Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
CC- IV.A.17.d.2.a
80. Using
Redetermination
Date: The
Agency’s
Language
CC- IV.A.17.d.2.b
81. Using
Redetermination
Date: When to Call
Enrollees
CC- IV.A.17.d.2.c
82. Using
Redetermination
Date:
Confidentiality
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
enrollees within a family who have the
same Medicaid redetermination date
provided that these enrollees share the
same mailing address/ phone number.
A health plan that chooses to use this
method to provide the information must
adhere to the following requirements:
For the voice messages, the health plan
uses only the language in the Agency’s
redetermination date notice template
provided to the health plan. The health
plan may add its name to the message
but makes no other changes, additions or
deletions to the message text.
The health plan makes automated calls to
each enrollee no more than 60 calendar
days and no less than 30 calendar days
before the redetermination date occurs.
The health plan does not include the
redetermination date information in any
file viewable by customer service or
community outreach staff. The
information will be used only in the
letter templates and automated scripts
provided by the Agency and cannot be
referenced or discussed by the health
plan with the enrollees, unless in
response to an enrollee inquiry about the
letter received, nor will it be used at a
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_IV_F2_07_11
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