Communication to Consumers

States often set standards for a managed care organization’s (MCO’s) telephone help lines.  These standards frequently require calls to be answered within a certain number of rings, and prohibit consumers from being put on hold for more than a specified number of minutes.

Contracts often require advance approval from the state for written materials such as member handbooks.  For instance, Wisconsin requires review of certain written materials by a group that must include consumer representatives.

Contents – To access the full text, please click each sub-topic.

  • MCO must answer all calls within 4 rings: Florida a, Hawaii b
  • MCO must ensure at least 99% of calls are answered by human or electronic device: Kansas c
  • MCO must ensure at least 95% of calls will be placed on hold for no longer than one minute: Kansas d
  • Average hold time must be 2 minutes or less: Hawaii e
  • Caller wait time must not exceed 3 minutes: Florida f
  • Blocked call rate must not exceed 1%: Florida g, Hawaii h
  • Rate of abandoned calls must not exceed 5%: Florida i, Hawaii j
  • MCO must provide voicemail system and ensure messages are responded to within 2 business days: Kansas k
  • MCO must resolve 90% of calls during initial contact: Kansas l
  • MCO must resolve 100% of inquiries within 15 business days: Kansas m
  • MCO’s fax lines must meet demand 98% of time: Kansas n
  • MCO must not have a separate number for members to call regarding behavioral health or long-term care services: Tennessee o
  • MCO must facilitate “warm” (person-to-person) transfer from help line when caller’s issue cannot be addressed by help line: Kansas p
  • MCO must report abandoned calls, average time to answer, call abandonment rate, and call answer timeliness: Tennessee q
  • MCO’s incoming and outgoing calls must be documented: Kansas r
  • MCO must track all phone contacts, including call volumes, length of time to answer, abandonment rates, length of the calls, nature of the calls, and who answered the call: Kansas s
  • MCO must record all calls for future retrieval: Kansas t

  • MCO must provide each member with handbook and description of MCO’s provider network: Arizona u
  • State specifies material which must be included in handbook: Florida v
  • Handbook must be consistent with model member handbook approved by CMS and state: New York w
  • MCO must make member materials available online at MCO website without requiring log-in as member: Florida x

  • MCO must develop and distribute at least two member newsletters annually: Arizona y

  • MCO must submit to the state for approval all materials related to contract: Florida ``
  • MCO must submit to the state for approval all written material intended for members or potential members: Minnesota aa
  • State must submit member handbook, and other specified documents, to state for approval: Kansas bb
  • MCO must submit all community outreach materials to state no later than 60 days before start of next contract period: Florida cc
  • MCO marketing materials must be jointly approved by state and CMS: New York dd
  • State will review marketing materials within 30 days of receipt: Wisconsin ee
  • State may not unreasonably withhold or delay approval of marketing materials: Minnesota ff
  • If MCO materials target American Indians, state will consult with tribal governments before approval: Minnesota gg
  • Marketing and outreach materials must meet requirements set forth in Medicaid program manual: New Mexico hh
  • All marketing and outreach materials produced by MCO must state that services are funded pursuant to agreement with state: New Mexico ii

  • All marketing and outreach materials must be reviewed by group that includes consumer representatives: Wisconsin jj

  • MCO must make all written materials available in alternative formats, including formats for those who are visually impaired or have limited reading proficiency: Florida kk, Minnesota ll
  • MCO must make all written material available in English, Spanish, and all other appropriate foreign languages: Florida mm
  • MCO must translate vital documents into prevalent non-English languages: Minnesota nn, New York oo, Wisconsin pp
  • MCO must include a statement on all written materials that the information is available in other formats for people with disabilities: Minnesota qq
  • MCO materials must reflect cultural sensitivity: Wisconsin rr
  • MCO’s written materials and websites must be at or near the 4th grade comprehension level: Florida ss
  • MCO’s written marketing materials must be at a 4th to 6th grade level: New York tt
  • MCO’s written materials must be at or near the 7th grade level: Minnesota uu

