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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
17. Additional New
Enrollee Materials
CC-IV.A.3.a.1-3
18. Additional New
Enrollee Materials
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
Additional new enrollee material to be
mailed to the new enrollee (not later than
5 calendar days following receipt of the
enrollment file from Medicaid or its
agent, whichever is later):
a. The date of enrollment.
b. The name, telephone number, and
address of the enrollee’s PCP
assignment.
c. The enrollee’s right to choose a
different PCP.
d. An explanation that enrollees may
choose to have all family members
served by the same PCP or may
choose different PCPs.
Additional new enrollee material to be
mailed to the new enrollee (not later than
5 calendar days following receipt of the
enrollment file from Medicaid or its
agent, whichever is later):
a. The procedure for changing PCPs,
including notice of the health plan’s
toll-free member services telephone
number, etc.
b. The enrollees’ right to change their
health plan selection, subject to
Medicaid limitations.
c. A request to update the enrollee’s
name, address (home and mailing),
county of residence, and telephone
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. 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 8