General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.
Appears in 3 contracts
Samples: Contract, Contract #0000000000000000000018227, Contract #0000000000000000000018225
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understoodunderstood and is readily accessible. This means, to the extent feasible, written materials shall not exceed a fifth fifth-grade reading level. Written materials shall be available in alternative formats in an appropriate manner that takes into consideration the special needs of the member or potential enrollee with disabilities or limited English proficiency. The Contractor must notify all members and potential enrollees that translated written materials are available and provide information on how to access. All written materials that are critical to obtaining services, including at a minimum, provider directories, enrollee handbooks, appeal and grievance notices, and denial and termination notices shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 As required by 42 CFR 438.10(d)(3), the Contractor shall take into consideration the special needs of the Affordable Care Act / 45 CFR 92.1member or potential enrollee with disabilities or limited English proficiency and make auxiliary aids available upon request, at no cost. Additionally, per this regulation, the Contractor shall ensure that for significant publications and communications written materials that are critical to obtaining services also include taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 fifteen (15) prevalent non-English languages spoken by limited English proficient populationsand in a conspicuously visible font size, explaining the availability of written translation or oral interpretation to understand the information provided, information on how to request auxiliary aids and services, and for smallinclude the toll-size free and TTY/TDY telephone number of the EXHIBIT 1.C SCOPE OF WORK Contractor’s member/customer service unit. For other significant publications and significant communications communications, a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. The Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. Unless a member specifically states their alternate-format request is a one-time request, the Contractor shall consider the request an ongoing request and supply all future mailed materials in the preferred format to the member. For first-time or one-time requests from a member, the Contractor shall mail the alternate version of the document in no more than seven (7) business days from the date of the request. If, for example, the member received a wellness visit reminder flyer and called the Contractor to ask for the flyer to be sent in braille, the Contractor shall take no more than seven (7) business days to mail the braille version from the date of the member request call. For first-time or one-time requests from a member, when the mailing is governed by NCQA or statutory requirements, the Contract shall have two (2) additional days from the NCQA or statutory timeframe to mail the document if no mailing has yet been sent to the member. For first-time or one-time requests from a member, when the mailing is governed by NCQA or statutory requirements and the statutory notice has already been fulfilled with a regular printed letter, the Contractor shall mail the alternate version of the document in no more than seven (7) business days from the date of the request. For existing on-going alternate format requests, the Contractor shall have two (2) additional business days from when the document would normally be required to be mailed, to mail the document in the alternate format. If, for example, a member had previously requested materials in braille, and an ID card would be sent to the member in five (5) business days, the timeline would be seven (7) business days for the braille version. The additional two (2) days applies for Contract requirements (such as ID cards) and additional mailings at the will of the Contractor, such as a wellness visit reminder postcard. For existing on-going alternate format requests which must comply with NCQA or State law requirement, such as utilization management letters, the Contractor shall mail the documents in the alternate format within the statutory or NCQA required timeline. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.EXHIBIT 1.C
Appears in 3 contracts
Samples: Contract #0000000000000000000051705, Contract #0000000000000000000051706, Contract #0000000000000000000051704
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-non- English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. As of May 1, 2020, the Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 30 calendar days after receipt of the notification from the practice or practitioner. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.
Appears in 2 contracts
Samples: Contract #0000000000000000000018227, Contract #0000000000000000000018225
General Member Information Requirements. The Contractor shall provide the information listed under this section within a reasonable timeframe, following the notification from the State fiscal agent of the member’s enrollment in the Contractor. This information shall be included in the member handbook. The Contractor shall notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Welcome Packet as described in Section 4.4 the Contractor shall notify members at least once a year of their right to request and obtain this information. Individualized notice shall be given to each member of any significant change in this information at least thirty (30) days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth fifth-grade reading levellevel and be in plain language. All written materials for members or potential members shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a regionfont size no smaller than 12-point. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in In accordance with 42 CFR 438.102438.10(e), the State must provide potential members with general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. This At minimum, this information must be relayed will include factors such as MCE service area; benefits covered; network provider information; information about the potential enrollee's/member’s right to disenroll consistent with the requirements of 42 CFR 438.56 and which explains clearly the process for exercising this disenrollment right, as well as the alternatives available to the potential enrollee/member based on their specific circumstance; which populations are excluded from enrollment, subject to mandatory enrollment, or free to enroll voluntarily in the program (for mandatory and voluntary populations, the length of the enrollment period and all disenrollment opportunities available to the member before must also be specified; any cost-sharing that will be imposed by the Contractor consistent with those set forth in the State plan; and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 Contractor’s responsibilities for additional informationcoordination of member care. The State shall provide information on Hoosier Care Connect MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor must notify all members of their quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to request develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and obtain information in accordance with 42 CFR 438.10quality of care and services. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4To facilitate State development of these materials, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance comply with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s its designee, requests for use in member education and enrollment, upon requestinformation needed to develop informational materials for potential members.
