Contractor?s performance and escalating project issues and risks to Steering Committee and project sponsors. The Agency will coordinate the State resources throughout the contract terms to participate in the necessary activities to successfully transition and operate the CSC. The Agency will also coordinate all WES activities and communications that require and impact the CSC Contractor. Improved communication and transparency into CSC operations and issues. Improved operational efficiencies and business processes. Increased compliance with Federal and State initiatives affecting Medicaid and Kid Care CHIP. Enhanced reporting and transparency into Medicaid and Kid Care CHIP Operations. Executive Sponsors Executive Sponsors consist of State Agency Directors and WDH Senior Staff. Executive Sponsors will oversee the project and provide overall project direction. Executive Sponsors have final decision Improved communication and transparency into CSC operations and issues. Increased compliance with Federal and State initiatives affecting Medicaid and Kid Care Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 21 of 150 Stakeholder DESCRIPTION BENEFITS making authority related to the CHIP. project. Enhanced reporting and transparency into Medicaid and Kid Care CHIP operations. CSC Steering The CSC Steering Committee Improved communication and Committee oversees the project and provides transparency into CSC project direction on scope, operations and issues. schedule, issues, risks, and other Increased compliance with areas. In addition to Agency Federal and State initiatives Stakeholders, the Steering affecting Medicaid and Kid Care Committee includes integrated CHIP. representatives from the WDH and Enhanced reporting and the Department Of Enterprise transparency into Medicaid and Technology Services Kid Care CHIP operations. WDH Contract The WDH Contract Vendor Improved communication and Vendor Manager Manager will oversee the project acting as the primary contact for the Contractor. The WDH Contract 8: Vendor Manager works hand-in- hand with the WES Project Manager (ETS) and manages all contract relationships between the WES and CSC Contractors to ensure compliance with contract requirements. The WDH Contract 8: Vendor Manager is primarily responsible for reporting contract compliance and approving all change orders to the CSC. transparency into CSC operations and issues. Enhanced reporting and transparency into Medicaid and Kid Care CHIP operations. WES Project The WES Project Manager (ETS) will Improved communication and Manager (ETS) work closely with the WDH transparency into CSC Contract Vendor Manager and operations and issues. the CSC Contractor to provide day- Enhanced reporting and to-day coordination of all project transparency into Medicaid and tasks. The WES Project Manager Kid Care CHIP operations. (ETS) is primarily responsible for reporting project status, issues and risks to the CSC Steering Committee and implementing recommended mitigation strategies. Agency Staff Agency Staff communicates with Improved communication and CSC on functions. transparency into CSC operations and issues. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 22 of 150 4.5 Stakeholder DESCRIPTION BENEFITS Centers for Medicare and Medicaid Services (CMS) CMS is the Federal partner to the Agency and is responsible for overseeing all state Medicaid and Kid Care CHIP services and projects. Enhanced reporting and transparency into Medicaid and Kid Care CHIP operations. WES Contractor The CSC relies on the WES for its daily business functions. It is the system where CSC representatives enter client data, process verifications, and conduct eligibility determination and case management services. Coordinated relationship and increased accountability. Enhanced reporting and transparency into Medicaid and Kid Care CHIP operations. WES Hosting The CSC relies on the WES hosting Coordinated relationship and Vendor vendor and its ability to provide increased accountability. hosting services to ensure WES is 100% functional. Agency LTC Unit The LTC Unit works directly with Coordinated relationship and the CSC to receive call transfers increased accountability. regarding LTC eligibility and Enhanced reporting and questions. The LTC will have access transparency into Medicaid and to CSC Tools for seamless access to Kid Care CHIP operations. client data. Clients Primary beneficiaries of Medicaid Enhanced customer service and Kid Care CHIP services. experience. RFP REQUIREMENTS: The Wyoming Department of Heath, Division of Healthcare Financing defined the requirements stated herein and created this RFP. For convenience, Contract Requirements have been consolidated into a single Appendix (Appendix A) to streamline Proposers' reviews. Note that some requirements may be repeated in Section 6 of the RFP based on the RFP template. THESE ARE MANDATORY REQUIREMENTS, WHICH MAY BE SUBJECT TO VARIATION AND MODIFICATION ONLY THROUGH THE APPROVAL OF THE AGENCY. Remainder of this page left blank. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 23 of 150 SECTION 5: REQUIREMENTS - RESPONSIBILITIES OF CONTRACTOR SCOPE OF PROJECT: The Agency will require the awarded Contractor to provide the same CSC services and implement efficiencies to improve the customer service experience. The Agency?s goal is to first transition and stabilize the CSC, then work with the selected Contractor to develop plans to address deficiencies. The high-level scope includes: - Provide Transition Services: If a new Contractor is selected, the awarded Contractor will work with the Incumbent Contractor to successfully transition the CSC services, any CSC systems owned by the state, documentation, knowledge, and training needs. 0 Provide CSC staff and infrastructure: The awarded Contractor will develop its resource plan and staff the CSC with qualified representatives and management, and provide the hardware and software, such as the Interactive Voice Response (NR) and Customer Relationship Management (CRM), required to meet RFP requirements and performance expectations. The awarded Contractor will also work with the WES Contractor to integrate required tools and obtain necessary system documentation, training, and assistance. The Agency requires that the selected CSC Contractor maintain an in-person service location with mailroom operations in a facility located in Cheyenne, WY, but will consider proposed models that have a portion of the call center operations offsite, as further described in Section 6.4.1.1. - Provide robust training and support for CSC representatives: The Agency and WES Contractor will work with awarded CSC Contractor trainers to identify the necessary system and policy training components for CSC representative training. The CSC Contractor trainers will be responsible for regular staff training and will also provide staff with the necessary tools and documentation to quickly access system, process, program, and policy information. The CSC Contractor will also be responsible for delivering a comprehensive Knowledge Management (KM) solution that will provide CSC staff access to CSC training materials, WDH policy information, and other pertinent knowledge to facilitate business processes. 0 Provide customer service and eligibility determination processing services: The awarded Contractor will provide call support, disseminate program information to clients, provide application assistance, process applications, renewals, and client changes in the WES, and provide ongoing case maintenance for Medicaid and Kid Care CHIP clients. Due to the complexities of the LTC program, the Agency will maintain the LTC applications and cases throughout the contract, unless new contract terms are negotiated. The CSC Contractor will triage LTC cases to the State LTC Unit for management. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 24 of 150 0 Provide mailroom and scanning support: The awarded Contractor will manage all eligibility-related inbound and outbound mail. The CSC will be responsible for triaging requests and scanning documentation into the Agency?s integrated EDMS and linked to the appropriate electronic case file reducing paper documentation. All records will be maintained in accordance with record retention requirements. 0 Provide ongoing security management: The awarded Contractor will provide ongoing security management and maintenance related to the CSC, its staff and its use of WES and related components to ensure compliance with Federal and State security rules, including but not limited to HIPAA and HITECH. 0 Provide Business Continuity and Disaster Recovery services: The awarded Contractor will provide business continuity and disaster recovery services for the appropriate systems and tools, in accordance to the agreed upon performance expectations. 0 Provide performance monitoring: The awarded Contractor will provide performance management and reporting in accordance to the agreed upon performance expectations. 0 Collaborate with the Agency and designated WES Contractor to improve the WES. As indicated in earlier sections, the Agency has identified several defects and enhancements to the current WES that will be resolved with the selected WES Contractor. The Agency expects the awarded CSC Contractor to collaborate with the WES Contractor and Agency to regulariy review identified defects impacting the CSC and develop short?term workarounds for issues until they are fully resolved in the system. A list of current defects and enhancements are included in Appendix E. 0 Partner with the Agency and WES Contractor to assist in CMS compliance needs: The awarded Contractor will meet regularly and collaborate with the Agency and WES Contractor to review status, issues, and potential risks with service delivery and compliance. Work with the Agency as directed to support CMS compliance needs. 0 Assist the Agency in interpreting future Federal policies and requirements: The awarded Contractor will provide consultation and expertise to Agency liaisons and assist in interpreting future polices and regulations; as well as their impact on the current system and service model. The comprehensive requirements and responsibilities under this Scope of Work are included in subsequent sections. 5.1.1 GOALS: It is the goal of the Agency to procure a qualified vendor to provide sufficient resources with the experience and expertise necessary to operate and enhance the CSC and meet the Performance Expectations in Appendix C. 5.1.2 OPERATIONAL OBJECTIVES: The Agency intends to meet the following operational objectives as an outcome of this project: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 25 of 150 5.2 5.3 0 Implement a customer service model that meets/exceeds service and processing standards. The CSC Contractor will takeover the current CSC scope of client support, application processing, renewal processing, client change processing, and mailroom/scanning management and design a model that will maximize efficiency and effectiveness in service delivery. The CSC Contractor is expected to provide the facilities, staff, tools and infrastructure to fully support requirements and performance expectations outlined in the RFP. a Partner with the Agency and WES Contractor and maintain a collaborative and transparent relationship throughout the term of the Contract. The Agency desires a partner that will help achieve the original intent and goals of the CSC and health insurance program modernization vision. The CSC Contractor must collaborate not only with the Agency, but also with the WES Contractor on a regular basis to understand eligibility issues, risks, and develop resolutions and plans to address future Agency needs. - Seamlessly integrate with the WES. The WES and CSC are highly dependent on each other for the delivery of health insurance eligibility services. The CSC will be required to integrate its tools with the WES and work collaboratively with the WES Contractor to address concerns and issues impacting CSC services. 5.1.3 SUGGESTED PROJECT DURATION: The current CSC contract will expire September 30, 2016. The Agency intends to successfully procure the awarded CSC Contractor for the start of transition services on July 1, 2016, allowing a three-month window to transition and establish the necessary services, hardware, software, documentation, and knowledge and prepare for full transition by October 1, 2016. The Contractor must be responsible for maintaining and enhancing the CSC for a minimum of four (4) base maintenance years. An additional two (2), two (2) year options may be exercised at the discretion of the Agency (for a maximum of eight (8) years). RELEVANT EXPERIENCE: 5.2.1 Mandatory Experience Requirements: Each Proposer must fully meet the experience requirements outlined in this section. Proposers who are unable to demonstrate/attest to their ability to meet these requirements may be disqualified. THESE ARE MANDATORY REQUIREMENTS, WHICH MAY BE SUBJECT TO VARIATION AND MODIFICATION ONLY THROUGH THE WRITTEN APPROVAL OF THE AGENCY. The Agency is seeking organizations that display a commitment to the highest-quality customer service. In addition to the information to address the mandatory requirements in Appendix A, Proposers are requested to provide information as part of their Proposal Response evidencing the organizations experience, qualifications, and ability to perform the services described in this RFP. More information on Proposal Response requirements is included in Section 7. SCOPE OF SERVICES: PHASE SPECIFIC REQUIREMENTS Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 26 of 150 The Agency has identified the following phases for the CSC Contract term. Each phase includes an overview of activities, the Contractor responsibilities, Agency responsibilities, Incumbent Contractor responsibilities (where appropriate), and Exit Criteria that objectively demonstrates that that phase has been successfully completed. The CSC Contractor and Agency may identify additional Exit Criteria in Contract negotiations and the initial Start-Up activities. 5.3.1 SCOPE OF ACTIVITY - START-UP The Start-Up activities will ensure that adequate planning and project management resources are dedicated to this project and the awarded Contractor is ready to begin work on Transition activities. The Agency anticipates that Start-U activities will be completed within the first three (3) weeks of the Contract execution period to ensure a successful transition of services by October 1, 2016, but will work with the selected Contractor to determine the appropriate timeframe. 5.3.1.1 Objectives: 5.3.1.1.1 Successfully conduct a Project Kick-Off meeting to introduce the key personnel, project plan, and other key project information necessary to successfully transition the CSC. 5.3.1.1.2 Establish the appropriate project and Contract documentation, tools, plans, and resources to successfully transition the CSC. 5.3.1.1.3 Ensure that adequate planning and project management resources are dedicated to this project. 5.3.1.1.4 Finalize Transition plans and schedules with the Agency. 5.3.1.2 Contractor Responsibilities: 5.3.1.2.1 Facilitate the Project Kick-Off meeting with key Agency, stakeholders, and Contractor staff to introduce the project, teams, and plans for the CSC transition and Contract. 5.3.1.2.2 Provide all services and requirements included in Appendix A in accordance to Agency expectations and the approved project plan. 5.3.1.2.3 Provide all phase deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B. 5.3.1.2.4 Adhere to all contract performance standards included in Appendix C. 5.3.1.3 Agency Responsibilities: 5.3.1.3.1 Participate in Project Kick-Off and provide feedback to the Contractor on plans. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 27 of 150 5.3.1.3.2 Monitor and approve all work performed by Contractor. 5.3.1.3.3 Facilitate communications between the Incumbent Contractor, the CSC Contractor, the WES Contractor, and other project stakeholders, as necessary. 5.3.1.3.4 Review all completed deliverables within the agreed upon timeframe for each deliverable. 5.3.1.3.5 Review progress and compliance with Phase exit criteria. 5.3.1.4 Incumbent Contractor Responsibilities: 5.3.1.4.1 If appropriate, participate in Start Up meetings, as directed by the Agency. 5.3.1.5 Exit Criteria: At minimum, the Contractor shall meet the following requirements prior to exiting the Start-Up phase. Additional Exit Criteria may be negotiated during Contract negotiations and Start-Up planning. 5.3.1.5.1 Successfully facilitate the Project Kick-Off meeting. 5.3.1.5.2 Receive Agency approval of all phase deliverables listed in Appendix B. 5.3.2 SCOPE OF ACTIVITY TRANSITION The Transition Phase includes the testing and transition of the CSC and tools to the new Contractor, and stabilization of CSC operations. The Transition Phase and plan must provide for a seamless transition of CSC operations, Agency and CSC staff, clients, applicants, and other CSC stakeholders. Transition activities must be completed by October 1, 2016 to ensure a successful transition of the WES to the awarded Contractor. 5.3.2.1 Objectives 5.3.2.1.1 Conduct thorough testing of all CSC related tools and systems to validate operational readiness. 5.3.2.1.2 Ensure that the awarded Contractor successfully completes conversion activities of all knowledge management, client data and necessary tools from the Incumbent Contractor to fully operate and maintain the CSC independently of the Incumbent Contractor. Detailed conversion requirements are included in Appendix A. 5.3.2.1.3 Successfully stabilize CSC operations in accordance to the agreed upon criteria and SLA. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 28 of 150 5.3.2.1.4 Ensure that the awarded Contractor implements any new tools, including, but not limited to, the IVR, CRM, dashboards, and reporting tools by September 30, 2016. 5.3.2.2 Contractor Responsibilities 5.3.2.2.1 5.3.2.2.2 5.3.2.2.3 5.3.2.2.4 5.3.2.2.5 Ensure adequate staffing on day one of Transition and adequate training throughout the phase to meet the requirements included in Appendix A. Provide all Transition services and requirements included in Appendix A in accordance to Agency expectations and the approved project plan. Provide all phase deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B. Work with the Agency to determine stabilization criteria that reflects the agreed upon SLA requirements. Adhere to all contract performance standards included in Appendix C. 5.3.2.3 Agency Responsibilities 5.3.2.3.1 5.32.3.2 5.32.3.3 5.32.3.4 5.32.3.5 5.3.23.6 5.3.2.3.7 5.3.2.3.8 5.3.2.3.9 Monitor and approve all work performed by Contractor. Oversee testing activities, if applicable and requested by the Contractor. Facilitate communications between the Incumbent Contractor, the CSC Contractor, and the WES Contractor, as necessary. Review all completed deliverables within the agreed upon timeframe for each deliverable. Provide access to the necessary Agency facilities, personnel, documentation, and other items under its control and provide coordination with and access to third parties, to facilitate transition services. Provide appropriate program policy training and to the Contractor in accordance to the agreed upon Training Plan. Attend any Contractor conducted training as identified by the Agency. Work with the CSC Contractor to determine stabilization criteria that reflects the agreed upon SLA requirements Validate operational readiness for CSC transition by conducting a review of tool readiness, CSC Contractor resource readiness, Agency staff readiness, and CSC readiness in accordance to pre-defined operational readiness criteria. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 29 of 150 5.3.2.3.10 Review progress and compliance with Phase exit criteria. 5.3.2.4 Incumbent Contractor Responsibilities 5.3.2.4.1 Provide the CSC Contractor with the necessary data access, code, documentation, and other components identified in the Incumbent?s Transition Plan necessary to successfully transition CSC operations. 5.3.2.4.2 Participate in meetings and knowledge transfer sessions with the Agency and CSC Contractor. 5.3.2.4.3 Clarify questions or concerns from the Agency or CSC Contractor on related items. 5.3.2.5 Exit Criteria At minimum, the Contractor shall meet the following requirements prior to exiting the Transition Phase. Additional Exit Criteria may be negotiated during Contract negotiations and Start-Up planning. 5.3.2.5.1 Objectively demonstrate readiness for CSC operations in accordance to the agreed upon stabilization criteria. 5.3.2.5.2 Receive Agency approval of all phase deliverables listed in Appendix B. 5.3.2.5.3 Successful transfer of operations, as deemed by the Agency. 5.3.3 SCOPE OF ACTIVITY- OPERATIONS During the Operations Phase, the Contractor will be responsible for operating the CSC. The CSC must be appropriately staffed and staff must be trained to meet stakeholder expectations. The Contractor will disseminate program information; screen clients; process applications, renewals, and changes; manage the centralized mailroom; provide reports; manage documents; conduct services; and answer basic questions using staff?s policy knowledge, the CRM, and IVR. The awarded CSC Contractor will perform an assessment and recommend opportunities to optimize the CSC model to enhance the customer service experience and service delivery model for its clients. Any resulting decisions to optimize the CSC will be managed through the Change Advisory Board and a task-order model. 5.3.3.1 Objectives 5.3.3.1.1 Ensure the CSC meets client, Agency, and stakeholder expectations. 5.3.3.1.2 Identify areas to further streamline CSC operations and business processes to provide operational and cost efficiencies, and improve the customer service experience and service delivery model. 5.3.3.2 Contractor Responsibilities Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 30 of 150 5.33.2.1 5.33.2.2 5.33.2.3 5.3.3.2.4 5.3.3.2.5 Agency Responsibilities 5.33.2.6 5.33.2.7 5.33.2.8 5.33.2.9 5.3.3.2.10 5.3.3.2.11 5.3.3.2.12 5.3.3.2.13 Provide all Operation services and requirements included in Appendix A in accordance to Agency expectations and the agreed upon performance expectations in Appendix C. Provide all phase deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B. Adhere to all contract performance standards included in Appendix C. Work with the Agency and WES Contractor, as needed. Provide the Agency with recommendations to streamline CSC operations and business processes to provide operational and cost efficiencies, and improve the customer service experience and service delivery model. Monitor and approve all work performed by Contractor. Participate in regular issue and risk review meetings throughout operations. Facilitate communications between the WES Contractor, and the CSC contractor, as necessary. Review all completed deliverables within the agreed upon timeframe for each deliverable. Provide consultation on policy training and modifications to enable successful interpretation of new policies or requirements per the agreed upon Training schedule and process. Participate in CSC Contractor training, as agreed to in the Training Plan. Monitor Contractor and system compliance with the Contract and performance expectations. Meet with the CSC Contractor to discuss recommended changes to the CSC model to streamline CSC operations and business processes to provide operational and cost efficiencies, and improve the customer service experience and service delivery model. if determined appropriate, initiate the necessary contract amendments to implement any agreed upon changes. 5.3.3.3 Exit Criteria At minimum, the Contractor shall meet the following requirements prior to exiting the Operations Phase. Additional Exit Criteria may be negotiated during Contract negotiations and Start-Up planning. Attachment to the Information Technology (lT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 31 of 150 5.3.3.3.1 Receive Agency approval of all phase deliverables listed in Appendix B. 5.3.3.3.2 Fulfill all Operation requirements and obligations in accordance to the agreed upon Contract. 5.3.4 SCOPE OF TURNOVER SERVICES As requested, but approximately six (6) months prior to the end of the base contract period(s) or any extension thereof, the Contractor shall provide, at no extra charge, assistance in turning over the final Contractor responsibilities to the Agency or another contractor. 5.3.4.1 Objectives 5.3.4.1.1 Successfully turnover all CSC services, appropriate tools, and documentation to the Agency or its designee within the required timeframe. 5.3.4.2 Contractor Responsibilities 5.3.4.2.1 Provide all Turnover services and requirements included in Appendix A in accordance to Agency expectations. 5.3.4.2.2 Provide all phase deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B. 5.3.4.2.3 Adhere to all contract performance standards included in Appendix C. 5.3.4.3 Agency ReSponsibilities 5.3.4.3.1 Initiate turnover services with the Contractor. 5.3.4.3.2 Review and approve Turnover Plan to facilitate transfer of the operational responsibilities to the State or its designee. 5.3.4.3.3 Coordinate turnover services as initiated by the Contractor. 5.3.4.3.4 Identify training and support requirements. 5.3.43.5 Make State staff or designated replacement Contractor operations designee available to be trained in the operation of the system. 5.3.4.3.6 Review and approve Lessons Learned document and/or provide feedback on areas where improvement is needed. 5.3.4.4 Exit Criteria 5.3.4.4.1 Receive Agency approval of all phase deliverables listed in Appendix B. 5.3.4.4.2 Fulfill all requirements and obligations in accordance to the agreed upon Contract. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 32 of 150 5.4- GENERAL REQUIREMENTS: The following requirements apply to all phases and services included in the final WES Contract. 5.4.1 LOCATION AND WORK ENVIRONMENTS: 5.4.1.1 On-site requirements: The CSC Contractor shall provide a facility located in Cheyenne, Wyoming to provide in-person services and mailroom operations. 5.4.1.1.1 Onsite CSC staff are required to work from the CSC facility located in Cheyenne, Wyoming during CSC hours of operation (Monday through Friday, 7:00 PM), with the exception of State holidays, which include: a. New Year?s Day b. Martin Luther King Jr. Day c. President?s Day d. Memorial Day e. Independence Day f. Labor Day g. Veterans? Day h. Thanksgiving 1. Christmas 5.4.1.1.2 Management staff must be present during the hours of operation. 5.4.1.1.3 The Agency has the right to perform physical security audits of the CSC facility at the Agency?s discretion. 5.4.1.2 Offsite Remote Requirements: 5.4.1.2.1 The Agency requires that the selected CSC Contractor maintain the in- person services and mailroom operations at the local facility, but will consider proposed models that have a portion of the call center Operations Offsite. Any proposed Offsite operations must be conducted within the continental United States. Additional information on the proposal response requirements is included in Section 7. 5.4.1.2.2 The Agency requires all Contract services and activities to be conducted within the continental United States. With the exception of security Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 33 of 150 controls, software development and defect resolution to Contractor- supplied software which may leverage global resources. 5.4.1.2.3 Any key personnel staff identified in Section 6.8 who are approved by the Agency to work offsite must be available to come to Cheyenne at the Agency?s request to attend meetings or participate in functions in support of the Scope of Work. 5.4.2 GENERAL MANAGEMENT REQUIREMENTS: 5.4.2.1 Agency/Contractor Requirements: Contractor staff will have an ongoing relationship with Agency staff that is based on trust, confidentiality, objectivity and integrity. The Contractor will be expected to operate at all times in the Agency?s best interests and in a straightforward, trustworthy and professional manner. The Contractor shall work cooperatively with the staff of the Agency and the Agency?s external partner Agencies/Vendors whenever required in the course of performing the functions required by the RFP and resulting Contract. A summary of the relationship expectations for each external agency/vendor is included below. Table 6.4.2.1.1: Contractor Relationship Expectations External Relationship Expectations: Agency/Vendor WES Vendor a Meet regularly to discuss system and workflow issues or concerns and develop mitigation strategies under the Agency's guidance. 0 Provide training and user documentation, as required in Section 6.10. Note that the Agency will adopt a train-the-trainer model and reserves the right to invite anybody to Contractor training sessions they deem appropriate. WES Hosting Vendor 0 Support Agency in WES Hosting Vendor Requests ETS I Support Agency in ETS requests CMS 0 Support Agency in CMS requests or Agency designee when requested As described in Section 5, the CSC Contractor will have a high level of interaction and collaboration with the awarded WES Contractor. The Agency anticipates that the CSC Operations Manager, or similarly experienced designees, collaborate regularly with the WDH Contract Vendor Manager and WES Operations Manager or designee to review CSC operational status and discuss issues or concerns with WES functionality or performance. 5.4.2.2 Contract Management Requirements: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 34 of 150 Specific requirements related to Contract Management are included in Appendix A. 5.4.3 COMMUNICATION REQUIREMENTS: The Agency desires a significant level of transparency and visibility into the awarded Contractor?s activities related to the CSC Contract. The Contractor will be a partner with the Agency project staff and is expected to be proactive in identifying problems or areas for improvement and communicating any issues or recommendations to the Agency in a timely manner. Specific Communication Requirements are included in Appendix A. 5.4.4 RISK AND ISSUE MANAGEMENT REQUIREMENTS: The Contractor must adhere to the Project Management Institute (PMI) or similar industry- standard risk and issue management standards throughout the Contract term and effectively communicate all potential risks and corresponding mitigation plans to the Agency. Specific Risk Management Requirements are included in Appendix A. 5.4.5 EQUIPMENT: With the exclusion of the WES and EDMS, the Contractor must provide all equipment, hardware, software, and technology needed to complete the Scope of Work and performance expectations described in this RFP. The Contractor is responsible for the successful acquisition and management of the data needed to perform the responsibilities under this Contract. Specific requirements for Equipment are included in Appendix A. The Agency may choose to purchase the equipment at a fair market price in the event that the contract is terminated. 5.4.6 STATE PERSONNEL: The WDH Contract Vendor Manager will work closely with the WES Project Manager (ETS) and manage the WES and CSC contract and activities, communicate contract compliance to key stakeholders, and participate in all project-related meetings. The organizational chart below depicts the anticipated project reporting structure. Figure 6.4. 6-1: Summary of State Personnel Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 35 of 150 5.5 Eat-mm. Sponwr. g-mlr'r; Adm Pro-1mm Ma m-j- :3 sh?: WDH Conlm 3 Vr'n?lrir {Junta-gm Pr was Commcior CSC Contractor WES Contractor CSC Comm-rim Program Director Mandi)? WES Commctor CSC Contra: tor SLIM Skill The Agency will leverage the existing Project Steering Committee and Executive Sponsors with representatives from WDH and ETS to provide high-level oversight into project decisions, issues, and risks. The Project Steering Committee will report directly to the Executive Sponsors. The Agency, in conjunction with ETS, will provide direct project oversight of both the CSC reprocurement, transition, and contract management. The Agency will utilize its existing WES Project Manager (ETS), WDH Contract Vendor Manager, and approximately nine (9) WDH subject mater experts (SMEs) that will be dedicated to this project on a part-time basis. SYSTEM OR WYOMING IT STANDARDS: The services, work products and final deliverables provided by the Proposer shall be in compliance with State Statues, CID Promulgated Rules, State IT policies and standards and the Wyoming Department of Health standards for required system hardware, software and development components, when completed and accepted by the Agency. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 36 of 150 5.5.1 State Standards: 5.5.2 5.5.3 State of Wyoming CIO Promulgated Rules on Electronic Transactions: State of Wyoming IT Policies and Standards: page-2.html Wyoming Department of Health Standards and Best Practices: CMS Application Life Cycle Management (ALM) Collaborative Environment and Life Cycle Governance - Exchange Reference Architecture (ERA) Supplement Exchange Life Cycle model (ELC) Federal Acquisition Regulation (FAR) clause 52.239-1 IRS Publication 1075 ISO 27001/2 Medicaid Information Technology Architecture (MITA) NIST Special Publication 800-14 NIST Special Publication 800-47 NIST Special Publication 800-53 NIST Special Publication 800-57 rev 4 Federal Information Processing Standards (FIPS) Statutory Mandates: 18 U.S.C. 641 Criminal Code: Public Money, Property or Records; 18 U.S.C. 1905 Criminal Code: Disclosure of Confidential Information; CFR Title 21 - Food and Drugs: Parts 1 to 1499; CFR Title 45 (Parts 1-199) (Code of Federal Regulation Title 45 Public Welfare Revised (Specifically 164 Security and Privacy); Economic Recovery Act of 2009; Emergency Medical Treatment 8: Labor Act Federal Information Security Management Act of 2002 Freedom of Information Act (FOIA), Health Insurance Portability and Accountability Act (HIPAA) of 1996 P.L. 104-191; OMB Circular A-130, Appendix Security of Federal Automated Information Systems; Privacy Act of 1974, 5 U.S.C. 552a; Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 37 of 150 Section 1011 - Emergency Health Services Furnished to Undocumented Aliens; The Deficit Reduction Act of 2005; The Health Information Technology for Economic and Clinical Health (HITECH) Act The Patient Protection and Affordable Care Act of 2010 (ACA) The Sarbanes-Oxley Act of 2002 5.6 TECHNOLOGY AND SPECIFICATIONS: 5.6.1 The CSC Contractor shall provide, implement and operate an IVR, CRM, KM, dashboard, reporting tools, and any other tools necessary to effectively operate the CSC. The Agency may choose to purchase the tools at a fair market price if the event that the Contract is terminated in the future. The CSC Contractor must have the capabilities to seamlessly interface with the WES system and its EDMS to allow CSC representatives access to necessary information to address client concerns. WES is a web-based system with a Service Oriented Architecture (SOA) architecture that uses a blend of Open Source and Commercial off the Shelf (COTS) products, a rules-engine and database supported eligibility system transferred from the state of Montana and enhanced to meet WDH functional requirements and compliance with the Affordable Care Act (ACA). Additional technical information on the WES is included in the Procurement Library [located at The Contractor must be prepared to operate and maintain the CSC in accordance with the Operation responsibilities and requirements in Section 6.3.4. Specific requirements to each CSC tool are included in Appendix A. 5.6.2 REPORTING The CSC Contractor will be responsible for providing operational reporting from its tools IVR, CRM, workforce management system, etc.) as de?ned in Appendix A. 5.6.3 SECURITY The CSC will need a multi-Iayered security architecture that utilizes user and role-based access to support State and Federal requirements and national best practice standards. The CSC Contractor must maintain the detailed Security requirements included in Appendix A. 5.6.4 BUSINESS CONTINUITY AND DISASTER RECOVERY CSC tools and operations will need to be implemented with business continuity and disaster recovery planning in mind so that essential functions are able to continue in the event of a disruption or disaster. The CSC Contractor must maintain current expectations related to business continuity and disaster recovery, as outlined in requirements in Appendix A. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 38 of 150 5.7 5.8 HOSTING: The Contractor must host and provide ongoing support for all Contractor-specific systems and tools utilized to support this Scope of Work in accordance to the agreed upon SLA. CONTRACTOR STAFFING QUALIFICATIONS: The Contractor shall provide qualified personnel to perform the work necessary to accomplish the tasks defined in the Scope of Work sections. The Contractor must identify the individuals who will fill the key staff positions to the Agency by the Contract effective date, including those that are not directly employed by the Contractor. The Agency reserves the right to approve the key personnel assigned to this Contract. The Agency also reserves the right to request removal of any Contractor and/or subcontractor staff and demand immediate response by the Contractor with plans to replace the requested staff member. The Agency also has the authority to approve proposed replacements of key personnel by the Contractor. Throughout the course of the Contract resulting from this RFP, the Agency may review the Contractor?s hiring practices, employee satisfaction measures, turnover, and any other metrics associated with staffing and work environment. The following include staffing and qualification requirements, as it relates to the services set forth in the RFP. 5.8.1 RESOURCE MANAGEMENT AND STAFFING PLAN The Contractor shall ensure that the CSC Contract is adequately staffed with experienced, knowledgeable personnel who can meet the responsibilities outlined in this RFP throughout the Contract term. Specific requirements to resource management and staffing are included Appendix A. 5.8.2 RESOURCE RESPONSIBILITIES: The Contractor shall designate the following key personnel for the Contract term. Key Personnel shall be available and ready to start Work by the Contract effective date, including those that are not directly employed by the Contractor. Key Personnel roles must be filled at all times throughout the duration of the Contract, unless specified by the Agency. Key Personnel include, but are not limited to: - CSC Account Manager 0 Operations Manager 0 Training Manager 0 IT Specialist - Manager 0 Reporting Analyst Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 39 of 150 0 Consulting Policy Analyst 0 Mailroom Lead Specific responsibilities and requirements for each designated role are included in Appendix A. The Proposer may also propose additional key personnel if advantageous for the WES Scope of Work. 5.8.3 SUBCONTRACTORS: Any approved subcontractor will report to and be responsible to the awarded Contractor. If applicable, the Proposer shall provide a description of all work to be subcontracted to third parties. Additional information on proposal response requirements are included in Section 7. 5.9 PROJECT MANAGEMENT AND REPORTING: The Contractor will provide overall project management for the tasks under this Contract related to requirements for each phase of the project. The Contractor will work with the Agency to define a reporting structure and process to ensure transparency into all Contract work and projects. Specific requirements for project management and reporting are included in Appendix A. System reporting requirements are also included in Appendix A. 5.10 TRAINING AND KNOWLEDGE TRANSFER PLAN: The Contractor shall provide a training program and documented Training Plan that describes the commitment of the Contractor staff to provide initial and ongoing training to Contractor and Agency staff, if applicable. The Contractor will provide training to appropriate Agency staff when new tools or processes present a significant change to the CSC. Specific requirements for training are included in Appendix A. 5.11 OPERATIONAL READINESS AND OPERABILITY TESTING: Operational Readiness and Operability Testing Requirements are included in the Transition Phase responsibilities in Section 6.3.2 and specified in Appendix A. 5.12 MAINTENANCE AND SUPPORT REQUIREMENTS: Maintenance and Support Requirements are included in the Operations responsibilities in Section 6.3.4 and specified in Appendix A. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 40 of 150 5.13 5.14- 5.15 QUALITY ASSURANCE AND QUALITY CONTROL: The Contractor must implement comprehensive quality management practices that will be used throughout all phases of the Contract and include standards on timeliness, accuracy, and completeness for performance of, or reporting on, operational functions. Additionally, the CSC Contractor will assist the Agency in any Medicaid Hearings, such as preparing for the Hearing, providing testimony during the Hearing, and leveraging CSC-related content or call recordings to support the Agency in the Hearing process. Specific Quality Assurance and Quality Control requirements are included in Appendix A. CHANGE CONTROL MANAGEMENT: The Contractor will leverage the Agency's existing Change Advisory Board (CAB) and process and recommend improvements to the existing change control management procedures to ensure that all changes are thoroughly documented, reviewed, planned, and receive a timely decision. The Contractor will work with the Agency during Transition to properly transition change control procedures to the CSC Contractor. Specific requirements related to Change Management are included in Appendix A. DELIVERABLES AND MILESTONES: The Contractor must submit all deliverables included in this RFP within the Agency-defined timeframes. A comprehensive list of Contract deliverables and milestones is included in Appendix B. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 41 of 150 6.1 SECTION 6: PROPOSAL SUBMISSION REQUIREMENTS - SEQUENTIAL ORDER TECHNICAL PROPOSAL, FORMAT AND CONTENTS: Proposals must be submitted in two major sections: The Technical Proposal and the Cost Proposal. The Proper is responsible for submitting a separate section, within the proposal, in response to the following items. Omission of this section or any item within this section may result in the proposal being eliminated. 6.1.1 FORMATREQUIREMENTS Important: Proposers must submit one electronic copy to the Public Purchasing online bidding system, in addition to the hard copies requested below. The electronic copy must be in a searchable format. Proposers must provide all information requested in subsequent sections in their Proposals. Proposals must: 6.1.1.1 6.1.1.2 6.1.1.3 6.1.1.4 6.1.1.5 6.1.1.6 Use standard 8 1/2 by 11inch paper. Use Times New Roman 12-point font for Proposal content. 10-point font is allowed for graphics and tables. Number all pages of the Technical Pr0posal consecutively from start to finish (including appended materials, the Transmittal Letter, Executive Summary or RFP Signature Page). The Cost Proposal must also be numbered consecutively for all pages from start to finish (not required for appended materials). Include a Table of Contents in the Proposal for each file. The Table of Contents must list each section of the Proposal. Include tabs that are keyed to the Table of Contents to separate each section of the Proposal. Line spacing should be no less than single space. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 43 of 150 6.1.1.7 Provide one (1) original electronic copy uploaded to the Public Purchasing online bidding system, and ten (10) paper copies of both the technical proposal as well as the cost proposal. Hard copies must be delivered in person or mailed to by the proposal submission deadline to: Mandy Gershmel, Buyer Wyoming Department of Administration and information Procurement Section 700 W. let Street Cheyenne, WY 82002 Telephone: (307) 777-6718 E-mail: mandygershmelleyogov. The Proposer must adhere to the Agency?s required Proposal format, page limitations and required content. Failure to adhere to these requirements may result in the rejection of the Proposer?s Proposal. Note that the State will accept electronic signatures from submitting Proposers. TECHNICAL PROPOSAL RESPONSE The Technical Proposal must present a full and complete description of the Proposer?s qualifications to carry out the requirements set forth in Sections 6, as well as the approach and methods the Proposer proposes to use in completing the Scope of Work. The Technical Proposal must contain the following sections: 0 Transmittal Letter 0 Executive Summary I Proposer?s Background and Experience Approach to Transition 0 Approach to Operations The Proposer must format its Proposal to clearly identify each response section for evaluators. No reference to pricing information or elements of cost should be made within the Technical Proposal, including, but not limited to, the Transmittal Letter and Executive Summary. If any element of pricing or cost is referred to in the Transmittal Letter, Executive Summary or any part of the Technical Proposal, the Proposer may be disqualified. The Proposer?s Technical Proposal must contain the sections set forth below. The Agency is limiting Technical Proposals to 200 pages, including all Attachments. 6.1.1.8 TRANSMITTAL LE1TER Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 44 of 150 The Transmittal Letter must be submitted on official business letterhead. This letter is to transmit the Proposal and must identify all materials and enclosures being forwarded collectively as a response to this RFP. The Transmittal Letter must be signed by an individual authorized to commit the Proposer?s organization to the Scope of Work in this RFP. In addition, the Transmittal Letter must include: 6.1.1.8.1 Identification of the corporation or other legal entity submitting the Proposal and all subcontractors, including the percentage of work to be performed by the prime Contractor and subcontractor(s). 6.1.1.8.2 A statement of Affirmative Action that the Proposer does not discriminate in its employment practices with regard to race, color, religion, age (except as provided by law), sex, creed, marital status, political affiliation, national origin, or disability and complies with all applicable provisions of Public Law 101-336, Americans with Disabilities Act. 6.1.1.8.3 A statement that no cost or pricing information has been included in the Technical Proposal. 6.1.1.8.4 A statement of agreement with all General Provisions and Sample Contract. This Sample contract can be found at ets.wyo.gov/resources. The Proposer must furnish any exceptions to the provisions included in the Contract Terms and Conditions be noted in the Executive Summary. Identifying exceptions to the Contract Terms and Conditions does not in any way bind the State to accept such changes, but only ensures that discussion and resolution of their acceptance may be deferred until after tentative award is made. 6.1.1.8.5 A statement identifying all amendments to this RFP that have been received; if no amendments have been received, a statement to that effect should be included. 6.1.1.9 EXECUTIVE SUMMARY The Executive Summary should provide a summary of the proposed solution and highlight the contents of the Technical Proposal in such a way as to provide evaluators with a broad understanding of the entire Proposal. It should contain a concise overview summarizing the Proposer?s understanding of the project, the qualifications of key personnel, and operational structure for handling the Contract responsibilities. The Proposer should emphasize the most important features offered by the proposed approach and methodology. The Executive Summary should also demonstrate how the Proposer will Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 45 of 150 partner with the WES Contractor and Agency to better support the Agency and its clients? needs and meet the objectives listed in Section 3. 6.1.1.10 PROPOSER BACKGROUND AND EXPERIENCE In this section of the Proposal, the Proposer must present material describing its background and experience enabling the Proposer to successfully perform the Scope of Work identified in Section 6 of this RFP. This section should highlight specific details regarding current Contractual obligations, previous experience, and corporate resources. The Proposer must be able to substantiate to the satisfaction of the Agency that the Proposer has sufficient resources to complete the project successfully and meet the all agreed upon project milestones. The Proposer must address the following requirements in this section of the Proposal. 6.1.1.10.1 Present material describing the Proposer?s corporate capability to successfully perform all services and requirements included in this Scope of Work. This Section should highlight specific details regarding current contractual obligations, previous experience and corporate resources. Proposers should address each of the following items in detail in their responses to this Section: 1. Demonstrate that the organization and/or its subcontractors meet or exceed the mandatory minimum requirements as described in Section 6.2 of Appendix A. Provide the specific years of the experience for each experience requirement. If the Proposer plans to fulfill an experience requirement through the use of subcontractors, include a description of each subcontractor and its responsibilities with meeting that requirement. Subcontractor experience must be considered only for work that it is proposed to perform. 2. Describe the experience of the organization and/or its subcontractors that demonstrates the capability to perform the Scope of Work described in this RFP. 3. Include the locationis) of the company offices and location of the office that will provide the services described in this RFP. 4. Identify the name and telephone number ofthe person who will be responsible for signing the Contract and indicate that person?s position with the ?rm. 5. Disclose the legal structure and history of the Proposer?s organization. Attachment to the information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 46 of 150 6. List all related contracts with State/ Federal government performed in the last three (3) years. For each contract on the list, indicate if the contract was terminated for convenience or default, cancelled or otherwise ended before the expiration date. The list will not be subject to the page limitation for attachments to the Technical Proposal. 7. Identify at least two (2) client references with current telephone numbers to con?rm such experiences. For each reference, submit a reference letter from the reference describing their relationship with the Proposer and experience with working with the Proposer. Whenever possible, an alternative point of contact for each reference should be listed with phone number and email address. Each reference should depict relevant experience that can be brought to bear during the term of this RFP. In order to ensure current expertise, all work for client references provided must have been completed no more than three (3) years prior to the date of this RFP. a. References may be verified during the Proposal evaluation by telephone calls or through e-mail. b. If contact with the referenced contact person or an alternative that has knowledge of the Proposer is not made, after reasonable attempts during the designated evaluation period, the reference will be classified as unsatisfactory. All attempts to contact a referenced client will be documented, including the date and time of the attempt. c. NOTE: The Agency reserves the right to contact other agencies regarding engagements they may have had with the Proposer?s company in the past, in addition to the references provided in the Proposal. 8. Disclose any contracts terminated for cause or convenience in the past five (5) years. 9. Disclose all open or pending litigation initiated by Proposer or where the Proposer is a defendant in a case. Describe the Proposer?s experience in working with other contractors or external organizations with dependencies on the Proposer?s services or systems. Specifically, the description should include, at minimum: a. The Proposer?s plans for working with and maintaining an ongoing relationship with the Agency?s WES Contractor; Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 47 of 150 b. The Proposer's recommended approach to supporting WES Contractor?s communications and knowledge dissemination needs; c. The Proposer?s conflict resolution approach with the WES Contractor. 6.1.1.102 Describe the Proposer?s approach to staffing; including the location(s) of all operations and services and its approach to ensure sufficient onsite time for key personnel and other support staff as required in Appendix A. 6.1.1.103 Describe how the Proposer will address any potential conflicts between workload underway on the listed contracts and the Scope of Work required by this RFP. 6.1.1.104 Describe the personnel resources the Proposer has assembled to perform this Contract and other staff resources that are available as short-term support for specialized operational needs. Describe how local Agency staff can access these resources. 6.1.1.105 Describe the Proposer?s corporate technical infrastructure and resources available to this project outside of the key personnel. Specifically, describe the Proposer's experience in assisting clients with interpreting and implementing new Federal legislation and the current capacity and resources to help with any future legislation. 6.1.1.106 Describe the Proposer's key personnel proposed for this Scope of Work and their experience. Proposer?s may propose additional key personnel, but will only be evaluated on the key personnel identified by the Agency below. Include a resume and no fewer than two (2) references per key personnel as an Attachment to the Technical Proposal. 6.1.1.10] Identify the names of subcontractors and how they will be used. Provide detailed statements of experience for each identified subcontractor in the same level of detail as required for the Proposer. 6.1.1.108 Provide a proposed staffing plan and organization chart as an Attachment to the Technical Proposal that describes the Proposer's proposed organizational structure that will be used to perform the Scope of Work. An Organization Chart must be included with all proposed personnel, including the supervisor level, functional responsibilities, key personnel, and other staff members who will be involved in the project. The Staffing Plan must include, at minimum: Attachment to the Information Technology (lT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 48 of 150 1. Staffing levels by role (estimated by staff disciplines by month for the duration of the project) and how staffing levels will achieve consistent, dependable, service regardless of changes that may influence work volume; 2. Any staff located outside of the onsite facility, if applicable, and an explanation of why the Proposer is recommending the offsite resources; 3. Tools and processes used to screen available staff and fill positions; 4. Process for replacing key personnel within Agency-defined timeframes and procedures for backfilling key personnel during the transition; 5. Summary of all roles and responsibilities utilized throughout the Contract; and 6. Identification of subcontractor staff, if applicable. 6.1.1.109 Describe the Proposer?s method and selection process for hiring staff for the CSC Contract. 6.1.1.10.1ODescribe how the Proposer will retain staff and avoid turnover for the duration of the Contract. 6.1.1.11 APPROACH TO TRANSITION In this Section of the Proposal, the Proposer will provide its approach to transitioning and establishing the necessary services, documentation, and knowledge from the Incumbent Contractor and ensuring operational readiness CSC operations. The Proposer must address the following requirements in this Section of the Proposal. 6.1.1.11.1 Describe the Proposer?s approach to Start-up requirements and how it will work with the Agency and Incumbent Contractor to ensure the proper planning and project structure is in place to successfully transition CSC services by the required timeframe. 6.1.1.112 Describe the Proposer?s approach to completing all conversion activities of all data and ensuring timely implementation of all tools by the end of transition. 6.1.1.113 Describe the Proposer?s approach to providing appropriate staff at the appropriate times throughout the Contract and for maintaining staff training throughout the Transition Phase. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 49 of 150 6.1.1.11.4 Describe the Proposer?s approach to Transition requirements and how it will work with the Agency and the Incumbent Contractor to successfully transition CSC services by the required timeframe. 6.1.1.115 Provide a draft Transition Plan, which includes, at minimum: 1. A preliminary Project Plan as part of the including, but not limited to: a. Gantt charts that show all proposed project activities; b. Planning methodologies; c. Milestones; d. Task conflicts and/or interdependencies; e. Estimated time frame for each task identified in the Project Plan; and f. Strategies to avoid schedule slippage. 2. Approach for conducting a knowledge transfer from the Incumbent Contractor to the new Contractor; 3. Personnel and level of effort in hours; 4. Description of how the transition will be seamless to applicants and clients; 5. Procedures for updating production programs and documentation during transition; 6. Recommended stabilization criteria; and 7. Approach for having all appropriate staff performing Work as needed throughout the Contract, ensuring the CSC is operating with the same proficiency, and the clients?, Agency?s, and stakeholders' expectations are met. 6.1.1.116 Describe the Proposer?s approach to understanding WES and the dependencies between WES and the CSC, as well as its approach to review performance expectations that are dependent on WES functionality. 6.1.1.11.7 Identify all potential risks associated with the transition and project, proposed plan to mitigate the potential risks and include recommended strategies for managing those risks. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 50 of 150 6.1.1.11.8 Describe how the Proposer will work with the Agency to demonstrate operational readiness and the measures that will be in place to monitor final activities to ensure a seamless transition for CSC stakeholders. 6.1.1.12 APPROACH TO OPERATIONS In this Section of the Proposal, the Proposer will provide its approach to operating the CSC. The Proposer must address the following requirements in this Section of the Proposal. 6.1.1.12.1 Describe the Proposer?s approach to operating a similar CSC, including the planned approach to managing all activities involved in operations. The summary must include, at a minimum: 1. Strategy for meeting all requirements, deliverables, performance expectations of the CSC and services included in this RFP throughout the duration of the Operations phase; Proposed staffing levels and support model; Approach to communications management; Approach to quality management, including quality control and quality assurance; Approach to ongoing issues and risk management; Approach to tools, performance monitoring, and reporting; and Disclosure of any currently known or planned optimizations that would not be covered by the ongoing annual maintenance payment quoted in the Cost Proposal. 6.1.1.122 Outline the Proposer?s approach to handling: 1. 2. 6. 7. Requirements State policies and rules; CSC technology and environments; Security and HIPAA requirements; Integration of CSC technology with the Performance Expectations; Business continuity and resumption requirements; and Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 51 of 150 6.2 6.1.1.12.3 6.1.1.124 6.1.1.125 6.1.1.126 6.1.1.127 6.1.1.128 6.1.1.129 8. Client correspondence and notification needs. Describe any tools or software the Proposer will bring in under this Contract to support the Scope of Work and how each tool/software will be used to provide ongoing operations. The description should highlight any WES integration and interface needs currently identified by the Proposer. Provide the Proposer's understanding of WES and the dependencies between the CSC and WES. Describe the Proposer?s approach and tools to maintaining traceability of CSC requirements throughout the Contract term. Describe the Proposer?s approach to ongoing training for CSC Staff and Agency users, as required. Describe the Proposer?s approach to developing, documenting, and maintaining user documentation throughout the course of the Contract term. Describe the Proposer?s approach to conducting tool and software upgrades and process for ensuring minimal impact to CSC operations. Describe the types of documentation that accompany the upgrade tool and software, and the resources available if there are questions or problems applying the upgrade. Describe how the Proposer will work with the Agency to identify operational efficiencies and optimizations, new State or Federal policies and requirements, and analyze CSC needs. 6.1.1.12.1C)Describe the Proposer?s approach to reporting and meeting Contract reporting and data needs throughout the Contract term. The approach should include how the Proposer will ensure transparency into reporting and data analysis. 6.1.1.12.11Describe possible optimizations to enhance CSC operations and Proposer?s approach to implementing each optimization. 7.1.1.12.12Describe the Proposer's approach to expanding CSC services for dissemination of Medicaid Program Information to clients and acceptance of payments through various means as described in Appendix A, requirement 5077. COST PROPOSAL FORMAT AND CONTENT: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 52 of 150 Important: In addition to the hard copies requested below, one electronic copy of the original cost proposal must be uploaded as separate documents and identified as such using the Public Purchasing online bidding system. The electronic copy must be in a searchable format. 6.2.1 FORMAT REQUIREMENTS These pages are required by the Procurement Section and are the State?s official pricing documents. Each applicable Proposer must upload the Technical Proposal and the Proposal Price Sheet as separate documents and identify them as such using the Public Purchasing online bidding system and provide hard copies specified below. The price to be entered on this page is the total fixed price is the sum from Pricing Schedules A-B. In case of error in the extension of prices in the proposal, unit prices will govern. Cost breakdowns are not included on this page. The Proposer must ensure that all signatures and identifying numbers are properly affixed to this page in order for the Cost Proposal to be accepted. The Proposer must also provide ten (10) hard copies of the Cost Proposal that meet the same formatting requirements listed in Section 7.1.1.1. Cost Proposals must be separately sealed from Technical Proposals. 6.2.2 SCHEDULES The Cost Proposal must be submitted in a separate document from the Technical Proposal and must contain complete copies of each pricing schedule provided in Appendix D, Pricing Schedule Worksheets. A signature on all pricing worksheets is required. As stated above, the total of all pricing schedules (lump sum price) should be included in the Price Sheet in Section 10 and uploaded separately to the Public Purchasing online bidding system. Costs must be broken down as follows: 6.2.2.1 Pricing Schedule Transition Price: The Proposer must provide a fixed price for all services, resources, support, and final deliverable for the Transition activities. This also includes Start?Up activities included in Sections 6.3.1 Start- Up, 6.3.2 Transition (including Transition training and knowledge transfer), 6.11 Operational Readiness and Operability Testing associated requirements listed in Appendix A and associated deliverables listed in Appendix B. The maximum amount available for transition for the Contract term is $2,000,000. 6.2.2.2 Pricing Schedule Operations Price: The Proposer must provide an fixed price for all Operations services, resources, support, and final deliverables described in Sections 6.3.3 Operations, 6.3.4 Turnover, 6.4 General Requirements, 6.5 System and IT Standards, 6.6 Technology and Specifications, 6.9 Project Management and Reporting, 6.10 Training and Knowledge Transfer during Operations, 6.12 Maintenance and Support Requirements, 6.13 Quality Assurance and Quality Control, associated requirements listed in Appendix A and associated deliverables listed in Appendix B. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 53 of 150 The fixed price amount will account for all costs and assumes that all SLAs outlined in Appendix are met each month. Additional information regarding Contract Incentive Payments are described in RFP Section 9. Proposers shall state a maximum escalation percentage for Operations during optional contract extensions as described in Section 6.1.3. Proposer must guarantee that Operations cost will not exceed, or escalate, beyond this stated escalation percentage for the first and second optional contract extensions without receiving Agency approval through the appropriate change control process. The maximum amount available for operations for the Contract term is $21,600,000. If call volume exceeds 12,000 calls a month for six (6) consecutive months, the Agency will negotiate a contract amendment with the CSC Contractor. If call volume drops below 8,000 calls a month for six (6) consecutive months, the Agency will also negotiate a contract amendment with the CSC Contractor. 6.2.2.3 Pricing Schedule - All Inclusive Blended Hourly Rate: The Proposer must provide a blended hourly rate for any executed task orders for optimizations outside of the contracted Scope of Work, as approved by the Agency. This cost is separate from total lump sum shown on the Proposal Price Sheet in RFP Section 11. This rate must be a clear blended hourly rate and must include all travel and per diem charges. The proposed rate will be applied throughout the Contract term, unless agreed to by the Agency 6.2.2.4 Pricing Schedule Rolled Up Total: The Proposer must provide a total rolled up price that summarizes costs included in Pricing Schedules A-B. This shall reflect the total lump sum price entered by the Proposer into the Public Purchasing online bidding system. The maximum amount available for all activities for the Contract term is $23,600,000. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 54 of 150 7.1 7.2 7.3 SECTION 7: EVALUATION METHODOLOGY OVERVIEW: 7.1.1 Evaluation Committees: The Agency will conduct a comprehensive, fair, objective and impartial evaluation of proposals received in response to this RFP. Proposals will be evaluated by the Evaluation Committee. The Evaluation Committee is made up of members representing the project subject expertise. The Selection Committee is made up of members representing the project sponsorship. The Evaluation Committee will review and score all proposals and will make the final recommendation to the Selection Committee. The Selection Committee will make the final decision. Contractor selection and notification will be as stated in Section 3.9. Contract Negotiations. COMPLIANCE WITH MANDATORY REQUIREMENTS: 7.2.1 To be considered responsive, a submitted proposal must meet the minimum requirements defined in Section 6.2 of Appendix A. The minimum requirements are intended to ensure that evaluation of the Technical Proposal can proceed and that the Contractor agrees to perform all responsibilities within the RFP, Oral presentation and the Contract Terms and Conditions located in the IT Sample Contract. The sample contract may be found at ets.wyo.gov/resource. TECHNICAL SCORING AND RANKING: Technical Analysis: 75% of Total Score. The evaluation of the Technical Proposals will involve the point scoring of responses in each Technical Response Section described in Section 7, according to pre-established criteria for scoring. A maximum point score will be available for each Proposal received. Table 8.3.1 below includes a summary of the weights assigned to each Technical Response Section. Table 8. 3.1: Technical Evaluation Point Allocation TECHNICAL PROPOSAL COMPONENT POINT ALLOCATION (OF THE 75% TECHNICAL SCORE) Transmittal Letter Met/Not Met Executive Summary Met/Not Met Background and Experience 15% Approach to Start-Up 5% Approach to Transition 20% Approach to Operations 35% Technical Proposal Total 75% Evaluators will score items in each Technical Response Section using evaluation criteria Attachment to the Information Technology (lT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 55 of 150 7.4- 7.5 developed by the Agency. Each item will receive a score from zero to ten (010), with ten being the highest score possible and zero indicating the Proposal is non~responsive on a given item. Weights will be applied according to Agency priorities to reflect the percentage of points allocated for each technical area outlined in Table 8.5.1 below. The Evaluation Committee will tabulate the Technical Proposal scores and invite the top three (3) technical Proposers found technically acceptable to Oral Presentations, as described in Section 8.4. ORAL SCORING AND RANKING: Oral Presentation Analysis: Proposers with the top three (3) technical may be invited to participate in Oral Presentations onsite in Cheyenne, Wyoming. If The Agency holds Oral Presentations, it will have a list of standard questions for all participating Proposers based on Technical Proposal reviews and outstanding questions. There may be additional clarifying questions based on responses received during Orals. The Agency evaluators may adjust each of their original technical scores based on clarifying information presented by Proposers participating in Oral Presentations. Technical Proposal scores may be adjusted as a result of Oral Presentation performance. COST SCORING AND RANKING: Cost Analysis (Cost Proposal must be under separate cover): 25% of Total Score. The cost will be presented as key deliverables in the form of individual cost and a project total (sum of the deliverables). The total project cost must include all other items listed in Section 6. Requirements/Specifications Responsibilities of Contractor. If any additional items in Section 6 services cannot be provided in Contractor? proposal or the requirement cannot be met this is to be clearly explained as to why and what the alternative approach will be and its associated cost. If there are no exclusions or exceptions it will be determined that all of the criteria has been met for the price quoted, inclusive of all personnel, overhead, travel, equipment usage, and other miscellaneous costs for the contract period quoted. Cost proposals will be submitted on pricing schedules contained in Appendix and described in Section 7.2.2. Cost proposal criteria account for 25% of the total score. Cost proposal points will be awarded based on three (3) criteria. These criteria and point allocation for each are: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 56 of 150 Table 8.5.1: Cost Evaluation Point Allocation COST PROPOSAL CRITERION POINT ALLOCATION (OF THE 25% COST SCORE) Total All Inclusive Transition Price (Pricing Schedule A) 5% Total All Inclusive Operations (Pricing Schedule B) 15% All Inclusive Blended Hourly Rate (Pricing Schedule C) 5% Cost Proposal Total 25% 7.6 The acceptable proposal, which proposes the lowest price for providing the services within each of these criteria, will be awarded the maximum number of points for the criteria. 7.5.1 Pricing Schedule A Transition Price Total points will be awarded for the lowest Total All Inclusive Transition price evaluated for the CSC Transition scope of work. Points for other proposals? price will then be assigned based on a comparison to the highest-scoring proposal price for those services. 7.5.2 Pricing Schedule - Operations Price Points will be awarded for the lowest Total All Inclusive Operations price and for the lowest Escalation Percentage for Optional Contract Extensions. Total All Inclusive Operations points will be awarded for the lowest Total All Inclusive Operations price evaluated for the CSC Operations scope of work. Points for other proposals? price will then be assigned based on a comparison to the highest-scoring proposal price for those services. Total Escalation Percentage for Optional Contract Extensions points will be awarded for the lowest Escalation Percentage evaluated for the CSC Operations optional contract extensions. Points for other proposals? price will then be assigned based on a comparison to the highest-scoring proposal price for those services 7.5.3 Pricing Schedule - All Inclusive Blended Hourly Rates Points are allocated for evaluating the blended hourly rate bid. Points for other proposals? price will then be assigned based on a comparison to the highest-scoring proposal price for those services. EVALUATION POINT SUMMARY: The following table provides a summary of the assigned weights for each Proposal Section. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 57 of 150 Table 8.6.1: Evaluation Point Summary RFP MANDATORY MINIMUM REQUIREMENTS EVALUATION REFERENCE Appendix A Contractor must have experience operating a Met/Not Met state or Federal social services or medical eligibility program Customer Service Center during the past five (5) years. Appendix A Preference will be given to Proposers with Met/Not Met experience in operating a statewide call center. EVALUATION COMPONENT PERCENTAGE Transmittal Letter Met/Not Met Executive Summary Met/Not Met Background and Experience 15% Approach to Start-Up 5% Approach to Transition 20% Approach to Operations 35% Technical Proposal Total 75% Cost Proposal Total 25% 7.7 FINAL RANKINGS 0F PROPOSALS: 7.7.1 The State of Wyoming will be the sole authority with respect to the evaluation of proposals. The firm that best meets the conditions of each of the individual criterion will be awarded the highest (not necessarily maximum) points for that specific criterion. The balance of the Contractors will be rated based on their evaluated points. After each criterion is evaluated, the Contractor with the highest total number of points will be awarded the contract. 7.7.2 The State of Wyoming reserves the right to accept an entire proposal, a partial proposal, a single component proposal or no proposal at all. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 58 of 150 8.1 SECTION 8: PAYMENT TERMS TIME 8.1.1 The State will negotiate payment terms based upon a schedule to be determined by the Contractor and the State. Payments of invoices will be based upon the Contractor successfully completing the deliverables within the stated deadlines, and upon the Agency?s written acceptance of the deliverables and/or services. The state withholds 10% retainage that will be paid out after successful completion of the Operation Readiness criteria. 8.1.2 8.2 8.2.1 The Contractor is required to submit status reports with invoices outlining the contract's progress and compliance with milestones and delivery dates. Each report will be verified by the State?s representative that each of the RFP and contract requirements have been met to date. CONTRACT INCENTIVE PAYMENTS Upon meeting all SLAs as described in Appendix C, the Contractor may then be eligible to receive an incremental payment incentive to exceed the average criteria set forth in SLAs 15maximum of an additional 7% above the fixed payment. Criteria for achieving excellence in each of the five (5) SLAs is detailed in Table 9.2.1. Each month the Contractor may be eligible for incentive payments that increase based on the number of SLAs that meet the qualifying excellence criteria. Table 9.2.1: Incentive SLAs Qualifying Excellence Criteria SLA ID Description Minimum Excellence Criteria 15 Training 85% score Greater than 90% 33 Call Wait Times Less then (10) minutes for more then 95% of calls Six (6) minutes or less for more than 95% of calls 39 First CSR Contact Resolution 75% Greater then 83% 41 Quality Error and State Policy Accuracy 2% 1% or lower 43 Client Satisfaction Assessment 80% of respondent client satisfaction rating 4 or higher 80% of Respondents report that they connect with a CSR on the ?rst call 88% client satisfaction rating 4 or higher 88% report that they connect with a CSR on the ?rst call Table 9.2.2: Incentive Eligibility Matrix Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 59 of 150 Incentive One SLA Two SLAs Three SLAs Four SLAs Five SLAs Eligibility Meets Meet Meet Meet Meet Excellence Excellence Excellence Excellence Excellence Criteria Criteria Criteria Criteria Criteria 1% 2% 3% 5% 7% Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 60 of 150 SECTION 9: Table of Contents APPENDIX A - REQUIREMENTS TABLE OF CONTENTS BOOKMARK NOT DEFINED. SECTION 6.2 RELEVANT EXPERIENCE 62 PREFERRED EXPERIENCE REQUIREMENTS 62 SECTION 6.3 SCOPE OF SERVICES PHASE SPECIFIC REQUIREMENTS SECTION 6.3.1 START-U 63 SECTION 6.3.2 TRANSITION SERVICES 68 SECTION 6.3.3 OPERATIONS 75 SECTION 6.3.4 TURNOVER SERVICES 89 SECTION 6.4 SCOPE OF SERVICES: GENERAL REQUIREMENTS 91 SECTION 6.4.1 LOCATION AND WORK ENVIRONMENTS 91 SECTION 6.4.2.1 REQUIREMENTS 92 SECTION 6.4.2.1 CONTRACT MANAGEMENT 92 SECTION 6.4.3 COMMUNICATION REQUIREMENTS 94 SECTION 6.4.4 RISK AND ISSUE MANAGEMENT 94 SECTION 6.4.5 EQUIPMENT96 SECTION 6.5 SYSTEM OR WYOMING STANDARDS 97 SECTION 6.5.1 STATE STANDARDS 97 SECTION 6.5.2 AGENCY STANDARDS 97 SECTION 6.5.3 STATUTORY MANDATES 98 SECTION 6.6 TECHNOLOGY AND SPECIFICATIONS 100 SECTION 6.6.1 CSC TOOLS 100 SECTION 6.6.2 REPORTING 108 SECTION 6.6.3 SECURITY 108 SECTION 6.6.4 BUSINESS CONTINUITY AND DISASTER RECOVERY 111 SECTION 6.7 HOSTING 115 SECTION 6.8 CONTRACTOR STAFFING UALIFICATIONS116 SECTION 6.8.1 RESOURCE MANAGEMENT AND STAFFING PLAN SECTION 6.8.2 RESOURCE RESPONSIBILITIES 63 116 119 Attachment to the Information Technology (IT) Contract between the State Of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 61 of 150 SECTION 5.8.3 SUBCONTRACTORS SECTION 6.9 PROJECT MANAGEMENT AND REPORTING 133 SECTION 6.10 TRAINING AND KNOWLEDGE TRANSFER PLAN 137 SECTION 6.11 OPERATIONAL READINESS AND OPERABILITY TESTING SECTION 6.12 OPERATIONS AND MAINTENANCE REQUIREMENTS SECTION 6.13 QUALITY ASSURANCE AND QUALITY CONTROL 147 SECTION 6.14 CHANGE MANAGEMENT 149 SECTION 10: Require Requirement Language ment No. Contractor must have experience operating a state or Federal social services or medical eligibility program Customer Service Center (CSC) during the past five (5) years. experience in operating a statewide call center. 141 142 Performance Measure 132 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 62 of 150 Require ment No. fl g) Requirement Language deadlines that take into consideration any Federal or State regulatory deadlines and the Agency's holiday schedule (New Year's Day, Martin Luther King Jr. Day, President's Day, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving, Christmas). The detailed Project Plan shall include, but not be limited to: Project schedule including tasks, activities, duration, predecessors/successors, and dependencies; Project work plan for each deliverable, including a work breakdown structure; Planned effort (in hours) of each planned task; Start and completion dates of each task; Project milestones; Entrance and exit criteria for specific project milestones; and Project organization including a resource plan defining roles and responsibilities for the Contractor and its subcontractors (if applicable) and the Agency. The schedule shall be resource leveled to illustrate Provde deatild PojecPanwm)(thfied I Performance Measure The initial Project Plan shall be provided in the RFP proposal response. The first update to the Plan shall be delivered to the Agency by July 11, 2016. Any additional updates shall be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 63 of 150 Require Requirement Language Performance ment Measure No. planned resources for assigned tasks. 5003 Conduct a project Kick-off no more then The Kick-off meeting five (5) days after the Contract effective shall be held no more date. Items to be covered in the kick off than five (5) days meeting shall include, but not be limited after the Contract to: effective date. a) Introducing project teams and stakeholders and defining roles and responsibilities; b) Determining format and protocol for project status meetings and reporting; c) Defining lines of communication and reporting relationships; d) Reviewing the project mission and guiding principles; e) Reviewing the deliverable review process; f) Discussing high-risk or problem areas and strategies for mitigation; g) Describing the proposed issue resolution process; and h) Finalizing the project schedule and milestones. 5004 Establish all project and Contract All project and documentation, tools, plans, and Contract resources required to successfully . management tools, the CSC. plans and resources shall be delivered to the Agency no later than July 11, 2016 Any additional updates shall be made within three (3) business days upon Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 64 of 150 Require Requirement Language Performance ment Measure No. receipt of request, unless otherwise determined by the Agency. 5005 Prior to development and submission of each Contract deliverable, a summary document containing a description of the format and content of each deliverable shall be delivered to the WDH Vendor Contract Manager for review and approval. The summary document shall contain, at a minimum, the following: a) Cover letter; b) TableofContents; c) Outline of sections and brief description of the content of each section; d) Demonstrated traceability to Contract requirements for the deliverable (if applicable); e) Version and revision section; f) Anticipated number of pages; g) Identification of appendices/exhibits; and h) An approval/rejection section that can be completed by the Agency. The summary document shall be returned to the Contractor within a mutually agreed upon time frame. 5006 Agency Deliverable review times shall be Any subsequent determined by the approved and accepted deliverable detailed project plan and the approved dependent upon the acceptance of a prior deliverable shall not Contract. Once the review is completed, the Agency shall return to the Contractor the project deliverable sign-off form with Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 65 of 150 Require Requirement Language Performance ment Measure No. the Deliverable submission and review be accepted for history section completed. review until all issues related to the previous deliverable have been resolved. Deliverables determined by the Agency to be incomplete and/or unacceptable for review shall be rejected, not considered delivered and returned to the Contractor. 5007 If the Agency has comments and/or Deliverables shall not revisions to a deliverable, the following exceed two (2) shall be provided to the Contractor: submissions to address Agency a) The original deliverable sign-off form with comments. This an updated entry to the deliverable limitation is based on submission and review history section; first receipt of the b) A detailed explanation of the revisions to be comment(s). made and/or a marked up copy of the For Deliverables deliverable attached to the deliverable sign- submitted by the Off form; Contractor that exceeds two (2) reviews, Contractor will be fined one thousand dollars ($1,000) per A meeting will be conducted to discuss Agency comments and resolve issues related to the deliverable. Meeting outcomes shall be documented separately. Once an agreement is reached regarding changes, the Contractor shall add't'Pnf? incorporate them into the deliverable for submissmn. resubmission to the Agency. The The Contractor shall resubmission process shall reflect the have three (3) following requirements: working days, unless otherwise mutually agreed to, for review, c) All changes shall be easily identifiable by the Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 66 of 150 Requirement Language Performance Measure Requne ment No. d) e) fl 3) Agency; The resubmitted deliverable shall be accompanied by the original deliverable sign-off form; During the re?review process, the Agency may only comment on the original exceptions noted. All other items not originally commented on are considered to be accepted by the Agency; Once all revisions have been accepted, the original deliverable sign-off form signed by the appropriate Agency representatives shall be returned to the Contractor; and The Contractor shall provide an updated and completed master copy of each deliverable after approval and acceptance by the Agency. This review process shall continue until all issues have been resolved within a mutually agreed upon time frame. acceptance and/or rejection of Agency comments. A meeting to resolve outstanding issues shall be completed within three (3) business days after completion of the contractor?s review or a mutually agreed upon time frame. Resubmission of the deliverable shall occur within three (3) business days or a mutually agreed upon time frame of the resolution of any outstanding issues. 5008 Provide regular status reports per requirements detailed in Appendix A: Section 6.9 Project Management and Reporting below. 5009 Establish all project and Contract documentation, tools, plans, and resources required to successfully transition the CSC. 5010 Establish the change control procedures as described in Section 6.14 Change Change control procedures shall be Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 67 of 150 Requhe ment No. Requirement Language Performance Measure Control Management. established no later than July 11, 2016. Any additional updates shall be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. 5011 Attend and participate in all Start-Up related meetings, as requested by the Agency. 