eLaws of Florida

  SECTION 409.973. Benefits.  


Latest version.
  • 1(1) 2MINIMUM BENEFITS.4-5Managed care plans shall cover, at a minimum, the following services:
    16(a) 17Advanced registered nurse practitioner services.
    22(b) 23Ambulatory surgical treatment center services.
    28(c) 29Birthing center services.
    32(d) 33Chiropractic services.
    35(e) 36Dental services.
    38(f) 39Early periodic screening diagnosis and treatment services for recipients under age 21.
    51(g) 52Emergency services.
    54(h) 55Family 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.
    100(i) 101Healthy start services, except as provided in s. 109409.975(4)110.
    111(j) 112Hearing services.
    114(k) 115Home health agency services.
    119(l) 120Hospice services.
    122(m) 123Hospital inpatient services.
    126(n) 127Hospital outpatient services.
    130(o) 131Laboratory and imaging services.
    135(p) 136Medical supplies, equipment, prostheses, and orthoses.
    142(q) 143Mental health services.
    146(r) 147Nursing care.
    149(s) 150Optical services and supplies.
    154(t) 155Optometrist services.
    157(u) 158Physical, occupational, respiratory, and speech therapy services.
    165(v) 166Physician services, including physician assistant services.
    172(w) 173Podiatric services.
    175(x) 176Prescription drugs.
    178(y) 179Renal dialysis services.
    182(z) 183Respiratory equipment and supplies.
    187(aa) 188Rural health clinic services.
    192(bb) 193Substance abuse treatment services.
    197(cc) 198Transportation to access covered services.
    203(2) 204CUSTOMIZED BENEFITS.206-207Managed 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.
    252(3) 253HEALTHY BEHAVIORS.255-256Each 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.
    338(4) 339PRIMARY CARE INITIATIVE.342-343Each 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:
    371(a) 372Provide 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.
    408(b) 409If 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.
    477(c) 478Report to the agency the number of enrollees assigned to each primary care provider within the plan’s network.
    496(d) 497Report to the agency the number of enrollees who have not had an appointment with their primary care provider within their first year of enrollment.
    522(e) 523Report 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.

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