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

Standard IV: Enrollee Services & Enrollee Rights
CC- IV.A.11.b
CC-V.H.16.f.1
CONTRACT
SECTION
45. Telephone Call
Policies and
Procedures
CC- IV.A.11.c
46. Calls from Non-
English Speaking
Enrollees
CC- IV.A.11.d
47. Hours for
Telephone Help
Line
CC- IV.A.11.e
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The HO log may be a part of the helpline
log if the HO calls can be identified.
The health plan has telephone call
policies and procedures that include
requirements for:
a. Staffing.
b. Personnel.
c. Hours of operation.
d. Call response times.
e. Maximum hold times.
f. Maximum abandonment rates.
g. Monitoring of calls via recording or
other means.
h. Compliance with performance
standards.
The telephone help line handles calls
from non-English speaking enrollee, as
well as calls from enrollees who are
hearing impaired.
The telephone help line is fully staffed
between the hours of 8:00 a.m. and 7:00
p.m. in the enrollee’s time zone Monday
through Friday, excluding state holidays.
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
e. Yes
No
f. Yes
No
g. Yes
No
h. Yes
No
Yes
No
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
Page 17