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

Standard IV: Enrollee Services & Enrollee Rights
CC-IV.A.7.g
CONTRACT
SECTION
33. Contacting New
Enrollees
CC-IV.A.8.a
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
a. Up-to-date information about any
restrictions on access to providers,
including providers who are not
taking new patients.
b. An explanation to all potential
enrollees that an enrolled family
may choose to have all family
members served by the same PCP or
they may choose different PCPs
based on each family member’s
needs.
c. Any restrictions on counseling and
referral services based on moral or
religious grounds within ninety (90)
days after adopting the policy with
respect to any service.
The health plan contacts each new
enrollee at least twice, if necessary,
within ninety (90) calendar days of the
enrollee’s enrollment to offer to schedule
the enrollee’s initial appointment with
the PCP, which should occur within 180
days of enrollment.
This appointment is to obtain a health
risk assessment and/or CHCUP
screening. The “contact” is defined as
mailing a notice to or telephoning an
enrollee at the most recent address or
telephone number available.
Yes
No
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_IV_F2_07_11
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