Enrollee Information. 249 16.2 Providers Documentation. 250
Enrollee Information. The Contractor shall provide Enrollee Information to Enrollees and, upon request, to Members, including all the items detailed in Section 2.5.C. The Contractor shall make available written translations of Enrollee Information in Prevalent Languages and inform Enrollees how to obtain translated Enrollee Information or how to obtain an oral translation in a language other than a Prevalent Language. The Contractor shall make available Enrollee Information in Alternative Formats and inform Enrollees how to obtain such Enrollee Information. The Contractor shall provide Enrollee Information as follows:
1. Mail a printed copy of the information to the Enrollee’s mailing address;
2. Provide the information by email after obtaining the Enrollee’s agreement to receive information by email;
3. Post the information on the Contractor’s website and advise the Enrollees in paper or electronic form that the information is available on the Internet and include the applicable Internet address, provided that Enrollees with disabilities who cannot access this information online are provided free auxiliary aids and services; or
4. Provide the information by any other method that can reasonably be expected to result in the Enrollee receiving that information.
Enrollee Information. The MCO shall present to all new Enrollees the following information within fifteen (15) calendar days of availability of readable enrollment data from the STATE:
(A) Certificate of Coverage (COC). A Certificate of Coverage (COC) that has received prior approval by the STATE and CMS, and that includes the following:
(1) A statement that Enrollees are accountable to make efforts to maintain their health and inform health care Providers of changes in their health.
(2) A description of the MCO’s medical and remedial care program, including specific information on benefits, limitations and exclusions;
(3) A description of the MCO’s policies related to access to Case Management or Care Management services from the MCO;
(4) An explanation of the MCO’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT), known in Minnesota and hereinafter as the Child and Teen Checkups (C&TC) program;
(5) A description of Enrollee appeal rights for denial of prescription drug coverage;
(6) A description of the Enrollee’s rights and protections as specified in 42 CFR § 438.100;
(7) Cost sharing, if applicable;
(8) Notification of the open access of Family Planning Services and services prescribed by Minnesota Statutes, § 62Q.14;
(9) Information about providing coverage for prescriptions that are dispensed as written (DAW);
(10) A statement informing Enrollees that the MCO shall provide language assistance to Enrollees that ensures meaningful access to its programs and services;
(11) A description of how American Indian Enrollees may directly access Indian Health Service and certain tribal Providers and how such Enrollees shall obtain referral services. In prior approving this portion of the COC, the STATE shall consult with tribal governments;
(12) A description of how Enrollees may access services to which they are entitled under Medical Assistance, as described in Article 6, but are not provided under this Contract;
(13) A description of Medical Necessity for mental health services listed in Minnesota Statutes, § 62Q.53;
(14) A description of how transportation is provided;
(15) A description of how the Enrollee may obtain services, including: 1) hours of service; 2) appointment procedures; 3) Service Authorization requirements and procedures; 4) what constitutes Medical Emergency and Post Stabilization care; 5) the process and procedures for obtaining both Medical Emergency and Post Stabilization care, including a 24-hour telephone number for Medical Emergency Service...
Enrollee Information. The Contractor shall provide Enrollee Information to Enrollees and, upon request, to Members, including all the items detailed in Section 2.5.C. The Contractor shall make available written translations of Enrollee Information in Prevalent Languages and inform Enrollees how to obtain translated Enrollee Information or how to obtain an oral translation in a language other than a Prevalent Language. The Contractor shall make available Enrollee Information in Alternative Formats and inform Enrollees how to obtain such Enrollee Information.
Enrollee Information. The MCO must provide all paper and electronic informational materials (using a font size no smaller than twelve (12) point) relating to the Medicaid program in a manner and format consistent with the requirements of 42 CFR § 438.10. The enrollee must be informed that the information is available in paper form without charge upon request and must be provided with the information within five (5) business days. Electronic information must be placed on a website that is prominent and readily accessible. It must be provided in an electronic form which can be electronically retained and printed. Enrollee information provided by the MCO must be readable at the 6th grade level and easily understood, and available in the language(s) of the major population groups served and, as needed, in alternative formats (i.e., Braille) for those who are unable to see or read written materials. The MCO must make auxiliary aids and services, as well as oral interpretation services available in all non-English languages to all enrollees and potential enrollees free of charge. The MCO must notify enrollees that oral interpretation services are available for any language, that written information is available in prevalent languages, and how to access those services. Written materials must include taglines in the prevalent non-English languages and large print (in a font size no smaller than eighteen (18) point) explaining the availability of written translation or oral interpretation and the toll- free and TYY/TDY telephone number of the MCOs. MCOs must make its written material available in the prevalent non-English languages in its service area, as identified by BMS in accordance with Article III, Section 3.7.
