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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
58. Use of a Pharmacy
Benefits Manager
CC- IV.A.13
59. Updating the
Online PDL
CC- IV.A.13
60. Incentives for
Preventive Care
CC- IV.A.14.a
61. Incentives for All
Enrollees
CC- IV.A.14.a
62. Informing
Enrollees of
Incentives
CC- IV.A.14.b
63. Restrictions on
Incentives
CC- IV.A.14.c
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
If the health plan uses a pharmacy
benefits manager, the health plan’s
website includes its PDL.
The health plan may update the online
PDL by providing 30 calendar days
written notice of any changes to the
Bureau of Managed Health Care and
Pharmacy Services.
The health plan may offer incentives for
enrollees to receive preventive care
services. The health plan receives written
approval from BMHC before offering
any incentives.
The health plan makes all incentives
available to all enrollees and does not
use incentives to direct individuals to
select a particular provider.
The health plan informs enrollees about
specific incentives available.
The health plan does not include the
provision of gambling, alcohol, tobacco,
or drugs (except for over-the-counter
drugs) in any of its incentives and states
on the incentive award that it may not be
used for such purposes.
Yes
No
N/A
Yes
No
Yes
No
N/A
Yes
No
Yes
No
Yes
No
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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