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

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Standard XV: Immunizations, Pregnancy, Drugs & Transportation CONTRACT SECTION Factor-related Drugs CC-V.H.16.i 26. CAPITATED PLANS: Transportation Services CC-V.H. 20.a–20.c 27. NON-REFORM PLANS not Covering Transportation: CTD Providers Exhibit 5 28. CMSSP ONLY: Insurance, Safety Requirements and Standards AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT REQUIREMENT COMPLIANT SCORING with hemophilia and will not be responsible for the distribution of hemophilia factor-related drugs. Transportation services • Transportation services include the arrangement and provision of an appropriate mode of transportation for enrollees to receive medical services. • If the health plan provides transportation, it may do so through its own network of transportation providers or through a contractual relationship, which may include the Commission for the Transportation Disadvantaged. • If the health plan does not provide transportation services, it must assist enrollees in arranging transportation to and from medical appointments for Medicaid-covered services. The health plan refers enrollees needing transportation to the Agency’s contracted Commission for the Transportation Disadvantaged (CTD) provider in order to assist them to keep and travel to medical appointments. Instead of the minimal liability insurance requirements specified for Reform health plans in this exhibit, the health plan, as a unit of state government operated by the Department of Health, Children’s Medical Services, is insured under the state’s Comprehensive Risk Management Program as set DOCUMENTS REVIEWED FINDINGS State of Florida Compliance Monitoring_Standard_XV_F2_07_11 Yes No N/A Yes No N/A Yes No N/A Met Partially Met Not Met Met Partially Met Not Met Met Partially Met Not Met Page 15
Standard XV: Immunizations, Pregnancy, Drugs & Transportation CONTRACT SECTION Chapter 284, F.S Exhibit 5 AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT REQUIREMENT COMPLIANT SCORING forth in chapter 284, F.S. The health plan may act as a transportation provider, in which case it must follow all requirements set forth in the Medicaid Non- Emergency Transportation Services Coverage and Limitations Handbook. However, if the health plan subcontracts for transportation services, the health plan ensures the subcontractor’s compliance with the minimum liability insurance requirement of $100,000 per person and $200,000 per incident for all transportation services purchased or provided for the transportation disadvantaged through the health plan. (See s. 768.28(5), F.S.) Results for Standard XV Immunizations, Pregnancy, Drugs & Transportation Score # Elements Met Partially Met Not Met Not Applicable Total # Elements Total # Applicable Elements Percent of Elements Met DOCUMENTS REVIEWED FINDINGS State of Florida Compliance Monitoring_Standard_XV_F2_07_11 Page 16
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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32 33 34 35 36 APPLICATION ITEM 10.
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APPLICATION ITEM C. Criminal Backgr
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APPLICATION ITEM 43 13. For medical
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46 47 APPLICATION ITEM 16. Indicate
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49 APPLICATION ITEM 19. Describe in
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51 52 53 54 55 56 APPLICATION ITEM
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Attachment III Special Term and Con
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RICK SCOTT GOVERNOR Regulatory Auth
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e. Complete a credentialing review
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RICK SCOTT GOVERNOR Regulatory Auth
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Compliance Monitoring Tool with Spe
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Standard I: Care Management/Continu
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Results for Standard I Care Managem
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Standarrd II: Utilizatio on Managem
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Standard III: Eligibility, Enrollme
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Standard IV: Enrollee Services & En
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Results for Standard IV Enrollee Se
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Standard V: Provider Credentialing
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Standard VI: Provider Services CONT
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Standard VI: Provider Services CC-
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Standard VI: Provider Services CONT
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Standard VII: Provider Contracting
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Standard VIII: Quality Improvement
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Results for Standard IX Medical Rec
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Standard X: Access and Availability
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Results for Standard X Access and A
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Standard XI: Grievances and Appeals
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Results for Standard XII Administra
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Standard XIII: Community Outreach C
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Standard XIII: Community Outreach C
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Agency For Health Care Administrati
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Medical Loss Ratio The following dr
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RICK SCOTT GOVERNOR Better Health C
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Plan Name: AGENCY FOR HEALTH CARE A
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DRAFT ATTESTATION OF 201_ QUARTER E
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Draft MLR Reporting Schedule Health
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RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Attachment V Special Term and Condi
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RICK SCOTT GOVERNOR Mission to Ensu
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• Obtaining data from the health
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RICK SCOTT GOVERNOR Mission to Ensu
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Attachment VI Special Term and Cond
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RICK SCOTT GOVERNOR Better Health C
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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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