Common use of Marketing to Potential Members Clause in Contracts

Marketing to Potential Members. a. Contractor shall apply the prohibitions of this paragraph to its agents, Subcontractors, and Subcontractor’s agents. b. Contractor and its Subcontractor’s communications that express participation in or support for the Contractor by its founding organizations or its Subcontractors shall not constitute an attempt to compel or entice a Potential Member’s enrollment c. Contractor has sole accountability for producing or distributing Marketing Materials following OHA approval. d. Contractor shall ensure that Potential Members are not intentionally misled about their options by Contractor’s staff, activities or materials. Contractor’s materials may not contain inaccurate, false, confusing or misleading information. e. Contractor shall provide copies of all written Marketing Materials to all DHS and OHA offices within Contractor’s Service Area. Pursuant to 42 CFR 438.104(b)(2), Contractor shall make no assertion or statement (whether written or oral) that: (1) The Potential Member must enroll with Contractor in order to obtain benefits or not to lose benefits; or (2) The Contractor is endorsed by CMS, the federal or State government, or similar entity. f. Contractor shall comply with the information requirements of 42 CFR 438.10, 438.100 and (1) Not distribute any Marketing Materials without first obtaining OHA approval; (2) Distribute the Marketing Materials to its entire Service Area as indicated in this Contract; (3) Not seek to compel or entice Enrollment in conjunction with the sale of or offering of any private insurance; and (4) Not directly or indirectly engage in door to door, emailing, texting, telephone or Cold Call Marketing activities; and g. Contractor shall comply with OHA Materials Submission and Approval Form. The form is located at on the Contract Reports Web Site. Submission of the form goes to XXX.Xxxxxxxxx@xxxxx.xx.xx. h. OHA will develop guidelines through a transparent public process, including input from Contractor and other stakeholders. The guidelines will include, but are not limited to: (1) A list of communication or Outreach Materials subject to review by OHA; (2) A clear explanation of OHA’s process for review and approval of Marketing Materials; (3) A process for appeals of XXX’s edits or denials; (4) A Marketing Materials submission form to ensure compliance with PHP Marketing rules; and (5) An update of plan availability information submitted to the OHA on a monthly basis for review and posting. 1. Integration and Coordination a. Contractor shall make best effort to conduct an initial screen of each new Member’s needs, within 90 days of enrollment and make additional attempts if initial outreach is unsuccessful. b. Contractor shall ensure, and shall implement procedures to ensure, that in coordinating care, the Member's privacy is protected consistent with the confidentiality requirements in 45 CFR parts 160 and 164 subparts A and E, to the extent that they are applicable, and consistent with other State law or federal regulations governing privacy and confidentiality of health records. c. Contractor shall demonstrate involvement in integration activities such as, but not limited to: (1) Enhanced communication and coordination between Contractor and Dental Care Providers, mental health and Substance Use Disorders Providers; (2) Implementation of integrated Prevention, Early Intervention and wellness activities; (3) Development of infrastructure support for sharing information, coordinating care and monitoring results; (4) Use of screening tools, treatment standards and guidelines that support integration; (5) Support of a shared culture of integration across CCOs and service delivery systems; and (6) Implementation of a System of Care approach, incorporating models such as the Four Quadrant Clinical Integration Model of the National Council for Community Behavioral Healthcare or Wraparound for children with Behavioral Health disorders. d. Contractor shall coordinate the services the Contractor furnishes its Members with the services the Member receives from any other MCO, PIHP or PAHP to avoid duplication of services, as required by 42 CFR §438.208 (b)(2) and (5). e. Contractor shall contract with Oregon State Public Health Laboratory (OSPHL) to accept claims for the following tests:

Marketing to Potential Members. a. Contractor shall apply the prohibitions of this paragraph to its agents, Subcontractors, and Subcontractor’s agents. b. Contractor and its Subcontractor’s communications that express participation in or support for the Contractor by its founding organizations or its Subcontractors shall not constitute an attempt to compel or entice a Potential Member’s enrollment c. Contractor has sole accountability for producing or distributing Marketing Materials following OHA approval. d. Contractor shall ensure that Potential Members are not intentionally misled about their options by Contractor’s staff, activities or materials. Contractor’s materials may not contain inaccurate, false, confusing or misleading information. e. Contractor shall provide copies of all written Marketing Materials to all DHS and OHA offices within Contractor’s Service Area. Pursuant to 42 CFR 438.104(b)(2), Contractor shall make no assertion or statement (whether written or oral) that: (1) The Potential Member must enroll with Contractor in order to obtain benefits or not to lose benefits; or (2) The Contractor is endorsed by CMS, the federal or State government, or similar entity. f. Contractor shall comply with the information requirements of 42 CFR 438.10, 438.100 and (1) Not distribute any Marketing Materials without first obtaining OHA approval; (2) Distribute the Marketing Materials