Requirements for Potential Enrollee or Enrollee Communication Clause Samples

This clause establishes the standards and procedures for communicating with individuals who are either potential enrollees or current enrollees in a program or service. It typically outlines the types of information that must be provided, the methods of communication allowed (such as written notices, electronic messages, or phone calls), and any required timelines for delivering information. By setting clear expectations for how and when communication should occur, the clause ensures that enrollees and potential enrollees receive timely, accurate, and accessible information, thereby promoting transparency and informed decision-making.
Requirements for Potential Enrollee or Enrollee Communication. Written 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 website. 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. Written material for MSHO will include both Medicare and Medicaid information. The MCO will use the STATE-approved discrimination and complaint notice which includes the accessibility 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. 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 free of charge information in his or her primary language, by providing oral interpretation or through other means determined by the MCO. Language Block. All material sent by the MCO targeting Potential Enrollees or Enrollees under this Contract shall include the STATE’s fifteen (15) tagline language block. For significant smaller materials, such as tri-fold brochures or postcards the MCO must use the STATE’s two (2) 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.
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Requirements for Potential Enrollee or Enrollee Communication. ‌ The MCO shall submit to the STATE for review and approval written information intended for Potential Enrollees or Enrollees. 3.11.4.1 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. 3.11.4.2 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 language assistance 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. [42 CFR §438.10(d)(2), and (3); DHS Civil Rights Notice #CB-5] 3.11.4.3 Written material for SNBC SNP Enrollees will include both Medicare and Medicaid information.
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Requirements for Potential Enrollee or Enrollee Communication. ‌ The MCO shall submit to the STATE for review and approval written information intended for Potential Enrollees or Enrollees. 3.10.3.1 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. Written material for MSHO will include both Medicare and Medicaid information. 3.10.3.2 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 language assistance 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. [42 CFR §438.10(d)(2), and (3); DHS Civil Rights Notice #CB-5] 3.10.3.3 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
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Requirements for Potential Enrollee or Enrollee Communication. ‌ The MCO shall submit to the STATE for review and approval written information intended for Potential Enrollees or Enrollees. 3.11.4.1 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. 3.11.4.2 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 language assistance 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. [42 CFR §438.10(d)(2), and (3); DHS Civil Rights Notice #CB-5] 3.11.4.3 Written material for SNBC SNP Enrollees will include both Medicare and Medicaid information. 3.11.4.4 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
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Requirements for Potential Enrollee or Enrollee Communication 
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