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

Standard XIII: Community Outreach
CONTRACT
SECTION
s. 409.912, F. S.
CC-IV.B.2.f.1–5
14. Prohibited:
Offering
Valuables
CC-IV.B.2.g
15. Prohibited:
Offering Other
Insurance
CC-IV.B.2.h
16. Prohibited:
Enlisting
Assistance
from State
Employees
CC-IV.B.2.i
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
certified its endorsement in writing to the
health plan.
c. Community outreach representatives are
employees or representatives of the federal,
state, or county government, or of anyone
other than the health plan or the organization
by whom they are reimbursed.
d. The state or county recommends that a
Medicaid recipient enroll with the health
plan.
e. A Medicaid recipient will lose benefits under
the Medicaid program or any other health or
welfare benefits to which the person is
legally entitled if the recipient does not
enroll with the health plan.
The health plan is prohibited from engaging in
granting or offering any monetary or other
valuable consideration for enrollment.
The health plan is prohibited from engaging in
offering insurance, such as but not limited to,
accidental death, dismemberment, disability or
life insurance.
The health plan is prohibited from engaging in
enlisting assistance of any employee, officer,
elected official, or agency of the state in
recruitment of Medicaid recipients except as
authorized in writing by the Agency.
Yes
No
Yes
No
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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