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

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
Testing Positive
for Hepatitis B
CC-V.H.15.h.1-2
15. Pregnancyrelated
Requirements:
Health Plan
Requirements to
Monitor
Prenatal Care
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
health plan also reports said enrollees’ infants and
contacts to the Perinatal Hepatitis B Prevention
Coordinator.
• The health plan reports the following
information: name, date of birth, race,
ethnicity, address, infants, contacts, laboratory
test performed, date the sample was collected,
the due date or estimated date of confinement,
whether the enrollee received prenatal care,
and immunization dates for infants and
contacts.
• The health plan uses the Perinatal Hepatitis B
Case and Contact Report (DH Form 1876) for
reporting purposes.
Prenatal Care: The health plan:
• Requires a pregnancy test and a nursing
assessment with referrals to a physician, PA
or ARNP for comprehensive evaluation.
• Requires case management through the
gestational period according to the needs of
the enrollee.
• Requires any necessary referrals and followup.
• Schedules return prenatal visits at least every
four (4) weeks until week thirty-two (32),
every two (2) weeks until week thirty-six
(36), and every week thereafter until delivery,
unless the enrollee’s condition requires more
frequent visits.
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XV_F2_07_11
Yes
No
Met
Partially Met
Not Met
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