HHSC UNIFORM MANAGED CARE MANUAL OF 29. UNIFORM MANAGED CARE MARKETING March 1, 2010 POLICY AND PROCEDURES MANUAL Version 1.

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1 CHAPTER HHSC UNIFORM MANAGED CARE MANUAL OF 29 PAGE EFFECTIVE DATE UNIFORM MANAGED CARE MARKETING March 1, 2010 POLICY AND PROCEDURES MANUAL Version 1.2 DOCUMENT HISTORY LOG STATUS 1 DOCUMENT REVISION 2 EFFECTIVE DATE DESCRIPTION 3 Baseline N/A October 15, 2007 Revision 1.1 August 1, 2009 Revision 1.2 March 1, 2010 Initial version Uniform Managed Care Manual Chapter 4.3, Uniform Managed Care Marketing Policy and Procedures Manual. This chapter replaces both Chapter 4.1, Medicaid Managed Care Marketing Policy and Procedures Manual, and Chapter 4.2, CHIP Marketing Policy and Procedures Manual. The Applicability section is revised to change the reference to the Comprehensive Healthcare Program for Foster Care to STAR Health Program. Policies MP-01.00, MP-06.00, MP-07.00, and MP are revised to require MCOs to use the style and preferred terms required by the Consumer Information Tool Kit for all Member Materials and communications. Policy MP is revised to correct the fax number for Other Events. The Applicability section is revised to include the CHIP Dental Program. Form - MCO Checklist for Other Events is revised to add a checkbox for the CHIP Dental Program. 1 Status should be represented as Baseline for initial issuances, Revision for changes to the Baseline version, and Cancellation for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision e.g., 1.2 refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. 1

2 CHAPTER HHSC UNIFORM MANAGED CARE MANUAL OF 28 PAGE UNIFORM MANAGED CARE MARKETING POLICY AND PROCEDURES MANUAL EFFECTIVE DATE March 1, 2010 Version 1.2 Table of Contents Applicability of Chapter General Instructions 3 Other Applicable Legal Authorities 3 Specific Marketing Policies MP General Marketing Provisions 4 MP Prohibited Marketing Practices 6 MP Reporting Alleged Marketing Violations 8 Form - Marketing Complaint Form 9 MP Policies Related to CHIP and Medicaid Managed Care Program Providers 11 MP Use of Logo(s) 12 MP Website / Internet 13 MP Print Media 15 MP Electronic Media (Television / Radio / Internet) 16 MP Cold-Call Marketing 17 MP Direct-Mail Marketing 18 MP Use of Giveaways 19 MP Member Participation in MCO Activities 20 MP Periodic Surveys 21 MP Sponsorship / Donations 22 MP Participation in Medicaid Enrollment Events 23 Form - MCO Notification of an Medicaid Enrollment Event 25 MP Participation in Other Events 26 Form - MCO Checklist for Other Events 27 Glossary of Terms 28 Page 2 of 29

3 CHAPTER PAGE HHSC UNIFORM MANAGED CARE MANUAL OF 28 UNIFORM MANAGED CARE MARKETING POLICY AND PROCEDURES MANUAL EFFECTIVE DATE March 1, 2010 Version 1.2 Applicability of Chapter 4.3 Applicability Modified by Versions 1.1 and 1.2 This chapter applies to Health Maintenance Organizations (HMOs), the Exclusive Provider Organization (EPO), and CHIP Dental Contractors (collectively Managed Care Organizations (MCOs)) participating in the STAR Program, the STAR+PLUS Program, the CHIP Program, the CHIP Perinatal Program, the STAR Health Program, or the CHIP Dental Program. In this chapter, references to CHIP or the CHIP Managed Care Program(s) apply to the CHIP, CHIP Perinatal Program, and the CHIP Dental Program. References to Medicaid or the Medicaid Managed Care Program(s) apply to the STAR, STAR+PLUS, and STAR Health Programs. The requirements in this chapter apply to all Programs, except where noted. General Instructions to MCOs All MCOs contracting with the State of Texas are required to comply with the Marketing Policies and Procedures as they relate to CHIP and Medicaid Managed Care Programs. All Marketing Policies and Procedures are applicable to the MCO, its Agents, subcontractors and providers. Marketing Policies and Procedures are developed to provide accurate and consistent application as they relate to the CHIP and Medicaid Managed Care Programs in the State of Texas. Other Applicable Legal Authorities 42 U.S.C. 1396u-2 42 CFR Texas Government Code Texas Administrative Code Title 1, Part 15, Chapter 353, Subchapter E, Rule Page 3 of 29

