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DRAFT RBHA Communications Plan

Mercy Maricopa Integrated Care

RBHA Communications Plan

Mercy Maricopa Integrated Care (MMIC) is committed to communicating openly with its

members, their families, providers, advocates, regulators and other stakeholders, using a wide

variety of tools to do so. We understand that the best communications plan is not directed “AT"

recipients; but rather, is a vehicle to encourage exchanges of ideas and facilitate improvement in

our system. Good communications are key to making certain that Maricopa County residents are

aware of the service and have access to comprehensive, quality behavioral health care that

integrates with the health needs of the individual as a whole.

In order for us to succeed in this mission, we will assure that our communications system is

culturally aware, that we translate into languages needed by our members, that we have

communication models for special needs, including cognitive impairment, and that we employ

communication tools that also speak best to diverse communities. (See Attachment 1, Cultural

Competency, at the end of this document for more details.)

We are well aware that transitional periods always are difficult, and that past transitional

experiences in the Regional Behavioral Health Authority (RBHA) system have not always gone

smoothly. We believe that good communications can help make sure this transition goes well.

In fact, our communications efforts began months ago and will continue on an ongoing basis in

three phases:

1. For more than 10 months, we have been reaching out to stakeholders to attain knowledge of

the RBHA as well as their vision for the future. We have had more than 70 meetings, some

of them one-on-ones and some of them focus group settings. These meetings have been for

information-gathering as well as an opportunity to inform stakeholders in the behavioral

health system more about us. We have learned from this dialogue; indeed, it has helped to

define the plan we envision for Maricopa County, detailed in our response to the Request for

Proposals (RFP).

2. Upon contract award, we will increase and expand this outreach effort. Our commitment is

to work with stakeholders and the community to assure our communications approaches

work best for them. We will work with member and youth councils to identify best practices

and use the full scope of communications tools to reach out to current and prospective

Offeror: Mercy Maricopa Integrated Care ADHS13-00002257

Attachment 6, Section 11.4, Draft Communications Plan 1

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members, providers and all the other stakeholders in the system to provide information,

continue to receive their input and advice and establish additional resources. This continuing

dialogue will enable us to adjust our tools and communications approaches to best fit the

current needs of the stakeholders and the community and to modify our efforts as changing

circumstances require.

3. Finally, we are committed to an effective ongoing two-way communications engagement

with our members, their families, providers, advocates, regulators and other stakeholders.

Phase 1 – Pre-Award

Initial outreach to stakeholders began long before the RFP was issued. Since the beginning of

2012, MMIC has initiated more than 70 meetings with a wide universe of stakeholders. Our

executives, senior leaders, advisers and program professionals met with multiple providers,

program participants and stakeholders.

Sometimes these meetings lasted an hour; many times, they led to more extensive conversations

and involvement. For example, an initial meeting with the Alliance of Community Health

Centers (Alliance) has led to a collaboration between MMIC and the Alliance on two pilot

programs aimed at strengthening the Patient Centered Health Care Home capabilities of

community centers.

Table 1 below is a list of the meetings that occurred. Our findings from those meetings follow

the list.

Table 1: Meetings Held Organization Service St

1 AOC, Arizona Court-Appointed Special Advocate( CASA), Foster Care Review Board

Government/advocates Leticia D’Amore, Arizona CASA Manager.; Steve Lazere, Foster Care Review Board; Charlie Gray, supervisor

2 Alliance of Community Health Centers

Providers/advocates Meetings, leading to establishment of pilot projects, with John McDonald, CEO

3 Arizona Behavioral Health Care Provider Ted Williams, President & Chief Executive Officer (CEO)



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Organization Service St

4 Arizona Behavioral Health Care/Maricopa consumers, advocates and providers

Providers, consumers, advocates

Group meeting of providers

5 Arizona Children’s Association Child care providers

Michael Coughlin, CEO

6 Arizona Coalition for Military Families

Family support for military families

Thomas Winkel, Life Consultant

7 Arizona Coalition Against Domestic Violence, Governor’s Office for Children, Youth and Families, Arizona Dept. of Ec. Security Domestic Violence Program

Advocacy and training for domestic violence services

Jessye Johnson, Deputy Director, Arizona Coalition; Leah Meyers, Program Administrator, Governor’s Office for Children, Youth and Families; Laure Guild, Domestic Violence Program Manager, Arizona Department of Economic Security

8 Arizona Dept. of Economic Security/Rehabilitative Services Administration

Government regulator Letitia Labrecque, Deputy Director

9 Arizona Supreme Court Administration Office of the Courts, Dependent Children’s Services Division, CASA of Arizona, Foster Care Review Board

Organizations concerned with welfare of children, foster care review

Leticia D’Amore, Program Manager for CASA; Steve Lazere, Program Manager for the Foster Care Board; Charlie Gray, Supervisor

10 Asian Pacific Community in Action (APCA)

Advocate Doug Hirano, Executive Director

11 ASU Center for Applied Behavioral Health Services Policy

Provider Michael Shafer, Director; Vicki Staples, Assistant Director Clinical Initiatives

12 Aurora Behavioral Health Care Adult and children’s inpatient behavioral health hospital

Bruce Waldo, CEO

13 CHEEERS Community support center, group ILS and peer support

Mitch Klein

14 Chicanos por la Causa SA residential for men Pedro Cons, Chief Operating Officer (COO)

15 CHOICES Network of Arizona Provider Network Organization (PNO)

Ron Smith, CEO; Jill Teslow Rowland, Vice President of Recovery and Transformation



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16 Community Bridges Provider (PNO)

Frank Scarpati, CEO

17 Community Bridges, Jewish Family and Children Services, National Council on Alcoholism and Drug Dependence, Chicanos por la Causa, Lifewell, Southwest Human Services, Rio Salado Behavioral Health

Substance abuse services CEOs and Delegates:

John Hogeboom; Mary Jo Whitfield; Thelma Ross; Roland Moreno; Gabriella Guerra; Tino De Anda

18 Connections Provider (Psych urgent care) Chris Carson, CEO

19 CPR RBHA SMI eligibility vendor Mike Boylan, COO

20 Crisis Response Network (CRN)

Provider (RBHA Crisis System) Suzanne Rabideau, CEO

21 CRN; EMPACT, Connections AZ; Community Bridges; ComTrans

RBHA-wide crisis services CEOs and Delegates:

Suzanne Rabideau; Laura Larson-Huffaker; Brenda Benage; Frank Scarpati; Neal Thomas

