Common use of Enrollee Communications Clause in Contracts

Enrollee Communications. CMS and California agree that enrollee and prospective enrollee materials, in all forms, shall require prior approval by California and CMS and in accordance with all existing rules and regulation, unless CMS and California agree to changes to those rules, pursuant to applicable Medicare and Medicaid waiver authority and specific in Appendix 4 or 5, in order to meet the needs of the Demonstration. CMS and California will also work to develop pre-approved documents that may be used, under certain circumstances, without additional CMS or State approval. CMS and California will develop integrated materials that include, but not be limited to: outreach and education materials; enrollment and disenrollment materials; benefit coverage information; and operational letters for enrollment, disenrollment, claims or service denials, complaints, internal appeals, external appeals, and provider terminations. Such uniform/integrated materials will be required to be accessible and understandable to enrollees and their caregivers, including but not limited to those with cognitive and functional limitations and limited English proficiency, in accordance with Federal guidelines for Medicare and Medicaid. Where Medicare and Medicaid standards differ, the standard providing the greatest access to individuals with disabilities or limited English proficiency will apply.