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

Standard III: Eligibility, Enrollment, and Disenrollment
Exhibit 3
CONTRACT
SECTION
49. REFORM:
Disenrollment
Notice to
Enrollees
Exhibit 3
50. NON-
REFORM:
Sending
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
the Health Plan Report Guide. 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. Moved out of Reform health plan
service area.
b. Enrollee death.
c. Enrollee ineligible for health plan
enrollment.
The health plan notifies enrollees who will be
involuntarily disenrolled due to the reasons
above of the following at least two (2) months
before the anticipated effective date of the
involuntary disenrollment. The template for
such notice is submitted to and approved by
BMHC before use.
a. The reason for involuntary
disenrollment.
b. The telephone number of the choice
counselor/enrollment broker.
c. Transition information.
If an enrollee was disenrolled due to moving
outside the service area, a notice of
disenrollment is sent to all such recipients with
No
N/A
c. Yes
No
N/A
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
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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