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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998 141 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 Appendix C Florida KidCare Grievance Procedures

Statement of Intent The Florida KidCare Grievance Committee shall review and resolve grievances related to the Florida KidCare Program when all four levels of resolution through the Florida KidCare Dispute Review Process have been completed. Grievances involving more than one Florida KidCare Program will also be addressed by this committee. Grievances heard by the Florida KidCare Grievance Committee shall include eligibility and enrollment matters relating to Florida Healthy Kids, MediKids or the Children’s Medical Services Network. Section 409.818(3)(e), Florida Statutes, directs the Agency for Health Care Administration to: “Establish a mechanism for investigating and resolving complaints and grievances from program applicants, enrollees, and health benefits coverage providers, and maintain a record of complaints and confirmed problems. In the case of a child who is enrolled in a health maintenance organization, the agency must apply the provisions of s. 641.511 to address grievance reporting and resolution requirements.” To implement this provision, it is the intent of the Florida KidCare program that the procedures to provide remedies for complaints, problems and grievances be appropriate, timely and simple. The grievance procedures will conform to section 409.821, F.S. with respect to confidentiality of information. Florida KidCare Grievance Committee Members 1. The Florida KidCare Grievance Committee consists of one representative from each of the following Florida KidCare partners, appointed by their respective agency. The fifth representative shall be the Project Director (or designee) of the Florida Covering Kids and Family Coalition. • Agency for Health Care Administration (MediKids) • Department of Children and Family Services (Medicaid for Children) • Department of Health (Children’s Medical Services Network) • Florida Healthy Kids Corporation (Healthy Kids) • A representative of the Florida Covering Kids and Family Coalition 2. The Agency for Health Care Administration’s representative will serve as the committee chairperson. The committee members will elect a co-chair, who will serve as the chairperson in the absence of the Agency’s representative.