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

Standard XII: Administration and Management
CONTRACT
SECTION
55. Requied
Notifications
CC-XVI.V
56. Non-contracting
with Health Plans
whose Officials
have Committed
Offenses
CC-XVI.V
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan submits to the Agency:
a. Within five (5) business days, any
information on any officer, director, agent,
manageing employee, or owner of stock or
beneficial interest in excess of 5% of the
health plan who has been found guilty of or
enter a plea of nolo contendere or guilty to
offenses listed in s. 435.03, F.S.
b. Any officer, director, agent, manageing
employee, or owner of stock or beneficial
interest in excess of 5% of the health plan
who has a record of illegal conduct according
to the background check.
c. To avoid termination, the health plan submits
a corrective action plan to ensure that the
person is divested of all interest and/or
control and has no role in the operation
and/or management of the health plan.
The Agency will not contract with a health plan
that has an officer, director, agent, managing
employee, or owner of stock or beneficial interest
in excess of five percent (5%) of the health plan,
who has committed any of the above listed
offenses (see ss. 409.912 and 435.03, F.S.).
a. Yes
No
b. Yes
No
c. Yes
No
Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Reference: 435.03 Level 1 screening standards
DOCUMENTS
REVIEWED
FINDINGS
(1) All employees required by law to be screened shall be required to undergo background screening as a condition of employment and continued employment. For the
purposes of this subsection, level 1 screenings shall include, but not be limited to, employment history checks and statewide criminal correspondence checks through the Florida
State of Florida Compliance Monitoring_Standard_XII_F2_07_11
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