Member Handbook Requirements i. The PH-MCO must provide that the Member handbook is written at no higher than a sixth-grade reading level and includes, at a minimum, the information outlined in the PH- MCO Member Handbook Template as issued by DHS.
ii. The PH-MCO must notify members at least thirty (30) days in advance of the effective date of a significant change in the member handbook.
iii. The PH-MCOs must have written policies guaranteeing each enrollee’s right to be treated with respect and with due consideration for his or her dignity and privacy.
iv. The PH-MCOs must have written policies guaranteeing each enrollee’s right to receive information on available treatment options and alternatives, presented in a manner appropriate to the enrollee’s condition and ability to understand.
v. The PH-MCOs must have written policies guaranteeing each enrollee’s right to participate in decisions regarding his or her health care, including the right to refuse treatment.
vi. The PH-MCOs must have written policies guaranteeing each enrollee’s right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
vii. The PH-MCOs must have written policies guaranteeing each enrollee's right to request and receive a copy of his or her medical records, and to request that they be amended or corrected.
viii. The PH-MCOs must ensure that each enrollee is free to exercise his or her rights without the PH-MCO or its network providers treating the enrollee adversely.
Member Handbook Requirements. The PH-MCO must ensure that the Member handbook is written at no higher than a sixth grade reading level and include, at a minimum, the information outlined in Exhibit DD of this Agreement, PH-MCO Member Handbook.
Member Handbook Requirements. 4.3.3.1 The Contractor shall mail to all newly enrolled Members a Member Handbook within ten (10) Calendar Days of receiving the notice of enrollment from DCH or its Agent. The Contractor shall mail to all enrolled Member households a Member Handbook every other year thereafter unless requested sooner by the member.
4.3.3.2 Pursuant to the requirements set forth in 42 CFR 438.10, the Member Handbook shall include, but not be limited to: · A table of contents; · Information about the roles and responsibilities of the Member (this information to be supplied by DCH); · Information about the role of the PCP; · Information about choosing a PCP; · Information about what to do when family size changes; · Appointment procedures; · Information on Benefits and services, including a description of all available GF Benefits and services; · Information on how to access services, including Health Check services, non-emergency transportation (NET) services, and maternity and family planning services; · An explanation of any service limitations or exclusions from coverage; · A notice stating that the Contractor shall be liable only for those services authorized by the Contractor; · Information on where and how Members may access Benefits not available from or not covered by the Contractor; · The Medical Necessity definition used in determining whether services will be covered; · A description of all pre-certification, prior authorization or other requirements for treatments and services; · The policy on Referrals for specialty care and for other Covered Services not furnished by the Member’s PCP; · Information on how to obtain services when the Member is out of the Service Region and for after-hours coverage; · Cost-sharing; · The geographic boundaries of the Service Regions; · Notice of all appropriate mailing addresses and telephone numbers to be utilized by Members seeking information or authorization, including an inclusion of the Contractor’s toll-free telephone line and Web site; · A description of Utilization Review policies and procedures used by the Contractor; · A description of Member rights and responsibilities as described in Section 4.3.4; · The policies and procedures for Disenrollment; · Information on Advance Directives; · A statement that additional information, including information on the structure and operation of the CMO plan and physician incentive plans, shall be made available upon request;
4.3.3.3 Information on the extent to which, and how, afte...
Member Handbook Requirements. 4.3.3.1 The Contractor shall mail to all newly enrolled Members a Member Handbook within ten (10) Calendar Days of receiving the notice of enrollment from DCH or its Agent. The Contractor shall mail to all enrolled Members a Member Handbook at least annually thereafter.
4.3.3.2 Pursuant to the requirements set forth in 42 CFR 438.10, the Member Handbook shall include, but not be limited to:
4.3.3.2.1 A table of contents;
4.3.3.2.2 Information about the roles and responsibilities of the Member (this information to be supplied by DCH);
4.3.3.2.3 Information about the role of the PCP;
4.3.3.2.4 Information about choosing a PCP;
4.3.3.2.5 Information about what to do when family size changes;
4.3.3.2.6 Appointment procedures;
4.3.3.2.7 Information on Benefits and services, including a description of all available GHF Benefits and services;
4.3.3.2.8 Information on how to access services, including Health Check services, non-emergency transportation (NET) services, and maternity and family planning services;
4.3.3.2.9 An explanation of any service limitations or exclusions from coverage;
4.3.3.2.10 A notice stating that the Contractor shall be liable only for those services authorized by the Contractor;
4.3.3.2.11 Information on where and how Members may access Benefits not available from or not covered by the Contractor;
4.3.3.2.12 The Medical Necessity definition used in determining whether services will be covered;
4.3.3.2.13 A description of all pre-certification, prior authorization or other requirements for treatments and services;
4.3.3.2.14 The policy on Referrals for specialty care and for other Covered Services not furnished by the Member’s PCP;
4.3.3.2.15 Information on how to obtain services when the Member is out of the Service Region and for after-hours coverage;
4.3.3.2.16 Cost-sharing;
4.3.3.2.17 The geographic boundaries of the Service Regions;
4.3.3.2.18 Notice of all appropriate mailing addresses and telephone numbers to be utilized by Members seeking information or authorization, including an inclusion of the Contractor’s toll-free telephone line and Web site;
4.3.3.2.19 A description of Utilization Review policies and procedures used by the Contractor;
4.3.3.2.20 A description of Member rights and responsibilities as described in Section 4.3.4;
4.3.3.2.21 The policies and procedures for Disenrollment;
4.3.3.2.22 Information on Advance Directives;
4.3.3.2.23 A statement that additional information, including information on the structure and ...
Member Handbook Requirements. The Contractor must ensure that the Member handbook is written at no higher than a fourth grade level and include, at a minimum, the information outlined in Exhibit DD of this Agreement, HealthChoices PH-MCO Member Handbook.
Member Handbook Requirements. The PH-MCO must provide that the Member handbook is written at no higher than a sixth grade reading level and includes, at a minimum, the information outlined in the PH- MCO Member Handbook Template as issued by DHS. The PH-MCO must notify members at least thirty (30) days in advance of the effective date of a significant change in the member handbook.
