Notices

To ensure that enrollees in integrated models understand the model and their rights within it, enrollees must receive notices and other documents that explain, for example, enrollment rights and options, plan benefits and rules, the individual’s care plan (including care options that were considered but not included in the plan of care), coverage denials, appeal rights and options, transition protections and potential conflicts that may arise from relationships between providers, suppliers and others. Without meaningful notice, important protections such as choice and appeals and grievances lose their effectiveness.