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

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Agency For Health Care Administration
Managed Care Organizations
Case Management/Continuity of Care Review Tool
REQUIREMENTS FOR CASE MANAGEMENT/CONTINUITY OF CARE
Requirement File #1 File #2 File #3 File #4 File #5
Specialty Health Needs members received assistance with referral
and scheduling
Case management monitoring of members with developmental
services
For non-covered services, the member received assistance with
referrals and appointments from Healthy Start
Child Health Check Up referral if member is more than 2 months
behind in periodic screening
Children placed by the Department of Children and Family Services
into protective custody, ER shelter, foster care with a 72-hour
evaluation
WIC referral for pregnant, breast feeding and post partum women,
infant children under 5 years of age
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
7 Provide referral for out-of-plan Exceptional Services Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
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Case Management follow-up services for children with abnormal
levels of lead
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
9 Pregnant members receiving CM through gestational period Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
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HIV infected pregnant women are receiving counseling and are
offered treatment
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
11 WIC referral for HIV-infected women, infants and children Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
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Documentation of referral services in enrollee medical records,
including reports resulting from the referral
Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A
Managed Care Organizations Page 1
Case Management/Continuity of Care Review Tool F1_03_10
Florida Medicaid