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

Standard XII: Administration and Management
CONTRACT
SECTION
37. Sufficient IT
Staff
CC-X.D.5
38. Timely
Submission from
Providers
CC-X.D.6
39. Agencysponsored
Workgroups
CC-X.D.7
40. Conflict of
Interest
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan designates sufficient IT and
staffing resources to perform these encounter
functions as determined by generally accepted
best industry practices.
Where a health plan has entered into capitation
reimbursement arrangements with providers, the
health plan requires timely submissions from its
providers as a condition of the capitation
payment.
The health plan participates in Agency-sponsored
workgroups directed at continuous improvements
in encounter data quality and operations.
The health plan discloses to HSD within ten (10)
business days of discovery the name of any
officer, director, or agent who is an employee of
the State of Florida, or any of its agencies.
a. The health plan discloses the name of any
state employee who owns, directly or
indirectly, an interest of five percent (5%) or
more in the health plan or any of its affiliates.
b. The health plan covenants that it presently
has no interest and will not acquire any
interest, direct or indirect, which would
conflict in any manner or degree with the
performance of the services hereunder.
c. The health plan further covenants that
in the performance of the Contract no person
having any such known interest will be
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
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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