Common use of Eastern Standard Time Clause in Contracts

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  New Year’s Day;  Xxxxxx Xxxxxx Xxxx, Xx. Day;  Memorial Day;  Independence Day (July 4th);  Labor Day;  Thanksgiving; and  Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  Access to health care services;  Identification or explanation of covered services;  Special health care needs;  Procedures for submitting a member grievance or appeal;  Potential fraud or abuse;  Changing PMPs, if the Contractor utilizes a PMP model;  Incentive programs;  Disease management, care management and complex case management services;  Health crises, including but not limited to, suicidal callers; and  Balance billing issues. The Contractor shall maintain sufficient equipment and staff to ensure the following:  For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  • New Year’s Day;  • Xxxxxx Xxxxxx Xxxx, Xx. Day;  • Memorial Day;  • Independence Day (July 4th);  • Labor Day;  • Thanksgiving; and  • Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents The Contractor shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the EXHIBIT 1.B. SCOPE OF WORK member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  • Access to health care servicesservices and Hoosier Care Connect benefits;  • Identification or explanation of covered services;  • Special health care needs;  • Procedures for submitting a member grievance or appeal;  • Potential fraud or abuse;  • Changing PMPs, if the Contractor utilizes a PMP model;  • Incentive programs;  • Disease management, care management and complex case management services;  • Health crises, including but not limited to, suicidal callers; and  • Balance billing issues; and • Referrals to local services or community-based organizations for assistance. The Contractor shall maintain sufficient equipment and staff to ensure the following:  • For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  • For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  ▪ New Year’s Day;  ▪ Xxxxxx Xxxxxx Xxxx, Xx. Day;  ▪ Memorial Day;  ▪ Independence Day (July 4th);  ▪ Labor Day;  ▪ Thanksgiving; and  ▪ Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents The Contractor shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  ▪ Access to health care servicesservices and Hoosier Care Connect benefits;  ▪ Identification or explanation of covered services;  ▪ Special health care needs;  ▪ Procedures for submitting a member grievance or appeal;  ▪ Potential fraud or abuse;  ▪ Changing PMPs, if the Contractor utilizes a PMP model;  ▪ Incentive programs;  ▪ Disease management, care management and complex case management services;  ▪ Health crises, including but not limited to, suicidal callers; and  ▪ Balance billing issues; and ▪ Referrals to local services or community-based organizations for assistance. The Contractor shall maintain sufficient equipment and staff to ensure the following:  ▪ For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  ▪ For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  ▪ For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  ▪ If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  ▪ Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  ▪ For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents ▪ The Contractor shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  ▪ A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  ▪ Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency Emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency Emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the t he Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  ▪ New Year’s Day;  ▪ Xxxxxx Xxxxxx Xxxx, Xx. Day;  ▪ Memorial Day;  ▪ Independence Day (July 4th);  ▪ Labor Day;  ▪ Thanksgiving; and  ▪ Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents The Contractor shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  ▪ Access to health care servicesservices and Hoosier Care Connect benefits;  ▪ Identification or explanation of covered services;  Special health care needs;  Procedures for submitting a member grievance or appeal;  Potential fraud or abuse;  Changing PMPs, if the Contractor utilizes a PMP model;  Incentive programs;  Disease management, care management and complex case management services;  Health crises, including but not limited to, suicidal callers; and  Balance billing issues. The Contractor shall maintain sufficient equipment and staff to ensure the following:  For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency departments.;

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  • New Year’s Day;  • Xxxxxx Xxxxxx Xxxx, Xx. Day;  • Memorial Day;  • Independence Day (July 4th);  • Labor Day;  • Thanksgiving; and  • Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents The Contractor shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor EXHIBIT 1 SCOPE OF WORK shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  • Access to health care servicesservices and Hoosier Care Connect benefits;  • Identification or explanation of covered services;  • Special health care needs;  • Procedures for submitting a member grievance or appeal;  • Potential fraud or abuse;  • Changing PMPs, if the Contractor utilizes a PMP model;  • Incentive programs;  • Disease management, care management and complex case management services;  • Health crises, including but not limited to, suicidal callers; and  • Balance billing issues; and • Referrals to local services or community-based organizations for assistance. The Contractor shall maintain sufficient equipment and staff to ensure the following:  • For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  • For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  EXHIBIT 1 SCOPE OF WORK • Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  • For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents The Contractor shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  • A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  • Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency Emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency Emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  New Year’s Day;  Xxxxxx Xxxxxx Xxxx, Xx. Day;  Memorial Day;  Independence Day (July 4th);  Labor Day;  Thanksgiving; and  Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents The Contractor shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor EXHIBIT 1 SCOPE OF WORK shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  Access to health care servicesservices and Hoosier Care Connect benefits;  Identification or explanation of covered services;  Special health care needs;  Procedures for submitting a member grievance or appeal;  Potential fraud or abuse;  Changing PMPs, if the Contractor utilizes a PMP model;  Incentive programs;  Disease management, care management and complex case management services;  Health crises, including but not limited to, suicidal callers; and  Balance billing issues; and  Referrals to local services or community-based organizations for assistance. The Contractor shall maintain sufficient equipment and staff to ensure the following:  For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds. EXHIBIT 1 SCOPE OF WORK  Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents The Contractor shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency Emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency Emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  • New Year’s Day;  • Xxxxxx Xxxxxx Xxxx, Xx. Day;  • Memorial Day;  • Independence Day (July 4th);  • Labor Day;  • Thanksgiving; and  • Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents The Contractor shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a EXHIBIT 1 SCOPE OF WORK Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  • Access to health care servicesservices and Hoosier Care Connect benefits;  • Identification or explanation of covered services;  • Special health care needs;  • Procedures for submitting a member grievance or appeal;  • Potential fraud or abuse;  • Changing PMPs, if the Contractor utilizes a PMP model;  • Incentive programs;  • Disease management, care management and complex case management services;  • Health crises, including but not limited to, suicidal callers; and  • Balance billing issues; and • Referrals to local services or community-based organizations for assistance. The Contractor shall maintain sufficient equipment and staff to ensure the following:  • For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  • For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  EXHIBIT 1 SCOPE OF WORK • Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  • For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents The Contractor shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  • A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  • Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency Emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency Emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  New Year’s Day;  Xxxxxx Xxxxxx Xxxx, Xx. Day;  Memorial Day;  Independence Day (July 4th);  Labor Day;  Thanksgiving; and  Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  Access to health care services;  Identification or explanation of covered services;  Special health care needs;  Procedures for submitting a member grievance or appeal;  Potential fraud or abuse;  Changing PMPs, if the Contractor utilizes a PMP model;  Incentive programs;  Disease management, care management and complex case management services;  Health crises, including but not limited to, suicidal callers; and  Balance billing issues. The Contractor shall maintain sufficient equipment and staff to ensure the following:  For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency departments.

