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

AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
MCO Health Plan: Contract Number:
Contract Manager: Date(s) of Monitoring:
Standard I: Care Management/Continuity of Care
CONTRACT
SECTION
1. Referrals and
Assistance
45 CFR 160 and 164
CC-VIII.B.2.a
2. Need for
Services
45 CFR 160 and 164
CC-VIII.B.2.b
3. Follow-up for
Lead Levels
45 CFR 160 and 164
CC-VIII.B.2.c
4. Discharge
Planning with
Post-
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan maintains written case
management and continuity of care protocols
that include appropriate referral and
scheduling assistance of enrollees needing
specialty health care/transportation services,
including those identified through Child
Health Check-Up Program (CHCUP)
Screenings.
The health plan maintains written case
management and continuity of care protocols
that include determination of the need for
non-covered services and referral of the
enrollee for assessment and referral to the
appropriate service setting (to include
referral to Women, Infants, and Children
[WIC] and Healthy Start) utilizing assistance
as needed by the area Medicaid office.
The health plan maintains written case
management and continuity of care protocols
that include case management follow-up
services for children/adolescents whom the
health plan identifies through blood
screenings as having abnormal levels of lead.
The health plan maintains written case
management and continuity of care protocols
that include coordinated hospital/institutional
Yes
No
Yes
No
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_I_F2_07_11
Page 1