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

Standard XIII: Community Outreach
CONTRACT
SECTION
39. Provider
Compliance:
Comparing
Health Plans
CC-IV.B.5.b
40. Provider
Compliance:
Providing
Patients a List
of Health Plans
CC-IV.B.5.c
41. Provider
Compliance:
Co-sponsoring
Events
CC-IV.B.5.d
42. Provider
Compliance:
Cannot Provide
a List of
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
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 cannot orally or in writing
compare benefits or provider networks among
health plans, other than to confirm whether they
participate in a health plan’s network.
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 announce a new
affiliation with a health plan and give their
patients a list of health plans with which they
contract.
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 co-sponsor events,
such as health fairs, and advertise with the health
plan in indirect ways such as television, radio,
posters, fliers, and print advertisement.
The health plan ensures, through provider
education and outreach, that its health care
providers are aware of and comply with the
following:
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
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