Common use of Use of Subcontractors for Marketing Clause in Contracts

Use of Subcontractors for Marketing. The MCO may not use subcontractors to market MSHO to MSHO-eligible individuals not currently enrolled in the MCO. Direct Marketing for MSC+. Direct Marketing for MSC+ is not allowed, except for mailing and publications set forth in section 3.6.4(G). Except through mailings and publications, the MCO, which includes any of its subcontractors, agents, independent contractors, employees and Providers, is restricted from Marketing and promotion to Beneficiaries who are not enrolled in the MCO. This restriction includes but is not limited to: telephone Marketing, face-to-face Marketing, promotion, cold- calling, or direct mail Marketing. Mailings shall not contain false or misleading information. The MCO shall not make any written or oral assertions or statements that a Beneficiary or Enrollee must enroll in the MCO in order to obtain or maintain covered benefits, or that the MCO is endorsed by CMS, the STATE, or federal government. MSHO Marketing Consistent with CMS Requirements: The MCO, its agents and Marketing representatives, shall not: Offer or grant any reward, favor, compensation or provide for cash or any other monetary rebate, as an inducement to a Beneficiary or an MSHO Enrollee to enroll in the MCO. This restriction does not prohibit the MCO from explaining any legitimate benefits a Beneficiary might obtain as an Enrollee of the MCO. The MCO shall not seek to influence a Recipient’s enrollment with the MCO in conjunction with the sale of any private insurance. Offer or grant any reward, favor or compensation to a person, county or organization that is not directly hired or contracted by the MCO to conduct marketing, who in the process of informing potential Enrollees about Medical Assistance or other Medicare Programs, steers or attempts to steer the potential Enrollee toward a specific plan or limited number of plans. Engage in any discriminatory activities. Engage in any activities that could mislead or confuse Beneficiaries, or misrepresent the MCO. Make any written or oral assertions or statements that a Beneficiary or Enrollee must enroll in the MCO in order to obtain or maintain Medical Assistance and covered Medicare benefits, or that the MCO is endorsed by CMS, Medicare, the STATE, or federal government. The MCO may explain that it is approved for participation in Medicare. Conduct door-to-door solicitation to current or potential MSHO Enrollees. In addition, the MCO must comply with Medicaid regulations that do not allow direct or indirect telephone or other cold-call marketing activities to potential MSHO Enrollees. Distribute Marketing Materials for which the MCO has not received STATE and CMS approval. Enrollment Confirmation for MSHO. In its Marketing for MSHO, the MCO must establish and maintain a system for confirming that enrolled Dual Eligible Beneficiaries have in fact enrolled in the MCO and understand the rules applicable under the plan. The enrollment form must include a statement indicating to Enrollees that upon voluntary disenrollment from MSHO, they will remain enrolled in the MCO’s MSC+ product, unless they request the STATE to return them to the MSC+ product in which they were enrolled immediately prior to enrollment in MSHO. If the MCO does not comply with the requirements of this section, the STATE may seek remedies including, but not limited to, the remedies specified in section 5.6 of this Contract. Mailings to Beneficiaries for MSHO and MSC+. The MCO may make no more than two mailings per calendar year to Enrollees of the MCO, or potential Enrollees who reside in the MCO’s Service Area. Two mailings per calendar year means the MCO may request no more than two mailing lists from the STATE per Contract. Additional mailings will only be allowed upon approval by the STATE, and limited to Service Area expansion, new programs, or other changes initiated by the STATE. Other Publications. The MCO, acting indirectly through the publications and other material distributed by the Local Agency or the STATE, or through mass media advertising (including the internet), may inform Beneficiaries who reside in the Service Area of this Contract of the availability of medical coverage through the MCO, the location and hours of service and other plan characteristics, subject to section 3.6.5. The MCO may distribute brochures and display posters at physician offices and clinics, informing patients that the clinic or physician is part of the MCO’s Provider Network, provided that all MCOs contracted with the Provider have an equal opportunity to be represented. The MCO may provide health education materials for Enrollees in Providers’ offices. All posters, brochures and Provider Network-related materials must be prior approved by the STATE and/or CMS as required in accordance with section 3.6.5(A).

