Uniform Managed Care Marketing Policy and Procedures Manual

CHAPTERPAGEHHSC UNIFORM MANAGED CARE MANUAL 4.3 3 OF 28UNIFORM MANAGED CARE MARKETINGPOLICY AND PROCEDURES MANUALEFFECTIVE DATEMarch 1, 2010Version 1.2Applicability of Chapter 4.3ApplicabilityModified byVersions1.1 and 1.2This chapter applies to Health Maintenance Organizations (HMOs), the Exclusive Provider Organization(EPO), and CHIP Dental Contractors (collectively Managed Care Organizations (MCOs)) participating inthe STAR Program, the STAR+PLUS Program, the CHIP Program, the CHIP Perinatal Program, theSTAR Health Program, or the CHIP Dental Program. In this chapter, references to “CHIP” or the “CHIPManaged 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 MCOsAll MCOs contracting with the State of Texas are required to comply with the Marketing Policies andProcedures as they relate to CHIP and Medicaid Managed Care Programs. All Marketing Policies andProcedures are applicable to the MCO, its Agents, subcontractors and providers. Marketing Policies andProcedures are developed to provide accurate and consistent application as they relate to the CHIP andMedicaid Managed Care Programs in the State of Texas.Other Applicable Legal Authorities42 U.S.C. §1396u-242 CFR §438.104Texas Government Code §533.008Texas Administrative Code Title 1, Part 15, Chapter 353, Subchapter E, Rule §353.405UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 3 of 29

POLICY TITLE:GENERAL MARKETING PROVISIONSPOLICY NO.:MP-01.00Purpose:Policy #MP-01.00Modified byVersion 1.1To ensure that the Marketing Policies and procedures:1. Provide accurate and consistent application of the Marketing Policies as they relate to CHIP andMedicaid Managed Care Programs in the State of Texas.2. Establish fair Marketing practices for all MCOs and/or their Agents, in order to prevent unfairMarketing practices and ensure Marketing plan and Marketing Materials are consistent with HHSC’sMarketing campaign.3. Provide continuous Marketing education through periodic updates and training on revised or newMarketing Policies and Procedures.4. Establish procedures for investigating and processing Marketing violations and imposing appropriateremedies, as applicable.Policy:1. Each MCO must comply with the Marketing Policies and Procedures in this manual, which shall bereferenced 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 theMCO. HHSC will accept for review any concerns or comments that are submitted in writing by theMCO.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 15Business Days of receipt. If HHSC does not respond by the 15 th day, the MCO may deem thematerial approved and proceed to use the submitted materials. HHSC reserves the right to requirediscontinuation 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 thgrade, 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 ofthe Consumer Information Tool Kit, which can be found athttp://www.hhsc.state.tx.us/medicaid/CommunicationsResources.shtml.8. The MCO must utilize the DADS Language Services Unit to translate Medicaid Managed CareMarketing 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-specificinformation. The MCO may use its own translator for translation of Health-related Materials that donot contain Medicaid-specific information.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 4 of 29

9. The MCO must utilize its own translator for translation of CHIP Marketing Materials into Spanish orany 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 Materialsb. Member materials (Provider Directories, Member Handbooks, Member ID cards, etc.)c. Information to be used on the MCO’s Website or the Internetd. Print mediae. Television and radio storyboards or scriptsf. Member participation materials10. The MCO’s Marketing representatives are required to complete the MCO’s Marketing orientation andtraining 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 betweenHHSC and the MCO.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 5 of 29

POLICY TITLE:PROHIBITED MARKETING PRACTICESPOLICY NO.MP-02.00Purpose:To ensure that the MCO is aware of the prohibited Marketing practices.Policy:A MCO engaging in prohibited Marketing practices will be considered in violation of the Marketing Policiesand 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’sMembers 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, afederal 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, ratherthan 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 tothe 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;UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 6 of 29

