Common use of Member Education Clause in Contracts

Member Education. Member education is defined as educational activities and materials directed at Enrollees of a CONTRACTOR’s Health Plan that increases the awareness, and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. The CONTRACTOR shall: 3.14.1. Through the initial mailing to all Members educate the member regarding the appropriate utilization of Medicaid services. Verbal education may compliment but not replace written materials. Please refer to Section 4 of this contract for more information regarding Medicaid services. 3.14.2. Include information and materials that inform the Member on the CONTRACTOR’s Policies, Procedures, requirements and practices. 3.14.3. Provide education no later than fourteen (14) Calendar Days from the CONTRACTOR’s receipt of Enrollment data from the Department, or its designee, and as needed thereafter. 3.14.4. Identify and educate Medicaid Managed Care Members who access the healthcare system inappropriately and provide continuing education as needed. 3.14.5. Be responsible for reminding pregnant Members that their Newborns will be automatically enrolled for the birth month and that the Medicaid Managed Care Member may choose to enroll the Newborn in another CONTRACTOR’s Health Plan after delivery by contacting South Carolina Healthy Connections Choices. 3.14.6. Ensure that where at least five (5) percent or more of the resident population of a county is non-English speaking and speaks a specific foreign language, materials will be made available in that specific language to assure a reasonable chance for all Medicaid Managed Care Members to understand how to access the CONTRACTOR and use services appropriately. 3.14.7. Have written Policies and Procedures for educating Medicaid Managed Care Members about their benefits. 3.14.8. Coordinate with the Department or its designee on Medicaid Managed Care Member education activities as outlined in the Managed Care Policy and Procedure Guide to meet the health care educational needs of the Medicaid Managed Care Members. 3.14.9. Not discriminate against Medicaid Managed Care Members on the basis of their health history, health status or need for health care services. 3.14.9.1. This applies to Enrollment, re-Enrollment or Disenrollment from the CONTRACTOR's Health Plan. 3.14.10. Refer to the Department’s Managed Care Policy and Procedure Guide for further guidance on Member education materials and activities.

Member Education. Member education is defined as educational activities and materials directed at Enrollees of a CONTRACTOR’s Health Plan that increases the awareness, and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. The CONTRACTOR shall: 3.14.1. Through the initial mailing to all Members educate the member regarding the appropriate utilization of Medicaid services. Verbal education may compliment but not replace written materials. Please refer to Section 4 of this contract for more information regarding Medicaid services. 3.14.2. Include information and materials that inform the Member on the CONTRACTOR’s Policies, Procedures, requirements requirements, and practices. 3.14.3. Provide education no later than fourteen (14) Calendar Days from the CONTRACTOR’s receipt of Enrollment data from the Department, or its designee, and as needed thereafter. 3.14.4. Identify and educate Medicaid Managed Care Members who access the healthcare system inappropriately and provide continuing education as needed. 3.14.5. Be responsible for reminding pregnant Members that their Newborns will be automatically enrolled for the birth month and that the Medicaid Managed Care Member may choose to enroll the Newborn in another CONTRACTOR’s Health Plan after delivery by contacting South Carolina Healthy Connections Choices. 3.14.6. Ensure that where at least five (5) percent or more of the resident population of a county is non-English speaking and speaks a specific foreign language, materials will be made available in that specific language to assure a reasonable chance for all Medicaid Managed Care Members to understand how to access the CONTRACTOR and use services appropriately. 3.14.7. Have written Policies and Procedures for educating Medicaid Managed Care Members about their benefits. 3.14.8. Coordinate with the Department or its designee on Medicaid Managed Care Member education activities as outlined in the Managed Care Policy and Procedure Guide to meet the health care educational needs of the Medicaid Managed Care Members. 3.14.9. Not discriminate against Medicaid Managed Care Members on the basis of their health history, health status or need for health care services. 3.14.9.1. This applies to Enrollment, re-Enrollment or Disenrollment from the CONTRACTOR's Health Plan. 3.14.10. Refer to the Department’s Managed Care Policy and Procedure Guide for further guidance on Member education materials and activities.

Member Education. Member education Education is defined as educational activities and materials directed at Enrollees enrollees of a CONTRACTOR’s Health Plan that increases the awareness, and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. The CONTRACTOR shall: 3.14.13.15.1. Through Educate by written documentation to all Members in the initial mailing to all Members educate the member regarding the appropriate utilization of Medicaid services. Verbal education may compliment but not replace written materials. Please refer to Section 4 of this contract Contract for more information regarding Medicaid services. 3.14.23.15.2. Include information and materials that inform the Member on the CONTRACTOR’s Policies, Proceduresprocedures, requirements and practices. 3.14.33.15.3. Provide education no later than fourteen (14) Calendar Days calendar days from the CONTRACTOR’s receipt of Enrollment enrollment data from the Department, or its designee, and as needed thereafter. 3.14.43.15.4. Identify and educate Medicaid Managed Care Members who access the healthcare system inappropriately and provide continuing education as needed. 3.14.53.15.5. Be responsible for reminding pregnant Members that their Newborns newborns will be automatically enrolled for the birth month and that the Medicaid Managed Care Member may choose to enroll the Newborn in another CONTRACTOR’s Health Plan after delivery by contacting South Carolina Healthy Connections Choices. 3.14.63.15.6. Ensure that where at least five (5) percent or more of the resident population of a county is non-English speaking and speaks a specific foreign language, materials will be made available in that specific language to assure a reasonable chance for all Medicaid Managed Care Members to understand how to access the CONTRACTOR and use services appropriately. 3.14.73.15.7. Have written Policies policies and Procedures procedures for educating Medicaid Managed Care Members about their benefits. 3.14.83.15.8. Coordinate with the Department or its designee on Medicaid Managed Care Member education activities as outlined in the Managed Care Policy and Procedure Guide Manual to meet the health care educational needs of the Medicaid Managed Care Members. 3.14.93.15.9. Not discriminate against Medicaid Managed Care Members on the basis of their health history, health status or need for health care services. 3.14.9.1. This applies to Enrollmentenrollment, re-Enrollment enrollment or Disenrollment disenrollment from the CONTRACTOR's Health Plan. 3.14.103.15.10. Refer to the Department’s Managed Care Policy and Procedure Guide for further guidance on Member education Education materials and activities.

