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

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Standard X: Access and Availability AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING CC-VII.C.5.a-b 30. New Providers CC-VII.C.6 31. Appointment Waiting Times 42 CFR 438.206(c)(1)(i) CC-VII.F.1.a-c 32. Geographic Standards for Providers notify the health plan, or when a provider fails credentialing. Under these circumstances, notice will be issued immediately upon the health plan’s becoming aware of the circumstances. The health plan notifies BMHC of any new network providers by the 15th of the month following execution of the provider agreement. The health plan assures that PCP services and referrals to participating specialists are available on a timely basis, as follows: a. Urgent Care: within one (1) day, b. Routine Sick Patient Care: within one (1) week, and c. Well Care Visit: within one (1) month. The plan has established geographic standards for providers. a. All PCPs, hospital and community mental health services are available within an average of thirty (30) minutes travel time from an enrollee’s residence. b. BMHC may waive this requirement, in writing, for rural areas and for areas where there are no PCPs, hospitals or community Yes No Yes No Yes No 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 Page 13
Standard X: Access and Availability AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING mental health centers within a thirty (30) minute average travel time. c. All participating specialists and ancillary providers are within an average of sixty (60) minutes travel time from an enrollee’s residence. d. For rural areas, if the health plan is unable to enter into an agreement with specialty or ancillary service providers within the required sixty (60) minute average travel time. BMHC may waive the requirement in writing. e. The health plans provide a designated emergency services facility within an average of 30 minutes travel time from an enrollee’s residence, that provides care on a 24-hour a day, seven days a week (24/7) basis. f. BMHC may waive the travel time requirement, in writing, in rural areas. g. Each designated emergency service facility has one or more physicians and one or more nurses on duty in the facility at all times. BMHC may waive the travel time requirement, in writing, in rural areas. DOCUMENTS REVIEWED FINDINGS State of Florida Compliance Monitoring_Standard_X_F2_07_11 Page 14
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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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Standard IV: Enrollee Services & En
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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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f. Posting of the Agency Summary of
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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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