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

Standard VIII: Quality Improvement Program
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
26. QI Activities – PIPs
CC-VIII.A.3
27. Agency-Approved PIPs
The health plan monitors and evaluates
the quality and appropriateness of care
and service delivery (or the failure to
provide care or deliver services) to
enrollees through performance
improvement projects (PIPs), medical
record audits, performance measures,
surveys, and related activities.
The health plan performs:
a. No less than four (4) Agencyapproved
PIPs for each population
(Reform and non-Reform). There
must be at least one clinical PIP and
one non-clinical PIP per population.
b. At least one (1) of the PIPs focuses
on Language and Culture, Clinical
Health Care Disparities, or Culturally
and Linguistically Appropriate
Services.
c. At least one (1) PIP is the statewide
collaborative PIP coordinated by the
EQRO.
d. At least one (1) of the PIPs is
related to Behavioral Health
Services, if the health plan covers
those services.
e. At least one (1) PIP is designated to
address deficiencies identified by the
plan through monitoring
performance measure results,
member satisfaction surveys, or other
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
N/A
e. Yes
No
f. Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_VIII_F2_07_11
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