Common use of Website Information Clause in Contracts

Website Information. ‌ The Contractor shall post on its website in a prominent place, in multiple languages and formats: THE ORIENTATION PACKET; CONTACT INFORMATION FOR EOHHS’ OMBUDSMAN; A METHOD FOR SUBMITTING INQUIRIES, PROVIDING FEEDBACK, AND INITIATING GRIEVANCES, INCLUDING FOR ATTRIBUTED MEMBERS WHO DO NOT HAVE ACCESS TO EMAIL; THE IDENTITY, CONTACT INFORMATION, ADDRESSES, OPERATING HOURS, QUALIFICATIONS, AND AVAILABILITY OF THE CONTRACTOR’S AFFILIATED PROVIDERS; HOW ATTRIBUTED MEMBERS MAY ACCESS ORAL INTERPRETATION SERVICES FREE-OF-CHARGE IN ANY NON-ENGLISH LANGUAGE SPOKEN BY ATTRIBUTED MEMBERS; HOW ATTRIBUTED MEMBERS MAY ACCESS WRITTEN MATERIALS IN PREVALENT LANGUAGES AND ALTERNATIVE FORMATS; AND ADDITIONAL INFORMATION AS SPECIFIED BY EOHHS. DISENROLLMENT‌ The Contractor shall not request that EOHHS disenroll an Attributed Member from a Contracting MCO for any reason, not influence in any way a Participating PCP or a Contracting MCO such that the Participating PCP or Contracting MCO requests that EOHHS disenroll an Attributed Member from a Contracting MCO, and not request that EOHHS disenroll an Attributed Member from a Contracting MCO on behalf of the Contracting MCO. WRITTEN POLICIES REGARDING ATTRIBUTED MEMBERS’ RIGHTS‌ The Contractor shall coordinate with the Contracting MCO to provide Attributed Members with, and have written policies ensuring Attributed Members are guaranteed, the following rights, and ensure that the Contractor’s employees and Material Subcontractors observe and respect these rights: THE RIGHT TO RECEIVE WRITTEN INFORMATION IN ACCORDANCE WITH SECTION 2.6.C; THE RIGHT TO BE TREATED WITH RESPECT AND WITH DUE CONSIDERATION FOR HIS OR HER DIGNITY AND PRIVACY; THE RIGHT TO BE AFFORDED PRIVACY AND CONFIDENTIALITY IN ALL INTERACTIONS WITH THE CONTRACTOR AND ITS‌ AFFILIATED PROVIDERS, UNLESS OTHERWISE REQUIRED BY LAW; THE RIGHT TO RECEIVE INFORMATION ON AVAILABLE TREATMENT OPTIONS AND ALTERNATIVES, PRESENTED IN A MANNER APPROPRIATE TO THE ATTRIBUTED MEMBER’S CONDITION, CULTURE, FUNCTIONAL STATUS, LANGUAGE NEEDS, REQUIRED MODES OF COMMUNICATION, AND OTHER ACCESSIBILITY NEEDS; THE RIGHT TO PARTICIPATE IN ALL ASPECTS OF CARE AND TO EXERCISE ALL RIGHTS OF APPEAL; THE RIGHT TO BE FULLY INVOLVED IN MAINTAINING THEIR HEALTH AND MAKING DECISIONS ABOUT THEIR HEALTH CARE, INCLUDING THE RIGHT TO REFUSE TREATMENT IF DESIRED, AND TO BE APPROPRIATELY INFORMED AND SUPPORTED TO THIS END; THE RIGHT TO BE FREE FROM ANY FORM OF RESTRAINT OR SECLUSION USED AS A MEANS OF COERCION, DISCIPLINE, CONVENIENCE, OR RETALIATION, IN ACCORDANCE WITH APPLICABLE FEDERAL LAW; THE RIGHT TO REQUEST AND RECEIVE ANY OF THEIR MEDICAL RECORDS IN THE CONTRACTOR’S POSSESSION, AND BE NOTIFIED OF THE PROCESS FOR REQUESTING AMENDMENTS OR CORRECTIONS TO SUCH RECORDS; THE RIGHT TO FREELY EXERCISE THEIR RIGHTS SET FORTH IN THIS SECTION AND NOT HAVE THE EXERCISE OF THOSE RIGHTS ADVERSELY AFFECT THE MANNER IN WHICH THE CONTRACTOR OR ANY AFFILIATED PROVIDER TREATS THE ATTRIBUTED MEMBER; THE RIGHT TO BE NOTIFIED OF THESE RIGHTS AND CONSIDERATIONS AT LEAST ANNUALLY, IN A MANNER THAT THEY CAN UNDERSTAND, THAT TAKES INTO CONSIDERATION THEIR CULTURE, FUNCTIONAL STATUS, LANGUAGE NEEDS, AND REQUIRED MODES OF COMMUNICATION. THIS RIGHT SHALL INCLUDE THE RIGHT TO REQUEST AND OBTAIN THE INFORMATION LISTED IN THE ORIENTATION PACKET AT LEAST ONCE PER YEAR, AND THE RIGHT TO RECEIVE NOTICE OF ANY SIGNIFICANT CHANGE IN THE INFORMATION PROVIDED IN THE ORIENTATION PACKET AT LEAST 30 DAYS PRIOR TO THE INTENDED EFFECTIVE DATE OF THE CHANGE; THE RIGHT TO NOT BE DISCRIMINATED AGAINST BECAUSE OF THEIR RACE, ETHNICITY, NATIONAL ORIGIN, RELIGION, SEX, GENDER IDENTITY, AGE, SEXUAL