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

Standard IV: Enrollee Services & Enrollee Rights
CC- IV.A.11.g
CONTRACT
SECTION
52. Help Line
Mailbox Capacity
CC- IV.A.11.g
53. Answering
Messages on Help
Line
CC- IV.A.11.g
54. Translation
Services
CC- IV.A.12
55. Notifying
Enrollees of
Translation
Services
CC- IV.A.12
56. Oral Interpretation
Services
CC- IV.A.12
57. Preferred Drug List
CC- IV.A.13
messages.
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan ensures that the voice
mailbox has adequate capacity to receive
all messages.
A health plan representative responds to
messages on the next business day.
The health plan is required to provide
oral translation services of information to
any enrollee who speaks any non-
English language regardless of whether
an enrollee speaks a language that meets
the threshold of a prevalent non-English
language.
The health plan notifies its enrollees of
the availability of oral interpretation
services and how to access such services.
Oral interpretation services are required
for all health plan information provided
to enrollees including notices of action.
There is no charge to the enrollee for
translation services.
If the health plan adopts the Agency’s
PDL, the health plan’s website includes
an explanation and a link to the
Agency’s online PDL.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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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