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
40. Hysterectomies,
Sterilizations, and
Abortions
CC-V.H.13
41. Quality Enhancements
(QE)
The health plan:
• Maintains a log of all hysterectomy,
sterilization and abortion procedures
performed for its enrollees. The log
includes, at a minimum, the enrollee’s
name and identifying information, date
of procedure, and type of procedure.
• Provides abortions only in the
following situations:
• If the pregnancy is a result of an act of
rape or incest.
• The physician certifies that the woman
is in danger of death unless an
abortion is performed.
The health plan:
• Offers QEs in community settings
accessible to enrollees.
• Provides information in the enrollee
and provider handbooks on the QEs
and how to access related services.
• The health plan develops and
maintains written policies and
procedures to implement QEs.
• May co-sponsor the annual training of
providers, provided that the training
meets the provider training
requirements for the programs. The
health plan is encouraged to actively
collaborate with community agencies
and organizations, including CHDs,
local Early Intervention Programs,
Healthy Start Coalitions and local
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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