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

AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
MCO Health Plan: Contract Number:
Contract Manager: Date(s) of Monitoring:
Standard XIII: Community Outreach
CONTRACT
SECTION
CONTRACT REQUIREMENT COMPLIANT SCORING
1. Community The health plan’s community outreach
Yes
Met
Outreach
Events
representatives may provide community outreach
materials at health fairs/public events as noticed
by the health plan to the Agency.
No
Partially Met
Not Met
CC-IV.B.1.a
2. Approval of
Outreach
Material
CC-IV.B.1.b
3. Announcing
Participation in
Events
CC-IV.B.1.c
4. Plan to Control
the Action of
Outreach
Representatives
CC-IV.B.1.d
5. Application of
Policies
CC-IV.B.1.e
For each new Contract period, the health plan
submits to BMHC for written approval all
community outreach material no later than 60
calendar days before the start of the next
Contract period, and, for any changes in the
community outreach material, no later than 30
calendar days before implementation.
To announce participation at a health fair/public
event, the health plan submits a notice to BMHC.
The health plan is responsible for developing and
implementing a written plan designed to control
the actions of its community outreach
representatives.
All community outreach policies apply to staff,
subcontractors, health plan volunteers, and all
persons acting for or on behalf of the health plan.
Yes
No
Yes
No
Yes
No
Yes
No
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_XIII_F2_07_11
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