Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 34 No. 41, October 10, 2008 issue of the Florida Administrative Weekly.

These changes are in response to comments received from the Joint Administrative Procedures Committee and during the public hearing process.

We changed the title of the rule to read, “Good Cause for Disenrollment from Health Plans.”

59G-8.500(1). We added the following definition for “no change period” to the rule, “The no change period is defined as the period of time during which a recipient cannot change plans without a good cause reason in accordance with 42 CFR 438.56(c).”

59G-8.500(2). We deleted “for” from the title so it reads, “Good Cause Reasons.”

59G-8.500(2)(a). We revised the paragraph to read, “The recipient moves out of the county, or the recipient’s address is incorrect and the recipient does not live in a county, where the health plan is authorized to provide services.”

59G-8.500(2)(b). We combined former rule paragraph (b), “The health care provider is no longer with the health plan,” with former rule paragraph (f), now paragraph (e). The revised paragraph (e) now reads, “The recipient has an active relationship with a health care provider who is not on the health plan’s network, but is in the network of another health plan; or the health care provider with whom the recipient has an active relationship is no longer with the health plan.”

Former paragraph 59G-8.500(2)(c) was renumbered (b).

Former paragraph 59G-8.500(2)(d) now (c). We revised the paragraph to read, “A marketing violation occurred with the individual recipient that is substantiated by the Agency for Health Care Administration, Bureau of Managed Health Care. The recipient must submit the allegation in writing to the Bureau of Managed Care, 2727 Mahan Drive, M.S. 26, Tallahassee, FL, 32308.”

Former paragraph 59G-8.500(2)(e) was renumbered (d).

Former paragraph 59G-8.500(2)(f) was renumbered (e).

Former paragraph 59G-8.500(2)(g) was renumbered (f).

Former paragraph 59G-8.500(2)(h) was renumbered (g).

Former paragraph 59G-8.500(2)(i) was renumbered (h).

Former paragraph 59G-8.500(2)(j) was renumbered (i).

Former paragraph 59G-8.500(2)(k) now (j). For clarification, we deleted the reference to 42 CFR 438.56(d)(2) and itemized each of the allowable good cause reasons in the rule. The paragraph now reads, “Poor quality of care;”

59G-8.500(2)(k) was revised to read, “Lack of access to services covered under the contract, including lack of access to medically-necessary specialty services;”

59G-8.500(2)(l) was revised to read, “The health plan makes inordinate or inappropriate changes of the recipient’s primary care provider (PCP);”

59G-8.500(2)(m) was revised to read, “An unreasonable delay or denial of service;”

We added paragraph 59G-8.500(2)(n), which reads, “Service access impairments due to significant changes in the geographic location of services;”

We added paragraph 59G-8.500(2)(o), which reads, “There is a lack of access to health plan providers experienced in dealing with the recipient’s health care needs; and”

We added 59G-8.500(2)(p), which reads, “Fraudulent enrollment.”

Former paragraph 59G-8.500(2)(l) was renumbered (q).

Former paragraph 59G-8.500(2)(m) was renumbered (r).

59G-8.500(3)(a)(b). We deleted these paragraphs, because the purpose of the rule is state good cause reasons.

Former paragraph 59G8.500(4) now (3). We rewrote this paragraph to read, “The Agency’s vendors shall mail a Disenrollment Denial Letter, AHCA/HSD Form #1, Eng., January 2009; Spanish version, AHCA/HSD Form #1Sp., January 2009; or Creole version, AHCA/HSD, Form #1C., January 2009, incorporated by reference, to recipients whose requests to disenroll from plans during the no change period are denied.”