ORIENTATION, MEDICAL OR CLAIMS HISTORY, MENTAL OR PHYSICAL DISABILITY, GENETIC INFORMATION, OR SOURCE OF PAYMENT, PER SECTION 1557 OF THE AFFORDABLE CARE ACT (ACA); THE RIGHT TO HAVE ALL THE CONTRACTOR’S OPTIONS AND RULES FULLY EXPLAINED TO THEM, INCLUDING THROUGH USE OF A QUALIFIED INTERPRETER OR ALTERNATE COMMUNICATION MODE IF NEEDED OR REQUESTED; THE RIGHT TO CHOOSE A PLAN AND PROVIDER THAT THEY QUALIFY FOR AT ANY TIME DURING THEIR ANNUAL PLAN SELECTION PERIOD, INCLUDING DISENROLLING FROM A CONTRACTING MCO AND ENROLLING IN A MASSHEALTH ACO, ANOTHER MASSHEALTH-CONTRACTED MCO, OR THE MASSHEALTH PCC PLAN; THE RIGHT TO RECEIVE TIMELY INFORMATION ABOUT CHANGES TO THE BENEFITS OR PROGRAMS OFFERED BY THE CONTRACTOR AT LEAST 30 DAYS PRIOR TO THE INTENDED DATE OF THE CHANGE; THE RIGHT TO DESIGNATE A REPRESENTATIVE IF THEY ARE UNABLE TO PARTICIPATE FULLY IN TREATMENT DECISIONS. THIS INCLUDES THE RIGHT TO HAVE TRANSLATION SERVICES AVAILABLE TO MAKE INFORMATION APPROPRIATELY ACCESSIBLE TO THEM OR TO THEIR REPRESENTATIVE; THE RIGHT TO RECEIVE A COPY OF AND TO APPROVE THEIR CARE PLAN, IF ANY; THE RIGHT TO EXPECT TIMELY, ACCESSIBLE, CULTURALLY AND LINGUISTICALLY COMPETENT, AND EVIDENCE-BASED TREATMENTS; THE RIGHT TO OBTAIN EMERGENCY CARE 24 HOURS A DAY, SEVEN DAYS A WEEK FROM ANY HOSPITAL OR OTHER EMERGENCY CARE SETTING; THE RIGHT TO DETERMINE WHO IS INVOLVED IN THEIR CARE TEAM, INCLUDING FAMILY MEMBERS, ADVOCATES, OR OTHER PROVIDERS OF THEIR CHOOSING; THE RIGHT TO RECEIVE A SECOND OPINION ON A MEDICAL PROCEDURE; THE RIGHT TO EXPERIENCE CARE AS DESCRIBED IN THIS CONTRACT, INCLUDING TO RECEIVE A CARE NEEDS SCREENING AND APPROPRIATE FOLLOW-UP; THE RIGHT TO HAVE ADVANCE DIRECTIVES EXPLAINED AND TO ESTABLISH THEM; THE RIGHT TO FILE GRIEVANCES AS DESCRIBED IN THIS CONTRACT, AND THE RIGHT TO ACCESS EOHHS’ APPEALS PROCESSES; AND THE RIGHT TO BE PROTECTED FROM LIABILITY FOR PAYMENT OF ANY FEES THAT ARE THE OBLIGATION OF THE CONTRACTOR; DISCRIMINATION POLICY‌ The Contractor shall not, in any way, discriminate or use any policy or practice that has the effect of discriminating against Attributed Members on the basis of health status or need for health care services, race, color, national origin, sex, sexual orientation, gender identity, or disability. ACCESS TO EMERGENCY SERVICES PROGRAM AND MOBILE CRISIS INTERVENTION SERVICES‌ The Contractor shall facilitate Attributed Members’ immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week. OTHER‌ The Contractor shall otherwise provide Attributed Members with care in accordance with Contractor’s responsibilities under Section 2.5 of this Contract. TOTAL COST OF CARE (TCOC) ACCOUNTABILITY REQUIREMENTS FOR APPROVED ACO AGREEMENTS‌ Each of the Contractor’s Approved ACO Agreements with a Contracting MCO shall include financial accountability for the Contractor’s performance on Total Cost of Care (TCOC) and Quality Measures, as set forth in this Section. CONTRACTING MCO AND EOHHS INVOLVEMENT IN TCOC CALCULATION‌ EOHHS WILL CALCULATE AND PROVIDE THE CONTRACTING MCO WITH VALUES RELATED TO THE TCOC CALCULATIONS FOR THE CONTRACTOR. THE CONTRACTING MCO SHALL, FOR ALL CALCULATIONS DESCRIBED IN SECTION 2.7, USE SUCH VALUES OR OTHER AMOUNTS CALCULATED AND PROVIDED TO THE CONTRACTING MCO BY EOHHS. THE CONTRACTING MCO SHALL PROVIDE EOHHS WITH ANY REQUESTED INFORMATION OR ASSISTANCE IN CALCULATING SUCH VALUES. VALUES RELATED TO THE TCOC CALCULATION SHALL INCLUDE BUT MAY NOT BE LIMITED TO: THE CONTRACTOR’S TCOC BENCHMARK;‌ THE CONTRACTOR’S TCOC PERFORMANCE; THE CONTRACTOR’S QUALITY SCORE;‌ THE CONTRACTOR’S SHARED SAVINGS OR SHARED LOSSES PAYMENT, AS MODIFIED BY THE CONTRACTOR’S QUALITY SCORE; AND OTHER VALUES AS SPECIFIED BY EOHHS. OPTIONAL ▇▇ ▇▇ ADULT RISK SHARING ARRANGEMENT‌ FOR EACH REGION