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

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
CC-V.H.15.j.1-7
16. Pregnancyrelated
Requirements:
Nutritional
Assessment/
Counseling
CC-V.H.15.k.1-4
17. Pregnancyrelated
Requirements:
OB Deliveries
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
• Contacts those enrollees who fail to keep their
prenatal appointments as soon as possible, and
arranges for their continued prenatal care.
• Assists enrollees in making delivery
arrangements, if necessary.
• Ensures that all providers screen all pregnant
enrollees for tobacco use and make certain
that the providers make available to pregnant
enrollees smoking cessation counseling and
appropriate treatment as needed.
The health plan ensures that its providers supply
nutritional assessment and counseling to all pregnant
enrollees. The health plan:
• Ensures the provision of safe and adequate
nutrition for infants by promoting breastfeeding
and the use of breast milk substitutes.
• Offers a mid-level nutrition assessment.
• Provides individualized diet counseling and a
nutrition care plan by a public health
nutritionist, a nurse or physician following the
nutrition assessment.
• Ensures documentation of the nutrition care
plan in the medical record by the person
providing counseling.
The health plan develops and uses generally accepted
and approved protocols for both low-risk and highrisk
deliveries reflecting the highest standards of the
medical profession, including Healthy Start and
prenatal screening, and ensure that all providers use
these protocols.
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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