4 GENERAL MARKETING PROVISIONS POLICY NO.: MP Policy # MP Modified by Version 1.1 To ensure that the Marketing Policies and procedures: 1. Provide accurate and consistent application of the Marketing Policies as they relate to CHIP and Medicaid Managed Care Programs in the State of Texas. 2. Establish fair Marketing practices for all MCOs and/or their Agents, in order to prevent unfair Marketing practices and ensure Marketing plan and Marketing Materials are consistent with HHSC s Marketing campaign. 3. Provide continuous Marketing education through periodic updates and training on revised or new Marketing Policies and Procedures. 4. Establish procedures for investigating and processing Marketing violations and imposing appropriate remedies, as applicable. 1. Each MCO must comply with the Marketing Policies and Procedures in this manual, which shall be referenced as the Marketing Policies. 2. All Marketing Policies are applicable to the MCO, its Agents, subcontractors, and/or providers. 3. Defined terms are capitalized in this chapter, and definitions are located in the Glossary of Terms. 4. The Marketing Policies may be amended by HHSC at any time and changes will be distributed to the MCO. HHSC will accept for review any concerns or comments that are submitted in writing by the MCO. 5. Each MCO is required to submit to HHSC all Marketing Materials for review and approval prior to use. HHSC will notify the MCO of the approval of the materials or of any required changes within 15 Business Days of receipt. If HHSC does not respond by the 15 th day, the MCO may deem the material approved and proceed to use the submitted materials. HHSC reserves the right to require discontinuation of any Marketing Materials that violate the terms of the Marketing Policies. 6. All Marketing Materials and Member Materials must be written at a reading level not higher than 6 th grade, and must be translated into Spanish and the languages of other Major Population Groups. HHSC will notify the MCO if a Service Area includes other Major Population Groups. 7. All Marketing Materials and Member Materials must be written using the style and preferred terms of the Consumer Information Tool Kit, which can be found at 8. The MCO must utilize the DADS Language Services Unit to translate Medicaid Managed Care Marketing Materials into Spanish, upon receipt of HHSC approval of the English version. This does not include translation of Health-related Materials that do not contain Medicaid-specific information. The MCO may use its own translator for translation of Health-related Materials that do not contain Medicaid-specific information. Page 4 of 29

5 9. The MCO must utilize its own translator for translation of CHIP Marketing Materials into Spanish or any other language, upon receipt of HHSC approval of the English version. 10. Materials that require review and approval include but are not limited to: a. Marketing Materials b. Member materials (Provider Directories, Member Handbooks, Member ID cards, etc.) c. Information to be used on the MCO s Website or the Internet d. Print media e. Television and radio storyboards or scripts f. Member participation materials 10. The MCO s Marketing representatives are required to complete the MCO s Marketing orientation and training program prior to engaging in Marketing activities on behalf of the MCO. 11. Violation of any of the Marketing Policies is subject to remedies, as outlined in the contract between HHSC and the MCO. Page 5 of 29

6 PROHIBITED MARKETING PRACTICES POLICY NO. MP To ensure that the MCO is aware of the prohibited Marketing practices. A MCO engaging in prohibited Marketing practices will be considered in violation of the Marketing Policies and Procedures. The following prohibitions are applicable to each MCO, its Agents, subcontractors, and providers: 1. Distributing Marketing Materials without prior HHSC approval; 2. Distributing Marketing Materials written above the 6 th grade reading level; 3. Offering Incentives or Giveaways valued over $10.00 to potential Members; 4. Providing Incentives or Giveaways to providers for the purpose of distributing them to the MCO s Members or potential Members; 5. Directly or indirectly, engaging in door-to-door, telephone, and other Cold Call Marketing activities; 6. Marketing in or around public assistance offices, including eligibility offices; 7. Using Spam; 8. Making any assertion or statement (orally or in writing) that the MCO is endorsed by the CMS, a federal or state government agency, or similar entity; 9. Marketing to persons currently enrolled in another CHIP or Medicaid Managed Care MCO; 10. Inducing or accepting a Member s enrollment or disenrollment; 11. Using terms that would influence, mislead, or cause potential members to contact the MCO, rather than the Administrative Services Contractor, for enrollment; 12. Portraying competitors in a negative manner; 13. Making any written or oral statements containing material misrepresentations of fact or law relating to the MCO s plan or the CHIP and Medicaid Managed Care programs, services or benefits; 14. Making Giveaways conditional based on enrollment with the MCO; 15. Charging members for goods or services distributed at events; 16. Charging members a fee for accessing the MCO s website; 17. Influencing enrollment in conjunction with the sale or offering of any private insurance; 18. Using Marketing Agents who are paid solely by commission; 19. Posting MCO-specific, non-health related materials or banners in provider offices; Page 6 of 29

