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

Standard III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
8. Newborn
Enrollment
CC-III.B.3.b
9. Newborn
Activation
CC-III.B.3.d
10. Identification of
Pregnant
Members
CC-III.B.3.c.1
11. Notifying DCF
of a Pregnancy
CC-III.B.3.c.1
12. CMSSP
ONLY:
Activating the
Baby’s
Medicaid ID
Exhibit 3
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan uses the unborn activation
process to facilitate enrollment and is
responsible for newborns from the date their
enrollment in the health plan is effective.
Upon unborn activation, during the next
enrollment cycle, the newborn is enrolled in
the mother’s health plan.
Unborn activation occurs upon identification
of an enrollee’s pregnancy through medical
history, examination, testing, or claims.
The health plan immediately notifies DCF of a
pregnancy and any relevant information
known.
a. The health plan completes the DCF Excel
spreadsheet, submits it via electronic mail
to the appropriate DCF Customer Call
Center address, and copies MPI via
electronic mail.
b. The health plan indicates its name and
number as the entity initating the referral.
Once the health plan confirms activation of the
baby’s Medicaid ID, the health plan submits to
the Medicaid area office a request to enroll the
newborn. Newborn enrollments are effective
the next available enrollment month.
Yes
No
Yes
No
Yes
No
a. Yes
No
b. Yes
No
Yes
No
N/A
Met
Partially Met
Not Met
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_III_F2_07_11
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