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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
84. Using
Redetermination
Date: Log of Calls
CC- IV.A.17.e.2
85. Using
Redetermination
Date: Policies and
Procedures
CC- IV.A.17.f
86. Using
Redetermination
Date Information:
Quarterly Report
CC- IV.A.17.g
87. Rights and
Responsibilities
Policies and
Procedures
42 CFR 438.100
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
For each month of automated calls made,
a list of enrollees to whom a call was
made, the enrollee’s name, Medicaid
identification number, telephone number
to which the call was made, the date each
call was made, and the date of the
Agency’s enrollment file used to create
the automated call list.
A health plan that chooses to participate
in using the information will keep up-todate
and approved policies and
procedures regarding the use, storage,
and securing of this information as well
as addesses all requirements of this
subsection.
A health plan that participates in using
the information submits to the Agency’s
BMHC a completed quarterly summary
report.
The health plan has written policies and
procedures regarding the enrollee rights
and responsibilities.
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Yes
No
Met
Partially Met
Not Met
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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