Florida Statutes Part III - Medicaid (Ss. 409.901-409.9205)
- 409.901 - Definitions; Ss. 409.901-409.920.
As used in ss. 409.901-409.920, except as otherwise specifically provided, the term:(1) “Affiliate” or “affiliated person” means any person who directly or indirectly manages, controls, or...
- 409.902 - Designated Single State Agency; Payment Requirements; Program Title; Release Of Medical Records.
(1) The Agency for Health Care Administration is designated as the single state agency authorized to make payments for medical assistance and related services under Title...
- 409.90201 - Recipient Address Update Process.
The Agency for Health Care Administration and the Department of Children and Families, in consultation with hospitals and nursing homes that serve Medicaid recipients, shall...
- 409.9021 - Forfeiture Of Eligibility Agreement.
As a condition of Medicaid eligibility, subject to federal approval, a Medicaid applicant shall agree in writing to forfeit all entitlements to any goods or...
- 409.9025 - Eligibility While An Inmate.
(1) Notwithstanding any other provision of law other than s. 409.9021, in the event that a person who is an inmate in the state’s correctional system...
- 409.903 - Mandatory Payments For Eligible Persons.
The agency shall make payments for medical assistance and related services on behalf of the following persons who the department, or the Social Security Administration...
- 409.904 - Optional Payments For Eligible Persons.
The agency may make payments for medical assistance and related services on behalf of the following persons who are determined to be eligible subject to...
- 409.905 - Mandatory Medicaid Services.
The agency may make payments for the following services, which are required of the state by Title XIX of the Social Security Act, furnished by...
- 409.906 - Optional Medicaid Services.
Subject to specific appropriations, the agency may make payments for services which are optional to the state under Title XIX of the Social Security Act...
- 409.9062 - Lung Transplant Services For Medicaid Recipients.
Subject to the availability of funds and subject to any limitations or directions provided for in the General Appropriations Act or chapter 216, the Agency...
- 409.9066 - Medicare Prescription Discount Program.
(1) As a condition of participation in the Florida Medicaid program or the pharmaceutical expense assistance program, a pharmacy must agree to charge any individual who...
- 409.907 - Medicaid Provider Agreements.
The agency may make payments for medical assistance and related services rendered to Medicaid recipients only to an individual or entity who has a provider...
- 409.9071 - Medicaid Provider Agreements For School Districts Certifying State Match.
(1) The agency shall reimburse school-based services as provided in former s. 236.0812 pursuant to the rehabilitative services option provided under 42 U.S.C. s. 1396d(a)(13). For...
- 409.908 - Reimbursement Of Medicaid Providers.
Subject to specific appropriations, the agency shall reimburse Medicaid providers, in accordance with state and federal law, according to methodologies set forth in the rules...
- 409.9081 - Copayments.
(1) The agency shall require, subject to federal regulations and limitations, each Medicaid recipient to pay at the time of service a nominal copayment for the...
- 409.9082 - Quality Assessment On Nursing Home Facility Providers; Exemptions; Purpose; Federal Approval Required; Remedies.
(1) As used in this section, the term:(a) “Net patient service revenue” means gross revenues from services provided to nursing home facility patients, less reductions from gross...
- 409.9083 - Quality Assessment On Privately Operated Intermediate Care Facilities For The Developmentally Disabled; Exemptions; Purpose; Federal Approval Required; Remedies.
(1) As used in this section, the term:(a) “Intermediate care facility for the developmentally disabled” or “ICF/DD” means a privately operated intermediate care facility for the developmentally...
- 409.909 - Statewide Medicaid Residency Program.
(1) The Statewide Medicaid Residency Program is established to improve the quality of care and access to care for Medicaid recipients, expand graduate medical education on...
- 409.910 - Responsibility For Payments On Behalf Of Medicaid-eligible Persons When Other Parties Are Liable.
(1) It is the intent of the Legislature that Medicaid be the payor of last resort for medically necessary goods and services furnished to Medicaid recipients....
