Common use of MSHO Marketing Consistent with CMS Requirements Clause in Contracts

MSHO Marketing Consistent with CMS Requirements. The MCO, its agents and Marketing representatives, shall not: (1) Offer or grant any reward, favor, compensation or provide for cash or any other monetary rebate, as an inducement to a Beneficiary or an MSHO Enrollee to enroll in the MCO. This restriction does not prohibit the MCO from explaining any legitimate benefits a Beneficiary might obtain as an Enrollee of the MCO. The MCO shall not seek to influence a Recipient’s enrollment with the MCO in conjunction with the sale of any private insurance. (2) Offer or grant any reward, favor or compensation to a person, county or organization that is not directly hired or contracted by the MCO to conduct marketing, who in the process of informing potential Enrollees about Medical Assistance or other Medicare Programs, steers or attempts to steer the potential Enrollee toward a specific plan or limited number of plans. (3) Engage in any discriminatory activities. (4) Engage in any activities that could mislead or confuse Beneficiaries, or misrepresent the MCO. (5) Make any written or oral assertions or statements that a Beneficiary or Enrollee must enroll in the MCO in order to obtain or maintain Medical Assistance and covered Medicare benefits, or that the MCO is endorsed by CMS, Medicare, the STATE, or federal government. The MCO may explain that it is approved for participation in Medicare. (6) Conduct door-to-door solicitation to current or potential MSHO Enrollees. In addition, the MCO must comply with Medicaid regulations that do not allow direct or indirect telephone or other cold-call marketing activities to potential MSHO Enrollees. (7) Make available Marketing Materials for which the MCO has not received STATE and CMS approval. [42 CFR §422Subpart V.]

MSHO Marketing Consistent with CMS Requirements. The MCO, its agents and Marketing representatives, shall not: (1) Offer or grant any reward, favor, compensation or provide for cash or any other monetary rebate, as an inducement to a Beneficiary or an MSHO Enrollee to enroll in the MCO. This restriction does not prohibit the MCO from explaining any legitimate benefits a Beneficiary might obtain as an Enrollee of the MCO. The MCO shall not seek to influence a Recipient’s enrollment with the MCO in conjunction with the sale of any private insurance. (2) Offer or grant any reward, favor or compensation to a person, county or organization that is not directly hired or contracted by the MCO to conduct marketing, who in the process of informing potential Enrollees about Medical Assistance or other Medicare Programs, steers or attempts to steer the potential Enrollee toward a specific plan or limited number of plans. (3) Engage in any discriminatory activities. (4) Engage in any activities that could mislead or confuse Beneficiaries, or misrepresent the MCO. (5) Make any written or oral assertions or statements that a Beneficiary or Enrollee must enroll in the MCO in order to obtain or maintain Medical Assistance and covered Medicare benefits, or that the MCO is endorsed by CMS, Medicare, the STATE, or federal government. The MCO may explain that it is approved for participation in Medicare. (6) Conduct door-to-door solicitation to current or potential MSHO Enrollees. In addition, the MCO must comply with Medicaid regulations that do not allow direct or indirect telephone or other cold-call marketing activities to potential MSHO Enrollees. (7) Make available Marketing Materials for which the MCO has not received STATE and CMS approval. [42 CFR §422Subpart V.422.2268]