Section 22-B5505. MARKETING PRACTICES

 

5505.1The QO shall submit to the Department for prior written approval all marketing plans, procedures and materials including the following items:

 

(a)Marketing brochures and fliers;

 

(b)Advertising copy and public service announcements;

 

(c)Enrollment training guidelines; and

 

(d)Descriptions of proposed marketing approaches.

 

5505.2 The QO shall not engage in deceptive marketing practices that mislead, confuse, or defraud eligible enrollees or the Department.

 

5505.3 Marketing materials shall be clear and include at least the following:

 

(a)A description of the benefits;

 

(b)Hours of service available;

 

(c)Names and addresses of providers;

 

(d)Telephone numbers for emergencies; and

 

(e)Enrollment and disenrollment rights.

 

5505.4 The QO shall not provide cash, gift incentives or rebates to prospective members.

 

5505.5 The QO shall not claim superior medical care or provider skills or threaten, coerce or make untruthful statements regarding the merits of the plan.

 

5505.6 If the QO employs a system of compensation for marketing representatives based on commissions or other incentives, the QO shall assure the Department that sales activities are adequately supervised to conform to allowable practices.

 

5505.7 Each eligible Medicaid recipient in the category or categories covered under the contract shall be considered a potential enrollee and may not be discriminated against on the basis of health status or need for health care services.

 

5505.8 The QO marketing personnel and their supervisors may be required to participate in training sessions presented by the Department that set forth the Department’s requirements, expectations and limitations.

 

5505.9 No QO shall represent to any D.C. Medicaid recipient that he or she is required to enroll in any prepaid plan.

 

 

source

Final Rulemaking published at 34 DCR 1550, 1557 (March 6, 1987).