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

Standard XIV: Covered Services
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
Exhibit 5
4. Expanded Services:
Adult Vision Services
CC-V.C.1.e
5. Expanded Services:
Adult Hearing Services
CC-V.C.1.f
6. Excluded Services
periodontal treatment, surgical procedures
and/or extractions, orthodontic treatment,
complete and partial dentures, complete and
partial denture relines and repairs, and
adjunctive and emergency services.
b. Adult services include adult full and partial
denture services and medically necessary
emergency dental procedures to alleviate
pain or infection; and emergency dental care
is limited to emergency oral examinations,
necessary x-rays, extractions, and incision
and drainage of abscess.
Adult Vision Services may include eye exams,
eyeglasses and contact lenses.
Adult Hearing Services may include hearing
evaluations, hearing aid devices and hearing aid
repairs.
The health plan consults the DCF office to
identify appropriate methods of assessment and
referral for enrollees requiring long-term care
institutional services, institutional services for
persons with developmental disabilities or state
hospital services.
The health plan is responsible for transition and
referral of these enrollees to appropriate service
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
Yes
No
N/A
Yes
No
N/A
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Page 2
FINDINGS