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

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
22. Prescribed
Drugs:
Functional
Equivalents
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan:
• Ensures that its enrollees are receiving the
functional equivalent of those goods and
services received by fee-for-service Medicaid
recipients in accordance with the HSA.
• Conducts annual HSA surveys of no less than
five percent (5%) of all participating
pharmacy locations to ensure compliance with
the HSA.
• May annually survey less than five percent
(5%), with written approval from the Agency,
if the health plan can show that the number of
participating pharmacies it surveys is a
statistically significant sample that adequately
represents the pharmacies that have contracted
with the health plan to provide pharmacy
services.
• Does not include in the annual HSA survey
any participating pharmacy location that the
health plan found to be in complete
compliance with the HSA requirements within
the past twelve (12) months.
• Requires all participating pharmacy locations
that fail any aspect of the annual HSA survey
to undergo mandatory training within six (6)
months and then be re-evaluated within one
(1) month of the training to ensure that the
pharmacy location is in compliance with the
HSA.
• Ensures that it complies with all aspects and
surveying requirements set forth in Policy
Transmittal 06-01, Hernandez Settlement
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XV_F2_07_11
Yes
No
N/A
Met
Partially Met
Not Met
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