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

Standard III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
CC-III.B.3.d
24. Health Plan’s
Request to
Reduce
Enrollment
CC-III.B.4
25. Renewal of
Contract and
Enrollment
Status
CC-III.C.1.a
26. Voluntary
Disenrollment
CC-III. C.1.b
27. CMSSP
ONLY:
Exceptions to
Appeals for
Disenrollment
Rights
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
immediately upon the birth of the child. The
newborn will not automatically become a
health plan enrollee upon birth.
The health plan may ask the Agency to halt or
reduce enrollment temporarily if contined full
enrollment would exceed the health plan’s
capacity to provide required services under the
contract.
If the contract is renewed, the enrollment
status of all enrollees continues uninterrupted.
The health plan ensures that it does not restrict
the enrollee’s right to disenroll voluntarily in
any way.
In addition to the exceptions for appeal of
disenrollment rights listed in Attachment II,
Section III, Eligibility and Enrollment, Item
C.1.d., the following reasons are also included
as exceptions for the CCC program:
a. Aging out of the health plan at age 21.
b. No longer being clinically eligible to
participate in the health plan as
determined pursuant to the clinical
screening requirements specified
Yes
No
Yes
No
Yes
No
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
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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