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

Standard I: Care Management/Continuity of Care
CONTRACT
SECTION
Exhibit 8
21. REFORM
except
HIV/AIDS:
Plan of
Treatment
Exhibit 8
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
enrollment in the health plan.
b. Additionally, the health plan requests
that the enrollee sign a limited release of
information to aid the health plan in
accessing the DMO’s information for the
enrollee.
The health plan develops and uses a plan of
treatment for chronic disease follow-up care
that is tailored to the individual enrollee. The
purpose of the plan of treatment is to assure
appropriate ongoing treatment reflecting the
highest standards of medical care designed to
minimize further deterioration and
complications.
a. The plan of treatment is on file for each
enrollee with a chronic disease and
contains sufficient information to explain
the progress of treatment.
b. Medication management, the review of
medications that an enrollee is currently
taking, is an ongoing part of the plan of
treatment to ensure that the enrollee does
not suffer adverse effects or interactions
from contra-indicated medications.
c. The enrollee’s ability to adhere to a
treatment regimen also is monitored in
the plan of treatment.
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_I_F2_07_11
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