to its entire Service Area as indicated in this Contract; (3) Not seek to compel or entice Enrollment in conjunction with the sale of or offering of any private insurance; and (4) Not directly or indirectly engage in door to door, emailing, texting, telephone or Cold Call Marketing activities; and g. Contractor shall comply with OHA Materials Submission and Approval Form. The form is located at on the Contract Reports Web Site. Submission of the form goes to XXX.Xxxxxxxxx@xxxxx.xx.xx. h. OHA will develop guidelines through a transparent public process, including input from Contractor and other stakeholders. The guidelines will include, but are not limited to: (1) A list of communication or Outreach Materials subject to review by OHA; (2) A clear explanation of OHA’s process for review and approval of Marketing Materials; (3) A process for appeals of XXX’s edits or denials; (4) A Marketing Materials submission form to ensure compliance with PHP Marketing rules; and (5) An update of plan availability information submitted to the OHA on a monthly basis for review and posting. 1. Integration and Coordination a. Contractor shall make best effort to conduct an initial screen of each new Member’s needs, within 90 days of enrollment and make additional attempts if initial outreach is unsuccessful. b. Contractor shall ensure, and shall implement procedures to ensure, that in coordinating care, the Member's privacy is protected consistent with the confidentiality requirements in 45 CFR parts 160 and 164 subparts A and E, to the extent that they are applicable, and consistent with other State law or federal regulations governing privacy and confidentiality of health records. c. b. Contractor shall demonstrate involvement in integration activities such as, but not limited to: (1) Enhanced communication and coordination between Contractor and Dental Care ProvidersDCOs, mental health and Substance Use Disorders Providers; (2) Implementation of integrated Prevention, Early Intervention and wellness activities; (3) Development of infrastructure support for sharing information, coordinating care and monitoring results; (4) Use of screening tools, treatment standards and guidelines that support integration; (5) Support of a shared culture of integration across CCOs and service delivery systems; and (6) Implementation of a System of Care approach, incorporating models such as the Four Quadrant Clinical Integration Model of the National Council for Community Behavioral Healthcare or Wraparound for children with Behavioral Health disorders. d. c. Contractor shall coordinate the services the Contractor furnishes its Members with the services the Member receives from any other MCO, PIHP or PAHP to avoid duplication of services, as required by 42 CFR §438.208 (b)(2b) and (52). e. Contractor shall contract with Oregon State Public Health Laboratory (OSPHL) to accept claims for the following tests:

Marketing to Potential Members. a. Contractor shall apply the prohibitions of this paragraph to its agents, Subcontractors, and Subcontractor’s agents. b. Contractor and its Subcontractor’s communications that express participation in or support for the Contractor by its founding organizations or its Subcontractors shall not constitute an attempt to compel or entice a Potential Member’s enrollment c. Contractor has sole accountability for producing or distributing Marketing Materials following OHA approval. d. Contractor shall ensure that Potential Members are not intentionally misled about their options by Contractor’s staff, activities or materials. Contractor’s materials may not contain inaccurate, false, confusing or misleading information. e. Contractor shall provide copies of all written Marketing Materials to all DHS and OHA offices within Contractor’s Service Area. Pursuant to 42 CFR 438.104(b)(2), Contractor shall make no assertion or statement (whether written or oral) that: (1) The Potential Member must enroll with Contractor in order to obtain benefits or not to lose benefits; or (2) The Contractor is endorsed by CMS, the federal or State government, or similar entity. f. Contractor shall comply with the information requirements of 42 CFR 438.10, 438.100 and (1) Not distribute any Marketing Materials without first obtaining OHA approval; (2) Distribute the Marketing Materials to its entire Service Area as indicated in this Contract; (3) Not seek to compel or entice Enrollment in conjunction with the sale of or offering of any private insurance; and (4) Not directly or indirectly engage in door to door, emailing, texting, telephone or Cold Call Marketing activities; and g. Contractor shall comply with OHA Materials Submission and Approval Form. The form is located at on the Contract Reports Web Site. Submission of the form goes to XXX.Xxxxxxxxx@xxxxx.xx.xx.goes h. OHA will develop guidelines through a transparent public process, including input from Contractor and other stakeholders. The guidelines will include, but are not limited to: (1) A list of communication or Outreach Materials subject to review by OHA; (2) A clear explanation of OHA’s process for review and approval of Marketing Materials; (3) A process for appeals of XXX’s edits or denials; (4) A Marketing Materials submission form to ensure compliance with PHP Marketing rules; and (5) An update of plan availability information submitted to the OHA on a monthly basis for review and posting. 