12.2 Section 6.3.2 Transition Services SO12 T-1c, T-3c h) f) g) Develop a comprehensive Transition Plan for the CSC. The Transition Plan shall be updated during the Transition to include Agency feedback. The proposed plan shall include the following: Approach and timeline for transition. The timeline should correspond to the approved Project Plan; Approach for conducting a CSC knowledge transfer from the Incumbent Contractor to the new Contractor; Tasks and activities for transition; Personnel and level of effort in hours; Start and completion dates of activities; Transition milestones; Entrance and exit criteria that reflect the approved SLA (where applicable); The initial Transition Plan shall be provided with the Proposer?s solution. The first update to the Plan will be delivered to the Agency by July 11, 2016. Any additional updates will be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. For every day after the date provided in the Transition Plan and approved by the Agency that the Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 68 of 150 Require ment No. Requirement Language Performance Measure h) Contractor?s approach to ensuring a Contractor does not seamless transition to applicants and clients; have an identified Transition staff, i) Planned documentation updates, training, Contractor will be and procedures creation/updates required fined one thousand to support transition; and dollars ($1,000) per j) Approach for having key staff available at day. appropriate timeframes, as designated in their proposal. All staff must be hired, trained, and ready to preform activities associated with their position. k) A Transition Staff Organization chart 5013 Develop an Infrastructure Plan for the The Infrastructure CSC. The Infrastructure Plan shall be Plan shall be updated during the Transition to include established no later Agency feedback. The proposed plan shall July 11, 2016. include the following: The Infrastructure a) Required phone lines and phone Plan shall be updated hardware; during the Transition to include Agency b) CSC management . and operational feedback. software and supporting tools; c) Delineation of infrastructure needs by operational location call center versus local in-person facility and mailroom; d) Mailroom management software and/or tools; e) Personal desktops and staff support tools; f) Internet and security tools; g) Performance management software/tools; and h) Other infrastructure needs to support the proposed CSC model. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 69 of 150 ReqLiIre ment No. Requirement Language Performance Measure The Contractor is expected to propose technical solutions based on service- oriented architecture (SOA) concepts, including loose coupling of system components to reduce system dependencies and promote reuse. 5014 T-4c b) C) fl Develop a Collaboration Plan for CSC. The proposed plan shall include the following: Approach for sharing project documents with other Vendors and the Agency; Establishing communication protocols with other Vendors and the Agency; Approach for maintaining project schedules; Define roles, responsibilities, and governance; Establishing a process for documentation audits; and Approach for documenting process changes. The Collaboration Plan shall be established byJuiy 11, 2016. Any additional updates will be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. 5015 Provide regular status reports per requirements detailed in Appendix A: Section 6.9 Project Management and Reporting below. 5016 T-6c Attend question and answer sessions with the Incumbent Contractor and advise the Agency of any areas of concern based on previous presentations and reviews of documentation. The Incumbent Contractor, Agency, and the Contractor shall conduct technical interchange meetings as requested by either the Agency or the Contractor. The purpose of these meetings is to quickly resolve key technical issues that arise by assembling the appropriate Agency and Contractor Provide a question and answer status update to the Agency after each question and answer session. The Contractor shall attend all question and answer sessions during the transition penod. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 70 of 150 Requue ment N0. Requirement Language Performance Measure staff to understand and resolve the issue. 5017 Attend twice-weekly meetings with the Agency and the Incumbent Contractor to broker through issues. Contractor shall come to the meeting prepared and with questions for the Agency and Incumbent Contractor. Contractor and Agency shall have two (2) (Monday through Friday) fifteen (15) minute status stand-up meeting per week to facilitate quick issue resolution. 5018 Deliver meeting minutes detailing Distribute minutes to Contractor?s status meetings with the the Agency within Incumbent Contractor. two (2) days of the meeting. 5019 Establish technology, equipment and . Establish technology, faculities necessary to operate the CSC In . accordance to the approved Infrastructure equipment an aculitles necessary to Plan. operate the CSC by August 31, 2016. Failure to establish technology, equipment, and facilities necessary to operate the CSC by August 31, 2016 may result in termination of the Contract at the Agency?s sole discretion. 5020 Convert data necessary to provide continuity of operations and data related to the Knowledge Management (KM) solution. Data conversion must be completed by September 15, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 71 of 150 Require ment No. Requirement Language Performance Measure 5021 Maintain files ofarchived call recordings . . Maintain call provuded by the Agency. Provnde Agency . . recording archives for access to the recordings, as requested. seven (7) years. 5022 Collect and review current systems, user, Provide Agency with training, and WES system operational an update on status documentation, and clarify deficiencies as by August 31, 2016. it pertains to the CSC. 5023 Become familiar with Agency policies and Provide Agency with services through research and interviews an update on status T-9c with Agency and Incumbent Contractor by August 31, 2016. staff. The Contractor shall develop high- level overview of all applicable Agency policies and services identi?ed in Contractor?s interviews. 5024 Install the IVR, CRM, KM and any tools Complete the that the Contractor will use to support installation, including T-10c CSC operations. testing and user acceptance by September 30, 2016. Failure to complete the installation on or by September 30th, 2016 may result in termination of the Contract at the Agency?s sole discretion. 5025 Develop a CSC Transition Test and The CSC Transition Operational Readiness Test Plan that Test and Operational T-14c Readiness Plan shall includes all aspects of the IVR, CRM, other tools and processes that shall be tested by the transition staff and measures of success to demonstrate achievement of knowledge transfer and successful transition and readiness for CSC takeover. be established by July 31, 2016. Any additional updates will be made Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 72 of 150 Requue ment No. Requirement Language Performance Measure The plan should take into account any integration testing with the WES. See additional requirements in Appendix A: Section 6.11 Operational Readiness and Operability Testing below. within three (3) business days upon receipt of request, unless otherwise determined by the Agency. 5026 Conduct formal testing of the IVR, CRM, Provide the results of KM and other tools, as necessary, with the system testing documented results for Agency review in with by August 15, accordance with the approved Test Plan. 2016. For any installation that takes place after August 15, 2016, provide the testing results to the Agency by September 20, 2016. 5027 Develop a Transition Phase Readiness Report to the Agency Assessment including the results of the on the Transition readiness test, and assessment of Phase Readiness Contractor?s staff and its understanding of Assessment the WES system. Document by September 15, 2016. 5028 Conduct a formal readiness Conduct the with the Agency demonstrating that its readiness T-21c IVR, CRM, tools, and CSC Staff are ready to with the begin Operations. Agency by September 26, 2016. 5029 Participate in the WES Contractor's WES Conduct orientation Train-the-Trainer orientation and final and final training of 1"ch training. Contractor staff between August 15, 2016 and September 20, 2016. 5030 Develop materials and conduct Conduct orientation orientation and final training of Contractor CSC staff as described in Appendix A: and final training of Contractor staff Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 73 of 150 Require ment No. Requirement Language Performance Measure Section 6.10 Training and Knowledge between August 15, Transfer. 2016 and September 20, 2016. 5031 Make arrangements for a warm transfer By August 31, 2016, of all pending customer service submit a document to the Agency outlined updates, applications and outstanding the acceptance of all correspondence and mail from the pending customer Incumbent Contractor for completion service after Transition. requests/inquiries/re newals/client updates, applications and outstanding correspondence and mail from the incumbent Contractor for completion after transition. Incorporate Agency feedback by September 15, 2016 Obtain final Agency approval by September 30, 2016. 5032 Develop and submit by the Agency- designated timeframes, all Transition Deliverables as described in RFP Appendix B. 5033 Document recommendations for process improvements, based on industry standards, best practices, and/or cost efficiencies and report to the Agency. These recommendations may be discussed during the Optimization phase once the CSC operations have stabilized. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 74 of 150 Require Requirement Language Performance ment Measure No. 1-2.3 section 6.3.3 Operations 5034 Act as the primary processing point and customer service contact for all Wyoming health insurance programs within the Scope of Work. Such responsibilities include: a) Disseminating program education and information; b) Answering customer inquiries regarding eligibility; c) Screening clients for programs; d) Processing applications, renewals, and client changes; e) Following up on needed client verifications; f) Providing front line customer representatives assistance to the Agency or Attorney General?s Office to research or respond to Medicaid Hearings, if necessary; g) Answering basic questions regarding denials and closures of benefits; h) Performing other case management functions; i) Providing CSC staffing and training; j) Providing the CSC infrastructure and CSC- specific tools, including the NR and k) Managing the centralized mailroom through the use of the State?s Electronic Document Management System I) Maintaining quality assurance and Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 75 of 150 Require Requirement Language Performance ment Measure No. conducting quality control activities; and m) Providing CSC reporting. Additional detailed requirements are included in Section 6.3.4 Operations below. 5035 Disseminate program information to clients in accordance to Agency policies, including but not limited to: a) Medicaid Program Information, such as: 1. General health insurance program descriptions; 2. Income, resource and other eligibility requirements; 3. General eligibility; 4. Refer highly specialized eligibility inquiries to the State's LTC unit; 5. Application and enrollment process; 6. Renewal process; 7. Process for reporting changes; 8. Program documentation requirements; 9. PE process and requirements; and 10. Population speci?c program information, such as citizenship and immigration requirements. b) Kid Care CHIP Information 1. General Kid Care CHIP program description; Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 76 of 150 Require ment No. Requirement Language Performance Measure 2. Income and other eligibility requirements; 3. Application and enrollment process; 4. Renewal process; 5. Process for reporting changes; 6. Cost sharing requirements, if applicable; and 7. Program documentation requirements. 5036 OM-lc bl C) Leveraging existing documentation, update and maintain an Operational Procedures Plan, includes a comprehensive description of CSC operations, processes and procedures. The Contractor may choose to leverage and update the existing documentation, or develop a new format subject to Agency review and approval. At minimum, the Operational Procedures Manual shall contain policies, processes, and workflows related to: Staffing model for the Operations Phase; Approach to staffing management (or incorporated by reference in the Staffing Management Plan); Approach to staff training (or incorporated by reference in the Training Plan); Processes and procedures related to eligibility processing and customer service; Operational issue reporting and resolution procedures; The initial Operational Procedures Plan shall be established by September 15, 2016. Updates shall be made at least every twice annually. Any additional updates will be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 77 of 150 Require ment No. Requirement Language Performance Measure f) g) i) k) Triage and communication strategies; Approach to maintaining compliance with privacy and security requirements; System documentation for the CRM, and other technology used in operations; Integration Plan for the mailroom to scan, transfer, and electronically index all incoming documents; Approach to maintaining performance and Performance and Operational reporting processes; Approach to maintaining quality assurance and conducing quality control activities; Audit approach; and An accurate glossary of terms. All CSC operations shall be managed in accordance to the approved Plan. 5037 Leveraging existing documentation, update and maintain policy manuals and process guides for use by CSC staff to aid them in addressing client concerns and managing formal grievances. Update the policy manual and process and provide documentation to the Agency that the policy manual and process guides were updated along with a summary of updated information. Initial policy manuals and process guides shall be established by September 15, 2016. Update the policy manual and process guides as changes occur, or within three (3) business days upon receipt of request, unless otherwise determined by the Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 78 of 150 Require ment No. Requirement Language Performance Measure Agency. 5038 Provide day-to-day oversight of the CSC operations to effectively manage all CSC responsibilities as defined in agreed upon Operations Procedures Plan and performance expectations. 5039 Provide a toll-free telephone line for clients. The toll-free line shall be established by September 30, 2016. 5040 Provide ?live? operator assistance in English and Spanish between the hours of 7:00 AM and 6:00 PM (MDT), Monday through Friday, excluding holidays as determined by the Agency. 5041 Provide translation services for language not supported by the CSC. 5042 Provide walk-in services to clients. The walk-in area should be handicap accessible and provide clients with the necessary privacy when working with a CSC representative. Details regarding the location required for walk-in services are provided in Section 6.4.1 Location and Work Environments. 5043 Facilitate warm transfers to and from the Agency?s LTC Unit or other Agency representative to ensure seamless connections for clients. A warm transfer is initiated and facilitated by the original CSC representative, who transfers the caller on their behalf to the receiving representative to ensure a seamless connection for the client. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 79 of 150 Require Requirement Language Performance ment Measure No. 5044 Develop procedures and workflows to ef?ciently and accurately collect information on applications, renewals, and client changes over the phone using the WES. The resulting procedures and work?ows should be incorporated into the ?nal policy manuals and process guides. Procedures and work?ows are subject to Agency review and approval. 5045 Develop procedures and workflows to ef?ciently and accurately process mail- in, email, and fax applications, renewal forms, and client changes using the WES and EDMS. The resulting procedures and work?ows should be incorporated into the ?nal policy manuals and process guides. Procedures and work?ows are subject to Agency review and approval. 5046 Develop procedures and workflows to ef?ciently and accurately support walk- in applicants and clients. The resulting procedures and work?ows should be incorporated into the ?nal policy manuals and process guides. Procedures and work?ows are subject to Agency review and approval. 5047 Input updated eligibility and contact information received over the phone directly into the WES. Update changes such as household residency, household composition, income, expenses and private insurance coverage and make a preliminary assessment of the eligibility. 5048 Identify any outstanding verifying documentation and inform the applicant/client of the required document and the date by which it must be received. Follow-up any phone conversation with a mailing, reiterating Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 80 of 150 Require Requirement Language Performance ment Measure No. the required documentation; including absent parent questionnaires, TPL requests, or missing information notices. 5049 Provide appropriate staff to perform administrative functions and document management responsibilities, including: a) Developing and maintaining a mail center to manage incoming and outgoing mail. Distributing materials provided by the Agency about the programs, including copies of the necessary applications, as well as other general materials about the program. The Agency will provide the Contractor with the necessary program materials. The Contractor will be responsible for the mailing and costs associated with mailing materials. b) Scan any applicant/client documentation received and index paper documents into the electronic case ?le. c) Process any outgoing client noti?cations or mail generated by the WES, Agency, or CSC. d) Manage paper documentation received by the CSC in accordance to the record retention requirements included in Section 6.12 Maintenance and Support. 5050 Maintain all equipment and technology described in Appendix A: Section 6.4.5 Equipment and Appendix A: Section 6. 6.1 CSC Tools below. 5051 Accept and respond to written and Accept and respond emailed client inquiries. to written and emailed client inquiries within two Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 81 of 150 Require Requirement Language Performance ment Measure No. (2) business days. 5052 Maintain adequate records in the WES and/or CRM that clearly document actions taken with clients. 5053 Provide safeguards to ensure pmper identification of the clients calling about cases, as defined by Agency and program rules. 5054 Return all calls interrupted due to Return all calls Contractor-controlled circumstances. interrupted due to For example, if the CSC representative Contractor- hangs up during the call, it is the controlled responsibility of the CSC representative circumstances to callback. within two minutes of the interruption. Exceptions include power outages, downed telephone lines or other circumstances as defined by the Agency. 5055 Ensure that clients do not receive a busy signal. Exceptions include power outages, downed telephone lines or other circumstances as de?ned by the Agency. 5056 Research and work to resolve client questions, issues, and account discrepancies. 5057 Provide assistance to clients navigating the Client Web Portal. 5058 Provide the ability to track all inbound calls and route them to the appropriate agent Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 82 of 150 Requne ment No. Requirement Language Performance Measure 5059 Evaluate the satisfaction of CSC users on a Conduct client regular basis through the use of customer satisfaction surveys satisfaction surveys through the IVR or as will be offered to otherwise approved by the Agency. every 10th caller. Results of the survey should be included with the regular CSC reports described below in Appendix A: Section 6.9 Project Management and Reporting. 5060 Maintain a log and record of all Provide any recommendations for continuous continuous improvements in Customer Service improvement Representative (CSR) Scripts, FAQs and recommendations as Scripts to provide to the Agency. part of the regular This log/ record is available for review status report. on demand by the WDI-I Vendor and Contract Manager and other designated Agency personnel. Recommendations shall be included with the regular CSC reports described below in Appendix A: Section 6.9 Project Management and Reporting. 5061 Accept information regarding complaints Provide the Agency about the programs and provide written with the written information regarding complaints to the complaint within two Agency for follow-up. (2) business days of the complaint. 5062 Respond to complaints either directly or Respond to by capturing the information and referring it to Agency staff. Once the Agency has investigated the complaint and determined the outcome, the Agency will inform the person who made the complaint. The Contractor must maintain a database containing information on the speci?c subjects of all such referred or transferred calls, and share such information with Agency staff on an as needed basis (at least complaints as directed by the Agency within two (2) business days of the complaint. Attachment to the information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 83 of 150 Require ment No. Requirement Language Performance Measure so that the Agency may provide training to CSC staff as necessary on those issues. 5063 Report applicant/client grievances to the All grievances shall be Agency. reported to the Agency within one (1) business day. Any grievances escalated to hearings and/or appeals shall be handled by the Agency. 5064 Manage short-term high volume call loads See SLAs. to minimize the impact to clients. 5065 Evaluate the number of telephone lines Evaluate efficiency installed and the number of CSRs and provide a report available to measure the ef?ciency of to the State WDH the current infrastructure and provide a Vendor Contract report to the WDH Vendor 81 Contract Manager Manager. As call volumes increase, the This may be Contractor shall install additional lines reported along with and/ or equipment and add staff in order the CSC Operations to meet Contract calls response report described timeliness requirements at the below. Contractor's expense. Infrastructure ef?ciency reporting shall be included in regular CSC reports described below in Appendix A: Section 6.9 Project Management and Reporting. 5066 Provide reports on CSC Provide operations in a format agreed to by the Agency. Reports will include averages, ranges, and totals, as appropriate, regarding call volume and characteristics and summaries of staffing, maintenance, and operational issues. Operational reporting shall be included in regular CSC reports described below in Appendix A: reports on CSC operations in a format agreed to by the Agency by the 5th business day of the month. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 84 of 150 Require Requirement Language Performance ment Measure No. Section 6.9 Project Management and Reporting 5067 To support the reports, the Contractor must collect, at a minimum, the following information on each call: a) Date time; b) Disposition (abandoned, queued, connected, completed); c) Time to connect; Duration (connect to ?nish); e) For answered calls: language; 0 For answered calls: subject (checklist of g) For answered calls: how caller heard of program; h) For answered calls: outcome (complete, referred, requires follow-up); i) For follow-up calls: follow-up effort (estimated time spent to respond); and For IVR Systems: tallies of all menu selections. Additionally, the Contractor must collect the following information on operations: k) Staf?ng by category and hours of operation; and l) Identi?ed problems and proposed Changes to resolve problems. The Agency may require additional information and report formats over the course of the contract at no additional Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 85 of 150 Require Requirement Language Performance ment Measure No. cost 5068 Provide all additional required reports outlined in the Operational Procedures Plan in accordance to the agreed upon timeframes. A Reporting Analyst shall be provided to perform ad-hoc queries and analysis. The Reporting Analyst position is further described in Appendix A: Section 6.8 Contractor Staffing/Qualifications. 5069 Provide designated Agency users with access to the performance management system or reporting tool that will allow the Agency the option to independently run performance reports and gauge CSC performance against standards. 5070 Provide designated Agency users with access to a real-time dashboard for performance management. The Agency shall be able to access the tool to independently run performance reports and gauge CSC performance against standards. The dashboard shall display, at a minimum: a) Statistics by disposition (Abandoned, Queued, Connected, Completed) b) Statistics on Time to Connect; c) Current Average Duration (Connect to Finish); d) Current call volume, and average call volume for the day; e) Current active calls; f) Number of calls in queue; 3) Wait time; Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 86 of 150 Require Requirement Language Performance ment Measure No. h) Availability of representatives; i) Number of active supervisors; and j) Number of calls in queue, wait time, availability of representatives, number of active supervisors, etc. 5071 Provide the ability for designated Agency users to listen in on active calls. 5072 Permit individuals designated in writing by the WDH Vendor Contract Manager access to inspect the Contractor?s operations. Such individuals may include, but are not limited to, Federal of?cials and auditors, Agency of?cials and employees, and other entities approved by the WDH Vendor 81 Contract Manager. On the basis of such inspection, Speci?c measures may be required if the Contractor is found to be noncompliant with Contract requirements. 5073 Regularly monitor the effectiveness of the Report the corrective CSC procedures, including but not limited action plan to the to: Agency within ten (10) business days of a) Ensuring suf?cient staf?ng levels to meet identifying the agreed upon performance expectations. deficiency b) Assuring the accuracy and completeness of the information collected over the phone or inputted from mail-ins. c) Reporting cases of apparent fraud to the Agency. Develop a corrective action plan for any area found to be insufficient or out of compliance and report the corrective action plan to the Agency. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 87 of 150 Require Requirement Language Performance ment Measure No. 5074 Assist the Agency in responding to Medicaid Eligibility Quality Control (MEQC), Quality Monitoring Review and Payment Error Rate Measurement (PERM) requests. 5075 Upon an Agency-agreed timeframe and frequency, conduct an assessment of the E-1c CSC business processes, documentation, training processes, and staffing and provide recommendations on improvement and optimization opportunities. 5076 Leveraging assessments and ongoing optimization logs, review identified improvements and opportunities with the Agency, along with proposed changes, effort, timeline, and cost to implement changes, and identified benefits of the change. The Agency will review proposed changes in accordance to the Change Control process and requirements identified below in Appendix A: Section 6.14 Change Control Management. 5077 Upon an Agency-agreed timeframe and frequency, propose an approach to expanding CSC services to phase?in the current enrollment and benefit client services currently handled by the State?s Fiscal Agent, as well as and other possible future add-on projects when notified by the Agency. The phase-in will result in contract negotiations and the Contractor will negotiate the terms in good-faith with the Agency. Potential add?on work could include but is not limited to: The Contractor?s approach shall be provided in the RFP proposal response. a) Dissemination of Medicaid Program Information to clients; including but not Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 88 of 150 Require Requirement Language Performance ment Measure No. limited to: i. Covered bene?ts; ii. Premium or co-pay requirements; Provider information; iv. Transportation information; and v. Issuing Medicaid ID Cards b) Acceptance of payments through various means (credit, debit, or other forms of electronic payment deemed acceptable by the Agency), in accordance with procedures established by the Agency and Contract. Assisting clients with client portal needs, including, but not limited to, checking eligibility, completing a transportation request, and requesting a Medicaid ID Card. 5078 Develop and submit by the Agency- designated timeframes, all Operations Deliverables as described in Appendix B. 12.4 Section 6.3.4 Turnover Services 5079 Prior to the conclusion of the Contract No less then three (3) awarded through this procurement, months prior to the provide, at no extra charge, assistance in end of the base turning over the final Contractor Contract period(s) or responsibilities to the Agency or its any extension designee. thereof. 5080 Provide, at no additional cost, a Turnover No less then three (3) Plan to the Agency. The plan shall include: months prior to the end of the base a) Proposed approach to turnover; Contract period(s) or any extension Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 89 of 150 Require ment No. Requirement Language Performance Measure b) Tasks and subtasks for turnover; thereof. c) Schedule for turnover; d) Documentation update procedures during turnover; and e) Description of Contractor coordination activities that shall occur during the turnover task that shall be implemented to ensure continued system and services as deemed appropriate by the Agency. 5081 Transfer to the Agency or its designee, as No less then one (1) requested, a copy of all CSC related data month prior to the on media determined by the Agency. end of the base Contract period(s) or any extension thereof. 5082 Beg-In training Agency staff, or Its . . As requested, but desrgnee, in relevant operations approximately three - - . of the CSC. Such training shall include. (3) months prior to 3) CSR processes and procedures; the end 0f the contract(s) or any b) Administrative processes and procedures; extension(s) thereof. and Training shall be c) Review of application backlog and plan to completed prior to resolve, if applicable. the end of the contract or any extension thereof. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 90 of 150 Require Requirement Language Performance ment Measure No. - 583 I I .. Prvdeaoifaciliw ocated Wyoming to provide in-person client services and mailroom operations. Models that have a call center operations offsite will be reviewed and approved by the Agency. 5084 The Agency requires all Contract services and activities to be conducted within the continental United States. With the exception of security controls, software development and defect resolution to Contractor-supplied software which may leverage global resources. Global support shall not have access to any virtual machines that process PHI or data. 5085 During the Contract Sta rt-Up, Transition and Operational Periods of this Contract, the Contractor, within reasonable notice, shall provide adequate meeting Space to accommodate the needs of intended audiences. 5086 The Contractor shall limit access to its offsite facilities; including storage facilities, and provide the Agency with a copy of its security plan as described in Appendix A: Section 6.6.15 Security. The Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 91 of 150 Require Requirement Language Performance ment Measure No. Agency has the right to perform physical security audits, vulnerability assessments and/or penetration testing of the Contractor?s offsite and onsite facilities at the Agency?s discretion. 5087 Full-time staff not located in Cheyenne, WY must be available onsite Monday starting at noon until Friday at noon, when requested. 5088 Key personnel staff identified in Appendix A: Section 6.8 Contractor Sta?ing/Qualifications who are approved by the Agency to work offsite must be available to come to Cheyenne at the Agency?s request to attend meetings or participate in functions in support of the SOW. 13.2 Section 6.4.2.1 Agency/Contractor Requirements 5089 Appoint a single point of contact for the Respond to Agency Agency, WES Contractor, and Incumbent and WES Contractor G-9c Contractor to address concerns. requests within one (1) business day. 5090 Provide immediate notice to the Agency of any occurrence that affects the G-10c Contractor?s ability to perform all or any part of the Contractor?s responsibilities under this Contract, along with an assessment of the time and effort necessary to recover. 13.3 Section 6.4.2.1 Contract Management 5091 Provide the ability to use secure and email accountls) for the Contractor staff to report problems, Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 92 of 150 Require ment No. Requirement Language Performance Measure G-12c questions or client issues to the Agency while safely exchanging as required. 5092 Participate in a weekly Change Control Board with the Agency and the WES G-14c Contractor in accordance to the agreed triage process. 5093 Participate in a regular collaborative Distribute minutes to meeting with the Agency and WES the Agency within Contractor to facilitate resolutions related two (2) days of the to client service and access needs and meeting. concerns. The Contractor shall produce and distribute minutes of the meeting unless otherwise directed by the Agency. 5094 Participate in any other meetings with the Distribute minutes to Agency and other entities including, but the Agency within G?18c not limited to: CMS, other agencies, and two (2) days of the other vendors, other entities upon Agency meeting. request. The Contractor shall produce and distribute minutes of the meeting unless otherwise directed by the Agency. 5095 Work with the Agency to identify and The review shall be propose annual Contract year goals, conducted within measures, Service Level Agreements and thirty (30) days Performance Expectations, and timelines. before the Contract review period. 5096 Develop and maintain a regular schedule The assessment shall to assess the satisfaction of Agency be completed 6'24?: personnel with the services provided by by the fifth the Contractor, and make improvements (5th) business day of to address substantive concerns raised by the month. the assessment. Findings should be included in CSC Operational report. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 93 of 150 Require Requirement Language Performance ment Measure No. The initial 5097 Develop and maintain a CSC Communication Management Plan that Communication 6'27?3 serves as the guideline to manage Management plan communications across all stakeholders, shall be delivered to including status reporting and other key the Agency by July 11, communications. In addition, the Plan 2016. shall address communications between the WES Contractor and the Agency, Any additional including a weekly status meeting. updates shall be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency 5098 Participate and facilitate weekly communications between the Agency and WES Contractor in status meetings. These communications shall include any potential issues and timeframes for mitigating. Contractor shall participate in the meetings in good faith and make every effort to work with the WES Contractor and Agency to ensure the objectives of the project are reached. s? 1:11:33; (if 5099 Develop a-Risk Management Plan. The The initial Risk Plan shall Include the Contractor?s Management Plan 6'29?3 approach to managing risk during the CSC shall be delivered to the Agency by July 11, 2016. transition as well as describe the Contractor?s understanding of risk management. Any additional updates shall be Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, inc. Page 94 of 150 Require ment No. Requirement Language Performance Measure made within three (3) business days upon receipt of request, unless otherwise determined by the Agency 5100 Maintain a Risk Register that includes: Report on status of risks weekly on G-30c a) All CSC transition-related risks; Weekly Status b) Initial risk prioritization (urgency), and Reports the Agency otential risk impacts (each risk)- and provude the Agency access to the c) Risk responses for each risk; RiSk Register within three (3) business d) A risk mitigation strategy for each risk; and days of a request. e) Assignments and updated ownership, due dates, and status tracking notes to each risk. 5101 Utilize a Project Control and Issue Tracking The Project Control tool to collect and track reported issues and Issue Tracking and resolutions. The tool shall capture, at tool shall be in use by minimum: the Agency and the Contractor by July 11, a) All applicable information about the issue 2016. and caller, including date of contact, name of individual making contact, organization/agency name/work unit (if applicable); b) Phone number and e-mail address; c) Description of problem/complaint; and d) Description of any follow up investigation/resolution plans, including the date and time of return calls, and any problem report numbers assigned or related to contact. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 95 of 150 Require ment No. Requirement Language Performance Measure The Contractor shall provide appropriate Agency personnel with access to the tool. 13.6 Section 6.4.5 Equipment 5102 G-31c Acquire and begin using necessary hardware and software for the CSC in accordance with the approved Infrastructure Plan. Examples of necessary hardware and software includes: Project Management Tools; Development Tools Visual Studio, Quality Studio); and, Hardware/software determined by the Contractor required to support Work on the Contract. Acquire any necessary hardware and software for the transition by July 15, 2016. Failure to acquire necessary hardware/softwa re by July 15, 2016 may result in termination of the Contract at the Agency?s sole discretion. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 96 of 150 Require Requirement Language Performance ment Measure No. Comply with State of Wyoming CIO Promulgated Rules on Electronic Transactions: es.aspx. 5103 5104 Comply with State of Wyoming IT Policies and Standards: page-2.html 14.2 Section 6.5.2 Agency Standards 5105 Comply with Wyoming Department of Heath, Division of Healthcare Financing Standards and best practices; including, but not limited to: a) CMS Application Life Cycle Management b) Collaborative Environment and Life Cycle Governance - Exchange Reference Architecture (ERA) Supplement; c) Exchange Life Cycle model d) Federal Acquisition Regulation (FAR) clause 52.239-1; e) IRS Publication 1075; Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 97 of 150 Require Requirement Language Performance ment Measure No. f) ISO 27001/2; 3) Medicaid Information Technology Architecture h) NIST Special Publication 800-14,- i) NIST Special Publication 800-47; j) NIST Special Publication 800-53,- and, k) NIST Special Publication 800-57 rev 4. I) Federal Information Processing Standards (FIPS) 14.3 Section 6.5.3 Statutory Mandates 5106 Comply with all Statutory Mandates, including but not limited to: a) 18 U.S.C. 641 Criminal Code: Public Money, Property or Records; b) 18 U.S.C. 1905 Criminal Code: Disclosure of Confidential Information; c) CFR Title 21 - Food and Drugs: Parts 1 to 1499; d) CFR Title 45 (Parts 1-199))Code of Federal Regulation Title 45 Public Welfare Revised (Specifically 164 Security and Privacy); e) Economic Recovery Act of 2009; f) Emergency Medical Treatment Labor Act g) Federal Information Security Management Act of 2002 h) Freedom of Information Act Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 98 of 150 Require Requirement Language Performance ment Measure No. i) Health Insurance Portability and Accountability Act (HIPAA) of 1996 P.L. 104- 191; j) OMB Circular A-130, Appendix Security of Federal Automated Information Systems; k) Privacy Act of 1974, 5 U.S.C. 552a; l) Section 1011 - Emergency Health Services Furnished to Undocumented Aliens; m) The Deficit Reduction Act of 2005; n) The Health Information Technology for Economic and Clinical Health (HITECH) Act,- 0) The Patient Protection and Affordable Care Act; of 2010 and p) The Sarbanes-Oxley Act of 2002 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 99 of 150 Require Requirement Language Performance ment Measure No. 5107 With the exclusion of Agency system Acquire any necessary described within the RFP, the Contractor hardware and shall provide the necessary software for the telecommunications telephony transition by July 31, technologies, including hardware and 2016. software, to support all CSC operations and staff in accordance with the approved Failure to acquire Infrastructure Plan. As described in necessary Appendix A: Section 6.3.2, the Contractor hardware/ software shall propose its infrastructure plan that by My 31' 2015 may includes, but is not limited to: result in termination of the Contract at the a) Required phone lines and phone Agency?s sole hardware; discretion. b] CSC management and operational software and supporting tools; c) IVR functionality; d) CRM functionality; e) Mailroom management software and/or tools. Note that the Agency will provide the EDMS through the WES. Additional management tools will need to be pr0posed and incorporated with the existing EDMS functionality; f) A fax server (not a fax machine); g) Personal desktops and staff support tools. Desktops should interface with the scanning software and allow documents Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 100 of 150 Require Requirement Language Performance ment Measure No. to be scanned and downloaded without printing; h) Internet and security tools; i) Performance management software/tools; The Contractor is expected to propose a solution based on service-oriented architecture (SOA) concepts, including loose coupling of system components to reduce system dependencies and promote reuse. 5108 Provide the ability to seamlessly transfer calls to the LTC Unit from a remote CSC location. 5109 Provide the necessary tools to maximize efficiency in CSC operations. The Agency expects this to include, at minimum, a CRM system, IVR, Workforce Management system, and Knowledge Management (KM) tools. The Contractor shall also host and maintain all technology brought in by the Contractor under this Contract. Additional requirements on each tool are included below. Each Proposer will describe the recommended tool set as part of its proposal response, further detailed in Section 7 of the RFP. Plan, test and train staff on use of the CRM by September 30, 2016. 5110 Provide a CRM that is a web-based system and capable of capturing and tracking all activities and operations of the CSC. At a minimum the CRM shall: a) Be the primary system for all CSC activity and be made available to the WDH Vendor Contract Manager and individuals designated by the WDH Vendor Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 101 of 150 Require Requirement Language Performance ment Measure No. Contract Manager. b) Permit customizable object names /?elds and dashboards, which display real-time performance metrics. c) Support Agency outreach activities like bulk emailing and surveys to clients and third? party vendors. d) Have secure role-based privilege settings to de?ne user access, interfaces, and report generation. The Contractor shall work with the State Project Manager to identify these settings. e) Integrate with Agency email, calendar and contacts. Currently Agency uses Google email and does not permit f) Integrate with Agency software systems to enable service requests to be ?ltered through existing systems, allowing for proper tracking and metrics gathering if needed in the future without modi?cations to Agency systems. g) Mask PII data during input/presentation. Audit trail information should be captured if any user is permitted to view the masked PII. h) Provide standard and advanced reporting features such as: 1. Auto-generate/schedule reports. 2. Produce user de?ned reports. 3. Track answered and unanswered client inquiries and 4. Export reports in different formats such as Excel or PDF. . Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 102 of 150 Require ment No. Requirement Language Performance Measure i) Manage web forms for Administration speci?c activities. 5111 g) h) Leverage an IVR to provide the initial message to callers and triage callers to the appropriate queue. The Contractor will work with the Agency to design the IVR set-up based on Contractor experience and expertise. The IVR must support: Fully customizable menus. The Contractor will work with the Agency to design the most effective menu options based on the scope of services. The use of automated messages available in English and Spanish. Recordings using broadcast standard recording techniques. Features for professional voice recording of Scripts in English and Spanish. The IVR shall play appropriate language prompts based on IVR prompt selection. Customizable messages to play while clients are on hold after making a choice on the IVR in addition to on-hold music. The option to transfer a caller directly from the IVR to a CSC representative, or other identi?ed entities outside the CSC, as well as allow the caller to return to the main menu. Self-service options for callers who want to request information (applications, brochures) to be mailed to them. It may also be used for potentially screening eligibility. The ability to provide a call ?ow that allows callers to get the information they need using the fewest number of prompts Plan, test and train staff on use of the IVR by September 30, 2016. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 103 of 150 Require Requirement Language Performance ment Measure No. and options. i) Provide remote announcement updates for Special situations. An after hours message to callers that identifies hours of CSC operation, provides basic information about the programs, offers an option for callers to request written information about the programs, and requests that the caller call back during active hours of operation, if additional information is required. k) Meet or exceed Internal Revenue Service (IRS) IVR Safeguards. Refer to (lVR)-Systems. 5112 Provide a searchable online Knowledge The KM shall be Management (KM) solution. Provide and established by maintain all information for CSC staff, with September 1, 2016. highly flexible search criteria to enable a user to quickly find needed information in policy manuals, training material, call scripts implementation memos, etc. and all help functions. The KM shall serve as the official repository for CSRs to locate all pertinent information to perform Work. The Contractor shall also provide access to designated Agency staff, upon Agency request. 5113 Provide integration services to integrate CRM, IVR, and WES necessary Contractor tools/systems, systems shall be including, but not limited to the IVR and integrated and tested CRM, with the WES as required by the by September 30, WES Contractor. The Contractor will need 2016. to allow for the future expansion of the tools to be used by the Long Term Care Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 104 of 150 Require ment No. Requirement Language Performance Measure Unit. 5114 Provide call recording capabilities to capture information from callers such as agreement to consent language. The call recording system may also be used for quality assurance purposes and complaint investigations, as well as tracking calls to the CSC during off hours. Records will be maintained for seven (7) years. Addition al Require ment Please see requirement 5207 and 5208 at the end of the document. Addition al Requke ment Please see requirement 5208 at the end of the document. 5115 Provide the capability to receive calls forwarded from other toll-free numbers that may be directed to the CSC. 5116 Complete requests for system changes and/or access as the result of legislative changes, service changes, lawsuits, etc. Complete requests for system changes and/or access as the result of legislative changes. service changes, lawsuits, etc. no later than two (2) Business Days after the request by the Vendor Contract Manager or designee, unless there is suf?cient reason for further delay. 5117 Provide TTD or TDY capacity to meet the needs of hearing impaired callers. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 105 of 150 Require Requirement Language Performance ment Measure No. 5118 CSC systems shall be capable of supporting the archiving, retrieval, and purging of data. Systems shall be kept in an online mode during the length of the Contract with exceptions of approve downtime in accordance to the approved Business Continuity and Disaster Recovery Plan, as detailed in Appendix A: Section 6.5.4 Business Continuity and Disaster Recovery. 5119 Ensure security data transfers as specified in the Appendix A: Section 6.6.3 Security. 5120 Provide system generated emails to Emails shall be clients (where applicable) to remind them provided within of upcoming due dates for fourteen (14) days of documentation, application receipt, the due date. renewal receipt, etc. 5121 Provide the Agency?s LTC Unit access and direct use of CSC tools to support LTC client call management and services. The Contractor shall work with the Agency to: a) Allow for separate LTC reports; b) Allow Agency access and direct use of the Contractor?s c) Incorporate LTC routing and needs into the d) Provide LTC staff with the necessary training, communications and knowledge management related to the tools; e) Provide language lines for use by LTC representatives; f) Any additional Contractor technology or tools that can streamline the integration and workflows between the CSC and LTC Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 106 of 150 Require Requirement Language Performance ment Measure No. Unit. 5122 couple the NR and CRM with WES to provide reporting capabilities and ensure accurate data. Allow for stand- alone dynamic reporting. Specific reporting needs are included in Appendix A: Section 6.6.2 Reporting. 5123 Ensure the Contractor?s equipment meets or exceeds WDH standards for virus protection and security. More details on standards are provided in Appendix A: Section 6.6.3 Security. 5124 Provide uninterrupted services in the event that any telephone ine(s) stops working in accordance with the approved Business Continuity and Disaster Recovery Plan. More details on the Plan are included in Appendix A: Section 6.5.4 Business Continuity and Disaster Recovery. 5125 Upgrade hardware, software, and other related systems, including communication systems as needed and at the expense of the Contractor. All components of the CSC system must be kept current with industry standards. This includes functionality across common web- browsers (Le. lnternet Explorer, Firefox, Chrome, Safari, etc). 5125 Allow the Agency to purchase Contractor's equipment required under this Contract at a fair market price in the event that the contract is terminated. 5127 Provide telecommunications and technology support for desktop usage, desktop support, telecommunications and technology systems, voice and data network equipment, hardware and Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 107 of 150 Require Requirement Language Performance ment Measure N0. software support. 5128 Allow the Agency to purchase Contractor?s tools required under this Contract at a fair market price in the event that the contract is terminated. 15.2 Section 6.6.2 Reporting 5129 Provide operational performance reports as defined in the Operational Procedures Plan and by the Agency in Appendix A: Section 6.3.4 Operations and as described in Appendix F. 5130 Provide data and reporting support to the Agency and its designees, upon Agency request. 5131 Provide reporting data and support to coordinate with PERM. 5132 Contractor shall allow Agency to access all Agency shall be reports and data showing how report was granted access to all generated. reports and data within one (1) business day of the request. 15.3 Section 6.6.3 Security 5133 Adhere to applicable technical standards for site and System security policies and procedures throughout the CSC Contract term to protect Agency and client information and system components that house Agency data. Wyoming security policies have been provided in Appendix A: Section 6.5 System or Wyoming IT Standards. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 108 of 150 Require Requirement Language Performance ment Measure No. 5134 Enter into and sign a Business Associates Agreement (BAA) in compliance with the Privacy and Security provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This is an agreement to protect personal or sensitive information. A sample BAA is included in Appendix K. 5135 To ensure that the information contained in each CSC tool or system component is properly safeguarded, the Agency and/or Federal government may elect to perform annual security reviews of Contractor operations by Agency staff, Federal government personnel, or separate Contractor services. 5136 Update and maintain the State Security The SSP shall be Plan (SSP) detailing the Contractor?s delivered to the approach to ongoing CSC security. The Agency by August 15, updated SSP should reflect the 2016. Contractor?s approach to: a) Ensure confidentiality, integrity, and availability of CSC Services and client data; b) Ensure accountability with security, which includes the approach to establishing and maintaining security responsibility and accountability; c) Processes for granting or restricting access to all the applications (including Web- enabled applications) and data; auditing security events, auditing security configurations, and changes, generating security reports, and monitoring the system Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 109 of 150 Require Requirement Language Performance ment Measure No. for vulnerabilities and intrusions; d) Plan for managing authorized users for user creation, assignment of new User ID (User Identification)/password/ personal identification numbers (PINS), role assignments, and activity monitoring; e) Plan for ensuring compliance including the approach to maintaining compliance with law, standards, and best practices; f) Plan for monitoring, managing, and reporting security incidents, in accordance with the Business Associates Agreement (BAA) and SLA requirements; g) Network segmentation; h) Perimeter security; i) Application security and data sensitivity classification; j) Security of PHI and PH data elements; k) Intrusion detection and prevention management; Host hardening; m) Managing remote access; n) Maintaining minimum AES 128 bit 0) Managing a statewide active directory services for authentication; p) Interface security; q) Security test procedures; r) Managing network security devices; Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 110 of 150 Require Requirement Language Performance ment Measure No. s) Defending against viruses, mobile code and code of unknown origin. t) Secure Sockets Layer (SSL) for providing communications security over the Internet; and u) Plan for security patch management. Revise the SSP and meet revised State and Federal standards, as directed by the Agency. Submit updates to the SSP to identify all potential threats and hazards to the physical sites and System components, including the probability of occurrence, and identify the assets and controls to protect against such threats and hazards. The Contractor may submit this plan in conjunction with the Business Continuity and Disaster Recovery Plan described below. 15.4 Section 6.6.4 Business Continuity and Disaster Recovery 5137 Maintain current expectations related to business continuity and disaster recovery, as outlined in requirements and included the SLAs. 5138 Maintain and update a Business The Business Continuity and Disaster Recovery Plan, Continuity and which includes, at a minimum, the Disaster Recovery following: Plan shall be delivered to the a) Identification of the core CSC business Agency by August 15' processes; including the ability to answer 2016. calls, CRM, IVR, and KM. For each core business process: 1. Identification of potential system Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 111 of 150 Require Requirement Language Performance ment Measure No. failures for the process; 2. Risk analysis; 3. Impact analysis; 4. Definition of minimum acceptable levels of outputs; 5. Outline a set of business and System administration rules that shall be enforced; 6. Document of contingency plans if the CSC is not available; 7. Definition of triggers for activating contingency plans; 8. Discussion of establishment of a business resumption team; 9. Maintenance procedures for the Plan and Disaster Recovery and Business Continuity processes; and 10. Plans to conduct a business continuity simulation not less than once a year from the Contract effective date b) Retention and storage of back-up files and software; 1. Hardware back-up for critical system components; 2. Facility back-up; 3. Back-up for any telecommunications links and networks; 4. Back-up procedures and support to accommodate the loss of any online Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 112 of 150 Require Requirement Language Performance ment Measure No. communications; 5. A detailed file back-up plan and procedures, including the off-site storage of crucial transaction and master files. The plan and procedures shall include a detailed frequency schedule for backing up critical files and (if appropriate to the backup media) their rotation to an off-site storage facility. The off- site storage facility shall provide security of the data stored there, including protections against unauthorized access or disclosure of the information, fire, sabotage, and environmental considerations; and 6. The maintenance of current System documentation and source program libraries at an off-site location. 7. The Plan and results of periodic disaster readiness simulations shall be available for review by State or Federal officials on request. The Contractor may elect to leverage and modify the existing Business Continuity and Disaster Recovery Plan if appropriate. 5139 Provide uninterrupted services in the event that any telephone line(s) stops working in accordance with the approved Business Continuity and Disaster Recovery Plan. 5140 Conduct an annual test of the Disaster The test and report Recovery Plan and submit a written report shall be provided of the outcome, corrective action plan, annually within thirty and revisions, if any to the Agency. (30) days of the annual Contract Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 113 of 150 Require Requirement Language Performance ment Measure No. effective date. 5141 The Business Continuity and Disaster Recovery Plan and results of periodic disaster readiness simulations shall be available for review by State or Federal officials upon request. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 114 of 150 Require Requirement Language Performance ment Measure No. 1' ?Er?fz'ifrt?f? my 1 ?e log-t u, a: 3., ensure that Service Level Agreements are met for: Availability Response time for repair; Security incident response; Security protection of Wyoming Department of Health and Federal Agency Partner data; Frequency of software upgrades related to hosted environments; and, Policy for software patches related to hosted environments. Procedures shall be delivered to the Agency by September 15, 2016. Any additional updates shall be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. 5143 H-12c Maintain policy and procedures to maintain and support the security of the Agency's confidential information held on Contractor-administered tools. Provide a description of your policies, procedures and protocol on data security breach. Data breach notification procedures and plans are maintained and shall at a minimum, comply with WS 40-12-502. [If applicable, data breach notification procedures and plans shall also comply with CFR 45 parts 160 and 164 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 115 of 150 Require ment No. b) d) 8) Requirement Language Develop and submit to the Agency for review and approval a Resource Management and Staf?ng Plan that includes, but is not limited to: Staf?ng Levels by role (estimated by staff disciplines by month for the duration of the project) and how the staf?ng levels shall achieve consistent, dependable service regardless of changes that may in?uence work volume; Organization chart, depicting each component of CSC operations and locations, all cross-cutting functional units of the organization/project, numbers and types of staff for each component/function, and identified lines of authority governing the interaction of staff, and relationships with major subcontractors; Tools and processes used to screen available staff and fill positions; Process for replacing key personnel within Agency-defined timeframes and procedures for back-filling key personnel during the transition; Summary of all roles and responsibilities Performance Measure The initial Resource Management and Staffing Plan shall be provided with the Proposer?s solution. The first update to the plan shall be delivered to the Agency by July 11, 2016. Any additional updates shall be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 116 of 150 Require Requirement Language Performance ment Measure No. utilized throughout the Contract; and 0 Identification of subcontractor staff (if applicable). The Plan update should be regularly updated to reflect current staffing levels. 5145 Identify and use accepted operational standards to provide a sufficient number of staff qualified to fulfill the scope of work and adjust staff levels as work volume fluctuates. 5146 When possible, the Agency shall be notified at least thirty (30) calendar days prior to key personnel changes or departures. Notify the Agency in advance of any planned key personnel changes or reassignment. In unexpected termination circumstances, the Agency shall be notified at least two (2) days after receiving notification of departure. 5147 Within the boundaries of the Contractor?s control, do not remove personnel whose names and resumes are submitted in the Proposal without prior approval of the Agency. The Contractor shall not substitute or add additional personnel until a is received and approved by the Agency. 5148 When possible, the In the event that a key personnel reSIgns Agency shall be Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 117 of 150 Require ment No. Requirement Language Performance Measure or is terminated, the Contractor shall provide the Agency with immediate notice of the vacancy, the reason(s) for the vacancy, and an action plan for backfilling the position until a replacement is found and approved by the Agency. The Contractor may not ?ll vacant key personnel positions with other existing key personnel without approval by the Agency. The Agency should also have the authority to approve proposed replacements of key personnel by the Contractor. noti?ed at least thirty (30] calendar days prior to key personnel changes. A key personnel position shall not be vacant for more than sixty (60) consecutive calendar days. For every week after sixty (60) calendar days of vacancy the Contractor will be ?ned one thousand dollars ($1,000) per day. No more than two (2) staff turnover for the Operations Manger per year shall occur. The Contractor will be fined one thousand- five hundred (515,00) dollars for every turnover thereafter. 5149 Ensure that the appropriate level of knowledge is transferred to new employees and employees are adequately trained prior to starting work as to not disrupt business operations. 5150 Notify the Agency of any background checks for potential employees or subcontractors when negative findings are uncovered. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 118 of 150 Require Requirement Language Performance ment Measure No. Perform background checks on Contractor employees and subcontractors, at no cost to the Agency, to ensure the safety and security of the client data. The background checks shall be performed by recognized law enforcement agencies or qualified third parties only, including the Federal Bureau of Investigations (FBI), on an annual basis. The Agency reserves the right to disqualify any employees or subcontractors of the Contractor whose background checks suggest conduct, involvement, and/or associations that the Agency determines, in its reasonable discretion, are inconsistent with the performance and/or security requirements set forth in this Contract. The Agency reserves the right to request the Contractor to perform additional background checks on Contractor? 5 employees and subcontractors. 5151 Do not employ any individual who has a job relevant conviction for a felony or misdemeanor, or for whom a warrant is outstanding. 5152 Establish and implement Contractor At minimumContractor shall personnel administration poliCIes that . prowde staff With reflect the State and Federal policies, standards, and regulations. HIPAA and Security training annually. 17.1.2 Section 6.8.2 Resource Responsibilities 5153 Provide qualified personnel to perform the work necessary to accomplish the tasks defined in the Scope of Work sections. The Contractor shall identify the individuals who shall fill the key staff positions to the Agency by the Contract Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 119 of 150 Require Requirement Language Performance ment Measure No. effective date, including those that are not directly employed by the Contractor. Key Personnel roles shall be filled at all times throughout the duration of the Contract, unless the position is within the 30 day vacancy timeframe. 5154 Proposers may propose and name additional personnel as ?key personnel,? but shall include at least the following positions: a) CSC Account Manager b) Operations Manager c) Training Manager d) IT Specialist e) Manager f) Reporting Analyst g) Consulting Policy Analyst h) Mailroom Lead Additional descriptions and qualifications are provided below. More details on proposal response requirements are included in the RFP. 5155 At its discretion, the Agency may request that the Contractor?s key personnel staff shall have to go through an oral interview process. This interview may be conducted onsite, via video conference or teleconference, as determined appropriate by the Agency. 5156 Provide a CSC Account Manager (Contract Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 120 of 150 Require Requirement Language Performance ment Measure N0. manager). The CSC Account Manager serves as the Contract primary point of contact to maintain communication with the Agency for activities related to Contract administration, correspondence between the Agency and the Contractor, and executive reporting to the Agency. The CSC Account Manager role shall be fulfilled by a single resource. The CSC Account Manager resource shall not be named to another key position. The CSC Account Manager shall be full- time. The CSC Account Manager shall be available onsite upon request by the Agency. Required qualifications include: a) At least five (5) years of experience providing CSC Account Management. b) At least three (3) years of experience in working in health care or human service program eligibility. c) Detailed knowledge of HIPAA regulations and requirements. d) Bachelor?s degree from an accredited college or university. In lieu of an Associate degree, an additional two (2) years of relevant experience (for a total of seven years). In lieu of a Bachelor's degree, four (4) additional years of relevant experience will be accepted for a total of nine (9) years. Preferred Qualifications: e) Demonstrated broad knowledge of public Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 121 of 150 Require Requirement Language Performance ment Measure No. assistance or human services eligibility programs and policies, an understanding of general business management principles and practices, and financial management. f) Demonstrated experience and knowledge of industry standard and best practices regarding large-scale and enterprise?level contracts. g) Extensive knowledge of health care administration, Medicaid and CHIP eligibility or enrollment processes. h) Specific practical experience in their submitted area of expertise. i) Extensive experience in technical writing. 5157 Provide an Operations Manager. The Operations Manager serves as the day-to-day point of contact during Operations to maintain communication with the Agency for activities related to CSC Operations; including developing and enforcing operational policies and procedures, managing CSC Staff, monitoring and managing to CSC SLAs, correspondence between the Agency and the Contractor, and operational status reporting to the Agency. The Operations Manager role shall be fulfilled by a single resource. The Operations Manager resource shall not be named to another key position. The Operations Manager shall be full- time and dedicated 100% to this Contract. Required qualifications include: Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 122 of 150 Require Requirement Language Performance ment Measure No. a) At least three (3) years of successful experience in general CSC operations. b) At least five (5) years of successful experience in managing a team of at least ten (10) employees. c) Bachelor?s degree from an accredited college or university. In lieu of an Associate degree, an additional two (2) years of relevant experience [for a total of ?ve (5) years]. In lieu of a Bachelor?s degree, four (4) additional years of relevant experience will be accepted for a total of seven (7) years. Preferred Qualifications: d) Knowledge of public assistance or health care, Medicaid and CHIP eligibility or enrollment processes. e) Knowledge of Federal and state statutes, legislative initiatives and regulations, as well as Federal, State, and local policies that may impact the CSC operations and state health care programs. f) Experience with eligibility determination systems, and electronic document management. g) Demonstrated understanding and appreciation of CSC concepts and practices, including: use of systems, call routing, contact channels, types of customer transactions/interactions, workforce management, performance measurements, quality initiatives, coaching and mentoring, career path development, staff development, diverse learning styles, and the unique demands of frontline staff. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 123 of 150 Require Requirement Language Performance ment Measure No. h) Experience and knowledge of ACA, specifically related to health insurance program eligibility rules and requirements. 5158 Provide a Training Manager. The Training Manager must PrOVide leadership, mentoring, and customer issue resolution. The Training manager must ensure the CSC employees are trained in positive customer relations and ensuring customer requests are handled appropriately and timely. The Training Manager role shall be fulfilled by a single resource. The Training Manager resource shall not be named to another key position. Required quali?cations include: a) At least three (3) years as a Training and Manager. b) At least two (2) years of successful experience as a training facilitator, designer, or other training support function with a CSC environment. c) Bachelor?s degree from an accredited college or university. In lieu of an Associate degree, an additional two (2) years of relevant experience [for a total of ?ve (5) years). In lieu of a Bachelor?s degree, four additional years of relevant experience will be accepted for a total of seven years. Preferred Qualifications: 3) Demonstrated understanding and appreciation of CSC concepts and practices, including: use of systems, call routing, Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 124 of 150 Require Requirement Language Performance ment Measure No. contact channels, types of customer transactions/ interactions, workforce management, performance measurements, quality initiatives, coaching and mentoring, career path development, staff development, diverse learning styles, and the unique demands of frontline staff. b) Superior writing skills related to informational and instructional material, including the ability to present content in a non-paragraph and linear way. c) Proven to be task-, team-, and dead-line oriented; and a team player. d) Demonstrated experience in communicating effectively with all levels of management and representatives. 5159 Provide an IT Specialist. RM-17C The IT Specialist will provide IT support. research and implement technological strategic solutions as needed, and assist CSC and Agency staff with IT related issues. The IT Specialist role shall be fulfilled by a single resource. The IT Specialist resource shall not be named to another key position. Required quali?cations include: a) Two (2) years experience as an IT Specialist. b) Ability to work independently and with a team. c) Excellent oral and written communication skills, detail oriented, and solid business Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 125 of 150 Require Requirement Language Performance ment Measure No. logic and analytic skills. d) Bachelor?s degree from an accredited college or university. In lieu of an Associate degree, an additional two (2) years of relevant experience (for a total of four (4) years). In lieu of a Bachelor?s degree, four additional years of relevant experience will be accepted for a total of six years. Preferred Qualifications: Preferable to have IT Specialist experience within a CSC. 5160 Provide a Manager. The Manager oversees the design of call monitoring formats and quality standards; performs call monitoring and providers trend data to the management team; uses data to compile and track performance at the team and individual level and provides feedback; monitors customer relations; and prepares and analyzes internal and external quality reports for management staff and Agency review. The Manager role shall be fulfilled by a single resource. The Manager resource shall not be named to another key position. Required qualifications include: a) At least two (2) years of CSC experience. b) Excellent oral, written, and interpersonal communication skills and strong listening and analytic skills. c) Strong knowledge of customer care Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 126 of 150 Require ment No. Requirement Language Performance Measure processes and techniques. d) Ability to work well with a team and provide exception customer service. e) Bachelor?s degree from an accredited college or university. in lieu of an Associate degree, an additional two (2) years of relevant experience (for a total of four (4) years). In lieu of a Bachelor's degree, four (4) additional years of relevant experience will be accepted for a total of six (6) years. Preferred Qualifications: Preference for healthcare related customer care experience. 5161 Provide a Reporting Analyst. The Reporting Analyst will provide reporting and database development support to the Operations Manager and other team members. The responsibilities include design and development of database, spreadsheets, and reports as request by the CSC staff and Agency; analysis and reporting of data from electronic data sources; define problems, independently conduct research, formulate solutions, and make recommendations; assist in the preparation of reports, correspondence, visual presentation, and other materials; and oversee the flow of information and ensure reporting deadlines are met. The Reporting Analyst may be part-time. Required qualifications include: e) At least two (2) years experience as a Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 127 of 150 Require Requirement Language Performance ment Measure No. reporting analyst. f) General knowledge of computerized data management and experience with word processing, spreadsheet, database, statistical, and presentation software as well as other text, communications, and relational database software. g) Ability to work independently and with a team. h) Excellent oral and written communication skills, detail oriented, and solid business logic and analytic skills. i) Bachelor?s degree from an accredited college or university. In lieu of an Associate degree, an additional two (2) years of relevant experience (for a total of four years). in lieu of a Bachelor?s degree, four additional years of relevant experience will be accepted for a total of six (6) years. Preferred Qualifications: A college degree in IT or computer engineering. 5162 Provide a Consulting Policy Analyst The Consulting Policy Analyst works directly with the CSC Account Manager and serves as the Contractor?s consultant to review and analyze new and proposed Federal and State policies and regulation to provide guidance and recommendations on the potential impact to the Agency and to the CSC. The Consulting Policy Analyst shall be available onsite upon request by the Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Heaithcare Financing and Maximus Health Services, Inc. Page 128 of 150 Require Requirement Language Performance ment Measure No. Agency. Required qualifications include: a) At least ten (10) years of experience in analyzing health care policy regulations and reporting to State?s on potential impacts and providing recommendations. b) At least three (3) years of experience in performing similar services on complex systems-based modern technology or operational systems. c) Detailed knowledge of HIPAA regulations and requirements. d) Bachelor's degree from an accredited college or university. In lieu of an Associate degree, an additional two (2) years of relevant experience (for a total of twelve (12) years). In lieu of a Bachelor?s degree, four (4) additional years of relevant experience will be accepted for a total of fourteen (14) years. Preferred Qualifications: a) Demonstrated knowledge of state policies and processes, an understanding of general business management principles and practices, and financial management. b) Demonstrated experience and knowledge of industry standard and best practices regarding large-scale and enterprise-level projects. c) Extensive knowledge of health care administration, Medicaid and CHIP eligibility or enrollment processes. d) Specific practical experience in their Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 129 of 150 Require Requirement Language Performance ment Measure No. submitted area of expertise. e) Extensive experience in technical writing. Addition Please see requirement 5209 at the end of al the document. Requne ment 5163 Provide CSC Supervisors CSC Supervisors work directly with the Customer Service Representatives and serve as the day-to-day managers and mentors to ensure adherence to quality and timeliness SLAs. The CSC Supervisors shall be full-time and shall be scheduled to maintain adequate management of CSR activities during designated CSC hours of operations. One or more Supervisors are required at all locations, per the Contractor?s Resource Management and Staf?ng Plan. Required qualifications include: a) At least two years' experience in Telemarketing Supervision. b) Computer skills including: Excel, Microsoft Word and Outlook. c) A Professional Attitude with Proven Track Record of Performance and Results. d) Self-Motivation and be detail oriented. e) Bachelor's degree from an accredited college or university. In lieu of an Associate degree, an additional two years of relevant experience (for a total of four (4) years). In lieu of a Bachelor?s degree, four Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, inc. Page 130 of 150 Require Requirement Language Performance ment Measure No. (4) additional years of relevant experience will be accepted for a total of six (6) years. Preferred Qualifications: f) Bilingual (Fluency in both English and Spanish) a plus but not required g) Knowledge of public assistance or health care, Medicaid and CHIP eligibility or enrollment processes. h) Experience with eligibility determination systems, and electronic document management. 5164 Provide a Mailroom Lead The Mailroom Lead works directly with the Operations Manager and serves as the point of contact for management of the centralized, eligibility?related mail facility. The Mailroom Lead is full-time and dedicated 100% to this Contract. The Mailroom Lead shall be present onsite at the local facility within the designated CSC hours of operations. Required qualifications include: a) At least two years' experience in a mailroom. b) Computer skills including: Excel, Microsoft Word and Outlook. c) A Professional Attitude with Proven Track Record of Performance and Results. d) Self-Motivation and be detail oriented. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 131 of 150 Require Requirement Language Performance ment Measure No. 17.1.3 Section 6.8.3 Subcontractors 5165 All subcontractors will report to and be the responsibility of the Contractor. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 132 of 150 Require ment 5166 PM-lc Requirement Language Deploy a project management methodology that follows industry best practices throughout the duration of the Contract term. Performance Measure 5167 Provide and maintain a detailed project plan for any CSC projects or enhancements as described in Appendix A: Section 6.2.1 Start-Up. 5168 Utilize the Project Control and Issue Tracking tool described in Appendix A: Section 6.4.4 Risk and Issue Management. 5169 Attend and participate in all project related meetings requested. The Contractor shall prepare materials or briefings for these meetings as requested by the Agency. Minutes shall be taken and distributed by Contractor staff, unless othen/vise specified by the Agency. Distribute minutes to the Agency within two (2) days of the meeting. 5170 Attend and participate in Steering Committee meetings, when requested by the Agency. 5171 Distribute status reports, along with an agenda for status meetings with Agency participants. The Agency reserves the right to review and approve each Report and request that additional information be added to the report template at any Submit status reports within the designated weekly timeframe established by the Contractor and Agency in Start-Up Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 133 of 150 Require ment No. Requirement Language Performance Measure point in the project. planning. Distribute the status agendas at least one (1) day in advance of the meeting. 5172 During the Transition phase, conduct Provide a weekly weekly status meetings. The Contractor? 5 Status Report to the Account Manager, Operations Manager Agency. Failure to and Key Personnel, as necessary, shall provide a weekly attend all status meetings. The Contractor report for two (2) shall generate a Status Report as the basis consecutive weeks, for the status meeting. In the Status without written Report, the Contractor shall address: Agency approval, may result in termination a) Project schedule (current status of all of the Contract at the activities); Agency?s sole discretion. b) Near term activities; Contract c) Key milestones and training Activities; Management d) Deliverables (submitted, due, overdue, Meetings ?(Ill be held approval status and payment status) weekly during Transition. After e) Staffing levels; Transition, the Contractor and f) Project risks from the risk register (including Agency will schedule mitigation status); meetings, as necessary. g) Issues from the issues tracking tool (log of identified issues with status of each); and Distribute minutes to the Agency within h) Action items (log of items with status of two (2) days of the each). meeting. 5173 During the Operations phase, provide the Submit Agency with a Status Report for status reports by the business day of high-level project status reporting within the Agency defined timeframe. The Status Report. Status Reports shall contain, at a minimum, the the month. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 134 of 150 Require Requirement Language Performance ment Measure No. following information: a) Description of the status of project activities in terms of the approved Project Plan Baseline; b) Plans for activities scheduled for the next month; c) Proposed changes to the Project Plan Baseline, if any; d) Deliverable status, with percentages of completion; e) Updated issues Iog- including issues encountered, proposed resolutions, and actual resolutions; f) Progress against planned CSC monitoring metrics; g) Progress against planned metrics; h) Analysis of risks anticipated, proposed mitigation strategies, and resolved risks; i) List of policy change requests, if applicable; j) List of continual improvement recommendations; k) Report of infrastructure efficiencies planned equipment utilization); I) Agency satisfaction assessment results; m) Client satisfaction survey results; and n) Identification of Contractor employees assigned to specific tasks and any anticipated staffing changes. The Agency may request a meeting with the CSC Account Manager, Operations Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 135 of 150 Require Requirement Language Performance ment Measure No. Manager and key staff to discuss the Status Reports. The Agency reserves the right to review and approve each Status Report and request additional information be added to the report template at any point in the project. 5174 Provide the annual training report to the WDH Vendor 81 Contract Manager as described in Appendix A: Section 6.10 Training and Knowledge Transfer Plan Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 136 of 150 Require Requirement Language Performance ment Measure The Training Plan shall be delivered no later than August 31, 2016. Provide an initial Training Plan that details the Contractor?s approach to initial and ongoing training. The Plan should include, at minimum: 3) Approach to training to ensure staff has the information to effectively complete their jobs (basic, intermediate and advanced); b) Approach to working with the WES Contractor to receive adequate training and updates on WES system needs; c) Approach to working with the Agency to receive adequate policy and program information for training dissemination; d) Identi?cation of any training required for Agency staff on CSC operations and/or tools; e) Course listing and descriptions; f) Available user documentation to support job duties; g) Operational procedures; h) Training materials; i) Student Evaluation Forms; j) Ongoing policy and work?ow knowledge testing evaluation; and k) Training and knowledge testing Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 137 of 150 Require Requirement Language Performance mont Measure No. evaluation schedule 5176 Develop all materials speci?cally related to the CSC personnel?s day-to-day operational roles and responsibilities. Training materials should include job aids and tests. The Contractor shall adjust and update course material and/or delivery methods at the direction of the WDH Vendor Contract Manager to be implemented by the next regularly scheduled course delivery. 