(1) The agency shall use the claims payment systems, utilization control systems, cost control systems, case management systems, and other systems and controls that it has developed for the management and control of the Medicaid program to assist other agencies and entities, if appropriate, in paying claims and performing other activities necessary for the conduct of programs of state government, or for working with other public and private agencies to solve problems of lack of insurance, underinsurance, or uninsurability. When conducting these services, the agency shall ensure:
(a) That full payment is received for services provided.
(b) That costs of providing these services are clearly segregated from costs necessary for the conduct of the Medicaid program.
(c) That the program conducted serves the interests of the state in ensuring that effective and quality health care at a reasonable cost is provided to the citizens of the state.
(2)(a) The agency shall seek federal statutory or regulatory reforms to establish a Medicaid buy-in program to provide medical assistance to persons ineligible for Medicaid because of current income and categorical restrictions. The agency shall use funds provided by the Robert Wood Johnson Foundation to assist in developing the buy-in program, including, but not limited to, the determination of eligibility and service coverages; cost-sharing requirements; managed care provisions; changes needed to the Medicaid program’s claims processing, utilization control, cost control, case management, and provider enrollment systems to operate a buy-in program.
(b) The agency shall seek federal authorization and financial support for a buy-in program that provides federally supported medical assistance coverage for persons with incomes up to 250 percent of the federal poverty level. The agency shall not implement the Medicaid buy-in program until it has received necessary federal authorization and financial participation and state appropriations.
History.—s. 45, ch. 91-282; s. 52, ch. 93-129; s. 189, ch. 99-8.
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.