Enrollee Information information about the Contractor for Enrollees that includes, but is not limited to, a Provider directory that meets the requirements of Section 2.5.E, and an Enrollee handbook that meets the requirements of Section 2.10.B.7, and an identification card.
Enrollee Information. The MCO must provide all paper and electronic informational materials relating to the Medicaid program in a manner and format consistent with the requirements of 42 CFR § 438.10. Enrollee information provided by the MCO must be readable at the 6th grade level and easily understood, and available in the language(s) of the major population groups served and, as needed, in alternative formats (i.e., Braille) for those who are unable to see or read written materials. The MCO must make oral interpretation services available in all non-English languages to all enrollees and potential enrollees free of charge. The MCO must notify enrollees that oral interpretation services are available for any language, that written information is available in prevalent languages, and how to access those services.
Enrollee Information. HPS shall not supply information regarding any Enrollee to any Party that is not affiliated with HPS or Provident, except as may be required by this Agreement or Applicable Law, or as permitted in writing by such Enrollee.
Enrollee Information. 210 16.2 Providers Documentation. 211 16.3 Treatment 211 16.4 Compliance with State Law 211 16.5 Education. 211 Article. 17 Disclosure 211 17.1 Disclosure Requirements 211 General Disclosures 211 Disclosure of Management/Fiscal Agents 212 17.2 Disclosure of, Compliance With, and Reporting of Physician Incentive Plans. 212 Disclosure to the STATE 212 Disclosure to Enrollees 213 Article. 18 Emergency Performance Interruption (EPI) 213 18.1 Business Continuity Plan. 213 18.2 EPI Occurrence. 214 Article. 19 Miscellaneous 216 19.1 Modifications 216 19.2 Entire Agreement 216 19.3 Assignment 216 19.4 Liability 216 19.5 Waiver 216 19.6 Severability 216 19.7 Execution in Counterparts 216 Article. 20 Survival 216 THIS CONTRACT, which shall be interpreted pursuant to the laws of the State of Minnesota, is made and entered into by the State of Minnesota, acting through its Department of Human Services (DHS) (hereinafter STATE), and UCare Minnesota, Managed Care Organization (MCO) (hereinafter MCO).
Enrollee Information. The Agency’s choice counseling vendor will ensure that enrollees are provided with full and complete information about their plan options. The Agency’s choice counseling vendor will provide information regarding an individual’s choice to select a plan. Through the Agency’s choice counseling vendor, the Agency will develop enrollee education materials so individuals will fully understand their choices and will be able to make an informed selection. Outcomes important to enrollees will be measured consistently for each plan, and the data will be made available publicly. Specifically, the Agency’s choice counseling vendor will provide information on selecting a plan. As it does now, the Agency’s designated choice counseling vendor will provide information about each plan’s coverage in accordance with federal requirements. Additional plan information will include, but is not limited to, benefits and benefit limitations, cost-sharing requirements, provider network information, prescription drug formulary information and contact information. In addition, the Agency will supplement coverage information by posting performance information on each plan once such data is available. Information provided will include enrollee satisfaction survey results and performance measure data. Enrollment materials will be provided in a variety of ways including print, telephone, online and face-to-face. All written materials will be at the fourth-grade reading level and available in a language other than English when 5% of the region speaks a language other than English. The Agency’s choice counseling vendor will also provide oral interpretation services, regardless of the language, and other services for impaired recipients, such as TTD/TTY. The choice counseling vendor will operate a toll-free number that individuals may call to ask questions and obtain assistance on plans. The call center will be operational during business days, with extended hours and will be staffed with professionals qualified to address the needs of the enrollees and potential enrollees. Individuals in mandatory groups for the MMA program will receive information (mandatory new eligible packet) about the plan choices in their region and will be informed of their option to select an authorized plan or be assigned to a plan. The choice counseling vendor will: • Send a pre-welcome letter to each recipient 120 days prior to the MMA program “go-live” date by region. The pre-welcome letter will describe the MMA...
