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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998 129 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 • Florida KidCare ensures the opportunity for continuation of enrollment pending the completion of reviews as required in 42 CFR§457.1170.

• Florida KidCare provides enrollees and applicants timely written notice of all determinations as required in 42 CFR §457.1180.

Process Description The Florida Healthy Kids Corporation serves the Florida KidCare Program in two capacities. The Corporation is a service provider for children ages 5 and over, and it also contracts with the Agency for Health Care Administration to perform as the central processor for Florida KidCare. In this capacity, they process each application for enrollment, regardless of the KidCare component for which the child qualifies.

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 Committee 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’s SCHIP utilizes the same review processes in place for contracted providers of health services in Title XIX, all of which comply with 42 CFR §457.1120. For the Healthy Kids program, FHKC contracts with licensed health and dental insurers who assume the responsibility for providing the benefits covered under the Healthy Kids program. In these contracts, the plans also have the responsibility to have review processes in place that conform with all federal and state requirements. The specific steps taken by each plan may vary, but all of the plans are required, by contract, to meet the specific time standards as detailed in the SCHIP regulations. Participating plans are also monitored by the Agency for Health Care Administration for compliance with all state requirements in this regard as well.

Premium Assistance Programs