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

Vendor Name:
Review Period:
Date of Review:
Reviewer:
Participating Vendor Staff Member:
Agency For Health Care Administration
Managed Care Organizations
Subcontract Audit Tool
Subcontract Review Tool
Item Number Standard Standard Met Reference Comments
1
All provider subcontracts prohibit the provider from seeking payment
from the enrollee for any covered services provided to the enrollee
within the terms of the Contract.
Y N CC-XVI.O.2
2 All provider subcontracts contain termination procedures. Y N CC-XVI.Q.1
3
Make payment to all subcontractors pursuant to all state and federal
laws.
In subcontracts, the health plan agrees to:
Managed Care Organizations Page 1
Subcontract Audit Tool F1_03_10
Florida Medicaid
Y N
CC-XVI.O.2.a.1
s. 641.3115, F.S.
42 CFR 447.46
42 CFR 447.45(d)(2),
(3), (d)(5), & (d)(6)
4 Provide for prompt submission of information needed to make payment. Y N CC-XVI.O.2.a.2
5
6
7
8
9
Provide for full disclosure of the method and amount of compensation
or other consideration to be received from the health plan.
Require an adequate record system be maintained for recording
services, charges, dates and all other commonly accepted information
elements for services rendered to the health plan.
Specify that the health plan assumes responsibility for cost avoidance
measures for third party collections.
Provide that the Agency and DHHS may evaluate through inspection or
other means the quality, appropriateness and timeliness of services
performed.
Provide for inspections of any records pertinent to the Contract by the
Agency and DHHS.
Y N CC-XVI.O.2.a.3
Y N CC-XVI.O.2.a.4
Y N CC-XVI.O.2.a.5
Y N CC-XVI.O.2.b.1
Y N CC-XVI.O.2.b.2