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

Standard XII: Administration and Management
CONTRACT
SECTION
46. Misuse of
Symbols,
Emblems, or
Names
CC-XVI.M
47. Disclosure of
Ownership and
Management
Forms
CC-XVI.V.1
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
No person or health plan may use, in connection
with any item constituting an advertisement,
solicitation, circular, book, pamphlet or other
communication, or a broadcast, telecast, or other
production, alone or with other words, letters,
symbols or emblems the words “Medicaid,” or
“Agency for Health Care Administration,” except
as required in the Agency’s Standard Contract,
Section I., Item N., Sponsorship, unless prior
written approval is obtained from the Agency.
a. Specific written authorization from the
Agency is required to reproduce, reprint, or
distribute any Agency form, application, or
publication for a fee. State and local
governments are exempt from this
prohibition.
b. A disclaimer that accompanies the
inappropriate use of program or Agency
terms does not provide a defense.
c. Each piece of mail or information constitutes
a violation.
Disclosure is made on forms prescribed by the
Agency:
a. For the areas of ownership and control
interest (42 CFR 455.104, Form CMS 1513).
b. Business transactions (42 CFR 455.105).
c. Conviction of crimes (42 CFR 455.106).
d. Public entity crimes (s. 287.133(3)(a), F.S.).
e. Disbarment and suspension (52 Fed. Reg.,
pages 20360-20369, and Section 4707 of the
Balanced Budget Act of 1997).
a. Yes
No
b. Yes
No
c. Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
e.Yes
No
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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