22 Division of Behavioral Health Services (DBHS)

Government Regulator Laura Nelson, Bureau Chief

23 EMPACT Provider Laura Larson-Huffaker, Executive Director

24 Family Involvement Center Advocate Jane Kallal, Executive Director

25 FasPsych RBHA telemedicine vendor Abraham Barton

26 FIC, Raising Special Kids, STAR

Family support services CEOs:

Jane Kallal; Joyce Millard; Suzanne Legander

27 Foundation for Senior Living – SMI Health Homes Discussion

Provider Group meeting

28 Haven Senior Horizons Provider Kathy Shaw, CEO



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29 Hope Lives (Vive la Esperanza) Community services, peer support; access to health care for diverse communities

Christopher Gonzales, CEO

30 Lifewell Behavioral Wellness Supported housing, substance abuse, counseling, residential treatment

Gabriella Guerra, Chief Clinical Officer

31 Marc Center Provider Randy Gray, CEO

32 Maricopa County Association of Governments

County-wide HSS programs all jurisdictions

Amy St. Peter, Human Services Manager

33 Maricopa County Human Services Division

Human Services Campus, shelter and homeless services, special human services programs and grant-funded projects, workforce development, justice support services, etc.

David Bridge, Managing Director, human services campus; Linda Mushkatel, Special Projects Director; Trish Georgeff, Director, Maricopa County Human Services Division; Margaret Trujillo, Assistant Director

34 Maricopa County Jail Behavioral Health Unit

Behavioral health services Dawn Nogle, Director

35 Maricopa County Manager County Services Tom Manos

36 Maricopa Integrated Health System

Health system Numerous meetings with various individuals, including:

Betsey Bayless, CEO; J. Barry Birmingham, Vice President of Ambulatory and Physician Services

37 Mesa Fire and Police Departments

Liaison services with RBHA Officer Tom Gussic (Crisis Intervention Training Coordinators);Dan Stubbs, asst. chief, Emergency Services; Mary Cameli, Assistant Chief; Anita Mapes, Education Specialist

38 Midwestern University, Phoenix Education about system; training

Michael Stumpf, Professor and M.D., Psychiatry, Training for ADHS in behavioral health

39 MIKID Provider/Advocacy (Parent to Parent Organization)

Michael Puthoff, Executive Director

40 Mountain Health and Wellness Provider Rob Evans



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41 Mountain Park Health Center Provider 2 meetings:

1st meeting: Essen Out, Diversity & Cultural Competency Director;

2nd meeting: Byrd Evans; Brandy Segura; Maria Campos; Diana Beltran, billing

42 National Alliance of the Mentally Ill (NAMI)/Arizona Alliance (E. Valley, Phx., W. Valley, SE Valley)

Advocacy and stigma reduction training

Group meeting; WALK; meeting with CEO Jim Dunn

43 Native American Connections House, substance abuse, counseling – adult and children’s

Dede Devine, DCEO

44 Native American Connections Provider, Native Americans Diana Yazzie-Devine

45 National Council on Alcoholism and Drug Dependence (NCADD)

Advocacy and education Thelma Ross, CEO; Holly Williamson, Clinical Director

46 NOVA IP and OP substance abuse services

Steve Carter, CEO

47 Partners in Recovery Provider (PNO) Christy Dye, CEO

48 Partners in Recovery East and West

Adult SMI clinics Focus groups – Provider Network Organizations (PNOs) – Advisory Boards (Christy Dye; Chief Medical Officer Greg Gale; COO Stacey Garner; West Valley Site Administrators Norm Sartor & advisory board members)

49 Phoenix City Police Department Liaison services with RBHA Nick Margiotta, Ombudsman

50 Phoenix Indian Medical Center Health care services for Native Americans-general health, SMI, behavioral health, substance abuse

Dr. John Molina, CEO; Dr. Connie Hunt, Director, Behavioral Health

51 PSA and Art Awakenings Art therapy, support housing, counseling

Sara Marriott, CEO

52 Quality of Care Network Provider (PNO) Gary Brennan, CEO



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(Children)

53 Recovery Empowerment Network

Community support center – Group Independent Living Services (ILS), peer support

Anne Rider, CEO

54 Recovery Innovations of Arizona

Counseling, crisis recovery center, Restart, etc.

Gene Johnson, President & CEO; Michelle Bloss, Recovery Services Administrator; Tom Updike, Chief Strategy Officer

55 Rural Metro PMT Provider/ambulance services 1st meeting: Jeff Baker, Division General Manager

2nd meeting: Dan Caudle, Fire Chief

56 Southwest Network Provider (PNO) Amy Henning, CEO

57 Southwest Network, People of Color Network, CHOICES, Partners in Recovery

Adult SMI clinic services; second meeting on children’s comprehensive services

Amy Henning, Southwest Network;Tomás León (People of Color CEO) Ron Smith, CHOICES; Christy Dye, Partners

58 St. Joseph’s Hospital Provider Mark Hillard, CEO

59 St. Luke’s Behavioral Health Center

IASIS – Provider Gregory Jahn, CEO

60 St. Luke’s Health Initiative Advocate Roger Hughes

61 Stand Together and Recovery (Peer Service Organization)

Provider Individual meeting

62 STAR Community support center – group ILS and peer support

Suzanne Legander. CEO

63 STAR East and STAR West Community support center – group ILS and peer support

Focus groups – consumer service agency – program participants

64 SW Behavioral Health Provider Jeff Jorde, CEO

65 Tanner Community Development Corporation

Faith-based community; substance abuse prevention

Meetings with:

Rev. Arnold Jackson Robert Young, Program Director



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66 Terros Provider Dale Rinard, CEO

67 Touchstone Behavioral Health Services

Provider Steve Ginsberg

68 Valle del Sol Behavioral health provider Kurt Sheppard, CEO

69 Valley of the Sun United Way Housing, and other services/funding

Janet Garcia, Vice President for Community Impact; Kim Van Nimwegen, Community Impact Manager

70 Valley Hospital (CHW) Provider Jason Caplan, M.D., Chief Medical Officer

71 ValueOptions Health Maintenance Organization

Eddie Broadway

72 Visions of Hope (Peer Service Organization)

Provider James Russo, CEO

73 Your Neighborhood Healthcare Center

Provider Harry Garewal, President

74 Youth, Etc. Specialty children’s OP services provider

Jim Oleson, CEO

Feedback summary

The meetings described in the chart above have produced a wealth of information about what

works in the current system and what could use improvement. Each time we engage in dialogue

with a stakeholder in the system, we are left our sessions with two major realizations: (1) there

are a lot of people working in the RBHA system who care and have adopted as their missions

serving people in need and using limited resources well; and (2) Many of the issues they have

encountered in trying to fulfill their missions will be greatly helped by integrating the acute,

behavioral and Medicare programs, if the integration for the Seriously Mentally Ill (SMI) is done

well.

