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

Standard IV: Enrollee Services & Enrollee Rights
CONTRACT
SECTION
76. Using
Redetermination
Date: Agencyprovided
Notices
CC- IV.A.17.d.1.b
77. Using
Redetermination
Date: Sending
Notices
CC- IV.A.17.d.1.c
78. Using
Redetermination
Date: Automated
Voice Response
CC- IV.A.17.d.2
79. Using
Redetermination
Date: Automated
Messages
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
The health plan uses the Agencyprovided
template for its redetermination
date notices. The health plan puts this
template on its letterhead for mailing;
however, the health plan makes no other
changes, additions or deletions to the
letter text.
The health plan mails the
redetermination date notice to each
enrollee no more than 60 calendar days
and no less than 30 calendar days before
the redetermination date occurs.
The health plan may use redetermination
date information in automated voice
response (AVR) or integrated voice
response (IVR) automated messages sent
to enrollees reminding them that their
Medicaid eligibility may end soon and to
reapply for Medicaid, if needed.
A health plan that chooses to use this
method to provide the information must
adhere to the following requirements:
The health plan sends the
redetermination date messages to each
enrollee for whom that health plan has
received a redetermination date and for
whom the health plan has a telephone
number. The health plan may send an
automated message to the enrollee’s
household where there are multiple
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
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