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

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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 Page 17
Standard III: Eligibility, Enrollment, and Disenrollment CONTRACT SECTION Disenrollemnt Notices CC-III.C.5 AGENCY FOR HEALTHCARE ADMINISTRATION MANAGED CARE ORGANIZATIONS Compliance Monitoring Tool with Specific Contract Standards CONTRACT REQUIREMENT COMPLIANT SCORING instructions to contact the choice counselor/enrollment broker to make a plan choice in the new service area. Results for Standard III Eligibility, Enrollment, and Disenrollment Score # Elements Met Partially Met Not Met Not Applicable Total # Elements Total # Applicable Elements Percent of Elements Met DOCUMENTS REVIEWED FINDINGS State of Florida Compliance Monitoring_Standard_III_F2_07_11 Page 18
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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Standard VIII: Quality Improvement
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Results for Standard IX Medical Rec
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Standard X: Access and Availability
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Results for Standard X Access and A
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Standard XI: Grievances and Appeals
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Standard XII: Administration and Ma
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Results for Standard XII Administra
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Standard XIII: Community Outreach C
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Results for Standard XIII Community
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Standard XIV: Covered Services AGEN
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Standard XV: Immunizations, Pregnan
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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13 14 15 Agency For Health Care Adm
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f. Posting of the Agency Summary of
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5. 6. 7. 8. 9. local WIC office to
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14 Agency For Health Care Administr
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8 providers Agency For Health Care
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Medical Loss Ratio The following dr
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RICK SCOTT GOVERNOR Better Health C
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Plan Name: AGENCY FOR HEALTH CARE A
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DRAFT ATTESTATION OF 201_ QUARTER E
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Draft MLR Reporting Schedule Health
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RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Attachment V Special Term and Condi
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RICK SCOTT GOVERNOR Mission to Ensu
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• Obtaining data from the health
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RICK SCOTT GOVERNOR Mission to Ensu
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Attachment VI Special Term and Cond
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RICK SCOTT GOVERNOR Better Health C
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