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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 90 Section 7. Quality and Appropriateness of Care  Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 8.

7.1. Describe the methods (including external and internal monitoring) used to assure the quality and appropriateness of care, particularly with respect to well-baby care, well- child care, and immunizations provided under the plan. (2102(a)(7)(A)) (42CFR 457.495(a))

Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.) 7.1.1.  Quality standards 7.1.2.  Performance measurement 7.1.3.  Information strategies 7.1.4.  Quality improvement strategies

MediKids MediKids providers are the same as traditional Medicaid providers. Participating managed care organizations must be licensed by the Office of Insurance Regulation of the Florida Department of Financial Services, in accordance with the Florida Insurance Code, comply with quality of care requirements, which are regulated by the Agency for Health Care Administration, and be accredited by a nationally recognized accreditation entity. MediPass providers must be credentialed in accordance with the MediPass program requirements. Healthy Kids • Health Plan Provider Standards Health plans in the FHKC program must be licensed by the Office of Insurance Regulation of the Florida Department of Financial Services, in accordance with the Florida Insurance Code. In addition, the insurer must possess appropriate accreditation. All insurers must maintain an adequate network of providers and facilities in order to provide appropriate access to care for all enrollees in their service area.