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

Standard VII: Provider Contracting
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
5. Provider
Termination:Notification
to BMHC
CC-VII.E.3
6. Terminated Provider
List to BMHC
CC-VII.E.3
7. Provider Termination:
Time Frame for
Notification
CC-VII.E.4
In a case in which a patient's health is
subject to imminent danger or a
physician's ability to practice medicine is
effectively impaired by an action by the
Board of Medicine or other governmental
agency, notice to both the provider and
BMHC will be immediate.
The health plan submits a list of terminated
providers to BMHC once a month.
The health plan notifies the provider,
BMHC, and enrollees in active care at
least sixty (60) calendar days before the
effective date of the suspension or
termination of a provider from the
network. If the termination was for
"cause," the health plan will provide to
BMHC the reasons for termination.
Results for Standard VII Provider Contracting
Score # Elements
Met
Partially Met
Not Met
Not Applicable
Total # Elements
Total # Applicable Elements
Percent of Elements Met
Yes
No
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_VII_F3_07_11
Page 3
FINDINGS