We have taken their input into consideration as we responded to the state’s RFP, and we will

continue to incorporate it in our transitional discussions and ongoing plans. Table 2 on the

following page is a summary of the major issues identified thus far in our conversations:



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Table 2: Major Issues Identified General RBHA

Issue Solution

1. Issues of resources exist at every age level, and silos within the system result in ability to leverage existing services effectively. Because of tight resources, the focus is on compliance with requirements, leaving no time or funding for exploring best practices/innovations. RBHA should support innovative practices by investing in better service delivery systems, creating and sharing short- and long-term goals, helping create balance between new ideas and constantly changing requirements, reducing non-meaningful workloads, creating open record-sharing and increasing true collaboration.

MMIC’s governance structure will include provider stakeholders on the Board of Directors, giving the opportunity for providers to help drive the policy changes required for issue resolution. Some of these discussion points may require revision of state policies & procedures. MMIC will work with our Board of Directors to support positive collaboration with ADHS/DBHS to promote change where needed.

2. Lack of resources and support for sharing electronic records results in delays in service and ineffective care management.

The development & implementation of our Health Information Exchange will support information-sharing that will facilitate system efficiency that results in timely service delivery.

3. Language barriers and lack of information about how to access services are always a concern. Providing culturally appropriate care is difficult if not impossible.

MMIC has more than 20 years of experience working with Medicaid members in Maricopa County & has a strong culturally competent approach to those members that it will use in the RBHA system as well.

4. More peer and family support services are needed throughout the service delivery system.

MMIC is committed to increasing peer & family support services, and to working with stakeholders to identify best-practice models that can be replicated.

SMI Issue Solution

1. Member experience: Integration of services is a concern throughout the system.

The new commitment to integrate acute and behavioral health will bring major improvements, allowing for holistic approaches to diseases that so often are inter-related & eliminating circumstances where the Primary Care Physician (PCP) is not aware of treatments that the Behavioral Health (BH) provider has instigated. MMIC is strongly supportive of integration in the system, based on decades of experience.



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2. Member experience: There is significant variability in the member experience between clinics. At some, members feel welcome & supported; this, in turn, lends itself to increased engagement from the member— in treatment, in training, in moving from supportive employment to competitive employment opportunities.

MMIC will initiate better training in member service for Case Managers and other staff, increase the use of peer staff & install measurements that go beyond simply measuring appointment timeliness to include the member experience.

3. Transition Youth Needs: Youth are transitioning into the SMI system require age-related and cultural-related supports. Currently, there is limited capacity & few providers.

MMIC will expand the availability of youth peer support programs. We will establish a Youth Member Council to help is developing a youth program and seek additional input from the provider organizations that are doing it well.

4. Clinic Provider Needs: SMI clinic providers do not currently receive timely data; the date they receive is 90-180 days old, meaning it is not actionable. The delay prevents them from pro-actively engaging members to prevent Emergency Room (ER) visits and admits.

We are committed to developing an effective Health Information Exchange with “push-and-pull” capability from an enterprise-wide data warehouse dedicated to providing “near real time data.”

5. Service Shortages: There is a shortage of available Dialectical Behavioral Therapists, Applied Behavioral Analysis Therapists, Multi-System Therapists & Desensitization & Reprocessing Therapists, and access to those available is not geographically dispersed throughout the County. These all require a professional license & lengthy training. (They are used for high-needs conditions such as Post-Traumatic Stress Disorder (PTSD), Autism Spectrum Disorders, Behavioral Management for Sexual Addictions.)

MMIC will work with Arizona State University, the University of Arizona and Argosy to develop increased training programs. We will sponsor programs and consider enhanced rates for these services, which are desperately needed.

Children Issues Solutions

1. The same service shortages exist as on the adult side, and there are particular shortages of Applied Behavioral Analysis Therapists for kids with autism spectrum disorders & sexualized behaviors.

Similarly to the adult side, MMIC will work with the universities to develop increased training programs, sponsoring training programs and exploring enhanced rates for these services.



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2. Case management is done by the PNOs & not by specialty providers. Most of the kids who are in complex case management get their counseling & medications from a specialty provider who knows them best & is equipped to manage their specific needs. The PNO Complex Care Managers are generalists who frequently cannot manage specialty needs.

We will not require that case management be provided by PNOs, allowing it to be provided by the specialty provider.

3. “Wrap-around” services are needed for children in the foster care system.

MMIC will commit to a stronger collaboration with Child Protective Services (CPS) and all the stakeholders, building systems for assuring connection to family-run organizations.

Dual eligibles Issues Solutions

1. Individuals who are dual eligible for Medicaid & Medicare often encounter delays in navigating the system.

MMIC’s sponsor, Mercy Care’s Advantage program has a well-established reputation for its service to members, and we will apply that experience to our RBHA members.

Phase 2 – Post-award transition communications

In the second phase of MMIC’s communications plan, we will enhance and expand the earlier

outreach efforts begun pre-RFP. While we work on forming the foundation of our

communications system as the new RBHA, we will simultaneously enact a transitional plan. Our

goal is to effect a smooth transition with minimal disruption to our members and providers.

During this phase, we will work intensively and cooperatively with the government

administrators, the current RBHA contractor and all the stakeholders in the system to deliver

timely and accurate information about the transition to both members and providers.

Our initial communications strategy will be sensitive to the scope of change in the system and

descriptive of any specific changes that touch members and providers directly. (All messages to

members will be submitted for approval to ADHS/BDHS before distribution, during the

transition and afterwards.)

Targeted Audiences and Communication Tools

1. Members and Prospective Members



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Our primary focus will be to reach out to members and prospective members. That means also

reaching out to family members and advocates.

Tools: Engaging the universe of multi-generational, culturally diverse individuals who will be

our members and prospective members, their family members and caregivers will require a

variety of approaches. We will use the following:

Written communications (letters, fliers, Frequently-Asked-Questions [FAQ] sheets)

Email when possible

Individual and group meetings

Website (welcome kit, Member Handbook, benefit information, provider directory/search,

healthcare education materials/links and advocacy information, secure portal) in English and

Spanish (See Attachment 2, Website, at the end of this document)

Webinars

We will translate messaging and make them available in other formats helpful to members with

special needs. (See Attachment 1, Cultural Competency.)

Message: The primary messages will include an introduction to MMIC, detailed information

about the transition, particularly how it will affect members’ day-to-day as we integrate

behavioral health and acute care services to provide a more holistic approach to their health care

needs.