AND RATING CATEGORY II ADULT (HEREINAFTER REFERRED TO AS “RCII ADULT ”), THE CONTRACTOR SHALL HAVE THE OPTION TO ELECT TO SHARE RISK WITH EOHHS FOR THE NON-HCV MEDICAL COMPONENT OF THE TCOC BENCHMARK IN ACCORDANCE WITH THE FOLLOWING PROVISIONS. EOHHS SHALL SPECIFY, PRIOR TO THE OPERATIONAL START DATE, THE DATE, FORM, AND FORMAT BY WHICH THE CONTRACTOR SHALL MAKE SUCH ELECTION. SHOULD THE CONTRACTOR ELECT TO SHARE RISK WITH EOHHS IN THIS WAY, THE CONTRACTOR’S ARRANGEMENT WITH EOHHS SHALL HEREINAFTER BE REFERRED TO AS “THE CONTRACTOR’S CHOSEN ▇▇ ▇▇ ADULT RISK SHARING ARRANGEMENT.” ALL REGIONS SELECTED BY THE CONTRACTOR FOR THE CONTRACTOR’S CHOSEN RCII ADULT RISK SHARING ARRANGEMENT (HEREINAFTER REFERRED TO AS “SELECTED RCII ADULT REGIONS”) SHALL BE EXCLUDED FROM THE CONTRACTOR’S AGGREGATE NON-HCV TCOC BENCHMARK FOR THE PURPOSES OF PERFORMING SHARED SAVINGS/SHARED LOSSES CALCULATIONS DESCRIBED IN SECTION 2.7.F.2. SELECTED ▇▇ ▇▇ ADULT REGIONS SHALL BE INCLUDED FOR THE PURPOSES OF PERFORMING SHARED SAVINGS/SHARED LOSSES CALCULATIONS DESCRIBED IN SECTION 2.7.F.3. SHARED SAVINGS OR SHARED LOSSES PAYMENT CALCULATIONS‌ The Contractor’s Shared Savings or Shared Losses payment for each Contract Year shall be calculated as follows: THE CONTRACTOR’S TCOC BENCHMARK SHALL BE CALCULATED AS DESCRIBED IN SECTION 2.7.E.2; THE CONTRACTOR’S TCOC PERFORMANCE SHALL BE CALCULATED AS DESCRIBED IN SECTION 2.7.E.2;‌ IF THE DIFFERENCE WHEN THE CONTRACTOR’S TCC PERFORMANCE IS SUBTRACTED FROM THE CONTRACTOR’S BENCHMARK IS EQUAL TO AN AMOUNT GREATER THAN ZERO (0), SUCH DIFFERENCE SHALL BE THE CONTRACTOR’S SAVINGS. IF SUCH DIFFERENCE IS EQUAL TO AN AMOUNT LESS THAN ZERO (0), SUCH DIFFERENCE SHALL BE THE CONTRACTOR’S LOSSES. IF SUCH DIFFERENCE EQUALS ZERO (0) AND CONTRACTOR’S TCOC PERFORMANCE AND TCOC BENCHMARK ARE EQUAL TO EACH OTHER, CONTRACTOR SHALL HAVE NEITHER SAVINGS NOR LOSSES FOR THE CONTRACT YEAR; AND IF CONTRACTOR HAS SAVINGS OR LOSSES, THE CONTRACTOR’S SHARED SAVINGS PAYMENT AMOUNT OR CONTRACTOR’S SHARED LOSSES PAYMENT AMOUNT, RESPECTIVELY, SHALL BE CALCULATED BASED ON CONTRACTOR’S RISK TRACK, AS DESCRIBED IN SECTION 2.7.D, AND BASED ON CONTRACTOR’S QUALITY SCORE, AS DESCRIBED IN SECTION 2.7.E. IF CONTRACTOR HAS NEITHER SAVINGS NOR LOSSES FOR THE CONTRACT YEAR, CONTRACTOR SHALL HAVE NEITHER A SHARED SAVINGS PAYMENT NOR A SHARED LOSSES PAYMENT. RISK TRACKS‌ THE CONTRACTOR SHALL, PRIOR TO THE OPERATIONAL START DATE OR OTHER DATE AS DETERMINED BY EOHHS, SELECT CONTRACTOR’S RISK TRACK FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK AND NOTIFY EOHHS IN WRITING OF SUCH SELECTION. CONTRACTOR’S RISK TRACK FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK SHALL BE RISK TRACK 1 – LIMITED ACCOUNTABILITY (AS DESCRIBED IN SECTION 2.7.D.2.B), RISK TRACK 2 – MODERATE ACCOUNTABILITY (AS DESCRIBED IN SECTION 2.7.D.2.C), OR RISK TRACK 3 – INCREASED ACCOUNTABILITY (AS DESCRIBED IN SECTION 2.7.D.2.D). AS FURTHER SPECIFIED BY EOHHS, THE CONTRACTOR MAY ANNUALLY CHANGE THE CONTRACTOR’S RISK TRACK PRIOR TO THE START OF A CONTRACT YEAR, AS APPROVED IN WRITING BY EOHHS. THE CONTRACTOR MAY NOT CHANGE THE CONTRACTOR’S RISK TRACK PRIOR TO THE START OF CONTRACT YEAR 1; RISK TRACKS FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK, AS DEFINED IN SECTION 2.7.F.2.G, SHALL BE APPLIED AS FOLLOWS: SHARED SAVINGS AND SHARED LOSSES PAYMENTS FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK SHALL BE CALCULATED SUBJECT TO THE FOLLOWING RISK CORRIDOR PROVISIONS: THE MINIMUM SAVINGS AND LOSSES RATE SHALL BOTH BE EQUAL TO EITHER ONE PERCENT (1%) OR TWO PERCENT (2%) OF THE NON-HCV COMPONENT OF THE TCOC BENCHMARK, AS CHOSEN BY THE CONTRACTOR IN ADVANCE OF EACH CONTRACT YEAR THROUGH A DEFINED PROCESS AND ACCORDING TO A TIMELINE