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

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
s. 383.14, F.S.
s. 381.004, F.S.
64C-7.009, F.A.C.
CC-V.H.15.a.1-4
CC-V.H.15.i
7. Pregnancyrelated
Requirements:
Infant Risk
Screenings
CC-V.H.15.b
8. Pregnancyrelated
Requirements:
Healthy Start
Risk Screenings
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
completed within ten (10) business days of
completion of the screening.
• Collaborates with the Healthy Start care
coordinator within the enrollee's county of
residence to assure delivery of risk-
appropriate care.
Florida's Healthy Start Infant (Postnatal) Risk
Screening Instrument: The health plan ensures that the
provider completes the Florida Healthy Start Infant
(Postnatal) Risk Screening Instrument (DH Form
3135) with the Certificate of Live Birth and transmits
the documents to the CHD in the county where the
infant was born within ten (10) business days of the
birth. The health plan ensures that the provider keeps
a copy of the completed DH Form 3135 in the
enrollee's medical record and provides a copy to the
enrollee.
Pregnant enrollees or infants who do not score high
enough to be eligible for Healthy Start care
coordination may be referred for services, regardless
of their score on the Healthy Start risk screen, in the
following ways:
• If the referral is to be made at the same time
the Healthy Start risk screen is administered,
the provider may indicate on the risk
screening form that the enrollee or infant is
invited to participate based on factors other
than score.
• If the determination is made subsequent to
risk screening, the provider may refer the
enrollee or infant directly to the Healthy Start
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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