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Florida Administrative Code § 59G-8.100
Link to the law
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Current as of June 2015
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“Medicaid contracts for prepaid health plans under the Agency for Health Care Administration regulations”
A health maintenance organization offering Medicaid prepaid health plans must comply with the Medicaid program’s requirement, including:
- Marketing
A health maintenance organization must not engage in marketing practices which mislead, confuse or defraud Medicaid recipients. All marketing materials must be submitted to the Agency for Health Care Administration for approval.
- Enrollment and disenrollment
A health maintenance organization must not discriminate in enrollment, disenrollment, in the provision of health care, or in any other situation based on an enrollee’s health care status, sex, race, age, religion, national origin, political affiliation, or disability.
- Quality assurance
A health maintenance organization must develop a quality assurance system that meets standards currently prevailing in the medical community and include internal peer review and routine monitoring of cases to assess the utilization of services.
- Grievances
A health maintenance organization must establish a grievance procedure that is easily understandable and accessible by the enrollee.
- Reporting
A health maintenance organization must comply with all reporting requirements set forth in the contract between the agency and the health maintenance organization. This requirement includes submitting to audits by federal and state agencies and reporting service utilization and financial information.
Related laws:
Current as of June 2015
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