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    Materials Guide for Submitting Materials to DHS

    Please work with your contract manager to determine the appropriate review process for any materials, including marketing materials.

    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, such as in an envelope or folded and closed securely.

    Criteria for submitting materials

    • Per the Families and Children Prepaid Medical Assistance Program (PMAP), 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). 

    • MCOs may create materials in various mediums such as printed media, social media, signage, email, website, video and audio broadcasts, and any other formats.
    • Materials that are based on an approved model must strictly adhere to the model template, excluding MCO-specific contact information or those modifications allowed on the model or template. You must submit any exceptions to a model template to your contract manager for review and approval. For documents that also require Centers for Medicare & Medicaid Services (CMS) submission, the MCO is responsible for following CMS submission requirements before publishing the document.
    • Materials submitted to a contract manager for review and approval are subject up to a 30-calendar day review. If the 30th day falls on a weekend or a holiday, the review is due the following business day.

    Materials requiring approval include, but are not limited to:

    • Materials identified in an MCO contract as requiring approval
    • Materials that are applicable to unique 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 contract manager for review and approval 
    • Any documents relevant to the following (with or without templates):
      • Denial, termination, and reduction (DTR) notices 
      • Grievance or appeal forms or letters 
      • Member rights
      • Initial enrollee screening
    • Any MCO-created materials which contain 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:
      • Explanation of Benefits (EOB)
      • Medicaid 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 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 that do not have a model
      • 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
    • Multi-plan collaborative materials when directed to do so

    Materials to be submitted for informational purposes (FYI) (For DHS information only)

    DHS reserves the right to review and comment if materials are not accurate or do not meet materials requirements. MCOs may publish FYI materials on the date submitted to the contract manager. During the contract manager’s review, if changes are needed, the MCO will need to update their published materials incorporating these changes.

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

    The following template documents:

    • Complaint Block
    • Language Block and ADA initial templates (full size and small size versions)
    • List of covered drugs annual wrap language (Medicaid and Integrated products), including Preferred Drug List
    • 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 (Medicaid and integrated products)
    • SNBC non-integrated enrollment or disenrollment form
    • Transaction Reply Report (TRR) letters
    • Other DHS or CMS-Identified templates and models used without modification (including MSHO and SNBC Integrated templates within the CMS Plan Guides)

    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 (This should be from the translation company)
    • Health education content including disease education, health promotion, and enrollee education for appropriate benefit use
    • Instructions for accessing care (such as mail order pharmacy forms, nurse line brochures, and so forth)
    • List of covered drugs (Medicaid and integrated products) Change Reports and related materials, including Preferred Drug List updates
    • Member satisfaction surveys related to patient care 
    • 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 which merely link 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 modification, 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 modification that do not contain any information related to determining eligibility for programs, requesting information needed to maintain program eligibility, informing members that their benefits have increased, decreased, terminated, or denied, and 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 correspondence about general MCO news or announcements
    • Translated documents except for vital documents
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