20. Conducting member orientation in Common Areas of providers’ offices;21. Allowing providers to solicit enrollment or disenrollment in an MCO, or distribute MCO-specificmaterials at a Marketing activity (This does not apply to health fairs where providers doimmunizations, blood pressure checks, etc. as long as the provider is not soliciting enrollment ordistributing 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 HHSCcontractors 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 CareMarketing 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 Statusor 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 theCHIP or Medicaid Managed Care Programs, or relating to the providers or potential providerscontracting with the MCO; and28. Direct Mail Marketing to potential enrollees.This list is not intended to be exhaustive. Other prohibited activities are described throughoutChapter 4.3UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 7 of 29

POLICY TITLE:REPORTING ALLEGED MARKETING VIOLATIONSPOLICY NUMBER:MP-03.00Purpose:To establish a process to ensure the fair and consistent investigation of alleged violations of theMarketing Policies and Procedures.Policy:Alleged Marketing violations must be reported to HHSC in writing (use the attached Marketing ComplaintForm) for investigation. The MCO accused of violating the Marketing Policies and Procedures is requiredto cooperate with HHSC during the investigation.HHSC will investigate all reported alleged Marketing violations and take appropriate action. Upon writtenreceipt of any alleged violation(s), HHSC will:1. Acknowledge receipt, in writing, within five (5) Business Days from the date of the receipt of thealleged violation.2. Begin investigation within five (5) Business Days from receipt of the alleged violation and completeinvestigation within 30 calendar days. HHSC may extend the time for investigation if there areextenuating circumstances.3. Analyze the findings of the investigation and take appropriate action.4. Notify complainant after appropriate action has been taken.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 8 of 29

Date Filed: ______________________Date Received: __________________CHIP/Medicaid Managed Care Marketing Complaint FormComplainant (Name/Title/Organization):Address:Phone: E-mail: 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 anydocumentation to support this allegation.Why is this alleged violation a violation of the Marketing Policy and Procedures? Please include citations to specific policiesand 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?UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 9 of 29

Date Filed: ______________________Date Received: __________________Narrative/specifics (Continued)UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 10 of 29

POLICY TITLE:POLICIES RELATED TO CHIP AND MEDICAID MANAGED CAREPROGRAM PROVIDERSPOLICY NUMBER:MP-04.00Purpose:To establish specific Marketing Policies that apply to the MCO’s Network Providers.Policy: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 CarePrograms in which they participate.2. Providers may inform their patients of the benefits, services, and specialty care services offeredthrough the MCOs in which they participate. However, providers may not recommend one MCO overanother MCO, offer patients Incentives to select one MCO over another MCO, or assist the patient indeciding to select a specific MCO.3. At the patients’ request, Providers may give patients the information necessary to contact a particularMCO.4. Provider must distribute and/or display Health-related Materials for all contracted MCOs or choosenot 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 byeach MCO with whom they contract. Providers can choose which items to distribute or displayfrom each contracted MCO, as long as they distribute or display one or more items from eachcontracted MCO.5. Providers must display stickers submitted by all contracted MCOs or choose to not display stickersfor any contracted MCOs.a. MCO stickers indicating the provider participates with a particular health plan cannot be largerthan 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 andassist with completing the Application.7. Providers may direct patients to enroll in the CHIP/Medicaid Managed Care Programs by calling theAdministrative Services Contractor.8. The MCO may conduct Member orientation for its Members, in a private/conference room at aProvider’s office, but NOT in Common Areas at Provider’s office.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 11 of 29

POLICY TITLE:USE OF LOGO(S)POLICY NO:MP-05.00Purpose:To establish requirements for the use of HHSC, Medicaid Managed Care, and CHIP logos/insignias. TheHHSC logos are insignias established to identify HHSC as the administrator of the CHIP and MedicaidManaged Care Programs.Policy:1. Marketing Materials for potential members related to the CHIP and Medicaid Managed CarePrograms must include the appropriate program logo, unless a waiver is granted by your Health PlanManager.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: http://www.chipmedicaid.org/cbo/logos.htm.6. Giveaways do not require the CHIP or Medicaid Managed Care Program logo(s).Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 12 of 29