7 20. Conducting member orientation in Common Areas of providers offices; 21. Allowing providers to solicit enrollment or disenrollment in an MCO, or distribute MCO-specific materials at a Marketing activity (This does not apply to health fairs where providers do immunizations, blood pressure checks, etc. as long as the provider is not soliciting enrollment or distributing plan specific MCO materials.); 22. Making charitable contributions or donations from Medicaid/CHIP funds; 23. Purchasing or otherwise acquiring mailing lists from third party vendors, or for paying HHSC contractors or sub-contractors to send plan specific materials to potential members; 24. Referencing the commercial component of the MCO in any of its CHIP or Medicaid Managed Care Marketing Materials; 25. Discriminating against a Member or potential Member because of race, creed, age, color, religion, natural origin, ancestry, marital status, sexual orientation, physical or mental disability, Health Status or existing need for medical care; 26. Assisting with enrollment form or influencing MCO selection. 27. Making false, misleading or inaccurate statements relating to services or benefits of the MCO or the CHIP or Medicaid Managed Care Programs, or relating to the providers or potential providers contracting with the MCO; and 28. Direct Mail Marketing to potential enrollees. This list is not intended to be exhaustive. Other prohibited activities are described throughout Chapter 4.3 Page 7 of 29

8 REPORTING ALLEGED MARKETING VIOLATIONS POLICY NUMBER: MP To establish a process to ensure the fair and consistent investigation of alleged violations of the Marketing Policies and Procedures. Alleged Marketing violations must be reported to HHSC in writing (use the attached Marketing Complaint Form) for investigation. The MCO accused of violating the Marketing Policies and Procedures is required to cooperate with HHSC during the investigation. HHSC will investigate all reported alleged Marketing violations and take appropriate action. Upon written receipt of any alleged violation(s), HHSC will: 1. Acknowledge receipt, in writing, within five (5) Business Days from the date of the receipt of the alleged violation. 2. Begin investigation within five (5) Business Days from receipt of the alleged violation and complete investigation within 30 calendar days. HHSC may extend the time for investigation if there are extenuating circumstances. 3. Analyze the findings of the investigation and take appropriate action. 4. Notify complainant after appropriate action has been taken. Prohibitions: See MP for prohibitions. Page 8 of 29

9 Date Filed: Date Received: CHIP/Medicaid Managed Care Marketing Complaint Form Complainant (Name/Title/Organization): Address: Phone: Fax: Parties to alleged violation (violator, witnesses and others): Date/time/frequency of alleged violation: Location of alleged violation facility name including location (e.g. address, unit, room, floor) Narrative/specifics of alleged violation (use continuation page if additional space is needed). Please attach any documentation to support this allegation. Why is this alleged violation a violation of the Marketing Policy and Procedures? Please include citations to specific policies and procedures. What harm has resulted due to this alleged violation (e.g. misrepresentation, unfair advantage gained)? What is the complainant s expectation/desire for resolution/remedy, if any? Page 9 of 29

10 Date Filed: Date Received: Narrative/specifics (Continued) Page 10 of 29

11 POLICIES RELATED TO CHIP AND MEDICAID MANAGED CARE PROGRAM PROVIDERS POLICY NUMBER: MP To establish specific Marketing Policies that apply to the MCO s Network Providers. The MCO is required to inform its Network Providers of the following policies: 1. Providers are permitted to educate/inform their patients about the CHIP/Medicaid Managed Care Programs in which they participate. 2. Providers may inform their patients of the benefits, services, and specialty care services offered through the MCOs in which they participate. However, providers may not recommend one MCO over another MCO, offer patients Incentives to select one MCO over another MCO, or assist the patient in deciding to select a specific MCO. 3. At the patients request, Providers may give patients the information necessary to contact a particular MCO. 4. Provider must distribute and/or display Health-related Materials for all contracted MCOs or choose not to distribute and/or display for any contracted MCO: a. Health-related posters cannot be larger than 16 x 24. b. Children s books, donated by MCOs, must be in Common Areas. c. Materials may have the MCO s name, logo, and phone number. d. Providers are not required to distribute and/or display all Health-related Materials provided by each MCO with whom they contract. Providers can choose which items to distribute or display from each contracted MCO, as long as they distribute or display one or more items from each contracted MCO. 5. Providers must display stickers submitted by all contracted MCOs or choose to not display stickers for any contracted MCOs. a. MCO stickers indicating the provider participates with a particular health plan cannot be larger than 5" x 7 and not indicate anything more than the health plan is accepted or welcomed here. b. Effective January 1, 2009, the appropriate Program logo must be affixed. 6. Providers may distribute Children s Medicaid/CHIP Applications to families of uninsured children and assist with completing the Application. 7. Providers may direct patients to enroll in the CHIP/Medicaid Managed Care Programs by calling the Administrative Services Contractor. 8. The MCO may conduct Member orientation for its Members, in a private/conference room at a Provider s office, but NOT in Common Areas at Provider s office. Prohibitions: See MP for prohibitions. Page 11 of 29

