18 CRR-NY 360-10.9NY-CRR
OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 18. DEPARTMENT OF SOCIAL SERVICES
CHAPTER II. REGULATIONS OF THE DEPARTMENT OF SOCIAL SERVICES
SUBCHAPTER B. PUBLIC ASSISTANCE
ARTICLE 2. DETERMINATION OF ELIGIBILITY—CATEGORICAL
PART 360. MEDICAL ASSISTANCE
SUBPART 360-10. MEDICAID MANAGED CARE PROGRAMS
18 CRR-NY 360-10.9
18 CRR-NY 360-10.9
(a) An MMCO may only engage in marketing/outreach activities to the extent and in a manner approved by the department, in accordance with marketing/outreach and enrollment guidelines issued by the commissioner.
(b) MMCOs shall comply with marketing/outreach and enrollment guidelines issued by the commissioner.
(c) MMCOs shall comply with State and Federal laws and implementing regulations regarding marketing/outreach.
(d) Marketing/outreach shall include but not be limited to activities of the MMCO, a subcontractor, or individuals or entities affiliated with the MMCO, during which information and material regarding Medicaid managed care or the FHP program and information about a particular MMCO's affiliated products are presented. Such information may be presented through verbal exchanges, the distribution of written materials and/or the giving away of nominal gifts, as per guidelines issued by the commissioner.
(e) MMCOs shall comply with State and Federal laws and implementing regulations regarding confidentiality, including adherence to HIV, mental health, and substance abuse confidentiality requirements established under state law and implementing regulations; and ensure marketing/outreach representatives' compliance with such requirements through annual training, employee newsletters, and inclusion in the MMCO's policies and procedure manual.
(f) MMCOs shall prepare a marketing/outreach plan. Marketing/outreach plans shall not be implemented without the prior written consent of the commissioner.
(g) Each marketing/outreach plan shall include, but not be limited to:
(1) goals and general marketing/outreach strategy;
(2) a description of marketing/outreach activities;
(3) a staffing plan related to marketing/outreach including training and compensation methodology and levels;
(4) a description of how the MMCO will meet the informational needs of eligible persons including those who speak a language other than English as a first language and/or who have a hearing, visual, physical or cognitive impairment, in order to enable such persons to make a voluntary and informed choice;
(5) a description of the activities the MMCO will implement to monitor compliance with this section, including how the MMCO will ensure compliance with State and Federal laws and implementing regulations regarding confidentiality; and
(6) identification of the primary marketing/outreach locations at which marketing/outreach will be conducted.
(h) Marketing/outreach materials include materials that are produced in any medium by or on behalf of an MMCO and can be reasonably interpreted as intended to market or outreach to prospective enrollees. Marketing/outreach materials are to be made available in the other languages and in formats for those who have a hearing, visual, or cognitive impairment. Marketing/outreach materials may not be used by an MMCO without the prior written consent of the commissioner or his or her designee, and shall include:
(1) advertising, public service announcements, printed publications, and other broadcast or electronic messages designed to increase awareness and interest in Medicaid managed care or the FHP program and/or an MMCO's Medicaid or FHP managed care product; and
(2) any information that references the Medicaid managed care or the Family Health Plus Program, is intended for general distribution, and is produced in a variety of print, broadcast, and other media types. This includes but shall not be limited to: scripts or outlines of presentations, radio advertisements, television advertisements, billboards, newspapers, leaflets, informational brochures, videos and broadcast materials, telephone book yellow page advertisements, letters, posters and the member handbook.
(i) The sites at which MMCOs may distribute marketing/outreach materials, subject to the approval of the commissioner or his or her designee, may include, but shall not be limited to: community centers; resource centers; markets; pharmacies; shopping malls; any social services district office, subject to the approval of the social services district; primary care provider offices; health centers; approved areas in hospitals and other provider sites; schools; health fairs; and other non-prohibited sites authorized by the commissioner or his or her designee where prospective enrollees are likely to gather.
(j) Prohibited marketing/outreach and enrollment practices shall include but not be limited to:
(1) marketing/outreach without the permission of the commissioner;
(2) using deceptive or coercive marketing/outreach materials and practices such as:
(i) making false statements;
(ii) deceiving, misleading, or threatening an eligible person to influence or induce selection of a particular plan;
(iii) discouraging enrollment on the basis of health status or need for health care services;
(iv) signing a person's name on the enrollment agreement without consent;
(3) making any unsolicited personal contact;
(4) conducting door-to-door solicitation or making inquiries at the home of a prospective enrollee without the prospective enrollee having requested or assented to that contact;
(5) marketing/outreach in patient rooms or at treatment sites (other than waiting areas) unless requested by the prospective enrollee;
(6) marketing/outreach in emergency rooms, including waiting areas;
(7) seeking to induce selection of an MMCO by offering gifts to prospective enrollees which exceed the value specified in the marketing/outreach guidelines;
(8) distributing new or revised marketing/outreach materials that have not been approved by the department;
(9) violating State or Federal confidentiality laws and implementing regulations;
(10) providing misleading or false information to the department or the department's designee to substantiate a prospective enrollee's eligibility for enrollment; or
(11) accepting the enrollment of a person when the MMCO had access to information indicating the MMCO was not authorized to enroll the person.
18 CRR-NY 360-10.9
Current through May 15, 2021
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