General Information Requirements. 4.1.1 The PASSE must ensure that enrolled members are notified of the following: a. Their rights and responsibilities; b. The roles of their PCP, care coordinator, and case manager; c. The role of the member in developing and approving the PCSP; d. How to obtain needed care and services; e. What to do in an emergency or urgent medical situation; f. How to pursue a complaint, a grievance, appeal or Fair Hearing; g. How to report suspected Medicaid fraud, waste and abuse; h. How to report abuse, neglect and exploitation of themselves or another; and i. All other requirements and benefits of the PASSE. 4.1.2 The PASSE must provide information to both enrolled members and potential members in accordance with 42 CFR § 438.10. Additionally, and in accordance with the above-referenced CFR, the PASSE must notify enrolled members, on at least an annual basis, of their right to request and obtain information. 4.1.3 The PASSE must make all information provided to potential members and enrolled members, whether required by the Agreement or otherwise, accessible. Additionally, the PASSE must notify all potential or enrolled members of their right to accessible information at no additional cost and how to access information in an accessible format. Notification must be accessible, given in both English and Spanish and be provided in alternative formats when appropriate. At a minimum, “accessible” means that: a. All member communications, including written materials, spoken scripts and websites must be at or below the sixth (6th) grade comprehension level. b. All written materials must be provided in a font size no smaller than 12 point. c. All written materials must be made available in both English and Spanish. d. For all individuals whose primary language is not English, an interpreter must be provided, free of charge, in accordance with the Federal Limited English Proficiency (LEP) regulations. e. Interpretation, either oral or written, of any provided information must be made available in any language spoken by the enrolled member or potential member. f. All written and oral information must be provided in alternative formats, when appropriate, and in a manner that takes into consideration a member’s special needs, including are visual impairment, hearing impairment, limited reading proficiency, or limited English proficiency. g. Auxiliary aids and services must be made available upon request for enrolled member and potential members with disabilities.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
General Information Requirements. 4.1.1 The PASSE must ensure that enrolled members Members are notified of the following:
a. Their rights and responsibilities;
b. The roles of their PCP, care coordinator, and case manager;
c. The role of the member in developing and approving the PCSP;
d. How to obtain needed care and services;
e. What to do in an emergency or urgent medical situation;
f. How to pursue a complaintGrievance, a grievance, appeal Appeal or Fair Hearing;
g. How to report suspected Medicaid fraud, waste waste, and abuse;
h. How to report abuse, neglect and exploitation of themselves or another; and
i. All other requirements and benefits of the PASSE.
4.1.2 The PASSE must provide information to both enrolled members Members and potential members Potential Members in accordance with 42 CFR § 438.10. Additionally, and in accordance with the above-above referenced CFR, the PASSE must notify enrolled membersMembers, on at least an annual basis, of their right to request and obtain information.
4.1.3 The PASSE must make all information provided to potential members Potential Members and enrolled membersMembers, whether required by the Agreement or otherwise, accessible. These materials must be reviewed and approved by DHS in order to ensure compliance with the Agreement and 42 CFR § 438.10; and for content, before it is distributed. Additionally, the PASSE must notify all potential or enrolled members Members of their right to accessible information at no additional cost and how to access information in an accessible format. Notification must be accessible, given in both English and Spanish and be provided in alternative formats when appropriate. At a minimum, “accessible” means that:
a. All member communications, including written materials, spoken scripts and websites must be at or below the sixth (6th) grade comprehension level.
b. All written materials must be provided in a font size no smaller than 12 point.
c. All written materials must be made available in both English English, Spanish, and SpanishMarshallese.
d. For all individuals whose primary language is not English, an interpreter must be provided, free of charge, in accordance with the Federal Limited English Proficiency (LEP) regulations.
e. Interpretation, either oral or written, of any provided information must be made available in any language spoken by the enrolled member Member or potential memberPotential Member.
f. All written and oral information must be provided in alternative formats, when appropriate, and in a manner that takes into consideration a member’s special needs, including are visual impairment, hearing impairment, limited reading proficiency, or limited English proficiency.
g. Auxiliary aids and services must be made available upon request for enrolled member Member and potential members Potential Members with disabilities.
h. A Teletypewriter Telephone/Text Telephone (TTY/TDY) number must be provided for Members and Potential Member.
i. All written materials for members must include taglines in the prevalent non- English languages in a particular service area. Written materials that are critical to obtaining services are referenced in 42 CFR § 438.10(d)(3) and includes, at a minimum, provider directories, member handbooks, appeal and grievance notices, and denial and termination notices. Taglines must be in a conspicuously visible font size explaining the availability of written translation or oral interpretation to understand information provided, information on how to request auxiliary aids and services, and the toll-free and TTY/TDY telephone number of the PASSE’s Member Support Services unit. Auxiliary aids and services must also be available upon request of the member or potential member at no cost.