12 USE OF LOGO(S) POLICY NO: MP To establish requirements for the use of HHSC, Medicaid Managed Care, and CHIP logos/insignias. The HHSC logos are insignias established to identify HHSC as the administrator of the CHIP and Medicaid Managed Care Programs. 1. Marketing Materials for potential members related to the CHIP and Medicaid Managed Care Programs must include the appropriate program logo, unless a waiver is granted by your Health Plan Manager. 2. For each Program in which the MCO participates, the MCOs must use the following logo(s): 3. The size of the logo may vary, but it should be visible and legible. 4. The Medicaid logos can be obtained from your Health Plan Manager. 5. The CHIP logos may be obtained at: 6. Giveaways do not require the CHIP or Medicaid Managed Care Program logo(s). Prohibitions: See MP for prohibitions. Page 12 of 29

13 WEBSITE / INTERNET POLICY NO.: MP Policy # MP Modified by Version 1.1 To establish consistent policies and procedures regarding the MCO s Internet website in relation to the CHIP and Medicaid Managed Care Programs. 1. The MCO s website must include general information about its health plan as it relates to the CHIP/Medicaid Managed Care Programs, its Provider Network, its customer services, and its complaints and appeals process. The MCO may develop a page within its existing website to meet these requirements. 2. All information relating to the CHIP/Medicaid Managed Care Programs that is posted on the MCO s website must be pre-approved by HHSC and consistent with HHSC standards and State law. 3. The MCO must notify HHSC when the website is in place and when approved updates are made. 4. The MCO must remain HIPAA-compliant when providing Member eligibility or Member identification information on the website. 5. The MCO s website information directed to CHIP/Medicaid Managed Care potential enrollees and current Members must be: at a reading level no higher than 6 th grade; in English, Spanish, and the languages of any other Major Population Group in the Service Area; culturally appropriate; and geared to the health needs of the enrolled MCO population. The MCO s website information directed to CHIP/Medicaid Managed Care potential enrollees and current Members must be written using the style and preferred terms of the Consumer Information Tool Kit, which can be found at 6. The MCO s website must include the appropriate program logo and indicate the applicable service area if it contains information related to the CHIP/Medicaid Managed Care Programs. 7. The MCO must maintain access to a Provider Directory for its CHIP/Medicaid Managed Care Program(s) on its website with the designation of open versus closed panels. The MCO must list ancillary providers on its website. For Home Health Ancillary Providers, the MCO must include an indicator for Pediatric Services. The MCO shall update the Provider Directory at least quarterly. A look-up or Find by zip code feature can be an option, but the MCO must provide access to a copy of the entire Provider Directory on its website. (See Chapter 3 of the UMCM for other Provider Directory requirements.) 8. The MCO must follow the Print Media Policy (MP-07.00) and Electronic Media Policy (MP-08.00) when advertising on the Internet. Suggested Standards: The standards and approach used to develop and operate the website must recognize that many applicant families or community based organizations will use computers that are two or more years old with browsers and modems that are several generations behind current standards. To minimize download and wait times, the website must avoid tools or techniques that require significant memory or disk resources or require special intervention on the customer side to install plug-ins or additional software. Tools that take advantage of efficient data access methods and reduce that load on the server of bandwidth are strongly encouraged. Page 13 of 29

14 Prohibitions: See MP for prohibitions. Page 14 of 29

15 PRINT MEDIA POLICY NO.: MP Policy # MP Modified by Version 1.1 To establish policies for the use of print media when advertising and promoting MCO products and services and/or announcing MCO participation in the CHIP and/or Medicaid Managed Care Programs. 1. This policy applies to any displayed or published advertisement (i.e. newspaper articles, advertisements, billboards, decals, bus and bench displays, banners, brochures, Outreach materials, news releases, etc.) designed or intended to be read by CHIP and/or Medicaid Managed Care Program members or potential members. 2. All print media originating from the MCO or its Agents must be reviewed and approved by HHSC prior to publication or display. 3. All materials must be written no higher than a 6th grade reading level and must be distributed or displayed in English, Spanish, and the languages of any other Major Population Group in the Service Area. 4. All materials must be written using the style and preferred terms of the Consumer Information Tool Kit, which can be found at 5. The MCO must provide HHSC with a copy of all publications and displays, including when and where they will appear. 6. The print media must contain the appropriate program logo unless the Health Plan Manager provides a written waiver of this requirement. 7. Terms such as choose, pick, join, etc. are allowed in Marketing Materials as long as the Administrative Services Contractor s or the local community-based organization s telephone number is included. The Administrative Services Contractor s telephone numbers are: Medicaid Managed Care: CHIP: (877-KIDS-NOW) 8. An MCO is allowed to send Outreach materials, re-enrollment/re-certification notices, and non- Marketing correspondence to Members. 9. An MCO may send plan specific materials to potential Members at the potential Member s request. Prohibitions: See MP for prohibitions. Page 15 of 29

