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

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Agency For Health Care Administration Managed Care Organizations Hernandez Settlement Agreement Log Checklist Hernandez Settlement Agreement Log Item Number Standard Found on the Log Found on the Log Found on the Log Found on the Log The HSA Log contains: Q1 Q2 Q3 Q4 10 The explanation of the resolution Y N Y N Y N Y N 11 The name of the prescribed good/service Y N Y N Y N Y N 12 Trends and patterns Total # Applicable Elements Total # Compliant Elements Total Percent Compliant If the answer is Yes, explain in comments Y N Y N Y N Y N Comments Managed Care Organizations Page 2 HSA Log Audit Tool F1_03_10 Florida Medicaid
Vendor Name: Review Period: Date of Review: Reviewer: Date Report Received from Plan: Agency For Health Care Administration Managed Care Organizations Hernandez Settlement Agreement Report Checklist Hernandez Settlement Agreement Report Item Number Standard Answer to Standard Comments 1 The HSA Report contains: Total number of participating pharmacy locations surveyed are entered on the form Y N Enter number of pharmacies: ____________ 2 Process used to select the pharmacies is explained Y N 3 HSA areas surveyed are listed Enter counties surveyed: __________________________________ 4 HSA delinquencies are noted on the form 5 If the prior question was answered YES, check the area where the HSA delinquencies are noted on the report. If delinquencies were found, the number of delinquencies needs to be completed to meet the element 6 a. Rejection signs posted 7 b. Printed computer screen rejection distributed to recipient 8 c. Pamphlet distributed to recipient Managed Care Organizations Page 1 HSA Report Audit Tool F1_03_10 Florida Medicaid Y N Y N If NO, none of the answers for 6-15 should be checked If checked, enter number of delinquencies _____ If checked, enter number of delinquencies _____ If checked, enter number of delinquencies _____
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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 225 and 226: 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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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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