Common use of BENEFICIARY SERVICES Clause in Contracts

BENEFICIARY SERVICES. ‌ 2.9.1. Beneficiary Service Representatives (BSRs) 2.9.1.1. The ICDS Plan must employ BSRs trained to answer Beneficiary inquiries and concerns from Beneficiaries and prospective Beneficiaries, consistent with the requirements of 42 C.F.R. §§ 422.111(h) and 423.128(d) as well as the following requirements: 2.9.1.1.1. Be trained to answer inquiries and concerns from Beneficiaries and prospective Beneficiaries; 2.9.1.1.2. Be trained in the use of TTY, Video Relay services, remote interpreting services, how to provide accessible PDF materials, and other alternative formats; 2.9.1.1.3. Be capable of speaking directly with, or arranging for an interpreter to speak with, Beneficiaries in their primary language, including American Sign Language (ASL), or through an alternative language device or telephone translation service; 2.9.1.1.4. Inform callers that interpreter services are available and are free. 2.9.1.1.5. Be knowledgeable about Ohio Medicaid, Medicare, and the terms of the Contract, including the Covered Services listed in Appendix A; 2.9.1.1.6. Be able to respond to requests for information from beneficiaries regarding how to request a service, or the status of an existing Prior Authorization request/Coverage Determination request. 2.9.1.1.7. Be available to Beneficiaries to discuss and provide assistance with resolving Beneficiary Grievances and Appeals; 2.9.1.1.8. Have access to the ICDS Plan’s Beneficiary database and an electronic Provider directory; 2.9.1.1.9. Make oral interpretation services available free-of-charge to Beneficiaries in all non-English languages spoken by Beneficiaries, including ASL; 2.9.1.1.10. Maintain the availability of services, such as TTY services, computer-aided transcription services, telephone handset amplifiers, assistive listening systems, closed caption decoders, videotext displays and qualified interpreters and other services for deaf and hard of hearing Beneficiaries; 2.9.1.1.11. Demonstrate sensitivity to culture, including disability culture and the independent living philosophy; 2.9.1.1.12. Provide assistance to Beneficiaries with cognitive impairments; for example, provide written materials in simple, clear language, and individualized guidance from BSRs to ensure materials are understood; 2.9.1.1.13. Provide reasonable accommodations needed to assure effective communication and provide Beneficiaries with a means to identify their disability to the ICDS Plan; 2.9.1.1.14. Maintain employment standards and requirements (e.g., education, training, and experience) for Beneficiary services department staff and provide a sufficient number of staff to meet defined performance objectives; and 2.9.1.1.15. Ensure that BSRs make available to Beneficiaries and prospective Beneficiaries, upon request, information concerning the following: 2.9.1.1.15.1. The identity, locations, qualifications, and availability of Providers; 2.9.1.1.15.2. Beneficiaries’ rights and responsibilities; 2.9.1.1.15.3. The procedures available to a Beneficiary and Provider(s) to Appeal any Adverse Actions (denial, suspension, reduction or terminations of authorized services); 2.9.1.1.15.4. How to access oral interpretation services and written materials in Prevalent Languages and alternative formats; 2.9.1.1.15.5. Information on all Covered Services and other available services or resources whether any service may be obtained directly or through referral or Prior Authorization; 2.9.1.1.15.6. The procedures for a Beneficiary to change plans or to Opt Out of the Demonstration; and 2.9.1.1.15.7. Additional information that may be required by Beneficiaries and Potential Beneficiaries to understand the requirements and benefits of the ICDS Plan.

