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
postpartum programs. The health plan
coordinates its efforts with the local
Healthy Start care coordinator to
prevent duplication of services.
• Conducts regularly scheduled
smoking cessation programs as an
option for all enrollees, or the health
plan makes a good faith effort to
involve enrollees in existing
community smoking cessation
programs.
• Provides smoking cessation
counseling to enrollees.
• Provides participating PCPs with the
Quick Reference Guide to assist in
identifying tobacco users and
supporting and delivering effective
smoking cessation interventions.
• Offers annual substance abuse
screening training to its providers.
• Has all PCPs screen enrollees for
signs of substance abuse as part of
prevention evaluation at the following
times:
Initial contact with a new enrollee.
Routine physical examinations.
Initial prenatal contact.
When the enrollee evidences
serious over-utilization of medical,
surgical, trauma or emergency
services.
When documentation of emergency
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
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