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
41. Medicaid Fair
Hearing System
CC-IX.G.1
42. Timing of Filing for a
Medicaid Fair
Hearing with the
Health Plan’s Appeal
Process
CC-IX.G.2
43. Timing of Filing for a
Medicaid Fair
Hearing without
Health Plan’s Appeal
Process
CC-IX.G.3
44. Parties to the
Medicaid Fair
Hearing
CC-IX.G.4
45. Address to Request a
Medicaid Fair
Hearing
CC-IX.G.5
An enrollee may seek a Medicaid Fair
Hearing without having first exhausted
the health plan’s grievance and appeal
process.
An enrollee who chooses to exhaust
the health plan’s grievance and appeal
process may still file for a Medicaid
Fair Hearing within 90 calendar days
of receipt of the health plan’s notice of
resolution.
An enrollee who chooses to seek a
Medicaid Fair Hearing without
pursuing the health plan’s process
must do so within 90 days of receipt of
the health plan’s notice of action.
Parties to the Medicaid Fair Hearing
include the health plan as well as the
enrollee or that person’s authorized
representative.
The address at DCF for the Medicaid
Fair Hearing Office is:
Office of Public Assistance Appeals
Hearings,
1317 Winewood Boulevard, Building
5, Room 203 Tallahassee, FL 32399-
0700
Yes
No
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
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XI_F2_07_11
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