5177 Develop and conduct initial and ongoing training for necessary CSC and State staff K-lc on how to conduct operational and ad hoc reporting. This training should include how to build simple queries and how to set up scheduled ad hoc reporting. 5178 Conduct ongoing testing to evaluate CSRs on policy and workflow knowledge. CSRs must receive a score of 85% or higher. 5179 Provide and maintain the necessary training environments to support training needs. 5180 Provide training to Contractor staff Develop training when new Agency policy is being strategy and K-7c implemented. When new Agency policy communications no and procedures are implemented, WDH later than two (2) shall train the Contractor's trainer, who full Business Day shall then train Contractor?s staff. after noti?cation of the policy change. 5181 Maintain training records via online Maintain records for access for Agency review for the full life the Contract term. of the Contract. 5182 Ensure that all new hires are equipped with the proper access to the WES and K-9c CSC systems after completion of HIPAA and within 5 days of new hire training. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 138 of 150 Require Requirement Language Performance ment Measure No. Training shall be delivered by the most effective methods possible and shall include innovative techniques for learning and sharing lessons learned. Training delivery methods shall incorporate adult learning principles and facilitate understanding and retention of materials. 5183 Ensure that all Contractor staff are trained in the relevant Federal, State K-10c laws, policies, and procedures, as well as the Contractor's operations, systems and tools, job related duties and functions, and soft skills and business etiquette. 5184 Provide staff with the necessary desk guides and tools to equip staff with the necessary information to accurately conduct CSC services. This can include, but is not limited to, quick guides, fact sheets, tips and tricks, etc. 5185 Accommodate, upon written notice from the WDH Vendor Contract Manager, occasional site visits by designated Agency staff to the facility to observe training and request feedback from Contractor staff. 5186 Provide a training report to the WDH Reports shall be Vendor Contract Manager annually and provided annually after every training session that includes, within thirty (30) days at minimum: of the annual contract effective date. a) Training courses provided; b) Number of staff who completed the training; c) The training manuals with descriptions, and summaries of actual training instructions, along with test formats and evaluation Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 139 of 150 Require Requirement Language Performance ment Measure No. methodologies to ensure training effectiveness; and d) A summary of staff evaluations and targeted trainings designed to improve staff performance. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 140 of 150 Require Requirement Language Performance ment Measure No. 5187 Follow the policies and procedures outlined in the CSC Transition System Test and Operational Readiness Test Plan and demonstrate that the tools do what they should, and does so reliably/dependably. 5188 Provide written reports on status of CSC tool testing, staff hiring and training, and risks to implementing approved changes to demonstrate progress towards organizational readiness. 5189 Deliver all documentation for CSC Operations and Maintenance. Facilitate Agency approval of all necessary documentation. Including: a) Operational Procedures Plan; b) Policy manuals and process guides for use by CSC staff; c) Business Continuity and Disaster Recovery Plan; d) Hosting Agreement; e) Subcontracting Agreements; f) Risk Plan and Risk Register; and g) Security Plan and security testing results. 5190 Ensure that dependencies on all critical components are recorded. Attachment to the Information Technology (lT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 141 of 150 Require Requirement Language Performance ment Measure No. 5191 Work with the Agency to document functional and hierarchal escalation paths. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 142 of 150 Require Requirement Language Performance ment Measure No. 519 - - Perform operaonstiand aminnteance of CSC systems throughout the life of the Contract at no additional cost to the Agency, including: a) Monitoring of daily performance of the CSC systems; b) Applying updates, patches, licenses, and repairs to components of the CSC systems including but not limited to: 1. Hardware 2. Operating systems 3. Database systems 4. Application and other software 5. Integrated 3rd party products 6. Utilities for systems, database, software, communications 7. Voice, video, data communication lines 8. Communications software 9. Drivers 10. Configurations c) Ensuring all products are licensed appropriately and used in accordance to Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 142 of 150 Require Requirement Language Performance ment Measure No. licensing agreements; d) Conducting quality management, tracking, and resolution in accordance to the Operational Procedures Plan and Contract e) Maintaining systems, databases, network, and individual user level accounts. 5193 Provide a schedule for planned patches, maintenance and system releases for the IVR, CRM, KM and other tools. Provide the Agency with any updates to the schedule for approval prior to making requested changes. Provide updates through release notes to the Agency as requested. 5194 Provide multiple layers of external and internal security that provides administrative, physical, and technical means to protect sensitive or confidential information used in performing the responsibilities and duties set forth in this RFP. 5195 Emergency/Critical Priority Issues: Multi- 0 Communication to agency outages or critical Agency outage. Agency: Thirty (30) Severe security and/or financial minutes implications to the Agency/State. Resolution or plan for resolution: One (1) Hour 0 Contractor to document emergency services and service restoration order. CSC Manager will provide Agency with updates, status reports, and notification of expected delays. Agency notification by Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 143 of 150 Require Requirement Language Performance ment Measure No. CSC Manager. Agency emergency requests require that an Agency contact be available to Contractor at all times. Updates to Agency every hour, or as Agency requests. 100% Emergency will be resolved within two (2) hours of creation or receipt 5196 Urgent Priority Issue Resolution Serious disruption to Agency business where there is no alternative or work around. Serious security and/or financial implications to the Agency/State. 0 Communication to Agency: One (1) hour 0 Resolution or plan for resolution: Four to (4) hours - CSC Designee to provide journal updates to CSC Manager. CSC Manager will provide Agency with updates, status reports, and notification of expected delays. Agency notification by CSC Manager. Updates to Agency every two (2) hours or as Agency requests. 90% Urgent Priority Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 144 of 150 Require Requirement Language Performance ment Measure N0. issues will be resolved within four (4) hours of creation or receipt. 5197 Normal Priority Issue Resolution Affects small number of users. Causes inconvenience for an Agency or delays agency business. Prevents use of a fully supported service by the Agency or individual. a Communication to Agency: Four (4) hours 0 Resolution or plan for resolution: Three (3) business days 85% of Medium Priority issues will be resolved within 7 business days of creation. 5198 Low Priority Issue Resolution Problem concerning minor items, i.e. document formatting. Prevents use of non- supported service by the Agency or individual. 0 Communication to Agency: One (1) business day 0 Resolution or plan for resolution: Five (5) business days. 85% of Low Priority Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 145 of 150 Require Requirement Language Performance ment Measure N0. issues will be resolved within 21 business days of creation or receipt. 5199 Maintain the following records for the Files shall be made associated duration: available to the Agency immediately a) Call Recordings for seven (7) years upon contract b) Training materials for three (3) years termination. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 146 of 150 Requue meth No. Requirement Language - Provide regular report on issues/defcts Performance Measure Bug-Muf?n: _nb. - 1" k1. b) 5200 and their resolutions, as defined in the QA-lc Agency-approved Operational Procedures Manual. 5201 Implement comprehensive quality management practices that shall be used throughout all phases of the Contract and include standards on timeliness, accuracy, and completeness for performance of, or reporting on, operational functions. 5202 Develop a Quality Assurance/Quality Monitoring Plan that reflects the Contractor?s experience and approach to providing high quality services and how the Contractor shall measure, report on, and ensure Service Level Agreements described in Appendix C, Performance Expectations, are met. At a minimum the plan shall address the following key components: An overview of quality assurance activities and tasks to be performed; Processes and procedures for conducting activities, including: 1. Procedures for documenting, resolving, and reporting issues and risks identified during activities; including problems that may be identified by the Agency. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 147 of 150 Require ment No. Requirement Language Performance Measure 2. Performance monitoring reviews, measures, and reports cross-project status for project management review and decision-making. c) Description of the roles and responsibilities of the Contractor, subcontractors, and the Agency in performing activities and resolving identified issues. This shall include identification of the Contractor team members and their roles and responsibilities. 5203 Monitor the quality and accuracy of all Contractor work and deliverables. 5204 Assist the Agency in program QM activities, including Medicaid Eligibility Quality Control (M EQC) Payment Error Rate Measurement (PERM) and Quality Monitoring Review requirements, as defined by the Agency. Attachment to the information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 148 of 150 Requue Inent No. 525 Requirement Language Performance Measure - 53:13:13.7. 3' 1le "5511111313"Paig??gpr Maintain CSC tools development and configuration management, and provide traceability of CSC technical and business requirements, if necessary. The Contractor shall provide designated Agency staff with an overview of the System, as well as ongoing access throughout the Contract term. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 149 of 150 Require Requirement Language Performance ment Measure N0. SECTION, 24: Additional Requirements 5206 All (100%) inbound and outbound calls shall be recorded. 5207 Maintain call recordings for seven (7) years. Call recording retrieval timeframes are as follows: a) Call recordings within three (3) months or less from the original call date shall be immediately accessible; b) Call recordings within three (3) months to eighteen (18) months from the original call date shall be accessible within one (1) business day; and c) Call recordings eighteen (18) months or longer from the original call data shall be accessible within 5 business days. 5208 Provide onsite management for all facilities maintained under the contract call center versus local in-person facility and mailroom) to provide process governance and oversight of operations within the designated CSC hours of operations. Onsite management will oversee the facility operations and carry the authority to make decisions. Onsite management shall be full-time and shall be scheduled to maintain adequate management activities during designated CSC hours of operations. Attachment to the Information Technology (IT) Contract between the State of Wyoming, Wyoming Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 150 of 150 ATTACHMENT Proposal to Provide Wyoming Department of Health Customer Service Center Prepared For The Wyoming Department of Health Division of Healthcare Financing Offeror MAXIMUS Health Services, Inc. 189] Metro Center Drive Reston, VA 20190 Technical Proposal March 25, 201 6, 2:00 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 1 of 135 TABLE OF CONTENTS Attachment to the Information Technology Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 2 of 185 318W. Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS TABLE OF CONTENTS Section Page 1. TRANSMITTAL LETTER. 2 2. EXECUTIVE SUMNIARY . . . .. . . ..4 3. BACKGROUND AND EXPERIENCE 9 3.1 Corporate Capability 9 3.2 Approach to Staffing 31 3.3 Potential Con?icts 32 3.4 Personnel Resources 33 3.5 Technical Infrastructure and Resources 36 3.6 Key Personnel 37 3.7 Subcontractors 39 3.8 Staf?ng Plan 40 3.9 Hiring Process 44 3. 10 Staff Retention 46 4. APPROACH TO . . . 48 4.1 Approach to Start-up 49 4.2 Ensuring Timely Implementation 58 4.3 Staff Training During Transition 59 4.4 Approach to Transition Requirements 63 4.5 Draft Transition Plan 65 4.6 Understanding WES and Performance Expectations 81 4.7 Managing Risk 82 4.8 Operational Readiness 84 4.9 Advantages of the MAXIMUS Transition Approach 87 5. APPROACH TO OPERATIONS . . 88 5.1 Operating the CSC 89 5.2 Handling Rules and Regulations 122 5.3 Tools and Software 130 5.4 Understanding of WES 143 5.5 Traceability of CSC Requirements 144 5.6 Ongoing Training 145 5.7 User Documentation 145 5.8 Managing Upgrades 146 5.9 Identifying Efficiencies 147 5.10 Reporting and Data Analysis 148 5.11 Possible Optimizations 152 5.12 Approach to Expanding Services 154 ATTACHMENTS Attachment A: Resource Management and Staffing Plan 157 Attachment B: Resumes. 172 Table of Contents RF 1 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 3 of 185 SECHON 1: TRANSMITTAL LETTER TRANSMITTAL LETTER Attachment to the lnfomtation Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financmg and Maximus Health Services, inc? Page 4 of 185 1' -t l. . NWlMus HELPING GOVERNMENT SERVE HEPEOPLE March 23, 2016 Mandy Gershmel, Buyer Wyoming Department of Administration and Information Procurement Section 700 W. let Street Cheyenne, Wyoming 82002 Re: 0175-A, Wyoming Department of Health Customer Service Center Dear Ms. Gershmel: MAXIMUS Health Services, Inc. submits our proposal in reSponse to the above RFP, including one original and nine paper copies (10 copies in total) of the Technical and Cost Proposals, and one electronic copy uploaded to the Public Purchasing online bidding system. Our Technical Proposal includes all required sections: Transmittal Letter, Executive Summary, Background and Experience, Approach to Start-up, Approach to Transition, Approach to Operations, and all required attachments. We will perform 100 percent of the scope of work, assuring the State of quality control over our delivery of services. MAXIMUS does not discriminate in its employment practices with regard to race, color, religion, age (except as provided by law), sex, creed, marital status, political af?liation, national origin, or disability and complies with all applicable provisions of Public Law 101-336, Americans with Disabilities Act. We have not included cost or pricing information in the Technical Proposal. We agree with all General Provisions and Sample Contract, and we have noted proposed exceptions to the provisions included in the Contract Terms and Conditions in our Executive Summary, per the Agency's instructions. We have received the following amendments to this RFP: - Amendment One, February 3, 2016, including all accompanying documents - Addendum 2, February 26, 2016, including all accompanying documents - Answers to Bidder Questions, February 26, 2016 I am authorized to commit MAXIMUS to the scope of work in this RFP. Page 2 1891 METRO CENTER DRIVE I RESTON, VA 20190 I703 251 8500 i703 25l.8240 FAX MAXIMUS COM Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 5 of 185 Ms. Mandy Gershmel - 2 March 25, 2016 For questions regarding our proposal, please contact John Crouse, Vice President, at 303.285.7168 or JohnCrouse@ maximus.com. We look forward to the opportunity to discuss our offering with the State. Sincerely Adam Polatnick Vice President and Legal Counsel Page 3 MAXIM US Attachment to the Information Technology (IT) Contract between the State of Morning. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 6 of 185 SECTION 2: EXECUTIVE SUMMARY EXECUTIVE SUMMARY Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financmg and Maximus Health Services, Inc Page 7 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 2. Executive Summary Since starting the Customer Service Center in 2012, the Wyoming Department of Health has made strides in helping citizens apply for and receive health program bene?ts. With this procurement, the Agency is now preparing the ground for the next critical phase: transforming the CSC into the single source of help for all health program clients. This will require a contractor with extensive experience in two key areas: eligibility support and contact center services. MAXIMUS is that contractor. With over two decades experience in both critical areas. no other vendor provides the national footprint in eligibility support and contract center solutions. MAXIMUS has been a trusted partner to Wyoming for a dozen years. RFP Section 7.1.1.9, page 48 Wyoming is undertaking a transformation of its Medicaid Enterprise, with Wyoming Integrated Next Generation System (WINGS) as its centerpiece. We understand and embrace the Agency's vision for WINGS and how the Department of Health Customer Service Center supports that goal. We have designed our solution speci?cally to help the Agency achieve its ambitious WINGS goals with a particular towards cost containment. The MAXIMUS approach includes current technologies that can immediately enhance CSC operations and the customer experience in a cost sensitive way towards tax payer dollars. The Agency wants a partner to help it achieve its CSC goals and vision for health insurance program modernization. This requires Medicaid eligibility 1 expertise above all else. Our quali?cations far surpass the Agency's requirements to run the CSC: I Unique expertise and lessons learned supporting 19 state eligibility support projects over 21 years, serving 70 percent of the market I Current experience touching one in every two Medicaid consumers I Currently serving more than 100 health and human services contact centers nationwide Furthermore, we are highly quali?ed to take on the desired CSC expansion to handle calls currently answered by the Fiscal Agent. We currently handle such calls in Oklahoma, Iowa, and Massachusetts. Collaboration, innovation, ?exibility, and reliability are contractor characteristics desirable as well. MAXIMUS delivers on all counts. Our Denver regional headquarters is just 90 minutes away from our proposed Cheyenne CSC location, so additional resources can easily be on site as needed. As states move to different delivery models, exploring fee for service, managed care, and Accountable Care Organizations, MAXIMUS offers experience in all of those environments. And as Governor Mead continues to explore the impact of Medicaid expansion on the State's budget and its citizens' health, the Agency needs a ?exible partner who can accommodate the additional workload of Fiscal Agent calls, and eligibility and enrollment calls and applications. MAXIMUS offers that end-to-end expertise. Quali?ed Key Personnel and Optimal Structure for Contract Execution Our key personnel, working in Cheyenne, are essential to the successful implementation and execution of the CSC. These individuals have the required expertise, background, and quali?cations to effectively execute their proposed roles. 2. Executive Summary RF 4 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 8 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS Benjamin Coss, MAXIMUS Senior Vice President, will serve as the Executive Sponsor for the project. An expert on Medicaid operations, Mr. Coss oversees the largest managed care enrollment program in the nation for California. He will ensure the Agency has access to the full range of corporate resources MAXIMUS can provide. In addition, we will have suf?cient, well-trained frontline and supervisory staff in place, retaining all interested incumbent staff for knowledge continuity. We support them in their jobs with the MAXIMUS Eligibility Playbook, our KMS, for accurate. consistent answers and processing. Our CSC Account Manager, Jeremy Morgan, will the primary point of contact to maintain communication with the Agency for activities related to contract administration. He will receive support from Mr.Coss, on contract performance and from Adam Polatnick, Vice President and Assistant Legal Counsel, regarding contract administration. Our Operations Manager, Muna Pirrin, will ensure daily compliance with all contractual operational requirements. We train all our staff to understand their individual roles in ful?lling our contract obligations, including meeting SLAs. Best Practices Based Approach Our approach supports the Agency's key business needs: I Increase effectiveness and efficiency: We drive customer usage of more ef?cient channels, such as IVR and website, to push down costs in inef?cient channels like paper documents. Such cost containment helps Wyoming make better use of taxpayer dollars. I Improve CSC training and knowledge dissemination: Our Medicaid eligibility experts help design our staff training, while the MAXIMUS Expert CSC Management CSC Account Manager Jeremy Morgan brings 15 years of Medicaid operations experience, with 7 years as a program project director in Iowa. Operations Manager Muna Pirrin served as Eligibility Manager for the MAXIMUS Colorado Medicaid project. She has 10 years of experience with customer support operations. Mailroom Lead Michelle Munoz delivers proven experience and capabilities achieved during more than 10 years management of mailroom operations. Consulting Policy Analyst Jan Ruff offers more than 30 years of experience in government health policy, planning, and administration, specializing in Medicaid, CHIP, and Health Insurance Exchanges. Eligibility Playbook is the online reference tool staff need to stay up to date with every policy or process change. I Improve reporting capabilities: MAXIMUS DecisionPoint for Business Intelligence, available to Agency staff via smartphone and other mobile devices, puts actionable information at the Agency?s ?ngertips for better CMS compliance. We deliver the best functionality to support customers and CSC operations through numerous tools, leveraging current technologies so that the Agency and customers enjoy the resulting bene?ts faster. Our proposed Salesforce solution is uniquely positioned to close the gap between administration and citizens by way of its cloud implementation model, which removes the complexities of traditional enterprise software. Additionally, the solution will enable the Agency to drive cost containment measures by integrating with existing technologies to deliver power?il technology solutions bene?tting employees, citizens, primary care providers, and many other constituents. The proposed solution leverages best of breed apps provided by Cisco, Glance, 2. Executive Summary P23001.0060 March 25, 2016 RFP 5 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 9 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS InGenius, and Cirrus Insights delivered on the powerful Salesforce platform to enhance customer capabilities, while enabling the Agency to increase vendor diversity and options. This solution puts Wyoming on the cutting edge of modern technology assets which provide an immediate impact to consumer satisfaction and budgetary concerns. You do not have to wait weeks, months, or years to leverage private sector ef?ciencies that you purchase. Key features of our leveraged technology for CSC support include: I Salesforce CRM: We track all customer contacts and provide detailed reporting to the Agency using this leading solution for contact centers. Salesforce's powerful analytics engine delivers key performance metrics quickly, while the Salesforce cloud-based solution is certi?ed for assurance of data security. I Advanced Telephony and IVR: The Cisco Uni?ed Contact Center Enterprise telecommunications platform supports best-in-class contact center applications and reporting through the ACD and IVR. Telstrat call recording supports quality control and staff coaching. Our IVR will let applicants and clients self-serve at any time, 24/7, with recorded answers to frequently asked questions. Messaging about how to use the WES-provided website will help the Agency increase online applications for faster eligibility determinations. I Salesforce KMS: The MAXIMUS Eligibility Playbook, our Knowledge Management tool, gives CSRs instant access to the information, forms, and call scripts they need to answer questions accurately and consistently. We build it on the Salesforce platform, for ease of use I Web Chat and Co-browsing: With more communication channels, customers have greater choice in contacting the CSC. Younger clients especially like web chat sessions instead of calls. Our CSRs can deliver a richer consumer experience by conducting a simultaneous co- browse session where the CSR and the customer can ?ll out online applications together, ?eld by ?eld. I Email and Fax: Outgoing email campaigns quickly remind clients of appointments and the need to send in missing info. This increases CSC ef?ciency by preempting common call types, such as getting case status or con?rming we received a document. I MAXIMUS DecisionPoint for Business Intelligence: Dashboards and reporting draw from our telephony and CRM so we can analyze trends and performance against SLAs. Access to this data enables us to maintain an ef?cient customer service unit that, in turn, enables us to achieve our service level goals and handle a greater number of customer calls. Cost Effectiveness through Increased Efficiencies MAXIMUS offers features that increase customer choice and convenience, driving self-service and lower costs, including web chat and website co-browsing. We propose that the Agency, through its WES website contractor, add a simple web chat button that links to our CSRs. We have found that younger clients who often prefer texting to calling appreciate the ease of web chat. To help the Agency reach its goal of having 25 percent of applications completed online, we will implement co-browsing, in which our CSR can simultaneously view the same online application screen as the client. This will help applicants navigate the website as they complete application forms, making the entire process faster and easier for customers. 2. Executive Summary RF 6 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 10 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS A Drive Down Costs Wyoming Paper Fax/?ail Phone In Person Department 0 of Health 0. eb Chat Email uespstem. n} o.gm Increase Usage We care about clients' feedback about our service, so we offer them two options: automated surveys conducted every call, plus links in emails and notices to a Survey Monkey website, to give us comments about our service delivery in other channels, such as in-person or email. Partnering with Wyoming and its WES Contractor MAXIMUS is highly quali?ed as a partner for Wyoming and its WES contractor due to our experience with every major system vendor. We operate call centers with every one of the major eligibility system vendors, including Accenture and Deloitte, so we are familiar with making sure our operational approach aligns with our clients? systems approach. We are also quali?ed due to our health IT consulting experience. Whether states are seeking sources of funding, studying how to incorporate electronic health records, planning a Regional Health lnfonnation Organization, or planning for the implementation of a statewide-designated entity data clearinghouse, MAXIMUS assists by applying proven tools and taking advantage of leading technologies to gain new ef?ciencies and enhancements for state government programs. Our expertise gives us the deep understanding of health-program management systems needed for effective coordination with the Agency's WES contractor. Because the Agency may be transitioning the CSC and WES to new contractors at the same time, by October 1, 2016, collaboration between the vendors is critical. Afterward, MAXIMUS will continue working closely with the WES contractor and the Agency to look for more ways to enhance services for clients. Proposed Exceptions In accordance with the instructions at RFP Section 7.1.1 .8.4, MAXIMU request the opportunity to discuss and resolve the following exceptions and clari?cations to Sample Contract Terms and Conditions after tentative contract award. MAXHVIUS does not condition its proposal on the State's acceptance of the precise language stated below. MAXIMUS hopes to negotiate mutually acceptable ?nal terms for inclusion in the contract. 1. MAXIMUS requests the inclusion of a limitation of liability provision similar to the following. 2. Executive Summary RFP 7 P23001.0060 March 25, 2016 Attachment to the information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 11 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS CONTRACTOR WILL NOT BE LLABLE TO THE STATE FOR ANY LOST DATA, LOST PROFITS, OR INCIDENTAL, CONSEQUENTIAL, PUNITIVE, SPECIAL, OR OTHER INDIRECT DAMAGES OF ANY KIND FOR ANY REASON WHATSOEVER INCLUDING, BUT NOT LIMITED TO, DAMAGES BASED UPON, CONTRACT, WARRANTY, TORT, NEGLIGENCE, STRICT LIABILITY, OR ANY OTHER THEORY EVEN IF CONTRACTOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Contractor's total liability hereunder for damages, regardless of the form of action, will not exceed the total amount actually paid or payable to Contractor under this Contract in the Contractor year in which the events giving rise to the liability ?rst occur. 2. A number of the terms in the Sample Contract do not appear to apply to this RFP. MAXIMU REQUESTS the opportunity to negotiate deletion of terms that are not applicable to the scope of work and responsibilities. 3. As a clari?cation, MAXIMUS assumes that performance measurements will not include delays, interruptions, or fault attributable to events of force majeure as de?ned in the Sample Contract Section 8; (ii) delays or interruptions caused by the State, its employees, agents, vendors, or other contractors; or planned outages or downtime for maintenance, repairs, upgrades, and similar circumstances. 4. In the case of a termination for cause, MAXIMUS requests written notice of the breach or default and at least 30 days opportunity to cure after the party in breach or default receives the notice. 5. In the case of a termination, MAXIMUS would like to discuss terms providing for the reasonable recovery of unamortized startup costs. 6. MAXIMUS assumes that the State shall provide an equitable adjustment in price, schedule, and other affected terms as a result of any agreed change order, or as a result of a delay or interference by the State. Changes include change in laws, regulations, processes or procedures that affect the cost, time, or other material factors for performance of the work. 7. MAXIMUS requests the opportunity to discuss a limited indemni?cation that covers bodily injury and damage to property caused by MAXIMUS, infringement, and violations of law by MAXIMUS. 2. Executive Summary RFP 8 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 12 of 185 SECTION 3: BACKGROUND AND EXPERIENCE BACKGROUND AND EXPERIENCE Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department or Health. Division of Healthcare Financmg and Maximus Health Servrces. Inc. Page 13 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 3. Proposer's Background and Experience Wyoming citizens will ?nd that, with MAXIMUS, they will receive not only excellent customer service, but staff who understand the complexities of Medicaid and CHIP, and are trained to provide accurate, consistent answers. Our years of experience operating state eligibility support projects have helped us identify best practices that our clients ?nd bene?cial as they work to transform the way they serve Medicaid customers. RFP Section 7.1.1.10. page 48 - The Division of Healthcare Financing (Agency) will 9 ?ag? bene?t from our focus on delivering high-quality health . and human service operations on behalf of our state MAXIMUS presents: partners. MAXIMU offers more than resumes we . Unique expertise and lessons offer relationships and a familiarity with state agency learned supporting 19 state processes substantiated by real experience. eligibility support projects 3.1 Corporate Capability 0 Current experience touching one RFP Section 7.1.1.1o.1. page 49 in every two Medicaid The Agency stays closely in touch with its citizens and consumers the technologies that support the public services they . 9 years delivering Eligibility receive. This familiarity enhances the need for a vendor Support Services for Texas, the to expertly deliver eligibility support and contact center largest program in the country services in an environment that easily accommodates . 4 references with combined transformation and change. MAXIMUS brings best experience of 35 years, practices developed from operatmg contracts w1th over demonstrating long-term state 1,300 US. government chents in all 50 states and the District of Columbia. In each of these contracts, we help citizens and agencies navigate the challenges inherent in health and human services programs. In the contact centers that we currently operate, we handled more than 49 million calls in FY2015. Fourteen MAXIMUS projects have earned the "Certi?ed Center of Excellence" designation from BenchmarkPortal, a global leader in call center certi?cation, in collaboration with the Center for Customer~Driven Quality (CCDQ) at Purdue Research Park. Certi?ed Center of Excellence ranks among the top 10 percent of the 20,000 call centers evaluated by the CCDQ. With experience encompassing eligibility support, customer service call centers, integration of multiple programs into a single operation, child support services, workforce services, and providing innovations in service delivery in all programs, we understand the needs of the state governments and the people that we serve. partnerships MAXIMUS has thrived in the complex and changing environment of customer service centers for government programs since 1995. Currently operating more than 100 customer service centers, we are adept at providing prompt, effective support to public sector clients with diverse requirements, populations, and challenges. With the focus we place on quality, our call center operations provide appropriate, complete information that anticipates caller concerns, and our staff use tools to ensure that every caller receives consistent answers to their questions. Our empathic approach to service does not bind agents to scripts or timed tasks but rather encourages discussion and understanding leading to genuine ?rst call resolution. This makes for a more 3. Proposer's Background and Experience RF 9 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of VWoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 14 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS meaningful consumer interaction where bene?ciaries leave satis?ed. We focus on local hiring, providing staff drawn from and responsive to the communities we serve. Our nationwide service delivery centers routinely entail operational and administrative requirements comparable to those of the Wyoming Department of Health Customer Service Center (CSC) contract, including: I Customer?focused services that provide accurate, timely, and courteous assistance in facilitating eligibility determination to answer all inquiries from participants and other interested parties I Recruitment methods that identify job candidates most likely to represent a good ?t for our customer service centers and application support operations, combined with thorough new- hire and refresher training to support high-quality customer service I E?ective processing methods to facilitate eligibility determination support services and ensure cost containment I Expanded services to bene?ciaries that vary widely in service needs including aged, blind, and disabled populations I In?house capacity to meet the demand of Spanish-language callers as well as information in languages most prevalent in bene?ciary communities, including Language Line services I E?ective coordination with client staff, other vendors, and program stakeholders to further client objectives In our largest eligibility support service contract, a recent Texas Quality Assurance Report found that MAXIMUS call center staff achieved a quality score of 97.7 percent for providing accurate program information to callers about their bene?ts, services, or case status. They also achieved a quality score of 99 percent for taking appropriate action related to the purpose of the call. Our expertise in call center operations assures the Agency that we will maintain the high quality and accuracy service levels, for both day-to-day operations and the implementation of future initiatives. 3.1.1 Meeting Mandatory Minimum Requirements RFP Section 7.1.1.10.1.1, page 49, SOW Appendix A, 5000. 5001 Wyoming customers deserve excellent, consistent service from a contractor that understands the Medicaid system, and the needs of the people who use its services. We understand the best and most ef?cient way to run a customer service center, as our experience demonstrates. Our strong history includes integrating multiple programs into one-stop centers to provide the most effective, customer-friendly experience for applicants and clients, and helping consumers learn the quickest ways to help themselves using multiple channels of communication. We apply the latest technology, infrastructure, and business practices to our call center operations so that our government clients are assured of quality service delivery, scalability of operations, and the ?exibility to address changing program dynamics, requirements, and ?uctuations in call volumes andior work transactions. Our government clients have trusted in our ability to serve their citizens and view us as a partner in helping them meet their program objectives. We understand that we are the public face of the Agency. We take that charge seriously and our high satisfaction scores, with an average of 98.4 percent of our government clients reporting "excellent" or "above average" across nine of our government health projects 3. Proposer's Background and Experience RF 10 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 15 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS that conduct post-call surveys, demonstrate the effectiveness of our efforts to deliver high quality service. We recognize the human factor of the services we provide and understand the need for our staff to be more than just a voice on the phone. The information we provide to clients and applicants affects their livelihood and the well-being of their families, and it is essential that our staff have an ingrained understanding of the spectrum of services available to clients and the interconnection of service eligibility throughout the lifecycle of their use. A commitment to helping Wyoming families is at the very core of our operational philosophy and it is extended to the processes we have in place to respond to and resolve client inquiries. 3.1.1.1 Experience Operating Health Eligibility Customer Service Centers RFP Appendix A, 5000 Far exceeding the Agency's minimum requirements, MAXIMUS has 21 years of experience operating health insurance eligibility programs for multiple states, and 25 years of experience operating large call centers dedicated to health and human services operations and clients, with over 100 combined years of experience operating health insurance eligibility program CSCs. Our experience includes speci?c experience helping customers through the process of applying for Medicaid and CHIP. Since 2010, MAXIMUS has played a critical role in the practical implementation of the Affordable Care Act (ACA) at the state level. In Connecticut, the District of Columbia, Hawaii, Maryland, New York, and Vermont, we established call centers to support the newly formed state-based health insurance exchange market places. Our exchange call center operations have helped more than one million individuals obtain eligibility for and enroll in affordable health plans. 3.1.1.2 Experience Operating Statewide Call Centers RFP Appendix A. 5001 MAXIMUS operates more than 100 contracts with contact centers, as shown in Exhibit 3.1-1. 3. Proposer's Background and Experience RF #0175-Al ll P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Viiyorning, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 16 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS Contracts with Contact Center bert ices Provinces) 5 British ulninbm 1 Ontario 1 Pnnee Eduard Island I. titted States (37 States ILL.) 1 Arkansas 2 Kansas 1 0an 1 Arizona 3 Lou1sntna 1 Oklahoma 7 California 4 Maryland 1 Oregon 4 Colorado I 3 Perms) haunt 1 Connecticut 3 Michigan 3 1 Delaware 3 h-linnesntn 7 Tennessee I Dismct of 3 Mtssotui 4 Texas I Honda 1 Nebraska 1 Vermont (l .5.) 4 Georgia 1 New Hattipslutc 2 Vugunu l-edeml Marketplace (.?ustmner Contact Center ilawut?i 3 New Jersey 2 West Virginia: Federal Marketplace Eligibility Appeals (2 locations) . I .. I-edcml Servrecs Health Appeals (6 locations) 3 New Mexico 1 lax tinploychm'tees 2 3 New York 1 Wyoming ticket to Work Program 3 Iowa 3 North Carolina Exhibit 3.1-1: Our Contracts with Contact Center Services. MAXIM US has extensive experience in operating 100+ contact centers, gained from contracts throughout the United States and Canada, including a contact center in support of the Wyoming New Hire Reporting Program. We have been involved with Medicaid managed care programs since the earliest days of the program. MAXIMUS eligibility-related projects: I Entail a wide range of government programs including Medicaid, Children's Health Insurance Plan (CHIP), Temporary Assistance to Needy Families (TANF), and Supplemental Nutrition Assistance Program (SNAP) Serve a broad range of populations that span from fewer than 50,000 to more than four million individuals I Highlight re-awards for successful services as demonstrated by contract durations up to two decades 3.1.2 Experience with Scope of Work RFP Section 7.1.1 .10.1 .2, page 49 MAXIMU has the quali?cations that make us the high quality, low-risk option for the Agency, including: I Experience providing eligibility support services I Experience operating customer service centers I Corporate commitment to quality I Flexibility to respond to changing client needs 3. Proposer's Background and Experience RF #0175-Al 12 P23001.0060 March 25, 2016 Attachment to the lnfonnation Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 17 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center I Long-term government client relationships Experience Providing Eligibility Support Services Our experience providing eligibility support services gives us a wealth of best practices and lessons learned. For the CSC, we can leverage the most current technologies to bene?t customers right away, rather than taking years to build untested systems from scratch. Our expertise is based on day-to-day operational processes that support clear and fair eligibility decisions for clients. MAXIMU provides the core operational support to prepare applications for submission to states for eligibility determination. Exhibit 3.1-2 demonstrates our strength in the marketplace, which supports our expertise. Exhibit 3.1-3 shows our breadth of experience in delivering services similar and complementary to those required in this procurement. Our understanding of the needs of customers as well as providers, which we will share with Wyoming, has enabled us to develop MAXIMUS MAXIMUS Market Share of Medicaid Managed Care I MAXIMUS 59% I 13% Xerox 4% I HP 1% I Medicaid Enroll No Vendor 24% MAXIMUS Market Share of CHIP I MAXIMUS 26% . Xerox 5% I NH Kids No Vendor 69% IS-PZIMI 0007-29 Exhibit 3.1-2: MAXIMUS Market Share of Medicaid and CHIP Support Services. MAXIMUS is the market leader in providing eligibiliOI-related government programs that are similar in scope and complexity to Wyoming's CSC. processes and systems that simplify the eligibility support experience for both stakeholders. Projects Medicaid Enrollment Broker and Provincial Administrator Projects California Health Care Options HealthColorado District of Columbia Enrollment Broker Georgia Families Health Insurance British Columbia Client Enrollment Services Indiana Enrollment Broker Services Iowa Member Services 3. Proposer's Background and Experience P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning. Department of Health. Division of Healthcare Financing RFP #0175-Al l3 and Maximus Health Services, Inc. Page 18 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS (I 'Iioicc Counseling ?rcmium Collection . :5.4 Eligibility Processin [in and "or and Rene? :ils Education Louisiana Bayou Health Maryland Medicaid Enrollment Broker MassHealth Customer Services Michigan ENROLLS New York Medicaid CHOICE New York Health Options Enrollment Center Oklahoma SoonerCare Call Center Enrollment Assistance Program South Carolina Healthy Connections Choices Texas Enrollment Broker Services/Health Steps Vermont Green Mountain Care Customer Support Center Virginia Enrollment Broker and Education Services West Virginia Enrollment Brokering Services CHIP, Eligibility Support Projects, and Long-Term Care Projects California Healthy Families Program Colorado Eligibility and Enrollment for Medical Assistance Programs Florida Healthy Kids Georgia PeachCare for Kids Illinois Enhanced Eligibility Veri?cation Iowa hawk-i Kansas KanCare Clearinghouse Michigan Independent Enrollment Broker Tennessee CoverKids Texas CHIP/Eligibility Support Services Affordable Care Act Related Projects AccessHealth Connecticut Health Insurance Exchange District of Columbia Health Link Health Insurance Exchange Hawaii Health Connector Health Insurance Exchange Maryland Health Connection Health Insurance Exchange New York State of Health, Health Insurance Exchange Vermont Health Connect Health Insurance Exchange West Virginia In-Person Assistor Program Exhibit 3.1-3: MAXIMUS Experience Encompasses All Wyoming Requirements. With experience operating dozens of projects that provide customer service, eligibility, and other Medicaid/CHIP-related functions, MAXIMUS understands the big picture of eligibility support services. and has developed best practices in all areas that impact customers and providers and will bene?t Wyoming clients. 3. Proposer's Background and Experience RF 14 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 19 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center The Agency can rely on our strong performance to proactively support improvements and self- service models. Experience Operating Customer Service Centers MAXIMUS approach to customer service combines the right people, processes, and technology to give customers multi-channel access to one front door for account information. Our approach begins with knowledgeable, customer-friendly staff that will serve customers quickly and effectively, and that are trained to serve as we would want to be served. We complement staff with technology, designed by national experts, to route callers to the right resource to resolve issues quickly or provide self-serve access day or nights. Exhibit 3.1-4 shows our experience operating customer service call centers for Medicaid and CHIP customers. (all Volume in 2014 Program Population Purpose Linc Project Name California Health Care Options Medicaid Customer Service 1,490,687 1 1,553,000 Colorado EEMAP CHIP Customer Service 504,023 1,286,318 DC Enrollment Broker Medicaid Customer Service 94,470 261,000 Florida Healthy Kids CHIP Customer Service 2,388,085 3,580,000 Georgia Families Medicaid Customer Service 577,509 1,741,000 Georgia PeachCare for Kids CHIP Customer Service 590,293 1,044,000 Illinois Client Enrollment Services Medicaid Customer Service 1.246,399 1,400,000 Indiana Enrollment Broker Services Medicaid Customer Service 438,218 1,425,000 Iowa hawk?i CHIP Customer Service 97,749 64,000 Iowa Member Services Medicaid Customer Service 385,530 609,000 Kansas KanCare Clearinghouse CHIP Customer Service 219,190 348,973 Louisiana Bayou Health Medicaid Customer Service 161,074 1,079,000 Maryland Medicaid Enrollment Medicaid Customer Service 170,055 1,144,000 Broker MassHealth Customer Services Medicaid Customer Service 2,350,726 1,631,000 Michigan Medicaid/CHIP Customer 1,509,698 2,288,000 Service New York Medicaid CHOICE Medicaid Customer Service 1,008,000 6,758,000 New York Health Options Enrollment Center Medicaid Customer Service 3,506,714 4,606,000 Oklahoma SoonerCare Call Center Medicaid Customer Service 1,080,000 796,000 Enrollment Assistance Program Medicaid Customer Service 338,051 2,721,000 South Carolina Healthy Connections Choices Medicaid Customer Service 237,684 937,533 Tennessee CoverKids CHIP Customer Service 82,000 106,000 Texas CHIP/Eligibility Support Services CHIP Customer Service 7,594,101 4,684,783 Virginia Enrollment Broker and Education Services Medicaid Customer Service 230,610 956,600 Exhibit 3.1-4: MAXIM US Contact Center Experience. Having handled millions of calls ?om Medicaid and CHIP customers, our sta? understands the kind of support they need and how to best communicate with them to achieve the highest satisfaction levels for the Wyoming CSC. Our considerable experience in operating child support and human services programs across the nation is the basis for our Wyoming CSC program design that will provide customers with accurate and complete information and knowledgeable, sensitive support. This commitment to 3. Proposer?s Background and Experience P23001.0060 March 25, 2016 and Maximus Health Services. Inc. Page 20 of 185 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS excellent customer service translates into lasting partnerships and positive experiences for states and their program participants. Corporate Commitment to Quality Our commitment to quality and performance improvement directly aligns with the needs and policy imperatives of our government clients. Our projects in the United States and around the world entail a critical responsibility to help our government clients uphold the trust placed in them to provide services that affect citizen health and well-being. While commercial contact centers cycle consumers through as quickly as possible to comply with a metrics-driven management approach, our commitment to quality ensures there are quality control points along the performance pathway to position us to rapidly respond to any issues. In keeping with this commitment, we support our clients' quality goals through efforts that emphasize promoting, reinforcing, and acknowledging quality management activities throughout every area. Our QA program embodies our comprehensive solution for complying with contractual key performance requirements, meeting or exceeding quality standards, and maintaining a system of continual monitoring and improvement. Our program employs a three- tiered review process that includes: I Individual self-checks by front line staff as they perform their work I Proactive case and call monitoring reviews of work in progress by our on-site QC team I Quarterly retrospective QA reviews of randomly sampled cases and calls In addition to project-level QA activities, it is a company best practice to have our Of?ce of Quality and Risk Management (QRM) conduct periodic quality reviews to verify our compliance with corporate and project standards and to identify existing or potential operational issues. Another quality best practice is to have external professional organizations that establish and certify quality management standards review our operations to identify error trends that can help to prevent future de?ciencies and point to areas where focused training or corrective action might be needed at the individual or team level. Flexibility to Respond to Changing Client Needs To support our clients? vision and dynamic governmental climate, MAXIMUS has demonstrated the ability to reliably deliver consistent work products while maintaining the ?exibility to adapt to new and unexpected circumstances. We know from direct 7, experience that CSC projects constantly change to better serve their constituent population. We have met and resolved service challenges during times of programmatic, process, and systems Benchmark ihrul Q, a change. MAXIM US promotes a culture of excellen ce. MAXIMUS has operated health services projects over multiple Fourteen ofour projects contract terms and in some cases since program inception, earned designation as a allowing us to support clients through a variety of changes and "Certi?ed Center of expansions. Exhibit 3.1-5 summarizes some of these program Excellence" through the expansions and population changes for two of our longest-term Purdue University clients, the states of New York and Vermont. Center for Customer- driven Quality. 3. Proposer's Background and Experience RFP 16 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 21 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS .\eu \ork Medicaid CHOICE MC) I998 - Present . Managed extensive changes in scope and growth . Implemented Managed LongTerm Care (MLTC) program for dual eligbles - Implemented Fully Integrated Duals Advantage (FIDA) program to unity funding streams and service delivery - Integrated new services previously handled at the county level in rural areas 2015 Dual eligible expansion 2014 Expanded MLTC services to in-home clinical eligibility assessments 2008 Expanded 881 program to 10 cormties 2007 Expanded to neighboring counties and upstate areas 2005 Implemented mandatory 881 program 2003 Added the HIV Special Needs Program Vermont Green Mountain (are [996 - Present . Managed multiple changes in scope and volumes increase, up to 69% during start?up - Added customer service for Medicaid and health care insurance/pharmacy programs - Provided managed care enrollment for aged, blind, and disabled (ABD) population - Implemented changes in federal regulations (Medicare Part D, HIPAA, guidelines veri?cation) 2013 Established Vermont Health Connect (Vermont?s Health Insurance Exchange) 2007 Added new program to cover uninsured adults and a premium assistance program to support universal coverage 1998 Expanded operations to assume customer service for all Vermont health care insurance programs 1998 Began managed care enrollment for ABD pepuiation 15P21 001 0027-17 Exhibit 3.1-5: Representative Examples of Supporting Change. MAXIMUS has supported our state clients in managing change, new policy requirements, and e??iciencies. Wyoming can be assured that MAXIM US will apply the lessons learned from managing change on other large customer service center programs to CSC operations. Long-term Client Relationships Wyoming is offering an eight-year contract for the CSC, so it is important that the Agency select a contractor it can work with for the long-term. We offer a record of con?ict-free service delivery and performance integrity, attested to by numerous health services contracts of long standing, as shown in Exhibit 3.1-6. MAXIMUS performance has earned client con?dence as demonstrated by continual re-awards. Our in-depth understanding of the complexities of customer service centers is evidenced by the number of similar projects that MAXIMUS has been awarded. This list includes two of the contracts we cite as references: the Virginia Enrollment Broker Services and Iowa Medicaid Member Services projects, both of which have been continually re-awarded over 10-year tenures. 3. Proposer's Background and Experience P23001.0060 March 25, 2016 RFP #0175-Al 17 Attachment to the information Technology (lT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, inc. Page 22 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS l6-P23Ml.0060-l3 Exhibit 3.1-6: Long-term Partnerships. As the nation 's leading provider of customer service for health and human service programs, MAXIM US has served many states for nearly two decades. Project Highlight: Texas Eligibility Support Services In 2007, Texas awarded us a contract for the Eligibility Support Services (ESS) project in an emergency in order to stabilize and improve performance. We were previously working as a subcontractor to the prime contractor Texas Access Alliance (TAA). As the new prime contractor, we were required to hire as many quali?ed employees from TAA as possible to maximize service continuity. Approximately 500 employees transferred to us simultaneously. The challenges we faced included the administrative complexity of handling a large staff transition, dealing with staff on different terms and conditions, calculating bene?ts, and ensuring that each staff member was included in the payroll system. We needed to motivate staff to continue to perform above expectations, particularly in a difficult situation in which their previous employer was no longer delivering the service. Since then, ESS has become a successful partnership between MAXIMUS and the Texas Health and Human Services Commission (HHSC) with the goal of achieving an ef?cient, effective, and comprehensive health and human services system for Texans. The ESS project ?illy integrates health and human services programs, including Medicaid, CI-IIP, TANF, and SNAP, into one eligibility and enrollment ecosystem. As such, the project provides a one-stop shop for consumers looking to inquire about these services. Serving a population of more than 3 million active cases, MAXIMUS handles an average of nearly 600,000 calls per month. 3. Proposer's Background and Experience RF l8 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 23 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS At its core, the E83 contract is about supporting consumers through application support and contact center services. Our eligibility support call center has handled 39 million consumer calls and processed more than 42 million documents since project inception. Our call centers are staffed by customer care representatives who assist customers needing to be screened for programs, ?le applications, report changes, or request their case status. Clients also complete applications and re-certi?cations, submit bene?ts, and verify documentation by mail, through our dedicated website, or fax. Mail and fax information is imaged, linked to the appropriate case record and routed electronically by MAXIMU to HHSC staff for further processing. Eligibility support employees link images to new or existing cases, and process intake applications, re- determinations, veri?cation documents, change reports, and client correspondence. 3.1.3 Of?ce Location RFP Section 7.1 .1.1o.1.3, page 49, sow Appendix A. 5033, 5084. 5035 As shown in Exhibit 3.1-7, we have identi?ed several possible sites for the upon contract award, we will obtain Agency approval on our ?nal choice and build out the facility. We will continue to work with the sites we have selected so that we have acceptable lease terms and are ready to execute a lease upon Agency approval of our recommended site. We plan to have two options for the Agency to review and approve upon notice of contract award. Potential Locatiom in (he) )nlning Its-P2300] 0060-07 Exhibit 3.1-7: CSC Location. To access the best pool of potential sta? and o?er a cost-efective solution for Wyoming. we propose to locate the CSC in Cheyenne and perform all activities there. MAXIMUS looks for project space that re?ects how we do business. It must be spacious enough to comfortably accommodate staff and operations, yet structured enough to foster a collaborative work environment. For example, we use an open floor plan with lower cube walls in our call centers, which let Customer Service Representatives (CSRs) get a Supervisor's attention when they need assistance. Our facility will fully support the handling of customer service calls and serving walk-in clients with suf?cient space for all of our CSRs. We will also provide adequate meeting space as needed. 3. Proposer's Background and Experience RFP l9 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 24 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS In choosing a site and con?guring facilities for the CSC, we consider several criteria: I Convenience. Locating the of?ce for the maximum convenience of all stakeholders is of prime importance. We will have parking for staff and visitors, and the facility will be handicapped-accessible. Our proposed locations are convenient to public transportation. I Security. To provide maximum protection for the sensitive data handled in the of?ce and comply with all federal and State security and con?dentiality requirements, we take appropriate security measures, including locked doors on the facility, badge access for all staff, and sign-ins for visitors. I Comfort. We provide a professional and comfortable setting for our staff, which includes a conference room, training room, client interview rooms, work areas, a break room, a mailroom, and all necessary equipment. We will use our shared services of?ce in Denver, only 90 minutes from Cheyenne, for workload over?ow. Located at 4500 Cherry Creek South Drive in Glendale, this of?ce is just a few miles from our regional headquarters, which are at 1515 Wynkoop Street in downtown Denver. Some staff, such as the Consulting Policy Analyst, may work in the Denver of?ces from time to time. MAXIMUS has its global headquarters at 1891 Metro Center Drive in Reston, Virginia. Corporate resources, including human capital management, accounting, IT, privacy, and security, work in both our Denver and Reston of?ces; they are easily accessible to our CSC project staff. 3.1.4 Contact Person RFP Section 7.1 .1.10.1 .4, page 49 The person who will sign the contract is Adam Polatnick, Vice President Legal Counsel. His phone number is 703-234-3215. 3.1.5 Description of Organization RFP Section 7.1 .1.10.1 .5, page 49 Established in 2007, MAXIMUS Health Services, Inc. is a wholly owned subsidiary of MAXIMUS, Inc., which was incorporated in 1975 and whose stock is publicly traded on the New York Stock Exchange (MMS). Today, MAXIMUS is a team of 18,000 dedicated professionals across the United States, Canada, Australia, the United Kingdom, and Saudi Arabia. Everywhere we serve, we help foster economic development in the community by staf?ng our operations with local employees. Our diverse team helps to eliminate barriers and reduce disparities to match customers with the services they need. In 2014, MAXIMUS was rated one of America's 100 Most Trustworthy Companies by Ratings, a provider of research and ratings on environmental, social, governance and accounting-related risks affecting the performance of public companies. Our mission remains "Helping Government Serve the People? For 40 years, MAXIMU has partnered with federal, state, and local governments to make public health insurance programs run effectively for the individuals and families they serve. We provide complete solutions, making large, complex systems and programs run smoothly. We support communities and reach out to individuals, helping them get the services they need to improve health outcomes, and provide the following services, among others: I Eligibility and Enrollment Modernization: Helping states create a simpli?ed path to health care coverage 3. Proposer's Background and Experience RFP 20 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 25 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I Medicaid Expansion: Providing states with effective ways to reach and enroll Medicaid bene?ciaries through convenient and comprehensive customer support I Comprehensive CHIP Services: Streamlining processing, improving quality, promoting education, and providing more ef?cient, effective health bene?ts services to CHIP families I Long-term Care: Helping states meet the needs of vulnerable populations through effective and ef?cient long-term care programs I Dual Eligibles: Coordinated solutions to improve quality~of-care and reduce redundancies I Health Insurance Exchanges: Helping states expand health insurance coverage through our exchange solutions I Center for Health Literacy: Helping those with educational, cultural, or linguistic barriers understand and use important information related to government programs I Health IT Consulting: Creating more ef?cient health programs with state-of-the-art technology 3.1.6 List of Contracts RFP Section 7.1.1.1015, page 49 Exhibit 3.1-8 highlights contracts in which we provide comparable services including call centers, workforce management, complex reporting, and document processing. None of these contracts were terminated for convenience or default, or cancelled or otherwise ended before the expiration dateBritish Columbia Health Insurance Provincial Administrator California Health Care Options California Healthy Families (CHIP) California Pre-Existing Condition Insurance Plan Colorado Eligibility and Enrollment for Medical Assistance Programs (State-based Health insurance Exchange) Connecticut Health Insurance Exchange (Call Center) District of Columbia Health Bene?t Exchange Authority District of Columbia Enrollment Broker (Call Center) Georgia Families Federal Eligibility Appeals Project Federal Health Contact Center HealthColorado Illinois Client Enrollment Services Illinois Enhanced Eligibility Veri?cation (Medicaid/CHIP) lndiana Enrollment Broker Services Iowa hawk-I (CHIP) Iowa Medicaid Member Services Kansas KanCare Clearinghouse Medicaid/CHIP Contact Center Louisiana Bayou Health 3. Proposer's Background and Experience RF 21 .0060 March 25, 2016 Attachment to the information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. inc. Page 26 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS :3 5 a 5 Maryland Health Insurance Exchange (Call Center) Maryland Medicaid Enrollment Broker Program Massachusetts MassHealth Customer Services Michigan ENROLLS New York Health Options Enrollment Center (Medicaid/CHIP Eligibility) New York Pre-Existing Condition Insurance Plan New York Health Insurance Exchange Contact Center Oklahoma SoonerCare Call Center Enrollment Assistance Program Independent Enrollment Broker Medicaid Waiver Enrollment Services South Carolina Healthy Connections (Medicaid) Tennessee CoverKids (CHIP) Texas Eligibility Support Services Texas Enrollment Broker Services Vermont Green Mountain Care Member Services (Medicaid/CHIP) Vermont Health Insurance Exchange (Call Center) Virginia Enrollment Broker Services Exhibit 3.1?8: Related MAXIM US Contracts in Last Three Years. We provide relevant services across many contracts, o?ering continuous access to lessons learned, efficiencies. and innovations. In addition, MAXIMUS holds a number of contracts with the State of Wyoming, as seen in Exhibit 3.1-9. \ame Department Dales Wyoming CRIS Wyoming Department of Enterprise Technology Services 09/01/08 06i30i 16 State West Wyoming Department of Insurance 07/16/10 06/30/17 Wyoming New Hire Wyoming Department of Family Services 01/01/04 O6i'30t16 Reporting Program WY State IT Rate Wyoming Department of Administration and Information 04/26/13 01/31/16 Management Wyoming 1T Rate Wyoming Department of Administration and Information 08/01/09 01/31/13 Management Wyoming CHIP PERM Wyoming Department of Health 09/01/08 03/15/11 Wyoming State East Wyoming Department of Insurance 07/16/10 09/30/11 University of Wyoming University of Wyoming 02/01/09 08/31/10 Finance Accounting Exhibit 3.1-9: MAXIM US Contracts with the State of Wyoming in Recent Years. MAXIM US o?ers experience working with the Wyoming Department of Health and other state agencies. 3. Proposer's Background and Experience RF 22 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 27 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Over the years MAXIMUS has also worked with many private businesses throughout Wyoming, such as McDonald's, to help them secure Work Opportunity Tax Credits for hiring individuals participating in employment programs like TANF. Our company (as PSI) operated Wyoming's Full-Service Child Support contract in the 15?, 2nd, 3rd, and 9??judicial districts from 2000 to 2008. Both our tax credit and child support experience have made us familiar with the state's population. 3.1.7 Client References RFP Section 7.1.1 .10.1 .7, page 49 The projects we selected as references represent successful long-term state partnerships, as well as our ability to support modernization of the eligibility systems. They also demonstrate our ability to perform the RFP's Scope of Work and provide clear evidence of our capabilities to meet the Agency's goals for the contract. In this section, we provide all required information for the following references, including a Letter of Reference from each client: Illinois Enhanced Eligibility Veri?cation Indiana Enrollment Broker Iowa Medicaid Member Services Virginia Enrollment Broker Speci?cally, we selected these contracts to demonstrate our expertise in: I Improving access. The references demonstrate the ability to maximize service and improve high-quality access to program bene?ts. We offer this success on other contracts as evidence of our ability to support the Agency in helping clients access program services, including providing eligibility information, submitting applications, and recertifying benefits. I Promoting self-service. In these projects, as desired for the CSC, MAXIMUS has helped to promote and increase self-service as a delivery model, making it the channel of preference for the majority of clients while sustaining existing channels. I Supporting best-value modernization. MAXIMUS provides support for our clients to meet their modernization goals with measurable, best-value ef?ciencies for both client and customer. We have communications plans and protocols to ensure that the needs of clients and program stakeholders are continually understood and considered. leveraging current technologies to get bene?ts right away, rather than building something that takes years I Building long-term partnerships. MAXIMUS supports the success of these large and complex projects through cooperative relationships and scrupulous, transparent accountability, a key reason we are re-awarded contracts. Illinois Enhanced Eligibility Veri?cation Program Client: Illinois Department of Healthcare Family Services Project Time Period: 9/14/2012 12/31/2016 Contact Name: Julie Hamos, Director, Department of Healthcare Family Services Contact Telephone: 217.524.7979 Contact E-mail: julie.hamos@illinois.gov Project Description: MAXIMUS provides Medicaid redeterrnination services in the Illinois Enhanced Eligibility Veri?cation Program. Our call center provides assistance with verifying eligibility of individuals for medical assistance programs. We review all cases due for redetermination and verify certain key eligibility factors; assist in reviewing cases that contain potential anomalies; and manage a MAXIMUS-developed secure website that contains a selected set of additional data matches for State caseworkers to use in any determination of eligibility. 3. Proposer's Background and Experience RFP 23 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 28 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Illinois Iinlianced liligiliilit} Veri?cation Program The purpose of our work is to make certain that no eligible individual is denied enrollment, and that individuals who are not eligible are not enrolled. The Illinois Enhanced Eligibility Verification project is part of the larger Illinois Medicaid Redetermination project. The goal of the project is to process the backlog of cases that require immediate redetenninations and ensure that going forward; redeterminations will be processed in a timely manner so that eligibility for Medicaid coverage is veri?ed on an annual basis. MAXIMUS provides third-party data matching (income, citizenship, residency, household size, and other factors), requesting clari?cation of data and/or additional data (proof) from clients. We receive, scan, and attach requested/submitted documents to each client case, and review all data and veri?cation documents, including case notes. State caseworkers utilize the data sources and document received and processed by MAXI US to assist in their review and determination. Indiana Enrollment Broker Sen ices Client: Indiana Family and Social Services Agency Project Time Period: 11/1/2007 12/31/2020 Contact Name: Doug Montgomery, Director, Indiana Health Coverage Program (IHCP) Operations Contact Telephone: 317.234.4853 Contact E-mail: doug.montgomery@fssa.in.gov Project Description: MAXIMUS provides Medicaid enrollment broker services and operates the State's Helpline. We provide managed care education and enrollment services for Indiana's Medicaid program, and customer service as the operator of the state's Helpline for more than 650,000 Family Social Service Agency (FSSA) program bene?ciaries, including Hoosier Healthwise, the Healthy Indiana Plan (HIP), and the Indiana Care Select disease management program. Our project tasks include providing accurate, complete, and current information about health plans and their primary medical providers, and educating and informing bene?ciaries of their rights and responsibilities under managed care, the Medicaid and HIP programs, and HIPAA. We also inform bene?ciaries of the voluntary or mandatory nature of managed care and care management programs. We generate and mail notices and program materials to mandatory and voluntary members. MAXIMUS also transmits and receives data files from Indiana's MMIS (IndianaAIM) in a timely manner. We conduct health plan and primary medical provider enrollments and health plan disenrollments for Hoosier Healthwise, HIP and Care Select members. We utilize the managed care system for enrollment and disenrollment; tracking and reporting; generating forms, letters, and correspondence; maintaining plan/provider ?les; and customer service hotline for enrollment broker program activities. lo? a Medicaid Member Sen ices Client: Iowa Department of Human Services Project Time Period: 7/1/2005 6/30/20] 6 Contact Name: Andria Seip, Contract Manager Contact Telephone: 515.256.4697 Contact E-mail: aseip@dhs.state.ia.us Project Description: The Iowa Medicaid Member Services project serves as the ?rst contact for approximately 350,000 Iowa Medicaid members needing education or assistance with the Iowa Medicaid program. All informational services are designed to enhance members' access to. and promote cost effective utilization of, the Medicaid system and bene?ts. The IME Member Services team has put in place several different channels to assist its members and provide outreach, education, and enrollment services and information at our toll-free call center, by mail, e-mail, fax, and occasionally through an in-person meeting at our facility. Our services include answering questions about covered services, eligibility, how to apply, prior authorizations, premiums, available providers. and notices received. We process enrollments for the managed health care program and placing calls to members that have sent incomplete enrollment requests. We also record. resolve, and report complaints. MAXIM US Droduces 3. Proposer's Background and Experience RFP #01 24 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 29 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Irma Medicaid Scniccs member satisfaction surveys and distributes them to certain members based on their eligibility type. We verify member eligibility to Medicaid providers and maintain HIPAA regulations, verifying that information is only given to people that are approved based on the member's case ?le. MAXIMUS uses claims, eligibility data, and Provider Services to research and resolve billing issues or access to care issues. Virginia Enrollment Broker Scniccs Client: Virginia Department of Medical Assistance Services Project Time Period: 1 1/18/2002 12/31/2017 Contact Name: B. Jones, Director, Department of Medical Assistance Services Contact Telephone: 804.786.7933 Contact E-mail: gov Project Description: MAXIMUS operates a toll-free customer service call center providing managed care education and telephone-based enrollments in Virginia. We provide accurate and complete information on managed care health plan choices; educate recipients on their rights and responsibilities under managed care; conduct health status assessments on all recipients enrolling into managed care health plans; assist recipients who request exemptions from managed care; assist recipients who wish to ?le a complaint; and send educational materials that assist recipients in making managed care choices. We serve 468,000 consumers statewide. Letters of Reference We offer four letters of reference on the following pages. 3. Proposer's Background and Experience RFP 25 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 30 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS OF Healthcare {1nd Bruce Rauner. Governor Family SerVIces Felicia Norwood. Director 201 South Grand Avenue East Telephone: (217) 782-1200 Spring?eld. Illinois 62763-0002 WY: (800) 526-5812 March 7. 20?: To whom it may concern: Thank you for an opportunity to recommend MAXIMUS. I am the Bureau Chief of the Bureau of Eligibility Integrity with the Department of Healthcare 8: Family Sen-ices (HFS). HFS developed the Redcterniinntion Project (iMRl?) in late 2012, for which MAXIMUS is the contractor. We worked directly with their staff during all phases of the operations, including development. implementation. training. operation. and now transition to our new system. 1 have been most impressed with their staff, work ethic. and desire to go above and beyond to make a success. Their scope of work with our current program includes operating a statewide call center. mail processing (built outgoing and in-coming). case processmg and system, electronic case matching. eligibility reviews, and reporting. MAXIMUS has demonstrated a superior ability to work with our Department and be to the changes that come with working with state government. Noteworthy among their accomplishments during our contract: 0 Developing a computer tracking. matching and case recording system that met our state?s needs 0 Continuously meeting or exceeding pmiect- metrics 0 Completely revising the program and system operations as it result of a change required by the state during the contract Proactively identifying issues and resolving the situation l?rotviding classroom and web-based training to statewide staff 00 I highly recommend MAXIMUS because they have repeatedly demonstrated their experuae. responsn'eneiis. and reliability. no matter what the challenge. I am confident they can deliver. Sincerely. A John Spears Bureau of Eligibility Integrity, Bureau Chief Illinois Department of lealthcare a: Family Sen ices 20] Grand An.- East. l?I Fir Spring?eld. II. 62763 217 558 3803 F-mail- hfa hie anti! 3. Proposer's Background and Experience RFP 26 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 31 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS ?was! Pei-ice. Governor State at Indiana Indiana Family and Social Sen-ices Administration 5 402 WASHINGTON STREET, 0 BOX 7083 a INDIANAPOLIS. IN 46207-7083 1" .10th Wernert MD.Secretary ?March? March 8, 20 6 Christine Lal-?ortune MAXIMUS ISIS Wynkoop St #400 Denver. CO 80202 Dear Ms. LaFortune, On bchall?ot?OtTtee oI'Medieaid and Planning oI'lhe Indiana Family and Social Services Administration. I would like to extend this letter of recommendation Iiir MAXIMUS to be selected for a contract award as the Enrollment Broker Iiir the Slate oI?Wyoming. MAXIMUS is the Enrollment Broker for the State of Indiana. They provide Enrollment Broker services for the State?s Medicaid eligible Risk Based Managed Care population. They educate the potential Medicaid Enrollee about managed care plans available and facilitates their enrollment into the best-suited program in a timely fashion. MAXIMUS provides these services for the following programs, Hoosier l-lcalthwisc (HHW), the Healthy Indiana Plan (HIP 2.0). I-loosier Care Connect and the IMP Employer Benclit Link program (HIP Link). MAXIMUS was awarded the Enrollment Broker Contract in January I. 2008 for two new programs Indiana Care Select and the Healthy Indiana I?lan (HIP 1.0). 'I'heir value and ?exibility to perfonn their duties have made them a valued partner in maintaining our quality of service to the members of all our Risk Based Managed (?are programs. contract was extended through two extensions and was recently awarded a new contract by the State?s procurement process through 2020. Sincerely. ?Dag.? Lite- Doug Montgomery -?%imWort Services - Quality and Outcomes Indiana Medicaid - Indiana Family and Social Services Administration 402 W. Washington St., Room W374 - M507 - Indianapolis, IN 46204 O: (317)233-2834 - - govltasa Equal Opportunitywtirmadvo Action Employer 3. Proposer's Background and Experience RFP 27 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of VWoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 32 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS Howe Department of Human Services ?Ll Terry E. Branstad Kim Reynolds Charles M. Palmer Governor Lt. Governor Director March 9, 2016 To Whom This May Concern: I am writing this letter to strongly recommend MAXIMUS. The lows Medicaid Enterprise (IME) developed the Department of Human Services (DHS) Contact Center In October 2013. for which MAXIMUS is the contractor. I had the opportunity to work directly with MAXIMUS staff during development, implementation and operations for the DHS Contact Center. I am impressed with their staff, work ethic. diligence and efforts to effectively assist with making the DHS Contact Center a success within the IME. The DHS Contact Center provides statevride call center assistance to new or renewing applicants for Iowa Medicaid programs. MAXIMUS staff assists applicants by completing applications over the phone, checking application status and answering general questions regarding the application process. The DHS Contact Center also provides helpdesk support. MAXIMUS staff creates heipdesk tickets for eligibility system Issues. They are always prepared to proactively Identify options and solutions to challenges inevitably occurring In systems for eligibility workers throughout Iowa. MAXIMUS has been ?exible with adjusting to the many changes affecting iowa Medicaid. MAXIMUS staff has smoome made adjustments to enhance the flow of many processes. During our contract, the DHS Contact Center has accomplished meeting satisfaction service levels. creating or revising operations as a result of changes to Iowa Medicaid and providing continuous training. The success of any organization depends In large measure on the team assembled and the team's ability to communicate and work collaboratively toward goals. MAXIMUS has provided excellent service to Iowa Medicaid and their contribution is commendable. Again, 1 strongly recommend MAXIMUS because of their responsiveness. reliability and expertise. MAXIMUS will de?nitely go above and beyond to make your program a success. Regards. was Deputy Medicaid Director Iowa Medicaid Enterprise 100 Army Post Road Des Molnes. Iowa 50315 515-256-4644 Iowa Medicaid Enterprise -- 100 Army Post Road - Des Moines. IA 50315 3. Proposer's Background and Experience RFP #0175-Al 28 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 33 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Department of Madlcal Assistance Services can East Broad Street. Suite 1:00 Richmond, 23m 03/08/2016 To whom it may concern: Thank you for the opportunity to recommend MAM MUS Health Services, I am the Contract Monitor for the Virginia Enrollment Broker Services, for which MAXIMUS has provided enrollment broker services sincejanuary 2003. I've worked directly with their staff during ongoing operations and most recently with project implementation of new technology that will include both updated telephony and systems. and have been most impressed with their staff. work ethic, and desire to go above and beyond to make our program a success. Their scope of work with our program includes call center, processing both Medicaid and Dually Eligible Managed Care Enrollments, creating/ maintaining website management for both the Medallion 3.0 and programs, creating/printing informing materials. and the aforementioned new technology that is being implemented in 2016 as part of the recent reprocurement of the Commonwealth of Virginia Enrollment Broker and Education Services contract that was again awarded to MAXIMUS. MAXIMUS has demonstrated the ability to collaborate, plan, improve performance, and establish themselves as a true partner to the Virginia Department of Medical Assistance Services. Noteworthy among their accomplishments during our contract: 0 Completed the effort to extend fully capitated managed care to all areas of Virginia 0 Partnered with DMAS to implement the Expedited Enrollment Program. minimizing the time consumers spend in fee-for-service Medicaid Partnered with Virginia to incorporate additional Medicaid populations into Managed Care like HAP (Health and Acute Care Program) 0 Partnered with Virginia to launch the fourth Duals Demonstration in the US. known as the CommonWealth Coordinated Care Program, in March, 2014. Initiated and operate regular meetings betwren MAXIMUS dual eligible demonstration projects (9 of the II states operating duals demonstration projects). CMS. and state partners to share best practices and continuously improve these programs to promote their success I recommend MAXIMUS because they have repeatedly demonstrated their expertise, responsiveness, and reliability. Sincerely, Scott Cannady Contract Monitor Virginia Division of Medical Assistance Service 3. Proposer's Background and Experience RFP 75-A 29 P23001.006O March 25 2016 Attachment to the information Technology Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 34 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 3.1.8 Terminated Contracts RFP Section 7.1.1.1013, page 50 MAXIMU Health Services, Inc. has had no contracts terminated for cause or convenience in the last ?ve years. 