Letter to CMS - Medicaid Managed Care Policies - Agency for ...

AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
MCO Health Plan: Contract Number:
Contract Manager: Date(s) of Monitoring:
Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
CONTRACT REQUIREMENT COMPLIANT SCORING
1. Immunization The health plan:
Yes
Met
Schedule
No
Partially Met
• Provides immunizations in accordance with
the Recommended Childhood Immunization
Schedule for the United States, or when
medically necessary for the enrollee's health.
Not Met
• Provides for the simultaneous administration
of all vaccines for which an enrollee under the
age of 21 is eligible at the time of each visit.
• Follows only contraindications established by
the Advisory Committee on Immunization
Practices (ACIP), unless:
In making a medical judgment in
accordance with accepted medical
practices, such compliance is deemed
medically inappropriate
The particular requirement is not in
compliance with Florida law,
including Florida law relating to
religious or other exemptions.
CC-V.H.14.a–c
2. Vaccines for
Children (VFC)
The health plan:
• Participates, or directs its providers to
participate, in the VFC Program.
• Advises providers to bill Medicaid fee-forservice
directly for immunizations provided to
Title XXI MediKids participants.
• Provides documentation annually by October
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XV_F2_07_11
Yes
No
N/A
Met
Partially Met
Not Met
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