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    Materials Guide for Submitting Materials to DHS

    Work with your contract manager to determine the appropriate review process for any materials, including marketing materials.  This includes direction not found within this guide, the Department of Human Services (DHS) Material Review Checklist, and the Complaint Block and Language Block Guidance.

    You must send any material that contains content identifying members as an enrollee of Minnesota Health Care Programs (MHCP) using a method to protect the member’s privacy. This includes putting the identifying content in an envelope or folding and closing it securely.

    Note: While every attempt has been made to have this guide be as inclusive as possible, it may not describe every scenario or type of material an managed care organization (MCO) may create.

    Criteria for submitting materials

    • Per the Families and Children, Seniors and Special Needs BasicCare (SNBC) contracts, “marketing materials” means materials that:
      • are produced in any medium by or on behalf of a managed care organization (MCO) and 
      • can reasonably be interpreted as intended to influence individuals to enroll or reenroll in the MCO’s product(s) under this contract. See the Code of Federal Regulations, title 42, sections 438.104(a). 
    • You can create materials in various mediums such as printed media, social media, signage, email, website, video and audio broadcasts, and any other formats.
    • Materials based on an approved Centers for Medicare & Medicaid Services (CMS) or Department of Human Services (DHS) model model or template must follow the model or template’s format, excluding MCO-specific contact information or the changes allowed on the model or template. Materials following a CMS or DHS model without changes can be submitted to the contract manager for informational purposes (FYI). DHS reserves the right to review and comment if materials are not accurate or do not meet materials requirements. You may publish FYI materials on the date you submit the materials to the contract manager. During the contract manager’s review, if changes are needed, you must update the publications  to include these changes. You must submit any exceptions to a model or template to your contract manager for review and approval.  For documents that also require CMS submission, you are responsible for following CMS submission requirements before publishing the document.
    • Materials submitted to a contract manager for review and approval, in a final format, are subject to an initial 30-calendar day review. If the 30th day falls on a weekend or a holiday, the review is due the following business day.
    • Per CMS guidance, the phrase “Medical Assistance” or “Medical Assistance (Medicaid)” is to be used when referring to the State’s Medicaid program as this is what it is used by DHS.
    • Submisions that require a flesch score should include a copy of the material with the flesch score attached.  If the material is edited to exclude certain words, based on there not being an appropriate substitute for a word or the word(s) cannot be changed as the material is a template, a waiver must be requested. A redlined version of the material showing the excluded word(s) and the updated flesch score must be included in the submission.  Additionally, to ensure the flesch score is reflective of the final material content once approved, a new flesch score must be submitted any time a material requires revision(s) prior to approval.
    • Material submissions must include a completed Materials Review Checklist.  Material information must also be entered on the materials tracking sheet, located on the Medical Assistance (Medicaid) Materials Workgroup SharePoint site in order for the submission to be considered complete.

    Materials requiring approval include, but are not limited to:

    • Materials identified in an MCO contract as requiring approval
    • Materials that are unique to public health emergencies (such as a pandemic, natural disasters, and so forth) would follow the guidance given specific to that situation (for example, executive orders, waivers, and so forth) and must be submitted to your contract manager for review and approval 
    • Any documents related to the following:
      • Denial, termination, and reduction (DTR) notices (those without models or templates)
      • Grievance or appeal forms or letters (without models or templates)
        • Including but not limited to;
          • Complaint form
          • Grievance Acknowledgement Letter
          • Grievance Resolution/Outcome Letter
          • Grievance Withdrawn
          • Grievance Extension Letter
          • Any other letter sent to members regarding grievances such as grievance misclassified, etc.
      • Member rights (with or without models or templates)
      • Initial enrollee screening (with or without models or templates)
    • Any MCO-created materials containing statements describing MHCP benefits or access, including and not limited to network access, incentives, copays, and so forth. Examples of materials communicating benefits or access are:
      • Medical Assistance Explanation of Benefits (EOB)
      • Medical Assistance formulary change letters
      • Provider termination or clinic closure letters
      • Restricted recipient letters and brochures
      • Web pages showing benefit information
      • Member surveys
    • Any MCO-created material with marketing content targeting potential and existing MHCP members, in any format, including marketing targeted to American Indians. Examples are:
      • Inbound or outbound Medicare or integrated sales scripts
      • Medicare or integrated marketing materials or documents without a model or template
      • Newsletters containing marketing content sent only to MHCP members or articles specific to MHCP
      • MCO’s website information directed to MHCP members containing marketing content
      • Care Coordination materials related to marketing
      • Member surveys containing marketing content
    • Member Identification Cards
    • Joint MCO-created materials when directed to do so

