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

Standard III: Eligibility, Enrollment, and Disenrollment
Exhibit 3
CONTRACT
SECTION
28. Disenrollments
by Choice
Counselors or
Enrollment
Brokers
CC-III.C.1.c
29. CMSSP
ONLY:
Involuntary
Disenrollment
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
above.
c. Being a sibling of a sole beneficiary
who is no longer eligible for
enrollment in the health plan due to (1)
or (2) above.
The health plan or its agents will not provide
or assist in the completion of a disenrollment
request or assist the Agency’s contracted
choice counselor/enrollment broker in the
disenrollment process.
The following are also reasons for which the
health plan submits involuntary disenrollment
requests to the Agency’s choice
counselor/enrollment broker. In no event will
the health plan submit a disenrollment request
at such a date as would cause the
disenrollment to be effective later than fortyfive
(45) calendar days after the health plan’s
receipt of the reason for involuntary
disenrollment. The health plan ensures that
involuntary disenrollment documents are
maintained in an identifiable enrollee record.
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
above.
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
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_III_F2_07_11
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