Common use of Enrollment Information to be Presented Clause in Contracts

Enrollment Information to be Presented. The MCO shall present to all new Enrollees the following information within fifteen (15) calendar days of availability of readable enrollment data from the STATE. If an Enrollee becomes ineligible and is disenrolled from the MCO, but eligibility is reestablished within the following three months and the Enrollee’s eligibility is reestablished in the same program and he/she is re-enrolled in the same MCO, the MCO will not be required to send a new member packet, including the EOC or Member Handbook and a provider directory, but must send the Enrollee another MCO member identification card. For MSC+, an Evidence of Coverage (EOC) and for MSHO, a Member Handbook, that has been prior approved by the STATE and for MSHO, by CMS. For MSHO, the MCO will cooperate with the MSHO Plan Member Materials Workgroup to adjust the CMS Medicare model Member Handbook to incorporate STATE requirements. The MCO will use the model developed by the MSHO Plan Member Materials Workgroup to develop its own Member Handbook, which is then submitted to the STATE and includes information as below in section 3.6.6(A)(3)(a) through (s). For MSC+, the STATE will provide annually to the MCO a model EOC or EOC Addendum as the base document. Prior to distribution to the MCO, the model EOC or EOC Addendum will be prior approved by MDH to ensure that MDH’s requirements are included. The MCO will not have to subsequently submit the EOC or EOC Addendum to MDH after receiving approval from the STATE. After the MCO has incorporated its specific information, the completed EOC or EOC Addendum will be submitted to the STATE for prior approval. For MSHO the Member Handbook and for MSC+ the EOC or EOC Addendum must include the following, and must be distributed annually to MSC+ Enrollees no later than January 31, or for MSHO as required by CMS:

Enrollment Information to be Presented. The MCO shall present to all new Enrollees the following information within fifteen (15) calendar days of availability of readable enrollment data from the STATE. If an Enrollee becomes ineligible and is disenrolled from the MCO, but eligibility is reestablished within the following three months and the Enrollee’s eligibility is reestablished in the same program and he/she is re-enrolled in the same MCO, the MCO will not be required to send a new member packet, including the the‌ EOC or Member Handbook and a provider directory, but must send the Enrollee another MCO member identification card. For MSC+, an Evidence of Coverage (EOC) and for MSHO, a Member Handbook, that has been prior approved by the STATE and for MSHO, by CMS. For MSHO, the MCO will cooperate with the MSHO Plan Member Materials Workgroup to adjust the CMS Medicare model Member Handbook to incorporate STATE requirements. The MCO will use the model developed by the MSHO Plan Member Materials Workgroup to develop its own Member Handbook, which is then submitted to the STATE and includes information as below in section 3.6.6(A)(3)(a) through (s). For MSC+, the STATE will provide annually to the MCO a model EOC or EOC Addendum as the base document. Prior to distribution to the MCO, the model EOC or EOC Addendum will be prior approved by MDH to ensure that MDH’s requirements are included. The MCO will not have to subsequently submit the EOC or EOC Addendum to MDH after receiving approval from the STATE. After the MCO has incorporated its specific information, the completed EOC or EOC Addendum will be submitted to the STATE for prior approval. For MSHO the Member Handbook and for MSC+ the EOC or EOC Addendum must include the following, and must be distributed annually to MSC+ Enrollees no later than January 31, or for MSHO as required by CMS: