Common use of Medicaid Redetermination Notices Clause in Contracts

Medicaid Redetermination Notices. Upon implementation of a systems change relative to this section, the Agency will provide Medicaid recipient redetermination date information to the Health Plan. a. This information may be used by the Health Plan only as indicated in this subsection. b. The Agency will notify the Health Plan sixty (60) Calendar Days prior to transmitting this information to the Health Plan and, at that time, will provide the Health Plan with the file format for this information. The Agency will decide whether or not to continue to provide this information to Health Plan annually and will notify the Health Plans of its decision by May 1 for the coming Contract Year. In addition, the Agency reserves the right to provide thirty (30) Calendar Days notice prior to discontinuing this subsection at any time. c. Within thirty (30) Calendar Days after the date of the Agency’s notice of transmitting this redetermination date information, and annually by June 1 thereafter, the Health Plan must notify the Agency’s Bureau of Managed Health Care (BMHC), in writing, if it will participate in the use of this information for the Contract Year. The Health Plan’s participation in using this information is optional/voluntary. (1) If the Health Plan does not respond in writing to the Agency within thirty (30) Calendar Days after the date of the Agency’s notice, the Health Plan forfeits its ability to receive and use this information until the next Contract Year. (2) If the Health Plan chooses to participate in the use of this information, it must provide with its response indicating it will participate, to the Agency for its approval, its policies and procedures regarding this subsection. (a) A Health Plan that chooses to participate in the use of this information may decide to discontinue using this information at any time. In this circumstance, the Health Plan must notify the Agency’s BMHC of such in writing. The Agency will then delete the Health Plan from the list of Health Plans receiving this information for the remainder of the Contract Year. (b) A Health Plan that chooses to participate in the use of this information must train all affected staff, prior to implementation, on its policies and procedures and the Agency’s requirements regarding this subsection. The Health Plan must document such training has been provided including a record of those trained for the Agency review within five (5) Business days after the Agency’s request. (3) If the Health Plan has opted-out of participating in the use of this information, it may not opt back in until the next Contract Year. (4) Regardless of whether or not the Health Plan has declined to participate in the use of this information, it is subject to the sanctioning indicated in this subsection if this information has been or is misused by the Health Plan. d. If the Health Plan chooses to participate in using this information, it may use the redetermination date information only in the methods listed below, and may choose to use both methods to communicate this information or just one method. (1) The Health Plan may use redetermination date information in written notices to be sent to their Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must mail the redetermination date notice to each Enrollee for whom the Health Plan received a redetermination date. The Health Plan may send one notice to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address. (b) The Health Plan must use the Agency’s redetermination date notice template provided to the Health Plan for its notices. The Health Plan may put this template on its letterhead for mailing; however, the Health Plan may make no other changes, additions or deletions to the letter text. (c) The Health Plan must mail the redetermination date notices to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the redetermination date received from the Agency. (2) The Health Plan may use redetermination date information in automated voice response (AVR) or integrated voice response (IVR) automated messages sent to Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must send the redetermination date messages to each Enrollee for whom the Health Plan has received a redetermination date and for whom the Health Plan has a telephone number. The Health Plan may send an automated message to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address/phone number. (b) For the voice messages, the Health Plan must use only the language in the Agency’s redetermination date notice template provided to the Health Plan. The Health Plan may add its name to the message but may make no other changes, additions or deletions to the message text. (c) The Health Plan must make such automated calls to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the redetermination date received from the Agency. (3) The Health Plan may not include the redetermination date information in any file viewable by customer service or Community Outreach staff. This information may only be used in the letter templates and automated scripts provided by the Agency and cannot be verbally referenced or discussed by the Health Plan with the Enrollees, unless in response to an Enrollee inquiry regarding the letter received, nor may it be used a future time by the Health Plan. If the Health Plan receives Enrollee inquiries regarding the notices, such inquiries must be referred to the Department of Children and Families. e. If the Health Plan chooses to participate in using this information, the Health Plan must keep the following information available regarding each mailing made for the Agency’s review within five (5) Business Days after the Agency’s request: (1) For each month of mailings, a dated hard copy or pdf of the monthly template used for that specific mailing. (a) A list of each Enrollee for whom a monthly mailing was sent. This list shall include each Enrollee’s name and Medicaid identification number to whom the notice was mailed, the address to which the notice was mailed, and the date of the Agency’s enrollment file used to create the mailing list. (b) A log of returned, undeliverable mail received for these notices, by month, for each Enrollee for whom a returned notice was received. (2) For each month of automated calls made, a list including of each Enrollee for whom a call was made, the Enrollee’s Medicaid identification number, telephone number to which the call was made, and the date each call was made, and the date of the Agency’s enrollment file used to create the automated call list.

