MCO materials guide
Managed care organizations (MCOs) that serve Minnesota Health Care Programs (MHCP) members must follow these procedures when creating member materials. Any marketing material not specifically named on this page should be submitted to the Contract Manager for review.
DHS approval required
Materials required to be submitted to Contract Manager for review and approval. Subject to up to 30-day review. Materials submitted as templates must strictly adhere to the approved model template, excluding MCO-specific contact information. Materials included in this category:
- Materials identified in MCO contract as requiring approval
- Materials that require CMS review (not including those materials identified under the Submit as FYI category)
- Any materials that contain statements describing MHCP benefit package or changes, including incentives, copays or transportation.
Materials requiring approval include, but are not limited to:
- Advance Directive Materials
- Annual Notice of Change (ANOC) – SNBC integrated
- Care Coordination
- Complaint Block (CB)
- Evidence of Coverage (EOC) and Member Handbooks, Buck slips, Addenda, and Plan Guides
- Denial, Termination, and Reduction (DTR) notices, Grievance or Appeal Forms, Member Rights documents
- Explanation of Benefits (EOB)
- Formulary Change Letters
- Inbound/Outbound Medicare Sales Scripts
- Language Block (LB)
- Low Income Subsidy (LIS) Rider – SNBC integrated
- Marketing Letters & Materials, such as direct marketing mailings or brochures including marketing materials targeted to American Indians
- Member Identification Cards
- Newsletters - sent only to MHCP enrollees or articles specific to MHCP
- Medicare Part D and other Member Formularies – MSHO/SNBC integrated
- MCO Enrollment form (SNP)
- MCO’s website Information directed to MHCP members
- Performance Improvement Project (PIP) Collaborative Model Final Documents
- Presentations/Posters for MCO Public Programs
- Primary Care Network List (PCNL)
- Provider Directory and Subdirectories and Provider Directory/Subdirectory Monthly Change Form
- Provider Termination/Clinic Closure Letters
- Radio/TV Commercials, Bus Wraps, Bus Shelters, Billboards, and others of that nature
- Release of Information and Consent Forms (e.g. Release of Protected Health Information)
- Restricted Recipient Letters & Brochures
- Social Media
- Welcome Letters
Submit as FYI (for DHS information only)
(DHS reserves the right to review and comment if materials are not accurate or do not meet materials requirements.)
MCOs may publish FYI materials on the date submitted to the Contract Manager. During the Contract Manager’s review, if changes are needed, the MCO will need to update their published materials incorporating these changes.
- Annual Report to Enrollees (e.g. Financial Statement Summary and Organization Description)
- Disease Management Program materials such as: letters, brochures, phone scripts
- Health Promotion materials (e.g. flu shot reminders, asthma camp, violence prevention, healthy habits, tobacco cessation, ask-your-doctor checklist, healthy pregnancy program.
- Member phone scripts specific to health promotion outreach efforts
- Privacy Statements for all MHCP products
- Access Information (instructions for accessing care), e.g. mail order pharmacy forms, nurse line brochure
- DHS/CMS-Identified Templates and Models used without modification for Special Use (e.g. Medicare Advantage Enrollment Form and Notices, County Enrollment Forms (SNP), SNP Enrollment/Disenrollment information, Medicare Part D formulary change template, Transaction Reply Report (TRR) Letters).
- Enrollee Education Materials (e.g. appropriate ER use, coordination of benefit information, generics vs. brand name prescription drugs, Medication Therapy Management Program (MTM) materials).
- Coordination of Benefits surveys and other member surveys
- Non-English materials (attestation required)
NOTE: Any material containing statements regarding benefits, incentives or copays must be submitted for approval.
Do not submit
- Disclosures provided upon member request as required by law or rule (e.g. DME list, printed formulary, physician credentialing disclosure)
- Internet websites which merely link to the DHS website for information
- Materials specific to an individual enrollee such as phone script responses, letters or other health-related information (e.g. letters regarding missed appointments, appeal resolution letters)
- Member Advisory Committee information
- Newsletters sent to both commercial and MHCP enrollees which do not contain information about MHCP benefits, incentives or copays
- Press releases and correspondence about general MCO news or announcements
- Third Party materials, such as Disease Education information (e.g. brochures developed by American Heart Association, American Dental Association, American Medical Association, American Cancer Society)
- Translated Documents