16 ELECTRONIC MEDIA (TELEVISION / RADIO / INTERNET) POLICY NO.: MP Policy # MP Modified by Version 1.1 To establish policies for the use of electronic media (television, radio, and Internet) as a Marketing tool by the MCO. 1. All electronic media containing Medicaid/CHIP information originating from the MCO or its Agents must be reviewed and approved by HHSC prior to broadcast. 2. It is not necessary to submit storyboards or scripts to HHSC if electronic media advertisements are used as a means of developing name recognition, and no reference is made to the CHIP/Medicaid Managed Care Programs. 3. The TV storyboards or scripts must contain the appropriate program logo unless the Health Plan Manager provides a written waiver of this requirement. 4. Terms such as choose, pick, join, etc. are allowed in Marketing Materials as long as the Administrative Services Contractor or the local community-based organization telephone number is included. The Administrative Services Contractor telephone numbers are: Medicaid Managed Care: CHIP: (877-KIDS-NOW) 5. All information directed to CHIP/Medicaid Managed Care Members and potential Members must be: at a reading level no higher than 6 th grade; in both English, Spanish, and the languages of any other Major Population Group in the Service Area; culturally appropriate; and be geared to the health needs of the enrolled MCO population. 6. All printed information directed to CHIP/Medicaid Managed Care Members and potential Members must be written using the style and preferred terms of the Consumer Information Tool Kit, which can be found at 7. The MCO must provide HHSC with a schedule indicating when the electronic media advertisements will be aired, including date and station. Prohibitions: See MP for prohibitions. Page 16 of 29

17 COLD CALL MARKETING POLICY NO.: MP-9.00 To establish standard policies to prevent all Cold Call Marketing to all CHIP/Medicaid Managed Care Program potential Members by any MCO or its Agent. 1. Cold Call Marketing is strictly prohibited. Cold Call Marketing includes, without limitation: a. Unsolicited personal contact with a potential enrollee outside of an Enrollment Event, such as door-to-door or telephone Marketing. b. Marketing activities at an employer-sponsored Enrollment Event where employee participation is mandated by the employer. c. Any other personal contact with a potential Member if the potential Member has not initiated the contact with the MCO. 2. The MCO may only conduct telephone Marketing during incoming calls from potential Members. The MCO may return telephone calls to potential Members only when requested to do so by the caller. 3. The MCO must refer all telephone inquiries from potential Members in reference to CHIP/Medicaid Managed Care Program Enrollment to the HHSC Administrative Services Contractor. 4. Upon invitation from an appropriate person or entity, the MCO may market at businesses. The MCO must notify its HHSC Health Plan Manager, in writing, by , U.S. mail or fax regarding the invitation and must provide information about the Marketing activities the MCO will conduct at the particular business. However, the MCO may not engage in Marketing activities at an employersponsored Enrollment Event where employee participation is mandated by the employer. Prohibitions: See MP for prohibitions. Page 17 of 29

18 DIRECT MAIL MARKETING POLICY NO.: MP To establish uniform policies regarding Direct Mail Marketing. 1. Direct Mail Marketing to potential Members is prohibited. 2. The MCO is permitted to respond to verbal or written requests for information made by potential Members. a. The content of such mailings must be approved by HHSC prior to distribution. b. MCOs must refer inquiries regarding enrollment to the Administrative Services Contractor. c. All information directed to CHIP/Medicaid Managed Care Program potential Members must be: at a reading level no higher than 6 th grade; in English, Spanish, and the languages of any other Major Population Group in the Service Area; culturally appropriate; and be geared to the health needs of the enrolled MCO population. 3. The MCO is allowed to send plan specific, Outreach materials, re-enrollment/re-certification notices, and non-marketing correspondence to their Members. This is not considered Direct Mail Marketing. Prohibitions: See MP for prohibitions. Page 18 of 29

19 USE OF GIVEAWAYS POLICY NO.: MP To establish policies regarding the distribution of Giveaways and other items dispensed to Members and potential Members. This policy applies to any item purchased by the MCO for distribution to CHIP/Medicaid Managed Care Program Members and potential Members. 1. MCOs may provide promotional Giveaways valued at or under $10.00 to potential CHIP/Medicaid Managed Care Program Members. MCOs may distribute promotional Giveaways valued at more than $10.00 to current members only. 2. The MCO is allowed to accept items from third party sources, and distribute them to CHIP/Medicaid Managed Care Program Members and potential Members as Giveaways. The same dollar limits listed in number 1, above, apply. The MCO is allowed to adhere its plan sticker to third party items. 3. The MCO may not make Giveaways to potential Members conditional based on enrollment in the MCO. 4. Giveaways must be submitted to HHSC for approval, unless they meet the following conditions: a. The information included on the Giveaway is limited to the MCO s name or initials, and its phone number or website address; and b. The Giveaway makes no reference to the CHIP/Medicaid Managed Care Program in any way. 5. Giveaways are not required to include the program logo. 6. The MCO may not provide Giveaways to providers for the purpose of distributing them to Members or potential Members. Prohibitions: See MP for prohibitions. Page 19 of 29

