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

Standard IV: Enrollee Services & Enrollee Rights
Exhibit 4
CONTRACT
SECTION
29. Handbooks
CC-IV.A.6.a
30. Provider Directory
CC-IV.A.7.a
31. Hospital
Affiliation
CC-IV.A.7.b
32. Informing
Potential Enrollees
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
obtaining and submitting
documentation to MCM to verify
participation in a healthy behavior
without a procedure code. A
universal form is available with the
Agency’s website and is
submitted to the health plan to
document participation in healthy
behaviors without a procedure code.
The health plan has a separate enrollee
handbook for Reform and non-Reform
populations.
The health plan mails a provider
directory to all new enrollees, including
enrollees who re-enrolled after the open
enrollment period.
The provider directory includes
information concerning how to
determine a provider’s hospital
affiliation.
The information concerning the hospital
affiliation of providers is available online
and through the Customer Service
Department.
The health plan has procedures to inform
potential enrollees and enrollees, upon
request, of any changes to service
delivery and/or the provider network
including:
Yes
No
N/A
Yes
No
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
Met
Partially Met
Not Met
N/A
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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