Medicaid Redetermination Notices. Upon implementation of a systems change relative to this section, the Agency will provide Medicaid recipient redetermination date information to the Health Plan. a. This information may be used by the Health Plan only as indicated in this subsection. b. The Agency will notify the Health Plan sixty (60) Calendar Days prior to transmitting this information to the Health Plan and, at that time, will provide the Health Plan with the file format for this information. The Agency will decide whether or not to continue to provide this information to Health Plan annually and will notify the Health Plans of its decision by May 1 for the coming Contract Year. In addition, the Agency reserves the right to provide thirty (30) Calendar Days notice prior to discontinuing this subsection at any time. c. Within thirty (30) Calendar Days after the date of the Agency’s notice of transmitting this redetermination date information, and annually by June 1 thereafter, the Health Plan must notify the Agency’s Bureau of Managed Health Care (BMHC), in writing, if it will participate in the use of this information for the Contract Year. The Health Plan’s participation in using this information is optional/voluntary. (1) If the Health Plan does not respond in writing to the Agency within thirty (30) Calendar Days after the date of the Agency’s notice, the Health Plan forfeits its ability to receive and use this information until the next Contract Year. (2) If the Health Plan chooses to participate in the use of this information, it must provide with its response indicating it will participate, to the Agency for its approval, its policies and procedures regarding this subsection. (ai) A Health Plan that chooses to participate in the use of this information may decide to discontinue using this information at any time. In this circumstance, the Health Plan must notify the Agency’s BMHC of such in writing. The Agency will then delete the Health Plan from the list of Health Plans receiving this information for the remainder of the Contract Year. (bii) A Health Plan that chooses to participate in the use of this information must train all affected staff, prior to implementation, on its policies and procedures and the Agency’s requirements regarding this subsection. The Health Plan must document such training has been provided including a record of those trained for the Agency review within five (5) Business days after the Agency’s request. (3) If the Health Plan has opted-out of participating in the use of this information, it may not opt back in until the next Contract Year. (4) Regardless of whether or not the Health Plan has declined to participate in the use of this information, it is subject to the sanctioning indicated in this subsection if this information has been or is misused by the Health Plan. d. If the Health Plan chooses to participate in using this information, it may use the redetermination date information only in the methods listed below, and may choose to use both methods to communicate this information or just one method. (1) The Health Plan may use redetermination date information in written notices to be sent to their Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must mail the redetermination date notice to each Enrollee for whom the Health Plan received a redetermination date. The Health Plan may send one notice to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address. . (b) The Health Plan must use the Agency’s redetermination date notice template provided to the Health Plan for its notices. The Health Plan may put this template on its letterhead for mailing; however, the Health Plan may make no other changes, additions or deletions to the letter text. (c) The Health Plan must mail the redetermination date notices to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the redetermination date received from the Agency. (2) The Health Plan may use redetermination date information in automated voice response (AVR) or integrated voice response (IVR) automated messages sent to Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must send the redetermination date messages to each Enrollee for whom the Health Plan has received a redetermination date and for whom the Health Plan has a telephone number. The Health Plan may send an automated message to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address/phone number. (b) For the voice messages, the Health Plan must use only the language in the Agency’s redetermination date notice template provided to the Health Plan. The Health Plan may add its name to the message but may make no other changes, additions or deletions to the message text. (c) The Health Plan must make such automated calls to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the redetermination date received from the Agency. (3) The Health Plan may not include the redetermination date information in any file viewable by customer service or Community Outreach staff. This information may only be used in the letter templates and automated scripts provided by the Agency and cannot be verbally referenced or discussed by the Health Plan with the Enrollees, unless in response to an