SPECIFIED BY EOHHS. IF CONTRACTOR’S SAVINGS OR THE ABSOLUTE VALUE OF THE CONTRACTOR’S LOSSES ARE LESS THAN 2% OF THE NON-HCV COMPONENT OF THE TCOC BENCHMARK, THERE SHALL BE NO SHARED SAVINGS OR SHARED LOSSES PAYMENT. THE CONTRACTOR SHALL CHOOSE ITS MINIMUM SAVINGS AND LOSSES PERCENTAGE FOR EACH CONTRACT YEAR BY A DATE SPECIFIED BY EOHHS. THE CONTRACTOR MAY NOT CHANGE THE CONTRACTOR’S CHOSEN MINIMUM SAVINGS AND LOSSES PERCENTAGE UNTIL THE PROCESS BEGINS FOR THE NEXT CONTRACT YEAR; THE SAVINGS AND LOSSES CAP SHALL BE EQUAL TO TEN PERCENT (10%) OF THE NON-HCV COMPONENT OF THE TCOC BENCHMARK (HEREINAFTER REFERRED TO AS “THE NON-HCV CAP”). IF CONTRACTOR’S SAVINGS FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK ARE GREATER THAN THE THE NON-HCV CAP, CONTRACTOR’S SHARED SAVINGS PAYMENT SHALL BE CALCULATED AS IF CONTRACTOR’S SAVINGS WERE EQUAL TO THE NON-HCV CAP, AND CONTRACTOR SHALL RECEIVE NO ADDITIONAL SHARED SAVINGS PAYMENT FOR ANY SAVINGS BEYOND THE NON-HCV CAP. IF THE ABSOLUTE VALUE OF CONTRACTOR’S LOSSES FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK ARE GREATER THAN THE NON-HCV CAP, CONTRACTOR’S SHARED LOSSES PAYMENT SHALL BE CALCULATED AS IF THE ABSOLUTE VALUE OF CONTRACTOR’S LOSSES WERE EQUAL TO THE NON-HCV CAP, AND CONTRACTOR SHALL MAKE NO ADDITIONAL SHARED LOSSES PAYMENT FOR ANY LOSSES BEYOND THE NON-HCV CAP; RISK TRACK 1 – LIMITED ACCOUNTABILITY

Website Information. ‌ The Contractor shall post on its website in a prominent place, in multiple languages and formats: THE ORIENTATION PACKETThe Orientation Packet; CONTACT INFORMATION FOR Contact information for EOHHS’ OMBUDSMANOmbudsman; A METHOD FOR SUBMITTING INQUIRIESmethod for submitting inquiries, PROVIDING FEEDBACKproviding feedback, AND INITIATING GRIEVANCESand initiating Grievances, INCLUDING FOR ATTRIBUTED MEMBERS WHO DO NOT HAVE ACCESS TO EMAILincluding for Attributed Members who do not have access to email; THE IDENTITYThe identity, CONTACT INFORMATIONcontact information, ADDRESSESaddresses, OPERATING HOURSoperating hours, QUALIFICATIONSqualifications, AND AVAILABILITY OF THE CONTRACTOR’S AFFILIATED PROVIDERSand availability of the Contractor’s Affiliated Providers; HOW ATTRIBUTED MEMBERS MAY ACCESS ORAL INTERPRETATION SERVICES FREEHow Attributed Members may access oral interpretation services free-OFof-CHARGE IN ANY NON-ENGLISH LANGUAGE SPOKEN BY ATTRIBUTED MEMBERScharge in any non- English language spoken by Attributed Members; HOW ATTRIBUTED MEMBERS MAY ACCESS WRITTEN MATERIALS IN PREVALENT LANGUAGES AND ALTERNATIVE FORMATSHow Attributed Members may access written materials in Prevalent Languages and Alternative Formats; AND ADDITIONAL INFORMATION AS SPECIFIED BY and Additional information as specified by EOHHS. DISENROLLMENT‌ Disenrollment The Contractor shall not request that EOHHS disenroll an Attributed Member from a Contracting MCO for any reason, not influence in any way a Participating PCP or a Contracting MCO such that the Participating PCP or Contracting MCO requests that EOHHS disenroll an Attributed Member from a Contracting MCO, and not request that EOHHS disenroll an Attributed Member from a Contracting MCO on behalf of the Contracting MCO. WRITTEN POLICIES REGARDING ATTRIBUTED MEMBERSWritten Policies Regarding Attributed Members’ RIGHTS‌ Rights The Contractor shall coordinate with the Contracting MCO to provide Attributed Members with, and have written policies ensuring Attributed Members are guaranteed, the following rights, and ensure that the Contractor’s employees and Material Subcontractors observe and respect these rights: THE RIGHT TO RECEIVE WRITTEN INFORMATION IN ACCORDANCE WITH SECTION The right to receive written information in accordance with Section 2.6.C; THE RIGHT TO BE TREATED WITH