Eastern Standard Time. Beginning one (1) year after the Contract effective date, the Contractor may request FSSA approval to modify the hours of operation of the member services helpline based on call center traffic data. FSSA retains sole discretion for approval or denial of such requests. The Contractor shall provide a voice message system that informs callers of the Contractor’s business hours and offers an opportunity to leave a message after business hours. Calls received in the voice message system shall be returned the following business day. The member services helpline may be closed on the following holidays:  • New Year’s Day;  • Xxxxxx Xxxxxx Xxxx, Xx. Day;  • Memorial Day;  • Independence Day (July 4th);  • Labor Day;  • Thanksgiving; and  • Christmas. For all days with a closure, members must have access to the twenty-four (24) hour nurse call line described below. Call center closures shall not burden a member’s access to care. The Contractor shall provide Telecommunications Device for the Deaf (TDD) services for hearing impaired members. Respondents shall also describe any additional technology to be leveraged to communicate with hearing impaired members. Additionally, the member services helpline must offer language translation services for members whose primary language is not English. Automated telephone menu options must be made available in English and Spanish. The Contractor must have the ability to warm transfer members to outside entities including the Enrollment Broker, DFR and provider offices. Additionally, the Contractor shall ensure the warm transfer of calls for members that require attention from a Contractor care manager. The Contractor shall ensure the care manager has access to all information necessary to resolve the member’s issues. Any messages left with care managers must be returned by the next business day. The Contractor must maintain a system for tracking and reporting the number and type of member calls and inquiries it receives during business and non-business hours. The Contractor must monitor its member services helpline and report its telephone service level performance to FSSA in the timeframes and specifications described in the Hoosier Care Connect Reporting Manual, which shall be provided to Contractor following the Contract award date. The Contractor’s member services helpline staff must be prepared to efficiently respond to member concerns or issues including, but not limited to the following:  • Access to health care services;  • Identification or explanation of covered services;  • Special health care needs;  • Procedures for submitting a member grievance or appeal;  • Potential fraud or abuse;  • Changing PMPs, if the Contractor utilizes a PMP model;  • Incentive programs;  • Disease management, care management and complex case management services;  • Health crises, including but not limited to, suicidal callers; and  • Balance billing issues. The Contractor shall maintain sufficient equipment and staff to ensure the following:  • For any calendar month, at least ninety-seven percent (97%) of all phone calls to the helpline must reach the call center menu within thirty (30) seconds.  • For any calendar month, at least eighty-five percent (85%) of all phone calls to an approved automated helpline must be answered by a helpline representative within thirty (30) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • For any calendar month, at least ninety-five percent (95%) of all phone calls to an approved automated helpline must be answered by a helpline representative within sixty (60) seconds after the call has been routed through the call center menu. Answered means that the call is picked up by a qualified helpline staff person.  • If the Contractor does not maintain an approved automated call distribution system, for any calendar month, at least ninety-five percent (95%) of all phone calls to the helpline must be answered within thirty (30) seconds.  • Hold time does not exceed one (1) minute in any instance, or thirty (30) seconds, on average.  • For any calendar month, the lost call (abandonment rate) associated with the helpline does not exceed five percent (5%). Respondents shall provide a description of the proposed backup solution for phone service in the event of a power failure or outage or other interruption in service. Such plan shall include, at minimum, the following:  • A notification plan that ensures FSSA is notified when the Contractor's phone system is inoperative or a back-up system is being utilized; and  • Manual back-up procedure to allow requests to continue being processed if the system is down. In addition to the member services helpline which is staffed during regular business hours, the Contractor shall operate a toll-free twenty-four (24) hour nurse call line. The Contractor shall provide nurse triage telephone services for members to receive medical advice twenty-four (24) hours-a-day/seven (7)-days-a-week from trained medical professionals. The twenty-four (24) hour nurse call line should be well publicized and designed as a resource to members to help discourage inappropriate emergency room use. The twenty-four (24) hour nurse call line must have a system in place to communicate all issues with the member’s providers. In addition, as set forth in Section 3.3.1, the 24-Hour Nurse Call Line must be equipped to provide advice and copayment waivers for Hoosier Care Connect members seeking services from hospital emergency departments.