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

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Adequate Choices of Managed Care Options March 2012 Agency for Health Care Administration
RICK SCOTT GOVERNOR Better Health Care for all Floridians Adequate Choice of Managed Care Options Agency Mission to Ensure Quality Care: ELIZABETH DUDEK SECRETARY The Agency’s mission is to ensure quality care is provided to Florida’s residents. On occasion, market fluctuations result in a Medicaid health plan reaching its enrollment cap, leaving a county, terminating its contract, or being purchased by another entity. To ensure recipients in the demonstration area are provided adequate choice of health plan or provider, recipients are advised of their choices of health plan/provider. The following is a summary of the processes and requirements established to enable us to reach this goal. Policy: Recipients enrolled in the demonstration are provided 30 days to select a choice of health plans. If there are fewer than two plans in a demonstration county from which a recipient can choose, the Agency will allow the recipient to enroll in Florida’s primary care case management program (MediPass). Overview of MediPass (PCCM): MediPass is currently operational in all areas of the state (including the demonstration counties) and is available to recipients who may voluntarily enroll in the demonstration or where there are less than two plans in an area. The Agency ensures that MediPass has a sufficient network of providers through its ongoing credentialing and monitoring. Recipients have access to providers in accordance with 42 CFR 438.52. Overview of Choice Counseling Requirements: The Agency’s enrollment broker works in conjunction with Agency staff to ensure Medicaid recipients are informed of health plan choices. The Agency notifies the enrollment broker of changes in plan availability. The enrollment broker processes enrollments, changes and disenrollments, notifies recipients of required (mandatory) or voluntary participation in a health plan or MediPass, mails confirmations of enrollment, disenrollment and change requests and notification of open enrollment and annual change opportunity. The enrollment broker operates a toll-free helpline to provide choice counseling and enrollment assistance as well as a website with choice information and online enrollment, enrollment by mail and in person through face-to-face choice counseling. Choice Counseling Responsibilities when Choices Change or are Limited: Several functions are modified or updated when a health plan leaves a county or reaches enrollment capacity. 272 7 M ah an D r i v e • M ai l S t op #1 T al l a has s ee, F L 3 23 08 Page 1 of 2 V i s i t A H C A onl i n e at A H C A . M y F l or i da. c o m
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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 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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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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f. Posting of the Agency Summary of
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8 providers Agency For Health Care
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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
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Page 339 and 340: RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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