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

Standard XII: Administration and Management
CC-XVI.S
CONTRACT
SECTION
68. Written Notice of
Withdrawing
Services from a
County
CC-XVI.S
69. Notice of
Terminations
CC-XVI.Q.1
70. Transition
Planning
CC-XVI.Q.1
71. Termination
Notice
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
calendar days’ notice and works with the Agency
to develop a transition plan.
The health plan provides written notice to all
enrollees in that county at least sixty (60)
calendar days before the last day of service.
The health plan also provides written notice of
the withdrawal to all providers and
subcontractors in the county.
The health plan agrees to extend the thirty (30)
calendar-day notice found in the Standard
Contract, Section III., Item B.1., Termination at
Will, to one-hundred and twenty (120) calendar
days’ notice.
The health plan works with the Agency to create
a transition plan, including the orderly and
reasonable transfer of enrollee care and progress
whether or not they are hospitalized.
Depending on the volume of health plan
enrollees affected, the Agency may require an
extension of the termination date.
The party initiating the termination renders
written notice of termination to the other party
by certified mail, return receipt requested, or in
person with proof of delivery, or by facsimile
letter followed by certified mail, return receipt
requested.
The notice of termination specifies the nature of
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
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
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