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

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File # Case ID # Agency For Health Care Administration Managed Care Organizations Grievance File Review Tool 8 9 10 11 Written Notice Includes Results and Date of Resolution Written Notice Includes Enrollee’s Right to a Fair Hearing Written Notice Includes How to Request a Fair Hearing Written Notice Includes SAP/BAP Information 1 Y N Y N Y N Y N 2 Y N Y N Y N Y N 3 Y N Y N Y N Y N 4 Y N Y N Y N Y N 5 Y N Y N Y N Y N 6 Y N Y N Y N Y N 7 Y N Y N Y N Y N 8 Y N Y N Y N Y N 9 Y N Y N Y N Y N 10 Y N Y N Y N Y N 11 Y N Y N Y N Y N 12 Y N Y N Y N Y N 13 Y N Y N Y N Y N 14 Y N Y N Y N Y N 15 Y N Y N Y N Y N 16 Y N Y N Y N Y N 17 Y N Y N Y N Y N 18 Y N Y N Y N Y N 19 Y N Y N Y N Y N 20 Y N Y N Y N Y N 21 Y N Y N Y N Y N 22 Y N Y N Y N Y N 23 Y N Y N Y N Y N 24 Y N Y N Y N Y N 25 Y N Y N Y N Y N 26 Y N Y N Y N Y N Managed Care Organizations Page 3 Grievance File Review Tool F1_03_10 Florida Medicaid
File # Case ID # Agency For Health Care Administration Managed Care Organizations Grievance File Review Tool 8 9 10 11 Written Notice Includes Results and Date of Resolution Written Notice Includes Enrollee’s Right to a Fair Hearing Written Notice Includes How to Request a Fair Hearing Written Notice Includes SAP/BAP Information 28 Y N Y N Y N Y N 29 Y N Y N Y N Y N 30 Y N Y N Y N Y N # Applicable Files # Compliant Files Percent Compliant Managed Care Organizations Page 4 Grievance File Review Tool F1_03_10 Florida Medicaid
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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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Standard XII: Administration and Ma
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Results for Standard XII Administra
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Standard XIII: Community Outreach C
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Results for Standard XIII Community
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Standard XIV: Covered Services AGEN
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Page 219 and 220: Standard XIV: Covered Services AGEN
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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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