- 409.9101 - Recovery For Payments Made On Behalf Of Medicaid-eligible Persons.
(1) This section may be cited as the “Medicaid Estate Recovery Act.”(2) It is the intent of the Legislature by this section to supplement Medicaid funds that...
- 409.9102 - A Qualified State Long-term Care Insurance Partnership Program In Florida.
The Agency for Health Care Administration, in consultation with the Office of Insurance Regulation and the Department of Children and Families, is directed to establish...
- 409.911 - Disproportionate Share Program.
Subject to specific allocations established within the General Appropriations Act and any limitations established pursuant to chapter 216, the agency shall distribute, pursuant to this...
- 409.9113 - Disproportionate Share Program For Teaching Hospitals.
In addition to the payments made under s. 409.911, the agency shall make disproportionate share payments to teaching hospitals, as defined in s. 408.07, for...
- 409.9115 - Disproportionate Share Program For Mental Health Hospitals.
The Agency for Health Care Administration shall design and implement a system of making mental health disproportionate share payments to hospitals that qualify for disproportionate...
- 409.91151 - Expenditure Of Funds Generated Through Mental Health Disproportionate Share Program.
Funding generated through the mental health disproportionate share program shall be expended in accordance with legislatively authorized appropriations. If such funding is not addressed in...
- 409.9116 - Disproportionate Share/financial Assistance Program For Rural Hospitals.
In addition to the payments made under s. 409.911, the Agency for Health Care Administration shall administer a federally matched disproportionate share program and a...
- 409.9118 - Disproportionate Share Program For Specialty Hospitals.
The Agency for Health Care Administration shall design and implement a system of making disproportionate share payments to those hospitals licensed in accordance with part...
- 409.91188 - Specialty Prepaid Health Plans For Medicaid Recipients With Hiv Or Aids.
The Agency for Health Care Administration is authorized to contract with specialty prepaid health plans and pay them on a prepaid capitated basis to provide...
- 409.9119 - Disproportionate Share Program For Specialty Hospitals For Children.
In addition to the payments made under s. 409.911, the Agency for Health Care Administration shall develop and implement a system under which disproportionate share...
- 409.91195 - Medicaid Pharmaceutical And Therapeutics Committee.
There is created a Medicaid Pharmaceutical and Therapeutics Committee within the agency for the purpose of developing a Medicaid preferred drug list.(1) The committee shall be...
- 409.91196 - Supplemental Rebate Agreements; Public Records And Public Meetings Exemption.
(1) The rebate amount, percent of rebate, manufacturer’s pricing, and supplemental rebate, and other trade secrets as defined in s. 688.002 that the agency has identified...
- 409.912 - Cost-effective Purchasing Of Health Care.
The agency shall purchase goods and services for Medicaid recipients in the most cost-effective manner consistent with the delivery of quality medical care. To ensure...
- 409.91206 - Alternatives For Health And Long-term Care Reforms.
The Governor, the President of the Senate, and the Speaker of the House of Representatives may convene workgroups to propose alternatives for cost-effective health and...
- 409.9121 - Legislative Findings And Intent.
The Legislature hereby finds that the Medicaid program has experienced an annual growth rate of approximately 28 percent per year for the past 5 years,...
- 409.91212 - Medicaid Managed Care Fraud.
(1) Each managed care plan, as defined in s. 409.920(1)(e), shall adopt an anti-fraud plan addressing the detection and prevention of overpayments, abuse, and fraud relating...
- 409.91213 - Quarterly Progress Reports And Annual Reports.
(1) The agency shall submit to the Governor, the President of the Senate, the Speaker of the House of Representatives, the Minority Leader of the Senate,...
- 409.9122 - Medicaid Managed Care Enrollment; Hiv/aids Patients; Procedures; Data Collection; Accounting; Information System; Medical Loss Ratio.
