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
CC-V.E.2
7. Moral or Religious
Objections
42 CFR 438.102
CC-V.F
8. NON-REFORM
CAPITATED:
Co-payments
Exhibit 5
9. Child Health Check-Up
Program (CHCUP)
CC-V.H.2.a
providers, including helping the enrollees obtain
an attending physician; and the health plan
disenrolls all enrollees requiring these services.
The health plan provides or arranges for all
covered services. If, during the course of the
Contract period the health plan elects not to
provide, reimburse for, or provide coverage of a
counseling or referral service because of an
objection on moral or religious grounds, the
health plan notifies:
The Agency within one-hundred and twenty
(120) calendar days before implementing the
policy with respect to any service; and enrollees
within thirty (30) calendar days before
implementing the policy with respect to any
service.
The health plan will not require a copayment or
cost sharing for services listed in Attachment I
or Attachment II, Section V, Covered Services,
Item A., Covered Services, including optional
services, and Attachment II, Section V, Covered
Services, Item B., Optional Services, and
Attachment II, Section V, Covered Services,
Item C., Expanded Services.
The health plan may not charge enrollees for
missed appointments.
The health plan has a CHCUP that encompasses
all federal requirements.
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
Yes
No
Yes
No
N/A
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Page 3
FINDINGS