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 X: Access and Availability
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
1. Evidence of Capacity
to Provide Covered
Services
s. 1932(b)(7)
1932(b)(7) Social Security Act
s.4704(a) of the BBA
CC-VII.A.2.a-b
2. Submitting Network
Providers to the
Agency
CC-VII.A.3
3. Hospital Privileges
CC-VII.A.4.
4. Provider
Discrimination
The health plan:
a. Offers an appropriate range of
services and accessible preventive
and primary care services to meet
the needs of the maximum
enrollment level in each county.
b. Maintains a sufficient number, mix
and geographic distribution of
providers, including providers who
are accepting new Medicaid
patients.
At least monthly, the health plan
submits a file of all network providers
to the Agency or its agent in the
manner and format determined by the
Agency.
Each provider maintains hospital
privileges if hospital privileges are
required for the delivery of covered
services. The health plan may use
admitting panels to comply with this
requirement.
The health plan:
a. Does not discriminate against
a. Yes
No
b. Yes
No
Yes
No
Yes
No
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_X_F2_07_11
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