POLICY TITLE:WEBSITE / INTERNETPOLICY NO.:MP-06.00Purpose:Policy #MP-06.00Modified byVersion 1.1To establish consistent policies and procedures regarding the MCO’s Internet website in relation to theCHIP and Medicaid Managed Care Programs.Policy:1. The MCO’s website must include general information about its health plan as it relates to theCHIP/Medicaid Managed Care Programs, its Provider Network, its customer services, and itscomplaints and appeals process. The MCO may develop a page within its existing website to meetthese requirements.2. All information relating to the CHIP/Medicaid Managed Care Programs that is posted on the MCO’swebsite 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 identificationinformation on the website.5. The MCO’s website information directed to CHIP/Medicaid Managed Care potential enrollees andcurrent Members must be: at a reading level no higher than 6 th grade; in English, Spanish, and thelanguages of any other Major Population Group in the Service Area; culturally appropriate; andgeared to the health needs of the enrolled MCO population.The MCO’s website information directed to CHIP/Medicaid Managed Care potential enrollees andcurrent Members must be written using the style and preferred terms of the Consumer InformationTool Kit, which can be found athttp://www.hhsc.state.tx.us/medicaid/CommunicationsResources.shtml.6. The MCO’s website must include the appropriate program logo and indicate the applicable servicearea 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 CareProgram(s) on its website with the designation of open versus closed panels. The MCO must listancillary providers on its website. For Home Health Ancillary Providers, the MCO must include anindicator 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 copyof the entire Provider Directory on its website. (See Chapter 3 of the UMCM for other ProviderDirectory 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 manyapplicant families or community based organizations will use computers that are two or more years oldwith browsers and modems that are several generations behind current standards. To minimizedownload and “wait times,” the website must avoid tools or techniques that require significant memory ordisk resources or require special intervention on the customer side to install plug-ins or additionalsoftware. Tools that take advantage of efficient data access methods and reduce that load on the serverof bandwidth are strongly encouraged.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 13 of 29

Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 14 of 29

POLICY TITLE:PRINT MEDIAPOLICY NO.:MP-07.00Purpose:Policy #MP-07.00Modified byVersion 1.1To establish policies for the use of print media when advertising and promoting MCO products andservices and/or announcing MCO participation in the CHIP and/or Medicaid Managed Care Programs.Policy: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 CareProgram members or potential members.2. All print media originating from the MCO or its Agents must be reviewed and approved by HHSC priorto publication or display.3. All materials must be written no higher than a 6th grade reading level and must be distributed ordisplayed in English, Spanish, and the languages of any other Major Population Group in the ServiceArea.4. All materials must be written using the style and preferred terms of the Consumer Information ToolKit, which can be found at http://www.hhsc.state.tx.us/medicaid/CommunicationsResources.shtml.5. The MCO must provide HHSC with a copy of all publications and displays, including when and wherethey will appear.6. The print media must contain the appropriate program logo unless the Health Plan Manager providesa written waiver of this requirement.7. Terms such as “choose,” “pick,” “join”, etc. are allowed in Marketing Materials as long as theAdministrative Services Contractor’s or the local community-based organization’s telephone numberis included. The Administrative Services Contractor’s telephone numbers are:Medicaid Managed Care: 800-964-2777CHIP: 877-543-7669 (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-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 15 of 29

