Enrollee Information Requirements. The following information requirements must be met: a. The Contractor shall provide all enrollment notices, informational materials, and instructional materials relating to Enrollees or potential Enrollees in a manner and format that may be easily understood. b. The Contractor shall make its written information available in the prevalent non- English languages in the State of Mississippi, in compliance with the Division’s Limited English Proficiency Policy. c. The Contractor shall make oral interpretation services available free of charge to each Enrollee for all non-English languages. d. The Contractor shall notify Enrollees that oral interpretation services and interpretation services for the hearing impaired and vision-impaired are available and how to access those services. At the time the Enrollee is first enrolled in the Plan, the Contractor must provide the following information: a. General information about the basic features of care coordination, which populations are excluded from enrollment and which are subject to mandatory enrollment, and the responsibilities of the Contractor for coordination of Enrollee care. b. Specific information about the CCO and the MississippiCAN Program, including benefits covered, names, locations, telephone numbers of, and the identification of providers in the Plan that are not accepting new patients. c. Benefits that are available through the Contractor, but are not covered under the State Plan, and how and where Enrollees may obtain those benefits and how transportation is provided. d. The Contractor shall notify all Enrollees of their right to request and obtain the information specified in this Contract at least annually. e. The Contractor shall furnish to each of its Enrollees the information specified in this Contract within fourteen (14) days after the Contractor receives notice of the Beneficiary’s enrollment. f. The Contractor shall give each of its Enrollees thirty (30) days’ written notice of any significant change in the information specified in this Contract before its intended effective date. g. The Contractor must give written notice within fifteen (15) days of notice or issuance of termination of a provider to each Enrollee who received primary care from, or was seen on a regular basis by, the terminated provider. h. Any restrictions on the Enrollee’s freedom of choice among network providers. i. Enrollee rights and protections as specified in 42 CFR § 438.100. j. Information on grievance and fair hearing procedures as specified in 42 CFR § 438.10(g)(1). k. The amount, duration, and scope of benefits available under the Plan in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled. l. Procedures for obtaining benefits, including authorization requirements. m. The extent to which, and how, Enrollees may obtain benefits, including family planning services, from out-of-network providers and informs the Enrollees that there are no restrictions on the choice of provider from whom the Enrollee may receive family planning services and supplies. n. The extent to which, and how, after-hours and emergency coverage are provided, including: i. What constitutes an emergency medical condition, emergency services, and post-stabilization services, with reference to the definitions in 42 CFR § 438.114(a); ii. The fact that prior authorization is not required for emergency services; iii. The process and procedures for obtaining emergency services, including use of the 911-telephone system or its local equivalent; iv. The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post- stabilization services covered under the Plan; v. The fact that Enrollees have a right to use any hospital or other setting for emergency care; vi. The post-stabilization care services rules set forth at 42 CFR § 422.113(c);
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Samples: Contract Between the State of Mississippi Division of Medicaid and a Care Coordination Organization (Cco), Contract, Contract
Enrollee Information Requirements. The following information requirements must be met:
a. The Contractor shall provide all enrollment notices, informational materials, and instructional materials relating to Enrollees or potential Enrollees in a manner and format that may be easily understood.
b. The Contractor shall make its written information available in the prevalent non- English languages in the State of Mississippi, in compliance with the Division’s Limited English Proficiency Policy.
c. The Contractor shall make oral interpretation services available free of charge to each Enrollee for all non-English languages.
d. The Contractor shall notify Enrollees that oral interpretation services and interpretation services for the hearing impaired and vision-impaired are available and how to access those services. At the time the Enrollee is first enrolled in the Plan, the Contractor must provide the following information:
a. General information about the basic features of care coordination, which populations are excluded from enrollment and which are subject to mandatory enrollment, and the responsibilities of the Contractor for coordination of Enrollee care.
b. Specific information about the CCO Contractor and the MississippiCAN Program, including benefits covered, names, locations, telephone numbers of, and the identification of providers in the Plan that are not accepting new patients.
c. Benefits that are available through the Contractor, but are not covered under the State Plan, and how and where Enrollees may obtain those benefits and how transportation is provided.
d. The Contractor shall notify all Enrollees of their right to request and obtain the information specified in this Contract at least annually.
e. The Contractor shall furnish to each of its Enrollees the information specified in this Contract within fourteen (14) days after the Contractor receives notice of the Beneficiary’s enrollment.
f. The Contractor shall give each of its Enrollees thirty (30) days’ written notice of any significant change in the information specified in this Contract before its intended effective date.
g. The Contractor must give written notice within fifteen (15) days of notice or issuance of termination of a provider to each Enrollee who received primary care from, or was seen on a regular basis by, the terminated provider.
h. Any restrictions on the Enrollee’s freedom of choice among network providers.
