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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
5. New Enrollee
Material
CC-IV.A.1.d
6. Reinstated
Enrollees
CC-IV.A.1.d
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
New enrollee materials are not required
for a former enrollee who was
disenrolled because of the loss of
Medicaid eligibility and who regains
eligibility within sixty (60) days for a
non-Reform enrollee and one-hundred
and eighty (180) days for a Reform
enrollee and is automatically reinstated
in the health plan.
Enrollees who were previously enrolled
in a health plan, and who lose and regain
eligibility after the specified number of
days for Reform or non-Reform, will be
treated as new enrollees.
Unless requested by the enrollee, new
enrollee materials are not required for a
former enrollee subject to open
enrollment who was disenrolled because
of the loss of Medicaid eligibility,
regains eligibility within the time
specified in this paragraph and is
reinstated as a health plan enrollee.
A notation of the effective date of the
reinstatement is to be made on the most
recent application or conspicuously
identified in the enrollee’s administrative
file.
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_IV_F2_07_11
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