POLICY TITLE:ELECTRONIC MEDIA (TELEVISION / RADIO / INTERNET)POLICY NO.:MP-08.00Policy #MP-08.00Modified byVersion 1.1Purpose:To establish policies for the use of electronic media (television, radio, and Internet) as a Marketing tool bythe MCO.Policy:1. All electronic media containing Medicaid/CHIP information originating from the MCO or its Agentsmust 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 areused as a means of developing name recognition, and no reference is made to the CHIP/MedicaidManaged Care Programs.3. The TV storyboards or scripts must contain the appropriate program logo unless the Health PlanManager provides a written waiver of this requirement.4. Terms such as “choose,” “pick,” “join”, etc. are allowed in Marketing Materials as long as theAdministrative Services Contractor or the local community-based organization telephone number isincluded. The Administrative Services Contractor telephone numbers are:Medicaid Managed Care: 800-964-2777CHIP: 877-543-7669 (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 otherMajor Population Group in the Service Area; culturally appropriate; and be geared to the health needsof the enrolled MCO population.6. All printed information directed to CHIP/Medicaid Managed Care Members and potential Membersmust be written using the style and preferred terms of the Consumer Information Tool Kit, which canbe found at http://www.hhsc.state.tx.us/medicaid/CommunicationsResources.shtml.7. The MCO must provide HHSC with a schedule indicating when the electronic media advertisementswill be aired, including date and station.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 16 of 29

POLICY TITLE:COLD CALL MARKETINGPOLICY NO.:MP-9.00Purpose:To establish standard policies to prevent all Cold Call Marketing to all CHIP/Medicaid Managed CareProgram potential Members by any MCO or its Agent.Policy: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 asdoor-to-door or telephone Marketing.b. Marketing activities at an employer-sponsored Enrollment Event where employee participation ismandated by the employer.c. Any other personal contact with a potential Member if the potential Member has not initiated thecontact with the MCO.2. The MCO may only conduct telephone Marketing during incoming calls from potential Members. TheMCO 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/MedicaidManaged 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 MCOmust notify its HHSC Health Plan Manager, in writing, by email, U.S. mail or fax regarding theinvitation and must provide information about the Marketing activities the MCO will conduct at theparticular business. However, the MCO may not engage in Marketing activities at an employersponsoredEnrollment Event where employee participation is mandated by the employer.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 17 of 29

POLICY TITLE:DIRECT MAIL MARKETINGPOLICY NO.:MP-10.00Purpose:To establish uniform policies regarding Direct Mail Marketing.Policy: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 potentialMembers.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: ata reading level no higher than 6 th grade; in English, Spanish, and the languages of any otherMajor Population Group in the Service Area; culturally appropriate; and be geared to the healthneeds 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-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 18 of 29

POLICY TITLE:USE OF GIVEAWAYSPOLICY NO.:MP-11.00Purpose:To establish policies regarding the distribution of Giveaways and other items dispensed to Members andpotential Members. This policy applies to any item purchased by the MCO for distribution toCHIP/Medicaid Managed Care Program Members and potential Members.Policy:1. MCOs may provide promotional Giveaways valued at or under $10.00 to potential CHIP/MedicaidManaged Care Program Members. MCOs may distribute promotional Giveaways valued at morethan $10.00 to current members only.2. The MCO is allowed to accept items from third party sources, and distribute them to CHIP/MedicaidManaged Care Program Members and potential Members as Giveaways. The same dollar limitslisted 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 theMCO.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 phonenumber or website address; andb. 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 orpotential Members.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 19 of 29

POLICY TITLE:MEMBER PARTICIPATION IN MCO ACTIVITIESPOLICY NO.:MP-12.00Purpose:To establish policies for promoting Member participation in MCO activities, including focus groups andadvisory committees.Policy: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 Memberattendance at MCO activities.3. The MCO must maintain evidence that the Member has been informed that any monetarycompensation received must be reported to the Office of Eligibility Services/Social SecurityAdministration and that monetary compensation can affect the Members’ Medicaid eligibility. TheMCO must develop its own form, which must be approved by HHSC, and must translate the form intoSpanish and the languages of other Major Population Groups.4. HHSC must provide prior approval of all monetary and non-monetary compensation provided toMembers in exchange for participating in MCO activities.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 20 of 29

