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

Standard III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
13. Assigning a
Medicaid ID to
the Unborn
CC-III.B.3.c.2
14. Activating a
Newborn’s
Medicaid ID
CC-III.B.3.c.3
15. FFS PSNs &
CMSSP
ONLY:
Newborns not
Enrolled by
Unborn
Activation
Exhibit 3
16. FFS PSNs &
CCC ONLY:
Activating the
Baby’s
Medicaid ID
Exhibit 3
17. FFS PSNs &
CCC ONLY:
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
DCF generates the Medicaid ID number for
the unborn child. The number is transmitted to
the Medicaid fiscal agent and remains inactive
until the child is born and DCF is notified of
the birth.
When a pregnant enrollee presents to the
hospital for delivery, the health plan informs
the hospital, the mother’s attending physician,
and the newborn’s attending and consulting
physicians that the newborn is an enrollee only
if there is an unborn record in the system
awaiting activation.
Newborns not enrolled through the unborn
activation process are enrolled through the
Agency’s choice counselor/enrollment broker.
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.
The health plan complets an ENR-Newborn
Excel worksheet titled WORKBOOK-Invol
Yes
No
Yes
No
Yes
No
N/A
Yes
No
N/A
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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