20 MEMBER PARTICIPATION IN MCO ACTIVITIES POLICY NO.: MP To establish policies for promoting Member participation in MCO activities, including focus groups and advisory committees. 1. The MCO may solicit its current Members for participation in MCO activities. 2. The MCO may provide Incentives and Giveaways valued at more than $10.00 to encourage Member attendance at MCO activities. 3. The MCO must maintain evidence that the Member has been informed that any monetary compensation received must be reported to the Office of Eligibility Services/Social Security Administration and that monetary compensation can affect the Members Medicaid eligibility. The MCO must develop its own form, which must be approved by HHSC, and must translate the form into Spanish and the languages of other Major Population Groups. 4. HHSC must provide prior approval of all monetary and non-monetary compensation provided to Members in exchange for participating in MCO activities. Prohibitions: See MP for prohibitions. Page 20 of 29

21 PERIODIC SURVEYS POLICY NO.: MP To provide a method for the MCO to gather information relating to the satisfaction/dissatisfaction of former and currently enrolled CHIP/Medicaid Managed Care Program Members. 1. MCOs may survey their former and currently enrolled Members. 2. MCO may not use satisfaction/dissatisfaction surveys for the purpose of soliciting the re-enrollment of former Members. 3. The MCO may periodically survey its voluntarily disenrolled Members by method(s) other than faceto-face encounters. 4. All surveys must be approved by HHSC prior to use and must be translated into the English, Spanish and the languages of any other Major Population Group in the Service Area. 5. The MCO may provide Incentives or Giveaways approved by HHSC to encourage currently enrolled Members to participate in the surveys. Such Incentives or Giveaways may be valued at more than $ Prohibitions: See MP for prohibitions. Page 21 of 29

22 Sponsorship / Donations POLICY NO.: MP To establish fair and consistent policies for charitable contributions or donations given by the MCO to community events or causes. This policy applies to any charitable contribution, donation, or support from the MCO to an organization or entity in the form of cash, property, or services rendered from CHIP/Medicaid Managed Care Program funds. 1. The MCO is not allowed to make charitable contributions or donations from the CHIP/Medicaid Managed Care Program funds. 2. The MCO may make charitable contributions or donations from its general revenue, earned income funds, or other corporate income funds without HHSC approval, as long as the MCO does not report such charitable contributions or donations as an Allowable Expense. (See Cost Principles in Chapter 6 of the UMCM.) 3. When the MCO advertises its participation in an event related to the CHIP/Medicaid Managed Care Program, which is sponsored by the MCO or another organization, the MCO must comply with the policies and procedures outlined in the Television/Radio and Print Media policies. (See MP and MP-07.00, respectively.) 4. MCO participation in an event sponsored by the MCO or another organization must comply with the Other Events Policy (MP-16.00), including the distribution of MCO materials and approved Marketing items. Prohibitions: See MP for prohibitions. Page 22 of 29

23 MEDICAID ENROLLMENT EVENTS POLICY NO.: MP PURPOSE: To establish a forum for Marketing to eligible Medicaid Clients, providing enrollment information, educating potential Members regarding the Medicaid Managed Care Program, and distributing Application forms for Children s Medicaid/CHIP. Enrollment Events are open to all MCOs participating in the Medicaid Managed Care Programs. The Administrative Services Contractor may hold an exclusive Enrollment Event. If the event is exclusive and an MCO attends an event to which the plan was not invited, the event will cease from being an Enrollment Event until the plan leaves. The Administrative Services Contractor has the responsibility to ask the MCO to leave. POLICY: 1. An exclusive Enrollment Event specifically excludes MCO participation. 2. Medicaid Managed Care Program MCOs are encouraged to participate in Medicaid Enrollment Events coordinated by the Administrative Services Contractor. 3. In case of a cancellation, the Administrative Services Contractor will notify the MCO upon receiving notification. 4. MCOs are allowed to conduct plan recognition through Marketing activities at Medicaid Enrollment Events. 5. The Administrative Services Contractor will provide information on scheduled events and will complete and send the MCO Notification of Medicaid Enrollment Event form to: a. All MCOs within the Service Area. b. The community-based organization liaison supervisor. The MCO Notification of Enrollment Event form will be faxed within (10) Business Days prior to the event. On occasion, there may be less than a 10 Business Day notification period. Any questions or concerns regarding Enrollment Events should be directed to the Administrative Services Contractor. 6. Children s Medicaid/CHIP Application forms will be made available during Enrollment Events. 7. The Administrative Services Contractor will not share a display table with any MCO. The MCO is responsible for contacting the event coordinator to arrange a for a table. 8. MCOs are responsible for complying with the Marketing Policies and Procedures during Enrollment Events. The Administrative Services Contractor will not provide oversight/monitoring. 9. No more than five (5) Marketing representatives/health educators per MCO are allowed at the Enrollment Event. a. The Administrative Services Contractor may limit the number of participating Marketing representatives/health educators to less than five (5) based on the location and/or availability of space. b. If the anticipated/estimated attendance at an Enrollment Event is over 5,000 participants, those Medicaid Managed Care Program MCOs that are also CHIP MCOs may have a total of eight (8) Marketing representatives/health educators present at the event. Page 23 of 29

