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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 95 • Timely Treatment Standards

Timely treatment by health care providers is required, such that the Healthy Kids participant is seen by a provider in accordance with the following:  Routine care of patients who do not require emergency or urgently needed care shall be provided within seven (7) calendar days;  Physical examinations and routine dental examinations for cleaning and X-Rays shall be provided within four (4) weeks of request for appointment; and  Follow-up care shall be provided as medically appropriate. Children’s Medical Services Network The CMSN uses the same standards as the Florida Healthy Kids Corporation for its medical benefits. By state law, the Department of Children and Families is authorized to establish the following for the special behavioral services for children with severe emotional disturbances: • Behavioral health services standards; • Clinical guidelines for referral to behavioral health services; • Practice guidelines for behavioral health services to ensure cost- effective treatment and to prevent unnecessary expenditures; and • The scope of behavioral health services, including duration and frequency. The Agency for Health Care Administration monitors these functions on a regular basis to ensure compliance. 7.2.2 Access to covered services, including emergency services as defined in 42 CFR §457.10. (Section 2102(a)(7)) 42CFR 457.495(b)) Healthy Kids By contract with all its participating health and dental plans, emergency care must be provided immediately; urgently needed care shall be provided within twenty-four (24) hours. When contracts are bid, access to hospital and other urgent care providers is evaluated in order to ensure that enrollees have adequate access to these services. The Agency for Health Care Administration