Common use of Potential Enrollee and Enrollee Communication Clause in Contracts

Potential Enrollee and Enrollee Communication. 3.6.1 Communications Compliance with Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act. Title VI of the Civil Rights Act of 1964, 42 USC § 2000d et. seq., and 45 CFR Part 80 provide that no person shall be subjected to discrimination on the basis of race, color or national origin under any program or activity that receives Federal financial assistance and that in order to avoid discrimination against persons with limited English proficiency (LEP) and for LEP persons to have meaningful access to programs and services, the MCO must take adequate steps to ensure that such persons receive the language assistance necessary, free of charge. The MCO shall comply with the recommendations of the revised Policy Guidelines published on August 4, 2003 by the Office for Civil Rights of the Department of Health and Human Services, titled “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons” (hereinafter “Guidance” ) and take reasonable steps to ensure meaningful access to the MCO’s programs and services by LEP persons, pursuant to that document. The MCO shall apply, and require its Providers and subcontractors to apply, the four factors described in the Guidance to the various kinds of contacts they have with the public to assess language needs, and decide what reasonable steps, if any, they should take to ensure meaningful access for LEP persons. The MCO shall document its application of the factors described in the Guidance to the services and programs it provides. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health care programs and activities receiving federal financial assistance. The MCO will provide auxiliary aids and services, like qualified interpreters or information in accessible formats, free of charge and in a timely manner, to ensure an equal opportunity to participate in Minnesota Health Care Programs. The MCO will also provide translated documents and spoken language interpreting, free of charge and in a timely manner, when language assistance services are necessary to ensure limited English speakers have meaningful access to programs and services that are offered by the MCO.

Potential Enrollee and Enrollee Communication. 3.6.1 ‌ For SNBC SNP Enrollees. The SNBC MCO agrees to integrate all Medicare (including Part D) and Medicaid materials provided to Enrollees and Potential Enrollees to the extent allowed by CMS and the STATE. The STATE and the MCO will develop model materials for this purpose using guides provided by CMS. The MCO will work with the STATE to assure that where CMS language misrepresents or does not cover information about all Medicare and Medicaid benefits available to SNBC SNP Enrollees, clarifying language is included.‌ Communications Compliance with Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act. Title VI of the Civil Rights Act of 1964, 42 USC USC‌ § 2000d et. seq., and 45 CFR Part 80 provide that no person shall be subjected to discrimination on the basis of race, color or national origin under any program or activity that receives Federal financial assistance and that in order to avoid discrimination against persons with limited English proficiency (LEP) and for LEP persons to have meaningful access to programs and services, the MCO must take adequate steps to ensure that such persons receive the language assistance necessary, free of charge. The MCO shall comply with the recommendations of the revised Policy Guidelines published on August 4, 2003 2003, by the Office for Civil Rights of the Department of Health and Human Services, titled “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons” (hereinafter “Guidance” ”) and take reasonable steps to ensure meaningful access to the MCO’s programs and services by LEP persons, pursuant to that document. The MCO shall apply, and require its Providers and subcontractors to apply, the four factors described in the Guidance to the various kinds of contacts they have with the public to assess language needs, and decide what reasonable steps, if any, they should take to ensure meaningful access for LEP persons. The MCO shall document its application of the factors described in the Guidance to the services and programs it provides. The MCO shall provide to the STATE a copy of its Limited English Proficiency (LEP ) plan for its current service area annually. The MCO shall use the LEP plan template provided by the STATE as the minimum requirements of the plan, but may add additional measures. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health care programs and activities receiving federal financial assistance. The MCO will provide auxiliary aids and services, like qualified interpreters or information in accessible formats, free of charge and in a timely manner, to ensure an equal opportunity to participate in Minnesota Health Care Programs. Programs The MCO will also provide translated documents and spoken language interpreting, free of charge and in a timely manner, when language assistance services are necessary to ensure limited English speakers have meaningful access to programs and services that are offered by the MCO. Communications Compliance with the Americans with Disabilities Act.‌ (Americans with Disabilities Act of 1990, 42 USC, § 1210, et seq.; hereafter “ADA”). All communications with Enrollees must be consistent with the ADA’s prohibition on unnecessary inquiries into the existence of a disability. The MCO shall have information available in alternative formats and through the provision of auxiliary aids and services for the MCO’s health programs and activities, in an appropriate manner that takes into consideration the Beneficiary or Enrollee’s special needs, including those who have visual impairment or limited reading proficiency, and at no cost to the Beneficiary or Enrollee. Requirements for Potential Enrollee or Enrollee Communication.‌ Enrollee Information. The MCO shall submit to the STATE for review and approval written information intended for Potential Enrollees or Enrollees.‌ Information requiring approval is listed in the Materials Guide posted on the DHS managed care web site. The list of materials identifies information that is submitted for purposes of file and use, information only, STATE review and approval, or information not to be submitted. The STATE will notify the MCO of any changes or updates to the Materials Guide. The MCO will use the STATE-approved discrimination and complaint notice which includes the accessibility (auxiliary aids and services) language, and include this information with written communications from the MCO to Enrollees. The auxiliary aids and services language must be in a fourteen (14)point font size in the notice. These communications can either incorporate the notice information into the written communication or include it with the communication as a separate document. Any waiver from this requirement must be prior approved by the STATE. Written material for SNBC SNP Enrollees will include both Medicare and Medicaid information. The MCO shall determine and translate vital documents by qualified translators as defined in 45 CFR § 92.4, and provide them to households speaking a prevalent non-English language, whenever the MCO determines that five percent (5%) or one thousand (1,000) persons, whichever is less, of the population of persons eligible to be served or likely to be affected or encountered in the MCO’s Service Area speak a non-English language. If a Potential Enrollee or Enrollee speaks any non-English language, regardless of whether it meets the threshold, the MCO must provide that the Potential Enrollee or Enrollee receives information in his or her primary language, free of charge, by providing oral interpretation or through other means determined by the MCO. Language and Format. All material sent by the MCO targeting Potential Enrollees or Enrollees under this Contract shall include The STATE’s sixteen (16) tagline language block, and A large print (no smaller than 18 point) tagline, with information on how to request the materials in large print, free of charge. For significant smaller materials, such as tri-fold brochures or postcards the MCO must use the STATE’s three (3) tagline language block that reflects the STATE’s two top languages spoken by Enrollees with limited English proficiency. The MCO may request a change from this requirement, which must be approved by the STATE. Readability Test. All written materials, including Marketing, new Enrollee information, member handbooks, Grievance, Appeal and State Fair Hearing information and other written information, that target Potential Enrollees or Enrollees under this Contract and are disseminated to Potential Enrollees or Enrollees by the MCO in English must be understandable to a person who reads at the seventh grade