Page 36

State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

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, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 35 June 1, 2002, the comprehensive dental benefit was available in 67 Florida counties. As a result of legislation adopted by the 2003 Legislature, the dental benefit for the Healthy Kids program was modified. While the whole array of Medicaid dental benefits for children will still be available to Healthy Kids enrollees, an annual benefit cap of $750 per child per year was implemented effective July 1, 2003 through June 30, 2004. The benefit level was reduced to $600 effective July 1, 2004 through December 31, 2005 when the 2004 Legislature capped the dental premium rate to $12 per member per month. However, with the re-bid of the dental insurer contracts, the annual benefit cap was raised to $800 per member effective January 1, 2005. The $12 per member per month premium rate maximum remained in effect through June 30, 2006.

Effective July 1, 2009, contracts with four (4) statewide dental plans were executed and the dental benefit maximum was increased to $1,000 per year (measured July 1st through June 30th each year). Effective July 1, 2010, Florida Healthy Kids Corporation contracted with two (2) statewide dental plans and eliminated the annual dental benefit limit to comply with CHIPRA legislation.

Children’s Medical Services The CMSN providers are the same providers as those who serve Medicaid children under the MediPass option for children with special health care needs. CMSN contracts with providers to offer a full range of services for these children. Families are offered a choice of primary care providers in the network. The CMSN provides the standard Medicaid benefit package to its enrollees. The specialty care providers are primarily Medicaid providers and meet additional credentialing criteria or standards to serve children with special health care needs. For example, CMSN only uses certain facilities to perform cardiac surgery on children with special health care needs. Those facilities are designated by CMSN based on the recommendations of a cardiac advisory panel. This panel is comprised of experts in the field of pediatric cardiology and designates facilities based on national and state standards. Contract providers are required to submit encounter level data to the CMSN. The encounter level data are used to determine the reimbursement rates based on Medicaid fee schedules. The Department of Children and Families contracts with local mental health providers