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

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.F.2
33. Appointment Wait
Times Compliance
42 CFR 438.206(c)(1)(iv),(v)
and (vi)
CC-VII.F.6
h. At least one (1) pediatrician or one
(1) CHD, FQHC or RHC must be
available within an average of
thirty (30) minutes’ travel time
from an enrollee's residence,
provided that this requirement
remains consistent with the other
minimum time requirements of this
Contract. In order to meet this
requirement, the pediatrician(s),
CHD, FQHC, and/or RHC must
provide access to care on a twentyfour
hour a day, seven day a week
(24/7) basis.
i. BMHC may waive this
requirement, in writing, for rural
areas and where there are no
pediatricians, CHDs, FQHCs or
RHCs within the thirty (30) minute
average travel time.
Annually by February 1 of each
contract year, the health plan reviews a
statistically valid sample of PCP
offices’ average appointment wait
times to ensure that services are in
compliance.
Yes
No
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_X_F2_07_11
Page 15