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

Standard IV: Enrollee Services & Enrollee Rights
CC- IV.A.14.g
CONTRACT
SECTION
68. Agency Approval
for Incentives
CC- IV.A.14.h
69. Use of
Redetermination
Notices
CC- IV.A.17.c
70. Policies and
Procedures for the
Use of
Redetermination
Dates
CC- IV.A.17.c.1.
71. Discontinuing Use
of Redetermination
Dates
CC- IV.A.17.c.1.a.
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
intervention and prenatal care to decrease
infant mortality and low birth weight and
to enhance health birth outcomes. The
prenatal and postpartum incentives
include the provisions of maternity and
health-related items and education.
The health plan’s request for Agency
approval of all incentives contains a
detailed description of the incentive and
its mission.
By June 1 each year, the health plan
notifies BMHC, in writing, if it wants to
change the use of the redetermination
date information supplied by the Agency.
The health plan’s participation in using
the redetermination information is
voluntary.
A health plan that chooses to participate
in the use of redetermination dates must
provide its policies and procedures
regarding this subsection to BMHC for
its approval along with its response
indicating that the plan will participate.
A health plan that chooses to participate
in the use of redetermination dates may
decide to discontinue using the
information at any time and must so
notify BMHC in writing 30 calendar
days prior to the date it will discontinue
such use.
Yes
No
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
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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