Use of Subcontractors for Marketing. The MCO may not use subcontractors to market MSHO to MSHO-eligible individuals not currently enrolled in the MCO. Direct Marketing for MSC+. Direct Marketing for MSC+ is not allowed, except for mailing and publications set forth in section 3.6.4(G). Except through mailings and publications, the MCO, which includes any of its subcontractors, agents, independent contractors, employees and Providers, is restricted from Marketing and promotion to Beneficiaries who are not enrolled in the MCO. This restriction includes but is not limited to: telephone Marketing, face-to-face Marketing, promotion, cold- calling, or direct mail Marketing. Mailings shall not contain false or misleading information. The MCO shall not make any written or oral assertions or statements that a Beneficiary or Enrollee must enroll in the MCO in order to obtain or maintain covered benefits, or that the MCO is endorsed by CMS, the STATE, or federal government. MSHO Marketing Consistent with CMS Requirements: The MCO, its agents and Marketing representatives, shall not: Offer or grant any reward, favor, compensation or provide for cash or any other monetary rebate, as an inducement to a Beneficiary or an MSHO Enrollee to enroll in the MCO. This restriction does not prohibit the MCO from explaining any legitimate benefits a Beneficiary might obtain as an Enrollee of the MCO. The MCO shall not seek to influence a Recipient’s enrollment with the MCO in conjunction with the sale of any private insurance. Offer or grant any reward, favor or compensation to a person, county or organization that is not directly hired or contracted by the MCO to conduct marketing, who in the process of informing potential Enrollees about Medical Assistance or other Medicare Programs, steers or attempts to steer the potential Enrollee toward a specific plan or limited number of plans. Engage in any discriminatory activities. Engage in any activities that could mislead or confuse Beneficiaries, or misrepresent the MCO. Make any written or oral assertions or statements that a Beneficiary or Enrollee must enroll in the MCO in order to obtain or maintain Medical Assistance and covered Medicare benefits, or that the MCO is endorsed by CMS, Medicare, the STATE, or federal government. The MCO may explain that it is approved for participation in Medicare. Conduct door-to-door solicitation to current or potential MSHO Enrollees. In addition, the MCO must comply with Medicaid regulations that do not allow direct or indirect telephone or other cold-call marketing activities to potential MSHO Enrollees. Distribute Marketing Materials for which the MCO has not received STATE and CMS approval. Enrollment Confirmation for MSHO. In its Marketing for MSHO, the MCO must establish and maintain a system for confirming that enrolled Dual Eligible Beneficiaries have in fact enrolled in the MCO and understand the rules applicable under the plan. The enrollment form must include a statement indicating to Enrollees that upon voluntary disenrollment from MSHO, they will remain enrolled in the MCO’s MSC+ product, unless they request the STATE to return them to the MSC+ product in which they were enrolled immediately prior to enrollment in MSHO. If the MCO does not comply with the requirements of this section, the STATE may seek remedies including, but not limited to, the remedies specified in section 5.6 of this Contract. Mailings to Beneficiaries for MSHO and MSC+. The MCO may make no more than two mailings per calendar year to Enrollees of the MCO, or potential Enrollees who reside in the MCO’s Service Area. Two mailings per calendar year means the MCO may request no more than two mailing lists from the STATE per Contract. Additional mailings will only be allowed upon approval by the STATE, and limited to Service Area expansion, new programs, or other changes initiated by the STATE. STATE.‌ Other Publications. The MCO, acting indirectly through the publications and other material distributed by the Local Agency or the STATE, or through mass media advertising (including the internet), may inform Beneficiaries who reside in the Service Area of this Contract of the availability of medical coverage through the MCO, the location and hours of service and other plan characteristics, subject to section 3.6.5. The MCO may distribute brochures and display posters at physician offices and clinics, informing patients that the clinic or physician is part of the MCO’s Provider Network, provided that all MCOs contracted with the Provider have an equal opportunity to be represented. The MCO may provide health education materials for Enrollees in Providers’ offices. All posters, brochures and Provider Network-related materials must be prior approved by the STATE and/or CMS as required in accordance with section 3.6.5(A).