BENEFICIARY/ENROLLEE PROTECTIONS, PARTICIPATION, AND CUSTOMER SERVICE Sample Clauses

BENEFICIARY/ENROLLEE PROTECTIONS, PARTICIPATION, AND CUSTOMER SERVICE. 1. Choice of Plans: Where multiple ICOs serve the same region, beneficiaries may choose the ICO that provides the higher quality service and best meets their individual needs within the constraint of regional availability. 2. Choice of Providers: Enrollees will have freedom of choice of providers within the ICO networks. ICOs will contract with a diverse group of specialists, hospitals, nursing facilities, and home and community based service providers including personal care aides, and other providers to ensure rights of choice. 3. Self-Determination Arrangements: ICOs will be required to offer enrollees’ arrangements that support self-determination as an option within its LTSS benefit package. This service allows enrollees to choose their own LTSS providers within an established individualized budget managed by the enrollee with support from a fiscal intermediary. 4. Continuity of Care: CMS and MDCH will require ICOs to ensure that enrollees continue to have access to medically necessary items, services, and medical and long-term supports and service providers for the transition period as specified in Appendix 7. In addition, ICOs will advise enrollees and their providers of services that are provided during the transition period that would not otherwise be covered at an in-network level. On an ongoing basis, and as appropriate, ICOs must also contact providers not already members of their network with information on becoming credentialed as in-network providers. Continuity of care may also require continuity of participation in the Demonstration, which in turn depends on uninterrupted eligibility for, and enrollment in, Medicaid, as appropriate. Therefore, ICOs also will be required to promote continuity of care by providing timely assistance to enrollees who need help with paperwork, verification, or other steps to maintain their eligibility for, and enrollment in, Medicaid at annual or interim redeterminations of eligibility. 5. Enrollment Assistance and Options Counseling: As referenced in section C.2 and Appendix 7, MDCH will provide persons eligible for participation in the Demonstration with enrollment assistance and options counseling independent from the ICO to help them make enrollment decisions that best meet the needs of individuals. MDCH will work with Michigan’s Medicare Medicaid Assistance Program (MMAP) and its network, Michigan’s Enrollment Broker, and other local partners to ensure ongoing outreach, education, and support to beneficiari...