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

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Results for Standard VIII Quality Improvement Program Score # Elements Met Partially Met Not Met Not Applicable Total # Elements Total # Applicable Elements Percent of Elements Met AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards State of Florida Compliance Monitoring_Standard_VIII_F2_07_11 Page 12
AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards MCO Health Plan: Contract Number: Contract Manager: Date(s) of Monitoring: Standard IX: Medical Records CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING 1. Maintaining a Medical Record 42 CFR 456 CC-VII.J 2. Confidentiality of Medical Records 42 CFR Part 431 Subpart F 384.30(2), F.S. CC-VII.J.2.a 3. Medical Record Review CC-VIII.A.3.e.1 4. Medical Record Standards CC-VIII.A.3.e.2 5. Sites to be Included in the Medical Records Audit CC-VIII.A.3.e.3 & 4 The health plan ensures the maintenance of medical records for each enrollee. The health plan has a policy to ensure the confidentiality of medical records. The policy also includes confidentiality of a minor’s consultation, examination, and treatment for a sexually transmissible disease. If the health plan is not accredited, the health plan conducts reviews of enrollees’ medical records to ensure that PCPs provide high quality health care that is documented according to established standards. The standards, which must include all medical record documentation requirements addressed in the contract, are distributed to all providers. The health plan conducts medical record reviews at all PCP sites, individual offices and large group facilities, that serve 10 or more enrollees. Yes No Yes No 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 Met Partially Met Not Met Met Partially Met Not Met DOCUMENTS REVIEWED FINDINGS State of Florida Compliance Monitoring_Standard_IX_F2_07_11 Page 1
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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32 33 34 35 36 APPLICATION ITEM 10.
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APPLICATION ITEM C. Criminal Backgr
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APPLICATION ITEM 43 13. For medical
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46 47 APPLICATION ITEM 16. Indicate
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49 APPLICATION ITEM 19. Describe in
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51 52 53 54 55 56 APPLICATION ITEM
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Attachment III Special Term and Con
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RICK SCOTT GOVERNOR Regulatory Auth
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e. Complete a credentialing review
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RICK SCOTT GOVERNOR Regulatory Auth
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Compliance Monitoring Tool with Spe
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Standard I: Care Management/Continu
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Results for Standard I Care Managem
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Standarrd II: Utilizatio on Managem
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Standard III: Eligibility, Enrollme
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Page 75 and 76: Standard III: Eligibility, Enrollme
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Page 129 and 130: Results for Standard IX Medical Rec
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Standard XII: Administration and Ma
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Results for Standard XII Administra
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Standard XIII: Community Outreach C
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Results for Standard XIII Community
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Standard XIV: Covered Services AGEN
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Standard XV: Immunizations, Pregnan
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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13 14 15 Agency For Health Care Adm
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f. Posting of the Agency Summary of
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Name: Review Period: Date of Review
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5. 6. 7. 8. 9. local WIC office to
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14 Agency For Health Care Administr
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8 providers Agency For Health Care
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Medical Loss Ratio The following dr
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RICK SCOTT GOVERNOR Better Health C
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Plan Name: AGENCY FOR HEALTH CARE A
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DRAFT ATTESTATION OF 201_ QUARTER E
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Draft MLR Reporting Schedule Health
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RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Attachment V Special Term and Condi
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RICK SCOTT GOVERNOR Mission to Ensu
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• Obtaining data from the health
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RICK SCOTT GOVERNOR Mission to Ensu
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Attachment VI Special Term and Cond
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RICK SCOTT GOVERNOR Better Health C
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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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