Appears in 2 contracts
Samples: Contract #0000000000000000000051704, Contract #0000000000000000000051705
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth fifth-grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials EXHIBIT 1 SCOPE OF WORK must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. The Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 15 calendar days after receipt of the notification from the practice or practitioner. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. In the first and third quarter of every Contract year, the Contractor shall identify members who are potentially eligible for the Supplemental Nutritional Assistance Program (SNAP). The Contractor shall use the federal poverty level of 130% to identify potentially eligible members. The Contractor shall conduct an educational outreach campaign to the members identified as potentially eligible. The Contractor does not need to outreach to all potentially eligible members at once, but can conduct outreach on a rolling basis during the quarter identified and the following quarter (e.g., reach out to each potentially eligible member once in the first or second quarter and once again in the third or fourth quarter of every Contract year). The educational information provided to members shall include EXHIBIT 1 SCOPE OF WORK information on SNAP benefits, eligibility, and how to enroll. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.
Appears in 2 contracts
Samples: Professional Services Contract Contract #0000000000000000000051704, Professional Services Contract Contract #0000000000000000000051705
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. As of May 1, 2020, the Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the EXHIBIT 1.M SCOPE OF WORK member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 30 calendar days after receipt of the notification from the practice or practitioner. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.
Appears in 1 contract
Samples: Contract #0000000000000000000018225
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth fifth-grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section EXHIBIT 1 SCOPE OF WORK 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. The Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen to members at least thirty (1530) calendar days prior to the effective date of the Contractor’s receipt termination. However, if the practice or issuance practitioner notifies the Contractor less than 30 days prior to the effective date of the provider termination noticetermination, the Contractor shall then notify members as soon as possible but no later than 15 calendar days after receipt of the notification from the practice or practitioner. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. In the first and third quarter of every EXHIBIT 1 SCOPE OF WORK Contract year, the Contractor shall identify members who are potentially eligible for the Supplemental Nutritional Assistance Program (SNAP). The Contractor shall use the federal poverty level of 130% to identify potentially eligible members. The Contractor shall conduct an educational outreach campaign to the members identified as potentially eligible. The Contractor does not need to outreach to all potentially eligible members at once, but can conduct outreach on a rolling basis during the quarter identified and the following quarter (e.g., reach out to each potentially eligible member once in the first or second quarter and once again in the third or fourth quarter of every Contract year). The educational information provided to members shall include information on SNAP benefits, eligibility, and how to enroll. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.
Appears in 1 contract
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth fifth-grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify EXHIBIT 1.A. SCOPE OF WORK additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. The Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the Unless a member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of specifically states their right to alternate-format request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4is a one-time request, the Contractor must notify members at least once a year of their right to shall consider the request an ongoing request and obtain this information. Written notice must be given to each member of any significant change supply all future mailed materials in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility preferred format to the Contractor’s services and benefitsmember. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services For first-time or one-time requests from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. Additionally, upon the request of a member, the Contractor shall also provide information on mail the structure and operation alternate version of the health plan as well as information on physician incentive plansdocument in no more than seven (7) business days from the date of the request. The If, for example, the member received a wellness visit reminder flyer and called the Contractor must to ask for the flyer to be sent in braille, the Contractor shall take no more than seven (7) business days to mail the braille version from the date of the member request call. For first-time or one-time requests from a member, when the mailing is governed by NCQA or statutory requirements, the Contract shall have in place policies and procedures two (2) additional days from the NCQA or statutory timeframe to ensure that materials are accurate in content, accurate in translation relevant mail the document if no mailing has yet been sent to language or alternate formats and do not defraud, mislead or confuse the member. The For first-time or one-time requests from a member, when the mailing is governed by NCQA or statutory requirements and the statutory notice has already been fulfilled with a regular printed letter, the Contractor must provide information requested by shall mail the Statealternate version of the document in no more than seven (7) business days from the date of the request. For existing on-going alternate format requests, or the State’s designeeContractor shall have two (2) additional business days from when the document would normally be required to be mailed, to mail the document in the alternate format. If, for use example, a member had previously requested materials in braille, and an ID card would be sent to the member education and enrollmentin five (5) business days, upon request.the timeline would be seven (7) business days for the braille version. The additional two (2) days applies for Contract requirements (such as ID cards)
Appears in 1 contract
Samples: Contract #0000000000000000000051706
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. As of May 1, 2020, the Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of their right to request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4, the Contractor must notify members at least once a year of their right to request and obtain this information. Written notice must be given to each member of any significant change in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility to the Contractor’s services and benefits. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. Additionally, upon the request of a member, the Contractor shall also provide information on the structure and operation of the health plan as well as information on physician incentive plans. The Contractor must have in place policies and procedures to ensure that materials are accurate in content, accurate in translation relevant to language or alternate formats and do not defraud, mislead or confuse the member. The Contractor must provide information requested by the State, or the State’s designee, for use in member education and enrollment, upon request.This