BENEFICIARY SERVICES. ‌ 2.9.1. Beneficiary Service Representatives (BSRs) 2.9.1.1. The ICDS Plan must employ BSRs trained to answer Beneficiary inquiries and concerns from Beneficiaries and prospective Beneficiaries, consistent with the requirements of 42 C.F.R. §§ 422.111(h) and 423.128(d) as well as the following requirements: 2.9.1.1.1. Be trained to answer inquiries and concerns from Beneficiaries and prospective Beneficiaries; 2.9.1.1.2. Be trained in the use of TTY, Video Relay services, remote interpreting services, how to provide accessible PDF materials, and other alternative formats; 2.9.1.1.3. Be capable of speaking directly with, or arranging for an interpreter to speak with, Beneficiaries in their primary language, including American Sign Language (ASL), or through an alternative language device or telephone translation service; 2.9.1.1.4. Inform callers that interpreter services are available and are free. 2.9.1.1.5. Be knowledgeable about Ohio Medicaid, Medicare, and the terms of the Contract, including the Covered Services listed in Appendix A; 2.9.1.1.6. Be able to respond to requests for information from beneficiaries regarding how to request a service, or the status of an existing Prior Authorization request/Coverage Determination request. 2.9.1.1.7. Be available to Beneficiaries to discuss and provide assistance with resolving Beneficiary Grievances and Appeals; 2.9.1.1.8. Have access to the ICDS Plan’s Beneficiary database and an electronic Provider directory; 2.9.1.1.9. Make oral interpretation services available free-of-charge to Beneficiaries in all non-English languages spoken by Beneficiaries, including ASL; 2.9.1.1.10. Maintain the availability of services, such as TTY services, computer-aided transcription services, telephone handset amplifiers, assistive listening systems, closed caption decoders, videotext displays and qualified interpreters and other services for deaf and hard of hearing Beneficiaries; 2.9.1.1.11. Demonstrate sensitivity to culture, including disability culture and the independent living philosophy; 2.9.1.1.12. Provide assistance to Beneficiaries with cognitive impairments; for example, provide written materials in simple, clear language, and individualized guidance from BSRs to ensure materials are understood; 2.9.1.1.13. Provide reasonable accommodations needed to assure effective communication and provide Beneficiaries with a means to identify their disability to the ICDS Plan; 2.9.1.1.14. Maintain employment standards and requirements (e.g., education, training, and experience) for Beneficiary services department staff and provide a sufficient number of staff to meet defined performance objectives; and 2.9.1.1.15. Ensure that BSRs make available to Beneficiaries and prospective Beneficiaries, upon request, information concerning the following: 2.9.1.1.15.1. The identity, locations, qualifications, and availability of Providers; 2.9.1.1.15.2. Beneficiaries’ rights and responsibilities; 2.9.1.1.15.3. The procedures available to a Beneficiary and Provider(s) to Appeal any Adverse Actions (denial, suspension, reduction or terminations of authorized services); 2.9.1.1.15.4. How to access oral interpretation services and written materials in Prevalent Languages and alternative formats; 2.9.1.1.15.5. Information on all Covered Services and other available services or resources whether any service may be obtained directly or through referral or Prior Authorization; 2.9.1.1.15.6. The procedures for a Beneficiary to change plans or to Opt Out of the Demonstration; and 2.9.1.1.15.7. Additional information that may be required by Beneficiaries and Potential Beneficiaries to understand the requirements and benefits of the ICDS Plan.

BENEFICIARY SERVICES. ‌ 2.9.1. Beneficiary Service Representatives (BSRs) 2.9.1.1. The ICDS Plan must employ BSRs trained to answer Beneficiary inquiries and concerns from Beneficiaries and prospective Beneficiaries, consistent with the requirements of 42 C.F.R. §§ 422.111(h) and 423.128(d) as well as the following requirements: 2.9.1.1.1. Be trained to answer inquiries and concerns from Beneficiaries and prospective Beneficiaries; 2.9.1.1.2. Be trained in the use of TTY, Video Relay services, remote interpreting services, how to provide accessible PDF materials, and other alternative formatsAlternative Formats; 2.9.1.1.3. Be capable of speaking directly with, or arranging for an interpreter to speak with, Beneficiaries in their primary language, including American Sign Language (ASL), or through an alternative language device or telephone translation service; 2.9.1.1.4. Inform callers that interpreter services are available and are free. 2.9.1.1.5. Be knowledgeable about Ohio Medicaid, Medicare, and the terms of the Contract, including the Covered Services listed in Appendix A; 2.9.1.1.6. Be able to respond to requests for information from beneficiaries regarding how to request a service, or the status of an existing Prior Authorization request/Coverage Determination request. 2.9.1.1.7. Be available to Beneficiaries to discuss and provide assistance with resolving Beneficiary Grievances and Appeals; 2.9.1.1.8. Have access to the ICDS Plan’s Beneficiary database and an electronic Provider directory; 2.9.1.1.9. Make oral interpretation services available free-of-charge to Beneficiaries in all non-English languages spoken by Beneficiaries, including ASL; 2.9.1.1.10. Maintain the availability of services, such as TTY services, computer-aided transcription services, telephone handset amplifiers, assistive listening systems, closed caption decoders, videotext displays and qualified interpreters and other services for deaf and hard of hearing Beneficiaries; 2.9.1.1.11. Demonstrate sensitivity to culture, including disability culture and the independent living philosophy; 2.9.1.1.12. Provide assistance to Beneficiaries with cognitive impairments; for example, provide written materials in simple, clear language, and individualized guidance from BSRs to ensure materials are understood; 2.9.1.1.13. Provide reasonable accommodations needed to assure effective communication and provide Beneficiaries with a means to identify their disability to the ICDS Plan; 2.9.1.1.14. Maintain employment standards and requirements (e.g., education, training, and experience) for Beneficiary services department staff and provide a sufficient number of staff to meet defined performance objectives; and 2.9.1.1.15. Ensure that BSRs make available to Beneficiaries and prospective Beneficiaries, upon request, information concerning the following: 2.9.1.1.15.1. The identity, locations, qualifications, and availability of Providers; 2.9.1.1.15.2. Beneficiaries’ rights and responsibilities; 2.9.1.1.15.3. The procedures available to a Beneficiary and Provider(s) to Appeal any Adverse Actions Benefit Determinations (denial, suspension, reduction or terminations of authorized services); 2.9.1.1.15.4. How to access oral interpretation services and written materials in Prevalent Languages and alternative formatsAlternative Formats; 2.9.1.1.15.5. Information on all Covered Services and other available services or resources whether any service may be obtained directly or through referral or Prior Authorization; 2.9.1.1.15.6. The procedures for a Beneficiary to change plans or to Opt Out of the Demonstration; and 2.9.1.1.15.7. Additional information that may be required by Beneficiaries and Potential Beneficiaries to understand the requirements and benefits of the ICDS Plan.

