Common use of Additional Requirements for Communication with Contractor’s Members Clause in Contracts

Additional Requirements for Communication with Contractor’s Members. The Contractor shall submit all communication materials with its Members to the Division thirty (30) business days prior to the planned distribution and the Division must approve these materials before they are released. Communication activities must comply with all relevant Federal and State laws, including, when applicable, the Health Insurance Portability and Accountability Act, the anti- kickback statute, and civil monetary penalties prohibiting inducements to Members. The Contractor may be subject to sanctions if it offers or gives something of value to a Member that the Contractor knows or should know is likely to influence the Member’s selection of a particular Provider, practitioner, or supplier of any item or service for which payment may be made, in whole or in part, by Medicaid. Additionally, the Contractor is prohibited from offering rebates or other cash inducements of any sort to its Members, without prior written approval from the Division. The Contractor may be subject to liquidated damages, a fine, and/ or sanctions if it conducts any communication activity that is not approved in writing by the Division. 1. Allowable Contractor Communication Activities The Contractor may engage in the following activities with prior Division approval: a. Distribution of communication materials to Members pre-approved by the Division; and b. The Contractor is allowed to offer non-cash incentives to its Members for the purposes of rewarding for compliance in immunizations, prenatal visits, participating in Care Management, or other behaviors as pre-approved by the Division. On a case by case basis, the Division may approve cash-value incentives upon request by the Contractor, and if adequately justified. The Contractor shall analyze Member data to identify gaps in care and areas to improve outcomes. The Contractor must provide to the Division for approval information about the interventions the Contractor will employ to improve upon those gaps, including Member incentives the Contractor will provide to Members, and the expected impact of the incentives, along with a plan to evaluate the impact of those incentives. The Contractor is encouraged to use items that promote good health behavior, e.g., toothbrushes or immunization schedules. This incentive shall not be extended to any individual not yet enrolled in the Contractor. The Contractor must submit all incentive award packages to the Division for written approval at least thirty (30) calendar days prior to planned implementation. 2. Prohibited Communication Activities The following are prohibited communication activities targeting Members under this Contract: a. Engaging in any informational activities which could mislead, confuse, or defraud Contractor’s Members or misrepresent the Division; b. No assertion or statement (whether written or verbal) that the Contractor is endorsed by the Centers for Medicare and Medicaid Services (CMS); Federal or State government; or similar entity.

Additional Requirements for Communication with Contractor’s Members. ‌ The Contractor shall submit all communication materials with its Members to the Division thirty (30) business calendar days prior to the planned distribution and the Division must approve these materials before they are released. Communication activities must comply with all relevant Federal and State laws, including, when applicable, the Health Insurance Portability and Accountability Act, the anti- anti-kickback statute, and civil monetary penalties prohibiting inducements to Members. The Contractor may be subject to sanctions if it offers or gives something of value to a Member that the Contractor knows or should know is likely to influence the Member’s selection of a particular Provider, practitioner, or supplier of any item or service for which payment may be made, in whole or in part, by Medicaid. Additionally, the Contractor is prohibited from offering rebates or other cash inducements of any sort to its Members, without prior written approval from the Division. The Contractor may be subject to liquidated damages, a fine, and/ or and/or sanctions if it conducts any communication activity that is not approved in writing by the Division. 1. Allowable Contractor Communication Activities The Contractor may engage in the following activities with prior Division approval: a. Distribution of communication materials to Members pre-approved by the Division; and b. The Contractor is allowed to offer non-cash incentives to its Members for the purposes of rewarding for compliance in immunizations, prenatal visits, participating in Care Management, or other behaviors as pre-approved by the Division. On a case by case-by-case basis, the Division may approve cash-value incentives upon request by the Contractor, and if adequately justified. The Contractor shall analyze Member data to identify gaps in care and areas to improve outcomes. The Contractor must provide to the Division for approval information about the interventions the Contractor will employ to improve upon those gaps, including Member incentives the Contractor will provide to Members, and the expected impact of the incentives, along with a plan to evaluate the impact of those incentives. The Contractor is encouraged to use items that promote good health behavior, e.g., toothbrushes or immunization schedules. This incentive shall not be extended to any individual not yet enrolled in the Contractor. The Contractor must submit all incentive award packages to the Division for written approval at least thirty (30) calendar days prior to planned implementation. 2. Prohibited Communication Activities The following are prohibited communication activities targeting Members under this Contract: a. Engaging in any informational activities which could mislead, confuse, or defraud Contractor’s Members or misrepresent the Division; b. No assertion or statement (whether written or verbal) that the Contractor is endorsed by the Centers for Medicare and Medicaid Services (CMS); Federal or State government; or similar entity.