New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter II - Administrative Rules and Regulations
Subchapter R - Health Maintenance Organizations
Part 98 - Health Maintenance Organizations
Subpart 98-1 - Managed Care Organizations
Section 98-1.19 - Marketing by mltcps

Universal Citation: 10 NY Comp Codes Rules and Regs § 98-1.19

Current through Register Vol. 47, No. 12, March 26, 2025

(a) An MLTCP shall prepare a marketing plan. Marketing plans shall not be implemented without the prior written consent of the commissioner.

(b) Marketing means any activity of an MLTCP, a subcontractor of the MLTCP or individuals or entities affiliated with the MLTCP, by which information about the MLTCP is made known to potential enrollees for the purpose of persuading such persons to enroll with the MLTCP. Marketing activities are occasions during which marketing information and material regarding managed long term care and a particular MLTCP are presented. Such information may be presented through verbal exchanges and the distribution of written materials and the giving away of nominal gifts (value of $5 or less).

(c) Each marketing plan for an MLTCP submitted to the department for approval shall include but not be limited to:

(1) goals and general marketing strategy;

(2) a description of marketing activities and copies of all draft marketing materials;

(3) staffing plan including training and compensation methodology and levels;

(4) a description of how the MLTCP will meet the informational needs of eligible persons, including those who speak a language other than English as a first language and/or who have a hearing, visual, physical or cognitive impairment, and enable the person to make a voluntary and informed choice;

(5) a description of the MLTCP's monitoring activities to ensure compliance with this section; and

(6) identification of the primary marketing locations at which marketing will be conducted.

(d) Marketing materials means materials that are produced in any medium by or on behalf of an MLTCP and can reasonably be interpreted as intended to market to potential enrollees. Marketing materials may not be used by an MLTCP without the prior written consent of the commissioner, the superintendent and the director of the State Office for the Aging. Marketing materials requiring consent include:

(1) advertising, public service announcements, printed publications, and other broadcast or electronic messages designed to increase awareness of and interest in, or otherwise persuade an eligible person to enroll in an MLTCP; and

(2) any information that references the MLTCP, is intended for general distribution and is produced in a variety of print, broadcast, and direct marketing media, including, but not limited to, scripts, radio, television, billboards, newspapers, leaflets, brochures, videos, telephone books, advertising, letters, posters and the member handbook.

(e) An MLTCP is prohibited from engaging in the following practices:

(1) making unsolicited calls in person or by telephone or cold calling inquiries at the homes of eligible persons;

(2) marketing in emergency rooms, patient rooms or other service delivery sites unless requested by the eligible person;

(3) requiring providers to distribute plan specific marketing, promotional or informational materials of any kind to eligible enrollees;

(4) inappropriate marketing and enrollment encounters such as:
(i) making false statements;

(ii) deceiving, misleading or threatening an eligible person to influence or induce selection of a particular plan;

(iii) discouraging enrollment on the basis of health status or need for health care services;

(iv) signing a person's name on the enrollment agreement without consent;

(v) enrolling persons who are uninformed about the rules of the plan and/or the voluntary nature of enrollment;

(5) seeking to induce selection of an MLTCP by offering gifts which exceed a fair market value of $5;

(6) distributing new or revised marketing materials that have not been approved by the department;

(7) providing misleading or falsified information to the department or the department's designee to substantiate an applicant's eligibility for enrollment; or

(8) enrolling persons the plan is not authorized to enroll.

(f) The MLTCP must process applications for enrollment in the order in which they are received and must not discriminate on the basis of health status.

(g) Prior to enrollment in an MLTCP each enrollee must sign an enrollment agreement which indicates that the enrollee:

(1) received a copy of the member handbook which included the rules and responsibilities of plan membership and which expressly delineates covered and non-covered services;

(2) agreed to the terms and conditions for plan enrollment stated in the member handbook;

(3) understood that enrollment in the MLTCP is voluntary;

(4) received a copy of the MLTCP's current provider network listing and agreed to use network providers for covered services; and

(5) was advised of the projected date of enrollment.

Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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