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

Standard XII: Administration and Management
Exhibit 5
CONTRACT
SECTION
(CBP)
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
duration and scope of the following services for
non-pregnant adults: hospital outpatient not
otherwise specified (NOS) and hospital
outpatient physical, occupational, respiratory,
and speech therapy services; and home health,
dental, pharmacy, chiropractic, podiatry, vision,
hearing and durable medical equipment as
specified below.
a. Amount, duration and scope may vary for
durable medical supplies (DME) with the
exception of any prosthetic/orthotic supply
priced over $3,000 on the Medicaid fee
schedule and except for motorized
wheelchairs, which must be covered up to the
Medicaid State Plan (State Plan) limit.
b. Dialysis services, contraceptives, and
chemotherapy-related medical and
pharmaceutical services must be covered up to
the State Plan limit.
c. Hearing services for non-pregnant adults may
vary in amount, duration and scope except for
hearing aid services, which must be covered
up to the State Plan limit.
d. The health plan provides all medically
necessary services up to the State Plan limit in
accordance with the Medicaid Handbook
requirements for pregnant women,
children/adolescents, and enrollees with a
HIV/AIDS diagnoses as identified by the
Agency.
No
N/A
c. Yes
No
N/A
d. Yes
No
N/A
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XII_F2_07_11
Page 22