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
65C-29.008, FAC.
CC-V.H.18.a-c
43. Covered Therapy
Services
CC-V.H.19
time frames, approves the out-ofnetwork
claim and forwards it to the
Agency and/or its fiscal agent.
• Approves the claims and forwards
them to the Agency and/or the fiscal
agent for all CHCUP screenings for
children/ adolescents whose
enrollment and Medicaid eligibility
are undetermined at the time of entry
into the care and custody of DCF, and
who are later determined to be
enrollees at the time the examinations
took place.
Medicaid therapy services are physical,
speech-language (including augmentative and
alternative communication systems),
occupational and respiratory therapies.
a. The health plan covers therapy services
consistent with the Medicaid Therapy
Services Coverage and Limitations
Handbook requirements; therapy services
are limited to children/adolescents under
age 21; and the provision of school-based
therapy services to an enrollee does not
replace, substitute or fulfill a service
prescription or doctors’ orders for therapy
services covered by the health plan. .
b. Adults are covered for physical and
respiratory therapy services under the
outpatient hospital services program.
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XIV_F3_07_11
a. Yes
No
b. Yes
No
Met
Partially Met
Not Met
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