Page 140

State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998 139 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 members shall consist of two (2) Florida Healthy Kids Corporation Board members chosen based on accessibility or availability for the dispute resolution hearing and one of these members shall serve as the Chair. A Consumer Representative shall be appointed from an entity that assists families with health care or eligibility issues. The Florida Healthy Kids Corporation Corporate Counsel or, if the Corporate Counsel is not available, the Florida Healthy Kids Corporation, General Counsel shall serve as an advisor to the Dispute Review Panel.

The following applies to the Dispute Resolution hearing:

1. The complainant shall be given an adequate opportunity to examine the contents of the Dispute Review file and all other relevant documents and records prior to the hearing. The complainant can request and receive a complete copy of the materials provided to the Dispute Review Panel members prior to the hearing at no charge.

2. The complainant can represent themselves at the hearing or be assisted by a representative.

3. Complainants shall provide the names of any additional attendees (and their affiliations) they would like to have present at the hearing to the Resolution Coordinator in advance to be added to the hearing agenda.

The Dispute Review Panel shall make a decision to approve or deny the complainant’s dispute. The Resolution Coordinator shall notify the complainant of the Dispute Review Panel’s decision in writing within ten (10) calendar days of the hearing.

Level Four Dispute

Level Four – Appeal to the Florida Healthy Kids Corporation Board If the complainant is not satisfied with the Florida KidCare Dispute Review Panel’s decision, the complainant can request a review of the decision by the Florida Healthy Kids Corporation Board of Directors at its next regularly scheduled meeting. The complainant must submit a written statement and supporting documentation with the record of the Dispute Review hearing. No verbal testimony will be considered. The Board of Directors shall take one of three actions: 1. Accept the Dispute Review Panel’s decision. This acceptance will be considered final for this segment of the review process; 2. Modify the Dispute Review Panel’s decision. All modifications will be considered final for this segment of the review process; or 3. Send the dispute back to the Dispute Review Panel for further review as specifically directed by the Board of Directors.