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.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
Results for Standard X Access and Availability 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_X_F2_07_11 Page 16
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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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Page 93 and 94: Standard IV: Enrollee Services & En
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Page 113 and 114: Standard VII: Provider Contracting
Page 115 and 116: AGENCY FOR HEALTHCARE ADMINISTRATIO
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Page 129 and 130: Results for Standard IX Medical Rec
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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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