Enrollee inquiry regarding the letter received, nor may it be used a future time by the Health Plan. If the Health Plan receives Enrollee inquiries regarding the notices, such inquiries must be referred to the Department of Children and Families. e. If the Health Plan chooses to participate in using this information, the Health Plan must keep the following information available regarding each mailing made for the Agency’s review within five (5) Business Days after the Agency’s request: (1) For each month of mailings, a dated hard copy or pdf of the monthly template used for that specific mailing. (a) A list of each Enrollee for whom a monthly mailing was sent. This list shall include each Enrollee’s name and Medicaid identification number to whom the notice was mailed, the address to which the notice was mailed, and the date of the Agency’s enrollment file used to create the mailing list. (b) A log of returned, undeliverable mail received for these notices, by month, for each Enrollee for whom a returned notice was received. (2) For each month of automated calls made, a list including of each Enrollee for whom a call was made, the Enrollee’s Medicaid identification number, telephone number to which the call was made, and the date each call was made, and the date of the Agency’s enrollment file used to create the automated call list.

Medicaid Redetermination Notices. Upon implementation of a systems change relative to this section, the Agency will provide Medicaid recipient redetermination date information to the Health Plan. a. This information may be used by the Health Plan only as indicated in this subsection. b. The Agency will notify the Health Plan sixty (60) Calendar Days prior to transmitting this information to the Health Plan and, at that time, will provide the Health Plan with the file format for this information. The Agency will decide whether or not to continue to provide this information to Health Plan annually and will notify the Health Plans of its decision by May 1 for the coming Contract Year. In addition, the Agency reserves the right to provide thirty (30) Calendar Days notice prior to discontinuing this subsection at any time. c. Within thirty (30) Calendar Days after the date of the Agency’s notice of transmitting this redetermination date information, and annually by June 1 thereafter, the Health Plan must notify the Agency’s Bureau of Managed Health Care (BMHC), in writing, if it will participate in the use of this information for the Contract Year. The Health Plan’s participation in using this information is optional/voluntary. (1) If the Health Plan does not respond in writing to the Agency within thirty (30) Calendar Days after the date of the Agency’s notice, the Health Plan forfeits its ability to receive and use this information until the next Contract Year. (2) If the Health Plan chooses to participate in the use of this information, it must provide with its response indicating it will participate, to the Agency for its approval, its policies and procedures regarding this subsection. (ai) A Health Plan that chooses to participate in the use of this information may decide to discontinue using this information at any time. In this circumstance, the Health Plan must notify the Agency’s BMHC of such in writing. The Agency will then delete the Health Plan from the list of Health Plans receiving this information for the remainder of the Contract Year. (bii) A Health Plan that chooses to participate in the use of this information must train all affected staff, prior to implementation, on its policies and procedures and the Agency’s requirements regarding this subsection. The Health Plan must document such training has been provided including a record of those trained for the Agency review within five (5) Business days after the Agency’s request. (3) If the Health Plan has opted-out of participating in the use of this information, it may not opt back in until the next Contract Year. (4) Regardless of whether or not the Health Plan has declined to participate in the use of this information, it is subject to the sanctioning indicated in this subsection if this information has been or is misused by the Health Plan. d. If the Health Plan chooses to participate in using this information, it may use the redetermination date information only in the methods listed below, and may choose to use both methods to communicate this information or just one method. (1) The Health Plan may use redetermination date information in written notices to be sent to their Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must mail the redetermination date notice to each Enrollee for whom the Health Plan received a redetermination date. The Health Plan may send one notice to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address. (b) The Health Plan must use the Agency’s redetermination date notice template provided to the Health Plan for its notices. The Health Plan may put this template on its letterhead for mailing; however, the Health Plan may make no other changes, additions or deletions to the letter text. (c) The Health Plan must mail the redetermination date notices to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the