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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
13. Interpreter
Services
CC-IV.A.2.b
14. Enrollee
Information
42 CFR 438.10
CC-IV.A.2.c
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan provides, free of charge,
interpreters for potential enrollees or
enrollees whose primary language is not
English.
The health plan provides enrollee
information which addresses information
requirements related to written and oral
information, including:
a. Languages.
b. Format.
c. Health plan features (i.e., benefits,
cost sharing, service area, provider
network and physician incentive
plans).
d. Enrollment and disenrollment rights
and responsibilities.
e. Cost sharing.
f. Grievance system.
g. Advance directives.
h. Enrollees’ right to receive
information annually.
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
e. Yes
No
f. Yes
No
g. Yes
No
h. 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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