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
Newborns and Mothers Health
Protection Act (NMHPA) of 1996
CC-V.H.10.a.7
CC-V.H.10.a.8.a, b, c, d
32. REFORM: Inpatient
Hospital Services
• Penalizing or otherwise reducing or
limiting the reimbursement of an
attending physician because the
physician provided care in a manner
consistent with NMHPA.
• Prohibits providing incentives
(monetary or otherwise) to an
attending physician to induce the
physician to provide care in a manner
inconsistent with NMHPA.
• Prohibits restricting any portion of the
forty-eight (48) hour, or ninety-six
(96) hour, period prescribed by
NMHPA in a manner that is less
favorable than the benefits provided
for any preceding portion of the
hospital stay.
In Reform, for all child/adolescent enrollees
(up to age 21) and pregnant adults, the health
plan is responsible for providing up to threehundred
and sixty-five (365) days of healthrelated
inpatient care, including behavioral
health (if behavioral health is covered by the
health plan as specified in Attachment I), for
each state fiscal year.
For all non-pregnant adults in Reform, the
health plan is responsible for up to forty-five
(45) days of inpatient coverage and up to
three-hundred and sixty-five (365) days of
emergency inpatient care, including behavioral
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
Yes
No
N/A
Met
Partially Met
Not Met
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