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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
72. Redetermination
Training
CC- IV.A.17.c.1.b
73. Documenting
Redetermination
Training
CC- IV.A.17.c.1.b
74. Using
Redetermination
Date Information
CC- IV.A.17.d
75. Using
Redetermination
Date: One Notice
per Household
CC- IV.A.17.d.1.a
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
A health plan that chooses to participate
in the use of redetermination dates must
train all affected staff, prior to
implementation, on its policies and
procedures and the Agency’s
requirements.
The health plan must document that
redetermination training occurred,
including a record of those trained, for
the Agency’s review within 5 business
days after the Agency’s request.
A health plan that chooses to participate
in using the redetermination date
information uses the redetermination
date information only in the methods
listed below and uses either or both
methods to communicate this
information.
The health plan may use redetermination
date information in written notices to be
sent to their enrollees reminding them
that their Medicaid eligibility may end
soon and to reapply for Medicaid, if
needed.
A health plan may send one notice to the
enrollee’s household when there are
multiple enrollees within a family who
have the same Medicaid redetermination
date, provided that these enrollees share
the same mailing address.
Yes
No
N/A
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
Page 23