Recognizing that members often receive information from providers, community organizations,

advocacy groups and others, we will work with them all to distribute educational information

(not marketing materials). Our website will include an advocacy page for information about

meetings and other notices.

In addition, we will begin to outreach to identify members interested in participating in our

Member Advisory Council and Youth Advisory Council. As we move into ongoing

communications, these groups will provide valuable advice on how to best reach out to our

membership, their families and caregivers. As we begin to build the foundations of an ongoing

communications strategy, we will start by forming and immediately engaging our Member

Advisory Council and Youth Advisory Council. Together, we will assess the existing means of



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communications in the RBHA. Just as we asked those questions about the RBHA in the

meetings prior to the RFP, we will query our council members to make sure that we do not toss

out what is working, but rather augment and expand it. Among the questions we will be asking:

What works in communicating with you?

What does not?

What sorts of information are you not getting that you need?

Are you getting information often enough?

Do you use websites?

Have you engaged in social media and, if so, what kind of social media?

Do you know how to access services?

Do you feel you understand the resources currently are available in the system?

In more than 20 years of working with Maricopa County Medicaid members, MMIC’s sponsor,

Mercy Care Plan, has developed highly effective processes for personally reaching out to

members, including:

Collaboration with community organizations, providers and other stakeholders to reach out to

members and prospective members

Personal one-on-one outreach to high-risk populations

Use of Health Advisors at public events

Community forums and orientation meetings throughout the county

We will use all these resources as well as asking all the providers and advocacy groups to help us

by including information in their offices, their newsletters and other communications.

2. Providers

Tools: Not only is efficient, timely communications important to enable providers to do their

job, it also is crucial because of the key role providers play as a conduit of information to

members, both during the transition and on an ongoing basis. We will collaborate with

ADHS/DBHS in coordinating the provider communication with members about the transition

and about other developments related to their health care.



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During the transitional period, we will initiate a weekly electronic newsletter to providers, with

updates on the implementation. We will reconnect through meetings with those providers we

reached during Phase 1, and we will expand that group. We will use:

Telephone contacts

Written communications (letters, fliers, FAQ sheets)

Email when possible

Individual and group meetings

Website (See Attachment 2.)

Webinars

Phase 3 – Post-transition, ongoing

MMIC will initiate an effective ongoing communications engagement with our members, their

families, providers, advocates, regulators and other stakeholders. Our multi-year

communications strategy will be key to our efforts to build meaningful collaborations with the

vast umbrella of stakeholders in the Maricopa County behavioral health system. We will

communicate consistently with our universe of stakeholders as well as work collaboratively with

the state and more broadly to the general community as an advocate for the behavioral health

system.

Outreach

The goal of our outreach efforts is to assure all members, their families, advocates and other

stakeholders as well as the agencies serving them understand the benefits available through the

RBHA and how to access and use them. Outreach is especially critical for high-risk members

who may have challenges in receiving and understanding information about services and access

that is formatted and disseminated in traditional ways.

MMIC will engage members and stakeholders with a focus on continuous improvement of the

system of care while, at the same time, keeping them informed about available services and

providers, as well as supports, plan, and industry updates.

Both of our sponsors, Mercy Care Plan and Maricopa Integrated Health Systems, have a long

history of success in connecting and collaborating with advocacy groups, adjunct service and

support systems, schools and other stakeholders for the benefit of our members. Building on that



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success, MMIC will use multiple communications channels to promote understanding of

available benefits and services, including all of those mentioned before—the welcome kit, the

Member Handbook, the member newsletter, the website, email, focus groups, community town

halls/forums, webinars, letters and other written materials, and social media as approved by the

state.

We will continue to frequently convene our Member Advisory Council and Youth Advisory

Council to advise us on the content and to develop innovative approaches to disseminate

information and communicate with our members and the community. We also will empower

our Youth Leadership Council to design outreach and educational materials and approaches that

will capture the attention of, and engage youth in services. Diverse outreach activities have been

a cornerstone of MMIC’s success in connecting and collaborating with a range of key agencies,

advocacy groups, service and support systems, schools and other stakeholders for the benefit of

our members.

Our focus on proactive, preventive and personalized quality care that is readily accessible

through a large network of providers has improved clinical outcomes for members while

reducing unnecessary medical costs (e.g., emergency department). We have expanded our

community relationships to assist us in identifying and outreaching to members, making the full

range of community resources available to support them in achieving their health goals. We will

also collaborate with local community organizations and local community centers to meet

members in their communities.

MMIC will provide locally-based stakeholder liaison positions (family, peer and youth support)

into our staffing model. Their key functions will include coordinating and providing outreach;

building ongoing collaborative relationships across all sectors in the system and community; and

providing consultation, technical assistance and education. As a complement to the role these

functions bring, we tailor education and outreach strategies to meet the needs of each program as

well as the specialized needs of the local communities within each program.

Engaging high-risk members in care management

To further engage individual high-risk members, including members with a serious mental

illness and co-morbidities, we will employ a multi-pronged approach, beginning with an initial

welcome telephone call and following that with a visit. A member of the treatment team will



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introduce the member to MMIC and then explain the purpose of care management. If we cannot

reach a high-risk member by phone, MMIC will deploy peer support workers and/or community

outreach workers to locate the member in the community. A behavioral health clinician will then

perform a Health Risk Assessment at the member’s home or location of choosing. On an

ongoing basis we will engage members through the use of Peer Coaches and community

outreach workers.

Communicating on health education and prevention

MMIC will offer health education, prevention and outreach programs, and for these programs to

work, we must deliver a message that engages the member in his/her health care management.

MMIC will provide each member with respectful, understandable and culturally sensitive

information about our programs and services in the member’s preferred language. We have

adopted the U.S. Department of Health and Human Services Office of Minority Health’s

Culturally and Linguistically Appropriate Services (CLAS) standards for all education,

communication and outreach approaches. See Attachment 1, Cultural Competency, for more

details.

MMIC utilizes specific guidelines to communicate with our members in a clear, effective and

accurate manner. We provide all member materials at or below a sixth grade reading level as

determined by the Flesch-Kincaid readability tool. We will use bulleted lists, shorter sentence

structures and will not include healthcare “jargon.” Our written and verbal communication will

explain to the member technical or unfamiliar terms to assure accuracy and understanding.

MMIC will seek approval in writing by Arizona Health Care Cost Containment System

(AHCCCS) for all health education and outreach activities prior to implementation. We will also

enlist the use of Peer Support Specialists to assist in explaining any process.

For members who require written information in alternative formats, MMIC will make

translations available in Braille, large print, or audio CD. When an interpreter is needed to

further explain the material to the member, we will offer a telephonic interpreter at no cost to the

member. MMIC will also provide Peer Support Specialists to assist members in providing

reassurance or further explanation of information they may not understand.



