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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
64. Incentives
Proportion to
Importance of
Health Service
CC- IV.A.14.d
65. Limited Value of
Incentives
CC- IV.A.14.e
66. What Cannot Be
Considered in the
Dollar Limits
CC- IV.A.14.f
67. Goal for Pregnancy
Incentives
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
Incentives may have some health- or
child development-related function (e.g.,
clothing, food, books, safety devises,
etc.). Incentive dollar values are in
proportion to the importance of the
health service being incentivized (e.g., a
tee-shirt for attending one prenatal class,
but a car seat for completion of a series
of classes).
Incentives are limited to a value of $20,
except in the case of incentives for the
completion of a series of services, health
education classes, or other educational
activities, in which case the incentive is
limited to a value of $50.
The Agency allows a special exception
to the dollar value relating to infant car
seats, strollers, and cloth baby carriers or
slings.
The health plan does not include in the
dollar limits on incentives any money
spent on the transportation of enrollees to
services or childcare provided during the
delivery of services.
The health plan offers an Agencyapproved
program for pregnant women
to encourage beginning prenatal care
visits in the first trimester of pregnancy.
Prenatal and postpartum care incentive
programs are aimed at promoting early
Yes
No
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
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_IV_F2_07_11
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