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

Standard I: Care Management/Continuity of Care
CONTRACT
SECTION
45 CFR 160 and 164
CC-VIII.B.2.h
9. Documenting
Emergency
Care
45 CFR 160 and 164
CC-VIII.B.2.i
10. Nonduplication
of
Effort
45 CFR 160 and 164
CC-VIII.B.2.k
11. Protecting
Enrollees’
Privacy
45 CFR 160 and 164
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
following:
a. Acting as a liaison between the enrollee
and providers.
b. Ensuring the enrollee has adequate
support at home.
c. Assisting enrollees who are unable to
access necessary care due to their
medical or emotional conditions or who
do not have adequate community
resources to comply with their care.
d. Assisting the enrollee in developing
community resources to manage a
medical condition.
The health plan maintains written case
management and continuity of care protocols
that include documentation of emergency
care encounters in enrollees’ records with
appropriate medically indicated follow-up.
The health plan maintains written case
management and continuity of care protocols
that include sharing with other health plans
serving the enrollee the results of its
identification and assessment of any enrollee
with special health care needs so that those
activities are not duplicated.
The health plan maintains written case
management and continuity of care protocols
that include ensuring that in the process of
coordinating care, each enrollee’s privacy is
protected consistent with confidentiality
requirements regarding the privacy of
No
d. Yes
No
Yes
No
Yes
No
Yes
No
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 3