4.1.4 The PASSE must mail all Member materials to the Member’s primary address provided by DHS on the enrollment file unless an updated alternate address has been obtained from the member, and in accordance with the following requirements:
a. The PASSE’s name or logo must be included on the envelope or the front of every mailing so that it is easily distinguishable.
b. All information sent to Members by mail must include instructions for how a member can change or update their address.
c. If material sent to Members is returned to the PASSE as “undeliverable,” the PASSE must notify the PASSE Unit within thirty (30) calendar days on a monthly undeliverable mail report.
d. The PASSE may send emails in lieu of mailing if the Member has agreed, in writing, to receive information by email.
e. If an Member agrees to receive information by email, the PASSE must provide an opt-out process for that Member to elect to no longer receive information by email.
f. The PASSE must mail a Welcome Packet to a member who was disenrolled due to loss of Medicaid eligibility, and is subsequently re-enrolled in the PASSE, if:
i. It has been more than 180 days since the disenrollment; or
ii. It has been less than 180 days and there was a significant change in the member materials during the time they were disenrolled.
4.1.5 Due to the high rate of undeliverable mail, the PASSE is allowed to utilize postal service address correction software when mailing Member materials.
4.1.6 Information required to be provided by the PASSE may be sent to the member’s parent/legal guardian or authorized responsible person, as appropriate.
Appears in 1 contract
Samples: Provider Agreement
General Information Requirements. 4.1.1 The PASSE must ensure that enrolled members Enrolled Members are notified of the following:
a. Their rights and responsibilities;
b. The roles of their PCP, care coordinator, and case manager;
c. The role of the member in developing and approving the PCSP;
d. How to obtain needed care and services;
e. What to do in an emergency or urgent medical situation;
f. How to pursue a complaintComplaint, a grievanceGrievance, appeal Appeal or Fair Hearing;
g. How to report suspected Medicaid fraudFraud, waste and abuse;
h. How to report abuse, neglect and exploitation of themselves or another; and
i. All other requirements and benefits of the PASSE.
4.1.2 The PASSE must provide information to both enrolled members Enrolled Members and potential members Potential Members in accordance with 42 CFR § 438.10. Additionally, and in accordance with the above-above referenced CFR, the PASSE must notify enrolled membersEnrolled Members, on at least an annual basis, of their right to request and obtain information.
4.1.3 The PASSE must make all information provided to potential members Potential Members and enrolled membersEnrolled Members, whether required by the Agreement or otherwise, accessible. These materials must be reviewed and approved by DHS in order to ensure compliance with the Agreement and 42 CFR § 438.10; and for content, before it is distributed. Additionally, the PASSE must notify all potential or enrolled members Enrolled Members of their right to accessible information at no additional cost and how to access information in an accessible format. Notification must be accessible, given in both English and Spanish and be provided in alternative formats when appropriate. At a minimum, “accessible” means that:
a. All member communications, including written materials, spoken scripts and websites must be at or below the sixth (6th) grade comprehension level.
b. All written materials must be provided in a font size no smaller than 12 point.
c. All written materials must be made available in both English and Spanish.
d. For all individuals whose primary language is not English, an interpreter must be provided, free of charge, in accordance with the Federal Limited English Proficiency (LEP) regulations.
e. Interpretation, either oral or written, of any provided information must be made available in any language spoken by the enrolled member Enrolled Member or potential memberPotential Member.
f. All written and oral information must be provided in alternative formats, when appropriate, and in a manner that takes into consideration a member’s special needs, including are visual impairment, hearing impairment, limited reading proficiency, or limited English proficiency.
g. Auxiliary aids and services must be made available upon request for enrolled member Enrolled Member and potential members Potential Members with disabilities.
h. A Teletypewriter Telephone/Text Telephone (TTY/TDY) number must be provided for Enrolled Members and Potential Member.
i. All written materials must include taglines in Spanish, as well as large print, explaining the availability of written translation or oral interpretation to understand information provided and the toll-free and TTY/TDY telephone number of the PASSE’s Member Support Services unit. Large print means printed in a font size no smaller than 18 point and conspicuously visible.
4.1.4 The PASSE must mail all Enrolled Member materials to the Enrolled Member’s primary address provided by DHS on the enrollment file unless an updated alternate address has been obtained from the member, and in accordance with the following requirements:
a. The PASSE’s name or logo must be included on the envelope or the front of every mailing so that it is easily distinguishable.
b. All information sent to Enrolled Members by mail must include instructions for how a member can change or update their address.
c. If material sent to Enrolled Members is returned to the PASSE as “undeliverable,” the PASSE must notify the PASSE Unit within thirty (30) calendar days on a monthly undeliverable mail report.
d. The PASSE may send emails in lieu of mailing if the Enrolled Member has agreed, in writing, to receive information by email.
e. If an Enrolled Member agrees to receive information by email, the PASSE must provide an opt-out process for that Enrolled Member to elect to no longer receive information by email.
4.1.5 Due to the high rate of undeliverable mail, the PASSE is allowed to utilize postal service address correction software when mailing Enrolled Member materials.
4.1.6 Information required to be provided by the PASSE may be sent to the member’s parent/legal guardian or authorized responsible person, as appropriate.
Appears in 1 contract
Samples: Provider Agreement