RESPECT AND WITH DUE CONSIDERATION FOR HIS OR HER DIGNITY AND PRIVACYThe right to be treated with respect and with due consideration for his or her dignity and privacy; THE RIGHT TO BE AFFORDED PRIVACY AND CONFIDENTIALITY IN ALL INTERACTIONS WITH THE CONTRACTOR AND ITS‌ AFFILIATED PROVIDERSThe right to be afforded privacy and confidentiality in all interactions with the Contractor and its Affiliated Providers, UNLESS OTHERWISE REQUIRED BY LAWunless otherwise required by law; THE RIGHT TO RECEIVE INFORMATION ON AVAILABLE TREATMENT OPTIONS AND ALTERNATIVESThe right to receive information on available treatment options and alternatives, PRESENTED IN A MANNER APPROPRIATE TO THE ATTRIBUTED MEMBER’S CONDITIONpresented in a manner appropriate to the Attributed Member’s condition, CULTUREculture, FUNCTIONAL STATUSfunctional status, LANGUAGE NEEDSlanguage needs, REQUIRED MODES OF COMMUNICATIONrequired modes of communication, AND OTHER ACCESSIBILITY NEEDSand other accessibility needs; THE RIGHT TO PARTICIPATE IN ALL ASPECTS OF CARE AND TO EXERCISE ALL RIGHTS OF APPEALThe right to participate in all aspects of care and to exercise all rights of Appeal; THE RIGHT TO BE FULLY INVOLVED IN MAINTAINING THEIR HEALTH AND MAKING DECISIONS ABOUT THEIR HEALTH CAREThe right to be fully involved in maintaining their health and making decisions about their health care, INCLUDING THE RIGHT TO REFUSE TREATMENT IF DESIREDincluding the right to refuse treatment if desired, AND TO BE APPROPRIATELY INFORMED AND SUPPORTED TO THIS ENDand to be appropriately informed and supported to this end; THE RIGHT TO BE FREE FROM ANY FORM OF RESTRAINT OR SECLUSION USED AS A MEANS OF COERCIONThe right to be free from any form of restraint or seclusion used as a means of coercion, DISCIPLINEdiscipline, CONVENIENCEconvenience, OR RETALIATIONor retaliation, IN ACCORDANCE WITH APPLICABLE FEDERAL LAWin accordance with applicable federal law; THE RIGHT TO REQUEST AND RECEIVE ANY OF THEIR MEDICAL RECORDS IN THE CONTRACTOR’S POSSESSIONThe right to request and receive any of their medical records in the Contractor’s possession, AND BE NOTIFIED OF THE PROCESS FOR REQUESTING AMENDMENTS OR CORRECTIONS TO SUCH RECORDSand be notified of the process for requesting amendments or corrections to such records; THE RIGHT TO FREELY EXERCISE THEIR RIGHTS SET FORTH IN THIS SECTION AND NOT HAVE THE EXERCISE OF THOSE RIGHTS ADVERSELY AFFECT THE MANNER IN WHICH THE CONTRACTOR OR ANY AFFILIATED PROVIDER TREATS THE ATTRIBUTED MEMBERThe right to freely exercise their rights set forth in this Section and not have the exercise of those rights adversely affect the manner in which the Contractor or any Affiliated Provider treats the Attributed Member; THE RIGHT TO BE NOTIFIED OF THESE RIGHTS AND CONSIDERATIONS AT LEAST ANNUALLYThe right to be notified of these rights and considerations at least annually, IN A MANNER THAT THEY CAN UNDERSTANDin a manner that they can understand, THAT TAKES INTO CONSIDERATION THEIR CULTUREthat takes into consideration their culture, FUNCTIONAL STATUSfunctional status, LANGUAGE NEEDSlanguage needs, AND REQUIRED MODES OF COMMUNICATIONand required modes of communication. THIS RIGHT SHALL INCLUDE THE RIGHT TO REQUEST AND OBTAIN THE INFORMATION LISTED IN THE ORIENTATION PACKET AT LEAST ONCE PER YEARThis right shall include the right to request and obtain the information listed in the Orientation Packet at least once per year, AND THE RIGHT TO RECEIVE NOTICE OF ANY SIGNIFICANT CHANGE IN THE INFORMATION PROVIDED IN THE ORIENTATION PACKET AT LEAST and the right to receive notice of any significant change in the information provided in the Orientation Packet at least 30 DAYS PRIOR TO THE INTENDED EFFECTIVE DATE OF THE CHANGEdays prior to the intended