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

Standard XIII: Community Outreach
CONTRACT
SECTION
Enrollment
about
Incentives
CC-IV.B.2.m
22. Prohibited:
Giving
Potential
Members
Health-Plan
Specific
Information
CC-IV.B.2.n
23. Prohibited:
Distributing
Material
Without
BMHC
Approval
CC-IV.B.2.o
24. Prohibited:
Marketing
Materials Not
Mentioned in
Contract
CC-IV.B.2.p
25. Prohibited:
Subcontracting
with
Independent
Agents or
Brokers
Chapters 624-651 F. S.
CC-IV.B.2.q
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan may inform enrollees on or after
their enrollment effective date about the specific
incentives or programs available.
The health plan is prohibited from engaging in
discussing, explaining or speaking to a potential
member about health-plan specific information
other than to refer all health plan inquiries to the
member services section of the health plan or the
Agency’s choice counselor/enrollment broker.
The health plan is prohibited from engaging in
distributing any community outreach materials
without prior written notice to BMHC except as
otherwise allowed under Permitted Activities and
Provider Compliance subsections.
The health plan is prohibited from engaging in
distributing any marketing materials not
expressly allowed under this Contract.
The health plan is prohibited from engaging in
subcontracting with any brokerage firm or
independent agent for purposes of marketing or
community outreach.
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
Page 6