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

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Total # Applicable Elements 24 Total # Compliant Elements Total Percent Compliant Agency For Health Care Administration Managed Care Organizations Provider Handbook Audit Tool Managed Care Organizations Page 3 Provider Handbook Audit Tool F1_06_10 Florida Medicaid
Vendor Name: Review Period: Date of Review: Reviewer: Participating Vendor Staff Member: Agency For Health Care Administration Managed Care Organizations Rights and Responsibilities Audit Tool Rights and Responsibilities Review Tool Item Number Standard Found in Handbook Reference Comments 1 2 3 4 5 6 7 Enrollees have the right to be treated with respect and with due consideration for his or her dignity and privacy. Enrollees have the right to receive information on available treatment options and alternatives, presented in a manner appropriate to the enrollee’s condition and ability to understand. Enrollees have the right to participate in decision regarding his or her health care, including the right to refuse treatment. Enrollees have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. Enrollees have the right to request and receive a copy of his or her medical records, and request that they be amended or corrected. Enrollees have the right to be furnished health care services in accordance with federal and state regulations. The State must ensure that each enrollee is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the health plan and its providers or the State agency treat the enrollee. Y N 42 CFR 438.100 Y N 42 CFR 438.100 Y N 42 CFR 438.100 Y N 42 CFR 438.100 Managed Care Organizations Page 1 Rights and Responsibilities Audit Tool F1_03_10 Florida Medicaid Y N Y N 42 CFR 438.100 45 CFR 164.524 45 CFR 164.526 42 CFR 438.100 42 CFR 438.206 through 42 CFR 438.210 Y N 42 CFR 438.100
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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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Vendor Name: Review Period: Date of
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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13 14 15 Agency For Health Care Adm
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Page 265 and 266: f. Posting of the Agency Summary of
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Page 273 and 274: Agency For Health Care Administrati
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Page 283 and 284: 5. 6. 7. 8. 9. local WIC office to
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Page 315: Agency For Health Care Administrati
Page 329 and 330: Medical Loss Ratio The following dr
Page 331 and 332: RICK SCOTT GOVERNOR Better Health C
Page 333 and 334: Plan Name: AGENCY FOR HEALTH CARE A
Page 335 and 336: DRAFT ATTESTATION OF 201_ QUARTER E
Page 337 and 338: Draft MLR Reporting Schedule Health
Page 339 and 340: RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Page 343 and 344: RICK SCOTT GOVERNOR Mission to Ensu
Page 345 and 346: • Obtaining data from the health
Page 347 and 348: RICK SCOTT GOVERNOR Mission to Ensu
Page 349 and 350: Attachment VI Special Term and Cond
Page 351 and 352: RICK SCOTT GOVERNOR Better Health C
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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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