effective date of the change; THE RIGHT TO NOT BE DISCRIMINATED AGAINST BECAUSE OF THEIR RACEThe right to not be discriminated against because of their race, ETHNICITYethnicity, NATIONAL ORIGINnational origin, RELIGIONreligion, SEXsex, GENDER IDENTITYgender identity, AGEage, SEXUAL ORIENTATIONsexual orientation, MEDICAL OR CLAIMS HISTORYmedical or claims history, MENTAL OR PHYSICAL DISABILITYmental or physical disability, GENETIC INFORMATIONgenetic information, OR SOURCE OF PAYMENTor source of payment, PER SECTION per Section 1557 OF THE AFFORDABLE CARE ACT of the Affordable Care Act (ACA); THE RIGHT TO HAVE ALL THE CONTRACTOR’S OPTIONS AND RULES FULLY EXPLAINED TO THEMThe right to have all the Contractor’s options and rules fully explained to them, INCLUDING THROUGH USE OF A QUALIFIED INTERPRETER OR ALTERNATE COMMUNICATION MODE IF NEEDED OR REQUESTEDincluding through use of a qualified interpreter or alternate communication mode if needed or requested; THE RIGHT TO CHOOSE A PLAN AND PROVIDER THAT THEY QUALIFY FOR AT ANY TIME DURING THEIR ANNUAL PLAN SELECTION PERIODThe right to choose a plan and provider that they qualify for at any time during their annual plan selection period, INCLUDING DISENROLLING FROM A CONTRACTING including disenrolling from a Contracting MCO AND ENROLLING IN A MASSHEALTH and enrolling in a MassHealth ACO, ANOTHER MASSHEALTHanother MassHealth-CONTRACTED contracted MCO, OR THE MASSHEALTH or the MassHealth PCC PLANPlan; THE RIGHT TO RECEIVE TIMELY INFORMATION ABOUT CHANGES TO THE BENEFITS OR PROGRAMS OFFERED BY THE CONTRACTOR AT LEAST The right to receive timely information about changes to the benefits or programs offered by the Contractor at least 30 DAYS PRIOR TO THE INTENDED DATE OF THE CHANGEdays prior to the intended date of the change; THE RIGHT TO DESIGNATE A REPRESENTATIVE IF THEY ARE UNABLE TO PARTICIPATE FULLY IN TREATMENT DECISIONSThe right to designate a representative if they are unable to participate fully in treatment decisions. THIS INCLUDES THE RIGHT TO HAVE TRANSLATION SERVICES AVAILABLE TO MAKE INFORMATION APPROPRIATELY ACCESSIBLE TO THEM OR TO THEIR REPRESENTATIVEThis includes the right to have translation services available to make information appropriately accessible to them or to their representative; THE RIGHT TO RECEIVE A COPY OF AND TO APPROVE THEIR CARE PLANThe right to receive a copy of and to approve their Care Plan, IF ANYif any; THE RIGHT TO EXPECT TIMELYThe right to expect timely, ACCESSIBLEaccessible, CULTURALLY AND LINGUISTICALLY COMPETENTCulturally and Linguistically Competent, AND EVIDENCEand evidence-BASED TREATMENTSbased treatments; THE RIGHT TO OBTAIN EMERGENCY CARE The right to obtain emergency care 24 HOURS A DAYhours a day, SEVEN DAYS A WEEK FROM ANY HOSPITAL OR OTHER EMERGENCY CARE SETTINGseven days a week from any hospital or other emergency care setting; THE RIGHT TO DETERMINE WHO IS INVOLVED IN THEIR CARE TEAMThe right to determine who is involved in their care team, INCLUDING FAMILY MEMBERSincluding family members, ADVOCATESadvocates, OR OTHER PROVIDERS OF THEIR CHOOSINGor other providers of their choosing; THE RIGHT TO RECEIVE A SECOND OPINION ON A MEDICAL PROCEDUREThe right to receive a second opinion on a medical procedure; THE RIGHT TO EXPERIENCE CARE AS DESCRIBED IN THIS CONTRACTThe right to experience care as described in this Contract, INCLUDING TO RECEIVE A CARE NEEDS SCREENING AND APPROPRIATE FOLLOWincluding to receive a Care Needs Screening and appropriate follow-UPup; THE RIGHT TO HAVE ADVANCE DIRECTIVES EXPLAINED AND TO ESTABLISH THEMThe right to have advance directives explained and to establish them; THE RIGHT TO FILE GRIEVANCES AS DESCRIBED IN THIS CONTRACTThe right to file Grievances as described in this