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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
27. REFORM:
Enhanced Benefit
Program
Exhibit 4
28. REFORM:
Healthy Behaviors
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The Agency has identified a combination
of covered and non-covered services as
healthy behaviors that will earn credits
for an enrollee.
a. The Agency assigns a specific credit
to an enrollee’s account for each
healthy behavior service received
and notifies each enrollee of the
availability of the credits in the
account.
b. The credits in the enrollee’s account
are available if the enrollee enrolls
in a different health plan and for a
period of up to three (3) years after
loss of Medicaid eligibility.
The Agency administers the program
with assistance from the health plan.
a. For covered services identified as
healthy behaviors, the health plan
submits a monthly report to the
Medicaid Bureau of Contract
Management (MCM) by the tenth
calendar day of the month for the
previous month’s paid claims. A list
of procedure codes and healthy
behaviors are provided in the
Agency Report Guide posted on the
Agency’s website.
b. For non-Medicaid services, the
health plan assists the enrollee in
a. Yes
No
N/A
b. Yes
No
N/A
a. Yes
No
N/A
b. Yes
No
N/A
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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