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.10.a.2
30. Inpatient Hospital
Services: PT
CC-V.H.10.a.3
31. Inpatient Hospital
Services: Deliveries
care hospitals in both emergent and nonemergent
conditions.
The health plan will cover physical therapy
(PT) services when medically necessary and
when provided during an enrollee's inpatient
stay.
The health plan:
• Provides for no less than a forty-eight
(48) hour hospital length of stay
following a normal vaginal delivery,
and at least a ninety-six (96) hour
hospital length of stay following a
Cesarean section. In connection with
coverage for maternity care, the
hospital length of stay is required to be
decided by the attending physician in
consultation with the mother.
• Prohibits denying the mother or
newborn child eligibility, or continued
eligibility, to enroll or renew coverage
under the terms of the health plan,
solely for the purpose of avoiding the
Newborns and Mothers Health
Protection Act (NMHPA)
requirements.
• Prohibits providing monetary
payments or rebates to mothers to
encourage them to accept less than the
minimum protections available under
NMHPA.
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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