Appears in 1 contract
Samples: Contract #0000000000000000000018227
General Member Information Requirements. The Contractor shall comply with the information requirements at 42 CFR 438.10. All enrollment notices, informational and instructional materials must be provided in a manner and format that is easily understood. This means, to the extent feasible, written materials shall not exceed a fifth fifth-grade reading level. All written materials shall be provided in English and Spanish, and any additional prevalent languages identified by FSSA, upon FSSA’s or the member’s request. At the time of enrollment with the Contractor, the State shall provide the primary language of each member. The Contractor shall utilize this information to ensure communication materials are distributed in the appropriate language. The Contractor shall also identify EXHIBIT 1.A. SCOPE OF WORK additional languages that are prevalent among the Contractor’s membership. For purposes of this requirement, prevalent language is defined as any language spoken by at least three percent (3%) of the general population in the Contractor’s service area or three percent (3%) of the Contractor’s membership in a region. Written information must be provided in any such prevalent languages identified by the Contractor. Per Section 1557 of the Affordable Care Act / 45 CFR 92.1, Contractor shall ensure that for significant publications and communications taglines (short statements written in non-English languages to alert individuals with limited English proficiency to the availability of language assistance services, free of charge, and how the services can be obtained) must be included in the State’s top 15 languages spoken by limited English proficient populations, and for small-size significant publications and significant communications a tagline must be included in the State’s top two languages spoken by limited English proficient populations. The Contractor must notify all members that translated written information is available and provide information on how to access. Written materials must include taglines in prevalent languages regarding how to access materials in alternative languages. Additionally, written materials must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. This includes but is not limited to Braille, large font, audiotape and verbal explanations of written materials. The Contractor shall offer braille as an alternative format for receiving member materials. When a member has requested materials in braille, the Contractor shall supply future materials in braille to the member. The Contractor may review with the member the specific documents types the member wishes to receive in braille versus other formats. The Contractor may outreach to members to inquire if braille documents are still the desired format. All members and potential members must be informed that information is available in alternative formats and how to access those formats. The Contractor must provide notification to FSSA, the Enrollment Broker and to its members of any covered services that the Contractor or any of its subcontractors or networks do not cover on the basis of moral or religious grounds and guidelines for how and where to obtain those services, in accordance with 42 CFR 438.102. This information must be relayed to the Unless a member before and during enrollment and within ninety (90) calendar days after adopting the policy with respect to any particular service. Refer to Section 7.3.2 for additional information. The Contractor must notify all members of specifically states their right to alternate-format request and obtain information in accordance with 42 CFR 438.10. In addition to providing the specific information required at 42 CFR 438.10(f) upon enrollment in the Enrollment Packet as described in Section 4.4is a one-time request, the Contractor must notify members at least once a year of their right to shall consider the request an ongoing request and obtain this information. Written notice must be given to each member of any significant change supply all future mailed materials in this information at least thirty (30) calendar days before the intended effective date of the change. Significant change is defined as any change that may impact member accessibility preferred format to the Contractor’s services and benefitsmember. Grievance, appeal and fair hearing procedures and timeframes must be provided to members in accordance with 42 CFR 438.10(g)(2)(xi). Section 4.12 provides further information about procedures and information that the Contractor must provide to members regarding grievances and appeals. The Contractor must make a good faith effort to provide written notice of a provider’s disenrollment to any member that has received primary care services For first-time or one-time requests from that provider or otherwise sees the provider on a regular basis. Such notice must be provided within fifteen (15) calendar days of the Contractor’s receipt or issuance of the provider termination notice. Additionally, upon the request of a member, the Contractor shall also provide information on mail the structure and operation alternate version of the health plan as well as information on physician incentive plansdocument in no more than seven (7) business days from the date of the request. The If, for example, the member received a wellness visit reminder flyer and called the Contractor must to ask for the flyer to be sent in braille, the Contractor shall take no more than seven (7) business days to mail the braille version from the date of the member request call. For first-time or one-time requests from a member, when the mailing is governed by NCQA or statutory requirements, the Contract shall have in place policies and procedures two (2) additional days from t he NCQA or statutory timeframe to ensure that materials are accurate in content, accurate in translation relevant mail the document if no mailing has yet been sent to language or alternate formats and do not defraud, mislead or confuse the member. The For first-time or one-time requests from a member, when the mailing is governed by NCQA or statutory requirements and the statutory notice has already been fulfilled with a regular printed letter, the Contractor must provide information requested by shall mail the Statealternate version of the document in no more than seven (7) business days from the date of the request. For existing on-going alternate format requests, or the State’s designeeContractor shall have two (2) additional business days from when the document would normally be required to be mailed, to mail the document in the alternate format. If, for use example, a member had previously requested materials in braille, and an ID card would be sent to the member education and enrollmentin five (5) business days, upon request.the timeline would be seven (7) business days for the braille version. The additional two (2) days applies for Contract requirements (such as ID cards)
Appears in 1 contract
Samples: Contract #0000000000000000000051704
