64C-4.001. CMS Physician and Non-Physician Providers

(1) CMS Physician Providers: Participation Criteria. The CMS physician provider approval process is not a licensure process. It is a quality assurance process to ensure that prospective and participating CMS physician providers, who are interested in providing health care services to children with special health care needs, meet minimum standards deemed necessary by the Deputy Secretary for CMS for the provision of quality medical services to CMS participants. The CMS physician provider approval process is based on National Committee for Quality Assessment (NCQA) Standards in addition to recommendations from CMS Medical Directors. Physicians interested in participating in the CMS Program must comply with the CMS approval and re-approval process and criteria. The approval and reapproval process requires physicians to provide current information with regard to the following:

(a) State of Florida medical licensure status;

(b) Board certification status in area of practice;

(c) Drug Enforcement Agency (DEA) or Controlled Dangerous Substance (CDS) certificate of registration;

(d) Hospital admitting privileges at a CMS approved hospital(s) or a Letter of Transfer Agreement with a CMS approved physician who has admitting privileges at a CMS approved facility;

(e) Medical education and training;

(f) Work history;

(g) Active and closed professional liability claim(s); and

(h) Existence of Medicaid and Medicare sanctions.

Exceptions: The Deputy Secretary for Children’s Medical Services shall grant, upon recommendation from the area CMS Medical Director, provisional CMS approved provider status to any licensed physician, in order to provide participants access to health care not immediately available through CMS approved physician providers.

(2) CMS Non-Physician Providers.

(a) CMS may secure the services of non-physician providers in any field of knowledge deemed necessary to aid in its provision of services.

(b) CMS Non-Physician providers must meet applicable licensing and certification requirements of governmental agencies and professional associations in their specialty areas.

(c) Individuals performing genetic evaluations and counseling must be under the direction of a CMS approved physician certified by the American Board of Medical Genetics or the American Osteopathic Association in the area of genetics.

Specific Authority 391.026(18) FS. Law Implemented 391.026(10), 391.035 FS. History–New 1-1-77, Amended 2-11-85, Formerly 10J-5.07, Amended 3-28-96, Formerly 10J-5.007, Amended 2-2-03.