(1) The Agency for Health Care Administration shall be solely responsible for developing and enforcing standards to prohibit financial and other conflicts of interest among vendors selected to provide preauthorization and concurrent utilization review management with direct-service organizations providing substance abuse, mental health, or related services to clients or services to disabled persons who have services authorized through the preauthorization and concurrent utilization review management system established to achieve cost savings in the provision of substance abuse, mental health, or related services or services to disabled persons. The agency may require the posting of a surety bond to guarantee that no financial or other conflicts of interest exist or will exist among vendors selected to provide preauthorization and concurrent utilization review management services.
(2) Vendors selected to conduct preauthorization or concurrent utilization review management, or both, may be peer-review organizations, qualified licensed clinical practitioners, or public or private organizations that demonstrate the ability to conduct such reviews according to criteria developed by the agency and that have no financial or other conflict of interest with any direct-service organization providing substance abuse, mental health, or related services or services to disabled persons. Selection of vendors shall be accomplished through a competitive process.
(3) The agency shall help the Agency for Persons with Disabilities meet the requirements of s. 393.065(4). Only admissions approved pursuant to such assessments are eligible for reimbursement under this chapter.
History.—s. 5, ch. 97-260; s. 8, ch. 99-144; s. 54, ch. 2006-227.
Structure Florida Statutes
Chapter 409 - Social and Economic Assistance
Part III - Medicaid (Ss. 409.901-409.9205)
409.901 - Definitions; ss. 409.901-409.920.
409.90201 - Recipient address update process.
409.9021 - Forfeiture of eligibility agreement.
409.9025 - Eligibility while an inmate.
409.903 - Mandatory payments for eligible persons.
409.904 - Optional payments for eligible persons.
409.905 - Mandatory Medicaid services.
409.906 - Optional Medicaid services.
409.9062 - Lung transplant services for Medicaid recipients.
409.9066 - Medicare prescription discount program.
409.907 - Medicaid provider agreements.
409.9071 - Medicaid provider agreements for school districts certifying state match.
409.9072 - Medicaid provider agreements for charter schools and private schools.
409.908 - Reimbursement of Medicaid providers.
409.909 - Statewide Medicaid Residency Program.
409.9101 - Recovery for payments made on behalf of Medicaid-eligible persons.
409.9102 - A qualified state Long-Term Care Insurance Partnership Program in Florida.
409.911 - Disproportionate share program.
409.9113 - Disproportionate share program for teaching hospitals.
409.9115 - Disproportionate share program for mental health hospitals.
409.91151 - Expenditure of funds generated through mental health disproportionate share program.
409.9116 - Disproportionate share/financial assistance program for rural hospitals.
409.9118 - Disproportionate share program for specialty hospitals.
409.91188 - Specialty prepaid health plans for Medicaid recipients with HIV or AIDS.
409.9119 - Disproportionate share program for specialty hospitals for children.
409.91195 - Medicaid Pharmaceutical and Therapeutics Committee.
409.91196 - Supplemental rebate agreements; public records and public meetings exemption.
409.912 - Cost-effective purchasing of health care.
409.91206 - Alternatives for health and long-term care reforms.
409.9121 - Legislative findings and intent.
409.91212 - Medicaid managed care fraud.
409.9123 - Quality-of-care reporting.
409.91255 - Federally qualified health center access program.
409.9126 - Children with special health care needs.
409.9127 - Preauthorization and concurrent utilization review; conflict-of-interest standards.
409.9128 - Requirements for providing emergency services and care.
409.913 - Oversight of the integrity of the Medicaid program.
409.9131 - Special provisions relating to integrity of the Medicaid program.
409.9132 - Pilot project to monitor home health services.
409.9133 - Pilot project for home health care management.
409.914 - Assistance for the uninsured.
409.915 - County contributions to Medicaid.
409.916 - Grants and Donations Trust Fund.
409.918 - Public Medical Assistance Trust Fund.
409.920 - Medicaid provider fraud.