Beneficiary handbook a. The Contractor shall utilize, and require its subcontractor and network providers to utilize, the state developed model beneficiary handbook.
b. The Contractor shall ensure each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a).
c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum:
i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits.
ii. How and where to access any benefits, including EPSDT benefits, provided by the state and how transportation is provided.
iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled.
iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, or network provider.
v. The extent to which, and how, after-hours care is provided.
vi. Any restrictions on the beneficiary’s freedom of choice among network providers.
vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers.
viii. Beneficiary rights and responsibilities, including:
1. The beneficiary’s right to receive beneficiary and plan information.
2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 of this Agreement.
ix. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4)). Such information shall include:
1. The right to file grievances and appeals.
a. The Contractor shall ensure information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, t...
Beneficiary handbook. 1.12.5.1.1 Contractor shall provide each client with a beneficiary handbook at the time the client first accesses services.
1.12.5.1.2 Contractor shall give each client notice of any significant change to the information contained in the beneficiary handbook at least 30 days before the intended effective date of change.
1.12.5.1.3 Required informing materials must be electronically available on the Contractor’s website and must be physically available at the Contractor agency facility lobby for clients’ access.
1.12.5.1.4 Informing materials must be made available upon request, at no cost, in alternate formats (i.e., Braille or Audio) and Auxiliary Aids (i.e., California Relay Service (CRS) 711 and American Sign Language) and must be provided to clients within five business days. Large print materials shall be in a minimum 18-point font size. Contractor shall request materials from the County, as needed.
1.12.5.1.5 Informing materials will be considered provided to the client if Contractor does one or more of the following: 1) Mails a printed copy of the information to the client’s mailing address before the client first receives a SUD service; 2) Mails a printed copy of the information upon the client’s request to the client’s mailing address; 3) Provides the information by email after obtaining the client’s agreement to receive the information by email; 4) Posts the information on the Contractor’s website and advises the client in paper or electronic form that the information is available on the internet and includes applicable internet addresses, provided that clients with disabilities who cannot access this information online are provided auxiliary aids and services upon request and at no cost; or 5) Provides the information by any other method that can reasonably be expected to result in the client receiving that information. If the Contractor provides informing materials in person, when the client first receives SUD services, the date and method of delivery shall be documented in the client’s file.
Beneficiary handbook. 1.12.5.1.1 Contractor shall provide each client with a beneficiary handbook at the time the client first accesses services. The beneficiary handbook shall be provided to beneficiaries within 14 business days after receiving notice of enrollment.
1.12.5.1.2 Contractor shall give each client notice of any significant change to the information contained in the beneficiary handbook at least 30 days before the intended effective date of change as per BHIN 22-060.
1.12.5.1.3 Required informing materials must be electronically available on the Contractor’s website and must be physically available at the Contractor agency facility lobby for clients’ access.
1.12.5.1.4 Informing materials must be made available upon request, at no cost, in alternate formats (i.e., Braille or Audio) and Auxiliary Aids (i.e., California Relay Service (CRS) 711 and American Sign Language) and must be provided to clients within five business days. Large print materials shall be in a minimum 18-point font size. Contractor shall request materials from the County, as needed.
1.12.5.1.5 Informing materials will be considered provided to the client if Contractor does one or more of the following: 1) Mails a printed copy of the information to the client’s mailing address before the client first receives a SUD service; 2) Mails a printed copy of the information upon the client’s request to the client’s mailing address; 3) Provides the information by email after obtaining the client’s agreement to receive the information by email; 4) Posts the information on the Contractor’s website and advises the client in paper or electronic form that the information is available on the internet and includes applicable internet addresses, provided that clients with disabilities who cannot access this information online are provided auxiliary aids and services upon request and at no cost; or 5) Provides the information by any other method that can reasonably be expected to result in the client receiving that information. If the Contractor provides informing materials in person, when the client first receives SUD services, the date and method of delivery shall be documented in the client’s file.
Beneficiary handbook. The Contractor shall submit the handbook to the Department for prior approval initially and as revised. The Contractor shall not be required to submit for prior approval format changes, provided there is no change in the information conveyed.
