Ala. Admin. Code r. 560-X-53-.12

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-53-.12 - PACE Organization Marketing Requirements

(1) A written marketing plan that includes measurable enrollment objectives and a tracking system for effectiveness must be established and maintained by the PO.

(2) Information must be provided to the public regarding the PO and the marketing materials must be free of material inaccuracies, misleading information, and misrepresentations. The materials must contain information to assist individuals in making an informed decision regarding enrollment and at a minimum must include the following:

(a) A description of the policies and requirements for enrollment and disenrollment for the PACE program;

(b) Procedures for enrollment;

(c) A description of benefits and services provided;

(d) Information regarding premiums;

(e) Notice that all primary and specialized health care, other than emergency services, must be received through the PO or an entity that has been authorized by the PO;

(f) Notice that if services received are not provided or authorized by the PO, that the participant may be fully and personally liable for the costs incurred.

(3) All marketing information and materials must be approved by CMS before distribution. The initial marketing information is submitted as part of the PACE Organization application and is approved when the application is approved. Any revisions or updates to the material must also be approved by CMS. CMS will approve or disapprove the revisions or updates within 45 days of receipt of the materials. The materials will be deemed approved if CMS and AMA do not notify the PO of disapproval within the 45-day period.

(4) Marketing materials are to be printed in English and in any other primary language(s) of the community, as well as in Braille if necessary.

(5) A PO must ensure that prohibited marketing practices, as described in §460.82, are not used by its employees or agents when distributing marketing information and materials.

Ala. Admin. Code r. 560-X-53-.12

New Rule: Filed November 10, 2011; effective December 15, 2011.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 42 CFR 460.82.