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

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10 the enrollee’s medical record Agency For Health Care Administration Managed Care Organizations Pregnancy Related Requirements CONTRACT SECTION V.H.15 REQUIREMENTS FOR PREGNANCY-RELATED REVIEWS Required Components File #1 File #2 File #3 File #4 File #5 The health plan required a pregnancy test and a nursing assessment with referrals to a physician, PA, or ARNP for comprehensive evaluation 11 The health plan: 12 a. Required case management through the gestations period according to the needs of the enrollee b. Required any necessary referrals and follow-up c. Scheduled return prenatal visits at least every four weeks until week 32, every two weeks until week 36, and every week thereafter until delivery, unless the enrollee’s condition required more frequent visits d. Contacted enrollees who failed to keep prenatal appointments as soon as possible, and arranged for continued prenatal care e. Assisted enrollees in making delivery arrangements, if necessary f. Ensured that providers screened all pregnant enrollees for tobacco use and made available smoking cessation counseling and appropriate treatment as needed 13 Concerning nutritional assessment/counseling , the health plan: a. Ensured that providers supplied nutritional assessment/counseling to all pregnant enrollees b. Ensured the provision of safe and adequate nutrition for infants by promoting breast-feeding and the use of breast milk substitutes Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A Y N Y N Y N Y N Y N Y N N/A Y N N/A Y N N/A Y N N/A Y N N/A Y N Y N Y N Y N Y N 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 Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N c. Offered a mid-level nutrition assessment Y N Y N Y N Y N Y N d. Provided individualized diet counseling and a nutrition care plan by a public health nutritionist, a nurse, or physician following the nutrition assessment e. Ensured documentation of the nutrition care plan in the medical record by the person providing counseling Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Managed Care Organizations Page 3 Pregnancy Related Review Tool F1_07_11 Florida Medicaid
14 Agency For Health Care Administration Managed Care Organizations Pregnancy Related Requirements CONTRACT SECTION V.H.15 REQUIREMENTS FOR PREGNANCY-RELATED REVIEWS Required Components File #1 File #2 File #3 File #4 File #5 The health plan ensured that all providers document preterm delivery risk assessments in the enrollee’s medical record by week 28 15 The health plan: a. Provided a postpartum examination for the enrollees within 6 weeks after delivery b. Reported to the Perinatal Hepatitis B Prevention Coordinator at the local CHD all postpartum enrollees who tested HBsAgpositive c. Ensures that providers supplied voluntary family planning, including a discussion of all methods of contraception, as appropriate Total # Applicable Elements Total # Compliant Elements Total Percent Compliant Y N Y N Y N Y N Y N 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 Managed Care Organizations Page 4 Pregnancy Related Review Tool F1_07_11 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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Standard XV: Immunizations, Pregnan
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Standard XV: Immunizations, Pregnan
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Page 249 and 250: Vendor Name: Review Period: Date of
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Page 331 and 332: RICK SCOTT GOVERNOR Better Health C
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Page 335 and 336: DRAFT ATTESTATION OF 201_ QUARTER E
Page 337 and 338: 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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