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

Standard XI: Grievances and Appeals
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
34. Resolution and
Notification: Contents
of Notice of Results
CC-IX.E.7.c.1-3
35. Resolution and
Notification: Address
of SAP/BAP
CC-IX.E.7.c.4
The written notice of resolution
includes:
The right to appeal an adverse decision
on an appeal to the Subscriber
Assistance Program (SAP) for HMOs
or the Beneficiary Assistance Program
(BAP) for PSNs including how to
initiate such a review and:
a. Before filing with the SAP or BAP,
the enrollee must completed the
health plan’s appeal process.
b. The enrollee must submit the appeal
to the SAP or BAP within one year
after receipt of the final decision
letter from the health plan.
c. Neither the SAP nor the BAP will
consider an appeal that has already
been to a Medicaid Fair Hearing.
The written notice of resolution
includes:
The address and toll-free telephone
number of the SAP/BAP:
Agency for Health Care
Administration
Subscriber Assistance Program/
Beneficiary Assistance Program
Building 1, MS #26
2727 Mahan Drive
Tallahassee, FL 32308
(805) 921-5458
(888) 419-3456 (toll free)
a. Yes
No
b. Yes
No
c. Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XI_F2_07_11
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