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

Standard XIII: Community Outreach
CONTRACT
SECTION
Medicaid
Patients or
Participate in
Plan
Enrollment
CC-IV.B.5.e
43. Provider
Compliance:
Referring
Inquiries to
Choice
Counselors or
the Enrollment
Broker
CC-IV.B.5.f
44. Registering
Community
Outreach
Representatives
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
Health care providers will not furnish lists of
their Medicaid patients to the health plan with
which they contract, or any other entity, nor can
providers furnish other health plans’ membership
lists to the health plan, nor can providers assist
with health plan enrollment.
The health plan ensures, through provider
education and outreach, that its health care
providers are aware of and comply with the
following:
For the health plan, health care providers may
distribute information about non-health-planspecific
health care services and the provision of
health, welfare, and social services by the State
of Florida or local communities as long as any
inquiries from prospective enrollees are referred
to the member services section of the health plan
or the Agency’s choice counselor/enrollment
broker and to the Department of Health, for
clinical eligibility screening for children with
chronic conditions.
The health plan registers each community
outreach representative that represents the health
plan with BMHC .
a. The health plan submits its registration file to
BMHC and uses the Agency-supplied
template.
b. The health plan submits changes to the
community outreach representative’s initial
Yes
No
a. Yes
No
b. Yes
No
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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