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For members who are cognitively impaired, we will identify a person/ caregiver who supports

the member and whom the member has selected to represent him/her, assuring all legal

documentation regarding personal health information is in place. For those members or

members who have literacy issues, we will use oral culturally competent health care teaching or

communication. For members who require oral teaching only, we will work to achieve feedback

from the member and his/her caregiver, providing any materials to both (which may look very

different). The caregiver may receive our unedited materials or a written copy of any discussions

or Care Plans, while the member may receive pictures to describe conversations or a basic

document to describe the conversation. We will use pictures, oral repetition and the member

communication back to us to assure comprehension.

In order to reach more members, MMIC will actively and regularly reach out to educate

members about improving their health status through a variety of methods, including but not

limited to:

Through secure email, MMIC will electronically provide reminders on preventive health care

measures that follow the periodicity schedules for children and wellness program for women

and men that meet Healthcare Effectiveness Data and Information Set (HEDIS®)

requirements. Additionally, we will also send reminders on preventive services (e.g. flu

shots) and links to our website for members to view their newsletter, new information

concerning the program and important health education information.

Our preventive care tracking system will identify members who need reminders to access

services according to established periodicity, wellness or prevention schedules (such as

immunizations), well-child screenings, mammograms, Pap smears, and flu shots. MMIC will

use two methods for monthly member reminders: regular mail and interactive voice response

calls.

Our Member Service Representatives will have access to a Language Line. Language Line

gives members and providers no-cost, on-demand interpretive services for 175 languages 24

hours a day, 365 days a year.

MMIC will offer member access to a Nurse Line 24 hours a day, 7 days a week to provide

general health care and wellness-related information. We will inform members of the

availability of the Nurse Line through our website, the Member Handbook and the Provider



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Manual. Additionally, we will encourage providers to promote the Nurse Line with their

members and highlight this service through our member communications (e.g. newsletters,

brochures).

MMIC is developing more creative ways to use the new tools offered through social media

effectively, but responsibly, to reach and collaborate with stakeholder groups and members.

Social media tools can be used to work with stakeholders to build awareness of health plan

programs and services, strengthen relationships with key audiences, improve customer

service, increase website traffic and inspire health and wellness, so long as they are used in

accordance with protocols for review of materials. According to a Pew Research study, half

of adults look online for health information. Young people, Latinos and African Americans

are increasingly likely to use mobile devices to gather information. Social media gives us a

vehicle to interact with members. We want to work with our members to provide pertinent

information to them where and when they need it. As with any communications to members,

we will work with ADHS/DBHS officials for review and approval of social media outreach.

MMIC will offer targeted wellness and prevention programs to help our members achieve

their health and wellness goals related to topics such as drug and alcohol abuse prevention,

smoking cessation, weight management and preventing hospital readmissions. We will

educate members through written communications in the welcome packet and the Member

Handbook and on our website as well as through one-on-one discussions.

We will develop programs and activities to promote the health and well-being of our

members such as targeted Early Periodic Screening, Diagnosis and Treatment (EPSDT) and

immunization activities, prenatal programs and family planning services, and laboratory

services. We will offer our educational programs through toll-free phone numbers, the

Member Handbook, quarterly member newsletters, periodic reminder mailings (such as flu

shot reminders), brochures, Case Manager contacts and via our website, which will offer

links to podcasts and other information provided by national organizations.

Process for identifying members

Member self-identification – MMIC will send materials to all enrolled members (in member

newsletters, the Member Handbook, EPSDT reminders, chronic care newsletters) that

provide detailed information about services available, including health education programs

and care management services.



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Provider identification – Our network providers are also key partners in identifying members

who may benefit from care management services. We will educate our providers about the

health education program through numerous written methods, including newsletters, mailings

and the Provider Manual as well as direct communication methods such as site visits, forums

and meetings.

Identification through other internal and external parties – In addition to the above methods,

we may identify members needing health education through referrals from other MMIC

departments or activities. These include prior authorization, concurrent review, member

services, outreach, provider services, and prevention and wellness outreach activities. We

may also identify members through interactions from external sources; e.g., advocacy

groups, schools, community-based organizations, family members and caregivers. Our

Consolidated Outreach and Risk Evaluation (CORE) tool will enable us to identify early in

the intake process those members who will need the most case management by looking at

past claims related to acute care, pharmacy and behavioral health to identify members at high

risk for adverse future health outcomes.

EPSDT health promotion activities

Each new member will receive a Member Handbook that includes information on the EPSDT

program, child health guidelines and tips to keep children healthy. Our member newsletters will

typically include articles about the value of the EPSDT program. We will use our member

services toll-free line to educate members and their families on the EPSDT program during their

brief on-hold waiting periods. We will also include materials on our website for easy reference

regarding services offered to members at no charge.

Our Maternal Child Health/EPSDT Coordinator will mail a variety of age-specific health

materials to inform our members and their families/caregivers about our EPSDT Program. We

will offer 31 bilingual EPSDT mailings for the parent or guardian specific from birth to age 21,

reminding them of well-child checkups, current immunizations that their child should be getting,

along with helpful tips for parents with a child at each particular age range. MMIC’s EPSDT

outreach strategy recognizes the importance of emphasizing and repeating messages about the

value of EPSDT services to members and their families/caregivers. Our strategy will include:



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General reminders to members and providers – We will send all EPSDT members and

families/caregivers reminder cards about the need for and value of scheduling well-child

visits and obtaining age-appropriate immunizations as set forth in the EPSDT periodicity

schedule. We will notify providers through their secure web portal.

Targeted follow-up - We will make calls to the family/caregiver of EPSDT age members if

the member is late for an EPSDT appointment. During this call, we will take the proactive

step of scheduling an appointment with the responsible party and the member’s PCP /BH

provider office via a three-way call and arranging transportation.

Community collaboration- We will engage in community-based education at health fairs,

where we disseminate, among other things, EPSDT information and information about our

PCP network.

Our Member Services Department will perform general health promotion activities along with

targeted activities for pregnant members and those of a child-bearing age. Maternity care

information will be included in our

New member welcome letter, which includes steps to take if the member is pregnant

Member Handbook, which includes care guidelines, covered services, and stay healthy tips

when pregnant

Articles in our member newsletters that remind members about the importance of prenatal

care and postpartum follow up, the need for dental care while pregnant (coordination with the

carved out dental vendor is available through member services, care management, peer

support specialists, or provider services), and the importance of folic acid intake while

pregnant

Through maternity care reminders on our member services toll-free line on-hold messaging.

