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

Standard XIII: Community Outreach
CONTRACT
SECTION
CC-IV.B.6.a
45. Identification at
Events
CC-IV.B.6.b
46. Inform
Medicaid
Recipients of
Representing
the Health Plan
CC-IV.B.6.c
47. Training for
Representatives
CC-IV.B.6.d
48. Background
and Reference
Checks
CC-IV.B.6.e
49. Reporting
Violations
CC-IV.B.6.f
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
registration to BMHC and uses the Agencysupplied
template.
While attending health fairs/public events,
community outreach representatives wear picture
identification that shows the health plan
represented.
If asked, the community outreach representative
informs the Medicaid recipient that the
representative is not a state employee and is not a
choice counseling specialist, but is a
representative of the health plan, unless the
representative is a Department of Health
employee.
The health plan instructs and provides initial and
periodic training to its community outreach
representatives about the outreach and marketing
provisions of the contract.
The health plan implements procedures for
background and reference checks for use in
hiring community outreach representatives.
The health plan reports to BMHC any health plan
staff or community outreach representative who
violates any requirements of this contract within
15 calendar days of knowledge of such violation.
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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