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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
9. Contents of
Written
Notification
C-IV.A.1.e
10. Alternative
Formats
CC-IV.A.2.a
11. Access to
Alternative
Formats
CC-IV.A.2.a
12. Written Materials
in English and
Spanish
CC-IV.A.2.b
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The written notification to reinstate
enrollees includes information regarding:
a. Change procedures for cause.
b. General health plan change
procedures through the Agency’s
toll-free choice counselor/enrollment
broker telephone number, as
appropriate.
c. Instructions for enrollees to contact
the health plan if a new enrollee card
and/or a new enrollee handbook are
needed.
The health plan makes all written
enrollee materials available in alternative
formats and in a manner that takes into
consideration the enrollee’s special
needs, including those who are visually
impaired or have limited reading
proficiency.
The health plan notifies all enrollees and
potential enrollees and, upon request,
that information is available in
alternative formats and how to access
those formats.
The health plan makes all written
material available in English, Spanish,
and all other appropriate foreign
languages (i.e., languages in the health
plan service area spoken by
approximately five percent of the total
population).
a. Yes
No
b. Yes
No
c. Yes
No
Yes
No
Yes
No
Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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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