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

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Standard XIII: Community Outreach CONTRACT SECTION 31. Permitted: Distributing Outreach Materials to Community Agencies CC-IV.B.3.d 32. Written Notice of Attending Events CC-IV.B.4.a 33. Requirements for Attending Events CC-IV.B.4.a.1.a–f 34. Complete Disclosure AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT REQUIREMENT COMPLIANT SCORING The health plan may engage in the following activities upon prior written notice to BMHC: The health plan may distribute community outreach materials to community agencies. The health plan submits to BMHC a written notice of its intent to attend and provide community outreach materials at health fairs/public events. The Agency requires the following health fair/public event information: a. The event announcement to be given to the public. b. Date, time, and location of the event. c. Name and type of sponsoring organization. d. Event contact person and contact information. e. Health plan contact person and contact information. f. Names of participating community outreach representatives, their contact information and services they will provide at the event. If the health plan is the primary organizer of the event, the health plan submits in its community outreach health fairs/public events notification report to BMHC, complete disclosure information from each organization participating. Information includes the name of the Yes No Yes No a. Yes No b. Yes No c. Yes No d. Yes No e. Yes No f. 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 9
Standard XIII: Community Outreach CONTRACT SECTION CC-IV.B.4.a.2 35. Letter of Invitation to Attend an Event CC-IV.B.4.a.3 36. Community Outreach Health Fairs/ Public Events Notification CC-IV.B.4.b 37. Attending Force Majeure Events CC-IV.B.4.c 38. Provider Compliance: Displaying Material CC-IV.B.5.a AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT REQUIREMENT COMPLIANT SCORING organization, contact person information, and confirmation of participation. If the health plan has been invited by a community organization to be a sponsor or attendee of an event, the health plan submits in its community outreach health fairs/public events notification report to BMHC, a copy of the letter of invitation from the event sponsor(s) requesting the health plan’s participation. The health plan reports health fair/public event notices to BMHC by submitting a community outreach health fairs/public events notification report by the 20 th calendar day of the month prior to the event month. Amendments to the report are due no later than two weeks prior to the event. The monthly and two-week advance notice requirements are waived in cases of force majeure provided the health plan notices BMHC by the time of the event. Force majeure events include destruction due to hurricanes, fires, war, riots, and other similar acts. When providing the Agency with notice of attendance at such events, the health plan includes a description of the force majeure event requiring waiver of notice. The health plan ensures, through provider education and outreach, that its health care providers are aware of and comply with the following: Health care providers may display health-planspecific materials in their own offices. 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 10
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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32 33 34 35 36 APPLICATION ITEM 10.
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APPLICATION ITEM C. Criminal Backgr
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APPLICATION ITEM 43 13. For medical
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46 47 APPLICATION ITEM 16. Indicate
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49 APPLICATION ITEM 19. Describe in
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51 52 53 54 55 56 APPLICATION ITEM
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Attachment III Special Term and Con
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RICK SCOTT GOVERNOR Regulatory Auth
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e. Complete a credentialing review
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RICK SCOTT GOVERNOR Regulatory Auth
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Compliance Monitoring Tool with Spe
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Standard I: Care Management/Continu
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Results for Standard I Care Managem
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Standarrd II: Utilizatio on Managem
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Standard III: Eligibility, Enrollme
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Standard IV: Enrollee Services & En
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Results for Standard IV Enrollee Se
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Standard V: Provider Credentialing
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Standard VI: Provider Services CONT
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Standard VI: Provider Services CC-
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Standard VI: Provider Services CONT
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Standard VII: Provider Contracting
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Standard VIII: Quality Improvement
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Results for Standard IX Medical Rec
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Standard X: Access and Availability
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Results for Standard X Access and A
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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13 14 15 Agency For Health Care Adm
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f. Posting of the Agency Summary of
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5. 6. 7. 8. 9. local WIC office to
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14 Agency For Health Care Administr
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8 providers Agency For Health Care
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Medical Loss Ratio The following dr
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RICK SCOTT GOVERNOR Better Health C
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Plan Name: AGENCY FOR HEALTH CARE A
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DRAFT ATTESTATION OF 201_ QUARTER E
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Draft MLR Reporting Schedule Health
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RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Attachment V Special Term and Condi
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RICK SCOTT GOVERNOR Mission to Ensu
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• Obtaining data from the health
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RICK SCOTT GOVERNOR Mission to Ensu
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Attachment VI Special Term and Cond
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RICK SCOTT GOVERNOR Better Health C
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