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Medicaid Managed Care Organization Contract Provisions on MCO Marketing in Provider Offices

Date: 09/15/22

The Louisiana Medicaid managed care organization contract includes provisions about managed care organization marketing in provider offices. As a reminder, we are sharing the following guidance, found in the MCO contract, section 2.14.6. “Contractor” refers to all Medicaid MCOs.  

2.14.6.1 When conducting any form of Marketing in a provider’s office, the Contractor shall acquire and keep on file the written consent of the provider.

2.14.6.2 The Contractor shall not require its Network Providers to distribute Contractor‐prepared Marketing communications to their patients.

2.14.6.3 The Contractor shall not provide incentives or giveaways to providers to distribute Marketing communications to Enrollees or Potential Enrollees.

2.14.6.4 The Contractor shall not conduct member education or distribute member education materials in provider offices, with the exception of health education materials (branded or non‐branded) with the provider’s consent.

2.14.6.5 The Contractor shall not allow Network Providers to solicit Enrollment or Disenrollment in an MCO, or distribute Contractor‐specific materials as a Marketing activity.

2.14.6.6 The Contractor shall not provide printed materials with instructions detailing how to change MCOs to Enrollees of other MCOs to providers.

2.14.6.7 The Contractor shall instruct Network Providers regarding the following communication requirements:

2.14.6.7.1 Network Providers who wish to let their patients know of their affiliations with one (1) or more MCOs shall list each MCO with whom they have contracts;

2.14.6.7.2 Network Providers may display and/or distribute health education materials for all contracted MCOs or they may choose not to display and/or distribute for any contracted MCOs. Health education materials shall adhere to the following guidance:

2.14.6.7.2.1 Health education posters cannot be larger than 16” x 24”;

2.14.6.7.2.2 Children’s books, donated by MCOs, must be in common areas;

2.14.6.7.2.3 Materials may include the MCO’s name, logo, phone number and website; and

2.14.6.7.2.4 Providers are not required to distribute and/or display all health education materials provided by each MCO with whom they contract. Providers can choose which items to display as long as they distribute items from each contracted MCO and that the distribution and quantity of items displayed are equitable;

2.14.6.7.3 Providers may display Marketing Materials for MCOs provided that appropriate notice is conspicuously and equitably posted, in both size of material and type set, for all MCOs with whom the provider has a contract;

2.14.6.7.4 Providers may display MCO participation stickers, but they shall display stickers by all contracted MCOs or choose to not display stickers for any contracted MCOs;

2.14.6.7.5 MCO stickers indicating the provider participates with a particular MCO cannot be larger than 5" x 7” and may not include anything more than the MCO name and/or logo or with the statement that it is accepted or welcomed here;

2.14.6.7.6 Providers may inform their patients of the benefits, services and specialty care services offered through the MCOs in which they participate. However, providers shall not recommend one MCO over another MCO, offer patients incentives for selecting one MCO over another, assist the patient in deciding to select a specific MCO in any way, or otherwise intend to influence an Enrollee’s decision; and

2.14.6.7.7 The Contractor shall not produce branded materials instructing Enrollees on how to change a MCO. They must use LDH provided or approved materials and shall refer Enrollees directly to the Enrollment Broker for needed assistance.