Florida Statutes Part IV - Medicaid Managed Care (Ss. 409.961-409.985)
- 409.961 - Statutory Construction; Applicability; Rules.
It is the intent of the Legislature that if any conflict exists between the provisions contained in this part and in other parts of this...
- 409.962 - Definitions.
As used in this part, except as otherwise specifically provided, the term:(1) “Accountable care organization” means an entity qualified as an accountable care organization in accordance...
- 409.963 - Single State Agency.
The agency is designated as the single state agency authorized to manage, operate, and make payments for medical assistance and related services under Title XIX...
- 409.964 - Managed Care Program; State Plan; Waivers.
The Medicaid program is established as a statewide, integrated managed care program for all covered services, including long-term care services. The agency shall apply for...
- 409.965 - Mandatory Enrollment.
All Medicaid recipients shall receive covered services through the statewide managed care program, except as provided by this part pursuant to an approved federal waiver....
- 409.966 - Eligible Plans; Selection.
(1) ELIGIBLE PLANS.—Services in the Medicaid managed care program shall be provided by eligible plans. A provider service network must be capable of providing all covered...
- 409.967 - Managed Care Plan Accountability.
(1) The agency shall establish a 5-year contract with each managed care plan selected through the procurement process described in s. 409.966. A plan contract may...
- 409.968 - Managed Care Plan Payments.
(1) Prepaid plans shall receive per-member, per-month payments negotiated pursuant to the procurements described in s. 409.966. Payments shall be risk-adjusted rates based on historical utilization...
- 409.969 - Enrollment; Disenrollment.
(1) ENROLLMENT.—All Medicaid recipients shall be enrolled in a managed care plan unless specifically exempted under this part. Each recipient shall have a choice of plans...
- 409.971 - Managed Medical Assistance Program.
The agency shall make payments for primary and acute medical assistance and related services using a managed care model. By January 1, 2013, the agency...
- 409.972 - Mandatory And Voluntary Enrollment.
(1) The following Medicaid-eligible persons are exempt from mandatory managed care enrollment required by s. 409.965, and may voluntarily choose to participate in the managed medical...
- 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...
- 409.974 - Eligible Plans.
(1) ELIGIBLE PLAN SELECTION.—The agency shall select eligible plans through the procurement process described in s. 409.966. The agency shall notice invitations to negotiate no later...
- 409.975 - Managed Care Plan Accountability.
In addition to the requirements of s. 409.967, plans and providers participating in the managed medical assistance program shall comply with the requirements of this...
- 409.976 - Managed Care Plan Payment.
In addition to the payment provisions of s. 409.968, the agency shall provide payment to plans in the managed medical assistance program pursuant to this...
- 409.977 - Enrollment.
(1) The agency shall automatically enroll into a managed care plan those Medicaid recipients who do not voluntarily choose a plan pursuant to s. 409.969. The...
- 409.978 - Long-term Care Managed Care Program.
(1) Pursuant to s. 409.963, the agency shall administer the long-term care managed care program described in ss. 409.978-409.985, but may delegate specific duties and responsibilities...
- 409.979 - Eligibility.
(1) Medicaid recipients who meet all of the following criteria are eligible to receive long-term care services and must receive long-term care services by participating in...
- 409.98 - Long-term Care Plan Benefits.
Long-term care plans shall, at a minimum, cover the following:(1) Nursing facility care.(2) Services provided in assisted living facilities.(3) Hospice.(4) Adult day care.(5) Medical equipment and supplies, including incontinence supplies.(6) Personal...
- 409.981 - Eligible Long-term Care Plans.
(1) ELIGIBLE PLANS.—Provider service networks must be long-term care provider service networks. Other eligible plans may be long-term care plans or comprehensive long-term care plans.(2) ELIGIBLE PLAN...
- 409.982 - Long-term Care Managed Care Plan Accountability.
In addition to the requirements of s. 409.967, plans and providers participating in the long-term care managed care program must comply with the requirements of...
- 409.983 - Long-term Care Managed Care Plan Payment.
In addition to the payment provisions of s. 409.968, the agency shall provide payment to plans in the long-term care managed care program pursuant to...
- 409.984 - Enrollment In A Long-term Care Managed Care Plan.
(1) The agency shall automatically enroll into a long-term care managed care plan those Medicaid recipients who do not voluntarily choose a plan pursuant to s....
- 409.985 - Comprehensive Assessment And Review For Long-term Care Services (Cares) Program.
(1) The agency shall operate the Comprehensive Assessment and Review for Long-Term Care Services (CARES) preadmission screening program to ensure that only individuals whose conditions require...
Last modified: September 23, 2016