. i. Enrollee rights and protections as specified in 42 CFR § 438.100.
j. Information on grievance and fair hearing procedures as specified in 42 CFR § 438.10(g)(1).
k. The amount, duration, and scope of benefits available under the Plan in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled.
l. Procedures for obtaining benefits, including authorization requirements.
m. The extent to which, and how, Enrollees may obtain benefits, including family planning services, from out-of-network providers and informs the Enrollees that there are no restrictions on the choice of provider from whom the Enrollee may receive family planning services and supplies.
n. The extent to which, and how, after-hours and emergency coverage are provided, including:
i. What constitutes an emergency medical condition, emergency services, and post-stabilization services, with reference to the definitions in 42 CFR § 438.114(a);
ii. The fact that prior authorization is not required for emergency services;
iii. The process and procedures for obtaining emergency services, including use of the 911-telephone system or its local equivalent;
iv. The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post- stabilization services covered under the Plan;
v. The fact that Enrollees have a right to use any hospital or other setting for emergency care;
vi. The post-stabilization care services rules set forth at 42 CFR § 422.113(c);
Appears in 1 contract
Samples: Contract
Enrollee Information Requirements. The following information requirements must be met:
a. The Contractor shall provide all enrollment notices, informational materials, and instructional materials relating to Enrollees or potential Enrollees in a manner and format that may be easily understood.;
b. The Contractor shall make its written information available in the prevalent non- English languages in the State of Mississippi, in compliance with the Division’s Limited English Proficiency Policy.;
c. The Contractor shall make oral interpretation services available free of charge to each Enrollee for all non-English languages.;
d. The Contractor shall notify Enrollees that oral interpretation services and interpretation services for the hearing impaired and vision-impaired are available and how to access those services. ; At the time the Enrollee is first enrolled required to enroll in the Plan, the Contractor must provide the following information:
a. General information about the basic features of care coordination, which populations are excluded from enrollment and which are subject to mandatory enrollment, and the responsibilities of the Contractor for coordination of Enrollee care.;
b. Specific information about the CCO and the MississippiCAN Program, including benefits covered, names, locations, telephone numbers of, and the identification of providers in the Plan that are not accepting new patients.;
c. Benefits that are available through the Contractor, but are not covered under the State Plan, and how and where Enrollees may obtain those benefits and how transportation is provided.
d. The Contractor shall notify all Enrollees of their right to request and obtain the information specified in this Contract at least annually.;
e. The Contractor shall furnish to each of its Enrollees the information s specified in this Contract within fourteen (14) days after the Contractor receives notice of the Beneficiary’s enrollment.;
f. The Contractor shall give each of its Enrollees thirty (30) days’ written notice of any significant change in the information specified in this Contract before its intended effective date.;
g. The Contractor must give written notice within fifteen (15) days of notice or issuance of termination of a provider to each Enrollee who received primary care from, or was seen on a regular basis by, the terminated provider.
h. Any restrictions on the Enrollee’s freedom of choice among network providers.;
i. Enrollee rights and protections as specified in 42 CFR § Section 438.100.
; j. Information on grievance and fair hearing procedures as specified in 42 CFR § Section 438.10(g)(1).
k. The amount, duration, and scope of benefits available under the Plan in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled.
l. Procedures for obtaining benefits, including authorization requirements.
m. The extent to which, and how, Enrollees may obtain benefits, including family planning services, from out-of-network providers and informs the Enrollees that there are no restrictions on the choice of provider from whom the Enrollee may receive family planning services and supplies.
n. The extent to which, and how, after-hours and emergency coverage are provided, including:
i. What constitutes an emergency medical condition, emergency services, and post-stabilization services, with reference to the definitions in 42 CFR § 438.114(a);
ii. The fact that prior authorization is not required for emergency services;
iii. The process and procedures for obtaining emergency services, including use of the 911-telephone system or its local equivalent;
iv. The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post- stabilization services covered under the Plan;
v. The fact that Enrollees have a right to use any hospital or other setting for emergency care;
vi. The post-stabilization care services rules set forth at 42 CFR § 422.113(c);
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