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

Standard XII: Administration and Management
CONTRACT
SECTION
5. Providing
Covered Services
without Regard
to Usage
CC-II.D.17
6. CMSSP ONLY:
Screening Tools
Exhibit 2
7. CMSSP ONLY:
Updates to
Policies and
Procedures
Concerning the
Screening Tools
Exhibit 2
8. ALL PLANS
EXCEPT
REFORM
HMOs:
Furnishing
Services
Exhibit 2
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan provides covered services to
enrollees as required for each enrollee without
regard to the frequency or cost of services
relative to the amount paid pursuant to the
Contract.
The health plan’s policies and procedures include
both the clinical screening tool and the
administration of the clinical screening tool
performed by the State of Florida Department of
Health to determine beneficiary clinicaleligibility
for the specialty plan for children with
chronic conditions.
Any revisions to policies and procedures
concerning both the clinical screening tool and
the administration of the clinical screening tool is
approved by the Agency prior to use.
The health plan furnishes services in an amount,
duration and scope that are no more restrictive
than the services provided in the Medicaid feefor-service
program and may reasonably be
expected to achieve the purpose for which the
services are furnished.
Yes
No
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
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_XII_F2_07_11
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