Member Information Education and Outreach. The Contractor shall provide the information listed under this section within a reasonable timeframe, following the notification from the State fiscal agent of the member’s enrollment in the Contractor. This information shall be included in the member handbook. All correspondence between the Contractor and either pending HIP applicants or conditionally eligible HIP members shall provide notice that the individual has the right to select another MCE before the first payment is made or enrollment is otherwise finalized in accordance with Section 13.6. The notice shall be prominently displayed on the first page and include contact information for the Enrollment Broker available to assist with MCE selection and transfer. The Contractor shall notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Welcome Packet as described in Section 4.2.2, the Contractor shall notify members at least once a year of their right to request and obtain this information. Individualized notice shall be given to each member of any significant change in this information at least thirty (30) days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means written materials shall not exceed a fifth-grade reading level and be in plain language. All written materials for members or potential members shall be in a font size no smaller than 12-point.
Member Information Education and Outreach. The Contractor shall provide the information listed under this section within a reasonable timeframe, following the notification from the State fiscal agent of the member’s enrollment in the Contractor. This information shall be included in the member handbook. The Contractor shall notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Welcome Packet as described in Section 4.2.2, the Contractor shall notify members at least once a year of their right to request and obtain this information. Individualized notice shall be given to each member of any significant change in this information at least thirty (30) days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means written materials shall not exceed a fifth- grade reading level and shall be in plain language. All written materials for members or potential members shall be in a font size no smaller than 12-point. In accordance with 42 CFR 438.10(e), the State must provide potential members with general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. At minimum, this information will include factors such as MCE service area; benefits covered; network provider information; information about the potential enrollee's/member’s right to disenroll consistent with the requirements of 42 CFR 438.56 and which explains clearly the process for exercising this disenrollment right, as well as the alternatives available to the potential enrollee/member based on their specific circumstance; which populations are excluded from enrollment, subject to mandatory enrollment, or free to enroll voluntarily in the program (for mandatory and voluntary populations, the length of the enrollment period and all disenrollment opportunities available to the member must also be specified; any cost-sharing that will be imposed by the Contractor consistent with those set forth in the State plan; and the Contractor’s responsibilities for coordination of member care.
Member Information Education and Outreach
