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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998 126 Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/05, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 REVIEW PROCESSES FOR FLORIDA KIDCARE

Health Services Enrollment Florida Healthy Kids Medical Provider Internal Dispute Process

• Florida KidCare Dispute Process • Florida KidCare Grievance Committee MediKids Medical Provider Internal Dispute Process • Florida KidCare Dispute Process • Florida KidCare Grievance Cmte Medicaid Medicaid Fair Hearing Process Medicaid Fair Hearing Process Children’s Medical Services Network Medical Provider Internal Dispute Process • Florida KidCare Dispute Process • Florida KidCare Grievance Committee

Florida statutes afford families a wide array of consumer protections for recourse when they wish to challenge any decisions. Some of the options include:

• Children’s Medical Services Statewide Grievance Panel • HMO Grievance Process • Statewide Subscriber Assistance Panel • Florida KidCare Grievance Committee • Florida Healthy Kids Board of Directors • Medicaid Fair Hearing Process (for applicants/enrollees in Title XIX Medicaid)

For Issues Specific to Eligibility and/or Enrollment:

Florida KidCare sends applicants and enrollees timely written notice of determinations regarding eligibility or enrollment matters. Notices mailed to applicants/enrollees contain language and timeframes consistent with 42CFR 457.1180. The state will distribute a brochure that lists all of the rights and responsibilities of enrollees.

In its role of central processor for the Florida KidCare Program, Florida Healthy Kids has developed a comprehensive procedure for conducting reviews of eligibility or enrollment matters. This procedure ensures that any reviews are resolved within 90 days, consistent with 42 CFR 457.1160(a).

The resolution coordinator shall supervise the dispute process and prepare a written response to the applicant/participant explaining FHKC’s decision regarding the member’s eligibility and enrollment. The response shall include: 1) a brief summary of the dispute, 2) the reasons