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.
SUBJECT AREA TO BE ADDRESSED: Florida KidCare Dispute Review Process.
SPECIFIC AUTHORITY: 409.818(3)(f) FS.
LAW IMPLEMENTED: 409.814(10) FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: September 30, 2009, 3:00 p.m. – 5:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, 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: Any persons requiring a special accommodation at this meeting because of a disability or physical impairment should contact: Angela Wiggins at the Bureau of Medicaid Services, (850)922-7313, at least 48 hours prior to the meeting. 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Angela Wiggins, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: (850)922-7373, e-mail: wigginsa@ahca.myflorida.com
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT 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________.