(a) It is the intent of the General Assembly to ensure that potential and actual enrollees in a risk-based provider organization have a right to know:(1) Whether a direct service provider is or will be in-network with a particular risk-based provider organization; and(2) The consequences of choosing a risk-based provider organization in which that direct service provider is not participating as a network direct service provider.
(1) Whether a direct service provider is or will be in-network with a particular risk-based provider organization; and
(2) The consequences of choosing a risk-based provider organization in which that direct service provider is not participating as a network direct service provider.
(b) It is not a marketing violation for a direct service provider to inform an existing or potential Medicaid enrollee in a risk-based provider organization of its network status with a particular risk-based provider organization.
(c) The Department of Human Services or a risk-based provider organization shall not:(1) Require a direct service provider to separate communications about its network status from communications about open enrollment if the direct service provider informs the existing or potential enrollee that the enrollee has freedom of choice among risk-based provider organizations and network providers; or(2) Restrict direct service providers from responding to an individual's questions about open enrollment or network status if the direct service provider does not attempt to influence that individual's choice of risk-based provider organizations or respond in any manner that is inaccurate or misleading.
(1) Require a direct service provider to separate communications about its network status from communications about open enrollment if the direct service provider informs the existing or potential enrollee that the enrollee has freedom of choice among risk-based provider organizations and network providers; or
(2) Restrict direct service providers from responding to an individual's questions about open enrollment or network status if the direct service provider does not attempt to influence that individual's choice of risk-based provider organizations or respond in any manner that is inaccurate or misleading.
(d) A direct service provider shall comply with the provisions applicable to providers in the federal managed care rule on marketing activities at 42 C.F.R. § 438.104, as existing on January 1, 2025.
(e) The department shall revise the marketing rules to comply with this section.