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

Agency For Health Care Administration
Managed Care Organizations
Subcontract Audit Tool
Subcontract Review Tool
Item Number Standard Standard Met Reference Comments
27
28
Total # Applicable Elements
Total # Compliant Elements
Total Percent Compliant
Provide that compensation to individuals or entities that conduct
utilization management activities is not structured so as to provide
incentives for the individual or entity to deny, limit, or discontinue
medically necessary services to any enrollee.
Provide details about the following as required by Section 6032 of the
federal Deficit Reduction Act of 2005:
a. The False Claims Act
b. The penalties for submitted false claims and
statements.
c. Whistleblower protections.
d. The law’s role in preventing and detecting fraud,
waste and abuse, and each person’s responsibility
relating to detection and prevention.
Managed Care Organizations Page 4
Subcontract Audit Tool F1_03_10
Florida Medicaid
Y N
a. Y N
b. Y N
c. Y N
d. Y N
CC-XVI.O.2.d.11
CC-XVI.O.2.d.12