Perinatal care information is also available on our website.

We will disseminate targeted promotional materials to pregnant members or those of child-

bearing age and will include:

For female members 18 to 39 years of age, a brochure encouraging them to initiate a visit

with an Obstetrician/Gynecologist (OB/GYN) within the first trimester of their pregnancy.

For newly identified pregnant women, perinatal outreach materials including information

about signs of preterm labor, anemia, and nutrition and how to contact a Care Manager; and a



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“Taking Care of Yourself and Your New Baby” booklet with a letter that provides

information to newly identified pregnant women on the availability of free childbirth classes.

We also provide an informational flyer on the Women, Infant, Children (WIC) program,

including information on what is offered by the program, as well as how to apply.

Text4baby.org link as a resource for pregnant members to receive text messages on their cell

phones for reminders about prenatal care and other important health-related information

After delivery, a “You and Your New Baby” book, which provides tips on maintaining the

good health of newborns. New mothers will also receive a home visit and their new babies an

HRA within 28 days of birth to determine the need for referral to additional services.

Targeted outreach to inform and educate our pregnant members will continue throughout a

woman’s pregnancy and during her postpartum care. Since early identification is key to the

success of our outreach strategies, MMIC will identify pregnant women through several

processes, including external sources such as ED claims, OB/GYN observation admission report,

review of HRA completed by newly enrolled members, review of EPSDT tracking forms,

provider authorization requests for “total OB care,” and members directly contacting MMIC

about a pregnancy.

Once identified, our Maternal Child Health/EPSDT Coordinator will mail letter to the pregnant

member, congratulating her on her pregnancy and encouraging her to make an appointment with

her OB/GYN. This mailing will include the “Taking Care of Yourself and Your New Baby”

booklet.

Provider collaboration and support

MMIC recognizes our providers as important leaders on the team of our wellness and prevention

programs. We value provider input as well as their hard work and leadership in bringing

validation of our programs to each and every member. Based on the specific program and each

member’s unique needs, providers may identify members who are appropriate for a specific

program. They may also encourage members to participate in a specific program and provide

feedback on the member’s success. Educating providers about the programs is critical so that

they can be an effective partner for these activities. We will use multiple methods to inform

providers about our health education programs, including:

Our website and the secure provider web portal



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Provider newsletters

Provider relations visits and updates

Interaction with care managers



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Attachment 1: Cultural Competency

MMIC’s Cultural Competency/Health Literacy program promotes cultural competence and

health literacy education practices for staff, providers and members. Our goals center on

providing readily accessible, quality health services in a culturally competent manner to a diverse

membership. The program focuses on identifying opportunities that eliminate cultural and

communication barriers, increase awareness of activities to enhance cultural competence and

health literacy, and meet all federal and State requirements related to Limited English

Proficiency (LETP) and the Americans with Disabilities Act (ADA). This includes members

with limited cognitive functioning.

The knowledge MMIC has developed regarding culture and cultural dynamics is integrated into

every facet of our organization. Staff are trained to effectively utilize the knowledge they gain.

We believe that fully integrating cultural knowledge will affect changes in the way we deliver

healthcare to our members and enhance our ability to serve diverse populations.

To be considered a culturally competent organization, diversity must be prevalent and valued..

MMIC – through its sponsors – has been a leader in delivering high quality, culturally sensitive,

and community-based health care services to members in Arizona. Both of our sponsors Mercy

Care Plan and Maricopa Integrated Health System have decades of experience working with

Medicaid members. It is our standard operating procedure to assure our member educational

information is in an easily understood language and format, at an appropriate reading level. We

will routinely inform our members that translations are available at no cost for non-English

speakers, and we will make interpreters available at no cost. We take into consideration the

special needs of our members, and our materials are available in alternative formats at no costs to

members. The information that these materials are available in other languages and formats will

be provided – in alternative language as well as English – in our member handbook and on our

website.

To help minimize and prevent our members from experiencing delays in access to care due to

language barriers, MMIC will offer interpretive and sign language services at no cost to the

member through a third-party vendor. All member materials will notify members of the

availability of interpreters as well as of assistance for those who may be visually or hearing

impaired. All member communication materials will undergo an extensive evaluation so that



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content is appropriate for a population’s reading level and language, with images that are

culturally relevant. Lastly, we will review materials using Flesch-Kincaid to assess ease of

understanding. We will also use bulleted lists when appropriate, shorter sentence structures and

will not include healthcare “jargon.” Our written and verbal communication will explain to the

member technical or unfamiliar terms to assure accuracy and understanding. In addition, we will

use new formats, such as fotonovelas, to present educational information.

MMIC supports providers in delivering cultural competent services by offering training and

educational initiatives on relevant topics. We will reinforce the importance of cultural

competencies and health literacy during provider meetings, in our provider manual, through

educational tools, on our provider-facing website pages and via site visits. Through continuous

monitoring and evaluation of cultural competency practices, we strive to eliminate any

disparities that may hinder the delivery of exemplary services to members. We will employ

interventions, such as provider trainings and the creation of action plans to address any racial or

ethnic disparities identified through member complaints and provider visits.

Developing a Cultural Competency Plan

Cultural competency is a key value of our plan. As part of our program, we have developed an

annually updated Cultural Competency Plan, annual evaluation, policies and procedures, and

ongoing provider, staff, and stakeholder training to provide members with a system of care that

is considerate of their culture, individual preferences and needs. Further, we incorporate cultural

and linguistic principles and practices across every part of our delivery system to employees,

providers and members. We do not just do this because our regulators want us to; we believe in

and are committed to the principle of assuring that every member has access to the care he or she

needs. This cannot be done without effective communications.

Our Cultural Competency Plan describes the goals, policies, and methods we will use to promote

and measure the delivery of services in a culturally responsive and linguistically appropriate

manner. The plan supports Arizona Health Care Cost Containment System (AHCCCS) and

ADHS/DBHS cultural competency and health literacy requirements and incorporates the

standards required by the U.S. Department of Health and Human Services, Office of Minority

Health’s National Standards for Culturally and Linguistically Appropriate Services (CLAS) and

Limited English Proficiency (LEP).



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Our plan is founded on three principles of health literacy:

Accuracy. We will present information accurately and in a manner members are able to

understand.

Accessibility. We will use multiple distribution methods, appropriate languages and a

variety of formats to make certain that member materials actually meet our members. Our

Member Advisory Council (MAC) will help to make sure we are on-target.

Enabling action. Our method of communicating with members will be focused on providing

information that can be acted upon to improve health care outcomes.

