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

Agency For Health Care Administration
Managed Care Organizations
Enrollee Handbook Audit Tool
Enrollee Handbook Review Tool
Item Number Standard
The enrollee handbook contains:
geographic location of services.
Found in Handbook Reference Comments
q. Lack of access to providers experienced in dealing with the
enrollee’s health care needs.
r. Fraudulent enrollment.
The following statement (verbatim) in the disenrollment section of the
handbook:
19
20
21
22
Some Medicaid recipients can change health plans whenever they choose,
for any reason. For example, people who are eligible for both Medicaid
and Medicare benefits and children who receive SSI benefits can change
plans at any time for any reason. To find out if you can change plans, call
the (INSERT EITHER “CHOICE COUNSELOR” OR “ENROLLMENT
BROKER” AND APPROPRIATE TELEPHONE NUMBER).
Information that interpretation services and alternative communication
systems are available, free of charge, including for all foreign languages
and vision and hearing impairment, and how to access these services.
Information regarding health care Advance Directives.
The health plan provides policies and procedures for Advance Directives
to all enrollee’s age 18 and older and advises enrollees of:
a. Their rights under state law, including the right to accept or
refuse medical or surgical treatment and the right to formulate
advance directives.
b. The health plan’s written policies respecting the implementation
of those rights, including a statement of any limitation regarding
the implementation of advance directives as a matter of
conscience.
Information regarding health care Advance Directives.
The information about advance directives includes a description of state
law and must reflect changes in state law as soon as possible, but no later
than 90 calendar days after the effective change.
Managed Care Organizations Page 5
Enrollee Handbook Audit Tool F2_05_10
Florida Medicaid
Y N
CC-IV.A.6.a.1
Y N CC-IV.A.6.a.17
a. Y N
b. Y N
Y N
42 CFR 438.6(i)(1-2)
42 CFR 422.128
76.309 F.S.
CC-IV.A.6.a.18.a
42 CFR 438.6(i)(1-2)
42 CFR 422.128
765 F.S.
CC-IV.A.6.a.18.b