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

AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
MCO Health Plan: Contract Number:
Contract Manager: Date(s) of Monitoring:
Standard XIV: Covered Services
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
1. Expanded Services:
Drugs
CC-V.C.1.c
2. Expanded Services:
Adult Dental Services
CC-V.C.1.d
3. Covering Dental
The health plan may offer, upon written Agency
approval, an over-the-counter expanded drug
benefit, not to exceed $25.00 per household, per
month.
a. Such benefits are limited to nonprescription
drugs containing a national drug code
(NDC) number, first aid supplies and birth
control supplies.
b. Such benefits are offered directly through
the health plan's fulfillment house or
through a subcontractor.
c. The health plan makes payments for the
over-the-counter drug benefit directly to the
subcontractor, if applicable.
Adult Dental Services may include routine
preventive services, diagnostic and restorative
services, radiology services and discounts on
dental services.
For enrollees under age 21, the health plan
covers:
a. Diagnostic services, preventive treatment,
CHCUP dental screening (including a direct
referral to a dentist for enrollees beginning
at 3 years of age or earlier as indicated); and
restorative treatment, endodontic treatment,
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
Yes
No
N/A
a. Yes
No
N/A
b. Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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FINDINGS