BENEFICIARY SERVICES. ‌ 2.9.1. Beneficiary Service Representatives (BSRs) 2.9.1.1. The ICDS Plan must employ BSRs trained to answer Beneficiary inquiries and concerns from Beneficiaries and prospective Beneficiaries, consistent with the requirements of 42 C.F.R. §§ 422.111(h) and 423.128(d) as well as the following requirements: 2.9.1.1.1. Be trained to answer inquiries and concerns from Beneficiaries and prospective Beneficiaries; 2.9.1.1.2. Be trained in the use of TTY, Video Relay services, remote interpreting services, how to provide accessible PDF materials, and other alternative formatsAlternative Formats; 2.9.1.1.3. Be capable of speaking directly with, or arranging for an interpreter to speak with, Beneficiaries in their primary language, including American Sign Language (ASL), or through an alternative language device or telephone translation service; 2.9.1.1.4. Inform callers that interpreter services are available and are free. 2.9.1.1.5. Be knowledgeable about Ohio Medicaid, Medicare, and the terms of the Contract, including the Covered Services listed in Appendix A; 2.9.1.1.6. Be able to respond to requests for information from beneficiaries regarding how to request a service, or the status of an existing Prior Authorization request/Coverage Determination request. 2.9.1.1.7. Be available to Beneficiaries to discuss and provide assistance with resolving Beneficiary Grievances and Appeals; 2.9.1.1.8. Have access to the ICDS Plan’s Beneficiary database and an electronic Provider directory; 2.9.1.1.9. Make oral interpretation services available free-of-charge to Beneficiaries in all non-English languages spoken by Beneficiaries, including ASL; 2.9.1.1.10. Maintain the availability of services, such as TTY services, computer-aided transcription services, telephone handset amplifiers, assistive listening systems, closed caption decoders, videotext displays and qualified interpreters and other services for deaf and hard of hearing Beneficiaries; 2.9.1.1.11. Demonstrate sensitivity to culture, including disability culture and the independent living philosophy; 2.9.1.1.12. Provide assistance to Beneficiaries with cognitive impairments; for example, provide written materials in simple, clear language, and individualized guidance from BSRs to ensure materials are understood; 2.9.1.1.13. Provide reasonable accommodations needed to assure effective communication and provide Beneficiaries with a means to identify their disability to the ICDS Plan; 2.9.1.1.14. Maintain employment standards and requirements (e.g., education, training, and experience) for Beneficiary services department staff and provide a sufficient number of staff to meet defined performance objectives; and 2.9.1.1.15. Ensure that BSRs make available to Beneficiaries and prospective Beneficiaries, upon request, information concerning the following: 2.9.1.1.15.1. The identity, locations, qualifications, and availability of Providers; 2.9.1.1.15.2. Beneficiaries’ rights and responsibilities; 2.9.1.1.15.3. The procedures available to a Beneficiary and Provider(s) to Appeal any Adverse Actions Benefit Determinations (denial, suspension, reduction or terminations of authorized services); 2.9.1.1.15.4. How to access oral interpretation services and written materials in Prevalent Languages and alternative formatsAlternative Formats; 2.9.1.1.15.5. Information on all Covered Services and other available services or resources whether any service may be obtained directly or through referral or Prior Authorization; 2.9.1.1.15.6. The procedures for a Beneficiary to change plans or to Opt Out of the Demonstration; and 2.9.1.1.15.7. Additional information that may be required by Beneficiaries and Potential Beneficiaries to understand the requirements and benefits of the ICDS Plan.