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

Standard III: Eligibility, Enrollment, and Disenrollment
CONTRACT
SECTION
42 CFR 438.56(3)
CC-III.C.4.b
43. Involuntary
Disenrollment
Documents
CC-III.C.4.b
44. CMSSP
ONLY:
Involuntary
Disenrollment
Notice
Exhibit 3
45. Case-by-Case
Review of
Disenrollments
CC-III.C.4.c
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
disenrollment request at such a date as would
cause the disenrollment to be effective later
than 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.
The health plan notifies enrollees who will be
involuntarily disenrolled due to either aging
out (at age 21), or due to the enrollee no
longer being clinically eligible for enrollment
in the health plan, of the following at least two
months prior to the anticipated effective date
of the involuntary disenrollment. The template
for such notice must be submitted to and
approved by BMHC prior to use.
a. The reason for involuntary
disenrollment.
b. The telephone number of the choice
counselor/enrollment broker.
c. Transition information.
All requests will be reviewed on a case-bycase
basis and subject to the sole discretion of
the Agency. Any request not approved is final
and not subject to health plan dispute or
appeal.
Yes
No
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
Yes
No
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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