Medical Services

Managed Care

State Plan Amendment - Title XIX of the Social Security Act

Supplement 2 - Beneficiary Information

Program Information

The State shall ensure that beneficiaries, in a manner that is easily understood, receive notification of:

  • Program rules and regulations including lock-in provisions
  • Covered services
  • Out-of pocket costs
  • Telephone numbers to call for questions
  • Complaint procedures
  • Availability of no-cost interpretation services (for limited English proficient [LEP] and physically impaired beneficiaries)
  • How to obtain additional information or assistance
  • Basic features of managed care
  • Names of non-English languages spoken by PCCMs and the locations at which they furnish services
  • Any restrictions on the enrollee's choice of the listed PCCMs
  • How and where the enrollees may obtain benefits
  • Available transportation

Beneficiaries will receive program information at initial enrollment through distribution of the enrollment notices and the Beneficiary Handbook. On-going beneficiaries will be notified annually of the availability of program information or will automatically receive the information. Enrollment notices inform beneficiaries of their need to choose a provider and that beneficiary information is available in alternative formats. Alternative formats may consist of but are not limited to: Personnel who may read for the blind or illiterate, other languages (see “Language” below), written materials in larger fonts, and telecommunication service links for the hearing impaired.

Beneficiaries will also receive notice of significant program changes at least 30 days prior to the date of enactment through direct mail and other media such as web site postings. Significant changes include broad changes in covered services or restrictions and major changes PCCM referral policies.

Language

  • Written materials, including vital documents, will be translated for eligible limited English proficiency ("LEP") language groups that constitute ten percent or 3,000, whichever is less, of enrollees to be served in a given service area.
  • Vital documents will be translated for eligible LEP language groups that do not fall within the parameters of the item listed above, but constitute five percent or 1,000, whichever is less, of enrollees to be served in a given service area. Translation of other documents, if needed, can be provided orally.
  • A written notice of the right to receive competent oral translation of written materials in the primary language of the eligible LEP language group will be provided to enrollees that do not fall within the two items listed above.
  • This notice is available at the local social service office, and will be provided upon initial medical assistance application and during continued contact with the enrollee.
  • Statistics to measure the LEP language group will be obtained from a combination of the U.S. Census Bureau, Immigration and Naturalization Service, Lutheran Social Services, and county social service agencies.
  • Oral interpretation services must be available from health care providers free of charge to enrollees of the PCCM program.
  • Educational materials will inform enrollees and potential enrollees that oral interpretation and written information are available in languages other than English and how to access those services.

These processes are accomplished by a combination of county and state staff and private agreements with entities such as private individuals, and private social service agencies.