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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 97 MediKids 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. The plan must assure that primary care physician services and referrals to specialty physicians are available on a timely basis, to comply with the following standards: urgent care - within one day; routine sick patient care - within one week; and well care - within one month. Requests for prior authorization are handled exactly the same as those for Medicaid participants.

Children’s Medical Services Network The CMS program 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. Requests for prior authorization are handled exactly the same as those for Medicaid participants.