Beneficiary handbook. The Contractor shall utilize the DBH beneficiary handbook, and shall provide each beneficiary the DBH beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment. The handbook serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). Contractor shall provide the required information in this section to each beneficiary when first required to enroll in the Contractor’s SUD program.
Beneficiary handbook. (i) DVHA must provide each beneficiary with a beneficiary handbook within a reasonable time after receiving notice of the beneficiary’s enrollment.
(1) If there is any significant change in the beneficiary handbook, as defined by AHS, DVHA must provide each beneficiary handbook at least 30 days before the intended effective date of the change.
(2) The beneficiary handbook is considered to be provided if DVHA mails a printed copy of the information to the beneficiary's mailing address; provides the information by email after obtaining the beneficiary's agreement to receive the information by email; posts the information on its website and advises the beneficiary in paper or electronic form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost; or provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. DocuSign Envelope ID: F73EF454-508D-44AC-ABD8-2A528194331A
(ii) The beneficiary handbook must be specific to the Global Commitment to Health Medicaid Demonstration and serve as a summary of benefits and coverage available under the Global Commitment to Health Medicaid Demonstration. It must include information that enables the beneficiary to understand how to effectively utilize the Global Commitment to Health Medicaid Demonstration program. Specifically, the beneficiary handbook must include, at a minimum, information on:
(1) Benefits provided by DVHA, including, but not limited to, the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled;
(2) The amount, duration, and scope of benefits available under the contract in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled;
(3) Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the beneficiary's Primary Care Provider (PCP);
(4) The extent to which, and how, after-hours care is provided;
(5) With respect to emergency care: how emergency care is provided; what constitutes an emergency medical condition; what constitutes an emergency service; the fact that prior auth...
Beneficiary handbook. Contractor shall provide the KernBHRS Beneficiary Handbook to enrollees when first accessing specialty mental health services or substance use disorder services. The Beneficiary Handbook may be made available in hard copy, electronically through the KernBHRS public website, or the provider website.
Beneficiary handbook. Contractor shall provide the County of Santa Xxxxxxx Beneficiary Handbook to each potential beneficiary and beneficiary in an approved method listed in the Department of Behavioral Wellness’ Policy and Procedures #4.008 Beneficiary Information Materials when first receiving Specialty Mental Health Services and upon request. Contractor shall document the date and method of delivery to the beneficiary in the beneficiary’s file. Contractor shall inform beneficiaries that information is available in alternate formats and how to access those formats. (1915(b)
Beneficiary handbook. The Provider shall develop and maintain a Beneficiary Handbook that provides Beneficiaries at a minimum the following:
a. The availability of Dental services;
b. The Provider’s Administrative Information;
1. Office Hours
2. Location of central business office and hours of operation;
3. Phone Number
4. Fax Number
5. E- mail address
6. Internet website address
c. Accessibility Standards;
d. Eligibility Verification;
e. Prior Authorization;
1. Services
2. Policies and Procedures
3. Forms and Documentation
Beneficiary handbook a. The Contractor shall provide beneficiaries with a copy of the handbook and provider directory when the beneficiary first accesses services and thereafter upon request (BHIN 22-060).
b. The Contractor shall ensure that the handbook includes the current toll- free telephone number(s) that provides information in threshold languages and is available twenty-four hours a day, seven days a week (BHIN 22-060).
c. The beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include, at a minimum:
i. Benefits provided by the Contractor. (42 C.F.R. § 438.10(g)(2)(i)).
ii. How and where to access any benefits provided by the Contractor, including any cost sharing, and how transportation is provided. (42 C.F.R. § 438.10(g)(2)(ii)).
1. The amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. (42 C.F.R. § 438.10(g)(2)(iii)).
2. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the beneficiary’s provider. (42 C.F.R. § 438.10(g)(2)(iv)).
3. Any restrictions on the beneficiary’s freedom of choice among network providers. (42 C.F.R. § 438.10(g)(2)(vi)).
4. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. (42 C.F.R. § 438.10(g)(2)(vii)).
5. Cost sharing, if any, consistent with the State Plan. (42 6. C.F.R. § 438.10(g)(2)(viii); State Plan § 4.18).
