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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
CC-IV.A.3.a.4, 5, 6 &8
19. New Enrollee
Materials
CC-IV.A.3.a.7
20. Recording and
Sending New
Materials
CC-IV.A.3.b-c
21. Enrollee ID Card
CC-IV.A.4
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
number.
d. A postage-paid, pre-addressed return
envelope.
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 notice that enrollees who lose
eligibility and are disenrolled is
automatically re-enrolled in the health
plan if eligibility is regained within 60
days for non-Reform and 180 for
Reform.
Each mailing to new enrollees is
documented in the health plan’s records,
and materials may be sent in separate
mailings.
The enrollee ID card includes:
a. Enrollee’s name and Medicaid ID
number.
b. Health plan’s name, address and
enrollee services number.
c. A telephone number that a noncontracted
provider may call for
billing information.
Yes
No
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
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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