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2015 Florida Statutes

F.S. 409.973
409.973 Benefits.
(1) MINIMUM BENEFITS.Managed care plans shall cover, at a minimum, the following services:
(a) Advanced registered nurse practitioner services.
(b) Ambulatory surgical treatment center services.
(c) Birthing center services.
(d) Chiropractic services.
(e) Dental services.
(f) Early periodic screening diagnosis and treatment services for recipients under age 21.
(g) Emergency services.
(h) Family planning services and supplies. Pursuant to 42 C.F.R. s. 438.102, plans may elect to not provide these services due to an objection on moral or religious grounds, and must notify the agency of that election when submitting a reply to an invitation to negotiate.
(i) Healthy start services, except as provided in s. 409.975(4).
(j) Hearing services.
(k) Home health agency services.
(l) Hospice services.
(m) Hospital inpatient services.
(n) Hospital outpatient services.
(o) Laboratory and imaging services.
(p) Medical supplies, equipment, prostheses, and orthoses.
(q) Mental health services.
(r) Nursing care.
(s) Optical services and supplies.
(t) Optometrist services.
(u) Physical, occupational, respiratory, and speech therapy services.
(v) Physician services, including physician assistant services.
(w) Podiatric services.
(x) Prescription drugs.
(y) Renal dialysis services.
(z) Respiratory equipment and supplies.
(aa) Rural health clinic services.
(bb) Substance abuse treatment services.
(cc) Transportation to access covered services.
(2) CUSTOMIZED BENEFITS.Managed care plans may customize benefit packages for nonpregnant adults, vary cost-sharing provisions, and provide coverage for additional services. The agency shall evaluate the proposed benefit packages to ensure services are sufficient to meet the needs of the plan’s enrollees and to verify actuarial equivalence.
(3) HEALTHY BEHAVIORS.Each plan operating in the managed medical assistance program shall establish a program to encourage and reward healthy behaviors. At a minimum, each plan must establish a medically approved smoking cessation program, a medically directed weight loss program, and a medically approved alcohol or substance abuse recovery program. Each plan must identify enrollees who smoke, are morbidly obese, or are diagnosed with alcohol or substance abuse in order to establish written agreements to secure the enrollees’ commitment to participation in these programs.
(4) PRIMARY CARE INITIATIVE.Each plan operating in the managed medical assistance program shall establish a program to encourage enrollees to establish a relationship with their primary care provider. Each plan shall:
(a) Provide information to each enrollee on the importance of and procedure for selecting a primary care provider, and thereafter automatically assign to a primary care provider any enrollee who fails to choose a primary care provider.
(b) If the enrollee was not a Medicaid recipient before enrollment in the plan, assist the enrollee in scheduling an appointment with the primary care provider. If possible the appointment should be made within 30 days after enrollment in the plan. For enrollees who become eligible for Medicaid between January 1, 2014, and December 31, 2015, the appointment should be scheduled within 6 months after enrollment in the plan.
(c) Report to the agency the number of enrollees assigned to each primary care provider within the plan’s network.
(d) Report to the agency the number of enrollees who have not had an appointment with their primary care provider within their first year of enrollment.
(e) Report to the agency the number of emergency room visits by enrollees who have not had at least one appointment with their primary care provider.
History.s. 14, ch. 2011-134; s. 52, ch. 2012-5; s. 8, ch. 2012-44.