The proposed revision to the Children’s Medical Services Rules 64C1.001-1.004, F.A.C., updates definitions and requirements for applicants and participants; and repeals confidentiality language already addressed in state and federal laws and care ...

 

DEPARTMENT OF HEALTH

Division of Children’s Medical Services

RULE NOS.:RULE TITLES:

64C-1.001Definitions

64C-1.003Requirements of CMS Applicants and Participants

64C-1.004Methods of Service Delivery

PURPOSE AND EFFECT: The proposed revision to the Children’s Medical Services Rules 64C1.001-1.004, F.A.C., updates definitions and requirements for applicants and participants; and repeals confidentiality language already addressed in state and federal laws and care plans currently in policy.

SUMMARY: Definitions and requirements for applicants and participants in the Children’s Medical Services program.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: This rulemaking will not have an adverse impact or regulatory costs in excess of $1 million within five years as established in Section 120.541(2)(a), F.S.

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.

RULEMAKING AUTHORITY: 391.026(18) and 402.24(2)(h) FS.

LAW IMPLEMENTED: 391.026, 391.047, 402.24 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Kelli Stannard at [phone] or [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64C-1.001 Definitions.

As used in Chapters 64C-1 through 64C-4, F.A.C.:

(1) “Applicant” means an individual who: expresses a desire to be evaluated for eligibility for the Children’s Medical Services Managed Care Plan.

(a) Has reached the age of majority; or

(b) Is the parent or legal representative of a minor; or

(c) Has had the age of majority restriction removed, either by marriage or court order, and requests an eligibility determination for CMS sponsorship.

(2) No change.

(3) “Clinical eligibility” includes medical, developmental, behavioral, mental or emotional conditions.

(4) “CMS Program” means all Children’s Medical Services Programs, regardless of whether services are delivered by contract or state employees.

(5) Renumbered (3) No change.

(6) “Health Care Provider” is as defined in Section 391.021(5), F.S.

(7) “Participant” is as defined in Section 391.021(7), F.S.

(8) “Physician provider” is a physician licensed under Chapter 458 or 459, F.S.

(9) Renumbered (4) No change.

Rulemaking Specific Authority 391.026(18) F.S. Law Implemented 391.026 F.S. History–New 1-1-77, Formerly 10J-1.05, Amended 8-4-93, 3-28-96, Formerly 10J-1.005, Amended 1-26-03,______________.

 

64C-1.003 Requirements of CMS Applicants and Participants.

(1) Upon request, applicants for and participants in CMS will furnish to CMS accurate medical and financial information. Applicants and participants will also keep CMS informed of any changes in medical or financial circumstances, which includes notifying CMS of all assets, resources and funds, including health care insurance and plans, and funding acquired through contracts, settlements, awards and trust funds, which are available to the family for medical services.

(2) For CMS reimbursment pParticipants are required to utilize CMS credentialed approved providers and facilities if CMS is to pay for services and provide CMS case management.

(3) Participants must be Florida residents.

Rulemaking Specific Authority 391.026(18), 402.24(2)(h) F.S. Law Implemented 391.026, 391.047, 402.24 F.S. History–New 1-1-77, Formerly 10J-1.07, Amended 8-4-93, 3-28-96, Formerly 10J-1.007, Amended 1-26-03,____________.

 

64C-1.004 Methods of Service Delivery.

Rulemaking Specific Authority 391.026(18) FS. Law Implemented 391.026 FS. History–New 1-1-77, Formerly 10J-6.02, Amended 7-12-93, Formerly 10J-6.002, 64C-5.001, Amended 1-26-03,Repealed___________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Cheryl Young, Director, Office of CMS Managed Care Plan

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: John H. Armstrong, MD, State Surgeon General

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: September 16, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 12, 2015