1. Integration and Coordination a. Contractor shall make best effort to conduct an initial screen of each new Member’s needs, within 90 days of enrollment and make additional attempts if initial outreach is unsuccessful. b. Contractor shall ensure, and shall implement procedures to ensure, that in coordinating care, the Member's privacy is protected consistent with the confidentiality requirements in 45 CFR parts 160 and 164 subparts A and E, to the extent that they are applicable, and consistent with other State law or federal regulations governing privacy and confidentiality of health records. c. Contractor shall demonstrate involvement in integration activities such as, but not limited to: (1) Enhanced communication and coordination between Contractor and Dental Care Providers, mental health and Substance Use Disorders Providers; (2) Implementation of integrated Prevention, Early Intervention and wellness activities; (3) Development of infrastructure support for sharing information, coordinating care and monitoring results; (4) Use of screening tools, treatment standards and guidelines that support integration; (5) Support of a shared culture of integration across CCOs and service delivery systems; and (6) Implementation of a System of Care approach, incorporating models such as the Four Quadrant Clinical Integration Model of the National Council for Community Behavioral Healthcare or Wraparound for children with Behavioral Health disorders. d. Contractor shall coordinate the services the Contractor furnishes its Members with the services the Member receives from any other MCO, PIHP or PAHP to avoid duplication of services, as required by 42 CFR §438.208 (b)(2) and (5). e. Contractor shall contract with Oregon State Public Health Laboratory (OSPHL) to accept claims for the following tests:

Marketing to Potential Members. ‌ a. Contractor shall apply the prohibitions of this paragraph to its agents, delegated entities, Subcontractors, and Subcontractor’s agents. b. Contractor and its Subcontractor’s communications that express participation in or support for the Contractor by its founding organizations or its Subcontractors shall not constitute an attempt to compel or entice a Potential Member’s enrollment c. Contractor has sole accountability for producing or distributing Marketing Materials following OHA approval. d. Contractor shall ensure that Potential Members are not intentionally misled about their options by Contractor’s staff, activities or materials. Contractor’s materials may not contain inaccurate, false, confusing or misleading information. e. Contractor shall provide copies of all written Marketing Materials to all DHS and OHA offices within Contractor’s Service Area. Pursuant to 42 CFR 438.104(b)(2), Contractor shall make no assertion or statement (whether written or oral) that: (1) The Potential Member must enroll with Contractor in order to obtain benefits or not to lose benefits; or (2) The Contractor is endorsed by CMS, the federal or State government, or similar entity. f. Contractor shall comply with the information requirements of 42 CFR 438.10, 438.100 and (1) Not distribute any Marketing Materials without first obtaining OHA approval; (2) Distribute the Marketing Materials to its entire Service Area as indicated in this Contract; (3) Not seek to compel or entice Enrollment in conjunction with the sale of or offering of any private insurance; and (4) Not directly or indirectly engage in door to door, emailing, texting, telephone or Cold Call Marketing activities; and g. Contractor shall comply with OHA Materials Submission and Approval Form. The form is located at on the Contract Reports Web Site. Submission of the form goes to XXX.Xxxxxxxxx@xxxxx.xx.xx. h. OHA will develop guidelines through a transparent public process, including input from Contractor and other stakeholders. The guidelines will include, but are not limited to: (1) A list of communication or Outreach Materials subject to review by OHA; (2) A clear explanation of OHA’s process for review and approval of Marketing Materials; (3) A process for appeals of XXX’s edits or denials; (4) A Marketing Materials submission form to ensure compliance with PHP Marketing rules; and (5) An update of plan availability information submitted to the OHA on a monthly basis for review and posting. 1. Integration and Coordination a. Contractor shall make best effort to conduct an initial screen of each new Member’s needs, within 90 days of enrollment and make additional attempts if initial outreach is unsuccessful. b. Contractor shall ensure, and shall implement procedures to ensure, that in coordinating care, the Member's privacy is protected consistent with the confidentiality requirements in 45 CFR parts 160 and 164 subparts A and E, to the extent that they are applicable, and consistent with other State law or federal regulations governing privacy and confidentiality of health records. c. Contractor shall demonstrate involvement in integration activities such as, but not limited to: (1) Enhanced communication and coordination between Contractor and Dental Care Providers, mental health and Substance Use Disorders Providers; (2) Implementation of integrated Prevention, Early Intervention and wellness activities; (3) Development of infrastructure support for sharing information, coordinating care and monitoring results; (4) Use of screening tools, treatment standards and guidelines that support integration; (5) Support of a shared culture of integration across CCOs and service delivery systems; and (6) Implementation of a System of Care approach, incorporating models such as the Four Quadrant Clinical Integration Model of the National Council for Community Behavioral Healthcare or Wraparound for children with Behavioral Health disorders. d. Contractor shall coordinate the services the Contractor furnishes its Members with the services the Member receives from any other MCO, PIHP or PAHP to avoid duplication of services, as required by 42 CFR §438.208 (b)(2) and (5). e. Contractor shall contract with Oregon State Public Health Laboratory (OSPHL) to accept claims for the following tests: