Common use of CHC-MCO Internal Participant Dedicated Hotline Clause in Contracts

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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

CHC-MCO Internal Participant Dedicated Hotline. The CHC-MCO must maintain and staff a twenty-four (24) hour-per-day, seven (7) day-pera-week dedicated toll-free telephone dedicated hotline to respond to Participants’ inquiries, issues and problems regarding services. The CHC- CHC-MCO’s internal Participant hotline staff must ask the callers whether or not 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 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 monitor calls from Participants or their representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. The CHC-MCO is not permitted to utilize electronic call answering methods 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 phone 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populations. – The availability of contact information for, and the functions of, of the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

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 or not 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populations. – The availability of contact information for, and the functions of, the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, Participants or their representatives, representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

CHC-MCO Internal Participant Dedicated Hotline. The CHC-MCO must maintain and staff a twenty-four (24) hour-per-day, seven (7) day-pera-week dedicated toll-free telephone dedicated hotline to respond to Participants’ inquiries, issues and problems regarding services. The CHC- CHC-MCO’s internal Participant hotline staff must ask the callers whether or not 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 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 monitor calls from Participants or their representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. The CHC-MCO is not permitted to utilize electronic call answering methods 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 phone 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populations. – The availability of contact information for, and the functions of, of the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

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 or not 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 callthecall. 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populationscoveredpopulations. – The availability of contact information for, and the functions of, the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, Participants or their representatives, representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

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 or not 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 monitor calls from Participants, Participants or their representatives, representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All of the criteria above also applies apply to the Service Coordination functionality of the Participant Hotline.

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 or not 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 monitor calls from Participants, Participants or their representatives, representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All of the criteria above also applies apply to the Service Coordination functionality of the Participant Hotline.

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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies apply to the Service Coordination functionality of the Participant Hotline.

CHC-MCO Internal Participant Dedicated Hotline. The CHC-MCO must maintain and staff a twenty-four (24) hour-per-day, seven (7) day-pera-week dedicated toll-free telephone dedicated hotline to respond to Participants’ inquiries, issues and problems regarding services. The CHC- CHC-MCO’s internal Participant hotline staff must ask the callers whether or not 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 thecall. The CHC-MCO must provide the callDepartment 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 monitor calls from Participants or their representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. The CHC-MCO is not permitted to utilize electronic call answering methods methods, as a substitute for staff persons. The CHC-MCO must have a dedicated hotline that meets the following performance standardsperformancestandards: • Provides for a dedicated toll-free telephone phone 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populations. – The availability of contact information for, and the functions of, of the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

CHC-MCO Internal Participant Dedicated Hotline. ‌ The CHC-MCO must maintain and staff a twenty-four (24) hour-per-day, seven (7) day-pera-week dedicated toll-free telephone dedicated hotline to respond to Participants’ inquiries, issues and problems regarding services. The CHC- CHC-MCO’s internal Participant hotline staff must is required to ask the callers whether or not they are satisfied with the response given to their call. The CHC-MCO must document all calls. If calls and 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 and/or resolution. This referral must take place 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. call.‌ 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 monitor calls from Participants, Participants or their representatives, representatives and will cease all monitoring activity as soon as it becomes apparent that the call is not related to a Participant.‌ The CHC-MCO is not permitted to utilize electronic call answering methods, as a substitute for staff persons, to perform this service. The CHC-MCO must ensure that its dedicated hotline meets the following Participant services performance standards:‌  Provides for a dedicated toll-free phone line for its Participants.‌  Provide for necessary translation and interpreter assistance for LEP Participants.‌  Require representatives to document calls and forward call notes to the Participant’s Service Coordinator.‌  Be staffed by individuals trained in:‌ – Cultural, Linguistic, and Disability Competency. All criteria above also applies to – addressing the needs of covered populations. – the availability of, contact information for, and the functions of the Service Coordination functionality Unit. – the requirements for accessibility. – coordination with BH-MCOs. – how to identify and handle any emergency. – when to transfer callers to the nurse hotline. – Covered Services, the availability of protective and social services within the community. Medicare coverage and to address questions that relate 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 of less than or equal to five percent (5%) of the Participant Hotline.total calls.‌  Be staffed with adequate service representatives so that at least 85% of all calls are answered within thirty (30) seconds.‌  Provide for TTY and/or Pennsylvania Telecommunication Relay Service availability for Participants who are deaf or hard of hearing.‌

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 or not 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 callthecall. 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populations. – The availability of contact information for, and the functions of, the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, Participants or their representatives, representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.

CHC-MCO Internal Participant Dedicated Hotline. The CHC-MCO must maintain and staff a twenty-four (24) hour-per-day, seven (7) day-pera-week dedicated toll-free telephone dedicated hotline to respond to Participants’ inquiries, issues and problems regarding services. The CHC- CHC-MCO’s internal Participant hotline staff must ask the callers whether or not 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 thecall. The CHC-MCO must provide the callDepartment 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 monitor calls from Participants or their representatives and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. The CHC-MCO is not permitted to utilize electronic call answering methods methods, as a substitute for staff persons. The CHC-MCO must have a dedicated hotline that meets the following performance standardsperformancestandards: •  Provides for a dedicated toll-free telephone phone 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 callsin: – Cultural, Linguistic, and Disability Competency. – Addressing the needs of covered populationscoveredpopulations. – The availability of contact information for, and the functions of, of the Service CoordinatorCoordination. – 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 TTY 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 monitor calls from Participants, or their representatives, and will cease monitoring activity as soon as it becomes apparent that the call is not related to a Participant. All criteria above also applies to the Service Coordination functionality of the Participant Hotline.