New Participant Orientation. The CHC-MCO must provide an orientation to a new Participant within thirty (30) days of the new Participant’s start date with the CHC-MCO. For new Participant’s receiving LTSS, the CHC-MCO must conduct the orientation face-to-face (the orientation may be part of the service coordination visit). For purposes of New Participant Orientation, a Participant would be considered new to the CHC-MCO if they were not enrolled with the CHC-MCO 365 days prior to the current enrollment. The CHC-MCO must have a written orientation plan or program for new Participants that includes: • Educational and preventive care programs that include an emphasis on health promotion, wellness and healthy lifestyles and practices, • The proper use of the CHC-MCO identification card and the ACCESS Card, • The role of the PCP, • The Assessment process, • Access to behavioral health services, transportation, home modifications, etc., • What to do in an emergency or urgent medical situation, • How to report abuse, neglect, and exploitation, • How to utilize services in other circumstances, • How to request information from the CHC-MCO, • How to register a Complaint, file a Grievance or request a DHS Fair Hearing, • Notice that balance billing is prohibited and what to do in the event a Provider balance bills, • What Expanded Services or Value-Added Services the CHC-MCO has been approved to provide and how long these are required to be available to Participants who qualify to receive them, • Assistance in coordinating Medicare services that are available to the Participant, • The benefit of enrolling in a Medicare Part D plan with a zero copay. For participant’s receiving LTSS, the orientation must also include the following topics: • The role of the Service Coordinator, • The role of the PCPT, • PCSPs and the service planning process, • Participant Self-Directed models (for Participants receiving HCBS), • The role of Service Coordination Unit and how to contact it directly, if necessary. The CHC-MCO must obtain the Department’s advance written approval of the orientation plan or program. The CHC-MCO is prohibited from contacting a Potential Participant who is identified on the Daily Participant Enrollment File with an automatic assignment indicator (either an "A" auto-assigned or "M" Participant assigned) until five (5) business days before the Enrollment Date, unless otherwise requested by the Department.
New Participant Orientation. The CHC-MCO must have written policies and procedures for new Participants or a written orientation plan or program that includes: Educational and preventative care programs that include an emphasis on health promotion, wellness and healthy lifestyles and practices, The proper use of the CHC-MCO identification card and the ACCESS Card, The role of the PCP, The role of the Service Coordinator, The needs assessment process, The role of the PCPT, PCSPs and the service planning process, Access to behavioral health services, transportation, home modifications, etc., Participant Self-Directed models, What to do in an emergency or urgent medical situation, How to utilize services in other circumstances, How to request information from the CHC-MCO How to register a Complaint, file a Grievance or request a DHS Fair Hearing, Service Coordination Unit and how to contact it directly, if necessary. Notice that balance billing is prohibited and what to do in the event a Provider balance bills, What Expanded or Value-Added Services the CHC-MCO has been approved to provide and how long these are required to be available to Participants who qualify to receive them, Assistance in coordination Medicare services that are available to the Participant, The benefit of enrolling in a Medicare Part D plan with a zero copay. The CHC-MCO must obtain the Department’s advance written approval of the policies and procedures, plan or program. The CHC-MCO is prohibited from contacting a Potential Participant who is identified on the Daily Participant Enrollment File with an automatic assignment indicator (either an "A" auto assigned or "M" Participant assigned) until five (5) business days before the effective date of the Participant’s Enrollment unless otherwise requested by the Department.
New Participant Orientation. The CHC-MCO must have written policies and procedures for new Participants or a written orientation plan or program that includes: Educational and preventative care programs that include an emphasis on health promotion, wellness and healthy lifestyles and practices, The proper use of the CHC-MCO identification card and the Department's ACCESS Card, The role of the PCP, The role of the Service Coordinator, The needs assessment process, The role of the PSPT, Person-Centered Service Plans and the service planning process, Access to behavioral health services, transportation, home modifications, etc., Participant-Directed models, What to do in an emergency or urgent medical situation, How to utilize services in other circumstances, How to request information from the CHC-MCO How to register a Complaint, file a Grievance or request a DHS Fair Hearing. Service Coordination Unit and how to contact it directly, if necessary. The CHC-MCO must obtain the Department’s advance written approval of these policies and procedures. The CHC-MCO is prohibited from contacting a potential Participant who is identified on the Daily Participant Enrollment File with an automatic assignment indicator (either an "A" auto assigned or "M" Participant assigned) until five (5) business days before the effective date of the Participant’s Enrollment otherwise at the request of the Department.
New Participant Orientation. 15. CHC-MCO Identification Cards .........................................................