Specifically, we will weave our plan throughout all of the following areas:

Foundation documents, such as policies, procedures, goals and objectives will reflect a

commitment to cultural competency practices throughout the company.

The people we hire. Individuals from diverse backgrounds are a vital part of our company,

and the composition of our staff reflects the member groups we serve.

Interpretive and sign language services and material will be available for members with LEP.

Hiring and promotional practices and performance evaluations demonstrate our commitment

to building a culturally competent organization.

Clinical programs and guidelines are developed based on knowledge and consideration of

cultural groups.

All programs and procedures will reflect a commitment to managing a culturally competent

service delivery system and workforce.

Training encourages the development and enhancement of cultural competency skills.

Involvement of our members in developing, implementing, and evaluating materials,

practices, and interventions.

Evaluating the Cultural Competency Plan

We will evaluate the Cultural Competency Plan annually and will report result to AHCCCS. We

will measure and evaluate cultural competency practices that identify strengths and weaknesses

to develop an action plan for improvement. The evaluation will offer insight into the strengths,

gaps and needs, allowing us to address improvement opportunities as part of the upcoming

annual plan. We will gather data that determines the health needs of the community through the

Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey as well as



MAG-355-000025


monitoring member grievances and provider feedback to determine that communication,

education and outreach activities are delivered in a culturally competent manner. We will also

measure employee satisfaction in the areas of diversity.

The following are components of the evaluation plan:

Employee self-assessments

Analysis of the effectiveness of our usage of language line and sign language interpretive

service

Review of language indicator data from AHCCCS to evaluate the need to develop materials

in other languages

Provider office availability and accessibility audits to determine if resources are in place,

such as patient materials in other languages and special formats; and to assess if other

accommodations are available as needed and appropriate notifications are made that

interpretive services are available

Evaluations of website content for consistency with information standards, technology and

the standards regarding cultural competency and special needs described earlier

Member and provider satisfaction surveys designed to measure culturally competency-

related questions, such as appointment availability, communication with physicians and

translation needs

Analysis of member grievances to promptly identify and correct any cultural competency

issues

Monitoring of calls to evaluate staff awareness and application of culturally competent

practices and skills

Assessing services in GSA 6

With over two decades of experience serving Arizona populations through its sponsors, MMIC

brings both commitment and a thorough understanding of the unique needs of local, culturally

diverse communities. MMIC will conduct an ongoing assessment of services provided in

Geographic Service Area (GSA) 6 that focuses on culturally competent care delivered in the

network as part of our outreach and programs. We will strive to match the cultural and linguistic

needs of our members to providers in our network.



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To assess the effectiveness of our cultural competency efforts, we will analyze provider audits,

member grievances, satisfaction surveys, language line usage, member demographic reports, call

monitoring reports and other information. We will also review monthly ethnic and language

diversity reports to determine if we meet thresholds for translation of member materials. Member

enrollment data and provider information, such as background and languages spoken, can also be

compared and analyzed to identify trends or gaps in meeting the member’s cultural needs.

Training on cultural competent practices

To address the needs of our members, our staff will receive cultural competency training and will

work with our providers to understand differing cultural beliefs involving health and service

delivery.

MMIC will maintain a comprehensive orientation and training program to educate employees on

culturally and linguistically appropriate services to members. We will educate employees on

ethnicity and languages spoken by our members as well as the impact of racial and ethnic

disparity on health outcomes. This critical piece of training will be interactive and employees

will gain knowledge of racial and ethnic disparities to care.

As part of new hire training, employees will complete three modules on health literacy and

cultural competency:

Overview of Health Literacy

Culturally Competent Service

Cultural Competency Resources

Following the first year of service, employees will complete three classes, selecting from a

variety of sources, allowing training customized to meet their needs in relation to their position

and the level of contact they have with culturally diverse members, providers and stakeholders.

In addition, we will provide cultural competency training to our member and provider services

and clinical staff to enhance awareness of cultural and religious practices, racial disparities in

treatment, and strategies for removing cultural and linguistic barriers. These cultural

competency training materials can be easily accessed through training manuals and on our

website.

Training providers



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MMIC providers will receive initial and ongoing training on cultural sensitivity, health literacy

and health care disparities through orientation sessions, the provider materials in manuals,

meetings and the provider section of our website. We will design our education materials using

various forums, including professional trainers, site visits, interactions with clinical staff and

online resources. Understanding how busy our providers can be, we will also offer free training

opportunities through a secure web portal and will offer continuing medical education (CME)

credit. Training will cover topics such as delivering cross-cultural care, and taking into account

member’s cultural perspectives and preferences.

In preparation for this RFP and on behalf of MMIC, Mercy Care Plan (MCP) has participated on

the AHCCCS contractor Cultural Competency Collaboration team (C3) to examine ways to

enhance provider communication with members through education, awareness and outreach. The

team planned and facilitated the design of the annual cultural competency conference that

includes all AHCCCS contractors and health plans. MCP has regularly attended the annual

conference and has sponsored breakfast meetings to bring together a workgroup to address

healthcare disparities through provider education. MCP has also conducted forums to educate

providers in the areas of cultural competency, health literacy and to share any new information.

Providing cultural competency information to members

We will focus on educating members to overcome barriers related to cultural differences. We

will develop materials to help members understand their conditions, how to successfully navigate

services and the importance of asking their health care provider questions. We understand how

cultural differences can affect both the relationship and communication between a member and

provider, and we are constantly listening to our members for their input.

So that member materials are informative, easy-to-read, and visually appealing, our Member

Advisory Council (MAC) will participate in the development and review of member materials.

The MAC will collaborate with our staff to create materials that are easily understood by our

diverse membership. The MAC will also seek member input and feedback on our programs,

quality initiatives, and other education and outreach tools.

Our member information materials are evaluated for cultural sensitivity and health literacy. Our

educational materials will undergo extensive review to evaluate content, quality and reading

level are appropriate and to verify that translation is completed and appropriate for threshold



MAG-355-000028


languages. Our written materials will notify members of available oral interpretation services

and how they can be requested through our member services.

MMIC will also participate in Arizona community forums and events to engage and educate

members. We will gather feedback and information from members and community stakeholders

regarding the quality of our service delivery system and member satisfaction. We will report this

information to the MAC for recommendations on follow up actions.

Delivering communications using alternative formats

MMIC will comply with federal and state requirements offering interpreter and translation

services to limited English proficiency (LEP) members. Our member services will include

providing bilingual staff to assist LEP members and a TTY line for members who are hearing

impaired. Interpreters will be certified as proficient in the LEP threshold language(s). We will

encourage the use of professional interpreters, rather than family or friends, to best meet the

member’s needs and assure accuracy.