24 10. With HHSC s prior approval, MCOs may offer Giveaways valued at $10.00 or less as long as these gifts are not conditioned upon enrollment in the MCO. (See MP ), 11. MCOs promoting the Medicaid Managed Care Program and/or announcing an Enrollment Event are to comply with the Print Media Policy (MP-07.00) and the Television / Radio Policy (MP-08.00). 12. MCOs are allowed to use funds directly or indirectly from the Medicaid Managed Care/CHIP Program allocations for Marketing, but not for charitable contributions or donations. 13. MCOs may have the following reference materials available at the Enrollment Event: MCO-specific Marketing materials, Provider Directories, and Member Handbooks. The Administrative Services Contractor will provide attendees a copy of the MCO comparison chart. Prohibitions: See MP for prohibitions. Page 24 of 29

25 Notification for Medicaid Enrollment Events (To be completed by the Administrative Service Contractor) Sponsoring Organization: Date of Event: Time of Event: Contact Person: Title: Event Site Address: Type of Event: ρ Presentation ρ Community Event ρ Health Fair County: ρ Other (Explain) Mailing Address (if different): Language Needs: Phone Number ρ STAR ρ STAR+PLUS FAX Number Additional Information / Directions: Audience: YES NO Free Parking ρ ρ ρ ALL MCOS INVITED (All participating plans MUST contact the Sponsoring Organization to make arrangements) Tables (How Many) ρ ρ Chairs (How Many) ρ ρ Overhead Projector ρ ρ Wheelchair Accessible ρ ρ Electrical Outlets ρ ρ Sign Language Interpreter ρ ρ Bilingual Representative ρ ρ RSVP to Approved by : Regional Manager Date Administrative Service Contractor Plan Manager Date Date faxed to MCOs (This notification is faxed to the MCOs to inform them of an enrollment event) Page 25 of 29

26 OTHER EVENTS POLICY NO. MP To establish uniform standards regarding Outreach, education, and Marketing activities during Other Events. Other Events include, but are not limited to: MCO organized events; community events; health fairs; and Educational Events. 1. The MCO will be allowed to organize events and/or participate in Other Events relating to: a. MCO recognition b. Health education c. Program education d. Marketing and/or e. Distribution of Children s Medicaid/Children s Health Insurance Program Application 2. The MCO must provide prior notice of an Other Event to the Administrative Services Contractor, by faxing the MCO Checklist for Other Events to (512) Notice must be provided at least 2 days prior to the event. 3. The MCO may choose to inform/invite other MCOs in the Service Area to participate in the Other Event. If the sponsoring MCO agrees to invite or allow other MCOs to participate, the Administrative Services Contractor will notify the invited MCOs and the event may become an Enrollment Event. (See MP-15.00) If the event becomes an Enrollment Event, the Administrative Services Contractor will fax the MCO Notification of an Enrollment Event to the MCOs. 4. Based on the requirements of the sponsoring MCO, the Administrative Services Contractor may be allowed to participate in an Other Event to conduct or perform Outreach and educational activities only. 5. All MCO Marketing Materials used during Other Events must be approved by HHSC prior to distribution. 6. The Administrative Services Contractor will not provide oversight/monitoring of the Plans for compliance of Marketing Policies during Other Events. 7. There is no limit to the number of MCO representatives or health educators during Other Events. 8. With prior HHSC approval, the MCO is allowed to offer Giveaways valued at no more than $10.00 and free health screening to potential Members at Other Events, as long as they are not conditioned upon enrollment in the MCO. (See MP-11.00). Free health screenings cannot be used to identify and discourage less healthy potential Members from enrolling in the MCO. 9. The MCO is allowed to use funds directly or indirectly from the Medicaid Managed Care/CHIP Program allocations for Marketing, but not for charitable contributions or donations. 10. MCOs may distribute third-party Giveaways valued at $10.00 or less to potential Members at Other Events. Prohibitions: See MP for prohibitions. Page 26 of 29

