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

Agency For Health Care Administration
Managed Care Organizations
Medical Record Audit Tool
Medical Record Review Tool
Item Number Contents of the Medical Record: Found in Record Reference Comments
12
13
14
15
16
Contains:
a. Documented referrals
Y N N/A
b. Referral reports Y N N/A
Contains the primary language spoken by the member and any translation
needs of the enrollee
Identifies members needing communication assistance in the delivery of
health care services
Advanced Directives and:
a. Contains documentation that the member was provided written
information concerning the member’s rights regarding advance
directives (written instructions for living will or power of
attorney) and whether or not the member has executed an
advance directive
b. Contains copies of any Advanced Directives executed by the
member
Contains services provided (i.e., family planning, preventive services,
treatment of sexually transmitted diseases, etc.)
Y N N/A
Y N N/A
Y N N/A
Y N N/A
Y N N/A
17 Sufficient documentation was provided for the file review Y N
Total # Applicable Elements
Total # Compliant Elements
Total Percent Compliant
42 CFR 456
CC-VII.J.1.m
42 CFR 456
CC-VII.J.1.f
42 CFR 456
CC-VII.J.1.o
42 CFR 456
CC-VII.J.1.p
42 CFR 489.102
CC-VII.J.1.q
42 CFR 489.102
CC-VII.J.1.q
42 CFR 456
CC-VII.J.1.n
Managed Care Organizations Page 3
Medical Record Audit Tool F1_03_10
Florida Medicaid