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

Standard XIII: Community Outreach
CONTRACT
SECTION
6. Health Plan
Liability for
Violations
CC-IV.B.1.f
7. Donating to or
Sponsoring an
Event
CC.VI.B.1.g
8. Sponsoring
Other
Community
Evemts
CC-IV.B.1.g
9. Prohibited:
Marketing for
Enrollment
CC-IV.B.2.a
10. Prohibited:
Recruitment or
Enrollment
Activities
CC-IV.B.2.c
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan is vicariously liable for any
outreach and marketing violations of its
employees, agents or subcontractors.
Nothing precludes the health plan from donating
to or sponsoring an event with a community
organization where time, money or expertise is
provided for the benefit of the community.
If events are not health fairs/public events, no
community outreach materials or marketing
materials will be distributed by the health plan,
but the health plan may engage in brandawareness
activities, including the display of
health plan or product logos. Inquiries at such
events from prospective enrollees are referred to
the health plan’s member services section or the
Agency’s choice counselor/enrollment broker.
The health plan is prohibited from engaging in
marketing for enrollment to any potential
members or conducting any pre-enrollment
activities not expressly allowed under the
contract.
The health plan is prohibited from engaging in
activities not expressly allowed under this
contract for the purpose of recruitment or
enrollment.
Yes
No
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
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIII_F2_07_11
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