Operate a toll-free telephone line for Provider inquiries during normal business hours for a minimum of eight hours per day, Monday through Friday, and have a process in place to handle after-hours inquiries from Providers seeking to verify enrollment for an Enrollee in need of Urgent or Emergency Services provided, however, that the Contractor and its Providers shall not require such verification prior to providing Emergency Services; Maintain and distribute a Provider Manual(s), which includes specific information about ACO Covered Services, Non-ACO Covered Services, and other requirements of the Contract relevant to Provider responsibilities. The Contractor shall submit an updated Provider Manual(s) to EOHHS annually and such updated Provider Manual(s) shall be distributed to Providers annually and made available to Providers on the Contractor’s website. The Provider Manual(s) shall include, but not be limited to, the following information: Enrollee rights, including those in Section 6.1.L, and the requirement that Enrollees must be allowed to exercise such rights without having their treatment adversely affected; Provider responsibilities, especially those that apply to Enrollee rights; That Enrollees may file a Grievance with the Contractor if the Provider violates any Enrollee rights and the steps the Contractor may take to address any such Grievances; Enrollee privacy matters; Provider responsibility for assisting Enrollees with interpreter services; Provider obligation to accept and treat all Enrollees regardless of race/ethnicity, age, English proficiency, sexual orientation, health status, or disability; General rules of Provider-Enrollee communications; ACO Covered Services lists; Provider obligation to make Enrollees aware of available clinical care management options and all available care options; An explanation to all Providers that in certain situations minors under the law may consent to medical procedures without parental consent; Permissible Provider Marketing activities in accordance with Section 2.11.B.;
Operate a toll-free telephone line for Provider inquiries during normal business hours for a minimum of eight hours per day, Monday through Friday, and have a process in place to handle after-hours inquiries from Providers seeking to verify enrollment for an Enrollee in need of Urgent or Emergency Services provided, however, that the Contractor and its Providers shall not require such verification prior to providing Emergency Services; Maintain and distribute a Provider Manual(s), which includes specific information about ACO Covered Services, Non-ACO Covered Services, and other requirements of the Contract relevant to Provider responsibilities. The Contractor shall submit an updated Provider Manual(s) to EOHHS annually and such updated Provider Manual(s) shall be distributed to Providers annually and made available to Providers on the Contractor’s website. The Provider Manual(s) shall include, but not be limited to, the following information: Enrollee rights, including those in Section 6.1.L, and the requirement that Enrollees must be allowed to exercise such rights without having their treatment adversely affected; Provider responsibilities, especially those that apply to Enrollee rights; That Enrollees may file a Grievance with the Contractor if the Provider violates any Enrollee rights and the steps the Contractor may take to address any such Grievances; Enrollee privacy matters; Provider responsibility for assisting Enrollees with interpreter services; Provider obligation to accept and treat all Enrollees regardless of race/ethnicity, age, English proficiency, sexual orientation, health status, or disability; General rules of Provider-Enrollee communications; ACO Covered Services lists; Provider obligation to make Enrollees aware of available clinical care management options and all available care options; An explanation to all Providers that in certain situations minors under the law may consent to medical procedures without parental consent; Permissible Provider Marketing activities in accordance with Section 2.11.B.;
accountable-care-partnership-plan-model-contract.docx