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

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
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