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

Standard XIII: Community Outreach
CONTRACT
SECTION
17. Prohibited:
Offering
Financial Gain
to Any Person
CC-IV.B.2.j
18. Prohibited:
Marketing at
State Offices
CC-IV.B.2.j
19. Prohibited:
Promotional
Items Over
$5.00
CC-IV.B.2.k
20. Prohibited:
Offering Gifts
or Jobs to
Choice
Counselors or
Enrollment
Brokers
CC-IV.B.2.l
21. Prohibited:
Providing
Information
Before
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
offering material or financial gain to any persons
soliciting, referring or otherwise facilitating
Medicaid recipient enrollment.
The health plan ensures that its staff do not
market the health plan to Medicaid recipients at
any location including state offices or DCF
ACCESS centers.
The health plan is prohibited from engaging in
giving away promotional items in excess of
$5.00 retail value. Items to be given away have
the health plan’s name and are given away only
at health fairs/public events. In addition, such
promotional items are offered to the general
public and are not limited to Medicaid recipients.
The health plan is prohibited from engaging in
providing any gift, commission, or any form of
compensation to the choice counselor/enrollment
broker, including its full-time, part-time or
temporary employees and subcontractors.
The health plan is prohibited from engaging in
providing information before enrollment about
the incentives to be offered an enrollee.
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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