POLICY TITLE:PERIODIC SURVEYSPOLICY NO.:MP-13.00Purpose:To provide a method for the MCO to gather information relating to the satisfaction/dissatisfaction offormer and currently enrolled CHIP/Medicaid Managed Care Program Members.Policy: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 offormer Members.3. The MCO may periodically survey its voluntarily disenrolled Members by method(s) other than faceto-faceencounters.4. All surveys must be approved by HHSC prior to use and must be translated into the English, Spanishand 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 enrolledMembers to participate in the surveys. Such Incentives or Giveaways may be valued at more than$10.00.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 21 of 29

POLICY TITLE:Sponsorship / DonationsPOLICY NO.:MP-14.00Purpose:To establish fair and consistent policies for charitable contributions or donations given by the MCO tocommunity events or causes.Policy:This policy applies to any charitable contribution, donation, or support from the MCO to an organization orentity in the form of cash, property, or services rendered from CHIP/Medicaid Managed Care Programfunds.1. The MCO is not allowed to make charitable contributions or donations from the CHIP/MedicaidManaged Care Program funds.2. The MCO may make charitable contributions or donations from its general revenue, earned incomefunds, or other corporate income funds without HHSC approval, as long as the MCO does not reportsuch charitable contributions or donations as an Allowable Expense. (See Cost Principles in Chapter6 of the UMCM.)3. When the MCO advertises its participation in an event related to the CHIP/Medicaid Managed CareProgram, which is sponsored by the MCO or another organization, the MCO must comply with thepolicies and procedures outlined in the Television/Radio and Print Media policies. (See MP-08.00 andMP-07.00, respectively.)4. MCO participation in an event sponsored by the MCO or another organization must comply with theOther Events Policy (MP-16.00), including the distribution of MCO materials and approved Marketingitems.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 22 of 29

POLICY TITLE:MEDICAID ENROLLMENT EVENTSPOLICY NO.:MP-15.00PURPOSE:To establish a forum for Marketing to eligible Medicaid Clients, providing enrollment information,educating potential Members regarding the Medicaid Managed Care Program, and distributingApplication forms for Children’s Medicaid/CHIP. Enrollment Events are open to all MCOs participating inthe Medicaid Managed Care Programs. The Administrative Services Contractor may hold an exclusiveEnrollment Event. If the event is exclusive and an MCO attends an event to which the plan was notinvited, the event will cease from being an Enrollment Event until the plan leaves. The AdministrativeServices 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 EnrollmentEvents coordinated by the Administrative Services Contractor.3. In case of a cancellation, the Administrative Services Contractor will notify the MCO upon receivingnotification.4. MCOs are allowed to conduct plan recognition through Marketing activities at Medicaid EnrollmentEvents.5. The Administrative Services Contractor will provide information on scheduled events and willcomplete 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 theevent. On occasion, there may be less than a 10 Business Day notification period. Any questions orconcerns 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 isresponsible for contacting the event coordinator to arrange a for a table.8. MCOs are responsible for complying with the Marketing Policies and Procedures during EnrollmentEvents. The Administrative Services Contractor will not provide oversight/monitoring.9. No more than five (5) Marketing representatives/health educators per MCO are allowed at theEnrollment Event.a. The Administrative Services Contractor may limit the number of participating Marketingrepresentatives/health educators to less than five (5) based on the location and/or availability ofspace.b. If the anticipated/estimated attendance at an Enrollment Event is over 5,000 participants, thoseMedicaid Managed Care Program MCOs that are also CHIP MCOs may have a total of eight (8)Marketing representatives/health educators present at the event.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 23 of 29