(1) Notwithstanding s. 409.961, if a Medicaid recipient is diagnosed with HIV/AIDS, the agency shall assign the recipient to a managed care plan that is a...
- 409.9123 - Quality-of-care Reporting.
In order to promote competition between Medicaid managed care plans and MediPass based on quality-of-care indicators, the agency shall annually develop and publish a set...
- 409.9124 - Managed Care Reimbursement.
The agency shall develop and adopt by rule a methodology for reimbursing managed care plans.(1) Final managed care rates shall be published annually prior to September...
- 409.91255 - Federally Qualified Health Center Access Program.
(1) SHORT TITLE.—This section may be cited as the “Community Health Center Access Program Act.”(2) LEGISLATIVE FINDINGS AND INTENT.—(a) The Legislature finds that, despite significant investments in health...
- 409.9126 - Children With Special Health Care Needs.
(1) Except as provided in subsection (4), children eligible for Children’s Medical Services who receive Medicaid benefits, and other Medicaid-eligible children with special health care needs,...
- 409.9127 - Preauthorization And Concurrent Utilization Review; Conflict-of-interest Standards.
(1) The Agency for Health Care Administration shall be solely responsible for developing and enforcing standards to prohibit financial and other conflicts of interest among vendors...
- 409.9128 - Requirements For Providing Emergency Services And Care.
(1) In providing for emergency services and care as a covered service, neither a managed care plan nor the MediPass program may:(a) Require prior authorization for the...
- 409.913 - Oversight Of The Integrity Of The Medicaid Program.
The agency shall operate a program to oversee the activities of Florida Medicaid recipients, and providers and their representatives, to ensure that fraudulent and abusive...
- 409.9131 - Special Provisions Relating To Integrity Of The Medicaid Program.
(1) LEGISLATIVE FINDINGS AND INTENT.—It is the intent of the Legislature that physicians, as defined in this section, be subject to Medicaid fraud and abuse investigations...
- 409.9132 - Pilot Project To Monitor Home Health Services.
The Agency for Health Care Administration shall expand the home health agency monitoring pilot project in Miami-Dade County on a statewide basis effective July 1,...
- 409.9133 - Pilot Project For Home Health Care Management.
The Agency for Health Care Administration shall expand the comprehensive care management pilot project for home health services statewide and include private duty nursing and...
- 409.914 - Assistance For The Uninsured.
(1) The agency shall use the claims payment systems, utilization control systems, cost control systems, case management systems, and other systems and controls that it has...
- 409.915 - County Contributions To Medicaid.
Although the state is responsible for the full portion of the state share of the matching funds required for the Medicaid program, the state shall...
- 409.916 - Grants And Donations Trust Fund.
(1) The agency shall deposit any funds received from pharmaceutical manufacturers and all other funds received by the agency from any other person as the result...
- 409.918 - Public Medical Assistance Trust Fund.
It is declared that access to adequate health care is a right which should be available to all Floridians. However, rapidly increasing health care costs...
- 409.919 - Rules.
The agency shall adopt any rules necessary to comply with or administer ss. 409.901-409.920 and all rules necessary to comply with federal requirements. In addition,...
- 409.920 - Medicaid Provider Fraud.
(1) For the purposes of this section, the term:(a) “Agency” means the Agency for Health Care Administration.(b) “Fiscal agent” means any individual, firm, corporation, partnership, organization, or other...
- 409.9201 - Medicaid Fraud.
(1) As used in this section, the term:(a) “Prescription drug” means any drug, including, but not limited to, finished dosage forms or active ingredients that are subject...
- 409.9203 - Rewards For Reporting Medicaid Fraud.
(1) The Department of Law Enforcement or director of the Medicaid Fraud Control Unit shall, subject to availability of funds, pay a reward to a person...
- 409.9205 - Medicaid Fraud Control Unit.
(1) Except as provided in s. 110.205, all positions in the Medicaid Fraud Control Unit of the Department of Legal Affairs are hereby transferred to the...
Last modified: September 23, 2016