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Marketing Requirements & Restrictions
- Marketing and promotional activities (including provider promotional activities) shall comply with all applicable federal and state laws.
- Providers shall not offer cash or non-cash incentives to their enrolled or prospective members for the purposes of marketing, retaining beneficiaries within the providers' services, or rewarding behavior changes in compliance with goals and objectives stated in beneficiaries' individual service plans.
- While engaging in marketing activities, providers shall not:
- Engage in any marketing activities that could misrepresent the service or LDH;
- Assert or state that the beneficiary must enroll with the provider to prevent the loss of Medicaid benefits;
- Conduct door-to-door, telephone, unsolicited school presentations, or other cold call marketing directed at potential or current beneficiaries;
- Make home visits for direct or indirect marketing or enrollment activities except when specifically requested by the beneficiary or family;
- Collect or use Medicaid confidential information or Medicaid protected health information (PHI), as that term is defined in Health Insurance Portability and Accountability Act of 1996 (HIPAA), that may be either provided by another entity or obtained by marketing provider, to identify and market services to prospective beneficiaries;
- Violate the confidential information or confidentiality of PHI by sharing or selling or sharing lists of information about beneficiaries for any purposes other than the performance of the provider's obligations relative to its CSoC provider agreement;
- Contact, after the effective date of disenrollment, beneficiaries who choose to disenroll from the provider except as may be specifically required by Magellan;
- Conduct service assessment or enrollment activities at any marketing or community event; or
- Assert or state (either orally or in writing) that the provider is endorsed either by the Centers for Medicare and Medicaid Services, LDH, Magellan or any other federal or state governmental entities.
- Failure to meet requirements, or violation of any of the prohibition shall be subject to termination of their provider agreements for the services affected by the marketing plan/activities.