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

AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
MCO Health Plan: Contract Number:
Contract Manager: Date(s) of Monitoring:
Standard XII: Administration and Management
CONTRACT
SECTION
CONTRACT REQUIREMENT COMPLIANT SCORING
1. Accuracy of The health plan verifies that information it Yes
Met
Information submits to the Agency or its agents is accurate. No
Partially Met
Not Met
CC-II.D.2
2. Submitting
Documents to the
BMHC
CC-II.D.3-4
3. Prior Approval of
Documents and
Notification to
Enrollees
CC-II.D.4.a-b
4. Website
Documents
CC-II.D.6
The health plan submits all policies and
procedures, model provider agreements and
amendments, all subcontracts (including
behavioral health, if applicable), and all other
materials related to this Contract to the Bureau of
Managed Health Care (BMHC) for approval
before implementation.
To obtain BMHC approval:
a. The health plan provides written materials to
BMHC at least forty-five (45) calendar days
before the effective date of the change.
b. The health plan provides written notice of
such changes affecting enrollees to those
enrollees at least thirty (30) calendar days
before the effective date of change.
The health plan makes enrollee materials,
including the preferred drug list, provider
directory and enrollee handbook(s), available
online at the health plan’s website without
requiring enrollee log-in.
Yes
No
a. Yes
No
b. 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_XII_F2_07_11
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