3.1.9 Litigation RFP Section 7.1.1.1D.1.9, page 50 MAXIMUS Health Services, Inc. has not initiated any litigation nor been a defendant in any case in the last ?ve years. 3.1.10 Experience Working with Other Contractors RFP Section 7.1.1.10.1.9, page 50 MAXIMUS has extensive experience working with other contractors and external organizations. Many of these projects and situations involved either or both parties being dependent on the other's services or systems. Maintaining a Relationship with the WES Contractor Our having a collegial and productive relationship with the Wyoming Eligibility System (WES) Contractor helps ensure that any technology or process changes that the program requires are executed with the ?ll cooperation of both parties. Understanding how important this working relationship is for the success of both MAXIMUS and the WES Contractor, we will meet with the WES Contractor early in the implementation process to outline our respective roles and responsibilities, and de?ne the key touchpoints for our respective systems and services. At this time, we will also discuss the best channels and schedules for communication and identify speci?c individuals from our two organizations who will be working together. Supporting WES Contractor Communications To support open communications between MAXIMUS and the WES Contractor, we will hold regular meetings to review any issues and proactively mitigate areas of concern. As part of the agenda for our ?rst meetings, we will de?ne the referral process, determine protocols for information sharing, and identify processitechnology linkages. Establishing these shared elements provides us with a basis for developing shared policies and procedures, so that all parties are operating from agreed-upon processes and expectations. Resolving Conflicts with WES Contractor To meet the Agency's expectations and ensure sound, continuous project operation, MAXIMUS takes a proactive experience-based approach to issue identi?cation and the resolution of problems or de?ciencies. Effective issue management is essential to maintain project scope, cost, schedule, and quality. We have a documented process to manage and track issues, including their cause and resolution, and share the status of all issues with the WES Contractor and the Agency. The primary goal of the issue management process is to make sure that issues are identi?ed, evaluated, and assigned for resolution. This process then informs our continuous quality improvement measures in an effort to identify mitigation and avoidance strategies for future recurrence of the issue. The probability of issues reoccurring is reduced by root cause analysis and continuous improvement: a speci?c, repeatable, and measurable process for identifying the causes of critical, sometimes recurring, issues. 3. Proposer's Background and Experience RFP #0175-Al 30 P23001.006O March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 35 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Any issue that results in unscheduled downtime becomes a target for our root cause analysis process. Our experience-based systematic review of standing processes, systems, and policies determines the source of an issue, and enables us to ?nd or create the solution that will prevent the issue from recurring and causing future problems. We will work closely with the WES Contractor in this analysis and resolution. As part of our commitment to transparency, we immediately notify the Contract Monitor of any unscheduled downtime and again when the system has been restored. Meanwhile, we maintain a detailed chronology of the incident and provide agreed~upon updates to the Agency. Agency Involvement in Con?ict Resolution with the WES Contractor The Project Management Manual that all of our project managers are required to know and follow provides the foundation for our project-speci?c Problem Escalation Procedure (PEP). We have found that by adhering to these policies and procedures, our projects start on equal footing, operating in a disciplined, well-managed, and consistent manner that promotes the delivery of quality products and services. We will use our PEP to address and resolve issues that cannot be resolved as part of regular meetings with the WES Contractor, keeping the Agency informed along the way. Our PEP will start with addressing issues identi?ed in the project. We consider an issue to be an identi?ed occurrence that if not addressed, may affect schedule, scope, quality, or budget. The bene?t of our methodology is that it helps facilitate those functions that are so important to effectively handling issues, including: I Communication to all involved team members I Escalation of unresolved issues I Reporting of critical issues With this in mind, MAXIMUS maintains an Issues Log, which we share with the Agency on an agreed-upon schedule, with email noti?cations and updates. We continually update the Issues Log, which contains a description of the issue, resources assigned for resolution, the status of issue resolution, the priority for issue resolution, and the issue resolution due date. Our PEP will include contact infonnation for progressively higher levels of personnel in our project and the corporate staff who will become involved in resolving a problem. We also list contact information for persons responsible for resolving issues after normal business hours and in emergencies. 3.2 Approach to Staf?ng RFP Section 7.1.1.102, page 50 An essential element in meeting call center performance standards is matching staf?ng to workload to minimize wait times and create an environment in which CSRs provide patient and respectful service, while helping to contain cost. Based on the information provided in the RFP related to workload and contractual performance, we have developed a realistic, reliable staf?ng model for the CSC. Our staf?ng plan helps ensure adequate coverage for incoming calls at all times so that no caller ever hears a busy signal, and that we answer calls within the required service levels. We have built our proposed staf?ng solution on call center industry standards and our expertise in both human services and call centers. We go beyond generic call center staf?ng, staf?ng the 3. Proposer's Background and Experience RF 31 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 36 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS CSC to handle the speci?c types of calls we will receive. We base our model on more than call volume; we incorporate ef?cient and effective handling of eligibility calls into our solution. Based on our experience in similar call centers, we know that many calls are basic in nature. We route those calls to our Tier 1 CSRs. The remaining calls require more knowledge and go to our more experienced Tier 2 CSRs (many of whom we hope to transition from the current staff) and Team Leads. This decreases call transfers, thus increasing customer satisfaction. We considered numerous factors in modeling proper staf?ng for the CSC: I Peak volume times per day/week/month when we will need extra CSRs I Callers' "patience curve," a measure of how long callers are willing to wait before abandoning a call or leaving a callback request I CSR occupancy percentage, which is time spent handling calls after subtracting lunch and break times, training sessions, planned absences, sick time, and the like I Contractual SLAs, such as abandonment rate and speed to answer, that we must meet I Gradual ef?ciencies in Average Handle Time due to CSR expertise and continuous process improvement gained through the use of skills-based routing, training, and our CRM To calculate staf?ng needs, we use several tools, including Erlang modeling, to analyze actual call center patterns against a certain level of performance. To incorporate other operational factors, we use operations modeling software to simulate the arrival of calls and ?ne-tune the staf?ng model to meet performance standards. This process lets us project callers' likelihood to abandon if they wait too long. It also allows us to make realistic assumptions about call length in the true call center environment. Additionally, through use of business process management, data analytics, and modeling tools, we forecast and optimize staf?ng levels based on changes in call volumes and training demands while continuing to meet project requirements. For the CSC, we will use a ?exible staf?ng model, with full-time and part-time staff, to meet the SLAs for this project. This bene?ts the State, our customers, and MAXIMUS by: I Increasing the pool of highly quali?ed potential staff I Letting us quickly ?ll full-time positions with part~time staff who want full-time work I Best accommodating both staff and callers by using a staggered schedule to staff the project outside of normal business hours I Ensuring full coverage at peak times MAXIMU will work with our temporary staf?ng agency to identify, screen, and hire staff. 3.3 Potential Con?icts RFP Section 7.1.1.103, page 50 MAXIMU is a large company billion in revenue in 2015) with extensive resources (18,000+ employees), so we can easily add this RFP's scope of work without causing any con?ict with our current projects. Exhibit 3. 3-1 shows that the CSC will become the newest project in our Health Services division, with management and subject matter experts in the western United States who will guide the CSC throughout the contract. 3. Proposer's Background and Experience RFP #0175-Al 32 P23001.0060 March 25, 2016 Attachment to the information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 37 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS \lAXlul Richard A. \lnntoni, Bruce ell, President Shared Operating Services Units .. - lltallh HumanSemces llen Bnylinson Finance's: Legal Accomtmg Contracts Health S?mh est ., \lielmel Leinherg Communications Quality Risk Health . 8? Branding Management Northeast yoining of Health Health Customer Corporate Human New York Set-rice enter Capital Health Mid- Atlantic GEVf?ment Information a 0115 Technol Health Central Exhibit 3.3?1: The CSC Will Be Part of MAXIMUS Health Services. Because we have a large division devoted exclusively to health services, adding the CSC to our projects will not con?ict with our responsibilities to other clients. The state of Wyoming falls into our Health West group, which is dedicated to projects in the Rocky Mountains and West Coast. Management for Health West works mainly in California and Colorado, to be close to our clients. 3.4 Personnel Resources RFP Section 7.1.1.104. page so As described in our overall staf?ng plan in Section 3.8 and in the Attachments, we will have key staff and frontline staff to perform this contract. Corporate shared services will support the CSC project startup and operations: Resource I?rinmr} Responsibilities Quali?cations Information I Directs the design, development, and I Accomplished and experienced Technology Project implementation of project technology information technology professional Manager I Oversees system testing in accordance I Technical and project management with RF requirements in advance of experience in leading the design, Eric Hicks deployment development, and implementation of I Works with Agency staff, WES contractor, enterprise applications in health program and third parties to establish reliable projects interfaces between systems I Experience supporting software product I Ensures that all project technology development, system architecture, and milestones are delivered on time in management ofthe overall delivery accordance with Agency and RFP lifecycle across multiple health requirements Insurance 3. Proposer's Background and Experience RF 33 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 38 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Resou rec Primary Responsibilities Quali?cations Standardized Operations and Analytics/RPM Team Privacy Manager lra Rothman Security Manager Bob Burkhart Finance Director Theresa Brown I Implements operational best practices across key business functions, including contact center, data entry, mailroom, and document management I Evaluates workload, performance, and processes to optimize throughput and responsiveness, I Develops the DecisionPoint for Business IntelligenceTM reporting and analytics package that we will implement for Wyoming I Ensures that all reports and dashboards are developed, designed, and deployed per client requirements I Supports project staff with requests for ad hoc reports I Maintains responsibility for the development and implementation of policies, procedures, and practices according to HIPAA Privacy and Security Rules I Reviews privacy risk of new contracts and changes, establishing privacy policies and procedures, and training programs I Coordinates with project staff and the State to ensure that HIPAA privacy and security standards are maintained I Communicates with client privacy of?cials and federal agencies I Maintains responsibility for the development and implementation of policies, procedures, and practices to provide information security according to HIPAA Privacy and Security Rules I Develops actions to monitor information security policies, procedures, and practices to guarantee that they are upheld I Coordinates with project staff and the State to ensure that HIPAA privacy and security standards are maintained I Manages the day-to-day project ?nancial processes to ensure contract compliance and accuracy I Monitors quarterly. and annual forecasts with actual results and reports on variances I Performs internal monitoring of ?nancial processes and coordinates all external audits I The SOA Team supported our Business Process Management (BPM) modeling to determine optimal staf?ng levels for the CSC I Chief Privacy Of?cial for MAXIMUS, lnc. I Leads the MAXIMUS Privacy Of?ce responsible for investigating data privacy incidents and performing a thorough, good faith risk assessment as required by HIPAA and HITECH I Experience in health care information systems and operations I 27 years of experience in information security, computer systems integration and engineering, management and training I Experience managing professional security staff responsible for ensuring the con?dentiality, integrity and availability of critical information I Experience with technical vulnerability and risk I Experience developing and implementing security awareness programs I 9 years of experience as a MAXIMUS Finance Director I Solid background directing daily operations of ?nance department, including invoice processing, vendor communications, client invoicing, and corporate reporting 3. Proposer's Background and Experience .0060 March 25, 2016 Attachment to the information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing RFP #0175-Al 34 and Maximus Health Services, Inc. Page 39 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Resource l?rimnr} Responsibilities Quali?cations Human Resources Director John Viera I Directly manages the human resource ?lnctions for all assigned projects, including the CSC I Directs recruitment and hiring efforts to ensure compliance with MAXIMUS policies, contract, and federal and state laws I Ensures compliance with EEO and ADA requirements I Human Resources Manager with MAXIMUS since 2011, working with health program projects I In-depth understanding of project human resources needs and ability to provide policy guidance to support project management I Detailed experience in recruitment, onboarding, training, and employee development Exhibit 3. describes the depth of our organization's resources focused exclusively on supporting the needs of our government programs. implementation Support Corporate Administration Information Services Human Capital Employee Development and Training Quality and Risk Management Finance and Accounting Legal and Contracts ('orpornte Support Infrastructure Our implementation team supports the launch of new projects and major initiatives. The team provides project management support, coordinates with other corporate support groups, tracks progress on critical tasks and milestones, and maintains open communication. Corporate Administration supports MAXIMUS as a whole by providing a number of services, including real estate management, purchasing, and travel. They manage site selections, lease negotiations, opening new of?ces, and o?ice expansions. As the centralized purchasing unit, they assist project sites with ?lmiture acquisition, of?ce equipment (such as copiers and fax machines), and of?ce supplies. Our Of?ce of lnforrnation Services includes the Technical Support Team, Security and Audit Team, Equipment Purchasing, Telecommunications and Network Team, and email communications team, keeping a sound infrastructure in place for our projects Our human capital team leads staff recruitment and hiring for all projects, adhering to consistent guidelines, and maintaining an EEO Compliance Of?cer. They manage compensation and bene?ts, and cultivate fair and congenial work environments. The MAXIMUS Center for Employee Development provides enterprise-wide management and staff development initiatives, and ?eld training support to our project employees. The team includes classroom instructors, instructional designers, and instructional technologists who design and deliver traditional and technology-based training and development to keep our staff up to date on everything from ethics and HIPAA to techniques for caller courtesy. Our QRM team provides monitoring and addressing client satisfaction, performance monitoring and operations support, performance evaluation through project reviews, risk management through early identi?cation of proj ect performance concerns, and promoting communication of best practices and collaboration across business lines. This team oversees the management of all ?nancial aspects of MAXIMUS contracts, including job cost accounting, payroll processing, and overall ?nancial management. At the project level, managers oversee tracking and reporting on ?nancial activities and accurate invoicing. Our in-house legal team supports all legal elements of the company's business including compliance with applicable laws, regulations, and contractual obligations. Exhibit 3.4-1: MAXIMUS Corporate Support Infrastructure. Our project leadership draws on our corporate resources for support and best practices from across our organization. 3. Proposer's Background and Experience RFP #0175-Al 35 .0060 March 25, 20l 6 Attachment to the information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 40 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Short-term Support for Specialized Operational Needs One of the bene?ts of working with MAXIMUS is that we have extensive resources to help our projects handle temporary spikes in workloads and special projects for clients. Our shared services operation in Glendale is just a few miles from our corporate regional headquarters in downtown Denver. The Glendale facility offers over?ow capabilities, with customer service representatives, mail and ful?llment, email campaign management, and other services often needed for temporary workload increases or special ventures at our projects. For instance, should the Agency believe that a change in program policy will cause a large number of calls, we can enlist additional CSRs in Glendale to help ?eld those calls. Similarly, a procedural change that might require clients to submit additional paperwork may then require us to do more data entry in a short amount of time; Glendale staff can help index documents that our Cheyenne mailroom receives and images. For short?term volume increases, we will adjust staff schedules and other measures at our Cheyenne facility to handle the additional workload without activating our shared services of?ces, to save the Agency from additional costs. If we need further support for unusual operational situations outside the scope of our Glendale of?ce, we can also use our shared services facilities in Folsom, California, and Chicago, Illinois, both of which also support project overflow. Upon request, MAXIMUS will help the Agency de?ne the personnel and time needed for specialized operational services and give the Agency a cost estimate as appropriate. We welcome the opportunity to be of further service to our clients whenever they need us. 3.5 Technical Infrastructure and Resources RFP Section 7.1.1 .105, page 50 Corporate Technical Infrastructure Staff members in our MAXIMUS Information Technology (IT) department are responsible for managing our corporate data centers, corporate-wide telecommunications and networks and data security, and supporting more than 50 state, local, and federal government projects. Making wise use of such shared services helps ensure cost containment and saves taxpayer dollars. MAXIMUS IT is responsible for maintaining maximum availability for all application servers, as well as supporting the LAN and WAN, ?le/print services, a 24/7 corporate help desk, and email support. MAXIMU IT staff also manages our corporate help desk, which assists employees across the country. A MAXIMUS IT staff member is on call 24/7 to provide assistance with resolution of infrastructure issues, should the CSC need their assistance. Within MAXIMUS IT, we divide responsibility for different operational components among several groups: Data Center Services manages all servers in the data center; our Network Operations Center oversees circuits, routers, switches, and all connectivity issues; and Security and Audit manages all ?rewalls and security-related issues. In addition, the IT software team directs the design, development, and deployment of the central applications supporting the CSC, including the CRM and KMS. Our Digital Solutions team directs our use of email, web chat, and social media. Assistance with Federal Legislation Our CSC Consulting Policy Advisor, Jan Ruff, is well versed on current legislation and helped us prepare for program policy and procedural changes resulting from new legislation in all of our 3. Proposer?s Background and Experience RFP #0175-Al 36 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, inc. Page 41 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS projects. She will collaborate with fellow MAXIMUS subject matter experts in the health insurance ?eld and in our federal services subsidiary to keep aware of changes in the nation's healthcare programs. The Agency will bene?t from the deep expertise only MAXIMUS offers in this area. MAXIMUS has extensive experience assisting clients with interpreting and implementing new and future federal legislation. We continually track state and federal legislation that affects Medicaid, CHIP, 881, and other related programs, and we are mindful of relevant State and federal regulations that apply to data security and automated systems development. 3.6 Key Personnel RFP Section 7.1 .1.10.6. page so, sow Appendix A, 5154-5165. 5209 Our management team comprises key personnel essential to the successful implementation and execution of the CSC. These individuals have the required expertise, background, and quali?cations to effectively execute their proposed roles. Benjamin Coss, MAXIMUS Senior Vice President, will serve as the Executive Sponsor for the project, making certain the Agency has access to the full range of corporate resources MAXIMUS can provide. This includes ?xed assets such as hardware and network resources, as well as personnel resources such as managers and line staff, to assist with operational issues and other specialized needs as they arise. Mr. Coss will work with the Operations Manager to assess and manage operational procedures, staf?ng, organizational structure, strategy, and budget. He also provides strategic vision, leadership, and focus to facilitate successful operations. Exhibit 3.6-1 lists all named members of our proposed personnel team for the CSC and summarizes their relevant experience, expertise, and duties. MAXIMUS welcomes the opportunity to interview the individuals who are currently serving in key roles at the CSC. We will discuss continuing employment with them should they be interested in remaining in their positions and will obtain the Agency's approval if we would like to retain any current staff in place of the key staff we propose here. For positions not yet named, we provide the quali?cations we require of candidates. Key Staff Position Quali?cations CSC Account I Senior leader with 15 years of progressively responsible leadership experience in Manager government healthcare operations, with a focus on customer service I Proven knowledge of Medicaid and health Jeremy Morgan I 12 years of Medicaid operations experience I Proven ability to manage strategy and budgets I 7 years of experience as Project Director in a program that serves Medicaid members and providers through contact centers in Iowa I Proven ability to build client relationships, increase ef?ciency, and effectively implement large-scale programs and projects on budget and on schedule I Broad knowledge of public assistance or human services eligibility programs and policies, an understanding of general business management principles and practices, and ?nancial management I Demonstrated experience and knowledge of industry standard and best practices regarding large-scale and enterprise-level contracts I Extensive knowledge of health care administration, Medicaid and CHIP eligibility or enrollment processes, HIPAA regulations and requirements I Experienced in writing technical and training documents, as well as policies and 3. Proposer's Background and Experience RF #0175-Al 37 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 42 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Stall Position Quali?cations procedures I B.A., Advertising, Iowa State University I Project management training Operations I 10 years of experience in general customer support center operations Manager I IO years of experience in managing a team of 10+ employees I 2 years of experience as an Eligibility and Operations Manager Muna Pirrin I Strong knowledge of public assistance or health care, Medicaid and CHIP eligibility or enrollment processes I Knowledge of federal and state statutes, legislative initiatives and regulations, as well as federal, state, and local policies that may affect the CSC operations and state health care programs I Experience with eligibility determination systems, and electronic document management I Demonstrated understanding and appreciation of CSC concepts and practices, including use of systems, call routing, contact channels, types of customer transactions/interactions, workforce management, performance measurements, quality initiatives, coaching and mentoring, career path development, and staff I 3.8., Business Management, Brigham Young University Training and I 2 years of successful experience as a training facilitator, designer, or other training support Manager function with a CSC environment. I Bachelor's degree from an accredited college or university. In lieu of an Associate degree. To be hired an additional two years of relevant experience (for a total of five years). In lieu of a Bachelor's degree, four additional years of relevant experience will be accepted for a total of seven years. I Demonstrated understanding and appreciation of CSC concepts and practices, including use of systems, call routing, contact channels, types of customer transactiens/interactions, workforce management, performance measurements, quality initiatives, coaching and mentoring, career path development, staff development, diverse learning styles, and the unique demands of frontline staff. I Excellent oral, written, and interpersonal communication skills, and strong listening and analytic skills I Superior writing skills related to informational and instructional material, including the ability to present content in a non-paragraph and linear way. I Proven to be task-, team-, and deadline-oriented and a team player. I Demonstrated experience in communicating effectively with all levels of management and representatives I Preferred quali?cations include healthcare-related customer care experience I Training in Medicaid and related programs IT Specialist I Bachelor's degree, preferably in information systems I 2 years' experience as an IT Specialist within a call center To be hired I Ability to work independently and with a team I Excellent oral and written communication skills, detail oriented, and solid business logic and analytic skills I Bachelor's degree from an accredited college or university. In lieu of an Associate degree, an additional two years of relevant experience (for a total of four years). In lieu of a Bachelor's degree, four additional years of relevant experience will be accepted for a total of six years I Microsoft and SDLC Certi?cations I Preferred quali?cation: IT experience within a CSC 3. Proposer's Background and Experience RF i 38 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 43 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS Key Staff Position Quali?cations Reporting Analyst I B.S., Finance, Siena College I Four years of experience as a reporting and ?nancial analyst Brendon Seharf I Over four years of experience of contract management for large federal contracts I Extensive experience with data management software I Performs advanced data interrogation and analysis to identify breakdowns in business process and source systems I Performs Operation Research to help identify and improve business process ef?ciencies as well as research and analysis aiding in staff planning Consulting Policy I Master's degree in public administration ??om Western Michigan University Anal?? I Over 30 years of experience in government health policy, planning, and administration, including broad-based analysis of health issues with management of large and medium- Jan Ruff sized operations in health care I 14 years of experience as Deputy Chief of the Michigan Department of Health?s Center for Health Promotion and Disease Prevention, reporting to the State on potential impacts and providing recommendations I 6 years as Chief of Division of Policy and Planning for the Michigan Department of Community Health I 19 years of experience with MAXIMUS, performing similar services in projects with complex, systems-based, modern technology or operational systems I Detailed knowledge of HIPAA regulations and requirements I Additional experience with Health Services Opportunity Development, Health Market and Policy Analysis, CHIP and Medicaid Managed Care, Long Term Care Services and Supports, Health Literacy, Maternal and Child Health Programs, and Strategic Planning and Program Evaluation High school diploma, GED or equivalent certi?cation; bachelor's degree preferred Two years' mailroom experience Knowledge of postal and federal policies, statutes, procedures, and regulations Computer skills including Excel, Microsoft Word and Outlook Professional attitude with proven track record and performance and results Self-motivation and be detail oriented Exhibit MAXIM US Key Staff. We propose highly quali?ed individuals for the key positions at the CSC. For those we have not yet named, we will interview incumbent stay?" and retain as many who are interested in remaining with the CSC. For any open positions. we will recruit candidates who meet our requirements and success pro?les so that we stay?" the CSC with the best and brightest to serve clients. Mailroom Lead Michelle Munoz Our key staff will provide onsite management for all facilities maintained under the contract to provide process governance and oversight of operations within the designated CSC hours of operations. They will oversee the facility operations and carry the authority to make decisions. On-site management will be full-time and scheduled to maintain adequate management activities during designated CSC hours of operations. Resumes and References for Key Personnel Resumes and references for key personnel are included in Attachment B. 3.7 Subcontractors RFP Section 7.1.1.10], page 51, SOW Appendix A, 5186 MAXIMUS does not propose to use any subcontractors for this project, as contact center operations and eligibility support services are both core competencies of MAme S. By 3. Proposer's Background and Experience RFP 39 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 44 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS conducting all services ourselves, we assure the Agency that all work will be delivered to our exacting specifications and to those of the State. 3.8 Staf?ng Plan RFP Section 7.1 .1.10.8, page 51, Appendix A, 5145. page 48. 50W Appendix A 5145 Our proposed Resource Management and Staf?ng Plan and organization chart are located in AttachmentA, as required. Please see Section 3.6 above for a discussion of our proposed key personnel. 3.8.1 Staf?ng Levels by Role RFP Section 7.1.1.10.8.1. page 51, 80W Appendix A, 5146 Wyoming will receive excellent service, regardless of work volume. While we believe that our solution will enable us to handle call and application volumes as projected in the RFP, we recognize that there will be times where volume will spike. We identify and use accepted operational standards to provide a suf?cient number of staff qualified to ful?ll the scope of work. Our staffing model, supported by our experience and technology, enables us to meet performance metrics even in the event of unexpected spikes in workload. Exhibit shows our project staf?ng levels by staff disciplines, by month, for the four?year base contract. Project Stuf?ng l.e\ ll) Staff Disciplines Jan Feb Mar Apr \In} .lun .lul Sep Nm Dec CSC Account Manager 1 I Consulting Policy Analyst .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 Operations Manager I 1 1 1 I 1 Training and Manager Reporting Analyst 5 5 .5 IT Specialist .Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor I Customer Service Representative Mailroom Lead Mailroom Specialist CSC Account Manager Consulting Policy Analyst .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 Operations Manager Training and Manager I I I 1 Reporting Analyst 5 5 5 .5 5 IT Specialist .Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor 1 Customer Service Representative Mailroom Lead 1 I 1 I Mailroom Specialist Proposer's Background and Experience RFP 40 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 45 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Project Staf?ng Let els by Staff Disciplines YEAR 3 Jan FBI) Mar Apr Mn} June July. Aug Sep Oct Nov Der CSC Account Manager Consulting Policy Analyst Nh(J: Operations Manager Training and Manager Reporting Analyst Specialist 5 .5 5 .5 Eligibility Specialist CSC Supervisor 1 Customer Service Representative Mailroom Lead Mailroom Specialist 2 4 CSC Account Manager 1 Consulting Policy Analyst Operations Manager Training and Manager Reporting Analyst .5 IT Specialist .Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor 1 Customer Service Representative 6 Mailroom Lead Mailroom Specialist Exhibit 3.8-1: Project Staf?ng Levels by Staff Disciplines. Our sta?ing [eve/s meet project needs. Our management constantly monitors our detailed operational dashboards to adjust staf?ng based on calls in queue. We review real-time data on call volumes, service levels, and CSR availability to make quick operational changes when needed. If we ?nd that we are experiencing unusually high call volumes and wait times start to increase, the management team will make staffing adjustments, including adjusting break times and lunch times, or having Supervisors take calls. We cross-train all staff so everyone can help serve callers when needed. If we know that volume is likely to increase due to a program change or Agency announcement, we will temporarily increase our part-time staff to full-time to handle the increased number of calls. If we expect an increase in call volume for a signi?cant amount of time, such as several months, we will bring in temporary staff and train them to handle the expected call volume. We will also change our IVR and ACD messaging to alert callers to high volumes and redirect them to other channels, such as the Agency and WES websites, for service. Our self-service options in the IVR will help us to manage call volumes as well. Through web chat, customers have an alternative way to contact us; one CSR can handle chats with several customers at once. We will also make sure that the IVR has the right FAQs and that our staff educate customers about self? 3. Proposer's Background and Experience RF 41 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 46 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS service options. Should call volume exceed an average of 12,000 calls per month, we will hire additional staff as needed, per contract renegotiation. 3.8.2 Offsite Resources RFP Section 7.1.1.1082, page 51, SOW Appendix A, 5087, 5088 MAXIMUS intends to have most CSC staff work from our Cheyenne location, including the CSRs, mailroom staff, and eligibility specialists. Staff allocated to the CSC at less than full time, such as the Consulting Policy Analyst and IT Specialist, may work from our regional headquarters in Denver, Colorado, just a 90-minute drive from Cheyenne; those team members will be on site in Cheyenne as needed throughout the contract. Most of our corporate IT infrastructure staff already work in our Denver facility, which will be bene?cial in keeping all CSC systems operational. For specialized operational services, we will use our shared services of?ce in Denver. We will also use this location as our business continuity facility, in case of disruption due to ?ood. ?re, tornado, major power outage, and other natural disasters. Centrally located at 4500 Cherry Creek South Drive in Glendale, this office is just a few miles from our downtown Denver headquarters. 3.8.3 Screening Tools and Processes RFP Section 7.1.1.1033, page 51 MAXIMUS has developed and validated "success pro?les" for front-line positions based on our call center experience. We use these pro?les to rigorously screen all candidates and select only the highest quality personnel with the demonstrated skills and behavioral competencies necessary to perform this important work. For instance, we look for CSR candidates who have successfully serviced customers, preferably in person. We ?nd it is easier to teach phone skills to those individuals than to teach a service mentality to a call center worker, and it is a better We conduct screening interviews to measure aptitude skills. If appropriate, we test candidates to ensure they have the skills we want. As appropriate, we check references from each candidate and conduct background checks. 3.8.4 Process for Replacing Key Staff RFP Section 7.1.1 .10.8.4, page 51 Once the Agency approves key personnel, MAXIMUS will not divert or replace those personnel without its approval. MAXIMUS will notify the WDH Contract Manager of a proposed replacement at least 30 days in advance and provide the name, quali?cations, and background check of the replacement, making the candidate available for interview. We will give the Agency at least two days' notice in unexpected termination circumstances. We will not leave a key personnel position vacant for more than 60 days. MAXIMUS always seeks to promote from within, grooming our staff for advancement and continuously working our succession plan to avoid vacancies in key positions. 3.8.5 Staff Roles and Responsibilities RFP Section 7.11.10.11.51. page 51, sow Appendix A, 5147, 5148, 5149 MAXIMU staff ?il?ll clearly de?ned roles with speci?c responsibilities in the operation of the CSC, as shown in Exhibit 3. 8-2. Please see Section 4.5.3 for details on our Transition team. 3. Proposer?s Background and Experience RFP 42 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 47 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Job Role CSC Account Manager Operations Manager Training and Manager IT Specialist Reporting Analyst Consulting Policy Analyst Primary Responsibilities Guides entire project throughout the contract term Serves as the primary point of contact to maintain communication with the Agency for activities related to contract administration I Attends regular client meetings and reviews on CSC operational goals and achievements I Establishes operational objectives and work plans, and delegates assignments to subordinate managers implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results Oversees all customer service functions and sta?' on a daily basis Ensures compliance with all contractual operational requirements Provides technical assistance to staff regarding programs, policies, and procedures Ensures adequate staffing levels and staff training to meet contractual requirements Develops goals and objectives, and monitors achievement Works with and Training Managers to develop and implement quality control, quality assurance, and corrective action plans Conducts case audits and reviews reports to identify areas for improvement I Ensures CSC staff are trained in positive customer relations and handling of customer requests I Coordinates development and delivery of training programs and materials through collaboration with the CSC Account Manager, management, and other program stakeholders Ensures Operations staff has up-to-date knowledge of project processes and procedures by contributing to the Knowledge Management System Designs, delivers, tracks, and reports on training and coaching activities Coordinates project QA efforts Monitors CSRs for quality purposes Produces and updates staff resource materials including KMS, policy and procedure manual, training manual, quick reference guide, matrices, charts, and workflows Designs, produces, and disseminates reports Provides IT operations and desktop support to CSC Leads IT Engineering Implementation for CSC Facilitates IT design network delivery to meet business objectives Provides design documentation as it re?ects implementation and troubleshooting guidelines for operation support Provides reporting and database development support to the Operations Manager and other team members Manages the reporting program that gathers and analyzes operational data from CSC systems I Designs databases, spreadsheets, and reports as requested Provides contractually required project status reports to management Consults with the CSC Account Manager to review and analyze new and proposed federal and State policies and regulations to provide guidance and recommendations on the potential impact to the Agency and to the SC Researches, analyzes, and reports on trends in Medicaid, CHIP, Health Care Reform and other government sponsored health care initiatives. Remains current on health care initiatives and proposals I Analyzes impacts of initiatives on client service offerings and CSC operations I Develops, documents, and formulates impact analysis and makes recommendations for appropriate program responses to initiatives 3. Proposer's Background and Experience RFP 43 P23001.006O March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 48 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Job Role Primary Responsibilities CSC Supervisor I Works directly with the CSRs, managing day-to?day operations and mentoring staff to ensure adherence to quality and timeliness SLAs I Provides supervision, development, and coaching of CSRs to assure productivity, quality, attendance, and timeliness of work in the completion of assigned projects and departmental goals I Logs into CSR queues as required during high contact volumes Customer I Responds to client inquiries accurately, consistently, and professionally Service I Helps callers and in?person clients complete applications Representative I Documents activity in WES (CSR) I Escalates issues as needed for prompt resolution Mailroom Lead I Receives, sorts, and logs incoming mail for the CSC I Performs data entry of imaged documents into WES and meets quality standards I Distributes internal mail and documents to the appropriate staff I Maintains security and control over mailroom equipment Mailroom I Receives, sorts, and logs incoming mail Specialist I Performs data entry of imaged documents into WES and meets quality standards I Reviews correspondence for accuracy and completeness Exhibit 3.8-2: MAXIMUS Staff Roles and Responsibilities. By having each sta? member understand his or her role, we hello all members of the team appreciate how they contribute to a well??tnctioning project. We will notify the Agency in advance of any planned key personnel changes or reassignment. Within the boundaries of our control, we will not remove personnel whose names and resumes are submitted in the proposal without Agency approval. If one of our key personnel resigns or is terminated, we will immediately notify the Agency of the vacancy, the reason for the vacancy, and an action plan for back?lling the position until a replacement is found and approved. 3.8.6 Subcontractor Staff RFP Section 7.1.1 .10.8.6, page 51 As discussed in Section 3.7, MAXIMUS will not be using subcontractors in this project. 3.9 Hiring Process RFP Section 7.1.1.103. page 51,sow Appendix A, 5151,5152 MAXIMUS recruitment methods identify job candidates most likely to represent a good ?t for our customer service centers and application support operations, combined with thorough new- hire and refresher training to support high-quality customer service. Exhibit 3. 9-1 shows the steps we take to identify and hire talented individuals for programs such as the CSC. 3. Proposer's Background and Experience RF #0175-Al 44 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 49 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Step I: Need . Identify the recntitrnent need based on contractual requirements and perfonuance and qualin goals Step 2: . Adi crtise job positions intemall) and cxtemall) ia the interact. one-stops. and local Recrum ?g community -based organimtioas S: mag. (35 . Target advertising for special skills such as bi lingual capabilities - Develop job d?cription for all positions - Develop speci?c qualification let eis for each position - Comider prior uork experience. requirements. and education - Human Resources Recruitment Team rev-lens and screens all resumes . Develop speci?c screening criteria for each staff position uith preference given to those tvith prior relet ant experience . Reject resumes that do not meet minimum screening criteria . Send a rejection letter to each candidate hose resume does not meet initial screening criteria Receive and Screen Resumes - Schedule intcn ice 5 it It appropriate candidates . Applicants complete pie-employment application packers . Conduct screening inten lens/tests to marsure candidate aptitude skills l?te? ltitet\ . Conduct filial intervieus with Human Resources and appropriate department manager . Rate candidates using skills inten icu ing criteria - Require intervieu to provide rating and hiring recommendation - Complete ?nal hiring recommendation form that includes potential start date and salary - Program Manager approt es hiring decision Step 6: Final lnten rev. Process - Ask all candidates recommended for employ meal to prov ide supert isor} references from their last three employers . Human Resources Recruitment Team is responsible for coordinating reference Develop a reference checklist so that certain critical questions are asked - All candidates sign a release allou ing a criminal histoq reference check . Conduct criminal luster} and reference checks. a critical actit it}. particulariv on programs where stalfuork directly uith the general public . Positions are not offered to candidates convicted of a felorn im oiving illegal gain or use of government funds. grants. contracts. or Medicaid or Medicare monies; or convicted of embezzlement. tvire fraud. mail fraud. or securities iolation Step 7: Reference and ("nmrnal listott ("hacks - Offer letters sent to final candidates on completion of reference checks and cnnunal luster} checks - Offer letterincludes candidate's title. job description. starting salary. repon date. reporting location. and training schedule . Offer letter includes basic infonnation conceming the bene?ts package - All candidates are asked to sign and retum the offer letter as acceptance of the terms and conditions presented Exhibit MAXIM US Recruitment Process. Our de?ned process helps us ?nd the right sta?? for the CSC. Step it: Send {?andidatc Offer Letters art 3. Proposer's Background and Experience RFP 45 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 50 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS When implementing our Kansas Child Support Call Center in 2015, we faced competition from nearby call centers for good CSRs. In response, we shifted our recruitment focus from call center workers to customer service workers. By hiring staff who have successfully served customers face-to-face in industries such as retail, food service, or hospitality, we found CSRs who already had excellent customer service skills. We found it is far easier to teach staff with strong customer service skills how to work in a call center than it is to teach call center workers to provide excellent customer service. As a corporate practice, upon completion of our interview process and testing, we conduct national criminal history background checks on each successful applicant prior to allowing the individual to begin work. Any individual who will have on-site or remote access to the program will be subject to a background check. We will not give any staff member a security badge or card-key access unless they successfully pass the background check, and will notify the Agency of any background checks for potential employees when ?ndings are uncovered. We invest in our staff to develop their skills and abilities. Before staff can perform project tasks, they must undergo training. Our comprehensive, innovative training strategy is performance- based: that is, our strategy focuses not only on knowledge acquisition, but also on the application of that knowledge in a speci?c business context. Performance-based training focuses on speci?c outcomes, and then sets expectations, provides feedback, introduces tools and skill development, and teaches new skills and knowledge all aimed at supporting behavior that produces the desired outcome. It is designed, delivered, and continually improved to support our staff as they perform the services needed by the Agency. We provide additional detail about our staff training in Section 4: Approach to Transition and Section 5 Approach to Operations. 3.10 Staff Retention RFP Section 7.1.1.1010. page 51 A well-designed hiring strategy for the CSC is only as effective as the policies that are in place to retain employees. The MAXIMUS hiring philosophy focuses not only on attracting and hiring quali?ed personnel, but also on keeping them with us throughout the life of the project as a means of preserving valuable ?rst-hand knowledge and experience. To retain our highly trained staff, our supervisors and managers strive to create an environment in which excellence is the norm, quality is the focus, and partnership?both internally and with external stakeholders?is the standard. Understanding the importance of staff retention, we maintain initiatives aimed at increasing retention, such as training supervisors and managers on behavioral interviewing techniques. For example, we have worked to increase our rate of successful hires via interview training, staf?ng agency partnerjob previews, supervisory training, and competency and corresponding career path development for all job families. We also compensate staff using a salary structure that rewards performance and acquired skill sets, and is competitive in the marketplace. Retention is a critical business concern, because attrition results in turnover costs and satisfaction is greater when customers are working with an experienced CSR. Morale is higher in a stable work environment. We implement a multi-pronged approach to create a positive work environment, which minimizes staff turnover. This approach includes opportunities for advancement, continuous training, performance incentives, competitive compensation, personal 3. Proposer's Background and Experience RFP 46 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 51 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS and group recognition, a pleasant work enviromnent, options for both open door and formal grievance processes, and activities to encourage team bonding and a community atmosphere. Employees have multiple opportunities for personal and professional growth with MAXIMUS. We offer continuous training through our Center for Employee Development, employees have opportunities to rotate to new positions and compete for promotions, and management staff may attend meetings and seminars in their ?eld of interest. MAXIMUS also offers educational assistance to employees seeking degrees in higher education. We use a variety of tactics to help retain highly quali?ed project staff: I Instituting behavioral interviewing techniques to identify individuals with the skills and temperament to provide the kind of quality customer service our clients expect Enhancing skills screening to identify stronger "fits" for promotion among line staff Ensuring overall staf?ng levels prevent staff bum-out from excessive work loads Con?rming salaries are aligned with industry standards Awarding employee incentives and performance bonuses Developing competency-based position descriptions that match the requirements of the position and using them as tools during the interviewing process Establishing a leadership development program and a strong career path for staff I Promoting employee success by: Clearly stating thejob expectations and responsibilities throughout the recruitment and hiring process Furnishing all necessary knowledge and tools Employing recognition and reward programs De?ning career pathways through competencies and ladders I Creating a respectful and productive work environment by: Providing regular communication on policy or procedure updates Using team-building activities to increase trust between employees and project leadership - Offering opportunities for professional growth MAXIMUS values the knowledge and experience of the current CSC staff and intends to retain all incumbent staff who are interested in staying with the project, subject to the Agency's approval. The people who staff the current CSC are friends and neighbors of the people they are helping through the CSC, and we want to maintain that sense of community, which can truly be felt in a state such as Wyoming, as we implement proven new solutions to support customers in a way that delivers cost containment to the State. 3. Proposer's Background and Experience RF 47 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 52 of 185 SECTION 4: APPROACH TO TRANSITION APPROACH TO TRANSITION Attachment to the Infunnatlon Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 53 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 4. Approach to Transition MAXIMUS has met transition and start-up timelines for every health services project we have implemented. The Agency can rely on us to provide a detailed Transition Plan tied directly to your scope of work and embodying industry standards and best practices. Our proven project management methodology, in-depth knowledge of health contact center services, and experienced transition team position us to anticipate and mitigate risks, facilitating a seamless transition to the new contract. RFP Section 7.1.1.11, page 51 We understand that the Agency seeks to improve the quality of its customer service by delivering faster, effective responses to customer inquiries through a specialized Customer Service Center (CSC). Embarking upon a new era in CSC operations can be a daunting task, but it offers an opportunity for the Agency to use an updated, innovative approach to providing Wyoming's citizens with services. This is also an opportunity for the Agency to implement forward-thinking strategies to meet CSC needs today, while preparing for future challenges, ensuring cost containment, and saving taxpayer dollars. Making a decision to transition from the current contractor to a new one inherently involves some risk, but that risk is reduced considerably when the incoming contractor has signi?cant practical experience in managing all aspects of transitioning customer service center projects of a similar nature, using proven technology, innovative solutions, and an experienced team. As MAXIMU will demonstrate, our combination of experience and careful planning offers a clear path to a successful transition for CSC operations. Throughout this section, we discuss our ability and commitment to avoid any disruption in service to Wyoming customers during the transition period. Our strategy includes: Comprehensive planning Communications protocols Monitoring and tracking of all transition activities Using state-of-the-art technology for all technical systems Thorough testing prior to go-live to ensure a smooth transition We have crafted our implementation plan in a way that not only ensures compliance with existing requirements and timelines, but also provides new strategies to enhance operations today and address emerging needs as Wyoming implements an enhanced CSC. The Agency has ultimate responsibility for ensuring that CSC services continue during a change in contractors. By choosing MAXIMUS as your contractor, the Agency has a partner that has successfully transitioned and implemented customer service centers that assist health and human services populations since 1991. We deliver an outstanding Transition Team with multiple, complex transitions to their credit, including statewide call centers for Kansas and Missouri in the last six months. Our Transition Team offers their expertise, best practices, and unparalleled understanding of what it takes to transition-in without service interruption for Agency customers. Through their hands-on work on health projects, our team has a deep understanding of why customers call the CSC. They will bring these insights to project staff and train them to respond to customers with respect and understanding. 4. Approach to Transition RF 48 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 54 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center We demonstrate our ability to successfully implement and transition complex projects within aggressive timeframes in Exhibit 4-1. Project Location and pc cu Project or 'I'runsition Dale of Operations I Implementation! 'I'rnnsilion in \Ionths Missouri Statewide Contact Center Transition January 2016 2 Kansas Statewide Contact Center Transition October 2015 2 West Virginia Enrollment Broker Transition June 2015 2 Connecticut Health Insurance Exchange Contact New Project August 2013 2 Center Maryland Health Bene?t Exchange - Contact Center New Project August 2013 2 Hawai'i Health Insurance Exchange Contact Center New Project September 2013 3 DC Health Insurance Exchange Contact Center New Project September 2013 2 New York State of Health Customer Service Center New Project October 2013 3 Vermont Health Connect Contact Center New Project September 2013 5 Illinois Enrollment Broker Contact Center New Project February 2013 3 Louisiana Enrollment Broker Contact Center Transition December 201 2 Colorado Eligibility and Enrollment Modernization New Project October 2010 3 New York Enrollment Center Transition December 2010 3 Enrollment Broker Contact Center New Project December 2010 2.5 Texas Eligibility Support Services Project Transition January 2011 2 Enrollment Assistance Program Transition April 2009 3 Exhibit 4-1: Successful Past Implementations and Transitions. MAXIMUS has the proven ability to transition projects within de?ned timeframes, as evidenced by just a few of our projects shown here. While all implementations may present challenges, we have dealt with them in a way that has enhanced our relationships with our state customers, as well as external stakeholders with strong ties to the affected programs. Our experience makes us fully able to identify, address, and implement solutions for the future needs of the Agency, brought about by the ever-changing health care arena. 4.1 Approach to Start-up RFP Section 7.1.1.11.1, page 51,sow Appendix A, 5002, 5003, 5004,5005, 5005. 5007. 5003, 5009, 5010, 5011,5167, 5168 MAXIMUS implements a standardized, disciplined approach to meeting the requirements of the Project Plan, including quality management, issue and risk management, communication, regularly scheduled meetings, and continuous monitoring and improvement. Our Project Plan, including the Transition Plan, lays out a detailed and organized approach to both the transition and ongoing operations. The experienced Transition Team establishes a rigorous precedent, managing closely to the Project Plan and implementing solid management controls. The ongoing project team then continues to adhere to these controls and emphasizes responsibility and communication throughout the contract term. 4. Approach to Transition RFP #0175-Al 49 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 55 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS MAXIMUS adheres to the Project Management Body of Knowledge ,2 mm methodology and standards established by the Project Management Institute (PMI) for .. . . . PROJECT MANAGEMENT developing detailed Project Plans that guide the transition and BODY OF implementation of our prejects. We currently employ more (PMBOK GUIDE) than 100 project managers with Project Management Professional Certification. Employing staff with this level of expertise demonstrates our commitment to hiring staff who have established their experience, education, and competency to lead projects. Although our methodology is grounded in best practices and We follow the PMBOK industry-accepted management standards, we recognize that method of pr0ject the Agency has unique requirements for the CSC and our management, combined with approach has been tailored to meet your needs. Throughout our own best practices the contract period, we will review the management methods established throughout our and business practices described in our Project Plan for the 40 years of successfully CSC to ensure alignment with the Agency's needs as part of Operating prOjectS for our continuous business process improvement activities. government clients. PMBOK principles tailored to the CSC's requirements include the following: I Named key personnel and senior managers who are immediately available for the CSC project, and who are experienced in standing up, operating, and monitoring customer service center projects of similar size and scope for state government clients I A Transition Team that is linked to corporate support to help ensure that we have the right mix of staff and resources to meet all timelines, milestones, deliverables, and performance requirements during the transition phase I Properly-sized timelines and task-durations that allow for adequate infrastructure development, recruiting and hiring of CSC staff, training and certi?cation, and connectivity to Agency systems I Built-in risk management planning to identify and plan for potential risks, implementing mitigation strategies and plans well ahead of a risk materializing I A philosophy of transparency with the Agency throughout transition and ongoing operations so that we openly discuss and jointly solve issues I A clearly written understanding of the project scope, timelines, and expectations so that both the Agency and MAXIMUS manage to the same expectations We also follow quality management standards established by the International Organization for Standardization (ISO 9001) to de?ne and document all functions as repeatable processes, decrease variability through business process improvement, and reduce human error. Our expertise in applying best practice standards and methods, paired with our command and use of business process management (BPM) methods and tools, gives us the flexibility to manage and rapidly respond to the changes expected during the transition and operation of a large-scale program such as the CSC. We consistently document and revisit our best practices as we continue to grow and improve our business processes. 4. Approach to Transition RF 50 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of HeaIthcare Financing and Maximus Health Services. Inc. Page 56 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS As a testament to our business process improvement strategies, MAXIMUS won one of ?ve Gartner Business Process Management Excellence Awards and was named the Project/Program of the Year" in March 2011. Ten of our centers are ISO-9001 certi?ed and 14 have earned designation as a Benchmark Portal Center of Excellence. We will tailor our project start-up and transition approach for the CSC so that we implement disciplined and well-managed business processes and deliver services to Wyoming residents in a quality and timely manner. The right mix of planning, monitoring, and management can make the difference in completing a project on time, on budget, and with high quality results. The Wyoming Department of Health, Division of Healthcare Financing (Agency) needs a vendor with a tested project management methodology and standards-based approach, along with the tools and processes to achieve the desired results. Core Transition Management Components Effective management of resources includes a competent and responsible top-down management and a thorough understanding of the project, as well as clear communication with the Agency. Our approach to transition management consists of core components, each designed to keep the project on track, help ensure project requirements are met, and ultimately move the project towards successful completion: I Ready Access to the MAXIMUS Implementation Manager: The Agency will have ready access to our Implementation Manager at all times and will be able to communicate on the spot to obtain fast answers to questions and concerns. in addition, we will inform the incumbent and key stakeholders regularly about project progress through in~person debrie?ng meetings and reports. We take pride in demonstrating urgency in addressing concerns and issues I Ready Access to MAXIMUS Corporate Management: If necessary, Agency representatives may speak directly to executive management to discuss any concerns about the project. Our Implementation Manager reports to the MAXIMUS Vice President of Operations during the transition period, and can call upon additional corporate resources as necessary to secure the success of our efforts. I Detailed Up-Front Project Planning: We subscribe to the axiom that failing to plan is planning to fail. We created a detailed draft Transition Plan to accurately estimate and staff this project, outlining all phases, tasks, activities, assignments, and deliverables. Upon contract award, we will update this Plan with Agency input. This establishes a baseline for the project scope and identifies the complementary roles each stakeholder will play. Our plans also include complete lists and descriptions of deliverables, as well as staf?ng schedules that re?ect the day-to~day commitments of all project personnel. For each deliverable, we include a summary document containing a description of its format and content. We will work with the Agency to determine Agency Deliverable review times and we acknowledge that the Agency will return comments and hold a meeting to discuss comments and issues related to the deliverable. We take steps to ensure all project staff have a complete understanding of all the plans and schedules. We then use the plan as a baseline against which we report progress. 4. Approach to Transition RFP 51 P23OOI.OO60 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 57 of 135 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I High Quality Products and Services: The Agency rightfully expects to receive the highest quality products and services available. It is imperative that project team members and client staff understand what is expected and how the products are evaluated. Each major deliverable has a designated senior staff member responsible for sign-off prior to submission. Our tested methods allow us to focus on the unique aspects of getting the work accomplished. I Effective Budgeting and Cost Control: Inadequate attention to the budget can pose serious obstacles to effective transition management. If the available resources are not applied carefully, the Agency will not receive the best possible products and services for their investment. Project and corporate finance teams monitor project forecasts examining forecast variances closely to understand the root cause and take appropriate actions to help ensure projects stay within timelines, budgets, and quality expectations. An essential part of budget control is scope control. We institute a scope control mechanism as part of our transition management responsibilities. We continually review the scope of work to ensure that all entities remain focused on the objectives of the project. We immediately notify the Agency of any potential scope changes and determine the most effective approach to address the scope change. I Responsiveness to Agency Concerns: The Agency expects our management team to respond immediately to concerns about the project and you expect our response to be constructive and effective in resolving the problem. MAXIMUS provides an extensive depth and range of experience in risk and issue management to provide the Agency with a confidence level that is unmatched by our competitors. We not only view responsiveness to Agency concerns as a commitment to service excellence, but also to ful?lling contractual responsibilities with the highest level of quality. While we will hold regularly scheduled meetings with the Agency, and provide reports to document performance and quality, the CSC Account Manager will be directly available to WHD should any questions or concerns arise. As we continually monitor our own performance, service quality, and progress to meet performance standards and contractual metrics, we are fully prepared to readily address any concerns that the Agency may have. Knowledgeable and Skilled Transition Team Our Transition Team will manage subtasks related to facility support, technology, staff recruitment and training, and standard operating procedure development. Our Transition Team members bring knowledge of best practices and strategies to implement the project success?illy and on time. These professionals understand the Agency's mission and vision for helping customers receiving services. They bring their experience and knowledge to implementing a CSC that uses best practices for innovation, technology, and ability to manage the call center effectively. This Transition Team has the expertise to make certain that the CSC is implemented on time and with excellent customer service on the Go-Live date. Our Transition Team includes support in all aspects, from overall coordination to IT to hiring, as shown in Exhibit 4. Approach to Transition RFP 75-Al 52 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 58 of 185 Wyoming Department of Health. ofHealthcare Fmancmg Wyoming Department of Health Customer Servrce Center I - Resouru far'i nutrition Period 0an? - Ongoing CSC Project Resource l?rth't'l l? u-t'ulru' [l J. \qungt'r in MAXIMUS Qualit} and link I mil it:p; I- mm mg I .rnugt'rs l-i' lil/llh [in lulu-t I mm l?ulit?im l?rou?timm I t-ud ix 2 .. linen-it. nc lluslnuu 1 ad 1. Rb?! lilpultin: huh I .lli K- I Spur. I .Ilnh (IN .l '1 (unwilling -- I'nliu \ltalisl liim?utimn lunngu \l P: Ir Lmlullun mil li-gtln'lm nil Supt mm minim-r Mn In- cprut'nlal \l:m rl.l ? .rnll I out! \lulir mun \luilt'lmm .?r-Jlt I'a Eu it? :m 1 tall II 3. mt! 51.. ll Iiil) Solutions 1 mi .: Sulutuun mt Exhibit The MAXIMUS Transition Team. MAXIMUS has a dedicated cross?mcriona! Transition Team. .rlrategicaily organized ro?zcr?lirate and problem resolution. 4 Approach to Transition P23001.0060 March 25.2016 RFP 53 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Heelthcare Financing and Maximus Health Services. Inc. Page 59 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Exhibit 4.1-2 describes the depth of our organization's resources focused on supporting the Agency's needs during implementation. Key staff positions are marked with this symbol: 0-'r Role/Milne Transition Responsibilities Project Executive Benjamin Coss Implementation Manager Brandon Goad CSC Account Manager Jeremy Morgan 0?7 Consulting Policy Analyst Jan Ruff Operations Manager Muna Pirrin 0?1- Technology Solution Lead Eric Hicks Software Lead Dhiraj Katri Infrastructure Lead Shawn Dalton 4. Approach to Transition P23001.0060 March 25, 2016 Provides oversight to ensure project is on track for a timely transition Keeps corporate executives apprised of progress Oversees development of strategies to monitor performance and other operational deliverables Updates and manages the Transition Plan according to PMBOK methodology Manages all activities with assigned personnel Responsible for all transition phase deliverables Reports on transition activity status daily to all stakeholders Develops and implements strategies and processes for monitoring performance Develops new andi?or updates standard operating procedures Oversees new staff recruitment, hiring, and training Serves as implementation liaison to the Agency Provides subj ect-matter expertise Assists with identifying business processes for implementing statewide performance drivers Provides leadership on how policies a?'ect operations Executes strategies to ensure transition performance targets are met Oversees development of internal policies and procedures, work instructions,job aids, and other reference materials to meet operational requirements and assist staff in performing their work Directs and approves hiring and training of staff Directs the design, development, and implementation of project technology Oversees system testing in accordance with RFP requirements in advance of deployment Works with Agency staff, WES contractor, and third parties to establish reliable interfaces between systems Ensures that all project technology milestones are delivered on time in accordance with Agency and RFP requirements Designs and directs overall technology solution implementation Provides IT resources to the project Oversees modi?cations to required software, including CRM and KMS Manages team responsible for modi?cations to required so?ware, including CRM and KMS Manages testing and deployment of software including CRM and KMS Coordinates installation of local area network, servers, cabling, equipment, and computers Coordinates installation of data and telephone lines Coordinates design and deployment of IVR, ACD, and telephony Coordinates installation of hosting, storage, and backup of systems and data Tests and monitors the data network for connectivity to the internet, Agency systems, and hosted applications RFP #0175-Al54 Attachment to the Information Technology (lT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 60 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Role-"Name 'l'rnnsition Responsibilities IT Help Desk and I Provides information technology and telecommunications support to our operations Desktop Support staff, handling all IT-related issues and ensuring we meet all contract requirements for Lead technology implementation Matt Amstam I Manages Help Desk to troubleshoot and resolve technical problems I Improves ef?ciency and effectiveness of operations IT Specialist I Works with corporate IT resources to design and implement network delivery to meet business objectives TBD I Provides design documentation as it re?ects implementation Develops troubleshooting guidelines for operation support I Acts as on-the-ground resource to ensure all technology is operational Designs needed digital solutions, including email and webchat Coordinates implementation of all digital solutions in collaboration with other IT and operational resources and ensures they are ?Jnctioning properly Training Lead I As a member of the MAXIMUS Center for Employee Development, strengthens our Derek Parker capability to deliver relevant, high-impact training to our staff I Supports CSC Training Manager with training design and delivery I Con?rms that new staff receives appropriate training in person or through MAXIMUS University web portal Develops training materials in collaboration with the Agency Digital Solutions Lead Sarah Overcash Training Manager Craig Sanders I Finalizes training modules and course instructional materials Rashele Wiltzius I Delivers and tracks staff training Quality and Risk I Assures con?dentiality, integrity, access, and availability of business resources Management Lead I Ensures overall solution for physical security, emergency preparedness, information security, data privacy, compliance, IT audit, and incidents and investigations Manager I Works with the Agency and the Business intelligence and Reporting team to ?nalize QA procedures, reporting mechanisms, and systems to help ensure that all service level metrics and other key performance indicators are monitored I Establishes procedures for storing and maintaining training materials and other reference documents in the Knowledge Management System Privacy Lead I Maintains responsibility for the development and implementation of policies, Greg Gottainer procedures, and practices according to HIPAA Privacy and Security Rules I Reviews privacy risk of new contracts and changes, establishing privacy policies and procedures, and training programs I Coordinates with project staff and the State to ensure that HIPAA privacy and security standards are maintained I Communicates with client privacy o?icials and federal agencies Security Lead I Maintains responsibility for the development and implementation of policies, Bob Burkhart procedures, and practices to provide information security according to HIPAA Privacy and Security Rules I Develops actions to monitor information security policies, procedures, and practices to guarantee that they are upheld I Coordinates with project staff and the State to ensure that HIPAA privacy and security standards are maintained 4. Approach to Transition RF 55 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 61 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Rnlei'Nanle 'l?rnnsition Responsibilities Human Capital Lead John Viera Facilities Lead Walt Stone Business Intelligence Lead Ann Russo Reporting Analyst Brendon Scharf 0-1 Policy and Procedures Lead Shelly Schoen-Rene KMS Lead Eligibility Solution Lead Materials and Document Lead Open Issues Handoff Lead 4. Approach to Transition P23001.0060 March 25, 2016 Directs recruitment and hiring efforts to ensure compliance with MAXIMUS policies, contract, and federal and state laws Ensures compliance with EEO and ADA requirements Manages the interface with Bartech, our staf?ng agency Coordinates with the Networkfl?elecom Lead to obtain required system access and create logins/passwords for all new hires Finalizes the leasing agreement and supervises build-out activities and installation of furniture and equipment Coordinates with the Network/Telecom Lead and Agency staff to facilitate cabling for data and telephone lines and to meet all required security and safety regulations Manages vendors to ensure product quality and competitive pricing for our procurement of fumiture, of?ce supplies, and of?ce equipment. Implements operational best practices across key business functions, including contact center, data entry, mailroom, and document management Evaluates workload, performance, and processes to optimize throughput and responsiveness Develops the DecisionPoint for Business IntelligenceTM reporting and analytics package that we will implement for Wyoming Ensures that all reports and dashboards are developed, designed, and deployed per client requirements Implements operational best practices across key business functions, including contact center, data entry, mailroom, and document management Develops the DecisionPoint for Business IntelligenceTM reporting and analytics package that we will implement for Wyoming Supports project staff with requests for ad hoc reports Works with the Agency to establish connectivity and use of reporting and performance monitoring systems and tools, including the ACD, CRM, and knowledge management systems Develops and documents internal policies and procedures, work instructions,job aids, and other reference materials to meet operational requirements and assist staff in performing their work Populates Knowledge Management System with all required documents, including policies and procedures, work instructions,job aids, call scripts, CRM and WES guides, notices, and other reference materials Worl$ with the CSC Account Manager, Operations Manager, Technology Solution Lead, and Consulting Policy Analyst to ensure business processes, reporting mechanisms, and systems properly support program eligibility rules and regulations Works with Training Lead to ensure training modules and materials properly explain program eligibility rules and regulations Develops and implements processes, equipment, and systems for handling of incoming and outgoing mail Works with the Agency, incumbent vendor, and Operations Manager to transition any open issues, including work in progress and client complaints, to ensure these are properly accounted for and handed off RFP #0175-Al56 Attachment to the Information Technology (IT) Contract between the State of VWoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 62 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Rolct'Namc 'l?ransition Responsibilities Mailroom Lead I Works with the Agency, the incumbent vendor, and Operations Manager to transition Michelle Munoz mailroom tasks I Sets up mailroom systems, work processes, and technologies Exhibit 4.1-2: MAXIMUS Transition Roles and Responsibilities. has a dedicated cross-?mctional Transition Team to manage the wide range of activities required for a success?il hando?? to a new contract without disrupting services to customers. Clearly defined roles and responsibilities support accountability for all tasks, while our extensive resources provide ?ill support to the project team during transition and for 30 to 60 days after go-live, to make sure operations are stable. Corporate Transition Support Unlike smaller contractors, MAXIMUS already has an established, proven corporate infrastructure to fully support the Wyoming implementation from day one of the contract. We commit to providing staff from our corporate teams to assist our Transition Team and to provide the level of resources and responsiveness the Agency requires in critical support areas. Project Kick-Off Meeting To maximize communication, coordination, and transparency, MAXIMUS will hold a kick-off meeting with the Agency. We will work with the Agency to determine the optimal date, time, and location of the meeting to facilitate participation among key stakeholders and will prepare materials for the meeting. We follow our corporate guidelines, as outlined in PMBOK, Implementation and Project Management manuals, and Agency requirements for conducting the meeting. During the kick- off, we establish all project and contract documentation, tools, plans, and resources needed to success?slly transition the CSC. Speci?cally, we: Introduce project teams and stakeholders and de?ne their roles and responsibilities Determine the format and protocol for project status meetings and reporting De?ne lines of communication and reporting relationships Review the project mission and guiding principles Review the deliverable review process Discuss high-risk problem areas and strategies for mitigation Describe the proposed issue resolution process Finalize the project schedule and milestones Schedule related meetings to discuss aspects of the project management artifacts that need to be implemented immediately to support project management and implementation activities MAXIMUS will also provide meeting minutes and regular status reports throughout the transition. Comprehensive Project Plan By the due date, we will deliver a comprehensive Project Plan to the State Project Manager; the Plan describes our integrated approach, methods, and tools for monitoring CSC tasks throughout all phases of the project. It describes our use of management and ?nancial controls designed to ensure that contractual requirements are met, necessary project tasks and resources are identi?ed. progress occurs as scheduled, risks are averted or managed to reduce their impact, and accountability at all levels is enforced. It also identi?es key tasks to be performed throughout the project transition, the estimated duration for each task, assigned resources needed to complete 4. Approach to Transition RFP 57 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 63 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS each task, the predecessors or dependencies between tasks, and resources required from management, employees, and operational groups. We use the Gantt chart within our Project Plan to document, track, monitor, and report on our progress during all phases of the project. The Gantt chart is a dynamic document that we update regularly to re?ect changes and deliverables; we generate status reports based on the information contained in it. In addition to the Gantt chart, we produce a number of key reports, including Critical Path and Resource Usage reports, using Microsoft Project. We work closely with the Agency to produce required deliverables and reports that are meaningful and useful in documenting the status of all project transition tasks. Immediately following contract signing, our Implementation Manager meets with Agency staff to discuss and coordinate start-up activities. The Implementation Manager provides effective oversight for all aspects of our proposed approach, start-up, and transition activities. We leverage our extensive knowledge of healthcare programs and our experience in transitioning and implementing operational projects and systems to understand that coordination is required with the incumbent Contractor, and that there are key aspects of the project that are interrelated and must occur in a defined sequence. Issue and risk management are key components to reducing risk and increasing the efficiency of start-up and transition management; we know the importance of a smooth transition, which can influence how others perceive the program. As de?ned by RF Appendix Deliverables, we will complete the following deliverables during the start-up period. July 1 I, 2016: Updates made within 3 business days of receipt of request, unless otherwise determined by the Agency. Project Plan Project Kick Off Meeting Held no more than 5 business days after the Contract effective date. Project and Contract Management July I 1, 2016: Updates made within 3 business days of receipt of request, Tools, Plans, and Resources unless otherwise determined by the Agency. Establish Change Control Procedures July 11, 2016: Updates made within 3 business days of receipt of request, unless otherwise determined by the Agency. 