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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 91 The insurance product offered must have, or obtain, an approved rate filing with the Florida Department of Financial Services. A utilization management component for inpatient hospital stays, outpatient surgery and selected outpatient services is required. • Dental Insurer Standards Dental plans in the FHKC program must be licensed by the Florida Department of Financial Services, in accordance with the Florida Insurance Code. In addition, the dental insurers must maintain an adequate network of providers and facilities to serve the anticipated enrollment in each county. The insurance product offered by the dental insurers must also have or obtain an approved rate filing with the Florida Department of Financial Services. • Physician Credentialing Standards The Florida Healthy Kids Corporation maintains physician-credentialing standards that exceed the standards of the National Committee for Quality Assurance. Specifically, primary care physicians in the network of providers for the Healthy Kids program must meet one of the following criteria:  Pediatrician or Family Practitioner with Board Certification; or  Physician extenders or members of a residency program directly supervised by a Board Certified Practitioner. Reasonable exemptions are granted in instances where extenuating circumstances exist. Examples of these exceptions include: rural areas that are unable to meet the access standards without including other health care providers in the network, physicians serving inner city areas, physicians that have been practicing medicine for an exceptional length of time and physicians that are currently serving the required years of practice before taking the examination for board certification. Physicians that require an exemption are reviewed on an individual basis by a qualified group of physicians on behalf of the FHKC. Healthy Kids also requires its health plans to designate a medical home for each enrollee at the time of his initial enrollment into the plan. • Facility Standards Facilities used for Healthy Kids participants shall meet applicable accreditation and licensure requirements and meet facility regulations specified by the Agency for Health Care Administration.