Member Education. Member education Education is defined as educational activities and materials directed at Enrollees enrollees of a CONTRACTOR’s Health Plan that increases the awareness, and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. The CONTRACTOR shall: 3.14.13.15.1. Through Educate by written documentation to all Members in the initial mailing to all Members educate the member regarding the appropriate utilization of Medicaid services. Verbal education may compliment but not replace written materials. Please refer to Section 4 of this contract Contract for more information regarding Medicaid services. 3.14.23.15.2. Include information and materials that inform the Member on the CONTRACTOR’s Policies, Proceduresprocedures, requirements and practices. 3.14.33.15.3. Provide education no later than fourteen (14) Calendar Days calendar days from the CONTRACTOR’s receipt of Enrollment enrollment data from the Department, or its designee, and as needed thereafter. 3.14.43.15.4. Identify and educate Medicaid Managed Care Members who access the healthcare system inappropriately and provide continuing education as needed. 3.14.53.15.5. Be responsible for reminding pregnant Members that their Newborns newborns will be automatically enrolled for the birth month and that the Medicaid Managed Care Member may choose to enroll the Newborn in another CONTRACTOR’s Health Plan after delivery by contacting South Carolina Healthy Connections Choices. 3.14.63.15.6. Ensure that where at least five (5) percent or more of the resident population of a county is non-English speaking and speaks a specific foreign language, materials will be made available in that specific language to assure a reasonable chance for all Medicaid Managed Care Members to understand how to access the CONTRACTOR and use services appropriately. 3.14.73.15.7. Have written Policies policies and Procedures procedures for educating Medicaid Managed Care Members about their benefits. 3.14.83.15.8. Coordinate with the Department or its designee on Medicaid Managed Care Member education activities as outlined in the Managed Care Policy and Procedure Guide Manual to meet the health care educational needs of the Medicaid Managed Care Members. 3.14.93.15.9. Not discriminate against Medicaid Managed Care Members on the basis of their health history, health status or need for health care services. 3.14.9.13.15.9.1. This applies to Enrollmentenrollment, re-Enrollment enrollment or Disenrollment disenrollment from the CONTRACTOR's Health Plan. 3.14.103.15.10. Refer to the Department’s Managed Care Policy and Procedure Guide for further guidance on Member education Education materials and activities.

Member Education. Member education is defined as educational activities and materials directed at Enrollees of a CONTRACTOR’s Health Plan that increases the awareness, and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. The CONTRACTOR shall: 3.14.13.13.1. Through the initial mailing to all Members educate the member regarding the appropriate utilization of Medicaid services. Verbal education may compliment but not replace written materials. Please refer to Section 4 of this contract for more information regarding Medicaid services. 3.14.23.13.2. Include information and materials that inform the Member on the CONTRACTOR’s Policies, Procedures, requirements requirements, and practicespractices including member rights and responsibilities. 3.14.33.13.3. Provide education no later than fourteen (14) Calendar Days from the CONTRACTOR’s receipt of Enrollment data from the Department, or its designee, and as needed thereafter. 3.14.43.13.4. Identify and educate Medicaid Managed Care Members who access the healthcare system inappropriately and provide continuing education as needed. 3.14.53.13.5. Be responsible for reminding pregnant Members that their Newborns will be automatically enrolled for the birth month and that the Medicaid Managed Care Member may choose to enroll the Newborn in another CONTRACTOR’s Health Plan after delivery by contacting South Carolina Healthy Connections ChoicesChoices within ninety (90) days of birth. 3.14.63.13.6. Ensure Based on the most recent county census data, ensure that where at least five (5) percent or more of the resident population of a county is non-English speaking and speaks a specific foreign language, materials will be made available in that specific language to assure a reasonable chance for all Medicaid Managed Care Members to understand how to access the CONTRACTOR and use services appropriately. 3.14.73.13.7. Have written Policies and Procedures for educating Medicaid Managed Care Members about their benefits. 3.14.83.13.8. Coordinate with the Department or its designee on Medicaid Managed Care Member education activities as outlined in the Managed Care Policy and Procedure Guide to meet the health care educational needs of the Medicaid Managed Care Members. 3.14.93.13.9. Not discriminate against Medicaid Managed Care Members on the basis of their health history, health status or need for health care services. 3.14.9.13.13.9.1. This applies to Enrollment, re-Enrollment or Disenrollment from the CONTRACTOR's Health Plan. 3.14.103.13.10. Refer to the Department’s Managed Care Policy and Procedure Guide for further guidance on Member education materials and activities.