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 III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
CONTRACT REQUIREMENT COMPLIANT SCORING
1. CMSSP For purposes of determining clinical eligibility a. Yes
Met
ONLY:
Clinical
Eligibility
for enrollment, the health plan ensures that
only those children who meet the following
criteria are submitted to the Agency as
children with chronic conditions:
a. The child met the criteria specified
through a State of Florida Department
of Health clinical screening
performed on an Agency-approved
clinical screening tool.
b. The child met the clinical criteria for
enrollment in another Children’s
Medical Services program provided
the Agency has approved the
enrollment criteria as appropriate for
No
N/A
b. Yes
No
N/A
Partially Met
Not Met
Exhibit 3
enrollment in this health plan as
children with chronic conditions.
2. CMSSP If a recipient is enrolled in Medicaid under Yes
Met
ONLY:
Determining
a SSI eligibility assistance category, a Florida
Department of Health, Children’s Medical
No
N/A
Partially Met
Not Met
Clinical Services clinical screening is still required for
Eligibility purposes of determining clinical eligibility for
enrollment in this health plan. This clinical
Exhibit 3
screening is completed in full and cannot be
waived.
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_III_F2_07_11
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