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

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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 Page 13
Results for Standard XIII Community Outreach Score # Elements Met Partially Met Not Met Not Applicable Total # Elements Total # Applicable Elements Percent of Elements Met AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards State of Florida Compliance Monitoring_Standard_XIII_F2_07_11 Page 14
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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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Standard XI: Grievances and Appeals
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Standard XI: Grievances and Appeals
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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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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Name: Review Period: Date of Review
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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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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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