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
school districts in offering these
services.
• Involves the enrollee in an existing
community program for purposes of
meeting the QE requirement, the
health plan ensures documentation in
the enrollee’s medical record of
referrals to the community program
and follow up on the enrollee's receipt
of services from the community
program.
• Ensures that PCPs screen enrollees for
signs of domestic violence and offers
referral services to applicable
domestic violence prevention
community agencies.
• Conducts regularly scheduled
pregnancy prevention programs, or
makes a good faith effort to involve
enrollees in existing community
pregnancy prevention programs, such
as the Abstinence Education Program.
The programs is targeted towards teen
enrollees, but is open to all enrollees,
regardless of age, gender, pregnancy
status or parental consent.
• Provides regular home visits,
conducted by a home health nurse or
aide, and counseling and educational
materials to pregnant and postpartum
enrollees who are not in compliance
with the health plan's prenatal and
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
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