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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
7. Written
Notification to
Reinstated
Enrollees
CC-IV.A.1.e
8. Notification of
Change Procedures
C-IV.A.1.e
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan notifies, in writing, each
person who is to be reinstated.
The written notification must identify:
a. The effective date of the
reinstatement.
b. The assigned primary care
physician.
The written notification of reinstatement
distinguishes between enrollees subject
to open enrollment and enrollees not
subject to open enrollment. The
notification is provided to each affected
enrollee by the first calendar day of the
month following the health plan’s receipt
of the notice of reinstatement or within 5
calendar days from receiving the
enrollment file, whichever is later.
a. Yes
No
b. 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
Page 4