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 Found in Handbook Reference Comments
The enrollee handbook contains:
23
24
Information regarding health care Advance Directives.
The health plan’s information informs enrollees that complaints about
non-compliance with advance directive laws and regulations may be filed
with the state’s complaint hotline.
Information regarding health care Advance Directives:
a. The health plan educates enrollees about the enrollees’ ability to
direct their care using this mechanism.
b. The health plan specifically designates which staff and/or network
providers are responsible for providing Advance Directive education.
Managed Care Organizations Page 6
Enrollee Handbook Audit Tool F2_05_10
Florida Medicaid
Y N
a. Y N
b. Y N
42 CFR 438.6(i)(1-2)
42 CFR 422.128
76.309 F.S.
CC-IV.A.6.a.18.c
42 CFR 438.6(i)(1-2)
42 CFR 422.128
765 F.S.
CC-IV.A.6.a.18.d
25 Information about cost sharing for the enrollee, if any. Y N N/A CC-IV.A.6.a.19
26
27
28
29
30
Information about how and where to access any benefits that are available
under the Medicaid State Plan but are not covered under this contract,
including any cost sharing.
Information concerning how to obtain information from the health plan
about how it rates on performance measures in specific areas of service.
Information concerning how to obtain information about quality
enhancements.
Information concerning procedures for reporting fraud, abuse, and
overpayment that includes the following specific language:
To report suspected fraud and/or abuse in Florida Medicaid, call the
Consumer Complaint Hotline toll-free at 1-888-419-3456 or complete a
Medicaid Fraud and Abuse Complaint Form which is available online at
https://ahcaxnet.fdhc.state.fl.us/InspectorGeneral/fraud_complaintform.as
px.
Information regarding HIPAA relative to the enrollee’s personal health
information (PHI).
31 The toll-free telephone number of the appropriate Area Medicaid Office.
Y N CC-IV.A.6.a.20
Y N
CC-IV.A.6.a.21
Y N CC-IV.A.6.a.22
Y N
CC-IV.A.6.a.23
Y N CC-IV.A.6.a.24
Y N
CC-IV.A.6.a.25