Contract, AND THE RIGHT TO ACCESS and the right to access EOHHS’ APPEALS PROCESSESAppeals processes; AND THE RIGHT TO BE PROTECTED FROM LIABILITY FOR PAYMENT OF ANY FEES THAT ARE THE OBLIGATION OF THE CONTRACTORand The right to be protected from liability for payment of any fees that are the obligation of the Contractor; DISCRIMINATION POLICY‌ Discrimination Policy The Contractor shall not, in any way, discriminate or use any policy or practice that has the effect of discriminating against Attributed Members on the basis of health status or need for health care services, race, color, national origin, sex, sexual orientation, gender identity, or disability. ACCESS TO EMERGENCY SERVICES PROGRAM AND MOBILE CRISIS INTERVENTION SERVICES‌ Access to Emergency Services Program and Mobile Crisis Intervention Services The Contractor shall facilitate Attributed Members’ immediate and unrestricted access to Emergency Services Program and Mobile Crisis Intervention services at hospital emergency departments and in the community, 24 hours a day, seven days a week. OTHER‌ Other The Contractor shall otherwise provide Attributed Members with care in accordance with Contractor’s responsibilities under Section 2.5 of this Contract. TOTAL COST OF CARE (TCOC) ACCOUNTABILITY REQUIREMENTS FOR APPROVED ACO AGREEMENTS‌ Each of the Contractor’s Approved ACO Agreements with a Contracting MCO shall include financial accountability for the Contractor’s performance on Total Cost of Care (TCOC) and Quality Measures, as set forth in this Section. CONTRACTING MCO AND EOHHS INVOLVEMENT IN TCOC CALCULATION‌ EOHHS WILL CALCULATE AND PROVIDE THE CONTRACTING MCO WITH VALUES RELATED TO THE TCOC CALCULATIONS FOR THE CONTRACTOR. THE CONTRACTING MCO SHALL, FOR ALL CALCULATIONS DESCRIBED IN SECTION 2.7, USE SUCH VALUES OR OTHER AMOUNTS CALCULATED AND PROVIDED TO THE CONTRACTING MCO BY EOHHS. THE CONTRACTING MCO SHALL PROVIDE EOHHS WITH ANY REQUESTED INFORMATION OR ASSISTANCE IN CALCULATING SUCH VALUES. VALUES RELATED TO THE TCOC CALCULATION SHALL INCLUDE BUT MAY NOT BE LIMITED TO: THE CONTRACTOR’S TCOC BENCHMARK;‌ THE CONTRACTOR’S TCOC PERFORMANCE; THE CONTRACTOR’S QUALITY SCORE;‌ THE CONTRACTOR’S SHARED SAVINGS OR SHARED LOSSES PAYMENT, AS MODIFIED BY THE CONTRACTOR’S QUALITY SCORE; AND OTHER VALUES AS SPECIFIED BY EOHHS. OPTIONAL ▇▇ ▇▇ ADULT RISK SHARING ARRANGEMENT‌ FOR EACH REGION AND RATING CATEGORY II ADULT (HEREINAFTER REFERRED TO AS “RCII ADULT ”), THE CONTRACTOR SHALL HAVE THE OPTION TO ELECT TO SHARE RISK WITH EOHHS FOR THE NON-HCV MEDICAL COMPONENT OF THE TCOC BENCHMARK IN ACCORDANCE WITH THE FOLLOWING PROVISIONS. EOHHS SHALL SPECIFY, PRIOR TO THE OPERATIONAL START DATE, THE DATE, FORM, AND FORMAT BY WHICH THE CONTRACTOR SHALL MAKE SUCH ELECTION. SHOULD THE CONTRACTOR ELECT TO SHARE RISK WITH EOHHS IN THIS WAY, THE CONTRACTOR’S ARRANGEMENT WITH EOHHS SHALL HEREINAFTER BE REFERRED TO AS “THE CONTRACTOR’S CHOSEN ▇▇ ▇▇ ADULT RISK SHARING ARRANGEMENT.” ALL REGIONS SELECTED BY THE CONTRACTOR FOR THE CONTRACTOR’S CHOSEN RCII ADULT RISK SHARING ARRANGEMENT (HEREINAFTER REFERRED TO AS “SELECTED RCII ADULT REGIONS”) SHALL BE EXCLUDED FROM THE CONTRACTOR’S AGGREGATE NON-HCV TCOC BENCHMARK FOR THE PURPOSES OF PERFORMING SHARED SAVINGS/SHARED LOSSES CALCULATIONS DESCRIBED IN SECTION 2.7.F.2. SELECTED ▇▇ ▇▇ ADULT REGIONS SHALL BE INCLUDED FOR THE PURPOSES OF PERFORMING SHARED SAVINGS/SHARED LOSSES CALCULATIONS DESCRIBED IN SECTION 2.7.F.3. SHARED SAVINGS OR SHARED LOSSES PAYMENT CALCULATIONS‌ The Contractor’s Shared Savings or Shared Losses payment for each Contract Year shall be calculated as follows: THE CONTRACTOR’S TCOC BENCHMARK SHALL BE CALCULATED AS DESCRIBED IN SECTION 2.7.E.2; THE CONTRACTOR’S TCOC PERFORMANCE SHALL BE CALCULATED