Common use of Information Provided to Beneficiaries Clause in Contracts

Information Provided to Beneficiaries. A. The Contractor shall provide information to beneficiaries and potential beneficiaries including, at a minimum, all of the following: 1) The basic features of managed care. (42 C.F.R. § 438.10(e)(2)(ii).) 2) The mandatory enrollment process. (42 C.F.R. § 438.10(e)(2)(iii).) 3) The service area covered by the Contractor. (42 C.F.R. § 438.10(e)(2)(iv).) 4) Covered benefits, including: a. Which benefits are provided by the Contractor; and, b. Which, if any, benefits are provided directly by the State. 5) The provider directory. (42 C.F.R. § 438.10(e)(2)(vi).) 6) Any cost-sharing that will be imposed by the Contractor consistent with the State Plan. (42 C.F.R. §§ 438.10(e)(2)(vii); State Plan § 4. 7) The requirements for the Contractor to provide adequate access to covered services, including the network adequacy standards established in 42 Code of Federal Regulations part 438.68. (42 C.F.R. § 438.10(e)(2)(viii).) 8) The Contractor’s responsibilities for coordination of care. (42 C.F.R. § 438.10(e)(2)(ix).) 9) To the extent available, quality and performance indicators for the Mental Health Plan, including beneficiary satisfaction. (42 C.F.R. § 438.10(e)(2)(x).) B. The Contractor shall make a good faith effort to give written notice of termination of a contracted provider, within 15 calendar days after receipt or issuance of the termination notice, to each beneficiary who was seen on a regular basis by the terminated provider. (42 C.F.R. § 438.10(f)(1).)

Information Provided to Beneficiaries. A. The Contractor shall provide information to beneficiaries and potential beneficiaries including, at a minimum, all of the following: 1) The basic features of managed care. (42 C.F.R. § 438.10(e)(2)(ii).) 2) The mandatory enrollment process. (42 C.F.R. § 438.10(e)(2)(iii).) 3) The service area covered by the Contractor. (42 C.F.R. § 438.10(e)(2)(iv).) 4) Covered benefits, including: a. Which benefits are provided by the Contractor; and, b. Which, if any, benefits are provided directly by the State. 5) The provider directory. (42 C.F.R. § 438.10(e)(2)(vi).) 6) Any cost-sharing that will be imposed by the Contractor consistent with the State Plan. (42 C.F.R. §§ 438.10(e)(2)(vii); State Plan § 4. 7) The requirements for the Contractor to provide adequate access to covered services, including the network adequacy standards established in 42 Code of Federal Regulations part 438.68. (42 C.F.R. § 438.10(e)(2)(viii).) 8) The Contractor’s responsibilities for coordination of care. (42 C.F.R. § 438.10(e)(2)(ix).) 9) To the extent available, quality and performance indicators for the Mental Health Plan, including beneficiary satisfaction. (42 C.F.R. § 438.10(e)(2)(x).) B. The Contractor shall make a good faith effort to give written notice of termination of a contracted provider, within 15 calendar days after receipt or issuance of the termination notice, to each beneficiary who was seen on a regular basis by the terminated provider. The notice to the beneficiary shall be provided 30 calendar days prior to the effective date of the termination or 15 calendar days after receipt or issuance of the termination notice, whichever is later. (42 C.F.R. § 438.10(f)(1).)

Information Provided to Beneficiaries. A. The Contractor shall provide information to beneficiaries and potential beneficiaries including, at a minimum, all of the following: 1) The basic features of managed care. (42 C.F.R. § 438.10(e)(2)(ii).) 2) The mandatory enrollment process. (42 C.F.R. § 438.10(e)(2)(iii).) 3) The service area covered by the Contractor. (42 C.F.R. § 438.10(e)(2)(iv).) 4) Covered benefits, including: a. Which benefits are provided by the Contractor; and, b. Which, if any, benefits are provided directly by the State. 5) The provider directory. (42 C.F.R. § 438.10(e)(2)(vi).) 6) Any cost-sharing that will be imposed by the Contractor consistent with the State Plan. (42 C.F.R. §§ 438.10(e)(2)(vii); State Plan § 4. 7) The requirements for the Contractor to provide adequate access to covered services, including the network adequacy standards established in 42 Code of Federal Regulations part 438.68. (42 C.F.R. § 438.10(e)(2)(viii).) 8) The Contractor’s responsibilities for coordination of care. (42 C.F.R. § 438.10(e)(2)(ix).) 9) To the extent available, quality and performance indicators for the Mental Health Plan, including beneficiary satisfaction. (42 C.F.R. § 438.10(e)(2)(x).) B. The Contractor shall make a good faith effort to give written notice of termination of a contracted provider, within 15 calendar days after receipt or issuance of the termination notice, to each beneficiary who was seen on a regular basis by the terminated provider. The notice to the beneficiary shall be provided 30 calendar days prior to the effective date of the termination or 15 calendar days after receipt or issuance of the termination notice, whichever is later. (42 C.F.R. § 438.10(f)(1).)