4.2 Ensuring Timely Implementation RFP Section 7.1.1.112, page 51. SOW Appendix A, 5020,5021 MAXIMUS works closely with all stakeholders to ensure a timely transition and that all scope of work requirements are met. Our well-de?ned review process ensures timely submission and approval of all work products. Our approach includes the specific controls, methods, techniques, and tools to manage project deliverables, and monitor and complete all data conversion activities. Our process is mature and allows us to focus on the unique aspects of getting the work accomplished on schedule. A master deliverables list tracks all active, retired, and completed project deliverables. The list captures the name and ID of each deliverable, the deliverable standard, and the deliverable business owner, as well as the frequency of submission. We update the list as the team receives changes and additions to deliverables. The team continues to monitor and track all contract deliverables throughout the life of the contract. 4. Approach to Transition RF 58 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 64 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS As the WES is the system of record, we will not need to convert data in the WES. We intend to populate our CRM with certain WES data to facilitate call handling. We propose to do that by uploading a ?at ?le from the WES contractor that would contain basic case ?le information, such as name, address, account number, and PIN or other authorization ?eld data. Depending on the Agency's wishes for how to support client self-service through the IVR, this ?at ?le could be the same that we receive for use in the IVR. To ensure timely implementation of all tools that we will use in the CSC, we use the same PMBOK-based approach that drives our overall transition: assigning tasks and tracking progress. For example, our Technology Solution Lead will direct the design and implementation of all technology used in the CSC, from the CRM to email. Our Draft Transition Plan and Gantt chart, discussed below in Section 4.5, includes every task associated with deploying every tool; owners of each task manage the daily progress, while the Technology Solution Lead signs off on milestones such as User Acceptance Testing. The Implementation Manager acts as a ?nal checkpoint; we escalate and assign additional resources to any task not on track to meet its deadline. 4.3 Staff Training During Transition RFP Section 7.1.1.113, page 52, sow Appendix A. 5030, 5150, 5153, 5176, 5177, 5179, 5180. 5102, 5183, 5184. 5185, 5186, 5107 Immediately upon Noti?cation to Proceed, we will develop a detailed Training Plan for the CSC, which we will submit to the Agency for approval, and which we will implement in time to fully train our staff by the go-live date. The Plan will include schedules and curricula outlines, scoring tools, a database to track training completions, and all other items required in the RFP. We will develop all training materials to help staff perform all day-to-day responsibilities. During the early days of the transition phase, we ?nalize CSC modules, the training calendar, and all training materials. We will locate facilities with adequate equipment and space to provide all levels of training, including systems training. We will coordinate with the Agency for optimal ef?ciency and for making certain all staff receives required training. Our training approach includes assembling, re?ning, and tailoring our curriculum to include a combination of Agency information processes designed to give our employees the skills to perform their tasks ef?ciently and with a constant orientation to Agency needs and expectations. We also include modules related to MAXIMU standards and expectations, and business processes. We train all staff on relevant federal and state laws, policies, and procedures, as well as our operations, systems, tools, job-related duties and functions, and soft skills and business etiquette. We create a project-speci?c Procedures Manual for training staff, and implement personnel administration policies that re?ect state and federal policies, standards, and regulations. We continuously improve our training using the feedback we receive through our quality assurance processes, customer surveys, and other 2 channels to address gaps and plan for future needs. Our comprehensive, innovative training is performance-based; that is, we focus not only on the mere acquisition of knowledge, but also on how our staff will apply that knowledge in a speci?c business context, like the CSC. This increases the ability of our employees to effectively serve customers. Exhibit 4. summarizes the core elements of our Training Plan. 4. Approach to Transition RF 59 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Heatth Services, Inc. Page 65 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS ('ompreliensiw 'l?raining Plan Strategy Training Needs Project Requirements Change in Policy or Procedures Identification Audience Analysis Quality Assurance Monitoring Performance Standards Periodic Refresher Training Delivery Instructor-led Training On-the-Job Training Web and Computer-based Training Job Shadowing and Mentoring Goal-based Scenarios and Role Plays Coaching Resources Corporate Learning Management System Center for Employee Development Department Subject-Matter Experts Center for Health Literacy MAXIMUS SMEs Desk Reference Guides Knowledge Management System Administration Performance Oversight Training Database and Tracking Contract Standards Curriculum/Course Assignment Monitoring and Feedback Assessments Quality Assurance Results Completion Tracking and Reporting Feedback from Advisory Groups Rewards and Recognition Train?mg Evaluations Exhibit Comprehensive Training Plan Strategy. Our ??aining Plan incorporates needs identification, delivery, resources, and administration of our training program, which thoroughly prepares each 54!anr member to help CSC customers. 4.3.1 Performance-Based Training Approach We invest in our staff to develop their skills and abilities. Performance-based training focuses on specific outcomes, and then sets expectations, provides feedback, introduces tools and skill development, and teaches new skills and knowledge all aimed at supporting behavior that produces the desired outcome. Training is designed, delivered, and continually improved to support our staff as they perform the services needed by our clients and required by our contracts. All new employee trainings use an interactive learning approach. We use multiple instructional strategies and methods that result in staff gaining and retaining the highest levels of skill and knowledge. The typical course consists of trainer-led segments, role-playing, simulations, job shadowing, interactive exercises, demonstrations, and periodic quizzes and assessments. As our courses are founded on performance learning, we emphasize hands-on activities and minimize traditional lecture-heavy presentations. When appropriate, we use computer-based modules that staff can access from their desks for ongoing training. Learners must complete specific training and pass assessments to begin performing their job functions. In addition to the overall course test, the trainer conducts formal and informal assessments throughout the course to assess learning. Our initial training program for frontline staff includes our corporate new-employee orientation, core program training, CSC position- speci?c training, customer service training, and security training. 4.3.1.1 New Employee Orientation Training Our new employee orientation training includes: I Overview of the training curriculum 4. Approach to Transition RF 60 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 66 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS MAXIMUS history and mission Tour of the facility Introduction to the management team Emergency procedures I Overview of the project 4.3.1.2 Core Training Program All MAXIMUS staff hired to work at the CSC take our Core Training Program. The Core Training Program covers MAXIMUS policies, procedures, bene?ts, and culture. This series of courses conveys understanding of ethical business behavior and the importance of treating one another, as well as CSC customers, with respect. This foundational knowledge ensures that staff performs in a manner consistent with laws, policies, and a shared ethical framework. 4.3.1.3 Program-Speci?c Training Following core training, all project staff are required to take program-speci?c training. In addition to their speci?c topic eligibility services or customer support services we ensure that throughout this training, we educate staff on the sensitive nature of the con?dential information that they may handle as part of their job responsibilities. 4.3.1.4 Customer Service Training We teach program knowledge and processes, effective call management, and responsive customer service skills that are critical to the successful operation of the CSC. Speci?cally, the training includes: I Use of call scripts and our comprehensive MAXIMU Eligibility Playbook, documenting all policies and procedures for the Service Center I Required phone behavior including greeting, friendly tone of voice, active listening, and helpfulness Handling upset callers, non-English speaking callers, and callers with disabilities Promotion of use of self-service options for securing information Ful?llment of requests for materials Observation of CSRs taking calls Role-playing MAXIMUS also trains our staff to "think like a caseworker," which creates meaningful value for Agency staff and customers. Customers contacting our call centers report that 90 percent of the time, their questions are answered on the ?rst call. This is one re?ection of our staff?s ability and willingness to answer the immediate question as well as the next question a caller is likely to have. By thinking like a caseworker, our CSRs are working as advocates for the customer, helping them navigate a system that is unfamiliar and confusing by sharing their own expertise. Hiring and training staff who take a long-tenn view when serving customers may result in longer call times, but it can also keep down the volume of calls. 4.3.1.5 Security Training MAXIMUS regularly addresses the need for security awareness in our training. We educate all staff on security and con?dentiality policies, including HIPAA training; provide copies of all corporate, state, and federal program policies; and staff test on their acquired knowledge. The Security Training teaches staff to recognize and prevent potential information security breaches, 4. Approach to Transition RFP #Ol 75-A 6] .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Heaith. Division of Healthcare Financing and Maximus Health Services. Inc. Page 67 of 1 B5 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS to adhere to MAXIMUS security policy and procedures, and to immediately notify our corporate Security and Audit Team in the event of any suspected breach or incident. Network users are educated on proper password selection and use, to log out of their computer if they leave their desk, and to adhere to our "Clean Desk Policy" in which all hardcopy client information is stored in locked files or drawers unless the staff member is actively working a ?le. 4.3.2 Tracking Training Compliance and Success Our management team con?rms that all staff members have successfully completed their training and they monitor how successfully each staff member is applying their training, while providing feedback, coaching, and follow-up training to individuals and teams as needed. MAXIMUS University (MAXU), our web-based leaming management system, can schedule required courses, track course completion, tabulate and record test results, and administer course evaluations for MAXIMUS employees. Here, staff can register for courses, access and launch web-based self-study courses, and print or view their transcripts. We use this system to run reports and ensure employees meet course requirements and successfully complete all training requirements. Exhibit 4.3-2 shows a sample MAXU training record for an employee. pum??m Cour:- Disglav: 52L . In an Into-i 1101- rue Toll no: nu all nul- Vain It'- Ulri- g?ggf'mw' ?mm 0.00 0.00 100.00 Commend-Passed 1.00 4/23/2015 4:01:31 PM MAXIMUS Corporate Compliance M?uh?nmm (2015) 0.00 0.00 100.00 Completed Passed 1.00 4/23/2015 3.22.45 PM MAXIMUS Employee Disclosure (2015) 0.00 0.00 100.00 Commend-Passed 0.00 412312015 2:00:30 PM A?innadve Ac?onlEED Compliance: What Supervisors, Managers, and HR Need 00 0.00 0.00 100.00 Completed-Passed 0.20 4/23/2015 1:59:29 PM Know (2015 Raffle-her) Affirmative Action/EEO Compllonco: 2015 . . Rofruhor?l'raimng 0.00 0.00 100.00 Completed Passed 0.20 4/23/2015 1.27.52 PM MAXIMUS Corporate Compliance (2014) 0.00 0.00 100.00 Complemd passed 1.00 5/14/2014 12.53.34 PM ?d Eth'? 0.00 0.00 100.00 Completed-Fused 1.00 5/14/2014 11:49:54 AM mmus Eta-dove:- bison/511110014) 0.00 0.00 100.00 employed-Passed 0.00 5/14/2014 af?rm? 7mm? 0.00 0.00 100.00 Commend-Passed 0.50 4/29/2014 5:15:54 PM gm? m" 5?3 11 0.00 0.00 100.00 Commend-Passed 0.50 4/29/2014 4:40:03 pm 1:34 Exhibit 4.3-2: MAXIM US University Course Tracking. Our online Learning Management System keeps track of exactly which training employees complete, so we know when they need refresher training. Management can see who has jailed a course and needs extra help, such as coaching and more supervision, in order to succeed. All of our newly hired staff will be given the proper access to the WES and CSC systems after they have completed HIPAA training, and within 5 days of new hire training. We will provide all staff with annual refresher training on HIPAA and Security policies. 4. Approach to Transition RFP 62 P23001 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 68 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 4.3.3 Ongoing Staff Training A successful training program is not a one-time event. Ongoing staff training leads to exceptional service. Our supervisors continually assess performance and identify areas where staff needs additional training through evaluation of training effectiveness, on-the-job performance reviews, and initiatives for continuous improvement. We look to a variety of sources for our information, including questions asked and problems identi?ed by customer service staff, staff requests, quality assurance audits, and weekly meetings. Supervisors review changes to policy or procedure as needed and may provide quick training sessions. We hold all-staff trainings to ensure staff members are fully aware of changes in state policy and procedures. The management team discusses any other new material released by the State. If the topic is complex, training and management decide whether the training should be hands-on, in the classroom, or online. Training materials will serve as desk-reference guides. We will conduct ongoing testing to evaluate CSRs on policy and work?ow knowledge and will require a score of 85 percent or higher. We maintain training records via online access for Agency review for the full life of the contract and will submit a training report annually and after every training session. All staff must complete mandatory annual refresher training on speci?c topics such as business ethics, HIPAA, and security. We request feedback from staff on all trainings, constantly working to improve the content, delivery, and relevance of each training session. As with our CSC operations, we maintain an open door policy and invite Agency staff to observe our training. 4.4 Approach to Transition Requirements RFP Section 7.1.1.114. page 52 An orderly and controlled transition is in the best interest of Wyoming constituents served by the CSC, and we are committed to minimizing any disruption of services. The Agency's success carrying out a complex eligibility support services project is dependent upon having both a well- de?ned Project Work Plan as well as partnering with an organization that has in-depth experience implementing and providing eligibility support services to customers. By using MAXIMUS as your contractor, the Agency is choosing a partner with demonstrated experience successfully transitioning eligibility projects across the country. Our Project Plan is based on our knowledge and understanding of the complexity of the CSC project and our decades of experience with project transitions and complicated work plans. Through dozens of transitions, we have learned that success is maximized and risk minimized with a clearly de?ned approach tailored to Wyoming?s current environment (as-is state) and creating a plan to migrate to the desired environment (to-be state). An experienced Implementation Manager leads our transition process. The role of the Implementation Manager is to make sure the plan is adhered to, schedules are met, risks are identi?ed and mitigated, and a communication plan is developed and implemented. The Implementation Manager reports progress to MAXIMUS executive management, including the Senior Executive Leadership Team of MAXIMUS as necessary. Our goal is client satisfaction, and because customer service centers are one of our core competencies, positive results are critical to our brand. Our methodology includes standardized checklists, tools, manuals, communication reports, and forms, as well as a "lessons learned" library that we leverage through our internal SharePoint system. We deliver a proven solution for transition services that is backed by experienced staff, executive oversight, and quality assurance personnel. 4. Approach to Transition RFP 63 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 69 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS We document responsibilities and form cross-functional teams to ensure proper coordination and hand-offs. Status updates, delivered on a weekly basis at minimum, provide the latest assessment of each task and ensure communication across the team is maintained. We build checkpoints into the Transition Plan to evaluate and monitor risks and identify contingency plans to stay on track. Cross-trained resources are used to make certain that no single individual becomes a barrier. We track all key activities, timeframes, and dependencies across all project teams. Our individual teams also maintain detailed project plans to assign accountability of tasks to individuals. Our Implementation Manager evaluates the project plans weekly to ensure alignment with the key activities in the overall Transition Plan. We actively monitor quality by reviewing all deliverables for compliance with contract requirements, work plan deadlines, and federal and state regulations, as appropriate. We review work plan status and compliance for: Items jeopardizing key milestones Critical path item impact on completion deadlines Tasks at risk of not being completed on time Resource constraints and con?icts that couldjeopardize delivery Percentage of tasks completed accurately and on time Causes for missed task deadlines The transition methodology has core processes designed to make the CSC operational as quickly and as transparently as possible. Our best practices form the foundation for a results-oriented methodology, designed to mitigate the risk inherent in any customer service center transition. Working with the Agency and Incumbent Contractor to Transition the CSC Successful transition requires coordination and effective, open communication among members of the Transition Team, Agency of?cials, the incumbent contractor, and other stakeholders as necessary. All affected stakeholders must have an opportunity to participate in the transition process and to affirm their expectations and requirements. It is important that stakeholders understand their roles in the process, and how their roles affect other stakeholders. Because there are so many different components to implement at different times, including the CSC and WES, it is important at the beginning of the transition to develop a Communication Plan in conjunction with the Agency and the incumbent contractor. The Communication Plan identi?es the schedule and location of formal meetings, and a protocol for remaining available for impromptu meetings as requested by the Agency or incumbent. The Communication Plan lists all MAXIMUS transition staff, along with contact phone numbers and email addresses, which we update on a regular basis. We inform the Agency and incumbent when any of our key management staff members are out of the of?ce for extended periods due to vacations or other reasons. In these situations, MAXIMUS identi?es an alternate staff member to serve as the contact person for the Agency in the interim. When a project offers as much risk as the CSC due to the simultaneous replacement of WES, it is critical that the Agency remains aware of key aspects of the project throughout the transition; MAXIMUS will help ensure that the Agency is never surprised by project issues. During the start-up of each program component, the need for communication is critical as we formalize the business rules and program requirements to ensure that we are optimally transitioning the designated component of the CSC. We conduct all meetings in an organized and ef?cient way, with clear agendas and time allocations. We provide meeting materials requiring 4. Approach to Transition RFP 64 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 70 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Agency feedback and/or decision in advance, so that all staff have the opportunity to review them before the meeting. We ?nd that is the best way to help ensure a productive meeting and to advance the agenda without unnecessary use of the Agency's or incumbent vendor's time. 4.5 Draft Transition Plan RFP Section 7.1.1.115. page 52, sow Appendix A, 5012, 5013, 5014, 501a, 5019. 5024, 5173 We have developed a detailed draft Transition Plan, which illustrates the timing that will be required to start up the speci?c program elements. In addition, it addresses how programs and other functions will be phased in across the State. For each of the functions, we address speci?c activities required to complete the start-up and transition, including the following high-level work breakdown structure (WBS) areas. WBS 1.1: Key Dates. For purposes of creating our preliminary Gantt chart, we used April 25, Contract Award, as a starting point. We are beginning transition operations on July 1 in order to facilitate appropriate planning time and preparations necessary to meet the readiness review deadline of September 26, and full project operations on October 1. WBS 2.1: Project Initiation. MAXIMUS will immediately mobilize our Transition Team and will schedule an internal kick-off meeting with Team members to: I Finalize Roles and Responsibilities. We will ?nalize all team members' roles and responsibilities to make sure everyone knows who is doing what. This often includes establishing sub-teams that will work on various aspects of the transition. I Finalize Operational Solution. We will review and con?rm the details of our operational solution with all team members. I Finalize Transition Plan and Deliverables. The preliminary Transition Plan is reviewed and responsible resources are ?nalized for each milestone and major task and revised accordingly. WBS 2.2: Establish Client Interaction/Communication Process. The Team will establish expectations for communication vehicles, frequency, process, and participants. I Establish Communication Plan. We de?ne the modes of communication that we will use for both informal and formal noti?cations and exchange of information. These methods may include email, a shared collaboration site, telephone conference calls, and in-person meetings. We establish protocols that govern what type of communication is needed for what purpose, as well as a communications log. Following contract award, we will include the Agency and the incumbent in the Communication Plan to establish the preferred methods and frequency of interaction in order to ensure a smooth transfer of responsibilities. I Establish Regular Status Meeting Schedule. We establish regular status meetings for monitoring the progress of critical path tasks, budget, resource usage, and deliverables. I Establish Formal Progress Reports. We de?ne the schedule format, and method of submission for written progress reports to Transition Team management and to the Agency. WBS 2.3: Establish Change Advisory Board. The Team will de?ne the participants, procedures, and responsibilities for the Change Advisory Board. WBS 2.4: Meetings and Status Reports. The Team will agree upon and begin providing status reports for the transition phase. Weekly status meetings will commence the week after the initial kick-off meeting. These may take the form of conference calls or in-person meetings, and they 4. Approach to Transition RFP 65 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 71 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS involve all members of the Transition Team and designated Agency personnel. We will deliver minutes for each meeting. WBS 3.1: Project Kick-off Meeting. Not more than ?ve days after contract execution, the Team will meet with the State to review roles, responsibilities, status meetings, communication and reporting relationships, guiding principles, the project schedule, and other key transition elements. WBS 3.2: Start-Up Deliverables. Per Attachment and other sections of the RFP, we will review and submit deliverables for approval to the Agency within the speci?ed timeframes, as summarized in the Gantt chart; see Section 4. 5. 1 below. WBS 4.1: Transition Plan. We will update the Transition Plan based on the Project Kick-off meeting. WBS 4.2: Collaboration Plan. We will update the Collaboration Plan based on the Project Kick-off meeting. WBS 4.3: Facilities. The MAXIMUS Corporate real estate of?ce has already identi?ed suitable locations for the CSC facility. Upon contract award, we expect to sign a lease and immediately begin the build out and tenant improvements to customize the space to meet CSC requirements. This will include cubicles, management of?ces, conference rooms, training rooms, and computer network and Intemet infrastructure to establish the necessary connectivity to CSC systems. We order and install the furniture, hardware, software, cabling, and other infrastructure as part of our space build-out efforts. We ensure proper power is available to meet systems requirements, and we establish a secure data/telecommunications room or center to house equipment that requires speci?c environmental conditions to work properly, and that is protected from unauthorized access. We will ?nalize all equipment con?gurations for servers, routers, network switches, ACD, of?ce equipment, and staff workstations, as well as the scope of work requirements for the IVR. We will also ?nalize our vendor agreements, such as telephony products and janitorial services, modifying them to accommodate any changes that may have occurred since proposal submission. WBS 4.4: Technology Infrastructure and CSC Tools. The Team implements all aspects of telephony, CSC technology, and other technical systems to ensure effective operations, including: I Telephony. We work with our strategic vendors to ?nalize con?gurations and place orders for voice and data circuits. Establishing these circuits requires considerable leadtime, but we have special agreements with our telephony vendors to order circuits upon contract award so we can establish the needed connectivity in a timely manner. We will also ?nalize telephone system and NR speci?cations. I Systems. CRM implementation involves setting up development, UAT, and production environments, developing systems interfaces, and testing, documentation, readiness review, and deployment activities. We have implemented CRMs for numerous projects, and we will spend the transition period tailoring the system to meet Wyoming's needs. I Report Development. We will ?nalize reporting requirements de?nitions, receive sample ?le layouts, develop and con?gure reports, and conduct ?nal validation and User Acceptance Testing. 4. Approach to Transition RFP #Ol 75-A 66 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 72 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I KMS Data Migration. We will migrate data and knowledge articles, con?gure imaging and document indexing software, conduct testing, and deploy systems to production. I CSC Tools Implementation Testing. We will conduct implementation testing on all tools in advance of the readiness review. We also develop our Systems Security Plan, our Hosting solution, Support Plans and Procedures, Defect Resolution and Enhancement services, and Change Management and Control plan and processes. WBS 4.5: BCDR Plan. We will create our Business Continuity and Disaster Recovery Plan speci?c to the Wyoming CSC. WBS 4.6: Resource Management and Staf?ng. We will con?rm and ?nalize our key staff positions for the project, as well as recruit and hire staff to ?ll the other positions on our Operations Organizational Chart. This includes working with the current incumbent to interview interested staff for positions with MAXIMUS under the new contract. We will also ?nalize our Operations organization chart and reporting structure. WBS 4.7: Training. We will develop all training materials and modules, including the required training plan for staff. All project staff will undergo training during the transition phase of the project in order to be fully prepared for Go-Live. WBS 4.8: Business Rules and Operations Procedures. We will develop our Business Rules management process and Operations Procedures manual. WBS 4.9: Quality Assurance and Quality Control. We will develop our quality assurance and quality control rules and plan, and develop issue identi?cation and resolution reports. WBS 4.10: Operations Reports and Training. We will develop internal reports and client reports, and conduct training on reporting protocols. WBS 4.11: Operational Readiness and Operability Testing. We will meet with the Agency, and other relevant stakeholders to de?ne the expectations for readiness review and measurements for success. We will incorporate these Readiness Review components into our Transition Plan, providing the foundation for a systematic review of every facet of the operation including all of the supporting infrastructures. Our best practice model, developed over time, is comprised of three primary areas: Infrastructure, Human Capital, and Operations Readiness. We verify the preparedness for cutover of staff, business processes, systems, data, integration points, facilities, systems infrastructure, technology networks, governance, reporting and communications. We will work with the Agency to complete the agreed-upon readiness review activities. WBS 5.0: Operations and Maintenance Services. Effective October I, 2016, full operations will begin. We will hold a meeting following Go-Live with the Agency, Transition Team, and Operations Team to review the transition, identify any outstanding issues needing follow-up, discuss lessons learned, and start the hand-off to the Operations Team. Our key staff will be involved during the transition phase of the project, allowing for a smooth shift of responsibilities from the Transition Team to the Operations Team. The Implementation Manager provides continuity from transition to operations. In addition, the transition staff remain available to the project for 30 to 60 days after Go-Live or as long as it takes to stabilize operations to the Agency's speci?cations. 4. Approach to Transition RFP 67 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 73 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS The Transition Plan identi?es the effort and duration required for each task, as well as the resources allocated to these tasks. We also consider the following: I Interdependencies: During start-up, it is critical that all interdependencies are identi?ed as early as possible in order to avoid delays and effectively utilize available resources. Careful management of those tasks is the responsibility of the Implementation Manager and is crucial to an on-time start-up. Understanding and managing these interdependencies is a top priority for the Transition Team. I Agency Participation: As we work through the various transition tasks, MAXIMUS looks to the Agency for guidance and approval as we implement the CSC. This is very important in order to ensure that we are correctly interpreting your program requirements and are conveying your message accurately. Our Transition Plan incorporates time for Agency review and approval of a number of items identi?ed in the RFP. A thorough but rapid approval process is essential to an effective and timely transition. In addition to the Transition Plan, we will develop an Infrastructure Plan and a Collaboration Plan. The Infrastructure Plan will establish technology, equipment, and facilities, including the hardware, software, and tools we will use to support the CSC. Our Collaboration Plan will establish communication protocols and a process for documentation audits; de?ne roles, responsibilities, and governance; and, detail our approach for sharing documents, maintaining schedules, and documenting process changes. The Gantt chart for the CSC is located in Section 4. 5. 1: Preliminary Project Plan. 4.5.1 Preliminary Project Plan RFP Section 7.1 .1.11 .5.1, page 52. sow Appendix A, 5003, 5015 Exhibit 4. provides a draft of the overall timeline for the contract. Upon contract award, we will give the Agency a ?nal version of this Gantt. We know from experience how to carefully build and maintain a comprehensive Gantt chart, using Microsoft Project, which serves as the foundation of our transition operations activities. Every task is carefully identi?ed, resources are assigned, deadlines are established, and risks (including schedule slippage) are identi?ed and mitigated. It includes the sequencing and dependencies of major tasks and subtasks to be completed, and the project and corporate resources assigned to each of them. The Gantt is a dynamic document that we update regularly to re?ect changes; status reports, which we will deliver regularly in accordance with RF requirements, are based on the Gantt chart. 4. Approach to Transition RFP #Ol 75-A 68 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 74 of 185 Wyoming Department of Health, Divrsron of Healthcare Fmancmg Wyoming Department of Health Customer Service Center MAXIMUS JD was [Task Name Duration [sum Customer Servic- Cant-r Implementation Ind Tran-111011 Plan 112 day: Mon 4125116 Mon 1013116 I 2 1.1 Key om: . 112 day: Mon 4125116 Mon 10131111 1 . 3 111 ContractAwmi Date cum Mm4125116 T1 12 Contract Exewtion 16 days Mon 125116 1111015116116 35:. 5 1 1.3 Impla'naitatim Slar?l Date 06m Mm 5116116 Mm 5116116 6 1 1 4 Transi?u'l Phase Begins Odny: Fri 711116 Fri 711116 0 7 1 15 Operations Phase Bow-is Odayn Mon1013116 11101111113116 a 2 Prolcct Man-noment and sum Reporting 117 day: Tue 5117115 Mon 1015116 9 2.1 Project lnl?l?on 1 dny Tue 5117116 Tun 5117116 T211 Implementation Tum Kick-off meung 1 day 5117115 7110 51111111 11 21 1 1 Review solution, and transih'm plan 1 day Tue 5117116 Tua 5117116 12 1 1.2 Cour-111 org chart 11rd Mug 1 day Tue 5117116 Tue 5117116 13 21.2 ScheduleWYDOH Kid-0111110911119 1day 11155117116 Tuo5117116 14 2.2 Client Intogn?unl?ommunlu?nn Procnl 1 day 5124116 Tun 5126116 15 2 2.1 5518111511 Sidus Ropon'n? 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F11 912116 Fri 9116116 Eli?06111111111116; 11116111611116 1.111166 Respmee 511616111 (NR) 011m Fn 9139116 Fri 9130116 1) 7574.423 c1111 91 days Tue 5117116 F11 6123116 . . 125 4 42 3.1 1161111111111st 1411611111: 12111111 Tue 5117116 Thu 612116 In] 126 44232 51161611605191 1211111111 Fn 613116 1111116126116 127 4.4.23.3 omlopmaru 51 11-y- w611 611116 Thu 11111116 ?1 1211 4423.31 Amuntedeontecta 211m Tu116121116 Wed 6122116 129 4 4 2.3.3 2 am Menage-11ml 2 11:11 Thu 6.123116 F11 6124116 if 130 4 4233 3 Wodr?ows md Noti?cations 211w: 1110116127116 Tue 6128116 I 131 442334 Reporteenanshbouds 2116111 Wed6129116 Thu 61311116 132 4 4 2 :1 3 5 61161111111 Setup 2 1111111 Fri 711116 Tue 715116 423 3 6 Tool Setup 6 111111 Wed 716116 Tue 7112116 134 4 4 2 3 37 an [Cunputar Telephony 1111691111611) 5 111111 Wed 7113116 Tue 7119116 135 442335 Gm?wreArlideTy-pes 2day6 Wed 7120115 Thu 7121116 T4 4 2 3 a 11 1311111111111 14111116 Display 2 days Fri 7122116 Mon 7125116 137 4 4 2 3 3.111 661111111116 14111116 Management w61111111w 2 days Tue 7126116 1111611 7127116 1. 42 3 3.11 6611191111 01111 Calewiee 3114111: Thu7r211116 1.1.1111 1111116 5. 139 44233.12 5611111 Knowbdgehue?oies 3941's Tue812115 Thu 1114116 I 141:1 4 4 2.3 3.13 11190111 6611111 5 1111111 F11 616116 Thu 11111116 is Exhibit 4.5-1. Preliminary Project Plan (continued). Adhering to management methods and .11r411eg1es 1110111111111; prryect plunnmg. reduces rrsk, (111111111 1:11.115, and improves success rates. 4 Approach to Transition P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 78 of 185 RFP 72 Wyoming Department of Health, Division of Healthcare Financmg Wyoming Depamnent of Health Customer Service Center was ask Name ?Duration Isran [?nish 316 New 141 4.4.2.1114 Development 24 dayl Wed 611116 Tue 715116 142 44233141 external 11115113? 101111315 11106121115 Tu97151'16 In] 511m Tue6121116 1110116127116 111'. 144 4.423.114} Incoming interlu- Dnnlupment 211 day! Wed @1116 Tue 6126116 145 44233.143 Raceivesa-npiedetafries Ddaye Tue6114116 Tu96114116 146 44231143 15daya Wod6111'16 147 442133.143 Dovdopinlerlme?ias 1(1de Wed61'151'16 Tua6128116 148 4.4.23.3.144 Outgoing interface Development 15 day: Wed 611116 Tue 6121116 149 44233144 Anuiyzn?leapoceama?eaiadaiamws 15days 1111611511116 Tu06121116 150 44233144 10dayn Wad618116 Tua6f21116 pm] 151 4.4214 Veri?cation and Validation '19 day: Fri 613116 Fri 9123116 152 44234.1 vavpian Sdaya Fnenne Thu619116 153 442342 CreateTestCme 20111111: Fri 6110116 Frimn? 154 4.4 2 3.4 :1 iniag'atad Syaam Teat'ng 20am Fri 8112116 Fri 919116 dinner 155 4,11,23,44 UserAcceptanca Testing 10 days Mon9112116 Fn' 9123115 mu 156 4.4.24 K1115 Con?guration 6: days Fri 613116 Thu 311116 157 44241 Con?uweN?anilplay 5daye Thu71'14116 Wed71?20116 In 158 44242 Con?guaMnleMmagemthu?idiow 311m Tue81?2116 Thu814115 159 44243 Cun?gua 0111365wa 2113315 1511815116 150 4424.4 2daye Tu98191'16 WedBliD/Con?gueAr?de Tfpu. 2 day: Fri 711116 Tue 715116 162 4.4.24.6 K1116 Veri?cation and Valida?on 88 day: Fri 613116 Thu 1111116 163 44246.1 511m Fri 6.61116 Thu619116 17442462 CredeTealCasee 511m Fr16110116 Thu611?'16 W4 4 2.4 5 3 Iniegatad Teat'ng 10 days Fri 8112116 Thu 8125116 166 44246.4 Ddays Thu 911116 Thu911116 16? 4.4.25 Report Development 72 daye Tue 5124116 Fri 912116 W44 2 51 Reporting Raqurarma De?nitim 10dayc Tue 5124116 Tuesrme 169 44252 Oduya Tu9617116 Tun-317116 170 44253 20day?e 11110111618116 171 4 4 2 5 4 Raped and emfrguatim Thu717116 Wed 8117116 172 44255 Finalvatidei?ronanduwacceptmce 10111111: Thu?litiits 119115131116 173 44256 Pei'rniss?mswiduaarsamp Zdays Thu911115 F11912115 1'14 4.4.23 KMS Data Migration 911 days Tue 5124116 Fri 91311116 175 4 426.! Request Olin LEymiaandSanple Data Ddayl Tue5-?31116 Tu05131116 W51 1 Receive data layouts and dommenuoreadi mum Odaye Wed 7113115 Wed 1113115 Exhibit 4.5-1. Preliminary Project Plan (continued). Adhering to gaudprojecr management methods and strategies including project planning. reducer risk. avoidv 1:11.115, and improves success rates. 4. Approach to Transition P23001.0060 March 25, 2016 110175-1111 73 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health Division of Healthcare Frnancmg and Mammus Health Services. Inc. Page 79 of 185 Wyoming Department of Health, D1v1510n ofHealthcare F1nanc1ng - Wyommg Department of Health Customer Semce Center MAXIMUS was Task Name iDuration tart Finish I16 Nov 177 612 Raodve unpledale?ies Odays W967713716 Wed 7713716 i 1711 4 4 2 6.4 Data 7177971111011 (Initial. Inducing um :16 Mapphg) 5 days Fri 0719716 Thu 6725716 5 I 179 44265 KnaMedgeMdeMraiion 3116175 Fri 0726716 T068730716 Daliverdila: Knowledge Mmogu'nml (KM) Data Comm 0 day: Thu 9715716 Thu 9715716 9 131 4.4.26.7 Indexing 00 days Tue 5724716 Thu 11715716 132 44 26.71 Doomentajetem requi'a-nmIs 10 days Tue 5724716 Tue 677716 183 4 4 2 6.7.2 Con?wre software eppicalion 30 days Wed 678716 Wed 7720716 tum 1114 4 4 2 5.7.3 Conduct system 1esh'ng 20 day: Thu 7721715 Wed 9717716 115 4426.74 Conduct UATendbushIesa opgahms teeth-lg 20am Thu 8718716 Thu 9715716 may 186 Deployment In Production 1 day Thu 9729716 9730716 187 4.42661 l-loidgohogomeeling they Thu 9729716 Thu 9729716 185 4.4 2 6 6 2 Deiiverable Custm'lu' Releionship Management System (CHM) 0 days Fri 9730716 Fri 9730716 9 i 189 442683 DeIIwrabFeJIneteII CSC CRM. KM. Ohm Tools) Odeye Fn' 9730716 190 4.4.7.7 Tools Implementltinn Testing sad-ya? F11 7717115 Tue 5720715 191 4 4 2.71 1171115 Test Saints 20 am Fri 3.5715 Thu 971716 mug 192 4 4.2.7.2 Conduct lmpi?mnla?m Test'ng 10 day: Fri 771716 Fri 7715716 m. 193 442.73 lmplu?nmteiim Tesl?asulb Iday? 717017716716 71111117718716 194 4 4 2.7.4 Delivadile: (356 Tools Implunmlation Test ReetrhsilVR, CRM, KM, 0 days Mm 8715716 Mon 71715716 *1 Olher Tools) 195 4 4 2.7 5 Transition 135715. data m. knowledge Irmsia' 21 days Tue 0716716 Wed 9714716 311]]: 196 4 4 2.7 6 Deliverable: Trmsitim Phase Reed?nese Aswsanent 0 days Thu 9715716 Thu 9715716 197 4.4 2.7 Deinrerable WES Contracted: WES Train-?ie-Trniner Trtining 4 days Thu 9715716 Tue 9720716 swam. Security Plan sad-y- Tu. 57247111 Mon mans 199 4 4 3 I Develop Systems Seoun'ty P151 58 days Tue 5724716 Mon 6715716 W44 3 2 Sanity-related Device and Diagram) 58 days Tue 5724715 Mon 117157115 201 4 4 3 3 DELNERABLE: Systems Security Han 0 days Mon 8715716 Mm 8715716 ol 32?444 ?eeting 44 Sun 7731714 Fri 913111111 203 4.4 4.1 DELIVERABLE: Hosting Myation Flat 0 days Sun 7731716 Sun 7731716 204 4 4.4 2 DELIVERABLE. Hosting 5001.!in Poiides and Procedures 0 days Thu 9715716 Thu 9715716 . 205 4 4 4 3 Penile! Testing Results. il may 0 days Thu 9715716 Thu 9715715 0 206 4 444 Complete WES Honing Contractor Happiicdiie Odnye Fri 9730715 F71980716 207 4.4.5 Support Plans and Procedure: 36 day: Sun 7731716 Tue 9731710 208 4 4 5.1 Telemnmmications md Tedmology 514713011 0 days Sun 7731716 Sun 731716 . 209 4452 Plan 06m Tue9720116 Tue9720716 210 4 4 5.3 06th End-user Syilem Mnhistrahve Dournentation 0 days Tue 9720716 Tue 9720716 0 Exhibit 4.5-1. Preliminary Project Plan (continued). Adhering to good pro?cl management methods and including pmjecr planning, reduces risk. avoids costs. and success? rates. 4. Approach to Transition RFP ?74 March 25. 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Heatthcare Financing and Maximus HeaIth Services. Inc. Page 80 of 185 Wyoming Department of Health, of Healthcare - Wyoming Department of Health Customer Servrce Center MAXIMUS ID 5 [1351: Name lDuration sun 521-1111 116 Apr L?rrl I Nov 211 4.4.4 Detect Reeolu?en end Enhancement Sendeu 55 deye Fri 711118 Tue 91211118 212 4 4 1 Requieinmla Review Schedule (TED) 45 days Fri 711116 Fri 912116 um 213 44s 2 Requirenenis Review Meeting Minutes 2deys Tue916116 Wed91'1116 3' 214 4.4 a 3 Requirements Matrix any'e rue 9120116 Tue9120115 1; 215 44.64 Udeyc Tuesn?lts Tue9120116 . 216 4.4.7 Change Management sea-ye Mon 1111113 Fri 8130115 217 4 4 71 System Con?ouationPian Odays Fri 9130116 Fri 9130116 0 215 4472 Con?wrali?ori Odays Thu9115116 Thu 9115116 219 4473 CilmgaGmlmiPmeedura Odnys Muri7111r'16 Mor17111115 . 220 4.5 BCDR Plan 53deye Wed U1115 Men 5115116 221 451 53 dew Wed 611116 Mon8115116 [11m 222 452 Business Conthie'ly and DisasterRocwery Plan Ddays Mon?-?t?ii? 6' 223 4.4 Resource Management end Suiting 72 deye Tue 5124118 Men 91516 224 4 6 1 Develop Resource Management and Staffing Plan 30 days Tue 5124116 Wed 716116 ?mm 225 462 DELIVERABLE: Resource Mariam! and Staf?ng Plan any: Mon7111116 Mon7111r'16 226 4.6.3 Con?rm ?ef?ng nude 20 day: Tue 5124115 Tue 6121116 r?1 T4 6 31 Con?nnorgehertand needs 20de Tue 524115 Tue6121115 my 225 4.8.4 an?lne Staff - Recruit and Hire 23 Fri 7115118 Tue 8123115 229 4541 Posipoailione 10deyl Fri7115116 Thu 7128116 230 4642 Sounenndinlarviaw mpicmis 20dey: Wod7120116 Tue?r'i?ii? 231 4543 10daya Wed??li? 232 4644 Sdaya Weda117116 ruearzaiia -. 233 4 6 5 MILESTONE Sta-trials for irontiine staii 0 days Mon915116 Mon9i5r'16 ?5 ?234?4.? ruining 54 em Fri mm; Fri mire 235 4 7 1 Deveiep Training Fien 40 days Fri 711116 Fri maria 236 4 7.2 DELIVERABLE: TreiningPian 0 day: Wed 8131116 Wed some 9 237 4 7 3 Establish Training 43days Fn711116 Wed 8131116 238 4.1.4 Develop Training Materiele 45 deye Fri 711116 Fri 912115 239 4 7 4 1 Draft Training Malarials 30deye Fri 711116 Fri 8112116 240 4 7.4 2 Materials Wiley: Fri 826115 241 4 7 43 Revise Training Maiai'ide basad on iniemal feedback 5 days Mon 8129116 Fri 512116 242 4 7 4 4 Finalize Training Mnloi'ials 2 days Thu 911116 Fri 912116 I 243 4.7.5 Deliver Training (Schedule per Approved Training Plan) 20 deye Men 815115 Fri 9130118 244 4 75 1 MAXIMUS DevelopadCurriculum 20 days Mon915116 Fri 9130116 [1311' T4 7 5 2 WES Training 20 days Mon 915116 Fri some 246 4 7 5 3 Agency Bushes; Rules Editing Training 20 days Mon915115 Fri9130'16 um Exhibit Preliminary Project Plan (continued). Adhering to good prry?ecr management methods and strategies including project planning. reduces risk, avoids costs, and improves success rates. 4. Approach in Transition RFP 110115-14. 75 0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Dwisron of Healthcare Financing and Maximus Health Services. Inc Page 81 of 185 Wyoming Department of Health, Dlv1510n of Healthcare Fmancmg - Wyoming Department of Health Customer Semce Center MAXIMUS in; 1111 11?1111 am; one 2525 .. - . . ?11. lm 247 ?'54 CorrespondeneeTool 20days Mm91511t5 F11 9130115 [ml 2411 155 Orientation and Fuel Training olContreotor was System sun 20 days Mon 915115 Fri 9130115 249 1.8 Rulee end Operation! Procedure! 43 day! Fri THIN Wed slams 8.1 Develop Bustness Rites Management Process 43 days Fri 71'11'16 Wed 8131116 mm 2 DELIVERABLE Business Rites Management Process 0 days Wed 8131116 Wed 8131116 cl 5 3 Develop Operation: Procedures Manud 43 days Fri 711115 Wed 881116 [mm 3.4 DELIVERABLE Opanb'ons Mutual 0 days Wed Wed 8611?15 .l 85 Saviooe Udlyl Wed 3131116 .9 Guilty Anurence end Quality Cami 52 deye Fri 111116 Thu 91151116 91 Develop ouaily Amman Contrd tome) Plan 52 days Fri 111115 Wed 91141113 mammal:- 257 -l 9 2 DELIVERABLE Oudlly Mumdiiy Coniltl (MC) Plan 0 days Thu 911518 Thu 91'151?16 . 1 2511 .l 9 3 Develop leeueloeleot Identi?cation and Resolution Reports 30 days Mon 311115 Mon 9112116 mm 259 IUD Operation! Report and Training 54 deyl T?lts Fri 9110115 2760?4 101 Develop Reports per Opaatione Procedure Manual 43 days Fri 111116 Wed 3131116 251 .1102 Devdop Cmdance Reports 43 days F11 "([1115 Wed 8131116 [ml 262 410 3 Agency Rowling Training 5 days Mm M916 Fri 91'30/16 I 263 1104 initial Ad hot: Reporting Trailing 5 days Mon 9.26.116 Fri W15 Tum Dperetlonel Readlnm end Operebllity mung on day: 1:11 1111111 Men 91211115 I T1111 Treneiliai Swtam Test and Operation Readiness TeetHen alley- Wodaolilo 265" a 11.2 Written System Testing Report 15 day: Thu 911115 11111 W16 mu 267? a 11,: WES operations end Doaanoritetion 4:1 days Fri 711115 Wed 11131116 It 114 Odays Thu 915116 Thu 91'151'15 269 411.5 Transiltm Phase Readiness W1 0 days Thu 9115(16 Thu 9i151'1E W1 11.6 Funnel Readiness wettinrough 1 day Mm 9126115 Mon 926115 I . 271 11.12 MILESTONE. Trmeion Rambles: Complete 0 day: Fri 960116 913131115 0 Opentlenl and Maintenance 1758 deye Mon 105115 Fri 61311123 1 11111111114 Turnover Sentinel - TED 130 deyl Mon 112123 Fri 61301125 Syila'n Tia-nave! Pix: 130 day: Men $12.23 Fri 6130/23 mien Requirmienle Statement 1311 deye Mon 112123 Fn 61311.23 Opefn?md Code and d1 Cum! Dommentatlm 13(1de Mm 1M3 51130173 277 g! 4 Tun-ting to include 130113315 Mon 112/23 Fri 613023 We 41 Database Schema and ERD 1:10 deye Mon 1.223 Fri 61:10:23 279 42 Reviewineopenoeleoleend ssueLog laodeye Mm112123 reasons 280 43 130nm I mm? 1? . Exhibit Preliminary Project Plan (continued). Adhering to good pnyecl management methods and .rlralcgles planning, reduces risk, avoids? costs. and improves success rates: 4. Approach to Transition RFP 76 0060 -- March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Divisuon of Healthcare Financmg and Max1mus Health Services. inc. Page 32 of 165 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 4.5.2 Knowledge Transfer RFP Section 7.1.1.1152, page 52. sow Appendix A, 5016, 5017, 5018,5031 During the transition phase, we will use our model Knowledge Transfer Plan, a subset of the Transition Plan, which consists of the following four steps: I Step 1: Assess Knowledge Transfer Environment. We will work with the Agency and the incumbent vendor to determine the scope of the knowledge transfer in terms of technology, business processes, manual and automated workarounds, necessary skill sets, and required employees. I Step 2: De?ne Knowledge Transfer Approach and Plan. After assessing the knowledge transfer environment, we will work with WDH to determine the most suitable method for executing the knowledge transfer and create a plan to communicate this approach, which we will distribute to all involved parties. We will establish timeframes for the knowledge transfer activities so that all activities will be completed during the speci?ed transition duration. We will also identify deliverables, ensuring that knowledge is stored for future reference, in the event that a key resource becomes unavailable. In addition, we will identify milestones and success factors that measure the success of the knowledge transfer. We will include and track all knowledge transfer activities in the Gantt chart. I Step 3: Implement Knowledge Transfer Process. The individuals identified in the Knowledge Transfer Plan will exchange knowledge so that MAXIMUS will be in a position to continue services at an acceptable or improved level once the transition is complete. Knowledge transfer includes training materials, documentation review, recording of work sessions, and job shadowing programs. It also includes open issues, such as complaints in process. The Knowledge Transfer Plan speci?es the timeframes within which the knowledge transfer will occur, which will be tracked and reported. We will work with the Agency and the incumbent vendor to facilitate current staff transition opportunities to the new project, enhancing knowledge transfer goals. We will attend question and answer sessions with the incumbent vendor, and advise the Agency of any areas of concern based on previous presentations and reviews of documentation. We will also attend twice-weekly meetings with the Agency and the incumbent vendor to resolve any issues, and distribute minutes to the Agency within two days of each meeting. I Step 4: Hand-Over Responsibilities. The Implementation Manager will confirm that all knowledge transfer recipients have acquired the knowledge they need to deliver services to consumers. Before declaring the knowledge transfer complete, we will obtain sign-off from the Agency to document that we have conducted all knowledge transfer activities according to your satisfaction, and met all success and exit criteria. The Department will make the ?nal determination of when the knowledge transfer has been completed. Exhibit 4.5-2 provides highlights of what we will include in our approach to knowledge transfer. 4. Approach to Transition RFP 77 P23001.0060 March 25, 2016 Attachment to the lnfonnation Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 83 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Approach to 'l'rnnsitiott I Paper ?les of client information being held for disposal will be transferred to MAXIMUS. I Client electronic case ?les and information in the WES will be checked for success?Jl hand-off. I Information regarding CSC operations stored in the incumbent's Knowledge Management System that is identi?ed by the Agency as required for transition will be transferred in a manner, format, and media de?ned in the Transition Plan and approved by the Agency. I For any electronic ?les identi?ed as being Agency property, including logs for calls from individuals not in the WES, andtor integral to success?sl project operations, we will work with you and the incumbent to receive data in the format required for transfer to MAXIMUS. I The Transition Plan will de?ne the data and so?ware that will and will not be transferred and will coordinate the timeframe for data transfer. Status Reports I All past status reports, provided as required by the RFP and resultant contract, will already be submitted to WDH and, therefore, within its control to transfer to MAXIMU S. 1000 . . . . . . . 0 I We prepare and distribute speCIal status reports during the transmon phase of the 13 5 project to aid in managing transition activities, timeline, and deliverables. Open Issues I We will make arrangements for a warm hand-off of all pending customer service updates, applications, and outstanding correspondence and mail from the Incumbent Contractor for completion a?er transition. I Our Open Issues Handoff Lead will handle these critical issues to ensure a seamless transition to customers. Exhibit 4.5-2: Plan for Transfer of Information. We will collaborate with the Agency and incumbent Contractor to determine the most appropriate pathway to success?tl transfer of ?les and other materials related to providing eligibility services to Wyomingites. 4.5.3 Personnel and Level of Effort RFP Section 7.1 .1.11 .5.3, page 52 Having transitioned dozens of projects from other contractors and from State-run operations, MAXIMUS understands the methodology, staf?ng levels, critical roles, and essential functions necessary to bring each project to full operational capacity by the Go~Live date. Exhibit 4. 5-3 shows our personnel teams and level of effort in hours for this transition. Ilours lo 'l?rnnsitiou Corporate Oversight Implementation Management, including Facilities and Security 1,188 Operations, Quality Control, and Reporting 1.716 Staf?ng and Training 5,048 lnfonnation Technology 5,220 Exhibit 4.5-3: Transition Personnel Level of Effort. Our transition stay?? will devote as much time as needed to ensure a smooth transition for the CSC. RFP Section 7.1.1.1154, page 52 Through many years of experience, MAXIMUS has developed an approach that includes a methodology with documented best practices and experienced people to support the project transition. We've used this approach in countless transitions of call center services from another vendor to MAXIMUS. One of the key objectives in transitioning services is to provide a seamless implementation without disrupting customer service, making the transition to MAXIMU transparent to Wyoming customers and Agency staff. 4. Approach to Transition RF 78 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 84 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Our goal for every customer service center is predictable service delivery that provides an excellent customer experience. At the same time, we focus on meeting the RFP requirements, meeting SLAs, and, once operational, ?nding new and innovative ways to deliver a better customer experience as ef?ciently as possible. We call this "predictable delivery." It is the primary objective of transition planning and execution of our customer service center methodology. MAXIMUS leverages, where practical and feasible, industry standards for transition. We use Erlang for modeling the number of staff needed to meet requirements and SLAs. We also use the Project Management Institute (PMI) methodology for Project Management planning and execution as a foundation for our activities. 4.5.4 Updating Programs and Documentation RFP Section 7.1.1.11.5.5. page 52. sow Appendix A, 5022, 5023 During transition, we will review available documentation provided by the incumbent contractor. Before we develop unique and detailed policies and procedures for the CSC project, we plan to draw upon the current policies and procedures, as well as our extensive experience, as a base from which to begin. From that base, we will address and de?ne each contractual requirement and necessary function in order to build a successful operation that best serves customers. This strong and proven foundation will reduce our development time, prevent us from having to start from scratch, and allow us to use best practices from successfully operating similar projects. We will address and document each policy, procedure, and responsibility for the CSC, ultimately providing each employee with the resources and tools necessary to best perform theirjob activities. To ensure that they are approved and available for staff training, policies, and procedures will be fully We work with Agency staff to identify and access all developed and submitted to the relevant, existing procedures, and other source State for approval within 45 documentation. To develop the initial outline for a days of contract award. comprehensive Policies and Procedures Manual, we will organize the sections to properly re?ect our operations and increase its utility as our staff?s ultimate reference source. We create an outline that includes a title and document number for each functional area of the operation, related policies, procedures, and speci?c work instructions for each job responsibility. We work closely with the Agency to make certain that all contract areas are covered, and we will seek Agency approval of the completed outline before moving to the next phase. We begin developing program-speci?c policies and procedures during the implementation period, when the Agency de?nes each policy and clari?es each contractual requirement. During this phase, we will work very closely with the Agency to make certain that our understanding of the requirements is consistent with Agency expectations. We will then document each policy and procedure to develop an initial version of the CSC Policies and Procedures Manual, which will serve as the core of our Knowledge Management System. 4. Approach to Transition RFP 79 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 85 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Project management closely reviews the initial version to help ensure that contractual requirements are met and that procedures are operationally feasible. Once the contents are deemed complete, and within 45 calendar days after contract award, we will submit the Manual to the Agency for review and approval. We will work closely with the Agency during this process and provide iterations of individual policies and procedures as required. We consider each document to be a draft until the Agency approves it. 4.5.5 Recommended Stabilization Criteria RFP Section 7.1.1.11.5.6. page 52 The MAXIMUS Transition Team stays on after Go-Live for 30 to 60 days to ensure stable operations. We will work with the Agency to de?ne what operational stability means for this contract, such as meeting SLAs or achieving certain benchmarks. Based on our experience, we recommend that stabilization criteria include the following: I All key positions are ?lled and performing as expected I Key Service Level Agreements for all operational areas are being met I Major technological hurdles/gaps have been resolved 4.5.6 Pro?cient Operations that Meet Expectations RFP Section 7.1.1.11.5.7. page 52 We incorporate the following as our standard approach for making certain that the CSC operates with improved proficiency, and we meet the expectations of the Agency and other stakeholders. I A dedicated Transition Team and Implementation Manager I Designated team leads for major deliverables I Well-developed transition and implementation approach based on PMBOK methods and standards set by the Project Management Institute (PMI) I Formal development of project Policies and Procedures I Quality Assurance Plan and Disaster Recoveinyusiness Continuity plan I Communication Plan, including regularly scheduled status updates and reporting schedule Our approach establishes a series of controls, including properly identifying and addressing required tasks, securing suf?cient resources, monitoring progress against the schedule, averting risk, and universally enforcing accountability. We have integrated these controls within our own best practices to develop our Project Implementation Manual, providing our Transition Team with a structured process. Exhibit 4. 5-4 provides a glimpse into that approach. 4. Approach to Transition RFP #0175-Al 80 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 86 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS PROJECT IMPLEMENTATION MANUAL I INTRODUCTION TO THE IMPLEMENTATION MANUN I 1. PROJECT PLANNING .1-1 1.1 Essential Implementation Elements 1-1 1.1.1 Planning Your Project 1-1 1.1.1.1 General Implementation Planning Tasks 1-1 1.1.1.2 Implementation Workplan 1-2 1.1.2 Project Management O?ioe (PMO) Implementation Functions 1-4 1.1.3 Project Documentation and Repository: Implementation Project File 1-5 1.2 Implementation Team and Roles and Responsibilities 1-9 1.2.1 De?ning the Implementation Project Team 1.2.1.1 Assigning Roles and Responsibilities 1.2.1.2 De?ning Roles 1.2.2 Building an Effective Team 1-11 1.2.2.1 Managing Performance 1.2.2.2 Managing External Stakeholders 1-14 1.3 Internal and External Meetings . 1-16 1.3.1 lntemal Kick-Off Meeting .1-16 1.3.2 Extemal Kick-Off Meeting 1-17 1.3.2.1 Ongoing lntemal Meetings . . . ..1-18 1.3.2.2 Ongoing External Meetings 1-18 13.PIIO1.M45-IB Exhibit 4.5-4: Project Implementation Manual Table of Contents. Our corporate manual thoroughly covers the activities and best practices associated with a smooth transition to operations. This manual allows the MAXIMUS Transition Team to approach the operations period already envisioning what the CSC ought to look like, and ensures that all resources are effectively targeted to meet those requirements. We are able to leverage and customize project controls quickly to match the needs of the CSC project. 4.6 Understanding WES and Performance Expectations RFP Section 7.1.1.115, page 52 From the WES RFP, we understand that the WES is a rule-based system constructed on a Service-Oriented Architecture that supports eligibility determinations and case management for State health insurance programs, including Medicaid and Kid Care CHIP. It integrates with the Federal Data Services Hub and Federally Facilitated Marketplace through a determination model to support ACA requirements. The WES also provides a public-facing Client Web Portal and online application to increase customer service options, an electronic document management system (EDMS) to support paperless work?ows, and several other modules. It follows the NIST security guidelines and is compliant with HIPAA, HITECH, and other federal regulations. We have studied the detailed system diagrams and technical descriptions included in the WES Procurement Library. Implementation of the WES allowed the Agency to streamline its service delivery and establish the CSC. While the WES currently ful?lls the majority of intended business and system requirements, the Agency is now seeking a vendor to enhance the WES to meet all of its objectives. Such enhancements will help the Agency maintain compliance with CMS requirements, enable more Wyoming citizens to receive a real-time eligibility decision for 4. Approach to Transition RFP #0175-Al 81 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 87 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Wyoming Medicaid or Kid Care CHIP MAGI programs, and facilitate ef?cient and effective caseload management. A successful CSC is dependent on a well-designed WES that supports eligibility processing with robust features, ef?cient work?ows, and reliable uptime. In the CSC, our mailroom staff will rely on the interface between the EDMS and WES in order to image documents and accurately associate them with case records. Our eligibility specialists will need the WES to enter data and perform the processing that supports the State?s eligibility determinations; we will need the WES to generate the required notices that we will mail every day. Our CSRs will rely on the WES in order to answer callers? questions and update their case information. And the WES will support the Agency's web portal where citizens can apply for coverage; our CSRs will rely on that interface as they co-browse the online application with callers to help them apply. In short, there are few tasks in the CSC that can be performed without the support of the WES. To understand the WES as it undergoes its enhancements, MAXIMU will rely on frequent discussions between MAXIMUS, the Agency, and the WES contractor to give us the speci?c knowledge we will need in our operation of the CSC. We will come to these discussions with a solid understanding of the design and use of such systems, based on our years of experience in consulting with states on MMIS design and eligibility and enrollment workflows. Through collaboration, we will identify areas of interdependency between the WES and CSC performance, such as timely processing of applications and mailing of notices in accordance with SLAs. As we write our policies and procedures and develop our processes for the CSC, we will note such areas and work with the WES vendor and the Agency to mitigate points of risk or inef?ciency. With each enhancement to the WES, we will update our procedures and Knowledge Management System and hold associated training as needed so that our CSC staff are immediately and accurately informed of the impact on our operations. 4.7 Managing Risk RFP Section 7.1.1.111, page 53 Our risk and issue management process offers a full lifecycle approach to identifying, classifying, prioritizing, tracking, and mitigating risks before they evolve into issues. To safeguard a timely transition, MAXIMUS evaluates the Project Plan upon the notice of award and kicks off internal tasks. We recognize this approach is at our risk and accept this as a required element of on-time delivery. We monitor our Transition Plan to identify any problems expeditiously. All Transition Team members continuously identify and communicate risks through our risk management process. This monitoring occurs at multiple points: work group meetings, reviews of project schedules and work plans, and the use of risk identi?cation checklists, readiness assessment analysis, brainstorming, and contract reviews. We identify deliverables that are potentially at risk and notify the State Project Manager and executive management about these critical issues in a timely manner. We escalate any high-impact risks and any medium-to-high issues to the Agency immediately, providing transparency and giving the Agency early exposure to risk assessments and proposed mitigations. We develop a risk mitigation plan, and throughout the transition period, our team meets and discusses any risk factors that would prevent us from meeting our readiness date. If a risk 4. Approach to Transition RFP #0175?Al 82 P23 00] .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 88 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS surfaces, they immediately deploy the appropriate mitigation strategy to get transition back on track, as shown in Exhibit 4. 7-1. MAXIMUS Mitigation Strategy 112. . - Finalize and execute a comprehensive Implementation Plan - Dedicate a single implementation contact and experienced transition team Establish operations in Cheyenne with support in Denver 0 Corporate IT staff con?gures and tests in corporate o?ice before local installation - Resolve build-out issues with building owner - Draw ?'om equipment inventory - Rent fumishings Use alternative training site (Cheyetme or Denver) - Interview and retain all interested current sta?? - Use our established relationship with our staffing agency to ?ll openings - De?ne, document. and train all staff on new standard operating procedures - Offer a program manager who has eligibility and customer service experience - O??er experienced management to oversee work?ows and maximize e?iciencies - Apply our 25 years of experience providing eligibility and customer services and lessons learned - Finalize and execute our comprehensive Customer Service Plan - Employ highly quali?ed customer service representatives - Participate in all meetings and other knowledge transition activities s. - Finalize and execute our Quality Control Plan - Execute our proven work?ows based on years of similar project experience Use advanced tracking and reporting systems to accurately report perfonnance and help improve quality - Develop and execute complete System Test Plans on schedule - Provide quick, adaptable, and commercial o?lthe-shelf solution - Use our proven knowledge of state eligibility systems l?-i?2300l 0060-02 Exhibit 4.7-1: MAXIMUS Risk Mitigation Strategies. Given the number of projects we have implemented, we learned early on the importance of managing risk 4. Approach to Transition RF 83 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 89 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 4.8 OperationalReadiness RFP Section 7.1.1.113. page 53. SOWAppendlx A, 5025, 5026, 5027. 5028. 5029, 5032, 5033, 5133, 5139, 5190. 5191. 5192 MAXIMUS regularly participates in the Readiness Reviews for projects we implement, collaborating with our state clients, subcontractors, vendors, and other key stakeholders. The Readiness Review process will establish that MAXIMUS has submitted all transition deliverables, has met the requirements of the CSC as outlined by the Agency, and is prepared to serve customers. To guide our preparation for the Readiness Review, we rigorously follow PMBOK methods and standards set by the PMI, developing detailed work plans and a Transition Phase Readiness Assessment, that guide both the implementation and operation of our projects. As shown in Exhibit 4. 8-1, participation in the Readiness Review allows MAXIMUS to demonstrate full capacity and readiness to begin project operations in the following areas: possessing a thorough understanding of program and contract requirements; establishing accurate assessments and accountability controls; mitigating risk; and setting up appropriate facilities and infrastructure, to include completing staff training. We approach and prepare for the Readiness Review by employing best practices honed by years of project transition and implementation experience. Readiness Review ()lijeelive Proposed Method Ensure a complete Formal project kickoff that outlines all deliverables and milestones to be completed understanding of during the Readiness Review period. This includes working under the Agency?s program and contract leadership to develop a description of the Readiness Review process, success and requirements evaluation criteria, and formal sign off procedures. Formal project start-up activities include all MAXIMUS transition team members, Agency staff. and key stakeholders. Establish a formal Communication Plan. Establish a requirements traceability matrix maintained by the Implementation Manager. This document will map all contract requirements directly to MAXIMUS transition activities and methods. Policies and Procedures Lead ensures accuracy and completion of project protocols and communicates them to all supervisory and training staff. Establish accurate Employ a well-developed transition approach based on PMBOK methods and assessments and standards set by the PMI. strong accountability Develop a Quality Assurance Plan. controls Establish transparency and partnership. Provide regular reports during the Transition and Readiness Review periods and schedule ongoing status meetings with key Agency stakeholders. By doing so, MAXIMUS ensures that everyone we are in contact with is apprised of our progress. Mitigate risk to the Leverage internal MAXIMUS corporate quality resources from the MAXIMUS State, Agency, Quality and Risk Management (QRM) O?ice. QRM provides independent risk constituents, and evaluation and monitoring for all MAXIMUS projects and is responsible for reporting customers directly to the MAXIMUS Board and CEO. Establish regular status meetings with the Agency. These formal meetings are in place to keep the Agency up-to-date on progress, allowing MAXIMUS to quickly address and resolve any identified problem, minimizing risk. Develop and maintain a Disaster Recovery (DR) Plan, enabling project leadership and staff to respond quickly and effectively in the event of a disaster. The DR plan establishes practices for risk identi?cation and mitigation strategies, including staff training, system and operational testing, and problem resolution. Maintain a Security Plan outlining practices for secure document and data storage. The Plan prevents security breaches by ensuring protocols are communicated to all 4. Approach to Transition RF 84 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 90 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I I Proposed \letluul staff to handle case information con?dentially and allows for security standards to be enforced and evaluated uniformly across all project operations. Establish facilities, Provide dedicated support staff and direct Points of Contact for all MAXIMUS Readiness l{e\ ()hjeeth appropriate Transition and Readiness Review period activities through a seasoned MAXIMUS infrastructure, and transition team. conduct necessary Locate our facility in Cheyenne. training Designate team leads for each area, including Facilities, Telecom, Program Development, and Training. I Develop a CSC Transition Test and Operational Readiness Test Plan to demonstrate achievement of knowledge transfer and successful transition and readiness for CSC takeover. Conduct formal testing of the IVR, CRM, KMS, and other tools and document results for Agency review in accordance with the approved Test Plan. Completion of all staff training utilizing a Train-the-Trainer approach to ensure all project and agency staff are fully trained on CSC project policies and procedures. Exhibit 4.8-1: Readiness Review Objectives and Proposed Methodology. MAXIMUS demonstrates capacity and readiness through the Readiness Review process. We will deliver all documentation for CSC Operations and Maintenance and facilitate Agency approval of the documentation. We also record dependencies on all critical components and work with the Agency to document functional and hierarchal escalation paths. With the help of the Agency, we will develop a series of checklists and a comprehensive approach to the speci?c needs of the CSC project that provides the foundation for review of every facet of the project, including all of the supporting components. We will deliver written reports on the status of CSC tool testing, staff hiring and training, and risks to implementing approved changes to demonstrate progress towards organizational readiness. By verifying CSC programmatic knowledge, policies and procedures, facilities and systems infrastructure, data collection and storage methods, the preparedness of our staff, and an understanding of available resources in the community, we pre-emptively and signi?cantly reduces operational risk. Key processes of our organizational readiness preparation include: I Infrastructure Readiness. We use a checklist during this exercise to test all the support elements of a project. This process ensures we have developed a controlled and fully production-ready environment. Some of the elements of this checklist include facilities and facilities management, physical security, desktop systems, telephony systems, and network and intemet access. I Human Capital Readiness. A successful project must rely on the readiness of the staff driving the project. Therefore, a MAXIMUS Readiness Review tests the capabilities and processes required to maintain proper staf?ng levels, as well as provide a plan for scaling the staff for future growth if necessary. This portion of the process will evaluate and test the areas that include, but are not limited to, human capital resources and recruiting specialists, partnership agreements, organization charts and job descriptions, staff forecasting models, training plans and curricula, employee manuals, and all reporting and tracking systems associated with staff development, training, hiring and obtaining staff background checks. I Operations Readiness. This section of the Readiness Review aims at the heart of the operation the day-to-day work. In this assessment, we test every path the business process may follow to help ensure we can handle not only the normal processing requirements such 4. Approach to Transition RF 85 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 91 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS as intake and prioritization of calls, but also extraordinary situations. Because the Operations Readiness process focuses on ensuring the success of all project functions from end-to-end, we perform simulations that test how we screen calls and prioritize them, how we investigate and determine cases, and so on. During these tests, we place further emphasis on staff to guarantee everyone has the appropriate level of knowledge, gauged by knowledge tests, observation, and role-playing. Our corporate Office of Quality and Risk Management (QRM) also provides support and monitors progress during the Readiness Review period, helping to ensure the project is fully prepared to meet and exceed the Agency's requirements. QRM is empowered to ensure that a commitment to quality and continuous improvement is central to our operations and growth as a company. QRM coordinates our quality efforts, facilitating the sharing of best practices between projects, focusing on improving project execution, maintaining regulatory compliance, and ensuring that we implement quality-focused practices throughout the company so that we may continue to offer exceptional service to and mitigate risks for our government clients. The collaboration and interaction within the QRM framework provides our projects with expert guidance and multiple avenues for knowledge sharing and risk identi?cation, making certain that project managers receive accurate and effective training and support related to quality best practices and initiatives, and enabling MAXIMUS to monitor processes and proactively address challenges throughout the project life cycle. During and after the completion of the Readiness Review, MAXIMUS will demonstrate and document progress through reporting and regularly scheduled status meetings. If any components of the Readiness Review indicate outstanding issues, MAXIMUS will prepare a Plan of Correction. We have processes in place to develop a Plan of Correction when needed to identify and address Readiness Review issues All performance improvement and corrective action undertakings share the following elements: A project plan that delineates tasks, responsible individuals, and deadlines Objectives or desired outcomes Lines of accountability Budgetary, resource, and technology impact analysis Agreement on communication protocols, including regularly scheduled status meetings, daily or weekly email updates, phone calls, or as-needed conference calls Communication with outside stakeholders facilitated or directed by the Agency I Monitoring of the plan's implementation, including the development of any necessary quantitative reports or quality assurance methodologies designed to measure quality or the continuing impact of the plan on the desired outcomes I Adjustment of the plan as needed, including potential reassignment of tasks, deadline changes, and deletion or addition of tasks I Resolution, including documentation of best practices to be replicated and mistakes or misjudgments to avoid in the future We work with the Agency to establish a mutually agreeable schedule for regular status meetings, either face-to-face or via conference call, as a part of the Plan of Correction. To optimize performance of the CSC, we will document recommendations for process improvements based on industry standards, best practices, and cost efficiencies, and report these 4. Approach to Transition RFP 86 P23001.006O March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 92 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS to the Agency. We understand that they may be discussed during the Optimization phase once CSC operations have stabilized. 4.9 Advantages of the MAXIMUS Transition Approach A smooth transition is of critical importance to Wyoming families and the Agency. Through dozens of transitions our team has learned that success maximized and risk minimized when a clearly defined approach led by an experienced Implementation Manager makes certain that deliverables are met. The Implementation Manager coordinates the contributions from corporate staff, along with subject- matter experts supporting the transition effort, so we meet state- and project-speci?c requirements and follow standardized checklists and plans. Our experienced and committed Transition Team meets transition-in schedules and leverages lessons learned from past efforts to minimize risks. Our detailed approach is essential to the project's success: Document responsibilities to ensure proper coordination and hand-offs Submit weekly status updates, with the latest assessment of each task Maintain open communication across our internal team and with the Agency Track requirements from the RFP process to the Standard Operating Procedures to project execution, ensuring that all requirements are not only met, but routinely monitored for compliance Upon noti?cation of award and receipt of Notice to Proceed, our leadership team will meet and work with Agency staff to establish a format and schedule for formal transition status reports that re?ect Transition Plan progress, including the completion dates of tasks and subtasks and percentage of completion of remaining tasks. Any tasks not on schedule will be reported to the Implementation Manager along with the planned steps to complete the task, along with updated completion times. MAXIMUS maintains an issue resolution plan that indicates the need for issue escalation or alternative actions to resolve the issue. Exhibit 4. shows how our transition model will bene?t the Agency for an on-time operations start-up. Experienced and committed I E?icient implementation schedules are met because team members benefit from transmon team members lessons learned from past transitions clearly understand their roles and responsibilities Established suppliers and I Facilitates decision-making and shortens the time necessary for start-up partners I Provides the highest quality services and products, even when facing tight timeframes, because we have predetermined procedures and agreements I Achieves cost savings and ef?ciency because suppliers understand our needs, are accustomed to the pace of our installations, and have their own teams standing by to assist us 30d predictable I Quickly identi?es and resolves potential impact of issues in every area of transmon process transition activities I Ensures a ?'ee flow of communication during the transition period I Enables the Implementation Manager to act as a clearinghouse for transition issues, to facilitate strategy development, and to resolve issues as they arise Exhibit 4. 9-1: Benefits of the MAXIM US Transition Process. We deliver a proven solution that provides operating c1enc1es improved service, and constant communication. 4. Approach to Transition RF #0175-Al 87 0060-? March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming Department of Health Division of Healthcare Financing and Maximus Health Services. Inc. Page 93 of 185 5: APPROACH TO OPERATIONS APPROACH TO OPERATIONS Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, inc Page 94 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center 5. Approach to Operations MAXIMUS The Wyoming Department of Health and its applicants/clients will receive timely, accurate, and reliable services with MAXIMUS as your CSC contractor. Far more than a call center vendor, we are experts in Medicaid and CHIP eligibility, equating to better trained and monitored staff for higher quality answers. Our advanced technology, including Cisco Platform, IVR with enhanced options, web chat, co-browsing, integrated Salesforce modules, and cloud security enables Wyoming to realize bene?ts more quickly. Our DecisionPoint for Business Intelligence brings together comprehensive analytics to give our managers and the Agency real-time and historic transparency into CSC operations to facilitate continuous performance improvement. Our approach gives customers and the Agency a one-stop shop with better service and increased ef?ciency. RFP Section 7.1.1.12, page 53 The Wyoming Department of Health, Division of Healthcare Financing (Agency) has made a strong commitment to increasing the accessibility of its bene?t programs through modernized technology and innovations. Its unique position as a relatively less populated state enables leaders to stay closer to citizens and the technologies that deliver public services to them. The Customer Service Center (CSC) contract is a natural extension of that commitment, providing multi-channel access for clients and applicants to obtain the administrative services critical to determining eligibility for bene?t programs. As the CSC project moves forward, the Agency seeks a contractor that shares their desire to improve service delivery and enhance the business processes. MAXIMUS will deliver a comprehensive, proven solution to provide accurate, consistent, and reliable service that is customer friendly and meets or exceeds SLAs while containing costs. Our underpinning of eligibility support services experience and knowledge will provide the Agency with a strong foundation for ful?lling its long-tenn visions and meeting its objectives for the CSC. We have the speci?c experience as well as the technology and processes to help Wyoming solution HIGHLIGHTS Multi-channel access gives customers more choice Integrated technology supports effective call handling Knowledgeable and friendly staff Knowledge Management System gives staff all program information in one place First Call Resolution improves ef?ciency and customer satisfaction Promoting self-service in the Interactive Voice Response (IVR) system improves ef?ciency and customer satisfaction Innovations like web chat and co- browsing expand customer access implement their vision and requirements. MAXIMUS stands ready to help the Agency provide ef?cient and effective services for those applying for its customers. Throughout our years of service, we have never forgotten the important impact we have on the lives of those in need of health care coverage. This applies to all staff, from our Customer Service Representatives (CSR) and Eligibility Specialists (ES) who demonstrate their professionalism each day while assisting Wyoming customers to the managers who are dedicated to working in partnership with the Agency for program success. We bring innovative process improvements, customer-focused staf?ng selection, and a proven training curriculum designed to meet the needs of Wyoming health program clients. 