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

Standard I: Care Management/Continuity of Care
CONTRACT
SECTION
CC-VII.G.4
16. Continuity of
Care:
Providers
Terminated
for Cause
CC-VII.G.5
17. NON-
REFORM:
Disease
Management
Exhibit 8
18. REFORM
except
HIV/AIDS:
Disease
Management
Programs
Exhibit 8
19. REFORM
except
HIV/AIDS:
Disease
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan has policies and procedures
for this requirement.
The requirements set forth in Standard I
Elements 12, 13, 14 and 15 do not apply to
providers who have been terminated from the
health plan for cause.
The health plan has policies and procedures
for this requirement.
The Agency encourages the health plan to
develop and implement disease management
programs for enrollees living with chronic
conditions.
The health plan develops and implements
disease management programs for Reform
enrollees living with chronic conditions.
a. The disease management initiatives
includes, but are not limited to, asthma,
HIV/AIDS, diabetes, congestive heart failure
and hypertension.
b. The health plan may develop and
implement additional disease management
programs for its enrollees.
Each disease management program has
policies and procedures that follow the
National Committee for Quality Assurance’s
(NCQA’s) most recent Disease Management
Yes
No
Yes
No
N/A
a. Yes
No
N/A
b. Yes
No
N/A
a. Yes
No
N/A
b. 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
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