Regulation 364 Sample Clauses

Regulation 364 j of the NYS DOH requires that MCO's (and the LDSS in the marketer's absence) contact client's chosen provider to ensure that said provider is accepting new patients/Medicaid/MCO. Therefore, Rensselaer County Managed Care and the MCO's will comply with 364.J. Rensselaer County DSS will work with the MCO to form a corrective action plan in all instances whereby the action's/inaction's of a marketer are in question. These guidelines may be amended by the Managed Care office of Rensselaer County DSS as situations dictate. The MCO representatives will be notified of any such changes. APPENDIX E NEW YORK STATE DEPARTMENT OF HEALTH MEMBER HANDBOOK GUIDELINES APPENDIX E October 1, 2004 E-l This document contains member handbook guidelines for use by managed care organizations (MCOs) under contract to serve New York Medicaid beneficiaries. These guidelines may be revised from time to time based on changes in the law and the changing needs of the program. The guidelines reflect the review criteria used by the SDOH Office of Managed Care in its review of all Medicaid managed care member handbooks. Handbooks and addenda must be approved by SDOH prior to printing and distribution by MCOs. In addition, the SDOH has developed a model member handbook at the fourth to sixth grade reading level for use by MCOs. The model member handbook contains language to address required disclosure regarding free access for family planning; self referral policies; obtaining OB/GYN services; the definitions of medical necessity and emergency services; protocols for complaints, utilization review, external appeals, fair hearings and newborn enrollments; and listing of member entitlements, including benefits, rights and responsibilities, and information available upon request. MCOs must use the language provided in these required disclosure areas in their member handbooks. A copy of the model handbook is available from the Office of Managed Care, Bureau of Intergovernmental Affairs. GENERAL FORMAT Member handbooks must be written in a style and reading level that will accommodate the reading skills of many Medicaid recipients. In general the writing should be at no higher than a sixth-grade level, taking into consideration the need to incorporate and explain certain technical or unfamiliar terms to assure accuracy. The text must be printed in at least ten (10) point font. The SDOH reserves the right to require evidence that a handbook has been tested against the sixth-grade reading-level s...