Member Education. The Contractor shall provide members with general information about the benefits packages covered under the Hoosier Healthwise program. The Contractor shall have policies and procedures in place to ensure that member education information is accurate in content, accurate in translation relevant to language, and do not defraud, mislead, or confuse the member. Member education shall include, but not necessarily limited to the items noted below:
Member Education. In accordance with Section 2.10, “Member Services,” the Contactor must educate Members about the availability of Telemedicine services and include clear instructions on how to access Healthcare Services through Telemedicine on the Contractor’s website and in the Member Handbook.
Member Education. The MCO must, at a minimum, develop and implement health education initiatives that educate Members about:
Member Education. Member education is defined as educational activities and materials directed at Enrollees of a CONTRACTOR’s Health Plan that increases the awareness, and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. The CONTRACTOR shall:
3.14.1. Through the initial mailing to all Members educate the member regarding the appropriate utilization of Medicaid services. Verbal education may compliment but not replace written materials. Please refer to Section 4 of this contract for more information regarding Medicaid services.
3.14.2. Include information and materials that inform the Member on the CONTRACTOR’s Policies, Procedures, requirements and practices.
3.14.3. Provide education no later than fourteen (14) Calendar Days from the CONTRACTOR’s receipt of Enrollment data from the Department, or its designee, and as needed thereafter.
3.14.4. Identify and educate Medicaid Managed Care Members who access the healthcare system inappropriately and provide continuing education as needed.
3.14.5. Be responsible for reminding pregnant Members that their Newborns will be automatically enrolled for the birth month and that the Medicaid Managed Care Member may choose to enroll the Newborn in another CONTRACTOR’s Health Plan after delivery by contacting South Carolina Healthy Connections Choices.
3.14.6. Ensure that where at least five (5) percent or more of the resident population of a county is non-English speaking and speaks a specific foreign language, materials will be made available in that specific language to assure a reasonable chance for all Medicaid Managed Care Members to understand how to access the CONTRACTOR and use services appropriately.
3.14.7. Have written Policies and Procedures for educating Medicaid Managed Care Members about their benefits.
3.14.8. Coordinate with the Department or its designee on Medicaid Managed Care Member education activities as outlined in the Managed Care Policy and Procedure Guide to meet the health care educational needs of the Medicaid Managed Care Members.
3.14.9. Not discriminate against Medicaid Managed Care Members on the basis of their health history, health status or need for health care services.
3.14.9.1. This applies to Enrollment, re-Enrollment or Disenrollment from the CONTRACTOR's Health Plan.
3.14.10. Refer to the Department’s Managed Care Policy and Procedure Guide for further guidance on Member education materials and activities.
Member Education. The Contractor must implement, monitor, and evaluate a program to promote health education for its new and continuing Members. The Contractor shall maintain an annual health education and prevention work plan, based on the needs of its Members, and shall submit this work plan, with quarterly updates, to the Division for approval. The Division will work to review and approve work plan and quarterly updates within thirty (30) calendar days. At a minimum, the health education and prevention work plan shall describe topics to be addressed, the method of communication with Members, the method of identifying those Members who will be contacted, and the time frame s for distributing materials or outreach to Members. Any changes to the health education and prevention work plan, and all materials to be distributed to Members, must be approved by the Division prior to implementation or distribution. The comprehensive health education program shall support and complement the Contractor’s Care Management programs. The Contractor shall also conduct, in collaboration with the Division, a minimum of ten (10) MississippiCAN Workshops annually targeting Members. The Division will notify the Contractor of the dates, times, and locations for Workshops. The Division will determine the topics to be covered during each workshop and the Contractor shall assist in the presentation of the content.
Member Education. The HMO must, at a minimum, develop and implement health education initiatives that educate Members about:
Member Education. The Contractor shall provide members with general information about the benefits covered under the program. The Contractor shall have policies and procedures in place to ensure that member education information is accurate in content, accurate in translation relevant to language, and do not defraud, mislead, or confuse the member. Member education shall include, but not necessarily limited to the items noted below: ▪ Information on benefit coverage ▪ How to access the health care system appropriately (i.e. keeping appointments, appropriate use of Emergency Room services, how to file grievances and appeals) ▪ Information on covered dental services
Member Education. The Contractor must implement, monitor, and evaluate a program to promote h e a l t h education for its new and continuing Members. The Contractor shall maintain an annual health education and prevention work plan, based on the needs of its Members, and shall submit this work plan, with quarterly updates, to the Division for approval. The Division will work to review and approve work plan and quarterly updates within thirty (30) calendar days. At a minimum, the health education and prevention work plan shall describe topics to be addressed, the method of communication with Members, the method of identifying those Members who will be contacted, and the time frames for distributing materials or outreach to Members. Any changes to the health education and prevention work plan, and all materials to be distributed to Members, must be approved by the Division prior to implementation or distribution. The comprehensive health education program shall support and complement the Contractor’s Care Management programs. The Contractor may also be required to conduct, in collaboration with the Division, Workshops targeting Members. For such trainings in collaboration with the Division, the Division will notify the Contractor of the dates, times, and locations for Workshops. The Division will determine the topics to be covered during each workshop and the Contractor shall assist in the presentation of the content. The Contractor must submit material used at the Workshops to the Division for approval at least thirty (30) calendar days prior to the Workshop.
Member Education. CONTRACTOR must, at a minimum, develop and implement health education initiatives that educate Members about:
(a) How the HMO system operates;
(b) How to obtain services, including:
(1) Accessing OB/GYN and plan requirements concerning specialty care;
(2) Emergency services;
(3) Behavioral health care services;
(4) Prenatal services and unique aspects of CHIP/Medicaid eligibility prior- and post-partum;
(5) Care and treatment, under CONTRACTOR's plan, for Members with disabilities and Children with Complex, Special Health Care Needs; and
(6) Early Childhood Intervention (ECI) Services;
(c) Covered Services, limitations and any Value-added Services offered by CONTRACTOR;
(d) Member co-payments, if applicable; and
(e) The value of screening and preventive care. CONTRACTOR also must provide child-oriented, disease specific-information and educational materials to Members. In addition to the above requirements, CONTRACTOR must make any additional educational initiatives outlined in its Proposal appropriately available to Members. CONTRACTOR may respond to inquiries from pregnant Members or their families regarding their potential Medicaid eligibility and making an informed choice. CONTRACTOR's presentation should be balanced, presenting and explaining the advantages and disadvantages to the Member of both CHIP and Medicaid as appropriate in response to the Member's inquiries.
Member Education. The Contractor shall be responsible for educating members in the Member Handbook and other materials to inform members how to access covered behavioral health services. Materials shall include information about behavioral health conditions that may be treated by the member’s primary care physician (PCP) which includes anxiety, depression and ADHD. Refer to the AMPM for covered behavioral health services.
