Common use of Redetermination Assistance Clause in Contracts

Redetermination Assistance. Contractors may assist members in the eligibility redetermination process. Permitted assistance includes:  Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  Answering questions about the redetermination process; and  Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractors shall be prohibited from the following:  Discriminate against members, particularly high-cost members or members that have indicated a desire to change MCEs;  Talk to members about changing MCEs (if a member has questions or requests to change MCEs, the Contractor shall refer the member to the Enrollment Broker);  Provide any indication as to whether the member will be eligible (this decision shall be made by DFR);  Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  Sign the member’s redetermination form; or  Complete or send redetermination materials to DFR on behalf of the member. Contractors shall provide redetermination assistance equally across the membership and be able to demonstrate to OMPP that their redetermination-related procedures are applied consistently for each member.