whose redetermination date received from occurs within the month for which the enrollment file is received. Such notices must be mailed within five (5) Business Days after the Health Plan’s receipt of the Agency’s enrollment file for the month in which the Enrollee’s redetermination date occurs. (2) The Health Plan may use redetermination date information in automated voice response (AVR) or integrated voice response (IVR) automated messages sent to Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must send the redetermination date messages to each Enrollee for whom the Health Plan has received a whose redetermination date occurs within the month for which the enrollment file is received and for whom the Health Plan has a telephone number. The Health Plan may send an automated message to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address/phone number. (b) For the voice messages, the Health Plan must use only the language in the Agency’s redetermination date notice template provided to the Health Plan. The Health Plan may add its name to the message but may make no other changes, additions or deletions to the message text. (c) The Health Plan must make such automated calls to each Enrollee no more than sixty within five (605) Calendar Business Days and no less than thirty (30) Calendar Days prior to after the Health Plan’s receipt of the Agency’s enrollment file for the month in which the Enrollee’s redetermination date received from the Agencyoccurs. (3) The Health Plan may not include the redetermination date information in any file viewable by customer service or Community Outreach marketing staff. This information may only be used in the letter templates and automated scripts provided by the Agency and cannot be verbally referenced or discussed by the Health Plan with the Enrollees, unless in response to an Enrollee inquiry regarding the letter received, nor may it be used a future time by the Health Plan. If the Health Plan receives Enrollee inquiries regarding the notices, such inquiries must be referred to the Department of Children and Families. e. If the Health Plan chooses to participate in using this information, the Health Plan must keep the following information available regarding each mailing made for the Agency’s review within five (5) Business Days after the Agency’s request: (1) For each month of mailings, a dated hard copy or pdf of the monthly template used for that specific mailing. (a) A list of each Enrollee for whom a monthly mailing was sent. This list shall include each Enrollee’s name and Medicaid identification number to whom the notice was mailed, mailed and the address to which the notice was mailed, and the date of the Agency’s enrollment file used to create the mailing list. (b) A log of returned, undeliverable mail received for these notices, by month, for each Enrollee for whom a returned notice was received. (2) For each month of automated calls made, a list including of each Enrollee for whom a call was made, the Enrollee’s Medicaid identification number, telephone number to which the call was made, and the date each call was made, and the date of the Agency’s enrollment file used to create the automated call list.

Medicaid Redetermination Notices. Upon implementation of a systems change relative to this section, the Agency will provide Medicaid recipient redetermination date information to the Health Plan. a. This information may be used by the Health Plan only as indicated in this subsection. b. The Agency will notify the Health Plan sixty (60) Calendar Days prior to transmitting this information to the Health Plan and, at that time, will provide the Health Plan with the file format for this information. The Agency will decide whether or not to continue to provide this information to Health Plan annually and will notify the Health Plans of its decision by May 1 for the coming Contract Year. In addition, the Agency reserves the right to provide thirty (30) Calendar Days notice prior to discontinuing this subsection at any time. c. Within thirty (30) Calendar Days after the date of the Agency’s notice of transmitting this redetermination date information, and annually by June January 1 thereafter, the Health Plan must notify the Agency’s Bureau of Managed Health Care (BMHC), in writing, if it will participate in the use of this information for the Contract Year. The Health Plan’s participation in using this information is optional/voluntary. (1) If the Health Plan does not respond in writing to the Agency within thirty (30) Calendar Days after the date of the Agency’s notice, the Health Plan forfeits its ability to receive and use this information until the next Contract Year. (2) If the Health Plan chooses to participate in the use of this information, it must provide with its response indicating it will participate, to the Agency for its approval, its policies and procedures regarding this subsection. (ai) A Health Plan that chooses to participate in the use of this information may decide to discontinue using this information at any time. In this circumstance, the Health Plan must notify the Agency’s BMHC of such in writing. The Agency will then delete the Health Plan