5. Approach to Operations P23001.0060 March 25, 2016 88 Attachment to the Information Technology Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 95 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 5.1 Operating the CSC RFP Section 7.1 page 53 MAXIMUS will provide the necessary administrative functions to enable Agency eligibility staff to quickly and accurately assess and determine eligibility. The goal is to make the best use of State staff time by providing as complete an eligibility picture as possible. We understand our role in conducting initial processing and supporting applicants and clients. 2513916259? We are a trusted and capable partner with unrivalled quali?cations, proven 3-: experience, and innovative solutions. Wyoming can be con?dent in our ability to operate the CSC because we bring successful experience managing eligibility support services projects across 19 government programs. Our experience on these projects, including the Florida Healthy Kids and Kidcare, Georgia Peachcare, and Texas CHIP and Eligibility Support Services (Health Care and Human Services Program Eligibility Services) projects is similar in both scope and complexity to that requested for Wyoming and provides the framework for our CSC approach. The best practices and innovations that we use in our health services call centers across the nation form the framework of our solution for a consumer- if .3 . 1 focused CSC for Wyoming. . AMXIM US understands the need Usmg the proven approaches from these prejectsmore than just MAXIMUS Will: a voice on the phone. The I Increase effectiveness and ef?ciency while information we give customers containing costs with cloud-based, integrated a?ects their families well-being, technology, well-trained staff, and comprehensive so it is essential that our staff as tools to support accurate and timely information an ingrained understanding of I Offer multiple channels for communication the spectrum of services available Increase self-service by enhancing IVR options and the interconnection of I Promote ?rst call resolution as we have in Texas service eligibility. This is at the where we increased from 12 percent four years ago core of our operational to 70 percent now philosophy and extends to the I Deliver better reporting for the Agency and CMS processes we use to respond to through our business intelligence layer customers'questions. Core CSC Functions sow Appendix A. 5034. 5033, 5103-5106 We will act as the primary processing point and customer service contact for all Wyoming health insurance programs within the Scope of Work. Core functions of our project operations, which are discussed in detail in the subsequent subsections, are designed to meet all of the requirements de?ned in the Request for Proposals (RFP), including: I Disseminating program information and materials I Answering customer questions about programs and eligibility I Screening clients for programs at the Cheyenne of?ce I Accepting phone, mail, fax, email and Client Web Portal applications for processing 5. Approach to Operations RFP 89 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 96 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Interviewing customers in person about eligibility Processing applications, renewals, and client changes, including veri?cation of resources Following up on needed client veri?cations Performing case management for Medicaid, Kid Care CHIP, and State-funded medical programs To meet these objectives, we will: I Hire and train staff I Provide CSC infrastructure, including the IVR and CRM I Update records in WES in support of eligibility determinations I Provide quality assurance/quality control as requested, including MEQC and PERM I Manage the centralized mailroom and use the State's Our approach to customer Electronic Document Management System service is based on our Report 0? CSC performance experienced staff, proven We will provide day-to-day oversight of the CSC processes, reliable technology, operations to effectively manage all CSC responsibilities antlfocus 0" deliver in}? a as de?ned in the Operations Procedures Plan and posmve customer experience. performance expectations, and will comply with all State and Agency standards and statutory mandates. MAXIMUS will work closely with the Agency to provide transparency into the operations of the CSC project and align with the State's objectives. We apply corporate best practices for project management and CSC services to help ensure that we plan, execute, and complete all CSC operational tasks successfully. We follow a detailed work plan with a deliverables-oriented work breakdown structure to outline tasks and subtasks that are discrete, quanti?able, and derived from activity-based cost estimates. Our CSC Account Manager guides a leadership team that is linked to corporate resources to provide program visibility and ensure nimble and ?exible resource allocation to verify that all tasks are completed, deliverables are submitted, and milestones are achieved on time. MAXIMUS Approach for CSC Success To successfully manage each of these core functions we bring proven operational processes that support the effective use of multiple access channels, well-trained, knowledgeable call center staff who understand how best to direct and assist consumers in using these channels to obtain the information and services they need, and effective technology to support our staff and processes. In the table that follows, we detail the highlights of our approach and the bene?ts they will bring to the Agency and customers. 5. Approach to Operations RFP 90 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 97 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Solution Highlight Multi-Channel Access Integrated Technology that Supports Effective Operations Well-trained and Friendly Staff Knowledge Management System The MAXIMUS Eligibility Playbook First Call Resolution Description We balance user-friendly and conveniently accessible solutions like 24x7 phone-based self-service options and electronic communications with the traditional "high touch" telephone assistance for individuals who prefer speaking with a CSR. We make customers aware of all options available to them, helping them understand the channels through which self-service actions can be completed, and assisting them with accessing and using these channels. Our state-of-the-art technology includes an advanced Cisco Uni?ed Enterprise phone system with an Automated Call Distributor (ACD), an IVR, voice mail, and call recording. We also integrate several technology components using Salesforce for CRM, KMS, email, chat. Using Salesforce, we collect customer support requests from all channels, automate routine processes, and use the knowledge base and FAQ's to provide accurate information. Our solution also includes robust reporting. The heart of our proposed solution is our staff. We begin by working with incumbent staff to interview and transition interested staff. Then, we recruit and hire employees to ?ll the remaining open positions using evidence-based interviewing techniques. Once we have hired the right staff, we give them comprehensive training. Our Knowledge Management System (KMS) the MAXIMUS Eligibility Playbook, built on the Salesforce platform for ease of use and maintenance guides staff through every office process with clear and accurate systematic instructions. The online Playbook puts everything our staff needs to complete any project task, including procedures, call scripts, and FAQs, right at their ?ngertips. First call resolution, meeting each caller's needs the ?rst time they contact us, is our goal. Using their thorough training and the Playbook, our CSRs have all the information they need to handle nearly every call. We will strive to meet a customer's needs on the ?rst call, chat, email, or visit. This is the essence of excellent customer service. We bring experience achieving high ?rst call resolution rates; using our NR and well-trained staff, we increased ?rst call resolution in Texas from 12 percent four years ago to 70 percent now. Bene?t to yonling Gives customers more choice in how they get and receive information increasing customer satisfaction Gets customers the information they need in the medium they choose Promotes high quality service with the ability to quickly handle calls, monitor operations, and assess call quality Reporting capabilities to give the Agency transparency into our operations Leveraging current technologies translates into immediate bene?ts and cost-containment Effective knowledge transfer and program continuity by hiring existing staff Evidence based interviewing ensures we hire staff who are the best ?t for this work Comprehensive training from program experts results in staff who have the knowledge and tools they need to accurately and effectively serve customers. Gives staff all project information in one place Customers get accurate, consistent, and complete assistance Speeds calls and reduces hold time without sacri?cing quality More calls resolved the ?rst time means fewer calls in the future, improving contact center ef?ciency Increased customer satisfaction 5. Approach to Operations .0060 March 25, 2016 and Maximus Health Services. Inc. Page 98 of 185 RFP 91 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Solution Description Bene?t to yonling Highlight Promote Self- Promoting self-service to improve customer satisfaction I Improved e??iciency Service and program ef?ciency is another key objective of our . Provide signi?cant ?exibility and CSC solution. The CSC be the catalyst that drives the convenience to customers by movement toward self-service, with a focus on helping making information readily clients complete application tasks and access program available at all hours assistance through self-service channels. Innovations We constantly research emerging technologies and I Expands customer access analyze industry best practices in order to improve our . Promotes customer engagement service offerings. We propose using web chat and co- I Cost-effective and effective cost- browsing in the CSC. We bring success?il experience containment with these tools. In New York, we have handled more than 31,000 web chats since October 2013. 5.1.1 Strategy for Meeting All Project Requirements RFP Section 7.1.1.12.1.1, page 53, 50W Appendix A 5078 MAXIMUS brings Wyoming a proven strategy to meet all requirements, deliverables, performance expectations, and services for the CSC. We are committed to delivering quality services for all areas of CSC operations, including: I Multi-channel contact center services to give applicants and clients accurate and complete information I Eligibility support and application processing services that achieve accuracy and ef?ciency standards for processing documents received via fax or mail, linking images to the appropriate case I Mailroom, outbound mail, and print services that meet performance expectations and improve client response rates Our response to the scope of work includes a detailed methodology for developing all of the deliverables required by this RFP, in addition to a detailed scope of work outlining the activities we have proposed. We will develop and submit all Operations Deliverables by the Agency- designated timeframes. We discuss each project element and our approach to effectively deliver services throughout this section. Mum-Channel Contact Center Services sow Appendix A. 5035, 5039-5043, 5047. 5048, 5051-5059, 5051-5055, 51 ca, 5121 To assist applicants and clients in the format and at the time that is most convenient for them, our CSC will provide customers with the information they need through their choice of communication channels, as shown in Exhibit 5.1?1. 5. Approach to Operations RFP #0175-Al 92 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 99 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Internet In Person CSC Eligibility Support Mail i I?m Services IC-mail . Self-Semce Channel eh 'lizil . Inbound Outbound Channel Phone and . [Snulig?lgnis Channel - Application {'o-brousing Exhibit Multi-Channel Support Services. Customers can reach the MAXIM US CSC via the channel that is most convenient for them, improving customer satisfaction and increasing program e?iciency. The MAXIMUS CSC will handle inquiries through the following channels: I Telephone: We will provide a toll-free telephone line for clients. Customers will not receive a busy signal when contacting our of?ce. Callers can obtain general program information and self-serve in the IVR 24x7. Our CSRs provide live assistance during contact center operating hours. I Web Chat and Co-browsing: MAXIMUS offers live web chat and co-browsing assistance for individuals accessing services online to positively affect customer service and encourage clients to use these channels knowing that assistance IS a mouse away. Whether a client or applicant is I In-person Customers have access to face- using elf-se rv ice options over to-face serVices through our of?ce in Cheyenne the Internet orph one, speaking throughout the week, With extended hours for more to a CS directly, or completing convenience. . aform that will be faxed or I Email, Mail, and Fax: Customers can submit mailed, our goalfor the CSC is inqumes Via email, fax, or mail. We route these to create an environment of questions to a CSR who will contact the customer and helpfulness ease simplicity and provide a response. Clients and applicants also use the 3" ni e. fax and mail channels to submit applications and 5. Approach to Operations RF 93 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 100 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center other documentation that is necessary to process their application and maintain current case data. We will answer customer inquiries regarding eligibility as well as basic questions regarding denials and closure of bene?ts. We will staff the CSC with operator assistance in English and Spanish from 7:00 am. to 6:00 pm. Monday through Friday (excluding holidays as de?ned by the Agency). We will also provide walk-in services to clients. We support our well-trained staff with infrastructure and tools, including an IVR and CRM, discussed in more detail in Section 5.3: Tools and Software. We will research and respond to written responses via email or phone call within two business days of receiving the correspondence 95 percent of the time, and accept and respond to written and emailed client inquiries SPOTLIGHT ON: Successful contact center delivery approaches We provide substantiated experience in successful call center operations, and will bring this same underlying technology and operations to Wyoming. Our contact center success includes: I Operating customer service call centers in 37 states, including four of the nation's largest states in Texas, California, New York, and Florida I Processing more call center within two business days. Below, we ?rst discuss our general approach to handling inquiries, regardless of the inquiry method, and then we . detail speci?cally how we handle telephone calls the method from which most inquiries will come. Inquiry Handling Procedures enrollments, applications, and renewals than any other vendor Answering more than 2.5 million calls - Supporting 22 million bene?ciaries across 20 states Every day, clients and applicants contact us for information about their case or to ask general questions. Our CSRs will help applicants directly through the contact center and in-person should they need assistance completing applications, reporting changes, and submitting missing veri?cations. Our CSRs receive in~depth training on the various types of calls they might receive, as well as information and strategies for inquiry resolution. Our training program helps improve customer service, enhance e?iciency, and ensure we meet quality assurance standards. Because of 0 ur training, the Agency will have a team of professionals who are happy to be making the most of their talents, dedicated to helping customers, and always thinking of innovative ways to ensure the continued success of the CSC. 5. Approach to Operations P23001.0060 March 25, 2016 Because of the complexity of eligibility and the vast array of inquiries that the CSC supports, it is essential to have well-de?ned processes for handling inquiries, whether via phone, chat, or other means, to ensure accurate, consistent, and timely support. Our approach to inquiry management is based on our understanding of the case lifecycle, from providing basic program information to application processing to ?nal determination of bene?t availability. For each inquiry we receive, our CSRs review the client's case, identify any issues that may occur depending on a client's speci?c circumstances, and pay close attention to detail when speaking with a client about his or her concerns and questions. By understanding the end-to-end process of eligibility determination, our CSRs are able to RFP 94 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 101 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS address the primary inquiry at hand and identify additional topics that are relevant to a client's case status. We will research and work to resolve client questions, issues, and account discrepancies, and assist clients navigating the Client Web Portal with co-browsing. We train our CSRs to provide the highest quality service during every interaction, and we strive to resolve any inquiries, issues, or complaints the ?rst time a client or applicant reaches out to us. We escalate any issues which we cannot resolve or which require specialized attention to the Agency within approved guidelines and timeframes. We will disseminate program information to clients in accordance with Agency policies, including Medicaid Program Information and Kid Care CHIP information. This information will include general program information, eligibility requirements, application and enrollment processes, renewal processes, procedures for reporting changes, and other important information. Delivering Accurate, Consistent, and Timely Information to Clients A key tenet of the MAXIMUS customer service philosophy is an emphasis on quality ?rst, and we promote this throughout all aspects of our contact center operation. CSRs use their training, delivered by experts in government health, and the MAXIMU Eligibility Playbook to guide them through all processes and answer inquiries. We designed this tool to provide our staff with the knowledge and resources to fully address the broad array of inquiries that we receive with accuracy and consistency, minimizing the need for callbacks, referrals to the Agency, and follow-up action. Our comprehensive quality management process enables us to monitor our performance in delivering accurate and timely information, monitoring a random statistically valid sample of live or recorded calls and other of?ce processes to measure our performance against KPRs. We provide a detailed description of our approach to quality assurance in Section 5.1.4: Quality Management. Comprehensive Training and Supportive Tools Promote Accurate Service Our staff uses their extensive training and the MAXIMUS Eligibility Playbook to handle each inquiry and of?ce process. We approach training differently than most contractors. Our training will not be undertaken as a "one- and-done" function?quickly dispensed, passed, and It 1 forgotten. Rather we consider our staff to be in a constant - state of learning that goes well beyond the initial stages of The MAXIMUS Eligibility training. Prior to hiring, we screen staff to ensure they playbook supplements our bring the right set of quali?cations to empathetically serve extensive sta?training. It is an customers. After hiring, we train and monitor them to online centralized repository of make sure they are conducting meaningful interactions project documents, including with customers. To us, technology cannot take the place of policies and procedures, job experience and no amount of dynamic, guided scripting aids, templates, call scripts, can replace the competency gained through person-to- and reports easily updatable person interaction in the classroom and during on-the-job on the ?y as policies and training. procedures change 5. Approach to Operations RFP 95 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 102 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS We promote an ongoing training lifecycle designed to move staff beyond simplistic interactions with customers that are based on highly scripted scenarios. Employees will be required to demonstrate a history of competency. Competency testing will be continuous and ongoing and will supplement and complement live C1500 has been recognized as a leader training. We empower staff to legitimately interact with in Uni?ed Communicationby customers as experts in the ?eld. Gartner and has been POS?F?oned as a leader in the Gartner Magic Furthermore, our training program is not static and will Quadrant for Uni?ed SPOTLIGHT ON: Our telephony platform be adjusted according to shifting program needs. Communications. Training staff quickly resolve any issues and revise and Through Cisco, we have chosen a update training protocols. telephony platform that delivers: Our training is performance-based; that is, we focus not . Intelligent contact routing, call only on the mere acquisition of knowledge, but also on treatment, and contact how our staff will apply that knowledge in a speci?c management business context. We train staff on customer service A modernized infrastructure able skills, program information, project procedures, and the to support additional use of our technology that supports operations. We use standard training modules based on staff positions and con?gurable telephony and functions, and as necessary, develop additional training reporting applications modules incorporating newly identi?ed program Redundant data centers to knowledge and skills. Our training program is tied support operational business directly to quality assurance, which allows us to identify continuity for call centers problem areas quickly and get staff the knowledge, skills, and tools they need to do their best at all times. Our KMS, the MAXIMUS Eligibility Playbook, is an important supplement to the extensive training our staff receives. While core training programs foster the speci?c skills, techniques, and program information needed to best serve customers; the Playbook serves as a performance- support tool to reinforce what staff have learned. The Playbook is fully integrated into our training classes; its articles are used to demonstrate training activities, and trainees get hands-on practice using the Playbook to its full extent in support of handling customer encounters. The Playbook ensures standardized responses and eases the learning curve for new staff. The online Playbook operates as a simple web portal, accessible to all staff through the web browser installed on their PCs. To facilitate communication with Spanish-speaking callers, we present most frequently used information in the Playbook in Spanish, so our bilingual CSRs do not need to translate information before responding to callers. Telephone Inquiries MAXIMUS manages all telephone inquiries using our Cisco Uni?ed Contact Center Enterprise (UCCE) and contact center applications infrastructure, described in more detail in Section 5.3: Tools and Software. The UCCE tracks all inbound calls and routes them to the appropriate agency. All inbound calls are initially ?ltered through the IVR, and callers who request assistance are placed into a call center queue for prompt help from a CSR. Our skilled CSRs handle the majority of telephone-based client inquiries. 5. Approach to Operations RFP 96 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 103 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS Using the I to Triage Calls and Promote Service Requests When an applicant or client calls our of?ce, the call immediately goes to the IVR. The IVR provides the initial message to callers and triages them to the appropriate queue based on their menu selection. The IVR enables callers to get the information they need using the fewest number of prompts and options. It will play appropriate language prompts based on IVR prompt selection. Through the IVR, callers can: I Self-Serve a Case-Speci?c Request: If the State is able to provide us with a ?at ?le of certain WES data, we can populate the IVR to offer customers the option of completing various self-service requests in the IVR, such as checking application or review status; or. obtaining con?rmation that the CSC received their documents. Access to case-speci?c information and self-service actions related to a speci?c case requires that a caller authenticate his or her identity by entering unique identifying information, such as social security number and date of birth, when prompted. Once identi?cation has been veri?ed by the system, the caller will hear the information requested, such as disposition of their application or review status, (for example "missing minimum information", "in processing", or "screening complete") or the last ?ve documents the CSC has received and the date of receipt. We will work with the Agency to determine an appropriate way for the caller to authenticate to the IVR. I Self-Serve for General Information: MAXIMU will add functionality to the IVR enabling callers to get answers to frequently asked questions or request an application. These answers include of?ce hours, mailing address, website address, fax number, directions to the of?ce, contact information for other State programs and call centers, and general information on the review process. These self-service options optimize automation and maximize the IVR containment rate, resulting in satis?ed customers and a signi?cant off?load of routine calls. I Transfer Directly to a CSR: We recognize the .1 importance of preserving the necessary level of 590139" vice options in our IVR personal assistance to ensure that all clients, including give consumers 24/ 7 access ?0 those with diverse communication needs, have timely information, as answers (0 access to accurate program and case information. We frequently ?Ski?" questions. always make it easy for a caller to transfer to a CSR Callers can 303W connect ?0 a for personal assistance. Regardless of the caller's CSR at any timefor personal language preference, he or she will be routed to a CSR assistance. who can provide the necessary assistance, whether that is one of our English or Spanish-speaking CSRs or to a CSR with ready access to Language Line interpretation services. The IVR also provides convenient routing of teletype (TTY) callers to staff who are equipped with TTY communication capability and specialized skills for assisting individuals with hearing- or speech-impairments. I Transfer to Another Agency: Callers will also have the option to transfer to the appropriate State agency or other outside entity, based on IVR menu selections. Our ability to achieve the proper balance between self-service technology and personalized customer services comes from the knowledge and understanding acquired through millions of 5. Approach to Operations RFP #0175-Al 97 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Heaith Services. Inc. Page 104 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS interactions with a wide variety of customers whose needs, personal pro?les, cultural attributes, and knowledge of the health delivery system are analogous to those who need Wyoming CSC services. Our A CD Routes Calls to the Right CSR to Serve Each Customer If a customer chooses to connect to a CSR. the call is sent to our ACD where it is intelligently routed to the best CSR to handle the call. We can con?gure the ACD to send callers to the ?rst available CSR or the ?rst available CSR with a speci?c skill set, such as program or language expertise. Our ?exibility in call routing delivers better, faster service for every caller. Best Prentice 4 Based on our experience, we propose to route calls in a way that presents them i j, to available CSRs who possess the most appropriate set of skills to respond to a caller's needs. Calls are simultaneously queued to multiple skill sets to provide the maximum level of call coverage, while helping to ensure that the caller is directed to the best CSR to service the request. CSRs are assigned to multiple skill set categories, according to their abilities, and are given a priority for each skill set, de?ning their level of expertise for the given skill. Callers are routed to the ?rst available CSR with the highest priority level for the skills required to address the caller's issue. Knowledgeable, Well-trained CSRS Handle Calls Skills-basedcallrouting After routing, the CSR answers the call. At the start of provides the bene?ts of each customer interaction, we connect with the customer improving call processing time, and quickly determine the reason for their call. We shortening call duration, and understand that our customers can be highly emotional improving overall call about dif?cult issues. Our challenge is to turn all resolution, resulting in a interactions into positive customer service experiences. positive experience for callers We train our CSRs to focus on af?rming each customer's and a higher ?rst call resolution feelings, making the customer feel heard, valued, and able rate. Routing calls in this way to move ahead with the objective of their call. We teach helps to maintain lower our staff phrases to use that will foster a sense of abandonment rates and shorter partnership in resolving the issue. Ensuring that the wait times as calls are answered customer does not feel like they are alone in trying to more quickly and ef?ciently. resolve their issue is a great building block for a positive relationship between the customer and the CSC. For each call, our CSRs identify themselves by name, greet callers warmly, handle all conversations in a professional manner, and ensure each caller's right to privacy and con?dentiality. For every call, the CSR: I Veri?es the caller's identity before releasing any case-speci?c information I Asks the reason for the call I Reviews information and notes in WES and CRM to provide accurate information I Follows protocols, including querying appropriately to answer the caller's questions and concerns I If caller has an account, asks if contact information in the system is current and updates any changes 5. Approach to Operations RFP #0 75-A 98 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 105 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I Identi?es any outstanding verifying documentation and inform the customer of what is required in when it is required by and follow-up with necessary mailings reiterating the required documentation I Schedules and assigns follow-up actions, as appropriate I Recaps the information provided, and reiterates any action items that the caller or CSR has been assigned I If a referral needs to be made, informs the caller that they will send the information to the appropriate of?ce I If a call needs to be transferred to an outside entity, follows documented processes for proper referral and warm transfer to facilitate a seamless experience for the caller I Properly documents the call in WES and the CRM We will facilitate warm transfers to and from the Agency's LTC Unit or other Agency representatives to ensure seamless connections. We will directly transfer calls for the LTC Unit within 60 seconds of the transfer initiation. If a call is interrupted due to circumstances under our control, we will return the call to the customer within two minutes of the exception, unless there are outstanding circumstances such as a power outage. We understand the call volume statistics in the RF and acknowledge that call volumes below 8,000 calls per month or over 12,000 calls per month for six consecutive months will trigger a contract negotiation. Handling Spikes in Call Volume MAXIMUS built our CSC solution to accommodate ?uctuations in call volume. While we believe that our solution will enable us to handle the usual expected call volumes, we recognize that there will be times when volume will spike. Our staf?ng model, supported by our experience and technology, enables us to meet performance metrics even in the event of unexpected spikes in call volume. We will monitor the phone line capacity and the number of CSRs available to measure the ef?ciency of the current infrastructure and provide a report to the WDH Vendor Contract Manager. As call volumes increase, we will install additional lines and/or equipment and add staff in order to meet Contract response timeliness requirements at our expense. We include infrastructure ef?ciency reporting in the regular CSC report. Excellent staf?ng is a key component of maintaining service delivery, even during spikes in call volume. We considered numerous factors in modeling proper staf?ng for the CSC including peak volume times, overall call volumes factoring in population growth, callers' "patience curve,? a measure of how long callers are willing to wait before abandoning a call or leaving a call back request, CSR occupancy percentage, (which is time spent handling calls after subtracting lunch and break times, training sessions, planned absences, sick time, and the like), contractual SLAs, gradual ef?ciencies in Average Handle Time due to CSR expertise and continuous process improvement. We discuss our approach to staf?ng and staf?ng levels in more detail in Section 5.1.2: Sta?ing Levels. We can also use our shared services of?ce in Denver, only 90 minutes from Cheyenne, for workload over?ow if needed. 5. Approach to Operations RFP 99 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 106 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS Augmenting our ?exible staf?ng model is our ability to cross-train staff to maximize coverage. MAXIMUS cross-trains our staff to perform different functions, so that we can redirect staff from one functional area to another, adjusting staff when applications or call volumes ?uctuate up or down. This ?exible model provides us with quali?ed staff when we need to supplement staff in one area, yet allows us to redeploy staff to other functions when seasonal ?uctuations or program changes result in the need for staf?ng reductions. For example, all staff are trained to perform data entry, so when call volume is low and data entry needs are high, our CSRs may assist with data entry in between calls. In addition to our ?exible staf?ng plan, our technical solution is expandable to accommodate growth and help us to manage increased call volumes. Features that support this scalability include: I Offering a Scalable Technology and Infrastructure. Our technology and infrastructure is designed to handle the anticipated volume, including periodic surges. Our telephone system is engineered to easily con?gure additional circuits as needed should call volumes increase over time. Re?ned through years of experience and millions of customer interactions, our complete telephony solution handles the expected volume of calls, as well as any spikes in call volume. I Intelligent System Reporting. MAXIMUS uses historical call information and tracks and develops schedules based upon intra-day, daily, weekly, and seasonal call volumes. We take into consideration average handling times, service levels, skill sets, and call types to ensure an appropriate number of staff members are on the phones and available for customers during peak periods. Supervisors will continuously evaluate the call data throughout the day. If wait times start to increase, the management team will make staf?ng adjustments, including adjusting break times and lunch times, or having supervisors take calls to ensure we do not exceed the hold time. I Advanced Use of Call Routing Capabilities to Support Ef?cient Customer Service. By distributing incoming calls based on availability, language skills, and other CSR attributes, we can shorten call times, get the most appropriate CSR to the caller, and increase our ability to take more calls while still providing the caller with an excellent customer service experience. One of the techniques we deploy in a CSC like Wyoming is the use of skills-based routing to send general calls to our newer Tier 1 CSRs and more in-depth, case-speci?c calls, to our experienced Tier 2 staff. Another technique we have learned and leveraged is making immediate changes to call routing when call volume merits. This increases call ef?ciencies and provides better customer service, all aimed at achieving an effective outcome for the caller. Our training program gives Our management constantly monitors our detailed CSRS the necessary soft skills operational dashboards to adjust staf?ng based on calls in to re?ect compassion, empathy, queue. We review real-time data on call volumes, service respect, and professionalism as levels, and CSR availability to make quick operational they assist individuals With changes when needed. If we ?nd that we are experiencing SpeCifiC linguistic and cultural needs or persons with disabilities. 5. Approach to Operations RFP 100 P23001.0060 .. March 25, 2016 Attachment to the Information Technology (11) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 107 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS unusually high call volumes, we take steps that enable us to continue to serve customers within contractual SLAs. Customer satisfaction surveys are an efficient, and reliable tool for measuring the qualitative customer Handling Calls from Hearing-Impaired and Non-English Speaking Callers As a leading health and human services provider, experience. We use the MAXIMU IS sensmve to the need to ensure access to information obtained through servrces for a diverse population With varying needs. All surveys to continuously improve of our call centers areldesigned to support equal access our overall service as well as for ind1v1duals With d1sabilities and customers whose service provided by each CSR. primary language is not English. We accomplish this through specialized systems and services that are designed to accommodate these needs. We will equip the call center with a modern TTY system for communicating with hearing- and speech-impaired callers. Our TTY system is a software-based application designated CSRs access via their computer desktop. CSRs receive specialized training on effective communication with TTY users and appropriate TTY etiquette. Individuals with hearing and speech impairments can also use web chat and email to contact the CSC. It is a MAXIMUS best practice to include bilingual CSRs in our staf?ng model in a quantity that is proportionate to the non-English speaking population we will serve. When a caller needs assistance in a language other than English or Spanish, the CSR informs the caller that we have interpretation services available to them at no cost. We use Language Line, an external service provider, for telephone-based language interpretation services in more than 200 languages. Language Line has been a proven, trusted provider of interpretive services to MAXIMUS for many years, and we work with them in most of our health and human services call centers. This service is available during call center operating hours at no cost to the caller. When we use the Language Line, our CSR stays on the line and conducts a three-way conversation with the customer and the interpreter, so the caller never has to hang up and call another number for assistance. Surveying Callers MAXIMUS will work closely with the Agency in developing surveys that accurately measure the courtesy, knowledge, and helpfulness of our CSRs, the ease and convenience of using the IVR, and the overall quality of our services. We apply decades of experience designing and administering customer satisfaction surveys to provide every caller the opportunity to provide feedback. We know from experience it's important to design surveys very carefully to elicit speci?c feedback from our customers so that we can pinpoint exactly where we are doing well and where we need to improve. We will survey customers two ways: on the phone and online. At the close of each call, our IV will offer a survey to each caller. The survey will measure customer satisfaction with our services, including information provided by both the IVR and our CSRs. Adding surveys in the IVR increases the volume and variety of comments we receive, giving us more feedback about how the CSC is doing in meeting the needs of Wyoming customers. We will also develop a web-based survey using Survey Monkey and include the link in all of our communications with customers. We conduct a range of customer satisfaction surveys on nearly 5. Approach to Operations RFP 101 P23001.0060 March 25, 2016 Attachment to the Information Technology (In Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 108 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS all of our health services projects, and we have found Survey Monkey to be a powerful secure data collection tool for our survey activities. Our project management and quality assurance staff gather and use survey results to identify areas where we excel and ascertain potential areas for improvement at the project, unit, or individual employee level. We will include survey results in our regular reports to the Agency. The results of each survey question can be displayed using bar graphs that list the question, each response, and the percentage of people that responded to each option, making it easy to see results at a glance. Meeting Call Center Performance Standards performance - Being accountable to the Agency for meeting performance requirements is as 3 TM Important as servmg the customers who call the CSC. We Will meet each of the standards listed in the RF P. Our detailed approach to monitoring and complying with the performance standards is described throughout this response. Wyoming can be con?dent that we will meet these standards because MAXIMUS call centers routinely meet and exceed requirements similar to those required for the CSC. Meeting standards and consistently obtaining feedback about how we deliver services helps us to continuously improve our performance. Our proven approach to meeting performance standards revolves around several best practices and strategies we will bring to Wyoming including: I Carefully con?gured staf?ng plan, comprehensive training, and easy-to-use tools to accurately and completely answer questions maximize ?rst call resolution and customer satisfaction I Suf?cient phone lines, ef?cient call routing, informative messages, and the ability to monitor conditions in real time help us maintain low abandonment rates and meet average answer times I Business intelligence, performance monitoring, quality control procedures and complaint handling processes help us to provide excellent service, minimizing complaints We will gather required data, and analyze and report on that data. We will also perform trend and root-cause analyses to identify issues and opportunities for improvement, and initiate changes to improve performance and service delivery. Using Web Chat to Handle Inquiries Innovations As described in detail in Section 5.11: Possible Optimizations, with Agency .i in approval, MAXIMUS will offer web chat assistance as an additional support '1 channel. When a customer clicks on the web chat button on the web portal, one of our CSRs will see the request on their computer monitor, greet the customer, and then respond to questions posed. CSRs record web chat contacts in the CRM with any other information provided during the session, just as with a phone contact. In -Person Assistance MAXIMUS will serve customers in-person at our Cheyenne of?ce. Walk?in visitors are greeted by our front desk staff, who has them sign in and immediately contacts the staff member needed to assist the client. The front desk staff noti?es an English- or Spanish-speaking CSR or Eligibility Specialist, depending on customer needs. The designated staff member meets with the customer within 15 minutes or less in a private interview room, allowing for the necessary level 5. Approach to Operations RF #0175-Al 102 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 109 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS of con?dential communication. Our interview rooms are equipped with computer workstations with access to all necessary applications and documentation. We make appropriate accommodations in our waiting room area for families with children, including simple toys and coloring sheets. Our proposed facility is centrally located and accessible to public transportation, and will be ADA compliant to ensure accessibility to individuals with diverse needs. We currently have hundreds of staff across the country We recognize that some providing in-person assistance to customers, helping them customers prefer ?0 receive apply for a wide variety of state programs. In New York assistance in per 50'1- sta? alone, we have over 120 staff dispersed across the state serve walk-in customers in a performing this function. In West Virginia, as part of the timely accurate manner ?0 state's In-Person Assistance Program, we provided staff ensure they get the assistance representing each county in the state, helping consumers they need. navigate and complete the application and enrollment process for insurance affordability programs. Handling Inquiries via -mail, Mail, and Fax MAXIMUS will also answer inquiries received via e-mail, mail, and fax. As with phone calls, CSRs use the MAXIMUS Eligibility Playbook to inform their accurate and consistent responses to customer inquiries received via e-mail, mail, and fax. As a standard practice, our project staff accesses e-mail inbox accounts on a mail server to retrieve e-mail messages submitted by customers through a website link. To ensure that e-mail remains secure both on the sender and receiver side, we propose having the WES contractor add a web entry form to the State's website. Customers click a button to contact us via email that will take them to a web form where they can enter their question. The form is then securely transferred to the CSC where our CSRs research the inquiry and contact the customer. MAXIMU implements standardized quality assurance procedures and processes to monitor, measure, and improve e-mail-based customer service. These policies and procedures, housed in our Playbook, guide e-mail follow-up on customer inquiries to make certain we provide the same courteous, timely, and accurate responses to inquiries received via e-mail as we do for written and telephone contacts. When we receive a document or inquiry via mail, our mailroom staff will open, scan, and queue images. Mailroom Specialists will route inquiries to CSRs to contact the customer for resolution. We will also route any inquiries received via fax to CSRs for response. We can report on each inquiry received via e-mail, mail, or fax in our DecisionPointTM Business Intelligence (BI) Reporting system. Documenting Inquiries Through our staff training, and reinforced in our Playbook, we relay the importance of collecting complete information for each contact and detail procedures for documenting each contact with thorough notes. We will maintain adequate records in the WES andr?or CRM that clearly 5. Approach to Operations RFP #0175-Al 103 .0060 March 25, 2016 Attachment to the information Technology (IT) Contract between the State of wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 110 of185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS document the actions we take with applicants and clients. We will input updated eligibility and contact information received over the phone directly into the WES. We will also update changes such as household residency, household composition, income, expense, and private insurance coverage and make a preliminary assessment of the eligibility. A utomated Outbound Messaging Today, the majority of CSC calls are "Case Status" calls: clients calling to verify that they are approved for bene?ts, or that their document was received. We can reduce the need for customers to call with these routine questions by leveraging batch data interfaces to provide outbound emails for key case transactions. This enhances cost contaimnent and increases customer satisfaction with the CSC. Speci?c automated outbound emails include: Outbound e-mails notifying applicants and clients about the status of their case increase efficiency by pre- empting the need for follow- up calls. They improve client engagement for clients who prefer to access their case via messaging instead of ph one calls. I A reminder to clients for whom we received returned mail to update their address, and a noti?cation to the client when we have successfully updated their case record with the new address information they provide I A con?rmation that we have received an eligibility application through the Web Portal I A noti?cation that we have received a change request through the Web Portal I A reminder of an upcoming telephone or face-to-face appointment I A reminder to an applicant who has started an application, change, or redetermination on the Web Portal but has not yet completed it that he or she should log back in and complete the process I A reminder to submit missing information I A reminder to renew Medicaid bene?ts I A noti?cation that an account password has been changed Handling Complaints and Grievances To maximize customer satisfaction, MAXIMUS focuses on preventing issues from becoming complaints with customer-centric project management, compassionate communications, and quick resolution. We also understand that issues can and do occur. We document, track, and resolve or escalate complaints when they occur, and accept complaints by various channels including telephone, mail, and fax. We designed our complaint resolution processes so customers know that we understand and are empathetic to customer concerns. Our goal is not to simply "check a box" and declare a problem resolved, but to identify the true source of the issue, and resolve it If the issue falls outside of our operation, we quickly get the customer to the appropriate entity and person who can respond. 5. Approach to Operations RFP 104 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 111 of185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS We inform customers of the procedures for making a complaint, keep customers informed about the status of their complaints, provide numerous feedback avenues, ensure timely resolutions, and track each complaint in our call tracking system. MAXIMU trains and prepares our staff to capably handle complaints with detailed work instructions housed in our MAXIMUS Eligibility Playbook, and clear instruction on the proper use of internal and State systems, to enter, track, and resolve complaints and disputes. We will respond to complaints either directly or by capturing the information and referring it to Agency staff. We make every attempt to resolve complaints at the CSR or Supervisor level. Through training, our staff knows how to appropriately To maximize customer discuss and resolve complaints whenever possible. satisfaction and minimize They work with customers to resolve issues, which improves complaints, we train our sta?" customer trust in our staff and con?dence in the program. on how to handle complaints If the CSR is not able to fully resolve the complaint, and sensitive issues. This they escalate it appropriately for timely resolution. module instructs staffon how When a complaint is escalated, our managers respond to correctly identify, to the complaint immediately, acknowledging receipt document, escalate, and via email whenever possible, informing the customer that resolve complaints, and to we will respond within our designated timeframes, and appropriately handle callers logging the complaint. who may be upset. To generate reports, we export data about complaints from the CRM into DecisionPoint for BI, our reporting solution (discussed in more detail in Section 5.10: Reporting and Data Analysis). Using DecisionPoint, we analyze complaints to give us a snapshot of customer concerns. This helps us to learn how customers feel about our service delivery and any issues they may have. This knowledge is the ?rst step to opening up communications, which leads to quicker problem resolution. We will provide the Agency with written information regarding complaints for follow-up, and will share information about complaints from our Salesforce CRM so that the Agency may provide training to CSC staff as needed. We will also use our CRM to track all grievances. We will report grievances to the Agency within one business day. We acknowledge that any grievances escalated to hearings and/or appeals will be handled by the Agency. Eligibility Support Services sow Appendix A, 5044-5045 Processing new applications for coverage is one of the primary responsibilities 3 f? of the CSC. We strive to maintain the simple and easy application process, approved by the Agency, for all applicants using whatever available method is best for them. MAXIMUS currently operates 19 projects that provide eligibility determination support services for a variety of programs, including Medicaid, CHIP, state-based health 5. Approach to Operations RFP #0175?Al 105 P23 001 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of VWoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 112 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS insurance exchanges, and human services programs. This experience provides an exceptional base of knowledge and best practices for this scope of work. Working within the State's systems and regulations to process various types of documents can be complex. MAXIMUS, however, fully understands our responsibility to act in this capacity as a conduit for eligibility determinations and case changes functions which are carried out by Agency eligibility staff. Because of our experience operating similar projects we are uniquely quali?ed to complete each step of initial processing using State-provided tools and technology. The following sections describe our approach to providing eligibility support services using Agency-de?ned processes and procedures for data collection and routing within State-provided automation systems. Our approach is focused on optimizing our processes with the State system to comply with federal and State timeliness and accuracy standards, and to adjust to future changes or requirements. Exhibit 5.1-2 illustrates the variety of ways customers may submit an application. Wyoming Application Channels . L) . dg?i; Paper Online Walk-In Telephone Received mail, WES web Assisted paper or Application co-bromsing fax or email portal onliue application via web portal Exhibit 5.1-2: CSC Application Channels. We provide Wyoming applicants full support through their choice of application channels, enabling them to apply in the method that is most convenient for them. MAXIMUS will process telephone, mail, fax, e-mail, and web portal applications, renewals, and client changes, including veri?cation of resources for some cases. We will also follow up on needed client verifications. We will conduct quality assurance/quality control of applications and cases as discussed in detail in Section Quality Management. Using our experience in similar projects, we will develop speci?c procedures and workflows to ef?ciently and accurately: I Collect information on applications, renewals, and client changes over the phone using the WES I Process mail-in, e-mail, and fax applications, renewal forms, and client changes using the WES and EDMS I Assist applicants in completing applications whether over the phone or in-person I Help applicants report changes I Assist applicants with the submission of missing veri?cations needed to complete their determination We show an overview of our ef?cient work?ow in Exhibit 5.1-3. 5. Approach to Operations RF #0175-Al 106 P23001.0060 March 25, 2016 Attachment to the information Technology (tT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 113 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Phone/CSR n. . I. I iJEJn-m ec1a ISI Application Created 111 WES 1 Data Entry into WES ication Q: Q: Complete'T Yes No Agency sta?' notices ?819Ef?155m determines eligibility print and mail Exhibit 5.1-3: CSC Workflow. Our e?icient war/970w ensures timely and accurate application processing through all channels. We train our ESs how to accurately process all applications. Staff not only data enter information from each application, they con?rm that it is complete, request documentation if needed, facilitate complex processes, and help applicants to understand the required information or veri?cation materials. MAXIMUS will process all applications, renewals, and changes within the timelines required by the RFP. 5. Approach to Operations RF 107 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 114 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS We understand the application and renewal volumes presented in the RFP and acknowledge that the Contract will not be renegotiated on the bases of volume changes unless volume increases 20 percent or more for a period of six consecutive months. Handling Paper Applications and Documents Generally, Mailroom Specialists will open each piece of mail and scan it. After scanning, the specialist reviews the document, con?rms the image is a valid and legible document, and classi?es it. Applications, renewals, and changes are routed to an ES for processing. We will meet all RFP requirements for timely scanning. We follow these same procedures for applications submitted via fax, e-mail, and portal as well. Handling Telephone Applications Many applicants who do not have access to the Internet, or who prefer to talk to a person, will choose to apply for family medical programs by telephone. This important service is provided in MAXIMUS customer service centers across the country. We understand the unique challenges of the telephone application process, and we also understand that the process in each state is unique. When an applicant requests assistance, the CSR will walk the applicant through all of the information on the form, which mirrors the information that must be entered into WES. The CSR will also follow established protocols for identifying the applicant and explaining the application next steps. We record all application calls and log them in the CRM. Handling Walk-In Applications We will also accept applications from walk-in customers. Applicants may bring the application with them and drop it off or meet with an ES to complete an application during their visit. Either way, we enter all data into WES and ensure that everything is complete. Indexing Applications and Documents To ensure that Agency staff receive all of the information they need to determine eligibility, MAXIMUS staff will index each document to associate it with the appropriate case within the WES. In our other operations, we follow these general steps to index documents: I Review the image for information needed to identify the client or applicant and the reason for submitting the document I Route to a research queue for processing if the image is not legible or if there is not enough information available to identify the individual I Perform a detailed client search using prede?ned search criteria to gather more information about the client and determine if he or she has any active case ?les open or any previous case ?les I Classify the document based on gathered information and known program information I Determine if the image is from a new applicant and requires application registration I Link document to appropriate case in the system of record, such as WES We will develop similar procedures for Wyoming. Upon Agency review and approval, we will incorporate these procedures into the ?nal policy manuals and process guides. 5. Approach to Operations RF 108 P23001.006O March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, inc. Page 115 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS Entering Applications and Other Documents Eligibility Specialists enter data from each application (or other document) directly into WES. Having this information displayed using dual monitors facilitates data entry and enhances ef?ciency. Staff enters each data element following data entry rules and Agency-approved procedures. Once data entry is complete, the Specialist reviews the entered information before submitting the application. Once indexing and data entry are complete, we route the application, renewal, or any other form of documentation to the appropriate eligibility staff. Using dual monitors, the ES simultaneously displays the Following Up on Applications with Missing Information electronic image ofthe paper If we ?nd that an application is missing information, we application and WES. mail the automatically generated WES notice asking the applicant to send in the missing materials. The applicant then sends us the information (using any of the same channels as the original application), and we process it using the same steps we use for application processing. We will complete follow-up case tasks no later than two days from the date of receipt of the task 95 percent of the time. Quality Assurance for Applications and Document Management Timeliness and accuracy are both critical aspects of the eligibility support 3 process. MAXIMU understands the importance of performing tasks within *4 required timeframes, and we embrace our role in assisting the Agency to meet or exceed all essential State and federal requirements. We train our staff on all timeliness and accuracy requirements and use our quality assurance processes to ensure we remain in compliance. We discuss our approach to quality assurance in more detail in Section 5.1.6: Monitoring and Reporting. Mailroom Services SOW Appendix A 5049 Appropriate handling of incoming and outgoing mail is critical to the success of any operation. MAXIMUS will manage the centralized mailroom to manage incoming and outgoing mail for the CSC. Demonstrating our ability to handle incoming and outgoing mail volumes, our mail house for the California Health Care Options program designs and manages the printing and mailing of all program literature distributed to our bene?ciaries - approximately 14 million packets and letters to eligible program bene?ciaries, and our Texas Eligibility Support Services project has managed more than 42 million documents since project inception. We will provide appropriate staff to perfonn administrative functions and document management responsibilities including: I Developing and maintaining a mail center to manage incoming and outgoing mail I Distributing materials provided by the Agency about the programs, including copies of the necessary applications, as well as other general materials about the program 5. Approach to Operations RF #0175-Al 109 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 116 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I Scanning any applicant/client documentation received and indexing paper documents into the electronic case ?le I Processing any outgoing client noti?cations or mail generated by the WES, Agency, or CSC I Managing paper documentation received by the CSC in accordance to the record retention requirements Inbound Mail Established, proven processes for opening, sorting and controlling all incoming mail is the ?rst step in establishing the foundation needed to meet and exceed RFP requirements throughout the organization. Having supported mailroom services for clients across the country, we understand the importance the mailroom plays in successful overall operations. We have re?ned our processes and controls over the years to focus on continually improving procedures to reduce the potential of lost or misrouted documents. We will open, date stamp, sort, batch, image, and index incoming documents received in the mailroom. We will distribute LTC documents to the LTC Unit within two business days of receipt 95 percent of the time. Using the State-provided EDMS, our staff will scan any applicant/client documentation received and index paper documents into the electronic case ?le. The Mailroom Specialist reviews documents to make sure they can be easily read by the imaging software. For example, the Specialist straightens documents that are wrinkled or have bent comers, makes photocopies to improve the readability of certain documents, and removes staples and fasteners. In preparing documents for scanning we also insert separator sheets in between document sets (those received in the same envelope) so we can identify each unique mailing. Thorough document preparation prior to scanning improves quality and reduces the amount of time required to ?x and rescan documents that were not read properly the ?rst time. After scanning a batch of documents, the Mailroom Specialist reviews scanned images to determine if the images are readable and if the system captured all required metadata. Documents that are not read properly are re-imaged and if the system did not capture the metadata, the Mailroom Specialist enters the required information into the Kofax form. Once the image is complete, it automatically queues to an ES for processing. After the image has gone through the QA process and has been forwarded for further action, we manage paper documentation in accordance with the record retention requirements. Documents received by fax are handled similarly to the way we process incoming mail with a few upfront processing changes. When we receive a fax, we store it as an electronic image. A Mailroom Specialist quality checks the fax to ensure that it was received in full and is not missing pages or information. If a fax appears to be incomplete, a CSR is noti?ed via a work request through the CRM system, and the CSR will contact the sender and request that the documentation be resent. As with mailed documents that are scanned by a Mailroom Specialist, an event noti?cation is sent to the ES when a new fax document has been received, alerting staff that the image is ready for entry into WES. 5. Approach to Operations RFP 110 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 117 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Outbound Mail Equally crucial to our success is the proper handling of outgoing mail. We propose to handle outgoing mail through our MAXIMUS shared services center in California. In 2015, we printed and mailed 83,633 pieces of mail and processed 310,565 documents in the shared services center. Using existing infrastructure, secure processing methods, and trained mailroom staff helps contain costs and provides an ef?cient solution for timely delivery of forms and other mail. Many of the materials that the CSC sends are time sensitive. Customers and State staff depend on the timely delivery of forms and ?les to complete their tasks. We will send materials provided by the Agency about the programs and process any outgoing client noti?cations or mail generated by the WES, Agency, or CSC. Staff will insert outbound mail into envelopes, review it for complete addresses, meter it with postage, and send. We understand that most outgoing mail will be notices generated automatically by WES. When a CSR or ES enters an action that initiates a notice in WES, that notice will be printed directly in the mailroom in California for handling. Our CRM helps us track mailing functions outside of WES accurately. When a customer requests a document or notice that is not automatically generated by WES, our staff enters the request in the form request screen in the CRM, which is sent directly to the mailroom to send the documents. We will meet all RFP requirements for mailroom availability and timeliness. Our quality control system for correspondence and mailing tracks and measures timeliness and accuracy to make sure we meet all contractual standards. Ful?llment represents a key point of contact with customers, and the information we provide must meet high standards. To measure timeliness and accuracy of mailings, we: I Create a report that shows the duration between when documents/materials are ordered and when they enter the mail stream I Submit "seeded" requests for mailings (generated from dummy records) and monitor success in ful?llment I Track reporting of customer complaints about incomplete or incorrect mailings I Perform quality assurance activities on outgoing mail Assisting with Medicaid Hearings MAXIMUS staff will assist the Agency or Attorney General's of?ce to research or respond to Medicaid Hearings. We will respond to Medicaid Hearing requests for research and information within 24 hours of the request. Performing Other Case Management Functions We will perform other case management functions, such as updating case information, correcting case errors, and manually processing complex cases, as needed. 5.1.2 Staf?ng Levels RFP Section 7.1 .1.12.1 .2, page 53. Below, we present our proposed staf?ng plan for performing the CSC scope of work. 5. Approach to Operations RFP #0175-Al 111 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 118 of135 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Position Name Location CSC Account Manager Jeremy Morgan 1 Cheyenne, WY Operations Manager Muna Pirrin Cheyenne, WY Training and Manager To be recruited locally 1 Cheyenne, WY Reporting Analyst Brendon Scharf .5 Albany, NY Consulting Policy Analyst Jan Ruff .25 East Lansing, MI IT Specialist TBD 5 Denver, CO Mailroom Lead Michelle Munoz Cheyenne, WY Mailroom Specialist To be recruited locally 2 Cheyenne, WY CSC Supervisor To be recruited locally 2 Cheyenne, WY CSR Tier 2 To be recruited locally 8 Cheyenne, WY CSR Tier 1 To be recruited locally 9 Cheyenne, WY Eligibility Specialist To be recruited locally 9 Cheyenne, WY TOTAL FTE 35.25 To optimize accessibility and project performance over the life of the contract, we use a staff forecasting model to determine workforce planning, operations, training, and recruitment efforts for each project we operate. This model projects future staf?ng needs based upon current and historical workloads and call volumes. The goal of our model is to support a "just-in-time" staf?ng approach where the right number of staff come on board exactly when they are needed, working cost- effectively while ensuring we can fully support program Ea .. needs. Our process uses current and historical data from a . other similar projects, handle time and call arrival patterns, shrinkage elements, performance metrics and contract requirements, training constraints, and a Skill 0 I I ramp-up schedule as inputs to simulation models that use various types of analyses to produce staff and training We use advanced business projections. Using these projections we are able to begin process modeling to streamline recruitment efforts for identi?ed resource needs, with and resource ample lead-time to supply the necessary level of quali?ed planningfor the we can employees to accommodate changing call volumes, while continuously meet performance still adhering to performance expectations. standards. To calculate direct, supervisory, and administrative staf?ng needs, we utilize several tools, including Erlang modeling, to analyze actual call center patterns against a certain level of performance. To incorporate other operational factors, we use simulation modeling. Additionally, through use of business process management (BPM), data analytics, and modeling tools, we forecast and optimize staf?ng levels based on changes in call volumes and training demands while continuing to meet the requirements of our projects. We based our proposed staf?ng model for the CSC on careful consideration of multiple factors. We used statistical data given in the RFP, as the starting point on which to build additional assumptions which are rooted in our experience implementing and operating multiple contracts with comparable requirements and performance expectations. We use actual call center performance and staf?ng data from these projects as our baseline to develop projections for Wyoming. We built our proposed staf?ng solution on call center industry standards and our 5. Approach to Operations RF I 1 l2 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 119 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS expertise in similar projects. We go beyond generic call center staf?ng, staf?ng the CSC to handle the speci?c types of calls we will receive. We base our model on more than call volume; we incorporate ef?cient and effective handling of eligibility calls into our solution. Given our modeling for the CSC, we will use a ?exible staf?ng model, with full-time and part-time staff, to meet the SLAs for this project. We will re?ne our approach and model a technical staf?ng plan for the CSC as we receive additional volume data speci?c to this operation to ensure that our staf?ng is scaled accordingly on an ongoing basis throughout the duration of the contract. Our DecisionPoint reporting and analytics tool greatly facilitates this ongoing assessment of staff needs in alignment with actual conditions and performance standards. We use DecisionPoint to proactively evaluate call center dynamics so that we can quickly adapt our resource allocation to address volume ?uctuations, while maintaining performance standards. 5.1.3 CommunicationsManagement RFP Section 7.1.1.1213, page 53, SOW Appendix A, 5072, 5089-5098 Effective and open communication is critical for project success to ensure that 3 all stakeholders and involved parties are informed of all aspects of the project. Our goal is to develop the highest possible level of trust, communication, and partnership to better serve the needs of the Agency and the State's applicants and clients. Wyoming will have a transparent partner in MAXIMUS. We offer visibility into our operations through our open door policy, regular communications, and status reports. We promote communication throughout the process with regular meetings and reports as well as an open-door policy to ensure open communication. Our corporate-wide communications philosophy is based on a bedrock of key communication principles?open, detailed, and frequent exchanges with our clients?with delineated staff responsibilities for each action following an effective, transparent communication approach. We will develop, follow, and maintain a CSC Communication Management Plan that serves as the guideline to manage both formal and informal communications across all stakeholders, especially the Agency and the WES contractor. The plan will identify all stakeholders, their communication requirements, and the most ef?cient mode of communication. It provides the framework for program communications including internal and external communication procedures, status reporting, meetings and other key communications. The Communication Management Plan we will develop for the CSC will contain the following sections: I Program Stakeholders: Contains a stakeholder analysis identifying all stakeholders and their roles in the project. I Points of Contact for the Agency and Other Stakeholders: Our CSC Account Manager will serve as single point of contact for the Agency and WES Contractor to address concerns. We will include contact information, including phone numbers and email addresses for the Account Manager and other CSC staff. Our CSC management will be available 99 percent of the time during periods of operation. I Communication Procedures: Discusses the procedures for identifying what will be communicated and to whom and how it will be communicated. The plan will specify the lines of authority, change management guidelines, and protocols for escalating and resolving 5. Approach to Operations RFP #0175-Al 113 P23001.0060 March 25, 2016 Attachment to the lnfonnation Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 120 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS issues as they arise. It is critical that everyone involved receive and share knowledge in an open, transparent, and timely manner. This is important not just at leadership levels or for upward communication, but also in downward communication to keep the project staff informed and updated. I Status Reporting: Discusses status reporting frequency and distribution and our use of Microsoft Project to document, track, monitor, and report on our progress. The plan includes our commitment to provide regular status reports, as well as any ad hoc reports when needed. It lists the report types, frequency, and methods of delivery. Our reports will give the State a transparent view of our operational performance to help in project decisions. Our goal is to foster full transparency, trust, communication, and partnership with the State to best serve customer needs. I Project Meetings: Describes project meeting frequency and participants. The plan will list the regular meetings we plan to participate in, including weekly status meetings and regular collaborative meetings with the Agency and the WES Contractor, and weekly Change Control Board meetings. We also commit to participating in other meetings as needed. We will produce and distribute meeting minutes in compliance with the RFP. I Open-Door Policy: MAXIMUS welcomes the opportunity for both impromptu and announced site visits from the Agency and its designees. We have an open-door policy during normal business hours and will arrange after-hours access upon request. Staff and designees will have access to MAXIMUS staff, facilities, technology, procedures, and equipment used to support district office functions. We will permit designated individuals to inspect our operations. I Secure E-Mail: Our staff will use secure and email accounts to report problems, questions, or client issues to the Agency while safely exchanging as required. An important component of our communication with the Agency will be identifying and proposing annual contract year goals, measures, service level agreements, performance expectations, and timelines. In addition to regular communication, MAXIMUS will immediately notify the Agency of any occurrence that affects our ability to perform all or any part of our responsibilities under this contract, along with an assessment of the time and effort necessary to recover. We discuss our approach to Business Continuity in detail in Section 5.2 Handling Rules and Regulations. Our staff will respond to written inquiries/requests coming from the Agency within two business days 95 percent of the time. We acknowledge that responses will include information letting the Agency know that the request has been received and the length of time it will take to process. To assess the effectiveness of our communication with the Agency and our management of the project, we will develop and maintain a regular schedule to measure the satisfaction of Agency personnel with the services we provide and make improvements to address substantive concerns raised in this assessment. We will include ?ndings in our CSC Operational report. Our communication process is a natural extension of the operational transparency and integrity at the core of our approach to the CSC. 5. Approach to Operations RFP #0175-Al 114 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 121 of185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 5.1.4 Quality Management RFP Section 7.1.1.1114, page 53. SOW Appendix A, 5074. 5201, 5202. 5203,5205 The objective of our QA program for the CSC project is to provide objective, systematic monitoring and evaluation of all contact center and application I: support operations to help ensure that outcomes, products, and services delivered are of the highest quality, achieve superior customer satisfaction, and meet or exceed federal, State, and Agency requirements. Quality is an essential factor in successfully helping individuals and families apply for and renew health care bene?ts. Our commitment to quality is deeply embedded throughout the organization, strengthened by the company's strategic decision to create a corporate of?ce of Quality and Risk Management (QRM). This of?ce oversees and ensures adherence to industry standards and best practices in quality management and supports individual projects in developing project-speci?c plans following industry guidelines. MAXIMUS also has adopted BPM to promote quality assurance and continuous process improvement. In the same way that QRM supports project level activities, our BPM group maintains a team of experts who assist projects in implementing and using BPM methodologies to improve project operations. By deploying BPM methods and tools for the CSC, we will create business process maps for key functional areas and collect corresponding data for each business process. This allows the project to use BPM to monitor operations with the ?exibility to analyze tasks at the project, team, and individual levels. Using BPM, the project is able to proactively identify trends and potential process failures so that the management team can adjust operations before issues have a negative impact on customers. MAXIMUS will implement comprehensive quality management practices to measure all aspects of the CSC, including timeliness, accuracy, and completeness of operational function. We support a "quality ?rst" philosophy by applying industry standard best practices that foster greater accountability, more ef?cient processes, a disciplined use of proven methodologies, and continuous performance improvement. Our quality management approach promotes accountability across all organizational levels by clearly de?ning staff responsibilities related to quality and performance, as well as policies and the standards by which service delivery is observed and evaluated, and including the use of quality-focused analytical tools, Our quality management approach is based on methods, and systems. However, we understand that transparency and delrvermg a comprehenswe program of quality assurance accountability, systematic (QA) and quality control (QC) activates IS about more activities and than pohcres, tools, and systems, it 18 about 1n commitmentto continuous all CSC pr0ject staff a understanding of our improvement expectations and how to reach performance goals while maintaining a high level of customer service and quality. 5. Approach to Operations RFP 15 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 122 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS While many of our quality methods and tools provide staff with information they need to avoid errors, these methods are most effective when they are combined with a rigorous quality control and quality assurance process. Because all staff has an impact on all quality, everyone receives information about compliance with performance standards during New Hire Training. This allows staff to have a better understanding of all the performance standards the project must meet. With this increased knowledge, we encourage project staff to provide suggestions on ways to improve operational performance. Quality Assurance Plan We will develop a Quality Assurance/Quality Monitoring Plan that re?ects our experience and approach to providing high quality services and how we measure, report on, and help ensure Service Level Agreements described in Appendix C, Performance Expectations, are met. Our plan will be objective and include systematic monitoring of all operations. The plan includes required performance standards, methods of measuring, tracking, and calculating compliance, and a process for corrective action and continuous improvement. It includes: I An overview of QA activities and tasks to be performed I Processes and procedures for conducting QA including procedures for documenting, resolving, and reporting issues and risks identi?ed during QA and performance monitoring reviews, measures, and reports cross-project status for project management review and decision making I Description of the roles and responsibilities of MAXIMUS, subcontractors, and the Agency in performing QA and resolving identi?ed issues. We discuss our approach to monitoring for quality in more detail in Section 5.1.6: Monitoring and Reporting. Continual Improvement Activities Using our QA processes, we: I Assess error rates and adherence to timeliness standards to determine if changes to the training plan, staf?ng, or project materials such as job aids, policies and procedures, and work instructions are necessary to improve the accuracy and ef?ciency of services I Identify and document any potential processing issues so these can be immediately communicated to the Agency for further investigation and resolution and minimize the potential impact of these issues on eligibility decisions and case maintenance processing I Monitor trends in self?service rates and IVR and ACD abandonment rates to identify opportunities to optimize these systems or change staf?ng levels to enhance customer service I Determine gaps in reporting if additional reports or dashboard views will facilitate the project's ability to better manage tasks by having greater visibility into program operations We will regularly monitor the effectiveness of the CSC procedures and will develop a corrective action plan for any area found to be insuf?cient or out of compliance and report the corrective action plan to the Agency. We will also provide regular reports on issues/defects and their resolutions. 5. Approach to Operations RF 1 l6 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 123 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Assist the Agency in any Medicaid Hearings as Needed As needed, we will assist the Agency in program quality management activities, including Medicaid Eligibility Quality Control (MEQC) Payment Error Rate Measurement (PERM) and Quality Monitoring Review requirements, as de?ned by the Agency. 5.1.5 Risk Management RFP Section 7.1.1.1215, page 53, SOW Appendix A, 5099, 5100, 5101 To minimize risk for Wyoming, we adhere to a risk and issue management process and Risk Management Plan, based on Project Management Institute (PMI) standards, as described in Section 4. 7: Managing Risk. Through our systematic approach, we determine cost-effective risk reductions, and monitor and report on progress in reducing risk. While we expect few risks, we understand that there are potential risks to any operations, such as system outages, business disruptions, and staff turnover. We use our experience and our comprehensive risk management approach to mitigate and manage those risks. Additionally, we regularly incorporate and conduct security, privacy, and risk assessment processes and measures to determine the adequacy of controls for the integrity, con?dentiality, and availability of con?dential and protected data that we collect, maintain, use, or transmit. Focus areas include physical security, emergency preparedness, information security, data privacy, compliance, IT audit, and incidents and investigations. MAXIMUS will develop a Risk Management Plan that includes our approach to managing risk and describes our understanding of risk management. We will maintain a Risk Register that lists all risks, priorities, responses, mitigation strategies, assignments, tracking, and dates. We will also use a Project Control and Issue Tracking Tool to collect and track reported issues and resolutions. We will report on the status of risks weekly and provide the Agency with access to the Risk Register and Project Control and Issue Tracking Tool. 5.1.6 Monitoring and Reporting RFP Section 7.1.1 .12.1.6, page 53, sow Appendix A, 5071, 5073, 5204, 5207 To continuously keep quality high in the CSC, MAXIMUS devotes significant tools and resources to monitoring work and analyzing data. We strive to meet all SLAs. Toward that end. we have created plans, processes, and systems (described in detail throughout this section) to manage and report on our daily operations today, while at the same time projecting and planning for tomorrow. We have numerous management plans, rigorous monitoring processes, and internal administrative systems in place to help ensure that we meet operational requirements and deliverables in accordance with Agency direction. We also have a QAIQC Manager and Reporting Analyst dedicated to monitoring and analyzing performance. To meet performance requirements, we follow our structured Continuous Quality Monitoring Process shown in Exhibit 5.1-4. We gather required data, and analyze and report on that data at intervals and in a form agreed upon with the Agency. We also perform trend and root-cause analyses to identify issues and opportunities for improvement, and initiate changes to improve performance and service delivery. 5. Approach to Operations RFP #0175-Al 117 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 124 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Continuous Quality Monitoring Process - Communicate and disseminate monitoring results . Customer requirements and improvement information Customer expectations . Revise quality monitoring - - Intemal standards and evaluation methods accordingly PR 0 . Quality assurance standards . Identify 0mm, PERFECT marrow non-con ormities, and ?313130'15mm'?5 lb" Improvement . Monitoring and evaluation of operational . Problem areas, processes, and customer satisfaction - Corrective! prevention action planning . Con'eotive prevention action implementation Problem Correction PCP) Exhibit 5.1-4: Continuous Quality Monitoring Process. Wyoming applicants and ciients and the SC will receive high quality service as a result of MAXIM US Continuous Quality Monitoring. We regularly monitor the effectiveness of the CSC including ensuring suf?cient staf?ng, assuring the accuracy and completeness of the information we collect, and reporting cases of apparent fraud to the Agency. We are here to help Wyoming achieve its objectives and provide the best possible service to the families in need of its programs. Quality Assurance Areas We will conduct QA monitoring and review activities in the areas of 7 application support services and contact center operations. Our - Manager evaluates each process against the written procedures to ensure quality is maintained. If de?ciencies are identi?ed, they are documented and analyzed to determine the root cause and potential solutions. Monitoring CSC Activity To achieve compliance with performance SLAs and maintain high customer satisfaction, we routinely monitor both live and historic contact center activity, analyze historical call trends. monitor live calls, regularly assess staf?ng levels, conduct customer satisfaction surveys, and continuously identify best practices used from around our health and human services call centers to determine their applicability to each project including the CSC. For instance, using data from our telecommunication system, we analyze the average hold-to-abandon time to develop strategies, such as call routing, to decrease the hold-to-abandon time, subsequently reducing the number of abandoned calls. To drive project quality and integrity, we will provide a robust business intelligence (BI) solution, to help ensure governance, internal controls, transparency, and quality outcomes at all levels of the project. Our BI solution for reporting and analytics currently serves as the foundation for many required reports in our CHIP, Medicaid, and health insurance exchange (HIX) projects. 5. Approach to Operations RFP 18 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 125 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS DecisionPoint for BI, our reporting and data analytics ECIS I ON solution, streamlines the compilation of raw data into by maximus meaningful information and gives both MAXIMUS and the Agency a full view of operations through a single reporting tool. DecisionPoint optimizes our ability to monitor and evaluate CSC performance, identify trends or bottlenecks, and inform management intervention and resource reallocation to improve performance, if indicated. It allows for greater automation and ?exibility in tracking our performance in alignment with call center standards. Through the use of DecisionPoint, we are able to provide the Agency with full visibility into our operations and performance. For example, Agency staff will be able to view (in near real-time) the status of our application processing. This data can be combined with status updates from our contact center, providing a complete picture of the status of CSC operations. Our managers and supervisors use dashboard reports like the one shown in Exhibit 5.1-5 to review contact center status in real time and quickly make adjustments to meet call demands, especially during daily peak periods or temporary surges in activity. We also use dashboards in our CRM to show a snapshot of key metrics and performance indicators. Agent A You-n Plrrolmanco Summary m? "Illil? nan?unmanne- Iun minim-Inst hum-an.- Jun.? i m? runan?; m? Key '"tti? it .. - .. metrics for . Ill-? VIM YI- . - agents Mu2.11m" 13? Min?- . roan-is Tull-?1 anEas?y compare W. I an? tuna-J chin-mun agent 3 ?Mal? Y?lul erformance to mlmu . . . . a? . . ?Hip-H? I'll-nu . their team Exhibit 5.1-5: Sample Dashboard. Managers and supervisors use dashboards to see at a glance the level of activity and status of call center operations. Our dashboard will be available 99 percent of the time. We will also give designated Agency staff access to the dashboard for real time visibility into work queues and business objects for drag and drop analysis. There is no waiting a month for a report, CSC staff can see what we see at any time. In addition to displaying near real-time data, DecisionPoint also generates operational reports communicating project status, and the effectiveness of our operations. Exhibit 5.1-6 shows a sample of the information DecisionPoint will give our team to evaluate CSC operations and performance. 5. Approach to Operations RF 1 l9 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 126 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS and Summer, Dashboard i I 32- mum's lm?uinlnus In? lit?ml; Conditional - 7- .. J) KW - Form ottmg (Red? laz-1L m. hub- tuna-hm Yellow, Green) [5 7 used to easily spot deviations from :mwm hull?Ml?- targets. maul?n Mimi?Lin !m?lmi II 1033?!? mm Exhibit 5.1-6: DecisionPoint Reports. DecisionPoint pulls multiple data points into one location so staff can easily review status and improve performance. We will work with the Agency to de?ne a reporting structure and process to ensure transparency into all work on this project. We discuss our approach to reporting in more detail in Section 5.10: Reporting and Data Analysis. Monitoring Calls The goal of call center operations is to provide access to Agency-administered health and human services programs for all customers requesting information about these programs, applying or reapplying for eligibility, or providing information relevant to their case status. Our QA process ensures that CSRs verify authorized case members before giving out information, answer questions accurately, enter case notes correctly, and treat callers according to our high standards of service. MAXIMUS takes multiple steps to ensure our CSRs only provide accurate and appropriate information: I Comprehensive training on policy and procedures, and applicable federal and state laws I Use of approved call scripts I Up to date and complete MAXIMUS Eligibility Playbook covering applicable policies and procedures, directives, and regulations I Monitoring calls and giving CSRs feedback, including additional training or discipline if needed We keep call quality high by using the TelStrat recording system, part of our Cisco Enterprise Telephony Center, to record all calls. Call recording enables us to capture information from clients such as agreement to consent language and is integral to our call center QA process. In call recording, as in all aspects of our operations, we keep customer service in mind. We will provide a message to customers that calls will be recorded for monitoring and quality assurance purposes. We will maintain call recordings for seven years and retrieve them in accordance with RFP requirements. Call recording is one of the most effective means for providing customers great service: 5. Approach to Operations RFP 120 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 127 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I Service Pro?ciency We use recorded conversations for employee training purposes, resulting in greater skill in handling customers. We review the call content with our CSRs to make certain we are always providing accurate, respectful, and appropriate tone and information to callers I Service Accuracy - We listen to recorded calls and evaluate quality using a standard form (discussed below) to ensure our staff provided appropriate service and to measure CSR performance against our internal QA metrics. Should we receive a complaint, we can review the recordings to verify information provided and how the call was handled I Service Quality When personnel are aware that their calls are being recorded, they are more motivated to give all callers top quality service Our Manager audits random samples of call recordings and in-process calls as de?ned in our QA/Quality Monitoring Plan. We monitor for accuracy and completeness of CSR-caller interactions as well as adherence to operational policy and procedures. Audit criteria include, but are not limited to: I Accuracy, completeness, and appropriateness of caller information veri?cation, as applicable I Accuracy, completeness, and appropriateness of information provided Accuracy, completeness, and appropriateness of actions performed on the case including updating the system case log and addresses Appropriate use of "Hold" and "Transfer" features Professionalism in manners and documentation Behavior expressed toward the caller Call management skills (discerning a caller's needs, successfully resolving them, and keeping the call focused) Skill in navigation of systems and tools Properly redirecting callers Printing and mailing materials within 24 hours of triggering a noti?cation Using call monitoring tool to evaluate and score each call while listening Designated Agency users can listen in on active calls, too. We use similar procedures to monitor web chats, e-mails, and other customer interactions. Monitoring Application Services The goal of application support operations is to accurately associate and data enter a scanned document with the appropriate application, case, or individual and create tasks for new and existing customers requesting eligibility. We train and monitor staff to help them to provide accurate application processing. Our training plan incorporates sample application, review, and case maintenance cases the CSC typically handles so that staff are well prepared to manage different situations. The sample includes cases that occur frequently as well as those that are less common. To supplement training efforts, our management team keeps open lines of communication with staff to answer questions and help troubleshoot dif?cult cases. Our Eligibility Playbook also includes resource materials available in a searchable online format. This includes materials such asjob aids, work instructions, policies and procedures, and checklists. These materials are easily accessible through the Playbook and will provide staff with documented resource material to use to enhance accuracy. Our steps for meeting performance standards in application services include: 5. Approach to Operations RFP 121 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 128 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I At each stage of processing, staff members review and when necessary correct the work completed at the prior stage of processing. For example, ESs review document classification and image quality before entering the data from a document I Peer review provides ongoing quality control because errors are discovered and corrected before ?nalizing entry I During data entry, registration, and eligibility, staff check for duplicate cases and identify applications and reviews with missing information which are all necessary for maintaining accuracy I Supervisors review cases frequently to check for accuracy, timeliness, and compliance with procedures I QAKQC Manager audits a random sample of applications for accuracy and completeness as well as adherence to operational processes and procedures in accordance with our QAfQuality Monitoring Plan I We review to ensure applications were indexed and data entered correctly and that any follow-up was correctly completed. Improving Performance through Feedback We meet with staff to discuss results of the QA review process and any other performance- related issues. During these meetings, staff receives their quality control scores as well as detailed feedback on the results. Depending on their scores, they may receive constructive suggestions or spot training on how to improve performance on calls, customer interactions, or other work that does not meet all minimum required quality standards for accuracy, timeliness, program knowledge, and customer service. Conversely, they receive recognition for those areas where they consistently meet or exceed our standards. Staff signs and dates the monitoring form to acknowledge that the results have been reviewed with them. If a pattern develops where staff fails to meet minimum required standards, we give additional training, coaching, or mentoring. If performance does not improve, we may replace the employee. When more systemic issues are identi?ed, we may conduct refresher training and/or modify existing training programs, send staff updates, and revise policies and procedures,job aids and work instructions as necessary. We will develop a corrective action plan for any area found to be insufficient or out of compliance and report the plan to the Agency. 5.1.7 Operations Not Covered RFP Section 7.1.1.12.1.7, page 53 MAXIMUS does not have any known or planned optimizations not covered by the annual maintenance payment quoted in the Cost Proposal. However, we do offer several innovations to improve program service and ef?ciency in Section 5.11: Possible Optimizations. 5.2 Handling Rules and Regulations RFP Section 7.1.1.122, page 53, sow Appendix A, 5120, 5124, 5125, 5134-5142 . 5144, 5195 MAXIMUS uses our experience and proven procedures to handle each of the following: I Requirements: Our structured and strategic approach to properly executing the scope of work for the project is built around a thorough understanding of the statement of work and 5. Approach to Operations RFP #0175-Al l22 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning, Department of Health. Division of Healthcare Financing and Maximus Health Services, inc. Page 129 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS other contractual requirements. We make certain that all required tasks and deliverables are understood, accounted for, and closely monitored throughout the contract to ensure timely delivery. We identify pertinent performance outcomes and de?ne appropriate monitoring tools and quality assurance techniques for each key process and function. We discuss our approach to all requirements in Section 5.1.1: Strategy for Meeting All Project Requirements. I State policies and rules: Wyoming can be con?dent that MAXIMUS will maintain awareness of and comply with all applicable State policies and rules. We will operate the CSC in compliance with all RFP requirements, federal and state laws, State standards, regulations, and guidance for this project. We use the Playbook to keep staff up-to-date on all policies and laws. I CSC technology and environments: As described in Section 5.3: Tools and So?ware, we bring a solid foundation of technology to meet all requirements of the CSC. We will acquire, host, support, and manage all equipment, hardware, software, and technology needed to successfully complete this scope of work in accordance with the infrastructure plan. I Integration of CSC technology with WES: We intend to populate our CRM with certain WES data, to facilitate call handling. We propose to do that by uploading a flat ?le from the WES contractor that would contain basic case ?le information, such as name, address, account number, and PIN or other authorization ?eld data. Depending on the Agency's wishes for how to support client self-service through the IVR, this ?at ?le could be the same that we receive for use in the IVR. I Performance expectations: Being accountable to the State for meeting performance requirements is as important as serving the customers who call the CSC. Meeting these standards and consistently obtaining feedback about how we deliver services helps us to continuously improve our performance. Our approach to meeting performance standards revolves around several key factors and best practices we will bring to Wyoming including optimal staf?ng levels, tools and technology to support ef?cient operations, continuous monitoring of real-time conditions, and continuous quality improvement. We detail our operational plan to meet these expectations throughout this section. I Client correspondence and noti?cation needs: MAXIMUS uses a secure mailroom and proven processes to handle client correspondence and noti?cation needs. We ef?ciently and accurately process incoming mail so that applications, supporting documents, and inquiries are processed quickly. We also send noti?cations generated by WES and other correspondence each day. We use quality assurance processes to ensure that our mailroom processes meet all deliverables. We discuss our approach to mailroom services in more detail in Section 5.1.1: Strategy for MeetingAll Project Requirements. Below, we discuss our approach to security and BCDR in more detail. Security Maintaining the con?dentiality and integrity of sensitive information is paramount to the success of our - business and our commitment to We protect con?dential data in providing quality services to our customers. We the CSC using multiple layers recognize that securing con?dential information, whether 0f external and internal security in physical or electronic form, requires a formal approach and administrative, physical, based on compliance with state and federal laws and and technical means. alignment with industry best practices. MAXIMUS has a 5. Approach to Operations RFP #0175-Al 123 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 130 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS comprehensive security policy and internal security procedures to minimize risk and safeguard data. We will meet the privacy and security requirements associated with project services, including environmental security, physical site security, computer hardware and software security, data access and storage, client/applicant user security, telecommunications security, and network security. We will adhere to applicable administrative, physical and technical controls for site and system security policies and procedures throughout the CSC Contract term to protect Agency and client information and system components that house Agency data. Our security protocols include adherence to all State and federal requirements, including Federal Tax Information and HIPAA, as well as any State guidelines. We will enter into and sign a Business Associates Agreement in compliance with the Privacy and Security provisions of the Health Insurance Portability and Accountability Act of 1996 (H IPAA) as updated by the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) . Corporate Commitment to Security MAXIMUS brings Wyoming an extensive corporate security program that includes policies, expert security personnel, advanced software technologies and protocols, information technology controls and alerts, monitoring and audits, physical security, and employee training. We employ a dedicated team of security professionals who are responsible for ensuring the confidentiality, integrity, and availability of the data our clients entrust to us. This is not an outsourced function. We invest deliver it. Our corporate Information Security Office maintains the Information Security Policy and has the following responsibilities: Oversees system accreditation Monitors systems and databases for changes and potential malicious activity Provides oversight at program start-up Ensures compliance with security regulations Conducts security risk assessments Manages information security incident response Security Training We regularly address the need for security an . mu. awareness in our training. We educate all staff on security and con?dentiality policies; provide copies of all corporate, state, and federal program policies; and staff test on their acquired knowledge. The Security Training teaches staff to recognize and prevent potential information security breaches, to adhere to MAXIMUS security 'mr" policy and procedures, and to immediately notify our corporate Security and Audit Team in the event of any suspected breach or We educate all staffon security and incident. Network users are educated on con?dentiality policies proper password selection and use, to log out 5. Approach to Operations RFP 124 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 131 of185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS of their computer if they leave their desk, and to adhere to our "Clean Desk Policy" in which all hardcopy client information is stored in locked ?les or drawers unless the staff member is actively working a ?le. Physical, Data, and System Security We implement measures to keep our project and client information, and telecommunications and data systems secure, guarding against damage caused by malware, physical damage, corruption of data, theft, or destruction of data ?les. Our physical and data security policies are comprehensive to safeguard con?dential information from unauthorized use, modi?cations, or access. These policies include role-based access to information and system components, with a list of such employee authorizations maintained and veri?ed by management. Our physical security is comprehensive, safeguarding against unauthorized access to our facilities, data centers, systems, ?les, and data. Some of the physical security measures we take include: controlled access to facilities and secure areas, video surveillance, secured areas within facilities, intrusion alarms, and secure destruction of con?dential ?les. Our data center security controls have passed numerous audits including Statement on Auditing Standards (SAS) 70 (now replaced by SSAE 16) and Sarbanes-Oxley audits. Security Plan Our systems security policy and procedures are thoroughly documented in our Security Plan, customized by project, and reviewed and approved by our Information Security Of?ce. Across our many operations sites, MAXIMUS staff is skilled at working with a wide variety of and network technologies to maintain the con?dentiality and integrity of sensitive data during transmission and at rest. Our broad base of experience with varied technologies makes it easy for us to adapt to any protocols that the State may elect to use. We will ensure security of data transfers as speci?ed in the RFP. Additionally, our equipment will meet or exceed WDH standards for virus protection and security. We will update and maintain the System Security Plan detailing our approach to ongoing CSC security. The plan will re?ect our approach to: I Ensure con?dentiality, integrity, and availability of CSC Services and client data Ensure accountability with security, which includes the approach to establishing and maintaining security responsibility and accountability I Processes for granting or restricting access to all the applications (including Web~enabled applications) and data; auditing security events, auditing security con?gurations, and changes, generating security reports, and monitoring the system for vulnerabilities and intrusions I Plan for managing authorized users for user creation, assignment of new User ID/password/personal identi?cation numbers, role assignments, and activity monitoring I Plan for ensuring compliance including the approach to maintaining compliance with law, standards, and best practices I Plan for monitoring, managing, and reporting security incidents, in accordance with the BAA and SLA requirements I Network segmentation 5. Approach to Operations RFP #0175-Al 125 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 132 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Perimeter security Application security and data sensitivity classi?cation Security of PHI and data elements Intrusion detection and prevention Managing remote access Maintaining minimum AES 128 bit Managing a statewide active directory services for authentication Interface security Security test procedures Managing network security devices Defending against viruses, mobile code and code of unknown origin Transport Layer Security for providing communications security over the Internet Plan for application and Operating System patch management We will revise the plan and meet revised State and federal standards as directed by the Agency. We will also submit updates to the plan to identify all potential threats and hazards to the physical sites and system components and identify the assets and controls to protect against these threats and hazards. We train staff to recognize and prevent common information security breaches, to adhere to security policy and procedures, and to notify our project and corporate Information Security Of?ce immediately in the event of any suspected breach or incident. In the case of an incident where customer information is compromised, our staff is trained to follow our standard operating procedures and to: Notify MAXIMUS CSC Account Manager Notify MAXIMUS IT Security Staff Notify Agency Conduct Incident Analysis Perform Mitigation Activities Determine Necessary Client Support Services Document lessons learned to improve security in the future and avoid similar breach If personal information is compromised, MAXIMUS has protocols in place for communication, support, and modi?cation to ensure customers do not suffer because of a breach, and that we help protect them from further harm. We: I Follow State and federal laws and policies related to data breach noti?cation I Submit proposed noti?cation to the Agency for review and approval before distribution I Provide written noti?cation to individuals affected by the breach as soon as possible. The noti?cation, at a minimum, will inform the individuals of the following information: - What speci?c data was involved and what data elements potentially have been breached The facts and circumstances surrounding the breach, in language that the individual clearly understands how the breach occurred What protective actions we will be taking, or the individual can take, to mitigate against potential future harm. The notice will refer the individual to the current Federal Trade Commission (FTC) website pages on identity theft and the FTC's Identity Theft Hotline, toll-free 5. Approach to Operations RFP 126 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 133 of 135 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Mitigation support services (for example, free credit monitoring, identi?cation of fraud expense coverage for affected individuals, provision of credit freezes, and so on) offered to affected individuals, the process to follow to obtain these services, the period the services will be made available, and contact information (including a phone number, either direct or toll-free, email address, postal address) for obtaining more information I Provide the support services mentioned as appropriate for the breach and population We acknowledge that the Agency has the right to perform physical security audits of the CSC facility at their own discretion and that the Agency andlor federal government may elect to perform annual security reviews of our operations to ensure that the information contained in each CSC tool or system component is properly safeguarded. MAXIMUS understands and agrees to the performance measures related to security incidents, audit records review, compliance with applicable regulations, risk assessment, physical security incidents, and training in the RFP. Business Continuity Service to Wyoming clients is our main goal, and we recognize that service delivery cannot be disrupted due to power or service outage, technical failure, ?re, or natural disaster. MAXIMUS recognizes the need to establish comprehensive Business Continuity and Disaster Recovery (BCDR) policies to protect employees, customers, assets, and information as well as to minimize the time it will take to restore critical operations, functions, products, and services after an emergency is declared. In the event of a business disruption, our IVR, ACD, and CRM will be available using an Agency-approved disaster recovery site within 24 hours and business operations will be available per the approved Business Continuity Plan. Through real disasters, MAXIMUS has executed successful business continuity and disaster recovery plans to deliver the highest level of customer service during dif?cult times. As a provider of health and human services, we simply cannot afford to have any interruption in services. In the event of a natural disaster or crisis, we must continue to provide access to program benefits. Corporate Commitment to Business Continuity Because of our high level of commitment to disaster recovery planning. MAXIMUS has devoted substantial corporate resources to gaining broad-based knowledge and experience with disaster recovery planning and implementation approaches, seeking to ?nd industry best practices to implement on our projects, and implementing methodologies that allow us to follow a standard, consistent approach. We have a corporate-wide Contingency Planning and Disaster Recovery Guide that serves as a template for individual BCDR planning at our projects. The foundation of each plan is the resumption of services, at an agreed-upon recovery level, within the agreed-upon timeframe. We have designed this guide to help our projects prepare, train, test, and execute their plans in the case of a contingency requirement or disaster recovery response. Despite our adherence to these standard methodologies, MAXIMUS understands that conditions vary from client to client and from location to location, so that the solutions for different projects are unique to that set of circumstances, technology, and location. Our overall strategy addresses both technical and operational aspects redundant telephony, systems, and communications, as 5. Approach to Operations RFP 127 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 134 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS well as cross-trained personnel and backup centers to be successful. Our approach offers proven methods and industry best practices; ?exible staf?ng arrangements; and innovative technologies to accomplish our goal of little or no downtime for critical programs. Developing and Maintaining a BCDR Plan for the CSC We will maintain and update a BCDR Plan for the CSC to maintain business continuity. We design our technology for each project with business continuity in mind, for instance we use redundant data centers in Colorado and Virginia. We will maintain current expectations related to business continuity and disaster recovery. If there is any disruption in service to any part of our project, we will work with the Agency to identify and resolve the outage as quickly as possible. We have built preventative measures and resiliency into our solutions and infrastructure to minimize potential impacts on our operations. For the CSC, we will use our shared services of?ce in Denver as our business continuity facility, in case of disruption due to ?ood, ?re, tornado, major power outage, and other natural disasters. If needed, our staff would go to this site and continue to work until the Cheyenne facility is back on line. Our BCDR plan methodology begins with the standard corporate BCDR plan that we tailor to speci?c Agency needs and risks. Although our response to any event is completely dependent on the speci?c situation, there are generic processes that we have in place to respond that we can apply to any scenario we may encounter, including complete destruction of facilities, civil disturbance, weather event, or loss of communications systems or lines. This methodology, summarized in Exhibit 5. 2-1 minimizes risks by combining thorough planning with an analysis of mission-critical business processes and requirements. Ilisustt'l Runner} Rl5k or) Plan Rum er) Project Assessment Recovery [in l'lun lruiniug Vision and Strategy 7 Startup lusmess Development Rt'ttl?t mpact um lusting Analysis Der Continuing Support Exhibit 5.2-1: BCDR Plan Creation Methodology. Our methodology is based on an industry-standard approach. providing the Agency a realistic approach to a comprehensive plan for continuity of operations and recovery following disaster. The components of our methodology include: I Project Vision and Startup: De?ne expectations, requirements, and objectives that make up the contract scope. We carefully review the agreed-upon scope to understand the key functions that must be included in the BCDR plan. I Risk Assessment and Business Impact Analysis: Identify existing and potential physical, environmental, and operational events that could threaten operations or result in a declaration of disaster. We determine what hardware and software assets, functions, activities, and personnel resources are required to sustain operations until service is restored. We identify 5. Approach to Operations RFP #0175-Al 128 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 135 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS risks and vulnerabilities, quantify the impact of an outage or catastrophe, and determine minimum required service levels. I Recovery Strategy Development: Outline and discuss case-speci?c alternatives with the management team. During this phase, each element of the risk assessment document is reviewed and options for recovery are detailed with resource level requirements de?ned for each alternative. This document is then used by management to determine what level of response is appropriate for potential situations. I Recovery Plan Development: Produce a plan that guides the project through the recovery of critical business activities in the event of a major disruption or emergency event. Deliverables include processes and procedures to support disaster recovery, such as response procedures, assessment requirements, operational requirements, restoration procedures, and details regarding recovery teams and speci?c tasks for each team. I Maintenance Procedures Development: Develop and document plan update procedures and responsibilities and develop testing strategies. We integrate updates and testing with change management procedures. I Recovery Plan Training: Develop training material, conduct recovery team training, and conduct staff awareness and management training. I Recovery Plan Testing: Conduct testing to verify that the plan works in scenarios that approximate real potential events I Roll Out: Make approved BCDR plan available to the Agency. Store electronic and hard copies of BCDR plan both onsite and offsite, including at our corporate of?ce and the homes of key management staff. Provide online staff access to the plan through KMS. Our plan addresses business functions, business units, business processes, human resources, and the technology infrastructure that supports the project and facilitates the identi?cation of resources required to resume business operations at a survivable level. The plan also includes our procedures for retaining and storing back-up ?les and software. In the plan, we do each of the following for each core CSC business process: Conduct a Business Impact Analysis and Risk Assessment De?ne maximum tolerable outage values De?ne RTO Return to Operations values De?ne Restore Point Objectives Document contingency plans if the CSC is not available De?ne triggers for activating contingency plans Discuss establishment of a business resumption team Include maintenance procedures for the Plan and BCDR processes Describe our plans to conduct a business continuity simulation as required by contract Our Business Systems group will review project BCDR plans to verify that they have been tested, are regularly reviewed and updated and meet corporate requirements. Together, the corporate guide and resources allow consistent and repeatable processes to help ensure continuity of service for MAXIMUS projects. These corporate resources help projects conduct annual reviews to identify gaps and take corrective actions to improve our processes. We will conduct a test of the Disaster Recovery Plan and submit a written report of the outcome, corrective action plan, and revisions, if any to the Agency as required. 5. Approach to Operations RF #0175-Al 129 .0060 March 25, 2016 Attachment to the Information Technology (lT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 136 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Our BCDR plan and results of periodic disaster readiness simulations will be available for review by State and federal of?cials upon request. Using our tested approach and reliable services, we will strive to have no more than two infrastructure-related incidences per contract year, per the Agency's SLA expectations. 5.3 Tools and Software RFP Section 7.1.1 .12.3, page 54, SOW Appendix A 5050, 5102, 5109-5113, 5115-5119, 5122, 5123, 5127, 5128, 5129, 5143. 5193, 5194, 5196, 5197, 5200, 5206,5208 The CSC requires a solid foundation of technology to ensure timely and reliable access to services. MAXIMUS has a strong history of successfully implementing large-scale telecommunications and technology for health and human services projects. We will leverage current technologies, rather than building something that takes years to produce, resulting in immediate bene?ts and cost containment for the State. We will acquire, host, support, and manage all equipment, hardware, software, and technology needed to successfully complete this scope of work in accordance with the infrastructure plan. We will maintain all equipment and technology described in Appendix A of the RFP. Exhibit 5.3-1 shows an overview of the tools and software we will use to successfully operate the CSC. Using Salesforce, many of our technology components are integrated, bringing efficiency and ease of use. 5. Approach to Operations RFP #0175-Al 130 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 137 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center ?wining l-lenllh (SC Technology Schematic 82 Applicant/Client Commimitation Channels ?953 usto Service Representative Co- browsing Web Chat 83$ Eligibility Specialist ln-l?erson Outlook lntervien Secure Fax Email 85 DH Mail Contact Tracking ln-person Assistance Eligibility Tracking Quality Control CTI [Screen Pop Eit listei'nul Business Functions Saleslhree Salt-sluice l.i\ \gem Searchable Email Blast I Database Policies and (ms Procedu res Co-brovvsing lelslral llill Sum-t \lunket Call Recording tun?J. Kuhn ll Imaging - I Customer Survey ist?u Customer Survey ?sunning System l8) Web Chat Workforce Management andardized Operational Reports tuning HHIS 1632300] 0060-09 Exhibit 5.3-1: Technology Schematic. Through integrated technology, tools. and software, will e?iclentb/ and e?ectively operate the CSC. Our CSC systems will support the archiving, retrieval, and purging of data. We will keep systems in an online mode during the length of the Contract with the exception of approved downtime in accordance to the approved BCDR Plan. We will complete requests for system changes and/or access as the result of legislative changes, service changes, lawsuits, and so on. We will maintain CSC tools development and con?guration management, and provide traceability of CSC technical and business requirements, if necessary. We would be happy to give designated Agency staff an overview of the system, and we maintain an open door policy, giving the Agency access throughout the Contract term. Our solution is based on service-oriented architecture (SOA) concepts including loose coupling of system components to reduce system dependencies and promote reuse. We will use our Cisco UCCE telecom solution, and we will incorporate Salesforce CRM to track and manage user contacts as well as Salesforce KMS, chat, and email tools. We will also incorporate system components from Wyoming's existing solutions, such as the EDMS and access to WES. These solution components have been designed to perform autonomously around their speci?c 5. Approach to Operations P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 138 of 185 l3] Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center functions and as a part of a larger system. Because they are loosely coupled in the solution, they do not require sophisticated integration to perform the necessary business functions within the CSC scope of work. Eliminating the need for tight integration reduces the solution complexity and time to deliver and allows for ?exibility in solution design as components can be swapped in and out as necessary to meet solution requirements and functionality. We will provide the Agency's LTC Unit access and direct use of CSC tools to support LTC client call management and services, and we will provide LTC staff with the training, communication and knowledge management related to the tools. We will also allow for future expansion of the tools to be used by the Long Term Care Unit. Our expert corporate IT staff will provide telecommunications and technology support for desktop usage, desktop support, telecommunications and technology systems, voice and data network equipment, and hardware and software support. We will maintain our CSC systems throughout the life of the contract in accordance with RFP requirements. In the event the contract is terminated, we will allow the Agency to purchase the equipment and tools required under this Contract at a fair market price. Telephone System We use Cisco UCCE as our corporate telecommunications platform that supports many of our contact center operations. Cisco is an industry-leading telecommunications platform that provides the full complement of features and functionality to support inbound and outbound telephone services with signi?cant scalability and ?exibility to adapt to changing program needs. The underlying system infrastructure is already installed and operational in our corporate data centers. We will build upon this existing corporate infrastructure and expand the system to accommodate speci?c requirements and call volumes of the CSC. Our phone system provides the ability to accept local and toll-free inbound calls, make outbound calls, and receive calls transferred from outside entities and other contact centers. The Cisco system is hosted in our corporate data center with a redundant backup system in a secondary data center providing active-active pair failover in the event of a system or component failure in the primary data center. Additionally, the Cisco telephone system is MAXIMUS ADVANTAGE The major components of our technology solution are systems that MAXIMUS has success?illy implemented and integrated in multiple projects. While our solution is customized to the speci?c requirements of Wyoming, our 20+ years of experience deploying the underlying technical infrastructure to administer similar projects ensures our systems can achieve the Agency's vision for the CSC. Our technical solution enhances the customer experience and improves process ef?ciency. covered by a vendor maintenance agreement providing service and support for hardware and software issues. This fully redundant architecture and ready access to vendor support helps to ensure continuity of operations and uninterrupted service to clients in Wyoming. Our solution uses Voice over Internet Protocol technology to transmit telephone calls over data networks, and we use our already established, secure, corporate network infrastructure to support the project?s call volumes on an ongoing basis. Our telecommunications infrastructure is highly scalable and provides ?exibility in accommodating short-term call surges as well as long-term call volume change over time. In conjunction with our Cisco telephone system, we 5. Approach to Operations P23001.0060 March 25, 2016 RFP 132 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 139 of 185 Wyoming Department of Health, Division of Healthcare Financing . Wyoming Department of Health Customer Service Center MAXIMUS install the necessary Session Initiation Protocol trunks to support the call volumes. Our telecommunications carrier provides burstable trunks, which allow the call center to quickly increase the amount of available capacity during peak call volume periods. This burstable capacity improves network utilization and helps control costs. It provides signi?cant ?exibility in managing periodic call surges. We monitor network traf?c on a routine basis, enabling us to respond quickly to call volume changes that warrant additional capacity. In addition to scalable circuit capacity, we use concurrent licensing, which allows us to leverage a pool of corporate licenses to scale on demand in response to peak volume periods. This provides substantial ?exibility to scale capacity in a way that minimizes maintenance costs and provides greater operational ef?ciency. System con?guration is ?exible as well, allowing us to modify call routing, call ?ow, pre-recorded messages, and call queues to accommodate program changes. Our telephony platform includes an ACD system that provides skills-based queuing and routing, real-time call statistics, and comprehensive reporting capabilities. We use the ACD to route incoming calls in a monitored and measured enviromnent, routing calls by program, skill set, and All aspects of our Cisco phone language, as appropriate. The ACD provides the ability to system are designed to support track call data, such as calls received, calls answered, our ability to meet or exceed abandoned calls, speed to answer, and talk time, and we performance standards and feed this data to DecisionPoint to provide reports in a maintain high levels 0f dashboard presentation that simpli?es the Agency's consumerservice. ability to review and analyze our compliance with performance standards. Call Recording MAXIMUS keeps call quality high by using the TelStrat recording system, part of our Cisco Enterprise Telephony Center, to record all calls. TelStrat is a certi?ed Cisco Technology Developer Partner. The product is Cisco tested and certi?ed compatible with our call center technology. TelStrat provides full ?mctionality for inbound and outbound recording. We describe our approach to call recording and monitoring in Section 5.1.6: Monitoring and Reporting. IVR Our Cisco IV is highly con?gurable and scalable. We have corporate IT resources skilled in making modi?cations to the IVR call ?ow as well as vendor support through a service agreement with our Cisco equipment provider. We will maintain con?guration management documentation to track all modi?cations made to the IVR or ACD. Our IVR will support: I Fully customizable menus I The use of automated messages in both English and Spanish I Recordings using broadcast standard recording techniques I Recording of scripts in English and Spanish I Customizable messages to play while clients are on hold after making a choice on the IVR in addition to on-hold music 5. Approach to Operations RFP 133 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, inc. Page 140 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I The option to transfer a caller directly from the IVR to 3 CSR, or other identi?ed entities outside the CSC, as well as allow the caller to return to the main menu I Self-service options for callers who want to request information (applications, brochures) to be mailed to them I Remote announcement updates for special situations I An after-hours message that identi?es hours of CSC operation, provides basic information about the programs, offers an option for callers to request written information about the programs, and requests that the caller call back during active hours of operation, if additional information is required, or leave a voice mail I The ability to meet or exceed IRS IVR Safeguards I Dynamic reporting capability We design our IVR menus to facilitate a positive consumer experience by providing convenient, quick access to relevant information, while always making it easy for a customer to connect to a CSR for personal assistance; at any point in the IVR call tree, we present the option to "press 0" to speak with a CSR. We will work with the Agency to develop and record customizable messages, such as answers to frequently asked questions, or program updates, while customers are on hold after making a choice on the IVR. With Agency approval, we can also develop a "Did You Know" message for the beginning of each call to help point callers towards self-service options. We will also play informative messages to callers on hold and provide periodic reminders of their estimated wait time so that callers are less inclined to disconnect or abandon the call. We can also use this messaging to convey real time conditions, like weather closures or other information that may help the Agency to convey to the customers they serve that there is a 'situation' and what to expect. We ensure IVR performance is always optimized to current contact center processes, business goals, and customer experience initiatives. We use our expertise and experience to monitor IVR conditions and performance and make changes as needed to maximize performance. Data received from the IVR will be user accessible within three seconds at least 99.999 percent of the time. Additionally, IVR response time will average two seconds, and no individual transaction will exceed ten seconds. MAXIMUS has implemented IVR applications in many of our call centers, enabling us to bring a depth of experience to offer this technology in a way that is consumer-friendly, cost-effective, and highly reliable. Using our experience, we will work with the Agency to design the IVR set- up. We acknowledge that the IVR may also be used for potentially screening eligibility if the Agency and the WES contractor can support this functionality. If the Agency requests this, we will use our change control process to integrate this ?mctionality with the CSC. CRM Our integrated technology solution for the CSC includes robust, open standards-based CRM and KMS tools via Salesforce Service Cloud. Our CSRs and other operations staff will rely on Salesforce for the capture, classi?cation, tracking, and reporting of all contacts. 5. Approach to Operations RF 134 P23001.0060 March 25, 2016 Attachment to the information Technology (iT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 141 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Wyoming's relatively small population enables its leaders to stay closer to citizens and the technologies that deliver public services to them. The proposed Salesforce solution is uniquely positioned to further close the gap between administration and citizens by way of its cloud implementation model which removes the complexities of traditional enterprise software. Additionally, the solution will enable the Agency to drive cost containment measures by integrating with existing technologies to deliver powerful technology solutions bene?tting employees, citizens, primary care providers, and many other constituents. The proposed solution leverages best of breed apps provided by Cisco, Glance, InGenius, and Cirrus Insights delivered on the powerful Salesforce platform to enhance customer capabilities, while enabling the Agency to increase vendor diversity and options. service cloud Salesforce Service Cloud gives our CSRs the resources they need to deliver superior customer experiences, with high er ?rst call resolution, better performance, and in creased customer satisfaction ratings, and enables the Agency to drive cost containment measures by integrating with existing technologies to deliver powerful technology solutions. Vertiba will work with MAXIMUS to deploy Salesforce in the CSC, as shown in Exhibit 5. 3- 2. Vertiba is a Global Strategic Partner and highest in customer satisfaction ratings across all Salesforce implementation partners. Wyoming trusts Vertiba with its Salesforce implementation needs in many agenciesWham . . Ke . CRM EngagementCenter Be": ts A Solution Functions . lean ibl??l?" '3 MI: on It Milli a I mammoth. (flym?u all ?as . Ir? .. Exhibit 5.3-2: Salesforce Service Cloud Architecture. The Salesforce CRM provides high levels of performance. reliability, and security (image provided by Salesforce). 5. Approach to Operations P23001.0060 March 25, 2016 RFP #0175-Al 135 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 142 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Our CRM will meet each of the functional and performance requirements in the RFP. Salesforce provides a complete suite of modules that deliver call center management, knowledge management, work?ow-supported business processes, webchat functions, forum functions, and web content management. Salesforce's powerful analytics engine can also deliver key performance metrics quickly, without the need for code or IT resources. As a modern web-based solution, it provides mobile and broad web browser support along with noti?cations and alerting. To provide integration with other applications in the solution, the Salesforce platform allows customization of forms and data integrations to aid in the delivery of services to customers. CSRs use the Salesforce Service Cloud CRM, which supports multi-channel access methods such as live chat and co-browsing, to document all calls to the CSC. The tool will capture, at minimum, all applicable information about the caller, including date of contact, name of customer, contact information, description of call, and description of any follow up. We will also document any complaints in our Salesforce CRM system to ensure prompt resolution based on established protocols for responding to, escalating, and resolving complaints and issues as they arise. Maintaining current and accurate records of contacts gives us historical context, as well as details on individual preferences, so we can deliver customer-centered customer service for all subsequent interactions. Additionally, the wealth of data available in the CRM streamlines our reporting of call center activity and customer outcomes to the Agency. With the Agency's approval and the support of the WES contractor, we would like to populate our CRM with certain WES data, to facilitate call handling. We propose to do that by uploading a ?at ?le from the WES contractor that would contain basic case file information, such as name, address, account number, application status, and PIN or other authorization ?eld data. Depending on the Agency's wishes for how to support client self-service through the IVR, this ?at ?le could be the same that we receive for use in the IVR. The CRM will also include fully integrated CTI capabilities. When a CSR receives an inbound call, the system recognizes the customer and delivers a screen pop that contains all of the customer's information, saving the CSR valuable clicks and immediately enhancing the customer experience. MAXIMUS will provide appropriate Agency personnel with access to the Salesforce CRM, as shown in Exhibit 5. 3-3 . 5. Approach to Operations RFP 136 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 143 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I I. 000134;! ., mum II- . LaurenBoyie Hr ?n?hu b. Inn!- {L-c?lrls (-12. [autumn . ?and Haul-?1. Wu .- ?and? In an. m- ung-nun- Iu-uu-a-uu - hue-u haul-r- mm n-I?w? 1mm ii In- mm a? m'i-i-a?tu- anu- Mme-u Soul?!? nun-n h? huh? mmu gum Exhibit 5.3-3: Salesforce CRM Screenshot. Salesforce CRM allows integration with telephony and external systems. Collaboration is critical to organizational effectiveness and productivity. Salesforce provides numerous standard collaboration capabilities that are embedded into the fabric of how users work within the system with a complete audit trail. This includes unstructured communications, reports, dashboards, triggered alerts, document management. universal search, knowledge management, mobility and much more. Salesforce delivers a secure Cloud experience. The service has been designed to provide customers with privacy and high levels of performance, reliability, and security. Salesforce cloud-based solutions, SaaS and PaaS, are certi?ed at the Moderate Impact level to provide the State with the assurance that its data is secure. Focusing on a cloud-based application platform allows the State to minimize internal administration, while providing organizational agility, speed-to-value, and ease-of?use for a broad range of stakeholders. Since launching its ?rst service in 2000, Salesforce's list of more than 150,000 customers spans nearly every industry worldwide. The company's trusted cloud platform is creating a connected government experience for more than 1,000 government agencies including all federal cabinet government agencies and the majority of states. Salesforce Service Cloud is used in many similar projects including the Colorado Health Care Policy and Finance Customer Contact Center, a center than handles more than 1 10,000 calls per year from customers who require assistance with questions about eligibility, bene?ts, and enrollment or who need help in navigating the departments programs. Additionally, the State of Colorado's web-based portal, PEAK, is powered by Salesforce, which provides a self-service delivery model for eligibility services, allowing constituents to apply for welfare bene?ts online, via mobile apps, and through portal-connected contact centers for medical, food, and cash assistance programs. Salesforce helps deliver great service with 47 percent improved agent i productivity, 45 percent decrease in support costs, 48 percent faster case resolution, and 45 percent increased customer satisfaction. In addition, with the power of the Salesforce Force.com Platform, Salesforce Service Cloud can be quickly and easily extended, customized, and adapted to any customer service challenge. 5. Approach to Operations RF 137 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 144 of 185 Wyoming Department of Health, Division of Healthcare Financing 0 Wyoming Department of Health Customer Service Center MAXIMUS KMS Because of the complexity of medical assistance 7 did you programs and the various processes and policies with . KN OW which we must comply in providing services to support these programs, it is important to have a single, Salesforce is the application to be comprehensive resource that staff can reference when assisting customers. We use our online MAXIMUS veri?ed (Knowledge Centered Support). KCS principles include: Eligibility Playbook in many of our health services . Integrating the creation and projects, and we are proposing to implement this maintenance 0fkn0W1?dge into valuable tool for Wyoming. For the CSC, we build the the PTOblem process Playbook on Salesforce's patented knowledge base . Evolving content based on technology as our KMS. Using a KMS on the same demand and usage platform as our CRM promotes ease of use and DeveIOping a knowledge base of maintenance. the organization's collective Salesforce's patented knowledge base technology enables experience to date our CSRs to pinpoint what is relevant to the customer. It . Rewarding learning, provides tools?like knowledge analytics and widgets? collaboration, sharing, and that keep knowledge resources up to date and exposed to improving the proper channels. I Results include 60 percent The Playbook KMS includes: improvement in resolution time, 50 percent increases in ?rst I A knowledge Knowledge lets you contact resolution, 40 percent build a storehouse of information to help agents improvement in agent address issues quickly and accurately. As a result, satisfaction, and 50 percent customers get better resolutions as we improve increases in case de?ection. ef?ciency. Intuitive browsing and searching. We can categorize articles in the Playbook in a way that makes sense for the CSC. It includes advanced search capabilities that help staff quickly identify the right articles to resolve customer issues rapidly. I Administration. Salesforce includes a multilevel article-review process to ensure the quality of information. It's easy for anyone to create articles with our knowledge management tools, but only authorized users can review and publish them. I Work?ow. We can tailor our knowledge solution to support speci?c work?ow rules and automated knowledge-base management. Alerts and automatic task assignments notify appropriate administrators when prompt action is required. I Multilingual Articles. We can support customers in their local languages by maintaining articles in multiple languages for common service issues, so that customers get consistently excellent support no matter what language they speak. I Suggested Articles. The Playbook can automatically present related suggested articles to help staff serve customers. I Knowledge Ratings. The Playbook contains powerful analytics that monitor the effectiveness of various knowledge management tools and solicit feedback from customers as they access and explore articles. 5. Approach to Operations RFP #0175-Al 138 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. inc. Page 145 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I FAQ. A searchable list of frequently asked questions (FAQ) reduces repetitive work, and speeds resolutions. Withjust a few clicks, staff can create and post FAQs. We use the Playbook to electronically store the Operational Procedures Manual, Policy Manual, Procedures Manual, job aids, call scripts, templates, contact information, FAQs, forms, common letter formats, and other resources that CSC staff can quickly retrieve by searching on keywords. A sample screenshot is shown in Exhibit 5.3-2. Home Chatter GIL- Contact: mics Comic Repeal mum Papa . mm, If All Draft Articles To 3 final [M?l 50in, lcm? n- Published Articles .. Archived L, Action Ania-m ?lypl Ania-turn ?woman new r" Edithmi-n WHO Kama Man - - fi?j mm? Ll WWFAD KovitaMan Mamba - - Go (In Assigned By Knits MW ?1 5&th!!ku FAD Knits Man - - FinFAD Knvila Man Instruction - - ?My I Edit FAG Knits Man - - Products haw By Kavlta - . - Edit I Pmilw FAD Matt Rim Instructions - - nus-um: rimmed By Man Honey Edithrm?I-w Wm FAD KavitaMan instruction-a - - Assigned By Kevan Manhood: Edithmn-w FAO KavitaMan - - AOOM Du Vin-Joe limo-W- 144:] (Jammy .. s, .t i museum mama cm H. Alma mama-d an!? ?t?lmgi. . {may 3m; Exhibit 5.3?2: KMS Screenshot. Our powerful KMS will be accessible to project sta?? and designated Agency sta?? We update KMS articles and work instructions on a regular basis if program policy changes dictate a modi?cation to our processes or if our quality assurance audits indicate the need to adjust a process or the work instruction describing that process. This tool maintains the latest versions of all documents, eliminating the risk of disseminating out-of-date information on policies, timelines, or standard practices. Use of the Playbook to maintain and store project resource materials greatly enhances our ongoing training and quality assurance efforts and eliminates problems arising from the use of paper desk guides and other references that can become We will provide designated Agency staff with KMS quickly outdated. Easy access to access upon request. reference materials also The Playbook KMS also serves as our library for all improves customer satisfaction published reports. We will store current and historical and increases the speed 0f reports, including management reports, in PDF problem resolution by format. Designated Agency staff with access to the minimizing referrals to Playbook KMS will be able to view reports at any time Supervisors and reducing the through this convenient web-based tool. It includes search wait time for callers. 5. Approach to Operations RFP 139 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 146 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS functionality that makes it easy for the Agency and other authorized users to locate reports by entering criteria such as the report name, publication date, or key words contained within the report. DecisionPoint Dashboards MAXIMUS offer DecisionPoint as a powerful reporting and analytics tool which will provide enhanced ability to monitor and evaluate performance, identify trends or bottlenecks, and inform management intervention to improve call center services. DecisionPoint retrieves data from our CRM and the telephony system to provide in-depth data analytics and reporting functionality. It allows for greater automation and ?exibility in tracking our performance in alignment with call center standards. In essence, we will provide the Agency with access to our performance information on demand. We discuss DecisionPoint in more detail in Section 5.10: Reporting and Data Analysis. NICE IEX Workforce Management MAXIMUS recognizes that the continued success of the CSC depends on an appropriate number of well-trained, competent, respectful, compassionate, and knowledgeable staff, equipped with the tools they need to be effective. We will achieve this through rigorous capacity planning, which will include sizing for staff, telephony equipment, and software licensing based on projected call volumes and duration, as well as using NICE IEX, the workforce management system. NICE IEX will give our management team and the Agency instant visibility into contact center operations, staf?ng ef?ciency, and performance against new standards. This will enable us to proactively manage ?uctuating staf?ng needs based on anticipated call volumes and skill sets needed on a daily and hourly basis, letting us correct problems or remove bottlenecks before they pose any risk to the quality of our customer service. Project management will closely monitor all performance standards to ensure that we have proper staffing levels and provide services in a manner that meets or exceeds the Agency's expectations. Secure E-mail MAXIMUS uses Microsoft Exchange as our corporate e-mail system with staff PCs con?gured with the Microsoft Outlook e-mail client software. We send electronic communication with Protected Health Information (PHI) using a secure e- mail product, Iron Port, which uses Transport Layer Security (TLS) to comply with associated HIPAA requirements. In addition, in cases where it is necessary to use e-mail to transmit information of a con?dential nature, we include a HIPAA-compliant con?dentiality notice. Additionally, our e-mail system has built-in ?lters for spam detection and de?ection. Kofax MAXIMUS will integrate Kofax imaging software, a COTS product, with the State's electronic document management system (EDMS) to provide image capture, document indexing, document management, work?ow, and records management of document images. Kofax improves scanning productivity by reducing the time involved in manual document preparation and automatically enhancing the quality of scanned images. Kofax includes features such as intelligent rotation, intelligent cleanup, and blank page deletion. The adoption of Kofax in other 5. Approach to Operations RFP 140 .0060 March 25, 2016 Attachment to the information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 147 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS MAXIMUS projects has reduced rescans to less than I in 10,000 pages, a quality rate of greater than 99.99 percent. The Denver Data Center will host the server running the Kofax software thereby enabling us to share document management servers and achieve lower costs. From the server in Denver, Kofax VRS software can be managed, distributed, and installed on remote scanners using Windows Installer. xMedius Fax Our fax system, xMedius, allows for a high level of work?ow ef?ciency for our staff. The xMedius system's logical fax ports provide a highly scalable system for receiving and sending facsimile transmissions directly to and from the computer desktop, which increases ef?ciency, reduces paper consumption and allows us to easily provide of?cial documents to the Agency and customers. The xMedius Fax Server has unlimited fax licenses. We utilize the primary Session Initiation Protocol voice circuit for fax transmissions. Fax messages are automatically routed to the appropriate work queue for processing our staff members are noti?ed immediately upon receipt of a fax. Each fax message contains a header, which includes a time and date stamp, identifying sender information and the number of pages of the fax transmission. We monitor and report on both inbound and outbound fax transmissions through the fax server. Survey Monkey As described in Section 5.1.1: Strategy for Meeting All Project Requirements, we create web- based surveys using the online tool Survey Monkey. Web Chat and Co-browsing As described in detail in Section 5.11: Possible Optimizations, MAXIMUS proposes to use web chat and co-browsing to improve customer access and satisfaction. Secure File Transfer Using our secure server, we exchange data in a HIPAA-compliant format. is a Secure FTP-based product. It is a web-based tool that allows for ?le sharing in a secure manner. Files are in transit and protected at rest to help ensure that customer information is protected at all times. Hosting, Maintenance, and Support MAXIMU has multiple facilities that are capable of hosting computer systems per the required operational and security policies. We will host CSC systems (with the exception of the Salesforce CRM which is hosted in its Govemment Cloud) in our Culpeper, Virginia, data center with our Englewood, Colorado, Data Center as a redundant back up center. We will maintain policies and procedures to help ensure that we meet SLAs for: Availability Response time for repair Security incident response Security protection of Wyoming Department of Health and Federal Agency Partner data Frequency of software upgrades related to hosted environments Policy for software patches related to hosted environments 5. Approach to Operations RF #0175-Al 14l .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 148 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Our IVR, CRM, and KMS will be available in accordance with RFP requirements, excluding planned downtime. We will comply with the schedule, communication, and resolution requirements for Emergency/Critical, Urgent, Normal, and Low outages. We will make any updates outside of normal working hours or at times agreed to by the Agency. We acknowledge that planned downtime will not exceed ?ve hours per month and will make all appropriate noti?cations in accordance with the RFP. We will also meet all backup, retention, and ?le restoration standards in compliance with the RFP. Throughout the life of the contract, MAXIMUS provides technical support for computer hardware and software installation, end user problems, system connectivity, and hardware repair through our MAXIMUS IT Team. We will follow all maintenance and support requirements in the RFP, including communicating and resolving issues. Our solution enables us to meet and exceed performance measures. We provide all routine and remedial maintenance and support services (hardware and software), and maintain and operate the hardware and software to support interoperability between our CSC components. The CSC is supported with adequate data network services scaled to size for operational functionality. Maintenance agreements are purchased for all network components including routers, switches, ?rewalls, servers and PCs. Should a hardware failure occur, we maintain appropriate spares of critical components in order to replace the affected element and restore service as quickly as possible. We standardize on the use of redundant and diverse data network paths. We have monitoring tools and management in place to monitor errors, status, and load balancing for these connections. Salesforce also performs system maintenance to sustain the performance, reliability, security, and stability of the infrastructure supporting services. When non-emergency maintenance is scheduled, the speci?c timing and availability to be expected during that time will be communicated to all customers approximately one week in advance of the maintenance window upon login to Salesforce. In the event of planned maintenance where the services will be unavailable for more than four hours, or that requires customer action in advance, Salesforce strives to communicate via email several months in advance. Salesforce also uses Patch Releases and Emergency Releases to deliver scheduled and ad hoc application ?xes. Patch releases are scheduled weekly. Emergency releases are conducted on an as-needed basis and can occur any day of the week. Whenever possible, patches and emergency releases are deployed during off- peak hours and without downtime. The MAXIMUS IT Team includes a full staff of corporate technical resources responsible for installing, maintaining, and supporting the computer and telecommunications resources of the project. We purchase service agreements from our vendors for all equipment that we deploy to ensure prompt response and resolution for any equipment failures. MAXIMUS IT representatives coordinate any necessary service calls to our equipment and service vendors to ensure prompt response time and follow through to complete problem resolution. This preventive approach signi?cantly minimizes the risk of degraded customer service caused by systems that are temporarily down or mal?lnctioning desktop units. Our computer equipment is covered by a three-year warranty. The plan includes on-site dispatch of service technicians for situations that require hardware component replacement. 5. Approach to Operations RFP I42 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 149 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 5.4 Understanding of WES RFP Section 7.1.1.124. page 54 From the WES RFP, we understand that the WES is a rule-based system constructed on a Service-Oriented Architecture that supports eligibility determinations and case management for State health insurance programs, including Medicaid and Kid Care CHIP. It integrates with the Federal Data Services Hub and Federally Facilitated Marketplace through a determination model to support ACA requirements. The WES also provides a public-facing Client Web Portal and online application to increase customer service options, an EDMS to support paperless workflows, and several other modules. It follows the NIST security guidelines and is compliant with HIPAA, HITECH, and other federal regulations. We have studied the detailed system diagrams and technical descriptions included in the WES RFP's Procurement Library. Implementation of the WES allowed the Agency to streamline its service delivery and establish the CSC. While the WES currently ful?lls the majority of intended business and system requirements, the Agency is now seeking a vendor to enhance the WES to meet all of its objectives. Such enhancements will help the Agency maintain compliance with CMS requirements, enable more Wyoming citizens to receive a real-time eligibility decision for Wyoming Medicaid or Kid Care programs, and facilitate ef?cient and effective caseload management. A successful CSC is dependent on a well-designed WES that supports eligibility processing with robust features, ef?cient work?ows, and reliable uptime. In the CSC, our mailroom staff will rely on the interface between the EDMS and WES in order to image documents and accurately associate them with case records. Our eligibility specialists will need the WES to enter data and perform the processing that supports the State's eligibility determinations; we will need the WES to generate the required notices that we will mail every day. Our CSRs will rely on the WES in order to answer callers' questions and update their case information. And the WES will support the Agency's web portal where citizens can apply for coverage; our CSRs will rely on that interface as they co-browse the online application with callers to help them apply. In short, there are few tasks in the CSC that can be performed without the support of the WES. To understand the WES as it undergoes its enhancements, we will rely on frequent discussions between MAXIMUS, the Agency, and the WES contractor to give us the speci?c knowledge we will need in our operation of the CSC. We will come to these discussions with a solid understanding of the design and use of such systems, based on our years of experience in consulting with states on MMIS design and eligibility and enrollment work?ows. Through collaboration, we will identify areas of interdependency between the WES and CSC performance, such as timely processing of applications and mailing of notices in accordance with SLAs. As we write our policies and procedures and develop our processes for the CSC, we will note such areas and work with the WES vendor and the Agency to mitigate points of risk or inef?ciency. With each enhancement to the WES, we will update our procedures and knowledge management system and hold associated training as needed so that our CSC staff are immediately and accurately informed of the impact on our operations. 5. Approach to Operations RFP 143 P23001.0060 - March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 150 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 5.5 Traceability of CSC Requirements RFP Section 7.1 .1.12.5, page 54, SOW Appendix A 5036 To successfully deliver services for Wyoming, MAXIMUS will use tested project management methodologies and standards-based approaches informed by the experience we have acquired through the implementation, operation, and management of projects in support of multiple health and human service programs for 40 years. We understand the unique requirements of projects with large technology and operational components, both of which need to be implemented simultaneously, so we approach management of the contract from a structured and industry standard approach. We work closely with the Agency to create deliverables that provide transparency into the operations of the CSC and align with the State's objectives. Our experienced team establishes a rigorous precedent, managing all tasks to the Operational Procedures Plan and implementing solid management controls. We will establish the plan by September 15, 2016, and update it at least twice annually. We make any additional updates within three business days upon receipt of a request. The plan will include policies, processes, and work?ows related to all aspects of the operation. We include each task outlined in the RFP in our work plan. This effort re?ects our thought in putting together a solution that truly will meet the needs of the Agency and the customers we serve. We train staff according to these procedures, monitor their activities through our system monitoring and reporting capabilities, evaluate the quality of the service through sampling as speci?ed in our quality procedures, and initiate continuous improvement and change management procedures if the process needs adjustment. We will complete all tasks by Agency-imposed deadlines and delivered by the mutually agreed upon milestones provided in our Work Plan. We will submit deliverables no later than ?ve days from the date identi?ed in the work plan 98 percent of the time, and there will be no more than two submissions of any deliverable to gain acceptance by the Agency. We will complete 98 percent of approved project schedule tasks within baseline dates. Our managers monitor end-to-end work?ows to maintain traceability of all work tasks and identify process exceptions or bottlenecks. For example, they may identify work tasks that are in jeopardy of failing to meet timeliness standards, which can then be rerouted to a different queue or assigned a higher priority in the processing schedule to ensure prompt completion. They also may identify work tasks that have been sitting in a queue longer than expected, which may indicate a potential system problem. MAXIMUS employs a variety of methods to communicate the status of each task to the Agency and internal business owners. In addition to the Work Plan itself, we use quarterly, and annual calendars to track the due date of each task. We also create a KPR de?nitions guide at the beginning of every awarded contract to track CSC project compliance with the KPRs. The KPR de?nitions guide lists the tasks associated with a particular KPR. This approach supports our ability to stand up the CSC project; provide innovative solutions to meet project requirements and quality, timeliness, and budget objectives; monitor, track, and manage the contract successfully; and work collaboratively with the Agency. 5. Approach to Operations RFP 144 P23001.0060 March 25, 2016 Attachment to the Information Technology (In Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 151 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS 5.6 Ongoing Training RFP Section 7.1.1.125. page 54 Consistent with MAXIMUS continuous improvement plans and QA strategy, we manage training as an ongoing learning process, not as a single event. It occurs in concert with an individual's developmental cycle and in response to demonstrated need based on performance changes or shortfalls. We also conduct gap or refresher training to address training needs identi?ed through our quality assurance activities. MAXIMU also conducts ongoing or refresher training on an as-needed basis when changes to programs, policies, procedures, processes, or technologies occur. Training delivery varies depending on the urgency and impact of the information, but may include individual coaching, online updates, or formal training. Using the MAXIMUS Eligibility Playbook, we are able to quickly respond to policy or process changes, creating content and immediately deploying it to staff. We also provide systems build training to train staff on relevant systems changes or updates. Additionally, MAXIMUS is committed to offering professional development and growth opportunities through training and continuing education courses offered at both the project and corporate level. Leaders work with their staff to identify developmental needs and provide time and resources to work on these areas. These efforts can include job rotations, special team or project assignments, and job shadowing. Training staff may also develop solutions to help with these developmental efforts. The Training Department has identi?ed Professional Development topics on a host of different topics. We have created these courses for both frontline and supervisory staff. Professional development modules include customer service, professionalism in the workplace, professional communication, leveraging your time and task management, stress management, emotional intelligence, 360-degree feedback, effective coaching techniques, leading by example, managing Generation Y, and how to conduct productive meetings. Training on leadership and management concepts and practices is critical to the continued success of the project. We have created a focused program speci?cally tailored for the project's supervisors. Topics include progressive discipline, performance management, behavioral interviewing, coaching, communication skills, writing professionally, accountability, task/time management, goal setting, leadership, change management, creating a positive workplace, and team building. We will provide training to appropriate Agency staff when new tools or processes present a signi?cant change to the CSC. MAXIMUS will also provide consultation on policy training and modi?cations to enable successful interpretation of new policies. 5.7 User Documentation RFP Section 7.1.1.12], page 54, SOW Appendix A, 5037 The complexity of providing eligibility support services dictates the need for a structured set of processes and procedures for handling inquiries of various types and from various callers. The MAXIMUS Eligibility Playbook, described in detail in Section 5.3: Tools and Software, is the cornerstone of our approach to managing this complex service delivery model in a way that aligns with the Agency's goals and expectations. 5. Approach to Operations RF 145 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 152 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS To develop the Playbook, we compile and all project documents, including standard operating procedures, policies and procedures, job aids, templates, call scripts, and reports. We will leverage existing documentation and update and maintain policy manuals and process guides within our Playbook. We will establish the Playbook, including policy manuals and process guides, by September 15, 2016, and will update it as changes occur, or within three business days of request, unless otherwise determined by the Agency. We will update the Playbook and provide documentation to the Agency that it was were updated along with a summary of the updated information. As part of our continuous quality improvement cycle, we maintain and regularly update this manual whenever there is a procedural or system change. The Playbook keeps CSRs up to speed with the latest information, eliminating paper manuals that go out of date as changes occur. Managers update the Playbook quickly and easily, with most changes taking less than a minute. Since the Playbook is online, once we make an edit, all CSRs instantly have it, ensuring all staff always has current information. 5.8 Managing Upgrades RFP Section 7.1.1.123. page 54. sow Appendix A 5125 MAXIMUS recognizes that our technology environment is likely to go through upgrades and changes over the course of the contract. As part of program operations, we will upgrade our software, hardware, and communications systems as needed, keeping all system components and functionality across common web-based platforms current with industry standards and backwards compatible. Such change poses no problem for MAXIMUS, as we have built our solution using a SOA and open standards. SOA facilitates the development of enterprise applications as modular business services. MAXIMUS reviews and updates the baseline con?guration of the information system quarterly and updates with new images to include the latest patches and updates to COTS software in accordance with the organization-de?ned frequency and when required due to organization- de?ned circumstances. Additionally, Salesforce uses Major Release Maintenance three times a year to upgrade services to the latest product version to deliver enhanced features and functionality. Major release dates and times are posted online approximately one month before release to Sandbox instances. An email noti?cation and blog post regarding Sandbox preview instructions is also sent approximately one month prior to upgrading Sandbox instances. Email noti?cation of major release dates is sent one month prior to upgrading non-Sandbox instances. The Release Notes document describing the new features and functionality is posted in Help Training one month prior to upgrading non-Sandbox instances. Final release reminders are communicated to all customers approximately one week prior via email and upon logging into Salesforce. We will provide technology upgrades and enhancements that improve performance and high system availability. By leveraging a centralized solution, we can ef?ciently maintain database and system upgrades on a consistent and reliable basis to ensure continued performance and security without disrupting service. We also make software modi?cations when new operating requirements are needed to improve work?ow, add capability, or upgrade equipment and technology. We use industry-accepted processes for managing software upgrades and enhancements. 5. Approach to Operations RFP #0175-Al 146 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 153 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS To minimize the impact on CSC operations, we fully test any upgraded tools or software prior to implementation. System changes are ?rst tested in an isolated environment and are not deployed to the production environment until all potential impacts have been evaluated and the effectiveness of the change proven. This approach minimizes downtime and enables us to ensure system changes will not negatively impact productivity. We complete the upgrade during non- business hours. We include the Agency when considering modi?cations through a formal change control process. Our staff has the full support of our corporate IT Department if any questions or issues arise during upgrades. Our corporate IT Team is responsible for managing our data centers, corporate- wide telecommunications and networks, and data security. The MAXIMUS IT Team also manages our corporate help desk, ITHelp, which assists system users across the country. MAXIMUS IT staff is on-call 24? to provide assistance with resolution of infrastructure issues, should the CSC have need of their assistance. To document upgrades, we develop a design document to capture and track detailed technical requirements throughout the upgrade process. When the upgrade is complete, we produce release notes that discuss each change or update in the upgrade. We provide this documentation to stakeholders and update our Eligibility Playbook with the relevant information for staff. 5.9 IdentifyingEfficiencies RFP Section 7.1.1.129, page 54,sow Appendix A. 5060. 5075, 5076 MAXIMUS will work side by side with the Agency to maintain an i environment in which all facets of our operations share a common focus on operational ef?ciencies and optimizations, quality management, and operational transparency. We will analyze CSC needs and new State or federal policies and requirements to ensure our operations are always in compliance. Upon an Agency-agreed timeframe and frequency, we will assess CSC business processes, documentation, training processes, and staf?ng and provide recommendations on improvement and optimization opportunities. We will also leverage assessments and ongoing optimization logs, review identi?ed improvements and opportunities with the Agency, along with proposed changes, effort, timeline, and cost to implement changes and identi?ed bene?ts of the change. We understand that the Agency will review proposed changes in accordance to the Change Control process and requirements in the RFP. We use BPM methods and analytical tools to continuously calibrate business process work?ows to optimize ef?ciencies and deliver better service to more Wyoming families. MAXIMUS brings the flexibility to adapt to changing government conditions through a variety of methodologies and tools. As an example, we use our industry-leading BPM modeling methodology to improve business process work?ows and maintain a level of optimized ef?ciency. In Wyoming, we will use our BPM tools to improve our staffing, increase ef?ciencies of our work?ow, and continuously improve our operations. 5. Approach to Operations RF 147 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 154 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Our management team will identify operational ef?ciencies and help us achieve continuous improvement in our business processes over the course of the contract period. We have developed standardized management processes around forecasting and staff planning that we Business use to match staff capacity to changing transaction Process volumes in order to maintain or lower unit costs while Management maintaining or improving service. By determining both strategic (month over month) and tactical (day over day) staf?ng needs to meet service levels, we decide how to allocate staff resources and quickly ascertain the impact of changes in transactional volumes. The optimization of resources also identi?es opportunities for processing more volumes without increasing resource levels by understanding where capacity already exists in a process. US uses industry- leading BPM methodologies to improve work?ows and As an example of our use of our ef?ciencies, in our Texas maintain a level ofoptimized Enrollment Broker project we worked with our mail ef?ciency, while maintaining partner to use automated processes which include the the highest level ofquality in National Change of Address service from our operations. the United States Postal Service (USPS), to manage routine and large-scale mailings. Their use of reduces the volume of returned mail by forwarding mail to a customer's best known address automatically. USPS assigns each piece of mail a unique barcoded serial number that is used to report which pieces were not delivered rather than returning the actual materials. With more than seven million pieces of returned mail each year, Business Ink's use of saves us roughly $27 million annually in mailing costs. We will maintain a log and record of all recommendations for continuous improvements in CSR Scripts, FAQs, and IVR scripts to provide to the Agency. We will include these recommendations as a part of our regular status report. We look forward to collaborating with the Agency to improve ef?ciencies within the CSC, providing Wyoming families with more self-service options like text reminders and other electronic communications, and enhance service delivery through business process improvements and new technologies. 5.10 Reporting and Data Analysis RFP Section 7.1 .1.12.10, page 54, SOW Appendix A, 5066-5070. 5130-5133, 5174, 5175 Effective reporting tools, reports, and analysis are essential to monitoring 2 resource allocation and ensuring performance in compliance with contractual standards. MAXIMU will comply with all of the reporting requirements stated in the RF throughout the duration of the contract. DecisionPoint uses data from our various systems to give us in-depth data analytics and reporting fun ction ality. 5. Approach to Operations RFP #0175-Al 148 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 155 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Our approach leverages DecisionPoint for Business Intelligence which provides ?exible and actionable reporting, data analytics, and business process monitoring capability. By bringing together multiple sources of data?the telephony solution, Kofax imaging technology, and the Salesforce CRM?our solution gives us the ability to evaluate and adjust project performance in sophisticated and meaningful ways, such as identifying problematic trends or bottlenecks. BI also gives the Agency a higher level of insight into the ef?ciency and responsiveness of our operation. We are pro?cient in both creating and running reports in DecisionPoint, having built the solution internally and used them successfully in multiple call centers across the country. Our reporting solution provides real-time and historical reports drawn from the data ?owing through its components. Supervisors and managers log in to the high-level dashboard to see the status of the call center at a glance, and can drill down to get detailed information about call center performance. Exhibit 5.10-1 gives an overview of all of the actionable data that our reporting and analytics solution collects. Performance .\ll:ll) red and Grouped \vnilnhle Metrics Metric Contact Center I Project I Contacts Offered I Handle Time (Talk, Hold, Wrap) I Site I Contacts Handled I Speed of Answer I Call Type or Queue I Contacts Transferred I Service Level Answered I Time Interval I Contacts Abandoned Agent I Project I Total Paid Time I Total Occupancy Percentage I Site I Total Ready Time I Availability Percentage I Agent Attribute I Total Not Ready Time I Labor Time per call I Staff Title I Total Calls Handled I Scheduled/Actual Agent Time I Average Handle Time I Scheduled/Unscheduled Time Off I Logged In Time I Available Headcount I Available FTE Exhibit 5.10-1: Data Collected through DecisionPoint. The Agency will always know how the CSC is performing against metrics using the reports from the real-time reports in our reporting solution. We can schedule reports to run at speci?ed times or repeat at de?ned intervals, and to output to various formats, including PDF, CSV, XLS, RTF, and Microsoft Word. Project Status Reporting Project status reporting will provide an opportunity for Agency staff to compare the status of activities to contract speci?cations and will allow MAXIMUS and the State to make adjustments to ensure we meet all contract requirements. During the operations phase, we will submit a Status Report by the ?fth business day of each month. This report will include all of the elements required in the RFP. We will be available to meet with the Agency to discuss the Status Report upon request. Contact Center Reports Continuous assessment of call center metrics is part of our overall approach to quality assurance in the call center. Through regular analysis of quantitative data, we help to ensure that our infrastructure and staf?ng are proportional to expected call volumes at various times of the day and week. Call volume projections as well as known call based on historical information 5. Approach to Operations RFP 149 P23001.0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 156 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS allow us to identify the number of CSRs needed to answer calls quickly and minimize caller hold time and abandonment rates. We use DecisionPoint data in addition to data from our CRM to capture information on each call: I Date and time I For answered calls: language, subject I Disposition (abandoned, queued, (checklist of connected, completed) how caller I Time to connect heard of program, outcome (complete, I Duration (connect to finish) referred, requires follow-up) I For IVR Systems: tallies of all menu I For follow-up 031151 effort selections (estimated time spent to respond) We generate a variety of standard reports from our telephone system, which help us monitor the quality of service we are providing to callers. We can develop custom reports on measurable call center statistics, enabling us to monitor and report on such things as total inbound and outbound calls, average time in queue, abandoned calls, CSR activity, and a number of other statistics. We record, monitor, and analyze results to determine consistency and quality of customer service and develop training plans to address any issues that arise. Salesforce Service Cloud includes a powerful suite of analytics and reporting tools that help us view and analyze data for service quality. The reports and dashboards track service interactions, agent performance, and customer issues. Simple point and click, customizable dashboards give our staff instant access to real-time data and analysis. Dashboards provide a high-level snapshot of key metrics and performance indicators at a glance, and con?gurable reports help us to drill down for detail. Salesforce offers a wide range of standard reports, as well as custom reports that enable our managers to access exactly the information they need. Because reports and dashboards can be developed without 1T help, our management team can quickly and easily create the reports they need to see the information they want to ensure project performance. Additionally, we plan to integrate the Salesforce CRM solution with DecisionPoint to allow a single point of entry for reporting and data analysis and to support reports and dashboards that cross reference data from all the source systems including Kofax, Cisco Telephony, and Salesforce CRM. Exhibit 5.10?2 illustrates an example of a real-time monitoring dashboard we use to track actual performance against performance standards. 5. Approach to Operations RF 150 .0060 March 25, 2016 Attachment to the Information Technology Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 157 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Agent 8. Team Summary u, . . . fin-lad ?mm "mm Ruin-a tome-Juan!" Wm mute-n mm menu mm I Came. Flu Wm mm cocoon Hm: can. Fan-mm mm - mm: "arachnma:- In Jul Home In: muses-e. Mb CIA-1- Dun imam can Dunn M?n View on M: in unn- Bnul nun Cub: cum Item the. Cat-1 Dal-l km'mmtm tm-m:mt mew mt 240205223 "033 75?4? Cutout-:1 ITuf'l Tout tuoonn no: 17110030 ?none . ll O?i 10$ Siam mu 5 lumen unmu ?Jul!" lln?ml! Inn?! I Tim Schema Mull [m I Woman 1111.70]! tum-on unmen umExhibit 5.10-2: DecisionPoint Agent Performance Report. The DecisionPoint reporting system integrates data from the and the A CD to produce contact center performance reports. Training Report MAXIMUS will deliver the annual training report to the WDH Vendor Contract Manager as required in the RFP. Reporting Analyst In our experience, we have found it beneficial to have resources to manage, produce, and evaluate reports. To that end, and in compliance with the RF requirement, we include a Reporting Analyst in our staf?ng plan to evaluate reports, report data, and perform ad hoc queries and analysis as needed. Speci?cally, the Analyst will: I Provide reporting and ETL development support to the Operations Manager and other team members I Manage an effective reporting program that gathers and analyzes operational data from CSC systems I Design reports and dashboards as requested and collaborate with additional DecisionPoint development staff to enhance the analytics and reporting capabilities. I Provide contractually required project status reports to management Agency Access MAXIMUS will provide designated Agency users with access to our reporting tool and the real- time dashboard so they can independently run reports and gauge CSC performance. We will allow the Agency to access all reports and data showing how the report was generated. We will also provide reporting to support the Agency and its designees and to coordinate with PERM. We will have CSC report templates and creation of ad hoc reporting available as needed. 5. Approach to Operations RFP 151 P23001.006O March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 158 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 5.11 Possible Optimizations RFP Section 7.1.1 .12.11, page 54 MAXIMUS has identi?ed optimizations supporting self-service acceleration i and multi-channel management that bring value and will provide a discemable bene?t to the State. Self-Service Acceleration and Multi-Channe] Management Self-service functionality has matured over the past 10 years and continues to be an important area where MAXIMUS can add value. We have learned through our contracts nationwide that new self-service channels do not necessarily yield greater adoption. Adoption is the result of client behavior change, and MAXIMUS helps clients take a stronger role in managing their own bene?ts. We will promote self-service adoption through the IVR and enhanced use of the State web portal. The benefits of our self-service promotion efforts include lower service costs, faster services, and an increased client role in their own bene?t management. MAXIMUS understands that the future of self-service is not just an enhanced collection of features but rather it is empowered clients who understand the process, have the tools to complete the process, and the visibility to navigate it. We will educate clients about their self- service options and empower them to utilize those options whenever appropriate. Promoting IVR self-service starts with the ability to measure and analyze current self-service use against the larger strategic goals through access to data. After mapping the current baseline of self-service capabilities, the next step is measuring trends. With this information, we can strategically deploy measures to increase self-service features and adoption across channels. Web Chat With Agency approval, we propose offering customers the option to web chat with our CSRs for fast access to live input on their speci?c questions, increasing their satisfaction with the program and the ?exibility of the services we provide. We will use the reliable, scalable, and secure Salesforce Live Agent chat service product in concert with the State's web portal to provide customers with real-time chat assistance. Customers can communicate via chat online, facilitating quick, private dialogues without hold times. Our CSRs see a homepage that enables them to quickly review recent chat transcripts and visitor records, and launch the Live Agent console to manage Live Agent chats. CSRs can answer chat requests, conduct live chats, and interact with Salesforce records and Playbook articles. A few key bene?ts of web chat: I Improved customer satisfaction as clients have another convenient channel to contact the CSC I Reduces the number of calls that come through our call center and therefore reduces customer wait times to speak to CSRs I Allows CSRs to handle multiple sessions at a time, which reduces customer wait times for those customers using the web chat solution I Offers CSRs quick links, quick responses, and a knowledge base to provide easy access to content when responding to customer inquiries, allowing them to more quickly respond in a concise manner 5. Approach to Operations RFP 152 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 159 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS I Excellent alternative for hearing-impaired customers who might ordinarily use a device To enable customers to easily access web chat, we recommend that the Agency add a button to the WES website that would link to our CSRs. We would develop standard operating procedures to comply with Agency and privacy requirements to make sure our CSRs understand what can and cannot be communicated on web chat and give customers accurate information. When a customer clicks on the web chat button, one of our CSRs will see the request on their computer monitor, greet the customer, and then respond to questions posed. CSRs record web chats in the CRM with any other information Co-browsin lets our CSRs provide a rich er customer experience by conducting a simultaneous web session where prowded during the sessnon,just like a phone call. the CSR andthe customer can Our web chat solution seamlessly integrates with the ACD ?ll out forms together. With co- for automated chat session routing as well as integrated call browsing, our CSRs are and chat routing based on CSR skill sets. literally "on the same page as the applicant and can offer secure and con?dential over- the-shoulder assistance. We propose to schedule staff to serve as dedicated web chat agents in two-hour increments throughout the day; during that time, they focus on web chats instead of calls, depending on the volume in each communication channel. Since our CSRs are cross-trained in phone-based and web chat assistance, they can seamlessly and quickly switch from chat to phone, if necessary, with the customer's consent. If chat traf?c declines, CSRs can immediately receive phone calls until they are again needed to provide chat services. The combination of seamless switching between chat and phone during a chat session and of maintaining high utilization by taking phone calls when chat traf?c is low increases overall CSR productivity. MAXIMUS has successfully implemented live chat both on other states' existing infrastructure and on our own infrastructure. We will work collaboratively with the Agency to clearly de?ne our involvement in the implementation and support of live web chat, including providing the technical infrastructure, developing training curriculum and performance standards for all staff engaged in live chat, and forecasting staf?ng impacts as needed. We have successfully implemented web chat as a service access channel in our New York State Health Customer Service Center project and our Indiana Enrollment Broker project. The experience we gained through these efforts will inform our ability to deploy and support web chat functionality in Wyoming. Our experience with web chat in our New York project, where we handled approximately 53,000 chat sessions within the ?rst year of using this channel, has given us insight into the operational impacts and staf?ng needs to support this channel in conjunction with telephone customer service. 5. Approach to Operations RFP 75-A 153 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 160 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Co-browsing In addition to chat capabilities, we propose a co-browser capability using Salesforce, which will enable our CSRs to help clients in real time who may have questions or be experiencing problems completing their applications on the web site. This feature enables the CSR and client to ?ll out Wyoming's online Medicaid eligibility application or other form together, ?eld by ?eld, even highlighting speci?c areas of the form for additional clarity. Both the CSR and the customer can click, scroll, type, and browse, all in real- time. Like chat, we would work with the Agency to add a link to the State's Web Portal to enable co- browsing. We use co-browsing in our multiple projects, including Health Insurance Exchange projects in Maryland and the District of Columbia. 5.12 Approach to Expanding Services RFP Section 7.1.1.1212. 54, sow Appendix A, 5077 With our focus on ?exibility, innovation, and ef?ciency for CSC operations, MAXIMUS is uniquely positioned to work with the Agency to expand services. Following an Agency-agreed time and frequency, we will propose an approach to expanding CSC services to phase-in the current enrollment and bene?t client services currently handled by the State's Fiscal Agent, as well as and other possible future add-on projects when noti?ed by the Agency. We acknowledge that the phase-in will result in contract negotiations and we will negotiate the terms in good faith with the Agency. Experience Expanding Services Wyoming can be con?dent in our ability to successfully expand services. MAXIMUS consistently demonstrates ?exibility as we work with this diverse clientele and their changing needs. We have been able to establish and re?ne highly effective business processes to meet the changing needs of our government clients, allowing us to respond quickly as needed and plan appropriately for change. Combining this ?exibility with our deep knowledge of government health programs, we bring the wherewithal to expand our capabilities to support a broad range of new programs without adversely affecting our existing operation. We know from direct experience that projects constantly change to better serve their constituent population. MAXIMUS has operated health services projects over multiple contract terms, and in some cases since program inception, allowing us to support clients through a variety of changes and expansions. For instance in the New York Medicaid CHOICE project, one of our longest contracts, we have managed extensive changes in scope and growth including expanding to neighboring counties, expanding Managed Long Term Care for dual eligible, and integrating new services handled at the county level. Additionally, for another long-term client Vermont Green Mountain Care, we managed multiple changes in scope and volumes increase, added customer service for Medicaid and health care insurance/pharmacy programs, and established the Vermont Health Connect (Vermont's Health Insurance Exchange program.) These changes required us to modify internal policies and procedures as well as our systems, and staff training programs. We will leverage the lessons learned and best practices from managing change on other large eligibility support programs to successfully expand services in Wyoming if needed. 5. Approach to Operations RFP #0175-Al 154 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 161 of185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Experience with the Services Wyoming Wants We understand that potential add-on work could include: I Dissemination of Medicaid Program Information to clients I Acceptance of payments through various means in accordance with procedures established by the Agency and contract I Assisting clients with client portal needs, including checking eligibility, completing a transportation request, and requesting a Medicaid ID Card MAXIMUS brings extensive experience delivering these services in many states. For instance, in many of our government health projects, including projects in Iowa, Massachusetts, and Oklahoma, we provide community outreach, marketing, and public relations to educate participants about programs and responsibilities. We also bring experience accepting payments. In the Georgia ChildCare and Parent Services (CAPS) program, MAXIMUS provides child care payment processing services, including processing and paying child care Through PM modeling, invoices and.prov1ding all payment-related customer . continuous monitoring and serVice to child care providers. We utilize direct deposrt adjustment of work?ow, and electronic invoicmg in this program. In our California scalable systems and data Medi-Cal for Families programiwe process both centers, ?exible staf?ng, and electronic and paper payments;-1n the Kansas KanCare expandable facilities, we have Clearinghouse we collect premium payments for successfully plan It ed for and in our Texas Enrollment Broker program, we process changes in program scope and CHIP enrollment fee payments and Medicaid Buy-In and scale; responded to Medicaid Buy-In for Children premium payments. unanticipated work volumes; Assisting customers with portal needs is a task we perform and adapted systems and daily across various programs in many states. Our co- processes ?0 achieve greater browsing solution, described earlier in this section, emciency i" eligibiliw projects enables our staff to see exactly what the clients sees so we across the country. can quickly and easily help them check eligibility, complete requests, or navigate through the site. Change Management Process Our project management methodology requires a formal process for managing project changes. MAXIMUS uses an integrated change control process to document, review, and approve changes to the authorized project scope, schedule and cost. Should the Agency request the expanded services, we will use this process to implement that work. We keep all information related to a change in the change request form. Once an item has been identi?ed by MAXIMUS and the Agency as a change, our CSC Account Manager will complete the request and assessment portions of the form identifying the specific impact to the project including staff, cost and schedule. 5. Approach to Operations RFP #0175-Ai 155 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 162 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Once a change request is approved, our project team will work with the Agency to identify the best approach for implementing the change while minimizing the impact on the existing project work. MAXIMUS Approach for Expanding Services Our approach to expanding services includes use of BPM modeling tools to project staf?ng needs and phase rollouts, continuous monitoring of workflow to identify potential bottlenecks and ?nd opportunities to enhance ef?ciency, ?exible staf?ng, scalable system architecture and data centers that enable us to support additional processing demands, and facilities with room for expansion. Further, MAXIMUS brings a broad range of corporate resources such as our Center of Excellence for Long Term Services and Supports and our Center for Employee Development to support the program expansion. Should the Agency request expanded services we will: I Develop Solution: Upon request, MAXIMUS will use our experience providing similar services to develop a solution for expanded services for Wyoming. Working together with the Agency, we will review the solution. I Finalize Solution: Our project staff will work with the Agency to ?nalize the solution, looking at staf?ng levels, facility modi?cations, equipment, and other factors that will affect costs. I Implement Changes: Our CSC Account Manager and staff will work together with the Agency to plan, schedule, and implement any necessary changes. We will provide implementation plans that identify the solution components we will need to put in place to successfully accommodate new services as the Agency chooses to add them. I Assess Success: In keeping with our continuous improvement philosophy, MAXIMUS staff will assess and continuously re?ne our response to ensure that the solution we bring forward meets requirements and objectives for ef?cient and effective service delivery. 5. Approach to Operations RF 156 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 163 of 185 GNV EOBHOSEH .LNEWHOVJJV ATTACHMENT A: RESOURCE MANAGEMENT AND STAFFING PLAN Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Heaith Services, Inc. Page 164 of 185 Resource IVlanagcment and Staf?ng Plan Prepared For State of Wyoming Wyoming Department of Health Division of Healthcare Financing Prepared by MAXIMUS 157 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 165 of 185 Wyoming Depaitment of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Revision History Rot ision Date 031232016 07/11/2016 Version .\ulhur Summary of Change Plan created Operations Manager Operations Manager Update a?er contract signing, as required Attachment A: Resource Management and Staf?ng Plan RFP #0175-Al 158 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Heatthcare Financing and Maximus Health Services. Inc. Page 166 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Table of Contents Section Page Revision History 158 1. Introduction to the Plan 160 1.1 Purpose 160 1.2 Organization of the Plan 160 2. Responsibility and Authority 161 3. Staf?ng Strategy and Structure 162 3.1 Staf?ng Levels by Role 162 3.2 Offsite Resources 164 3.3 Screening Tools and Processes 164 3.4 Process for Replacing Key Staff 164 3.5 Staff Roles and Responsibilities 164 3.6 Subcontractor Staff 166 3.7 Hiring Process 166 3.8 Staff Retention 168 4. Organization Chart 170 5. Monitoring and Updating the Staf?ng Plan 171 5.1 Changes to CSC Personnel 171 Attachment A: Resource Management and Staf?ng Plan RFP #0175-Al 159 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 167 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 1. Introduction to the Plan MAXIMUS provides detailed plans outlining how we ful?ll CSC contractual requirements as directed by the State and de?nes our Staf?ng Plan for the project with this document. 1.1 Purpose The purpose of the Staf?ng Plan is to describe how MAXIMUS complies with the Wyoming Department of Health, Division of Healthcare Financing (Agency) requirements for providing an organization and staf?ng structure for the CSC. It also outlines steps taken by MAXIMUS to ensure state and federal compliance in all employment decisions. 1.2 Organization of the Plan Our CSC Resource Management and Staf?ng Plan outlines the processes for achieving consistent staf?ng levels and dependable service regardless of changes that may influence work volume. This plan encompasses a broad range of services and is designed to meet CSC staf?ng needs over the life of the contract. The key elements of the plan describe how MAXIMUS will: I Meet contractual responsibilities via an appropriate staf?ng and organizational structure. I Create an approach to ensure that all staff hired have, and subsequently maintain, the required competencies to perform the essential functions of each job. I Ensure that required background checks and appropriate due diligence are performed for all staff, prior to starting work for MAXIMUS or a partner agency, including con?rmation of employability under Wyoming contract standards and our company policy. I Ensure that required CSC standards are met. The CSC shall employ the appropriate number of eligibility support and customer service staff necessary to provide eligibility determinations and other services for Wyoming Medicaid and CHIP bene?ciaries? performing and carrying out the functions, requirements, roles, and duties required by the Agency including data entry, registration, research, case assignment, eligibility screening, eligibility determination, case maintenance, reviews, quality assurance, and reporting. We will also generate reports and administer surveys to track performance and uphold project transparency. I De?ne applicable laws and regulations. Attachment A: Resource Management and Staf?ng Plan RF 160 P23001.0060 - March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 168 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 2. Responsibility and Authority Primary responsibility for the administration of the Resource Management and Staf?ng Plan lies with the project?s Operations Manager. The Operations Manager ensures that the plan is implemented and improvement measures are carried out where appropriate. The Operations Manager reports to the CSC Account Manager who has overall responsibility for the performance of the project. To ensure Agency input, the Operations Manager will update this Staf?ng Plan with any recommended modi?cations on an annual basis at a minimum and more frequently as service volumes and staf?ng needs change, subject to approval by CSC project management. This updated plan will be submitted to the Agency for approval. MAXIMUS will staff the CSC to comply with all requirements set forth in the contract and as de?ned in this Resource Management and Staf?ng Plan. Attachment A: Resource Management and Staf?ng Plan RFP #0175-Al 16l P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 169 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 3. Staf?ng Strategy and Structure RFP Section 7.1.1.103, page 51, Appendix A. 5145. page 48. SOW Appendix A 5145 The MAXIMUS Resource Management and Staf?ng Plan enables us to achieve performance standards and maintain the level of high quality service we provide to CSC consumers. A key component of our integrated staff planning process is that all functional areas take ownership to provide operational inputs, such as work patterns and program changes. Support tools and resources including production planning, business process simulation modeling, and statistical methods are combined with experience and judgment to maintain CSC staf?ng levels appropriate to contractual service level requirements. 3.1 Staf?ng Levels by Role RFP Section 7.1.1.10.8.1. page 51. SOW Appendix A, 5146 Wyoming will receive excellent service, regardless of work volume. While we believe that our solution will enable us to handle call and application volumes as projected in the RFP, we recognize that there will be times where volume will spike. We identify and use accepted operational standards to provide a suf?cient number of staff quali?ed to ful?ll the scope of work. Our staf?ng model, supported by our experience and technology, enables us to meet performance metrics even in the event of unexpected spikes in workload. Exhibit shows our project staf?ng levels by staff disciplines, by month, for the four-year base contract. Project Staf?ng Lu by Staff Disciplines Jan Feb \lar Apr Ma} Jun Jul \ug ()ct Mn Dec CSC Account Manager 1 Consulting Policy Analyst .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 Operations Manager Training and Manager Reporting Analyst 5 .5 .5 5 iT Specialist .Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor I Customer Service Representative Mailroom Lead Mailroom Specialist 2 CSC Account Manager Consulting Policy Analyst .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 Operations Manager Training and Manager Reporting Analyst .Specialist . . . . . . . . . . . . Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor Customer Service Representative Attachment A: Resource Management and Staf?ng Plan RFP 162 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 170 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Mar June July Aug Sep Project Staf?ng Lm els Sliil'l' Disciplines Mailroom Lead 1 Mailroom Specialist .3 i?h'm CSC Account Manager 1 1 Consulting Policy Analyst .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 Operations Manager Training and Manager 1 1 1 1 1 Reporting Analyst Specialist .Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor 1 Customer Service Representative Mailroom Lead 1 1 1 1 Mailroom Specialist ?i IC 4 CSC Account Manager Consulting Policy Analyst .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 .25 Operations Manager Training and Manager 1 1 1 1 1 Reporting Analyst .5 5 .5 5 IT Specialist .Eligibility Specialist 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 9.3 CSC Supervisor 1 Customer Service Representative Mailroom Lead Mailroom Specialist Exhibit Project Staf?ng Levels by Staff Disciplines. Our sta?'ing levels meet project needs. Our management constantly monitors our detailed operational dashboards to adjust staf?ng based on calls in queue. We review real-time data on call volumes, service levels, and CSR availability to make quick operational changes when needed. If we ?nd that we are experiencing unusually high call volumes and wait times start to increase, the management team will make staf?ng adjustments, including adjusting break times and lunch times, or having Supervisors take calls. We cross-train all staff so everyone can help serve callers when needed. If we know that volume is likely to increase due to a program change or Agency announcement, we will temporarily increase our part-time staff to full-time to handle the increased number of calls. If we expect an increase in call volume for a signi?cant amount of time, such as several months, we will bring in temporary staff and train them to handle the expected call volume. We will also change our IVR and ACD messaging to alert callers to high volumes and redirect them to other channels, such as the WDH and WES websites, for service. Our self-service options in the IVR will help us to manage call volumes as well. Through web chat, customers have an alternative way to contact us; one CSR can handle chats with several customers at once. We will Attachment A: Resource Management and Staf?ng Plan RFP #0175-Al 163 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of vvyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services, Inc. Page 171 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS also make sure that the IVR has the right FAQs and that our staff educate customers about self-? service options. Should call volume exceed an average of 12,000 calls per month, we will hire additional staff as needed, per contract renegotiation. 3.2 Offsite Resources RFP Section 7.1.1.1032, page 51, sow Appendix A, soar, 5an MAXIMUS intends to have most CSC staff work from our Cheyenne location, including the CSRs, mailroom staff, and eligibility specialists. Staff allocated to the CSC at less than full time, such as the Consulting Policy Analyst and IT Specialist, may work from our regional headquarters in Denver, Colorado, just a 90-minute drive from Cheyenne; those team members will be on site in Cheyenne as needed throughout the contract. Most of our corporate IT infrastructure sta?' already work in our Denver facility, which will be bene?cial in keeping all CSC systems operational. For specialized operational services, we will use our shared services of?ce in Denver. We will also use this location as our business continuity facility, in case of disruption due to ?ood, ?re, tornado, major power outage, and other natural disasters. Centrally located at 4500 Cherry Creek South Drive in Glendale, this of?ce is just a few miles from our downtown Denver headquarters. 3.3 Screening Tools and Processes RFP Section 7.1.1 .10.8.3. page 51 MAXIMUS has developed and validated "success pro?les" for front-line positions based on our call center experience. We use these pro?les to rigorously screen all candidates and select only the highest quality personnel with the demonstrated skills and behavioral competencies necessary to perform this important work. For instance, we look for CSR candidates who have successfully serviced customers, preferably in person. We ?nd it is easier to teach phone skills to those individuals than to teach a service mentality to a call center worker, and it is a better We conduct screening interviews to measure aptitude skills. If appropriate, we test candidates to ensure they have the skills we want. As appropriate, we check references from each candidate and conduct background checks. 3.4 Process for Replacing Key Staff RFP Section 7.1.1.10.8.4, page 51 Once the Agency approves key personnel, MAXIMUS will not divert or replace those personnel without its approval. MAXIMUS will notify the WDH Contract Manager of a proposed replacement at least 30 days in advance and provide the name, quali?cations, and background check of the replacement, making the candidate available for interview. We will give the Agency at least two days' notice in unexpected termination circumstances. We will not leave a key personnel position vacant for more than 60 days. MAXIMUS always seeks to promote from within, grooming our staff for advancement and continuously working our succession plan to avoid vacancies in key positions. 3.5 Staff Roles and Responsibilities RFP Section 7.1.1.1035, page 51, sow Appendix A, 5147. 5148,5149 MAXIMUS staff ?il?ll clearly de?ned roles with speci?c responsibilities in the operation of the CSC, as shown in Exhibit 3. 5-1 . Attachment A: Resource Management and Staf?ng Plan RFP - 164 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 172 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center Rule Primary Responsibilities CSC Account Manager Operations Manager Training and Manager IT Specialist Reporting Analyst Consulting Policy Analyst Attachment A: Resource Management and Staffing Plan Guides entire project throughout the contract term Serves as the primary point of contact to maintain communication with the Agency for activities related to contract administration I Attends regular client meetings and reviews on CSC operational goals and achievements I Establishes operational objectives and work plans, and delegates assignments to subordinate managers Implements strategic policies when selecting methods, techniques, and evaluation criteria for obtaining results Oversees all customer service functions and staff on a daily basis Ensures compliance with all contractual operational requirements Provides technical assistance to staff regarding programs, policies, and procedures Ensures adequate sta?ing levels and staff training to meet contractual requirements Develops goals and objectives, and monitors achievement Works with and Training Managers to develop and implement quality control, quality assurance, and corrective action plans Conducts case audits and reviews reports to identify areas for improvement I Ensures CSC staff are trained in positive customer relations and handling of customer requests I Coordinates development and delivery of training programs and materials through collaboration with the CSC Account Manager, management, and other program stakeholders Ensures Operations staff has up-to-date knowledge of project processes and procedures by contributing to the Knowledge Management System Designs, delivers, tracks, and reports on training and coaching activities Coordinates project QA efforts Monitors CSRs for quality purposes Produces and updates staff resource materials including KMS, policy and procedure manual, training manual, quick reference guide, matrices, charts, and work?ows Designs, produces, and disseminates reports Provides IT operations and desktop support to CSC Leads 1T Engineering Implementation for CSC Facilitates IT design network delivery to meet business objectives Provides design documentation as it re?ects implementation and troubleshooting guidelines for operation support Provides reporting and database development support to the Operations Manager and other team members Manages the reporting program that gathers and analyzes operational data from CSC systems I Designs databases, spreadsheets, and reports as requested Provides contractually required project status reports to management Consults with the CSC Account Manager to review and analyze new and proposed federal and State policies and regulations to provide guidance and recommendations on the potential impact to the Agency and to the CSC Researches, analyzes, and reports on trends in Medicaid, CHIP, Health Care Reform and other government sponsored health care initiatives. Remains current on health care initiatives and proposals Analyzes impacts of initiatives on client service offerings and CSC operations Develops, documents, and formulates impact analysis and makes recommendations for appropriate program responses to initiatives .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 173 of 185 Wyoming Department of Health, Division of Healthcare Financing Wyoming Department of Health Customer Service Center MAXIMUS Job Role Primnr) Responsibilities CSC Supervisor I Works directly with the CSRs, managing day-to-day operations and mentoring staff to ensure adherence to quality and timeliness SLAs I Provides supervision, development, and coaching of CSRs to assure productivity, quality, attendance, and timeliness of work in the completion of assigned projects and departmental goals I Logs into CSR queues as required during high contact volumes Customer I Responds to client inquiries accurately, consistently, and professionally Service I Helps callers and in-person clients complete applications Representative I Documents activity in WES (CSR) I Escalates issues as needed for prompt resolution Mailroom Lead I Receives, sorts, and logs incoming mail for the CSC I Performs data entry of imaged documents into WES and meets quality standards I Distributes internal mail and documents to the appropriate staff Maintains security and control over mailroom equipment Mailroom I Receives, sorts, and logs incoming mail Specialist I Performs data entry of imaged documents into WES and meets quality standards Reviews correspondence for accuracy and completeness Exhibit 3.5-1: MAXIMUS Staff Roles and Responsibilities. By having each sta?" member understand his or her role, we help all members of the team appreciate how they contribute to a well-?mctioning project. We will notify the Agency in advance of any planned key personnel changes or reassignment. Within the boundaries of our control, we will not remove personnel whose names and resumes are submitted in the proposal without Agency approval. If one of our key personnel resigns or is terminated, we will immediately notify the Agency of the vacancy, the reason for the vacancy, and an action plan for back?lling the position until a replacement is found and approved. 3.6 Subcontractor Staff RFP Section 7.11.10.13.15, page 51 MAXIMUS will not be using subcontractors in this project. 3.7 Hiring Process RFP Section 7.1.1.109, page 51,sow Appendix A, 5151, 5152 MAXIMUS recruitment methods identifyjob candidates most likely to represent a good ?t for our customer service centers and application support operations, combined with thorough new- hire and refresher training to support high-quality customer service. Exhibit 3. 7-1 shows the steps we take to identify and hire talented individuals for programs such as the CSC. Attachment A: Resource Management and Staffing Plan RF 166 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 174 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Step I: - identify the recruitment need based on contractual requirements and performance and quality goals . Advertise job positions internally and externally in the intemet. one-stops. and local cu [j community-based organizations sir are 5 - Target advertising for special skills such as bilingual capabilities - Develop job description for all positions rl~ . Develop speci?c quali?cation levels for each position Dr: at: in . Comider prior ork experience. mold-lingual requirements, and education . Human Resources Recruitment Team reviens and screens all resumes - Develop specific screening criteria for each sta?? position with preference given to those ith prior relevant experience - Reject resumes that do not meet minimum screening criteria . Send a rejection letter to each candidate whose resume does not meet initial screening criteria Step 4: Rccervc and Screen Resumes Sir-[15: PIC- - Schedule interviews with appropriate candidates - Applicants complete pie-employment application packets - . I - Conduct screening to measure candidate aptitude skills - Conduct ?nal interviews itlt Human Resources and appropriate department rnamger - Rate candidates using skills interviewing criteria - Require inten ieners to provide rating and hiring recommendation - Complete fatal hiring reconunendation form that includes potential start date and salar) . Prognun Manager approves hiring decision Step (I: l?inzrl lnten rev. Process . Ask all candidates recommended for employ ment to provide supen isor_\ references from their last three employers 5? It 7: - Human Resources Recruitment Team is responsible for coordinating reference checking. Develop a reference checklist so that certain critical questions are asked - All candidates sign a release alien ing a criminal histon reference check - Conduct criminal history and reference checks. :1 critical activ it); particularly on programs where staff work direct!) ith the general public - Positions are not offered to candidates com icted of a felon} int olv irrg illegal gain or use of government funds. grants. contracts, or Medicaid or Medicare monies; or convicted of embezzlement. n'ire fraud. mail fraud. or securities iolation Reference ilismn - Offer letters sent to ?nal candidates on completion of reference checks and criminal histor) checks - Offer loner includes candidate?s title.job description. starting salary. report date. reporting location. turd training schedule - Offer letter includes basic information concerning the benefits package - All candidates are asked to sign and r?etum the offer letter as acceptance of the terms and conditions presented Step 8: Sentl Candidate Otter letters Sq: In Exhibit MAXIMUS Recruitment Process. Our de?ned process helps us ?nd the right sta?? for the CSC. Attachment A: Resource Management and Staf?ng Plan RF 167 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 175 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS When implementing our Kansas Child Support Call Center in 2015, we faced competition from nearby call centers for good CSRs. In response, we shifted our recruitment focus from call center workers to customer service workers. By hiring staff who have successfully served customers face-to-face in industries such as retail, food service, or hospitality, we found CSRs who already had excellent customer service skills. We found it is far easier to teach staff with strong customer service skills how to work in a call center than it is to teach call center workers to provide excellent customer service. As a corporate practice, upon completion of our interview process and testing, we conduct national criminal history background checks on each successful applicant prior to allowing the individual to begin work. Any individual who will have on-site or remote access to the program will be subject to a background check. We will not give any staff member a security badge or card-key access unless they successfully pass the background check, and will notify the Agency of any background checks for potential employees when ?ndings are uncovered. We invest in our staff to develop their skills and abilities. Before staff can perform project tasks, they must undergo training. Our comprehensive, innovative training strategy is performance- based: that is, our strategy focuses not only on knowledge acquisition, but also on the application of that knowledge in a speci?c business context. Perfonnance-based training focuses on speci?c outcomes, and then sets expectations, provides feedback, introduces tools and skill development, and teaches new skills and knowledge all aimed at supporting behavior that produces the desired outcome. It is designed, delivered, and continually improved to support our staff as they perform the services needed by the Agency. 3.8 Staff Retention RFP Section 7.1.1 .10.10. page 51 A well-designed hiring strategy for the CSC is only as effective as the policies that are in place to retain employees. The MAXIMUS hiring philosophy focuses not only on attracting and hiring quali?ed personnel, but also on keeping them with us throughout the life of the project as a means of preserving valuable ?rst?hand knowledge and experience. To retain our highly trained staff, our supervisors and managers strive to create an environment in which excellence is the norm, quality is the focus, and partnership?both internally and with external stakeholders?is the standard. Understanding the importance of staff retention, we maintain initiatives aimed at increasing retention, such as training supervisors and managers on behavioral interviewing techniques. For example, we have worked to increase our rate of successful hires via interview training, staf?ng agency partner job previews, supervisory training, and competency and corresponding career path development for all job families. We also compensate staff using a salary structure that rewards performance and acquired skill sets, and is competitive in the marketplace. Retention is a critical business concern, because attrition results in turnover costs and satisfaction is greater when customers are working with an experienced CSR. Morale is higher in a stable work environment. We implement a multi-pronged approach to create a positive work environment, which minimizes staff turnover. This approach includes opportunities for advancement, continuous training, performance incentives, competitive compensation, personal and group recognition, a pleasant work environment, options for both open door and formal grievance processes, and activities to encourage team bonding and a community atmosphere. Attachment A: Resource Management and Staf?ng Plan RF 168 P23001.006O March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 176 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS Employees have multiple opportunities for personal and professional growth with MAXIMUS. We offer continuous training through our Center for Employee Development, employees have opportunities to rotate to new positions and compete for promotions, and management staff may attend meetings and seminars in their ?eld of interest. MAXIMUS also offers educational assistance to employees seeking degrees in higher education. We use a variety of tactics to help retain highly quali?ed project staff: I Instituting behavioral interviewing techniques to identify individuals with the skills and temperament to provide the kind of quality customer service our clients expect Enhancing skills screening to identify stronger for promotion among line staff Ensuring overall staf?ng levels prevent staff bum-out ?'om excessive work loads Con?rming salaries are aligned with industry standards Awarding employee incentives and performance bonuses Developing competency-based position descriptions that match the requirements of the position and using them as tools during the interviewing process Establishing a leadership development program and a strong career path for staff I Promoting employee success by: - Clearly stating the job expectations and responsibilities throughout the recruitment and hiring process - Furnishing all necessary knowledge and tools - Employing recognition and reward programs De?ning career pathways through competencies and ladders I Creating a respectful and productive work environment by: Providing regular communication on policy or procedure updates Using team-building activities to increase trust between employees and project leadership Offering opportunities for professional growth MAXIMU values the knowledge and experience of the current CSC staff and intends to retain all incumbent staff who are interested in staying with the project, subject to the Agency's approval. The people who staff the current CSC are friends and neighbors of the people they are helping through the CSC, and we want to maintain that sense of community, which can truly be felt in a state such as Wyoming, as we implement proven new solutions to support customers in a way that delivers cost containment to the State. Attachment A: Resource Management and Staf?ng Plan RFP 169 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 177 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 4. Organization Chart Our organization chart for the CSC is shown in Exhibit 4-1. The State should bear in mind that this organization chart re?ects staf?ng for day one of the new contract period. The organization chart is in line with Agency requirements and provides a dedicated management team with speci?c Medicaid, CHIP, and Wyoming program experience. Our CSC leadership team includes highly quali?ed Wyoming staff with experience supporting the State's programs at all levels. Shared Services tt'r til (?M'I'Jlittlh Operational Human L'L'hlltiitig} Support apitnl Support \rrnunt l?uiir) \illit'dli Etna: O?n and Qt ?Miami il?if Rut-put It?: a It . II l-ill o?n I tutti \upt?Hiwn Ill' Key Staff 0-11 (?storm-t Hailnmm \pt't'mlixtx lil'l 2 usttilurt lit'r Exhibit Organization Chart. Attachment A: Resource Management and Staf?ng Plan RFP 170 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Heaithcare Financing and Maximus Health Services, Inc. Page 178 of 185 Wyoming Department of Health, Division of Healthcare Financing - Wyoming Department of Health Customer Service Center MAXIMUS 5. Monitoring and Updating the Staf?ng Plan A review of the Staf?ng Plan is conducted on an annual basis, or more frequently as needed or required. The review is designed to ensure our plan remains current and continues to address the needs of the Agency as well as CSC business requirements and promotes continuous improvement. MAXIMUS continually evaluates the plan's effectiveness and, based on the results, makes recommendations for modi?cations where necessary. 5.1 Changes to CSC Personnel MAXIMUS keeps our organizational chart current and will do so throughout the life of our contract with the State. We will provide an updated version of our organization chart to the Agency within three business days of any staf?ng changes and upon your request at any time. MAXIMUS will report staff departures to the designated Agency contact in advance of the scheduled separation and within one business day of the last date the employee is physically present on-site. Additionally, we will report staff role changes within three business days. MAXMUS will notify the State at least 30 days in advance of and obtain prior written approval for any plans to change, hire, or re-assign Key Personnel. Attachment A: Resource Management and Staf?ng Plan RFP 171 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Morning, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 179 of 185 ATTACHMENT B: RESUMES :3 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, Inc. Page 180 of 185 Jeremy Morgan Customer Service Center (CSC) Account Manager UA Ll FICAT 8 EXPERIENCE IS )cars ul'mpcricncc AmeriHealth Caritas Iowa, Director, Provider Network Opera- m" t. 2015 . cuamg on \icdicuul ovem er resell idct' I for contact center operations, and provider training ices operations . . 9 watts ni'upcricncc 2h MAXIMUS, PrOJect Director, Iowa Medicaid Enterprise 1,,in mum?. m- 1mm Member Servrces Provrder Servrces, DHS Contact Center l)l I (June 2007 November 2015): MttInglL?Ll or Ito \ml'l? I Responsible for all IME Member and Provider Services and . . . . ?man .u or DHS. Contact Center operations, cl1ent relationship, and 1mm ?Humid initialh 6 meeting all ?nancral and Performance goals and operated MAXIMUS, Project Director (February 2009 November [Iii-i1" . Ce 1 C1 2015): and Plan. and I Oversaw receiving and processing of Iowa hawk-i CHIP Elm Il?dmilinn In \lcdicnid applications and ensuring that contractual obligations were met ACS Federal Healthcare, Provider Services Manager Proposal Team (December 2006 June 2007): I Wrote proposals, designed staf?ng and training solutions, and worked with a team to create and implement innovations GeoLearning, Project Manager (October 2006 November 2006): I Implemented e-leaming solutions for clients PSI, Education and Outreach Supervisor, Iowa Medicaid Enterprise Provider Services (March 2005 September 2006): I Supervised and led a team of ?ve Outreach Coordinators, and developed and presented training materials to staff and clients ACS State Healthcare, Field Representative Unit Lead, Provider Relations (January 2001 February 2005): I Advised Iowa Medicaid providers about billing policies and assisted with operations EDUCATION REFERENCES B.A., Advertising, Iowa State University Dennis Janssen Unit Manager for the State of Iowa (Retired) 515.238.8500 DJanssenOI@q.com Andria Seip Unit Manager for the State of Iowa 773.960.1722 asp@dhs.state.ia.us Attachment B: Resumes RFP #0175-Al I72 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 181 of 185 Muna Pirrin Operations Manager UALI Fl (TATIONS EXPERIENCE Strong lltliiletill MAXIMUS, Operations Manager (2015 Present): 5 I Ensures all protects comply w1th contract requirements, state and and federal regulations, and corporate policies slxillx I Responsible for meeting all Service Level Agreements or . It ff . . production. L llit ll_\ con- . an mom a trammg trol. and MAXIMUS, Eligibility Manager (2014 2015): lis?lnti'?lmml I?I'ilimmrpl'lol'lti/ingz. um time Oversaw knowledge transfer of eligibility policies and proce- cumming, dures to staff; supervised performance of eligibility staff it mi humiln I Coordinated closely with Call Center to ensure accurate and . timely task creation and completion . I . mg. and um? I Ensured all serv1ces were compliant With federal, state, HIPAA, Hm_lw,lum, and other regulations I Monitored legislation affecting medical assistance programs Walmart, Assistant Manager (2011 2014): I Responsible for overseeing store operations and 375 staff I Managed customer contact service delivery Utah Group Incorporated, Operations Manager (2004 2011): I Organized team to return company?s misappropriated assets following a national change in leadership I Launched an international public relations campaign to increase awareness of events in the business sector Walmart, Assistant Manager (2002 2004): I Provided leadership for start-up of retail store that grew to $75 million in annual revenue Georgian Tobacco Manufacturing, General Manager (1999 - 2002): I Grew start-up facility from the ground up, resulting in annual sales of $72 million I Created positions and hired, trained, and managed 360 staff EDUCATION REFERENCES 3.8., Business Management, Brigham Young Tamara Paul-Reeff University 303.217.7175 Steven J. Law StevenJLaw@maximus.com 303.217.4211 Attachment B: Resumes RFP #0175?Al 173 P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing and Maximus Health Services, inc. Page 182 of 185 Brendon M. Scharf Repm?"g Ana?yS? QUALIFICATIONS EXPERIENCE 0 \pcrl skills. MAXIMUS, Senior Analyst RPM and Analytics (January 2012 m?m' .- ililLi il resen hislor} ol' dcliwrinp Kill? I Oversight of an Warehousing effort supporting MI- ?int-Jul business crostrategy Analytics Modules to newfexisting projects ??Gathered requrrements and documentation regarding end-to- 11:11:qu end validation and release for improvements to Process Models ?(hum I Performed advanced data interrogation and analysis to identify uml oi breakdowns in business process and source systems I Performed Operation Research to identify and improve busi? ness process ef?ciencies Senior Financial Analyst: I Oversaw the ?nancial health of 32 projects in the Specialty Programs business line I Developed budgeting and forecasting strategies and worked with project management to im- plement process improvements Financial Analyst: I Prepared ?nancial budgets, forecasting, and reporting I Maintained financial contract document management controls for client activity Noteworthy Industries, Purchasing Manager, Cost Accounting and Cost Control Manage- ment (January 2011 January 2012): I Led initiative to limiting costs while maintaining production quality and evaluated key cost drivers in the manufacturing process I Analyzed process inef?ciencies using intelligence tools and determining correction CGI Federal, Contract Specialist (January 2009 January 2011):Maintained a portfolio of 80 properties, completing contract renewals and rent adjustments EDUCATION REFERENCES B.S., Finance, Siena College, Loudonville, Allen Neufeild New York Vice President of Sales, Hill Markes 1997 St. Hwy. SS, Amsterdam, NY 12010 518.469.2285 Jeanne J. Grosso 139 Erie Blvd, Schenectady, NY 12305 518.370.8086 Attachment B: Resumes RFP #0175-Al 174 .0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health, Division of Healthcare Financing and Maximus Health Services. Inc. Page 183 of 185 a Ruff Consulting Policy Analyst QUALIFICATIONS EXPERIENCE MAXIMUS, Inc., Multiple prior positions ranging from Pro- ject Manager to Division President (1997 Present): Currently provides health policy analysis and new health mar- ket assessment for the MAXIMUS Domestic Health Group Previously led the health service's business development efforts including health care reform, Medicaid and State Children's Health Insurance, Long Term Care Services and Supports, and Health Insurance Exchange solutions Has made countless presentations to state clients and stake- holder conferences on health care reform, including the devel- opment of health reform articles, issue briefs and white papers Previously provided oversight to 11 project operations in the central United States focused on assisting Medicaid and CHIP consumers Michigan Department of Community Health, Chief, Division of Policy and Planning (1991 1997) Michigan Department of Public Health, Deputy Chief, Center for Health Promotion and Disease Prevention Administration (1977 1991) EDUCATION M.P.A., Public Administration, Western Michigan University A.B., University of Michigan REFERENCES 517.214.7027 517.482.9236 Attachment B: Resumes P23001.0060 March 25, 2016 and Maximus Health Services, Inc. Page 184 of 185 Priestc 1 @michi gan. gov 3t) )t'ars ol?e\perience in gmernment health pohc}. planning. and lion e\perience combining itII Inanaoenicnt ol'largzc and mediunMI/etl opera- tions In heallhcare l?rmen capabilit} in health \cn ices nppurtunil} tic- \elopnIcIIt: health serx ices operations: and Medicaid managed care: long term care sen ices and supports: health liter- ate}: maternal and child health programs: strategic planning1 and program exaluation: and health pol- ic} analyis Chris Priest, Deputy Director for Medical Ser- vices Administration, Michigan Department of Health and Human Services Steve itton, Principal, Health Management As- sociates (former Michigan Medicaid Director) RFP #0175-Al :75 Attachment to the Information Technology (IT) Contract between the State of Wyoming, Department of Health. Division of Healthcare Financing Michelle L. Munoz Mailroom Lead EXPERIENCE Inventory/Shipping and Receiving Technician, Thunder Beast Arms, Cheyenne, Wyoming (October 2015 Present): I Monitor, maintain, and verify inventory accuracy I Manage shipping and receiving ensuring correct deliveries I Ensure compliance with the ATP in order to use proper ship- ment requirements of product Of?ce/Mail Assistant, Wyoming Department of Transporta- tion, Cheyenne, Wyoming (April 2013 January 2015): I Inform public of mail services and postal regulations I Prepare and submit detailed summaries and reports of post of- fice activities to designated supervisors I Deliver mail to local government business along speci?ed routes by walking and/or driving, using a combination of satch- els, carts, cars or utility vans I Enter change of address orders and process forwarding address stickers QUALIFICATIONS and encr- grclic cmpio} cc ilh a sol- id histor} in tiicl Slates i?ustdl Sen icc \[otimlcd team leader ilh strong: oiggulii/alional and prioriti/alion ahililics Demonslralcd in troubleshooting. dclail management. and rc- spondingI to changes in abnormal siluations and attic!) I?ro\ ca iCiILiCi'\ilip capabil- ilics in produclion and processing. communica- lions. caslomcr and personal scr?. icc. limo and judgment and decision making Determine manner in which mail is to be sent and prepare it for delivery to mailing facilities I Direct speci?ed departments or units to prepare or ship orders to designated locations Mail Processing Clerk, U.S. Postal Service, Cheyenne, Wyoming (December 2004 Sep- tember 2012): I Organize and supervise activities such as processing of incoming and outgoing priority mail I Train seasonal employees and evaluate their performances I Inform the public of available services and postal laws and regulation I Load and unload mail trucks I Inspect mail machine output for defects and determine ways to prevent defects I Operate computer?controlled keyboards or voice recognition equipment in order to direct items according to established routing schemes EDUCATION REFERENCES Process Technology Certi?cate, OSHA David Messman 10 General Industry Safety Health Wyoming Department of Transportation Compensation, Laramie County Com- 307.777.4407 munity College, Cheyenne, Wyoming Tif?ane Young Wyoming Department of Transportation 307.286.0834 Darell Gregg 307.772.6513 Attachment B: Resumes P23001.0060 March 25, 2016 Attachment to the Information Technology (IT) Contract between the State of Wyoming. Department of Health. Division of Healthcare Financing and Maximus Health Services. Inc. Page 185 of 185 United States Postal Service 176 ATTACHMENT BUSINESS ASSOCIATE AGREEMENT BETWEEN THE WYOMING DEPARTMENT OF HEALTH, DIVISION OF HEALTHCARE AND MAXIMUS HEALTH SERVICES, INC. Purpose. The Parties to this Contract agree that Contractor, Maximus Health Services Inc., is a Business Associate of the Wyoming Department of Health, Division of Healthcare Financing, as de?ned by 45 CFR 160.103; therefore, this attachment is mandatory for purposes of this Contract. This attachment seeks to satisfy the requirements for the privacy and security and transmission of protected health information found in 45 CFR Parts 160, 162, and 164 as well as applicable Wyoming state law. Applicable Wyoming state law may include, but is not limited to, Wyo. Stat. Ann. 35-2-605 et seq., 9-2-125 et seq., and applicable rules and regulations. These statutes, rules, and regulations are collectively referred to as the ?Privacy and Security Rules.? De?nitions. The Parties agree that the de?nitions in 45 CFR Parts 160, 162, and 164 shall apply to the terms used in this attachment. For the purpose of this attachment, Contractor shall be known as the ?Business Associate.? Responsibilities of Business Associate Pursuant to this Attachment. Except as otherwise permitted or required by this attachment, the Business Associate may only create, receive, maintain, or transmit protected health information received from or on behalf of the Agency as necessary to execute the Statement of Work as set forth in the Contract, as required by law, or to carry out the proper management and administration or legal responsibilities of the Business Associate. Further, the Business Associate agrees: A. To not create, receive, maintain, or transmit protected health information in a manner that would violate any provision of the Privacy and Security Rules, or other applicable federal, state, or local law. B. To establish, use, and maintain administrative, physical, and technical safeguards to protect the con?dentiality, integrity, and availability of all protected health information that the Business Associate creates, receives, maintains, or transmits on behalf of the Agency and to prevent any use or disclosure of protected health information as provided by this attachment. C. To comply with Subpart of 45 CFR Part 164 with respect to electronic protected health information. The Business Associate shall provide notice of its designated security of?cer to the Agency within thirty (30) days following execution of this attachment. Attachment Business Associate Agreement Between The Wyoming Department of Health, Division of Healthcare Financing (Agency) And Maximus Health Services, Inc. Page 1 of 6 To limit its use, disclosure, or requests for protected health information to the extent practicable to the minimum necessary to accomplish the intended purpose of such use, disclosure, or request. To secure all protected health information in its possession in accordance with the most current standards established by the Secretary of Health and Human Services under 13402(h)(2) of Public Law 111?5 on the Health and Human Services website. To notify the Agency of any use or disclosure of protected health information not provided for by this attachment, any security incident, or any breach of unsecured protected health information of which the Business Associate becomes aware. i. Such notice shall include the identi?cation of each individual whose protected health information has been, or is reasonably believed to have been subject to such use, disclosure, incident, or breach, a statement indicating whether the protected health information was secured or unsecured, and a description of any security measures used. ii. A disclosure, incident, or breach shall be treated as discovered by the Business Associate as of the ?rst day on which such breach is known to the Business Associate, or, by exercising reasonable diligence, would have been known to the Business Associate. The Business Associate shall be deemed to have knowledge of a disclosure, incident, or breach if the same is known, or, by exercising reasonable diligence, would have been known to any person (other than the person committing the disclosure, incident, or breach) who is an employee, of?cer, or other agent (determined in accordance with the federal common law of agency) of the Business Associate. All reports of breach involving unsecured protected health information by the Business Associate shall also include the most current contact information available for each individual whose protected health information has been, or is reasonably believed to have been accessed, acquired, or disclosed, and any other information required by 45 CFR 164.404 for the noti?cation of individuals. In accordance with 45 CFR and to ensure that any subcontractor that the Business Associate uses to create, receive, maintain, or transmit protected health information on its behalf agrees to the same restrictions, conditions, and requirements that apply to the Business Associate under the terms of this attachment. Attachment Business Associate Agreement Between The Wyoming Department of Health, Division of Healthcare Financing (Agency) And Maximus Health Services, Inc. Page 2 of 6 To conduct electronic transactions covered by 45 CFR Part 162 as a standard transaction as required by 45 CFR Part 162, and ensure that any agents, including subcontractors, also process electronic transactions as required therein. To make all protected health information received from the Agency or otherwise created, maintained, or transmitted on behalf of the Agency available to the Agency as necessary for the Agency to comply with an individual?s request for access to protected health information under 45 CFR 164.524, a public records request under Wyo. Stat. Ann. 16-4-201 through 16-4-205, or any other request that may be required by law. If the Business Associate receives such request for protected health information directly, it shall notify the Agency within three (3) business days following its receipt of such request. Thereafter, the Parties agree to meet to discuss and jointly resolve the request for protected health information. The Parties? failure to reach an agreement regarding any such request prior to the timeframes speci?ed in 45 CFR 164.524 and Wyo. Stat. Ann. 16-4-201 through 16-4-205 shall be cause to terminate this Contract and all other contracts between the Parties. To make any amendments to protected health information in a designated record set held by the Business Associate or by any subcontractor or agent pursuant to 45 CFR 164.526. Should the Business Associate receive such request directly, it shall notify the Agency prior to providing any response to the person requesting amendment. Thereafter, the Parties agree to meet to discuss and jointly resolve the request for amendment to the protected health information. The Parties? failure to reach an agreement regarding any amendment prior to the timeframes speci?ed in 45 CFR 164.526 shall be cause to terminate this Contract and all other contracts between the Parties. To make internal practices, books and records relating to the use and disclosure of protected health information received from or created or received by the Business Associate on behalf of the Agency available to the Agency or to the Secretary of Health and Human Services for purposes of determining the Agency?s or Business Associate?s compliance with the Privacy and Security Rules. The Business Associate shall notify the Agency if it provides such information to the Secretary. To document such disclosures of protected health information and information related to such disclosures as would be required for the Agency to respond to a request by an individual for an accounting of disclosures under 45 CFR 164.528. The Business Associate shall comply with the Agency?s request for such information within seven (7) business days following the Agency?s request. Should the Business Associate receive such request directly, it will notify the Attachment Business Associate Agreement Between The Wyoming Department of Health, Division of Healthcare Financing (Agency) And Maxirnus Health Services, Inc. Page 3 of 6 0. Agency. Thereafter, the Parties agree to meet to discuss and jointly resolve the request for an accounting of disclosures. The Parties? failure to reach an agreement regarding any accounting of disclosures prior to the timeframes speci?ed in 45 CFR 164.528 shall be cause to terminate this Contract and all other contracts between the Parties. Unless otherwise provided, to provide notice within seven (7) business days of any event that triggers the Business Associate?s obligation to notify the Agency. That Business Associate may be subject to civil and criminal penalties enumerated at sections 1176 and 1177 of the Social Security Act (42 U.S.C. 1320d-5, 1320?6) with respect to violations of this attachment or the Privacy and Security Rules. To assume sole responsibility for its own compliance and the compliance of its workforce with the provisions of this section. Responsibilities of Agency Pursuant to this Attachment. The Agency shall inform the Business Associate of the Agency?s notice of privacy practices and restrictions on protected health information. The ?rst such notice and restrictions shall be given to the Business Associate no later than the date of the last signature to the Contract. In addition, the Agency agrees to the following: A. To provide the Business Associate with the notice of privacy practices the Agency produces in accordance with 45 CFR 164.520, as well as any changes to such notice. To provide the Business Associate with any changes in, or revocation of, permission by an individual to use or disclose protected health information, if such changes affect the Business Associate?s permitted or required uses and disclosures. To notify the Business Associate of any restriction to the use or disclosure of protected health information to which the Agency has agreed and which are applicable to the Business Associate, in accordance with 45 CFR 164.522 and section l3405(a) of Public Law 111?5. To not request that the Business Associate use or disclose protected health information in any manner that would not be permissible under the Privacy and Security Rules if done by the Agency. To timely notify the Business Associate of any material violation of this attachment or material Privacy or Security violation by the Business Associate of which the Agency becomes aware. The Agency shall specify a time for the Attachment Business Associate Agreement Between The Wyoming Department of Health, Division of Healthcare Financing (Agency) And Maxirnus Health Services, Inc. Page 4 of 6 Business Associate, within which the Business Associate must cure the violation, if cure is possible, or within which the Business Associate must end the violation. Special Business Associate Provisions A. Amendments. If the Contract must be amended to ensure compliance with the Privacy and Security Rules, the Parties shall meet in good faith to agree upon such amendments. If the Parties cannot agree upon such amendments, then either party may terminate the Contract upon thirty (30) days? prior written notice to the other party. Interpretation. Any ambiguity in this attachment shall be resolved in favor of a meaning that permits the Parties to comply with the Privacy and Security Rules. Nothing in the Contract shall be construed to allow or require either Party to violate such rules. Notices. In addition to the notice provisions set forth in the Contract, notices arising out of or from the provisions of this attachment shall be in writing and shall be deemed provided to each respective party if by personal delivery or by, at least, ?rst class United States mail, postage prepaid. Written notices to the Agency shall be provided to the attention of the Agency?s designated representative for this Contract and, by separate mailing, to the WDH Compliance Of?ce, 401 Hathaway Building, Cheyenne, Wyoming 82002. Termination. In addition to the termination provisions in the General Provisions section of this Contract, the Contract may be terminated for cause if the Business Associate materially violates the terms of this attachment. i. Material Violation of Attachment. Any violation by the Business Associate of any provision of this attachment or any other contract with the Agency which involves the use or disclosure of protected health information, as determined by the Agency, shall constitute a material violation and shall entitle the Agency to terminate this Contract immediately, seek related remedies, and to terminate all other contracts which involve the Business Associate in the use or disclosure of protected health information, by notifying the Business Associate of such termination. ii. Cure. If the Agency receives evidence of a material violation of the obligations set forth herein, or of the Business Associate?s primary contracts with the Agency, and the Agency does not terminate this Contract pursuant to subsection above, then the Agency may provide an opportunity to cure or end such violation, as applicable, within a reasonable timeframe speci?ed by the Agency. If the Business Associate?s efforts to cure or end such violation are unsuccessful within the time speci?ed, the Agency may terminate this Contract, where feasible, or if termination is not feasible, may report the Business Associate?s violation to the Secretary of Health and Human Services or his designee. Attachment Business Associate Agreement Between The Wyoming Department of Health, Division of Healthcare Financing (Agency) And Maximus Health Services, Inc. Page 5 of 6 Effect of Termination. Upon termination of this Contract for any reason, the Business Associate shall return or destroy all protected health information, regardless of form so that the Business Associate retains no copies of protected health information received or created on behalf of the Agency. If return or destruction of all protected health information is not feasible, the Business Associate shall notify the Agency of the conditions that make return or destruction infeasible. Upon agreement between the parties that the return or destruction of the protected health information is infeasible, the Business Associate shall extend the protections of this attachment to such information, and further limit the use and disclosure of such information only to those purposes that make its return or destruction infeasible, for so long as the Business Associate maintains the information. iv. This provision applies equally to the Business Associate and any of its agents or subcontractors in possession or control of protected health information subject to this attachment. REMAINDER OF PAGE INTENTIONALLY LEFT BLANK Attachment Business Associate Agreement Between The Wyoming Department of Health, Division of Healthcare Financing (Agency) And Maximus Health Services, Inc. Page 6 of 6