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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 39 the DOH funding for School Health Services Programs in Florida. Full Service School Health Services expands the Health Services Initiative to 20 additional counties. These counties have always provided full-services school health services. Prior to July 1, 2011, no federal funding was used, as all funding for full service school health services was State funded from the Tobacco Settlement Trust Fund. Starting July 1, 2011, the Florida Legislature changed the appropriations so that full service school services would be funded by a combination of federal Title XXI and General Revenue funds. Assurances The state will not use federal funds as the state matching share for receipt of Title XXI funds for the Department of Health’s Comprehensive School Health Services initiative. Only state funds or local funds will be used to meet the state matching requirement. This includes all school health tobacco settlement and general revenue funds. Health room records and state data coding will be used to document services provided and to ensure that the federal programs are billed correctly.

3.2. Describe the utilization controls under the child health assistance provided under the plan for targeted low-income children. Describe the systems designed to ensure that enrollees receiving health care services under the state plan receive only appropriate and medically necessary health care consistent with the benefit package described in the approved state plan. (Section 2102)(a)(4) (42CFR 457.490(b))

MediKids MediKids will be subject to the same utilization controls as the traditional Medicaid program. Examples include peer review, data analysis for over- or under-utilization of services, application of InterQual criteria to appropriateness of inpatient hospital stays, and case file review for outpatient ambulatory care. Healthy Kids Healthy Kids receives on a quarterly basis health care utilization reports from all of its contracted health and dental plans that are analyzed by the University of Florida Institute for Child Health Policy (ICHP) and a schedule of special reports is agreed to between the FHKC and ICHP each year. The health plans also conduct internal utilization control programs. As FHKC’s external quality review organization, ICHP also conducts activities with the contracted health and dental plans that ensure that enrollees receive appropriate services. ICHP reports using the voluntary CHIPRA measurements and creates an annual Quality Chart Book of its findings by plan that highlights performances under