from the list of Health Plans receiving this information for the remainder of the Contract Year. (bii) A Health Plan that chooses to participate in the use of this information must train all affected staff, prior to implementation, on its policies and procedures and the Agency’s requirements regarding this subsection. The Health Plan must document such training has been provided including provided, including, a record of those trained trained, for the Agency Agency’s review within five (5) Business days Days after the Agency’s request. (3) If the Health Plan has opted-out of participating in the use of this information, it may not opt back in until the next Contract Year. (4) Regardless of whether or not the Health Plan has declined to participate in the use of this information, it is subject to the sanctioning indicated in this subsection if this information has been or is misused by the Health Plan. d. If the Health Plan chooses to participate in using this information, it may use the redetermination date information only in the methods listed below, and may choose to use both methods to communicate this information or just one method. (1) The Health Plan may use redetermination date information in written notices to be sent to their Enrollees reminding them that their Medicaid eligibility may end soon and to reapply for Medicaid if needed. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must mail the redetermination date notice to each Enrollee for whom the Health Plan received a redetermination date. The Health Plan may send one notice to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address. (b) The Health Plan must use the Agency’s redetermination date notice template provided to the Health Plan for its notices. The Health Plan may put this template on its letterhead for mailing; however, the Health Plan may make no other changes, additions or deletions to the letter text. (c) The Health Plan must mail the redetermination date notices to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the whose redetermination date received from occurs within the Agency. (2) The Health Plan may use redetermination date information in automated voice response (AVR) or integrated voice response (IVR) automated messages sent to Enrollees reminding them that their Medicaid eligibility may end soon and to reapply month for Medicaid if neededwhich the enrollment file is received. If the Health Plan chooses to use this method to provide this information to its Enrollees, it must adhere to the following requirements: (a) The Health Plan must send the redetermination date messages to each Enrollee for whom the Health Plan has received a redetermination date and for whom the Health Plan has a telephone number. The Health Plan may send an automated message to the Enrollee’s household when there are multiple Enrollees within a family that have the same Medicaid redetermination date provided that these Enrollees share the same mailing address/phone number. (b) For the voice messages, the Health Plan must use only the language in the Agency’s redetermination date notice template provided to the Health Plan. The Health Plan may add its name to the message but may make no other changes, additions or deletions to the message text. (c) The Health Plan must make such automated calls to each Enrollee no more than sixty (60) Calendar Days and no less than thirty (30) Calendar Days prior to the redetermination date received from the Agency. (3) The Health Plan may not include the redetermination date information in any file viewable by customer service or Community Outreach staff. This information may only be used in the letter templates and automated scripts provided by the Agency and cannot be verbally referenced or discussed by the Health Plan with the Enrollees, unless in response to an Enrollee inquiry regarding the letter received, nor may it be used a future time by the Health Plan. If the Health Plan receives Enrollee inquiries regarding the notices, such inquiries Such notices must be referred to the Department of Children and Families. e. If the Health Plan chooses to participate in using this information, the Health Plan must keep the following information available regarding each mailing made for the Agency’s review mailed within five (5) Business Days after the Agency’s request: (1) For each month of mailings, a dated hard copy or pdf of the monthly template used for that specific mailing. (a) A list of each Enrollee for whom a monthly mailing was sent. This list shall include each Enrollee’s name and Medicaid identification number to whom the notice was mailed, the address to which the notice was mailed, and the date of the Agency’s enrollment file used to create the mailing list. (b) A log of returned, undeliverable mail received for these notices, by month, for each Enrollee for whom a returned notice was received. (2) For each month of automated calls made, a list including of each Enrollee for whom a call was made, the Enrollee’s Medicaid identification number, telephone number to which the call was made, and the date each call was made, and the date of the Agency’s enrollment file used to create the automated call list.five