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

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
CC-V.H.15.c.1-2
9. Pregnancyrelated
Requirements:
WIC Referrals
CC-V.H.15.d.1.a-c
10. Pregnancyrelated
Requirements:
Coordinate the
most recent
CHCUP with
WIC
CC-V.H.15.d.2-3
11. Pregnancyrelated
Requirements:
HIV Testing and
Counseling
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
care coordinator based on assessment of
actual or potential factors associated with high
risk, such as HIV, Hepatitis B, substance
abuse or domestic violence.
The health plan refers all infants, children up to age
five (5), and pregnant, breast-feeding and postpartum
women to the local WIC office. The health plan
ensurs providers provide:
• A completed Florida WIC program
medical referral form with the current
height or length and weight (taken within
sixty [60] calendar days of the WIC
appointment).
• Hemoglobin or hematocrit.
• Any identified medical/nutritional
problems.
For subsequent WIC certifications, the health plan
ensures that providers coordinate with the local WIC
office to provide the above referral data from the most
recent CHCUP.
Each time the provider completes a WIC referral
form, the health plan ensures that the provider gives a
copy of the form to the enrollee and keeps a copy in
the enrollee's medical record.
The health plan ensures that providers give all women
of childbearing age HIV counseling and offer them
HIV testing.
• The health plan ensures that its providers offer
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XV_F2_07_11
Yes
No
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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