10. With HHSC’s prior approval, MCOs may offer Giveaways valued at $10.00 or less as long as thesegifts are not conditioned upon enrollment in the MCO. (See MP-11.00.),11. MCOs promoting the Medicaid Managed Care Program and/or announcing an Enrollment Event areto 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 Programallocations for Marketing, but not for charitable contributions or donations.13. MCOs may have the following reference materials available at the Enrollment Event: MCO-specificMarketing materials, Provider Directories, and Member Handbooks. The Administrative ServicesContractor will provide attendees a copy of the MCO comparison chart.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 24 of 29

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 FairCounty: _______________________________ρ Other (Explain)__________________Mailing Address _____________________(if different):__________________________________________ Language Needs: _________________Phone Number _____________________ ρ STAR ρ STAR+PLUSFAX Number _____________________Additional Information / Directions:___________________________________________________Audience:___________________________________________________________________________YESNOFree Parking ρ ρ ρ ALL MCOS INVITED(All participating plans MUST contact theSponsoring Organization to makearrangements)Tables (How Many) ρ ρChairs (How Many) ρ ρOverhead Projector ρ ρWheelchair Accessible ρ ρElectrical Outlets ρ ρSign Language Interpreter ρ ρBilingual Representative ρ ρRSVP to __________________________________________Approved by : ____________________________________Regional ManagerDate____________________________________Administrative Service Contractor Plan ManagerDateDate faxed to MCOs____________(This notification is faxed to the MCOs to inform them of an enrollment event)UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 25 of 29

POLICY TITLE:OTHER EVENTSPOLICY NO.MP-16.00Purpose:To establish uniform standards regarding Outreach, education, and Marketing activities during OtherEvents. Other Events include, but are not limited to: MCO organized events; community events; healthfairs; and Educational Events.Policy:1. The MCO will be allowed to organize events and/or participate in Other Events relating to:a. MCO recognitionb. Health educationc. Program educationd. Marketing and/ore. Distribution of Children’s Medicaid/Children’s Health Insurance Program Application2. The MCO must provide prior notice of an Other Event to the Administrative Services Contractor, byfaxing the “MCO Checklist for Other Events” to (512) 533-3869. Notice must be provided at least 2days prior to the event.3. The MCO may choose to inform/invite other MCOs in the Service Area to participate in the OtherEvent. If the sponsoring MCO agrees to invite or allow other MCOs to participate, the AdministrativeServices 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 Contractorwill 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 beallowed to participate in an Other Event to conduct or perform Outreach and educational activitiesonly.5. All MCO Marketing Materials used during Other Events must be approved by HHSC prior todistribution.6. The Administrative Services Contractor will not provide oversight/monitoring of the Plans forcompliance 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 $10.00and free health screening to potential Members at Other Events, as long as they are not conditionedupon enrollment in the MCO. (See MP-11.00). Free health screenings cannot be used to identify anddiscourage 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/CHIPProgram 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 OtherEvents.Prohibitions:See MP-02.00 for prohibitions.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 26 of 29

MCO NOTIFICATION OF AN OTHER EVENTSponsoring Organization: _____________________________Contact Person: _________________________________Date of Event:_________________Time of Event:______________Title:__________________________Event Site Address: _______________________________________________________________County: _______________________________Mailing Address _____________________(if different):__________________________________________Language Needs: _________________Phone Number_____________________STARSTAR+PLUSFAX Number _____________________ CHIPCHIP Dental ProgramAdditional Information / Directions:_________________________________________________________________________________________________________________________Audience:____________________________________________________________________Free ParkingTables (How Many)YES NO COMMENTS:ORGANIZING MCO ONLYChairs (How Many)ALL PLANS INVITEDOverhead ProjectorWheelchair AccessibleElectrical OutletsSign Language InterpreterBilingual RepresentativeRSVP to __________________________________________Approved by : ____________________________________Regional ManagerDate_____________________________________________________HHSC Administrative Services Contractor DateDate faxed to health plans _________________UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 27 of 29

