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

Standard XII: Administration and Management
Exhibit 5
CONTRACT
SECTION
64. Background
Checks for
Subcontractors
CC-XVI.O.1.d
65. Subcontractor
Compliance with
HIPAA
CC-XVI.O.1.e
66. Health Plan
Retaining
Responsibility
for the Contract
CC-XVI.O.1.f
67. Withdrawing
Services from a
County
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
he/she has reached the maximum dollar
limit established by the health plan for a
benefit.
Subcontractors are subject to background checks.
The health plan considers the nature of the work
a subcontractor or agent will perform in
determining the level and scope of the
background checks.
The health plan documents compliance
certification (business-to-business) testing of
transaction compliance with HIPAA for any
subcontractor receiving enrollee data.
No subcontract that the health plan enters into
with respect to performance under the Contract in
any way relieves the health plan of any
responsibility for the performance of duties under
this Contract.
a. The health plan assures that all tasks related to
the subcontract are performed in accordance
with the terms of this Contract and are provide
BMHC with its monitoring schedule annually
by December 1 of each Contract year.
b. The health plan identifies in its subcontracts
any aspect of service that may be further
subcontracted by the subcontractor.
If the health plan intends to withdraw services
from a county, the health plan provides the
Agency with one-hundred and twenty (120)
Yes
No
Yes
No
a. Yes
No
b. Yes
No
Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XII_F2_07_11
Page 25