    Materials to be submitted to your DHS contract manager as an FYI (for DHS information only) 

    The following model or template documents:

    • Complaint Block (CB)
    • Denial, Termination and Reduction (DTR) Notices with models or templates 
      • DTR Notice
      • DTR For Denial of Payment Only
        • Integrated Dual Special Needs Plan (DSNP) Notices (model or template generated by DHS Managed Care Ombudspersons) 
        • CMS DSNP Coverage Decision Letter
        • CMS DSNP Fast Complaint Letter
        • CMS DSNP Appeal Decision Letter
    • Grievance or Appeal Notices with models or templates (including but not limited to)
      • Medicaid Assistance Appeal Rights Notices 
        • Health Plan Appeal Rights Notice (DHS-8320)
        • State Appeal Rights Notice (DHS-8324)
      • Appeal Notices
        • Appeal Acknowledgement Letter
        • Appeal Extension Letter
        • Denial of Request to Expedite Appeal
        • Appeal Dismissal Letter
        • Appeal Withdrawn Letter
        • Appeal Resolution Letter-Overturned
        • Appeal Resolution Letter-Denial Upheld
        • Appeal Resolution Letter-Denial Partially Upheld
        • Restricted Recipient Program (RRP)-Appeal Resolution Letter-Overturned 
        • RRP-Appeal Resolution Letter-Upheld
    • Language Block and Americans with Disabilities Act (ADA) initial templates (full size and small size versions)
    • List of covered drugs annual wrap language (Medical Assistance and integrated products), including Preferred Drug List (PDL)
    • Minnesota Senior Health Options (MSHO) and SNBC integrated Annual Notice of Change
    • MSHO and SNBC integrated Enrollment Form
    • MSHO and SNBC integrated enrollment or disenrollment information
    • MSHO and SNBC integrated Low Income Subsidy Rider
    • MSHO and SNBC integrated Summary of Benefits
    • Medicare Part D Formulary Change template
    • Member handbooks, Evidence of Coverage (EOC), addenda
    • Provider Directory and subdirectories annual wrap language (Medical Assistance and integrated products)
    • SNBC non-integrated enrollment or disenrollment forms
    • Transaction Reply Report (TRR) letters
    • Other DHS or CMS-Identified templates and models used without changes (including MSHO and SNBC integrated templates or models within the Medicare Communications and Marketing Guidelines [MCMG])

    Note: You must submit any exceptions to a model or template to your contract manager for review and approval.

    Other examples of materials to be submitted as FYI materials:

    • Advance directive materials
    • Annual report to enrollees (for example, financial statement summary and organization description)
    • Certificate of translation for non-English materials (Must be from the translation company)
    • Health education content including disease education, health promotion, and enrollee education for appropriate benefit use. This includes health promotion information, such as asthma or diabetes camp brochures.
    • List of covered drugs (Medical Assistance and integrated products) Change Reports and related materials, including Preferred Drug List (PDL) updates
    • Member satisfaction surveys related to patient care 
    • Changes to branding such as taglines
    • Newsletters without marketing content
    • Privacy statements for all MHCP products
    • Provider Directory Change Reports and materials
    • Release of information and consent forms (for example, Release of Protected Health Information)
    • Website and social media without marketing content 
    • Welcome letters

    Do Not Submit

    • Internet websites linking to the DHS website and other websites for information such as:
      • Americans with Disabilities Act (ADA)
      • Centers for Medicare & Medicaid Services (CMS)
      • Centers for Disease Control and Prevention (CDC)
      • Minnesota Department of Health (MDH), and so forth
    • Materials created by a third-party organization intended to be used without changes, such as disease education information (including brochures, social media, and websites developed by American Heart Association, and so forth). 
      • This does not include materials created by the MCO or a subcontractor on behalf of the MCO.
      • DHS or MDH created materials intended to be used without changes and it
        • does not contain any information related to determining eligibility for programs, 
        • does not request information needed to maintain program eligibility, 
        • does not inform members that their benefits have increased, decreased, terminated, or denied, and 
        • does not include important information about “rights and responsibilities.”
    • Materials specific to an individual enrollee such as phone script responses, letters or other health-related information (for example, letters regarding missed appointments or appeal resolution letters)
    • Press releases and communication about general MCO news or announcements
    • Translated documents
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