The Florida Senate

409.9126  Children with special health care needs.--

(1)  As used in this section:

(a)  "Children's Medical Services network" means an alternative service network that includes health care providers and health care facilities specified in chapter 391 and ss. 383.15-383.21, 383.216, and 415.5055.

(b)  "Children with special health care needs" means those children whose serious or chronic physical or developmental conditions require extensive preventive and maintenance care beyond that required by typically healthy children. Health care utilization by these children exceeds the statistically expected usage of the normal child matched for chronological age and often needs complex care requiring multiple providers, rehabilitation services, and specialized equipment in a number of different settings.

(2)  The Legislature finds that Medicaid-eligible children with special health care needs require a comprehensive, continuous, and coordinated system of health care that links community-based health care with multidisciplinary, regional, and tertiary care. The Legislature finds that ¹Florida's Children's Medical Services program provides a full continuum of coordinated, comprehensive services for children with special health care needs.

(3)  Except as provided in subsections (8) and (9), children eligible for ¹Children's Medical Services who receive Medicaid benefits, and other Medicaid-eligible children with special health care needs, shall be exempt from the provisions of s. 409.9122 and shall be served through the Children's Medical Services network.

(4)  The Legislature directs the agency to apply to the federal Health Care Financing Administration for a waiver to assign to the Children's Medical Services network all Medicaid-eligible children who meet the criteria for participation in the ¹Children's Medical Services program as specified in s. 391.021(2), and other Medicaid-eligible children with special health care needs.

(5)  The ¹Children's Medical Services program shall assign a qualified MediPass primary care provider from the Children's Medical Services network who shall serve as the gatekeeper and who shall be responsible for the provision or authorization of all health services to a child who has been assigned to the Children's Medical Services network by the Medicaid program.

(6)  Services provided through the Children's Medical Services network shall be reimbursed on a fee-for-service basis and shall utilize a primary care case management process.

(7)  The agency, in consultation with the ¹Children's Medical Services program, shall develop by rule quality-of-care and service integration standards.

(8)  The agency may issue a request for proposals, based on the quality-of-care and service integration standards, to allow managed care plans that have contracts with the Medicaid program to provide services to Medicaid-eligible children with special health care needs.

(9)  The agency shall approve requests to provide services to Medicaid-eligible children with special health care needs from managed care plans that meet quality-of-care and service integration standards and are in good standing with the agency. The agency shall monitor on a quarterly basis managed care plans which have been approved to provide services to Medicaid-eligible children with special health care needs.

(10)  The agency, in consultation with the ²Department of Health and Rehabilitative Services, shall adopt rules that address Medicaid requirements for referral, enrollment, and disenrollment of children with special health care needs who are enrolled in Medicaid managed care plans and who may benefit from the Children's Medical Services network.

(11)  The Children's Medical Services network may contract with school districts participating in the certified school match program pursuant to ss. 236.0812 and 409.908(21) for the provision of school-based services, as provided for in s. 409.9071, for Medicaid-eligible children who are enrolled in the Children's Medical Services network.

(12)  After 1 complete year of operation, the agency shall conduct an evaluation of the Children's Medical Services network. The evaluation shall include, but not be limited to, an assessment of whether the use of the Children's Medical Services network is less costly than the provision of the services would have been in the Medicaid fee-for-service program. The evaluation also shall include an assessment of patient satisfaction with the Children's Medical Services network, an assessment of the quality of care delivered through the network, and recommendations for further improving the performance of the network. The agency shall report the evaluation findings to the Governor and the chairpersons of the appropriations and health care committees of each chamber of the Legislature.

History.--s. 11, ch. 96-199; s. 5, ch. 97-168.

¹Note.--Section 6(2), ch. 96-403, transfers all existing legal authorities and actions of the Children's Medical Services program, except child protection and sexual abuse treatment teams established in chapter 415, to the Department of Health, Division of Children's Medical Services.

²Note.--The Department of Health and Rehabilitative Services was redesignated as the Department of Children and Family Services by s. 5, ch. 96-403, and the Department of Health was created by s. 8, ch. 96-403.