Current through Reg. 49, No. 38; September 20, 2024
(a) Prohibited
marketing activities. A provider participating in the Medicaid or child health
plan program, including a provider participating in the network of a managed
care organization that contracts with the Health and Human Services Commission
to provide services under the Medicaid or child health plan program, may not
engage in any marketing activity, including any dissemination of material or
other attempt to communicate, that:
(1)
Involves unsolicited personal contact, including by door-to-door solicitation,
solicitation at a child care facility or other type of facility, direct mail,
or telephone, with a Medicaid client or a parent whose child is enrolled in the
Medicaid or child health plan program;
(2) Is directed at the client or parent
solely because the client or the parent's child is receiving benefits under the
Medicaid or child health plan program; and
(3) Is intended to influence the client's or
parent's choice of provider.
(b) Permissible marketing activities by
providers participating in Medicaid or child health plan programs. Nothing in
this rule prohibits a provider participating in the Medicaid or child health
plan program from:
(1) Engaging in a
marketing activity, including any dissemination of material or other attempt to
communicate, that is intended to influence the choice of provider by a Medicaid
client or a parent whose child is enrolled in the Medicaid program, if the
marketing activity:
(A) Is conducted at a
community-sponsored educational event, health fair, outreach activity, or other
similar community or nonprofit event in which the provider participates and
does not involve unsolicited personal contact or promotion of the provider's
practice that is not used as part of health education; or
(B) Involves only the general dissemination
of information, including by television, radio, newspaper, or billboard
advertisement, and does not involve unsolicited personal contact;
(2) As permitted under the
provider's contract, engaging in the dissemination of material or another
attempt to communicate with a Medicaid client or a parent whose child is
enrolled in the Medicaid program or child health plan program, including
communication in person or by direct mail or telephone, for the purpose of:
(A) Providing an appointment
reminder;
(B) Distributing
promotional health materials;
(C)
Providing information about the types of services offered by the provider;
or
(D) Coordinating patient care;
or
(3) Engaging in a
marketing activity that has been submitted for review and obtained a notice of
prior authorization from the Health and Human Services Commission under
subsection (c) of this section.
(c) Review and prior authorization. At the
provider's option, a provider participating in the Medicaid program may submit
proposed marketing materials to the Health and Human Services Commission for
review and prior authorization to ensure that the materials are in compliance
with this rule. The Commission may grant or deny a provider's request for prior
authorization.