We will provide an interactive Language Line Interpreter Services with over-the-phone

interpreters in 170 languages, 24 hours a day, 7 days a week, at no cost to members or providers.

Based on language preference information received from AHCCCS and utilization information

received from the Language Line Interpreter Service, we can identify members that may have

LEP. Employees will receive training and can readily access information using Language Line

services. We will also train providers on Language Line services as part of their orientation and

ongoing review training. Information on Language Line and how to use these services will also

be included in the provider manual.

Our member services department within customer service operations will have a TTY line for the

hearing impaired and on-site interpreter services will be available as needed. We will provide

Sign Language Interpreters upon request to accompany members as they obtain covered services.

In May of 2011, MMIC’s sponsor, MCP, contracted with A-Z Interpretation Inc., to provide

face-to-face interpretation services that have been extremely beneficial when members and

providers cannot access telephonic services through Language Line Services. We will continue

to recruit, select and retain permanent employees to staff our member services department who

mirror our member demographics, with special emphasis on Spanish-speaking staff.

Examples of cultural competency initiatives



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The following are a few examples of initiatives MMIC’s sponsors MCP and MIHS already have

in place to promote culturally competent services for local communities:

Use of Promotoras and Cultural Health Navigators that provide a cultural link between

healthcare providers and the Hispanic community by guiding members through the process

of accessing care.

Use of fotonovelas and digital stories that facilitate culturally competent education and

empowerment.

Conducting provider forums featuring cultural competency topics on our website and in

provider newsletter articles.

Opening the Refugee Women’s Health Clinic to offer a culturally-grounded, patient-centered

medical home. The clinic is one of only two in the nation and has served more than 1,000

refugee women from 28 countries.

MMIC will continue and expand on these initiatives. Our sponsors combined have conducted

over 400 educational outreach events each year, including sponsored events held by community

partners. Through Family Learning Centers, daily community programs are provided and

several events have been held throughout the year at the Refugee Women’s Health Center. We

will collect outcomes data from events such as these including the purpose of the event,

education/services provided, type and number of informational materials distributed and the

contact information for individuals requesting follow up or referrals for service.

Additionally, in 2011 MMIC’s sponsors – MCP and MIHS – had staff donate more than 8,500

volunteer hours, the equivalent of nearly a full year of 24-hour days of volunteer time, to

organizations such as the Special Olympics, the National Alliance on Mental Illness (NAMI),

and Save the Family and the Southwest Autism Research and Resource Center (SARRC). Our

sponsors conducted five collections drives of items for those who need assistance, gathering

more than 7,000 items such as socks, shoelaces, school supplies, blankets, shoes, water and food

items.



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Attachment 2 – Website

MMIC will offer members and providers easy access to accurate, up-to-date information on a

website that is both user-friendly and easy to navigate, building on the website experience that

Mercy Care Plan has gained in communicating with the 342,000 Maricopa County Medicaid

members it serves. We will give our members and providers unlimited, immediate, convenient

and no-cost access to information that is compliant with Health Insurance Portability and

Accountability Act (HIPAA) privacy and security requirements. Our website also is compliant

with Section 508 of the Americans with Disabilities Act (ADA) and meets all standards the ADA

sets for people with visual impairments and disabilities. In addition, the site is translated into

Spanish, with timely translations of all new material added. Furthermore, we do not use

proprietary items that would require a specific browser.

Our public site will include, at a minimum, the following:

Member benefits

The most current version of the Member Handbook and the provider directory, including a

hyperlink to the ADHS/DBHS provider manual

Telephone contact information, including a crisis hotline and a toll-free member services

number prominently displayed and information on accessing the Telecommunications Device

for the Deaf (TDD)

A provider search function by location, specialty and language spoken

Information advising the member on how to obtain member materials translated to another

language or for special assistance, in alternative formats

EPSDT information

General member services information

Information for providers with contact information, claims submittal information, prior

authorization instructions and a toll-free telephone number

Information on how to file grievances and appeals

Instructions on reporting suspect fraud and abuse

The HIPAA Notice of Privacy Practices

Member newsletters



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Availability of language interpretive services for members with Limited English Proficiency

(LEP)

Links to public health initiatives

Provider newsletters

Policies and Procedures (P&Ps) dictate that our website and portal will comply with applicable

provisions of the Americans with Disabilities Act, as well as ACOM’s policy (405) concerning

cultural competency. In addition, any information included therein that is not specifically

identified by ACOM policy, but directly related to members or potential members, will first be

submitted to the Division of Health Care Management for prior approval. We will submit, by

November 15th of each year, an Annual Website Certification form (ACOM 404, Attachment B)

verifying that all required information is current and available.

MMIC’s goal for the proposed website is to leverage the latest technology and communication

tools to engage, inform and positively impact the outcomes achieved for our members by our

providers.

Via public pages on the provider area of the website, we will provide extensive information and

resources that will offer value to the provider community. These include provider handbooks,

which contain policies and procedures as well as utilization management and clinical practice

guidelines. In addition, the public pages will provide links to relevant research articles,

educational information on best practices, behavioral health news, and Centers for Medicare and

Medicare Services (CMS) and Substance Abuse Mental Health Services Administration

(SAMHSA) bulletin notices. Constantly updated, these notices will serve as a timely

communication tool to inform providers of any changes that may affect them.

There also will be information about fraud, waste and abuse, medical necessity criteria,

upcoming community events, links to clinical best practice guidelines and a cultural competency

toolkit.

MMIC’s web-based provider connectivity solution will conduct secured transactions and

exchange of data through the Internet. For claims inquiry information and the transfer of

protected health information (PHI), this tool will adhere to the national standards for the security

according to the HIPAA Security Rule.



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Our provider connectivity solution will improve efficiency by allowing contracted providers as

well as appropriate subcontractors, to view claims information and to communicate with MMIC

via a web interface. This process will reduce duplicate data entry, limit unnecessary phone

communication between affiliate providers, and save MMIC resources for functions that deliver

the highest value to our customers.

The provider portal will allow authorized providers to access eligibility and benefit information,

request or check clinical authorizations, submit or check status of claims, view claims summary,

update and submit clinical information, and conduct other functions or transactions over the

Internet.

Characteristics of easy navigation of MMIC shall be incorporated and will include but not

limited to the following:

Drop-down menus

Application-specific toolbars

Auto population of persistent data

Direct links to help, reference information, manuals and documentation

Short-cut and function key functionality

Mouse-over captions for all icons and data elements

Navigation menus, fields, and page tabs

Auto skips from field to field so that the cursor moves automatically to the next field as soon

as the last character in the previous field is completely filled

“Forward” and “Back” navigation



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