Common use of Member Information Education and Outreach Clause in Contracts

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. 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. The State shall provide information on HHW MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and quality of care and services. To facilitate State development of these materials, the Contractor must comply with State, or its designee, requests for information needed to develop informational materials for potential members. The Contractor shall make written information available in the language requested by the member. See Section 4.4.1. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. In addition, the Contractor shall identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area. Written information shall be readily provided to members in any such prevalent languages identified by the Contractor. Other non-prevalent languages shall be provided to the member following the requirements outlined in Section 4.4.1. As required by 42 CFR 438.10(d)(3), the Contractor shall take into consideration the special needs of the member or potential enrollee with disabilities or limited English proficiency and make auxiliary aids available upon request, at no cost. Additionally, per the regulation, the Contractor shall ensure that written materials that are critical to obtaining services also include taglines in the State’s top 15 prevalent non-English languages and in a conspicuously visible font size explaining the availability of written translation or oral interpretation to understand the information provided, information on how to request auxiliary aids and services, and include the toll-free and TTY/TDY telephone number of the Contractor’s member/customer service unit. For other significant publications and significant communications, a tagline must be included in the State’s top two languages spoken by limited English proficient populations. To the extent possible, written materials shall not exceed a fifth-grade reading level. The Contractor will provide auxiliary aids and services, like qualified interpreters or information in accessible formats, free of charge and in a timely manner, to ensure an equal opportunity to participate in the program. Pursuant to the Americans with Disabilities Act of 1990 (ADA) / 42 USC §12101 et. seq., all communications with members must be consistent with the ADA’s prohibition on unnecessary inquiries into the existence of a disability. Contractor shall have information available in alternative formats and through the provision of auxiliary aids and services for the Contractor’s health programs and activities, in an appropriate manner that takes into consideration the member’s needs, including those who have visual impairment or limited reading proficiency, and at no cost to the member. The Contractor shall distribute member materials as required by this Contract. Required materials, described below, include member handbooks, provider directories, quarterly member newsletters and identification cards at a minimum. The Contractor may distribute additional materials and information, other than those required to members in order to promote health and/or educate enrollees provided the materials are State approved. Materials, to the extent possible, shall be in plain language including the Member Handbook.