GLOSSARY OF TERMSThe terms below are specifically used within this chapter of the UMCM. Please refer to Article 2 ofthe HHSC Uniform Contract Terms and Conditions, “Definitions,” for terms not defined in thisGlossary.AAGENT – An entity that solicits, conducts Marketing or research on behalf of an MCO and/or takes ortransmits any Applications for insurance coverage.APPLICATION – A form completed to determine eligibility in the Medicaid Managed Care and CHIPPrograms. Eligibility is determined through the HHSC Office of Eligibility Services (OES).CCLIENT – A person who has applied for or is enrolled in the CHIP or Medicaid program and thus iseligible to receive services funded through CHIP or Medicaid.COLD CALL MARKETING – Any unsolicited personal contact with a potential enrollee by the MCO, anemployee of the MCO, its providers, subcontractors or Agents for the purpose of Marketing. Cold CallMarketing includes, without limitation:o Unsolicited personal contact with a potential enrollee outside of an Enrollment Event, such asdoor-to-door or telephone Marketing.o Marketing activities at an employer-sponsored Enrollment Event where employee participation ismandated by the employer.o Any other personal contact with a potential Member if the potential Member has not initiated thecontact with the MCO.COMMON AREAS – Any area in a provider’s facilities that is accessible to the general public. CommonAreas include, without limitation: reception areas, waiting rooms, hallways, etc.DDIRECT MAIL MARKETING – Any materials sent to potential Members by the MCOs or their Agentsthrough U.S. mail or any other direct/indirect delivery method.EEDUCATIONAL EVENT – A scheduled event in which there is a specific topic of discussion designed toprovide health related educational information that promotes a healthier lifestyle.ENROLLEE – A CHIP and or Medicaid Managed Care Program member who is currently enrolled in ahealth plan and/or eligible for services from a health plan.ENROLLMENT EVENT – An event coordinated by the Administrative Services Contractor, open to allMCOs for Medicaid Managed Care. The Enrollment Event is designed to market to, enroll and educateregarding Medicaid Managed Care programs and to distribute Children’s Medicaid/CHIP Applications.GGIVEAWAYS – Any promotional item offered by an MCO to Members or potential Members.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 28 of 29

HHEALTH PLAN MANAGERS – An employee of HHSC responsible for ensuring the assigned MCOcomplies 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.IINCENTIVES – Any form of financial compensation, travel or transportation reimbursement, child careservices, etc. offered to Members or potential Members.MMANAGED CARE – A system in which the overall care of a patient is overseen by a single provider ororganization.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 theentity, that can reasonably be interpreted as intended to influence the Client to enroll in that particularMCO’s Medicaid or CHIP product, or either to not enroll in, or to disenroll from, another MCO’s Medicaidor CHIP product.MARKETING COMPLAINT FORM – The form used to report a violation of the Marketing Policies andProcedures to HHSC.MARKETING POLICIES – Policies that govern acceptable Marketing activities for MCOs participating inthe CHIP and Medicaid Managed Care Programs.OOTHER EVENTS – These events include: MCO organized events; community events; health fairs; andEducational Events.OUTREACH – Working in the community or developing materials to share information aboutCHIP/Children’s Medicaid with families that may be eligible for the Programs.SSPAM – An unwanted, disruptive commercial message posted on a computer network or sent by email.SPAMMING – Flooding the Internet with copies of the same message, in an attempt to force themessage on people who would not otherwise choose to receive it. There are two principal types ofSpamming, and they have different effects on Internet users.o Usenet Spamming is a single message sent to 20 or more Usenet newsgroups. UsenetSpamming is aimed at “lurkers”; people who read newsgroups but rarely or never post and givetheir addresses away. Usenet “Spamming robs users of the utility of the newsgroups byoverwhelming them with a barrage of advertising or other irrelevant posts.o Email Spamming targets individual users with direct mail messages. Scanning Usenet postings,stealing Internet mailing lists, or searching the Web for addresses often creates email Spamminglists.UMCM Chapter 4.3 Uniform Marketing Policies and Procedures ManualPage 29 of 29