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.H.9. a–f
28. CAPITATED PLANS:
Paying for Non-network
Providers
CC-V.H. 9.d
29. Inpatient Hospital
Services: TB and Renal
such services.
• Makes available and encourages all
pregnant women and mothers with
infants to receive postpartum visits for
the purpose of voluntary family
planning, including discussion of all
appropriate methods of contraception,
counseling and services for family
planning to all women and their
partners.
• Directs providers to maintain
documentation in the enrollee's
medical records to reflect this
provision
• The provisions of this subsection are
not to be interpreted so as to prevent a
health care provider or other person
from refusing to furnish any
contraceptive or family planning
service, supplies or information for
medical or religious reasons. A health
care provider or other person will not
be held liable for such refusal.
For capitated health plans, if the enrollee
receives services from a non-network
Medicaid provider, then the health plan
reimburses at the Medicaid reimbursement
rate, unless another payment rate is negotiated.
Inpatient services also include inpatient care
for any diagnosis including tuberculosis and
renal failure when provided by general acute
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
Yes
No
N/A
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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