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
10. Transportation for
CHCUP
CC-V.H.2.f
11. Coordination and
Training of Providers
CC-V.H.2.g
12. CHCUP Screening
Rates
The health plan provides the following services:
CHCUP
If the health plan Contract covers transportation,
the health plan offers transportation to enrollees
in order to assist them to keep, and travel to,
medical appointments. If the Contract does not
cover transportation services, the health plan
offers to help enrollees schedule transportation.
The health plan provides the following services:
CHCUP
The CHCUP program includes the maintenance
of a coordinated system to follow the enrollee
through the entire range of screening and
treatment, as well as supplying CHCUP training
to medical care providers.
The health plan achieves a CHCUP screening
rate of at least sixty percent (60%) for those
enrollees who are continuously enrolled for at
least eight (8) months during the federal fiscal
year (October 1 – September 30).
a. This screening compliance rate is based on
the CHCUP screening data reported by the
health plan and due to the Agency by
January 15 following the end of each federal
fiscal year as specified in Attachment II,
Section XII, Reporting Requirements.
b. The data are monitored by the Agency for
accuracy, and, if the health plan does not
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
Yes
No
N/A
Yes
No
a. Yes
No
b. Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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FINDINGS