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

Standard XII: Administration and Management
CONTRACT
SECTION
48. Required
Submission of
Disclosure of
Ownership and
Management
Forms
CC-XVI.V.1
49. Definition of
Ownership
Requiring
Disclosure:
Part I
CC-XVI.V.2
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The forms are available through the Agency.
a. Submission to HSD is required with the
initial application for a Medicaid health plan
and annually to HSD and BMHC by
September 1 of each Contract year thereafter.
b. In addition, the health plan submits to the
BMHC and HSD full disclosure of
ownership and control of the health plan and
any changes in management within five
calendar days of knowing the change will
occur and at least sixty (60) calendar days
before any change in the health plan’s
ownership or control takes effect.
The following definitions apply to ownership
disclosure: A person with an ownership interest
or control interest means a person or corporation
that:
a. Owns, indirectly or directly, five percent
(5%) or more of the health plan's capital or
stock, or receives five percent (5%) or more
of its profits.
b. Has an interest in any mortgage, deed of
trust, note, or other obligation secured in
whole or in part by the health plan or by its
property or assets and that interest is equal to
or exceeds five percent (5%) of the total
property or assets.
c. Is an officer or director of the health plan, if
organized as a corporation, or is a partner in
the health plan, if organized as a partnership.
a. Yes
No
b. Yes
No
a. Yes
No
b. Yes
No
c. 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
Page 16