Common use of Prior Approval Required Clause in Contracts

Prior Approval Required. The MCO must submit its enrollment materials in a final format before approval from the STATE can be given. Approvals by the STATE for these materials shall not be unreasonably withheld. For MSHO Materials. The MCO agrees that the integrated Medicare, Medicare Part D and Medicaid Member Handbook sent to each MCO Enrollee and all Marketing Materials, plans, procedures, mailings, enrollment forms and their revisions that are designed for Beneficiaries shall be used only after receiving approval in accordance with section 3.6.4(D). The MCO must revise its Member Handbook for all substantial changes in its Grievance and Appeals procedures, and its health care delivery systems, including changes in procedures to obtain access to or approval for health care services. All revisions to the Member Handbook must be approved in writing by the STATE and CMS in accordance with section 3.6.4(D), and issued to Enrollees prior to implementation of the change. For MSC+ Materials. The STATE must approve all enrollment materials including the Evidence of Coverage (EOC) sent to Enrollees prior to their use. The MCO must revise its Evidence of Coverage for all substantial changes in its Grievance and Appeals procedures, and its health care delivery systems, including changes in procedures to obtain access to or approval for health care services. All revisions to the EOC must be approved in writing by the STATE in accordance with section 3.6.4(D) and must be issued to Enrollees prior to implementation of the change. The STATE agrees to inform the MCO of its approval or denial of MSC+ documents within thirty (30) days of receipt of these documents from the MCO.

Prior Approval Required. The MCO must submit its enrollment materials in a final format before approval from the STATE can be given. Approvals by the STATE for these materials shall not be unreasonably withheld. withheld.‌ For MSHO Materials. The MCO agrees that the integrated Medicare, Medicare Part D and Medicaid Member Handbook sent to each MCO Enrollee and all Marketing Materials, plans, procedures, mailings, enrollment forms and their revisions that are designed for Beneficiaries shall be used only after receiving approval in accordance with section 3.6.4(D). The MCO must revise its Member Handbook for all substantial changes in its Grievance and Appeals procedures, and its health care delivery systems, including changes in procedures to obtain access to or approval for health care services. All revisions to the Member Handbook must be approved in writing by the STATE and CMS in accordance with section 3.6.4(D), and issued to Enrollees prior to implementation of the change. For MSC+ Materials. The STATE must approve all enrollment materials including the Evidence of Coverage (EOC) sent to Enrollees prior to their use. The MCO must revise its Evidence of Coverage for all substantial changes in its Grievance and Appeals procedures, and its health care delivery systems, including changes in procedures to obtain access to or approval for health care services. All revisions to the EOC must be approved in writing by the STATE in accordance with section 3.6.4(D) and must be issued to Enrollees prior to implementation of the change. The STATE agrees to inform the MCO of its approval or denial of MSC+ documents within thirty (30) days of receipt of these documents from the MCO.