Page 146

State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998 145 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 services provider respond to the complainant’s dispute request in accordance with the time frames stated in the provider’s complaint or grievance process and 42 CFR s. 457.1160.

Children’s Medical Services Network – The Children’s Medical Services Network staff will refer health services complaints to the relevant Children’s Medical Service area office Nursing Director. The Children’s Medical Services Network staff shall request that the complainant’s dispute request is completed in accordance with the time frames stated in 42 CFR s. 457.1160.

 Benefits disputes. Each Florida KidCare partner is responsible for resolving disputes about benefits relating to its own program.  Medicaid eligibility issues. All decisions made by the Department of Children and Families with respect to Medicaid eligibility are final and may not be appealed beyond the Department’s own fair hearing process.

Appendix D

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Page 146

Official source

State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998 145 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 services provider respond to the complainant’s dispute request in accordance with the time frames stated in the provider’s complaint or grievance process and 42 CFR s. 457.1160.

Children’s Medical Services Network – The Children’s Medical Services Network staff will refer health services complaints to the relevant Children’s Medical Service area office Nursing Director. The Children’s Medical Services Network staff shall request that the complainant’s dispute request is completed in accordance with the time frames stated in 42 CFR s. 457.1160.

 Benefits disputes. Each Florida KidCare partner is responsible for resolving disputes about benefits relating to its own program.  Medicaid eligibility issues. All decisions made by the Department of Children and Families with respect to Medicaid eligibility are final and may not be appealed beyond the Department’s own fair hearing process.

Appendix D