CHC-MCO Internal Participant Dedicated Hotline. The CHC-MCO must maintain and staff a twenty-four (24) hour-per-day, seven (7) day-per-week dedicated toll-free telephone hotline to respond to Participants’ inquiries, issues and problems regarding services. The CHC- MCO’s internal Participant hotline staff must ask the callers whether they are satisfied with the response given to their call. The CHC-MCO must document all calls. If the caller is not satisfied, the CHC-MCO must refer the call to the appropriate individual within the CHC-MCO for follow-up and resolution within forty-eight (48) hours of the call. The CHC-MCO is not permitted to utilize electronic call answering methods as a substitute for staff persons. The CHC-MCO must have a dedicated hotline that meets the following performance standards: • Provides for a dedicated toll-free telephone line for Participants. • Provides for necessary translation and interpreter assistance for LEP Participants. • Includes a function specific to connecting Participants with their Service Coordinator. • Requires representatives to document calls and forward call notes to the Participant’s Service Coordinator. • Be staffed by individuals fully trained by the CHC-MCO in the following areas before allowing staff to assist Participants by handling phone calls: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populations. – The availability of contact information for, and the functions of, the Service Coordinator. – Requirements for accessibility. – Coordination with BH-MCOs. – How to identify and handle any emergency. – When to transfer callers to the Nurse Hotline. – Covered Services and the availability of protective and social services within the community. – Medicare coverage and addressing questions relating to the CHC- MCO’s companion D-SNP plan. – Medical and non-medical transportation. • Be staffed with adequate service representatives so that the abandonment rate is less than or equal to five percent (5%) of the total calls. • Be staffed with adequate service representatives so that at least eighty- five percent (85%) of all calls are answered within thirty (30) seconds. • Provide for TTY/Videophone and/or Pennsylvania Telecommunication Relay Service availability for Participants who are deaf or hard of hearing. The CHC-MCO must provide the Department with the capability to monitor the CHC-MCO’s Participant services and internal Participant dedicated hotline from each of the CHC-MCO’s offices. The Department will only m...
