391.011 – Short title.

391.011 Short title.—The provisions of this chapter may be cited as the “Children’s Medical Services Act.” History.—s. 1, ch. 78-106; s. 2, ch. 98-288.

391.016 – Purposes and functions.

391.016 Purposes and functions.—The Children’s Medical Services program is established for the following purposes and authorized to perform the following functions: (1) Provide to children with special health care needs a family-centered, comprehensive, and coordinated statewide managed system of care that links community-based health care with multidisciplinary, regional, and tertiary pediatric specialty care. The program shall coordinate […]

391.021 – Definitions.

391.021 Definitions.—When used in this act, the term: (1) “Children’s Medical Services network” or “network” means a statewide managed care service system that includes health care providers, as defined in this section. (2) “Children with special health care needs” means those children younger than 21 years of age who have chronic and serious physical, developmental, behavioral, or emotional […]

391.025 – Applicability and scope.

391.025 Applicability and scope.— (1) The Children’s Medical Services program consists of the following components: (a) The newborn screening program established in s. 383.14. (b) The regional perinatal intensive care centers program established in ss. 383.15-383.19. (c) The developmental evaluation and intervention program, including the Early Steps Program. (d) The Children’s Medical Services network. (2) The Children’s Medical Services program shall not […]

391.026 – Powers and duties of the department.

391.026 Powers and duties of the department.—The department shall have the following powers, duties, and responsibilities: (1) To provide or contract for the provision of health services to eligible individuals. (2) To provide services to abused and neglected children through Child Protection Teams pursuant to s. 39.303. (3) To determine the medical and financial eligibility of individuals seeking health […]

391.028 – Administration.

391.028 Administration.— (1) The Director of Children’s Medical Services must be a physician licensed under chapter 458 or chapter 459 who has specialized training and experience in the provision of health care to children and who has recognized skills in leadership and the promotion of children’s health programs. The director shall be the deputy secretary and the […]

391.029 – Program eligibility.

391.029 Program eligibility.— (1) Eligibility for the Children’s Medical Services program is based on the diagnosis of one or more chronic and serious medical conditions and the family’s need for specialized services. (2) The following individuals are eligible to receive services through the program: (a) A high-risk pregnant female who is enrolled in Medicaid. (b) Children with serious special health […]

391.0315 – Benefits.

391.0315 Benefits.—Benefits provided under the program for children with special health care needs shall be equivalent to benefits provided to children as specified in ss. 409.905 and 409.906. The department may offer additional benefits for early intervention services, respite services, genetic testing, genetic and nutritional counseling, and parent support services, if such services are determined to […]

391.035 – Provider qualifications.

391.035 Provider qualifications.— (1) The department shall establish the criteria to designate health care providers to participate in the Children’s Medical Services network. The department shall follow, whenever available, national guidelines for selecting health care providers to serve children with special health care needs. (2) The department shall require that all health care providers under contract with the […]

391.037 – Physicians; private sector services.

391.037 Physicians; private sector services.—It is not a violation of s. 112.313(7) for a physician licensed under chapter 458 or chapter 459 who is providing private sector services to clients of the department or who is employed by or has a contractual relationship with any business entity or agency that is a contract provider for the […]

391.045 – Reimbursement.

391.045 Reimbursement.— (1) The department shall reimburse health care providers for services rendered through the Children’s Medical Services network using cost-effective methods, including, but not limited to, capitation, discounted fee-for-service, unit costs, and cost reimbursement. Medicaid reimbursement rates shall be utilized to the maximum extent possible, where applicable. (2) Reimbursement to the Children’s Medical Services program for services […]

391.047 – Third-party payments.

391.047 Third-party payments.—The Children’s Medical Services program shall comply with s. 402.24, concerning third-party liabilities and recovery of third-party payments for health services. History.—s. 12, ch. 98-288.

391.055 – Service delivery systems.

391.055 Service delivery systems.— (1) The program shall apply managed care methods to ensure the efficient operation of the Children’s Medical Services network. Such methods include, but are not limited to, capitation payments, utilization management and review, prior authorization, and case management. (2) The components of the network are: (a) Qualified primary care physicians who shall serve as the […]

391.065 – Health care provider agreements.

391.065 Health care provider agreements.—The department is authorized to establish health care provider agreements for participation in the Children’s Medical Services program. History.—s. 14, ch. 98-288.

391.071 – Quality of care requirements.

391.071 Quality of care requirements.—The Children’s Medical Services program shall develop quality of care and service integration standards and reporting requirements for health care providers that participate in the Children’s Medical Services program. The program shall ensure that these standards are not duplicative of other standards and requirements for health care providers. History.—s. 15, ch. 98-288.

391.081 – Grievance reporting and resolution requirements.

391.081 Grievance reporting and resolution requirements.—The department shall adopt and implement a system to provide assistance to eligible individuals and health care providers to resolve complaints and grievances. To the greatest extent possible, the department shall use existing grievance reporting and resolution processes. The department shall ensure that the system developed for the Children’s Medical Services […]

391.095 – Program integrity.

391.095 Program integrity.—The department shall operate a system to oversee the activities of Children’s Medical Services program participants, and health care providers and their representatives, to prevent fraudulent and abusive behavior, overutilization and duplicative utilization, and neglect of participants and to recover overpayments as appropriate. For the purposes of this section, the terms “abuse” and “fraud” […]

391.097 – Research and evaluation.

391.097 Research and evaluation.— (1) The department may initiate, fund, and conduct research and evaluation projects to improve the delivery of children’s medical services. The department may cooperate with public and private agencies engaged in work of a similar nature. (2) The Children’s Medical Services network shall be included in any evaluation conducted in accordance with the provisions […]