AS DESCRIBED IN SECTION 2.7.E.2;‌ IF THE DIFFERENCE WHEN THE CONTRACTOR’S TCC PERFORMANCE IS SUBTRACTED FROM THE CONTRACTOR’S BENCHMARK IS EQUAL TO AN AMOUNT GREATER THAN ZERO (0), SUCH DIFFERENCE SHALL BE THE CONTRACTOR’S SAVINGS. IF SUCH DIFFERENCE IS EQUAL TO AN AMOUNT LESS THAN ZERO (0), SUCH DIFFERENCE SHALL BE THE CONTRACTOR’S LOSSES. IF SUCH DIFFERENCE EQUALS ZERO (0) AND CONTRACTOR’S TCOC PERFORMANCE AND TCOC BENCHMARK ARE EQUAL TO EACH OTHER, CONTRACTOR SHALL HAVE NEITHER SAVINGS NOR LOSSES FOR THE CONTRACT YEAR; AND IF CONTRACTOR HAS SAVINGS OR LOSSES, THE CONTRACTOR’S SHARED SAVINGS PAYMENT AMOUNT OR CONTRACTOR’S SHARED LOSSES PAYMENT AMOUNT, RESPECTIVELY, SHALL BE CALCULATED BASED ON CONTRACTOR’S RISK TRACK, AS DESCRIBED IN SECTION 2.7.D, AND BASED ON CONTRACTOR’S QUALITY SCORE, AS DESCRIBED IN SECTION 2.7.E. IF CONTRACTOR HAS NEITHER SAVINGS NOR LOSSES FOR THE CONTRACT YEAR, CONTRACTOR SHALL HAVE NEITHER A SHARED SAVINGS PAYMENT NOR A SHARED LOSSES PAYMENT. RISK TRACKS‌ THE CONTRACTOR SHALL, PRIOR TO THE OPERATIONAL START DATE OR OTHER DATE AS DETERMINED BY EOHHS, SELECT CONTRACTOR’S RISK TRACK FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK AND NOTIFY EOHHS IN WRITING OF SUCH SELECTION. CONTRACTOR’S RISK TRACK FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK SHALL BE RISK TRACK 1 – LIMITED ACCOUNTABILITY (AS DESCRIBED IN SECTION 2.7.D.2.B), RISK TRACK 2 – MODERATE ACCOUNTABILITY (AS DESCRIBED IN SECTION 2.7.D.2.C), OR RISK TRACK 3 – INCREASED ACCOUNTABILITY (AS DESCRIBED IN SECTION 2.7.D.2.D). AS FURTHER SPECIFIED BY EOHHS, THE CONTRACTOR MAY ANNUALLY CHANGE THE CONTRACTOR’S RISK TRACK PRIOR TO THE START OF A CONTRACT YEAR, AS APPROVED IN WRITING BY EOHHS. THE CONTRACTOR MAY NOT CHANGE THE CONTRACTOR’S RISK TRACK PRIOR TO THE START OF CONTRACT YEAR 1; RISK TRACKS FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK, AS DEFINED IN SECTION 2.7.F.2.G, SHALL BE APPLIED AS FOLLOWS: SHARED SAVINGS AND SHARED LOSSES PAYMENTS FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK SHALL BE CALCULATED SUBJECT TO THE FOLLOWING RISK CORRIDOR PROVISIONS: THE MINIMUM SAVINGS AND LOSSES RATE SHALL BOTH BE EQUAL TO EITHER ONE PERCENT (1%) OR TWO PERCENT (2%) OF THE NON-HCV COMPONENT OF THE TCOC BENCHMARK, AS CHOSEN BY THE CONTRACTOR IN ADVANCE OF EACH CONTRACT YEAR THROUGH A DEFINED PROCESS AND ACCORDING TO A TIMELINE SPECIFIED BY EOHHS. IF CONTRACTOR’S SAVINGS OR THE ABSOLUTE VALUE OF THE CONTRACTOR’S LOSSES ARE LESS THAN 2% OF THE NON-HCV COMPONENT OF THE TCOC BENCHMARK, THERE SHALL BE NO SHARED SAVINGS OR SHARED LOSSES PAYMENT. THE CONTRACTOR SHALL CHOOSE ITS MINIMUM SAVINGS AND LOSSES PERCENTAGE FOR EACH CONTRACT YEAR BY A DATE SPECIFIED BY EOHHS. THE CONTRACTOR MAY NOT CHANGE THE CONTRACTOR’S CHOSEN MINIMUM SAVINGS AND LOSSES PERCENTAGE UNTIL THE PROCESS BEGINS FOR THE NEXT CONTRACT YEAR; THE SAVINGS AND LOSSES CAP SHALL BE EQUAL TO TEN PERCENT (10%) OF THE NON-HCV COMPONENT OF THE TCOC BENCHMARK (HEREINAFTER REFERRED TO AS “THE NON-HCV CAP”). IF CONTRACTOR’S SAVINGS FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK ARE GREATER THAN THE THE NON-HCV CAP, CONTRACTOR’S SHARED SAVINGS PAYMENT SHALL BE CALCULATED AS IF CONTRACTOR’S SAVINGS WERE EQUAL TO THE NON-HCV CAP, AND CONTRACTOR SHALL RECEIVE NO ADDITIONAL SHARED SAVINGS PAYMENT FOR ANY SAVINGS BEYOND THE NON-HCV CAP. IF THE ABSOLUTE VALUE OF CONTRACTOR’S LOSSES FOR THE NON-HCV COMPONENT OF THE TCOC BENCHMARK ARE GREATER THAN THE NON-HCV CAP, CONTRACTOR’S SHARED LOSSES PAYMENT SHALL BE CALCULATED AS IF THE ABSOLUTE VALUE OF CONTRACTOR’S LOSSES WERE EQUAL TO THE NON-HCV CAP, AND CONTRACTOR SHALL MAKE NO ADDITIONAL SHARED LOSSES PAYMENT FOR ANY LOSSES BEYOND THE NON-HCV CAP; RISK TRACK 1 – LIMITED ACCOUNTABILITY