The proposed amendment to Rule 59G-14.004, F.A.C., incorporates a statutory provision requiring a request for a dispute review and continuation of coverage to be filed within ten (10) working days, as opposed to calendar days, of notification of ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-14.004: Florida KidCare Dispute Review Process
PURPOSE AND EFFECT: The proposed amendment to Rule 59G-14.004, F.A.C., incorporates a statutory provision requiring a request for a dispute review and continuation of coverage to be filed within ten (10) working days, as opposed to calendar days, of notification of adverse action. This will permit the enrollee to continue receiving the same category of coverage or services during the course of the dispute review determination process and will give families additional time to address adverse actions affecting program eligibility.
SUMMARY: Rule 59G-14.004, F.A.C., is being amended to change the time period for requesting the dispute review and continuation of coverage regarding notification of adverse action and to enable the enrollee to continue to receive the same category of coverage or services during this process.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 409.818(3)(f) FS.
LAW IMPLEMENTED: 409.814(10) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Tuesday, February 9, 2010, 3:00 p.m. – 5:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room B, Tallahassee, Florida 32308-5407
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Angela Wiggins at the Bureau of Medicaid Services, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Angela Wiggins, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, e-mail: [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-14.004 Florida Kidcare Dispute Review Process.

(1) through (3) No change

(4) The Florida Kidcare Dispute Review Process is comprised of four review levels addressing the denial of eligibility, failure to make a timely determination of eligibility and suspension or termination of enrollment, including disenrollment for failure to pay the family premium. The Florida Healthy Kids Corporation shall provide information regarding the dispute review process in correspondence to families, making them aware of the existence and availability of the Florida Kidcare Dispute Review Process.

(a) through (d) No change.

(e) If the complainant requests continuation of enrollment pending the completion of the review, the Florida Healthy Kids Corporation Dispute Resolution staff shall take the following steps:

1. Determine whether the complainant requested the continuation of enrollment within ten (10) working calendar days of the date of the letter indicating the suspension or termination of his or her child(ren)’s enrollment.

2. If the request was not made within ten (10) working calendar days of the date of the letter the complainant received informing him or her of suspension or termination of his or her children’s enrollment, the Florida Healthy Kids Corporation Dispute Resolution staff shall inform the complainant in writing of the denial of continuation of enrollment.

3. If the request was made within ten (10) working calendar days of the date of the letter the complainant received informing him or her of suspension or termination of his or her child(ren)’s enrollment, the Florida Healthy Kids Corporation Dispute Resolution staff shall take the following action to ensure continuation of enrollment, if the child(ren) meets all other Florida Kidcare Program qualifications:

a. through b. No change.

(f) through (r) No change.

Rulemaking Specific Authority 409.818(3)(f) FS. Law Implemented 409.814(10)818 FS. History–New 2-27-08, Amended_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Angela Wiggins
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Thomas W. Arnold
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 21, 2009
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: September 11, 2009