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

50
APPLICATION ITEM
20. Submit the applicant’s policies and procedures for ensuring
that changes in management or ownership are submitted timely
as required in the model Contract.
HSD Internal Working Document
MCO APPLICATION REVIEW CHECKLIST FOR Phase I
INSTRUCTIONS (if applicable)
Confirm the plan procedures comply with Contract
Section XVI.V(5):
The Health Plan shall submit to the Agency,
within five (5) business days, any
information on any officer, director, agent,
managing employee, or owner of stock or
beneficial interest in excess of five percent
of the Health Plan who has been found guilty
of, regardless of adjudication, or who
entered a plea of nolo contendere or guilty
to, any of the offenses listed in s. 435.04,
F.S.
The Health Plan shall submit information to
the Agency for such persons who have a
record of illegal conduct according to the
background check.
The Health Plan shall keep a record of all
background checks to be available for
Agency review upon request.
LOCATION IN
APPLICATION
(Binder, Tab & Page #)
Date Deficiencies
identified/Date
Deficiencies resolved
Revisions as of 1/23/2012 Page 17 of 19
INITIALS &
DATE
COMPLETED