27 MCO NOTIFICATION OF AN OTHER EVENT Sponsoring Organization: Contact Person: Date of Event: Time of Event: Title: Event Site Address: County: Mailing Address (if different): Language Needs: Phone Number STAR STAR+PLUS FAX Number CHIP CHIP Dental Program Additional Information / Directions: Audience: Free Parking Tables (How Many) YES NO COMMENTS: ORGANIZING MCO ONLY Chairs (How Many) ALL PLANS INVITED Overhead Projector Wheelchair Accessible Electrical Outlets Sign Language Interpreter Bilingual Representative RSVP to Approved by : Regional Manager Date HHSC Administrative Services Contractor Date Date faxed to health plans Page 27 of 29

28 GLOSSARY OF TERMS The terms below are specifically used within this chapter of the UMCM. Please refer to Article 2 of the HHSC Uniform Contract Terms and Conditions, Definitions, for terms not defined in this Glossary. A AGENT An entity that solicits, conducts Marketing or research on behalf of an MCO and/or takes or transmits any Applications for insurance coverage. APPLICATION A form completed to determine eligibility in the Medicaid Managed Care and CHIP Programs. Eligibility is determined through the HHSC Office of Eligibility Services (OES). C CLIENT A person who has applied for or is enrolled in the CHIP or Medicaid program and thus is eligible to receive services funded through CHIP or Medicaid. COLD CALL MARKETING Any unsolicited personal contact with a potential enrollee by the MCO, an employee of the MCO, its providers, subcontractors or Agents for the purpose of Marketing. Cold Call Marketing includes, without limitation: o Unsolicited personal contact with a potential enrollee outside of an Enrollment Event, such as door-to-door or telephone Marketing. o Marketing activities at an employer-sponsored Enrollment Event where employee participation is mandated by the employer. o Any other personal contact with a potential Member if the potential Member has not initiated the contact with the MCO. COMMON AREAS Any area in a provider s facilities that is accessible to the general public. Common Areas include, without limitation: reception areas, waiting rooms, hallways, etc. D DIRECT MAIL MARKETING Any materials sent to potential Members by the MCOs or their Agents through U.S. mail or any other direct/indirect delivery method. E EDUCATIONAL EVENT A scheduled event in which there is a specific topic of discussion designed to provide health related educational information that promotes a healthier lifestyle. ENROLLEE A CHIP and or Medicaid Managed Care Program member who is currently enrolled in a health plan and/or eligible for services from a health plan. ENROLLMENT EVENT An event coordinated by the Administrative Services Contractor, open to all MCOs for Medicaid Managed Care. The Enrollment Event is designed to market to, enroll and educate regarding Medicaid Managed Care programs and to distribute Children s Medicaid/CHIP Applications. G GIVEAWAYS Any promotional item offered by an MCO to Members or potential Members. Page 28 of 29

29 H HEALTH PLAN MANAGERS An employee of HHSC responsible for ensuring the assigned MCO complies with its Contract with HHSC, including but not limited to the Marketing Policies and Procedures. HEALTH STATUS The state of health of an individual or population. I INCENTIVES Any form of financial compensation, travel or transportation reimbursement, child care services, etc. offered to Members or potential Members. M MANAGED CARE A system in which the overall care of a patient is overseen by a single provider or organization. MANAGED CARE ORGANIZATION (MCO) An entity that provides or contracts for Managed Care. MCOs include entities such as HMOs and Prepaid Health Plans (PHPs). MARKETING Any communication, from an MCO to a Medicaid or CHIP Client who is not enrolled in the entity, that can reasonably be interpreted as intended to influence the Client to enroll in that particular MCO s Medicaid or CHIP product, or either to not enroll in, or to disenroll from, another MCO s Medicaid or CHIP product. MARKETING COMPLAINT FORM The form used to report a violation of the Marketing Policies and Procedures to HHSC. MARKETING POLICIES Policies that govern acceptable Marketing activities for MCOs participating in the CHIP and Medicaid Managed Care Programs. O OTHER EVENTS These events include: MCO organized events; community events; health fairs; and Educational Events. OUTREACH Working in the community or developing materials to share information about CHIP/Children s Medicaid with families that may be eligible for the Programs. S SPAM An unwanted, disruptive commercial message posted on a computer network or sent by . SPAMMING Flooding the Internet with copies of the same message, in an attempt to force the message on people who would not otherwise choose to receive it. There are two principal types of Spamming, and they have different effects on Internet users. o Usenet Spamming is a single message sent to 20 or more Usenet newsgroups. Usenet Spamming is aimed at lurkers ; people who read newsgroups but rarely or never post and give their addresses away. Usenet Spamming robs users of the utility of the newsgroups by overwhelming them with a barrage of advertising or other irrelevant posts. o Spamming targets individual users with direct mail messages. Scanning Usenet postings, stealing Internet mailing lists, or searching the Web for addresses often creates Spamming lists. Page 29 of 29