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

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
CC-V.H.14.i.1-3
5. Immunizations
for Enrollees
Requesting
Temp. Cash
Assistance
CC-V.H.14.j
6. Pregnancyrelated
Requirements:
Prenatal Risk
Screenings
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
services and provides medical records
documenting the immunization to the health
plan.
The health plan encourages PCPs to provide
immunization information for enrollees requesting
temporary cash assistance from DCF, upon request by
DCF and receipt of the enrollee’s written permission,
in order to document that the enrollee has met the
immunization requirements for enrollees receiving
temporary cash assistance.
The health plan provides the most appropriate and
highest level of quality care for pregnant enrollees.
Required care includes the following:
Florida's Healthy Start Prenatal Risk Screening: The
health plan ensures that the provider offers Florida's
Healthy Start prenatal risk screening to each pregnant
enrollee as part of her first prenatal visit.
The health plan:
• Ensures that the provider uses the DOH
prenatal risk form (DH Form 3134), which
can be obtained from the local CHD.
• Ensures that the PCP maintains all
documentation of Healthy Start screenings,
assessments, findings and referrals in the
enrollees’ medical records.
• Ensures that the provider submits the
completed DH Form 3134 to the CHD in the
county where the prenatal screen was
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XV_F2_07_11
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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