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

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Standard XII: Administration and Management AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING Department of Law Enforcement, and may include local criminal records checks through local law enforcement agencies. DOCUMENTS REVIEWED FINDINGS (2) Any person for whom employment screening is required by statute must not have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under any of the following provisions of the Florida Statutes or under any similar statute of another jurisdiction: (a) Section 393.135, relating to sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct. (b) Section 394.4593, relating to sexual misconduct with certain mental health patients and reporting of such sexual misconduct. (c) Section 415.111, relating to abuse, neglect, or exploitation of a vulnerable adult. (d) Section 782.04, relating to murder. (e) Section 782.07, relating to manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child. (f) Section 782.071, relating to vehicular homicide. (g) Section 782.09, relating to killing of an unborn quick child by injury to the mother. (h) Section 784.011, relating to assault, if the victim of the offense was a minor. (i) Section 784.021, relating to aggravated assault. (j) Section 784.03, relating to battery, if the victim of the offense was a minor. (k) Section 784.045, relating to aggravated battery. (l) Section 787.01, relating to kidnapping. (m) Section 787.02, relating to false imprisonment. (n) Section 794.011, relating to sexual battery. (o) Former s. 794.041, relating to prohibited acts of persons in familial or custodial authority. (p) Chapter 796, relating to prostitution. (q) Section 798.02, relating to lewd and lascivious behavior. (r) Chapter 800, relating to lewdness and indecent exposure. (s) Section 806.01, relating to arson. (t) Chapter 812, relating to theft, robbery, and related crimes, if the offense was a felony. (u) Section 817.563, relating to fraudulent sale of controlled substances, only if the offense was a felony. State of Florida Compliance Monitoring_Standard_XII_F2_07_11 Page 20
Standard XII: Administration and Management AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING (v) Section 825.102, relating to abuse, aggravated abuse, or neglect of an elderly person or disabled adult. DOCUMENTS REVIEWED (w) Section 825.1025, relating to lewd or lascivious offenses committed upon or in the presence of an elderly person or disabled adult. (x) Section 825.103, relating to exploitation of an elderly person or disabled adult, if the offense was a felony. (y) Section 826.04, relating to incest. (z) Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child. (aa) Section 827.04, relating to contributing to the delinquency or dependency of a child. (bb) Former s. 827.05, relating to negligent treatment of children. (cc) Section 827.071, relating to sexual performance by a child. FINDINGS (dd) Chapter 847, relating to obscene literature. (ee) Chapter 893, relating to drug abuse prevention and control, only if the offense was a felony or if any other person involved in the offense was a minor. (ff) Section 916.1075, relating to sexual misconduct with certain forensic clients and reporting of such sexual misconduct. (3) Standards must also ensure that the person: (a) For employees and employers licensed or registered pursuant to chapter 400 or chapter 429, and for employees and employers of developmental disabilities centers as defined in s. 393.063, intermediate care facilities for the developmentally disabled as defined in s. 400.960, and mental health treatment facilities as defined in s. 394.455, meets the requirements of this chapter. (b) Has not committed an act that constitutes domestic violence as defined in s. 741.28. 57. Minority Recruitment and Retention CC-XVI.W 58. REFORM CAPITATED: Customized Benefit Package The health plan implements and maintains a minority recruitment and retention plan. a. The health plan has policies and procedures for the implementation and maintenance of such a plan. b. The minority recruitment and retention plan may be company-wide for all product lines. The capitated health plan submits a customized benefit package (CBP). The CBP may vary the co-pays or the amount, a. Yes No N/A b. Yes No N/A a. Yes No N/A b. Yes Met Partially Met Not Met Met Partially Met Not Met State of Florida Compliance Monitoring_Standard_XII_F2_07_11 Page 21
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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32 33 34 35 36 APPLICATION ITEM 10.
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APPLICATION ITEM C. Criminal Backgr
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APPLICATION ITEM 43 13. For medical
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46 47 APPLICATION ITEM 16. Indicate
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49 APPLICATION ITEM 19. Describe in
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51 52 53 54 55 56 APPLICATION ITEM
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Attachment III Special Term and Con
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RICK SCOTT GOVERNOR Regulatory Auth
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e. Complete a credentialing review
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RICK SCOTT GOVERNOR Regulatory Auth
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Compliance Monitoring Tool with Spe
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Standard I: Care Management/Continu
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Results for Standard I Care Managem
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Standarrd II: Utilizatio on Managem
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Standard III: Eligibility, Enrollme
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Standard IV: Enrollee Services & En
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Results for Standard IV Enrollee Se
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Standard V: Provider Credentialing
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Standard VI: Provider Services CONT
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Standard VI: Provider Services CC-
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Standard VI: Provider Services CONT
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Standard VII: Provider Contracting
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Standard VIII: Quality Improvement
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Standard XIV: Covered Services AGEN
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Standard XV: Immunizations, Pregnan
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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13 14 15 Agency For Health Care Adm
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f. Posting of the Agency Summary of
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5. 6. 7. 8. 9. local WIC office to
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14 Agency For Health Care Administr
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8 providers Agency For Health Care
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Medical Loss Ratio The following dr
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RICK SCOTT GOVERNOR Better Health C
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Plan Name: AGENCY FOR HEALTH CARE A
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DRAFT ATTESTATION OF 201_ QUARTER E
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Draft MLR Reporting Schedule Health
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RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Attachment V Special Term and Condi
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RICK SCOTT GOVERNOR Mission to Ensu
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• Obtaining data from the health
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RICK SCOTT GOVERNOR Mission to Ensu
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Attachment VI Special Term and Cond
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RICK SCOTT GOVERNOR Better Health C
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