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

Standard XIII: Community Outreach
CONTRACT
SECTION
11. Prohibited:
Discouraging
Enrollment
ss. 409.912 and 409.91211,
F. S.
CC-IV.B.2.d
12. Prohibited:
Solicitation and
Cold Calling
Section 4707 BBA
s.409.912, F. S.
CC-IV.B.2.e
13. Prohibited:
Misleading or
Confusing the
Recipients
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan is prohibited from engaging in
practices that are discriminatory, including, but
not limited to, attempts to discourage enrollment
or re-enrollment on the basis of actual or
perceived health status.
The health plan is prohibited from engaging in
direct or indirect cold call marketing or other
solicitation of Medicaid recipients, either doorto-door,
telephone, or other means.
The health plan is prohibited from engaging in
activities that could mislead or confuse Medicaid
recipients or misrepresent the health plan, its
community outreach representatives or the
Agency.
No fraudulent, misleading, or misrepresentative
information is used in community outreach,
including information about other government
programs. Statements that could mislead or
confuse include, but are not limited to, any
assertion, statement or claim (whether written or
oral) that:
a. The Medicaid recipient must enroll in the
health plan to obtain Medicaid or to avoid
losing Medicaid benefits.
b. The health plan is endorsed by any federal,
state, or county government, the Agency,
CMS, or any other organization that has not
Yes
No
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
e. Yes
No
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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