  • MCO must ensure providers comply with requirements: Florida vv
  • Providers may display MCO-specific materials in their own offices: Florida ww
  • Providers are prohibited from communicating about benefits or provider networks to members, other than confirming participation in MCO network: Florida xx
  • Providers may announce new affiliation with MCO: Florida yy
  • Providers may co-sponsor events and advertise with MCO in indirect ways (e.g., TV, radio): Florida ```
  • Providers may distribute information about non-MCO-specific health care services for the MCO: Florida aaa
  • MCO may not require participating providers to distribute MCO-prepared communications to patients: New York bbb
  • Residential services providers may not conduct marketing that focuses on ability of MCO programs to pay for services from provider after consumer has exhausted private financial resources: Wisconsin ccc

  • Violation of marketing guidelines may result in warning letter, monetary penalties, suspension of MCO enrollment, or termination of contract: New York ddd
  1. Fla. Contract, Atch. II, pp. 56-57.  (back)
  2. Haw. RFP, pp. 196-97.  (back)
  3. Kan. RFP, pp. 91-92.  (back)
  4. Kan. RFP, pp. 91-92.  (back)
  5. Haw. RFP, pp. 196-97.  (back)
  6. Fla. Contract, Atch. II, pp. 56-57.  (back)
  7. Fla. Contract, Atch. II, pp. 56-57.  (back)
  8. Haw. RFP, pp. 196-97.  (back)
  9. Fla. Contract, Atch. II, pp. 56-57.  (back)
  10. Haw. RFP, pp. 196-97.  (back)
  11. Kan. RFP, p. 91.  (back)
  12. Kan. RFP, pp. 91-92.  (back)
  13. Kan. RFP, pp. 91-92.  (back)
  14. Kan. RFP, pp. 91-92.  (back)
  15. Tenn. Contract, p. 40.  (back)
  16. Kan. RFP, p. 61.  (back)
  17. Tenn. Contract, Atch. IX, Exh. M, p. 531.  (back)
  18. Kan. RFP, pp. 91-92.  (back)
  19. Kan. RFP, p. 91.  (back)
  20. Kan. RFP, p. 91.  (back)
  21. Ariz. Contract, p. 43.  (back)
  22. Fla. Contract, Atch. II, pp. 51-52, Exh.4, pp. 10-11.   (back)
  23. N.Y. Medicaid Advantage Plus Contract, App. E, p. 2.  (back)
  24. Fla. Contract, Atch. II, pp. 38-39.  (back)
  25. Ariz. Contract, p. 43.  (back)
  26. Fla. Contract, Atch. II, p. 38.   (back)
  27. Minn. Contract, p. 46.  (back)
  28. Kan. RFP, p. 92.  (back)
  29. Fla. Contract, Atch. II, p. 58.   (back)
  30. N.Y. Medicaid Advantage Plus Contract, App. D, p. 3.  (back)
  31. Wis. Contract, p. 127.  (back)
  32. Minn. Contract, p. 47.  (back)
  33. Minn. Contract, p. 47.  (back)
  34. N.M. Contract, p. 149.  (back)
  35. N.M. Contract, p. 149.  (back)
  36. Wis. Contract, p. 127.  (back)
  37. Fla. Contract, Atch. II, p. 49.  (back)
  38. Minn. Contract, p. 45.  (back)
  39. Fla. Contract, Atch. II, p. 49.  (back)
  40. Minn. Contract, p. 46.  (back)
  41. N.Y. Medicaid Advantage Plus Contract, App. D, p. 2-3.  (back)
  42. Wis. Contract, p. 136.  (back)
  43. Minn. Contract, pp. 45-46.  (back)
  44. Wis. Contract, p. 136.  (back)
  45. Fla. Contract, Atch. II, p. 49.  (back)
  46. N.Y. Medicaid Advantage Plus Contract, App. D, p. 2.  (back)
  47. Minn. Contract, p. 46.  (back)
  48. Fla. Contract, Atch. II, pp. 62-63.  (back)
  49. Fla. Contract, Atch. II, pp. 62-63.  (back)
  50. Fla. Contract, Atch. II, pp. 62-63.  (back)
  51. Fla. Contract, Atch. II, pp. 62-63.  (back)
  52. Fla. Contract, Atch. II, pp. 62-63.  (back)
  53. Fla. Contract, Atch. II, pp. 62-63.  (back)
  54. N.Y. Medicaid Advantage Plus Contract, App. D, p. 7.  (back)
  55. Wis. Contract, p. 109.  (back)
  56. N.Y. Medicaid Advantage Plus Contract, App. D, pp. 8-9.  (back)

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