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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 94 Florida’s KidCare law authorized the Department of Children and Families to establish behavioral health services standards and practice guidelines for special behavioral health services provided to children with serious emotional disturbance or substance dependence problems. Development of these standards is underway. 7.2. Describe the methods used, including monitoring, to assure: (2102(a)(7)(B)) (42CFR 457.495) 7.2.1 Access to well-baby care, well-child care, well-adolescent care and childhood and adolescent immunizations. (Section 2102(a)(7)) (42CFR 457.495(a)) Providers for the KidCare Medicaid expansion coverage group (newborns to one year old) and MediKids are also Medicaid providers. As such, they are required to comply with the same standards established for the Florida Medicaid program in accordance with Title XIX of the Social Security Act. Details of these requirements are incorporated in Florida’s Title XIX state plan. Healthy Kids Standards: Healthy Kids has established its own minimum standards for quality of care to its enrollees. Health and dental plans contracting with Healthy Kids must meet the following minimum requirements both at the initial contract implementation as well as throughout the contract term: • Geographical Access Standards Primary Care Standards – Medical and Dental Providers

Geographical access of approximately twenty (20) minutes driving time from the Healthy Kids participant’s residence to primary care providers and primary care dental providers must be provided by the health plan or dental insurer in each program site. The driving time is reasonably extended in areas where this access standard is unattainable, such as rural areas. In such instances, the health plan must provide access to the nearest providers.

Specialty Care Standards

Specialty physician services, ancillary services and specialty hospital services are to be available within sixty (60) minutes driving time from the enrollee’s residence to provider. Driving time standards may be waived with sufficient justification if specialty care services are not obtainable due to a limitation of providers, such as in rural areas.