Common use of Right Choices Program Level of Service Clause in Contracts

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  Enroll members in the RCP;  Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitals;  Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  Provide appropriate customer service to providers and members;  Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in on the Bidder’s LibraryState “Manuals” page (xxxxx://xxx.xx.xxx/medicaid/partners/medicaid- partners/managed-care-health-plans/mce-secure-landing-page/mce-manuals/). The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  ▪ Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration. FSSA shall monitor the Contractor’s compliance with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual through its monthly onsite visits and/or external quality review activities. The Contractor may be subject to the non-compliance remedies as set forth in Exhibit 2 if the Contractor fails to comply with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual. FSSA OMPP reserves the right to review pharmacy and emergency room utilization figures for the Contractor’s RCP membership, including the number of RCP members who have had more than one emergency room visit in a thirty (30)-calendar day period, in assessing the effectiveness of the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in on the Bidder’s LibraryState “Manuals” page (xxxxx://xxx.xx.xxx/medicaid/partners/medicaid-partners/managed-care- health-plans/mce-secure-landing-page/mce-manuals/). The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.;

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.and

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  Enroll members in the RCP;  Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitals;  Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  Provide appropriate customer service to providers and members; members;\  Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the t he Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in on the Bidder’s LibraryState “Manuals” page (xxxxx://xxx.xx.xxx/medicaid/partners/medicaid-partners/managed-care- health-plans/mce-secure-landing-page/mce-manuals/). The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.;

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation Investigat ion for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.and

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  ▪ Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration. FSSA shall monitor the Contractor’s compliance with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual through its monthly onsite visits and/or external quality review activities. The Contractor may be subject to the non- compliance remedies as set forth in Exhibit 2 if the Contractor fails to comply with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual. FSSA OMPP reserves the right to review pharmacy and emergency room utilization figures for the Contractor’s RCP membership, including the number of RCP members who have had more than one emergency room visit in a thirty (30)-calendar day period, in assessing the effectiveness of the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  ▪ Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration. FSSA shall monitor the Contractor’s compliance with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual through its monthly onsite visits and/or external quality review activities. The Contractor may be subject to the non- compliance remedies as set forth in Exhibit 2 if the Contractor fails to comply with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual. FSSA OMPP reserves the right to review pharmacy and emergency room utilization figures for the Contractor’s RCP membership, including the number of RCP members who have had more than one emergency room visit in a thirty (30)-calendar day period, in assessing the effectiveness of the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively extensi vely than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  ▪ Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration. FSSA shall monitor the Contractor’s compliance with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual through its monthly onsite visits and/or external quality review activities. The Contractor may be subject to the non-compliance remedies as set forth in Exhibit 2 if the Contractor fails to EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE comply with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual. FSSA OMPP reserves the right to review pharmacy and emergency room utilization figures for the Contractor’s RCP membership, including the number of RCP members who have had more than one emergency room visit in a thirty (30)-calendar day period, in assessing the effectiveness of the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  Enroll members in the RCP; EXHIBIT 1.M SCOPE OF WORK  Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitals;  Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  Provide appropriate customer service to providers and members;  Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  • Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  • Enroll members in the RCP;  • Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  • Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  • Provide appropriate customer service to providers and members;  • Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  • Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  • Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.;

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  ▪ Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration. FSSA shall monitor the Contractor’s compliance with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual through its monthly onsite visits and/or external quality review activities. The Contractor may be subject to the non-compliance remedies as set forth in Exhibit 2 if the Contractor fails to comply with the RCP dut ies set EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE forth in this Scope of Work and the Right Choices Program Policy Manual. FSSA OMPP reserves the right to review pharmacy and emergency room utilization figures for the Contractor’s RCP membership, including the number of RCP members who have had more than one emergency room visit in a thirty (30)-calendar day period, in assessing the effectiveness of the Contractor’s RCP program administration.

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  ▪ Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  ▪ Document member enrollment and compliance in Portal; ▪ Enroll members in the RCP;  ▪ Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  ▪ Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  ▪ Provide appropriate customer service to providers and members;  ▪ Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  ▪ Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  ▪ Provide ad-hoc reports about RCP to FSSA upon request;  ▪ Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  ▪ Meet with FSSA about RCP program implementation as requested by FSSA; and  ▪ Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.. FSSA shall monitor the Contractor’s compliance with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual through its monthly onsite visits and/or external quality review activities. The Contractor may be subject to the non- compliance remedies as set forth in Exhibit 2 if the Contractor fails to comply with the RCP duties set forth in this Scope of Work and the Right Choices Program Policy Manual. FSSA OMPP reserves the right to review pharmacy and emergency room utilization figures for the Contractor’s RCP membership, including the number of RCP members who have had more than one emergency room visit in a thirty (30)-calendar day period, in assessing the effectiveness of the Contractor’s RCP program administration. EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peerspeers and/or exhibit drug-seeking behaviors. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The RCP follows the CMS design of a Patient Review and Restrict (PRR) program that is focused on behaviors of Doctor Shopping and excessive utilization of Controlled Substances, especially Opioids. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Bidders’ Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  • Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  • Enroll members in the RCP;  • Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitalsphysicians and pharmacies;  • Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  • Provide appropriate customer service to providers and members;  • Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  Provide ad-hoc reports about RCP to FSSA upon request;  Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  Meet with FSSA about RCP program implementation as requested by FSSA; and  Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.;

Right Choices Program Level of Service. The Right Choices Program (RCP) is Indiana's restricted card program. The purpose of the RCP is to identify members who use covered services more extensively than their peers. The program, set forth in 405 IAC 1-1-2(c) and 405 IAC 5-6, is designed to monitor member utilization, and when appropriate, implement restrictions for those members who would benefit from increased care coordination. The Contractor will provide appropriate disease management, care management or complex case management services to the RCP members. Program policies, set forth by the FSSA for the RCP, are delineated in the Right Choices Program Policy Manual. The Contractor shall comply with the program policies set forth in the Right Choices Program Policy Manual, which is provided in the Bidder’s Library. The Contractor shall be responsible for RCP duties for their members, as outlined in the Right Choices Program Policy Manual, including, but not limited to, the following:  • Evaluate claims, medical information, referrals and data to identify members to be enrolled in the RCP. Before enrolling a member in the RCP, the Contractor must ensure a physician, pharmacist or nurse confirms the appropriateness of the enrollment;  • Enroll members in the RCP;  • Provide written notification of RCP status to such members and their assigned primary physicians, pharmacies and/or hospitals;  • Intervene in the care provided to RCP members by providing, at minimum, enhanced education, case management and care coordination with the goal of modifying member behavior;  • Provide appropriate customer service to providers and members;  members;\ • Evaluate and monitor the member's compliance with his or her treatment plan to determine if the RCP restrictions should terminate or continue;  • Notify FSSA of members that are being reported to the FSSA Bureau of Investigation for suspected or alleged fraudulent activities;  • Provide ad-hoc reports about RCP to FSSA upon request;  • Cooperate with FSSA in evaluation activities of the program by providing data and/or feedback when requested by FSSA;  • Meet with FSSA about RCP program implementation as requested by FSSA; and  • Develop, for FSSA approval, and implement internal policies and procedures regarding the Contractor’s RCP program administration.