Section 482-3-005 - ENROLLMENT ACTIVITIES AND CHOICE COUNSELINGThe enrollment broker must complete the following enrollment and choice counseling activities for mandatory and potential mandatory members in coordination with the health plans and Medicaid:
(A) Educate members concerning Heritage Health including:(i) A general explanation of Heritage Health;(ii) Mandatory and excluded members; and(iii) The role of the health plans in coordinating care.(B) Provide information specific to each health plan available in the State, including: (ii) Cost sharing, if any;(iii) Names, locations telephone numbers of, and non-English languages spoken by current contracted providers;(iv) Identification of providers not accepting new patients; and(v) For Medicaid benefits not covered under Heritage Health, the enrollment broker must provide information about how and where to obtain services, any cost sharing, and how transportation is provided;(C) Provide an explanation of those services which do not require primary care provider or health plan approval or prior authorization;(D) Provide an explanation of the availability of interpreter services and alternative formats for written materials;(E) Provide an explanation of passive enrollment;(F) Provide an explanation of disenrollment and waiver of enrollment;(G) Provide the member with enrollment materials that are easily understood by the member, and developed in ways appropriate to meet the needs of the member; and(H) Enter the health plan and primary care provider (PCP) selection in the Heritage Health file.482 Neb. Admin. Code, ch. 3, § 005