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

Standard III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
33. Effective Date
of Approved
Disenrollment
CC-III.C.1.f
34. Disenrollment
Date if
Approved by
Agency
42 CFR 438.56(e)(1)
CC-III.C.1.f
35. Disenrollment
Date if Not
Approved by
Agency
42 CFR 438.56(e)(2)
CC-III.C.1.f
36. When
Disenrollment
Can Occur
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The effective date of an approved
disenrollment is the last calendar day of the
month in which disenrollment was made
effective by the Agency or its agent.
In no case will disenrollment be later than the
first calendar day of the second month
following the month in which the enrollee or
the health plan files the disenrollment request.
If the Agency or its agent fails to make a
disenrollment determination within this
timeframe, the disenrollment is considered
approved.
An enrollee may request disenrollment at any
time. The Agency or the choice counselor/
enrollment broker performs disenrollment as
follows:
Without cause for enrollees subject to open
enrollment:
a. During the 90 days following the enrollee’s
initial enrollment, or the date the Agency or
its agent sends the enrollee notice of the
enrollment, whichever is later.
Yes
No
Yes
No
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
e. Yes
No
N/A
f. Yes
No
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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