Letter to CMS - Medicaid Managed Care Policies - Agency for ...

How to Become a Florida Medicaid Health Plan
Welcome, prospective health plan! We are pleased you are interested in contracting with the
Agency for Health Care Administration to provide comprehensive health care services to
Medicaid recipients. On these pages you will find the information you need to become a Florida
Medicaid health plan, which includes health maintenance organizations, provider service
networks, and specialty plans. Just follow the steps below.
Applications received after April 1, 2012, are not likely to be fully reviewed and processed prior
to the release of the procurement documents for Statewide Medicaid Managed Care.
(*Note if you are an organization not authorized to do business in Florida and wish to become a
licensed HMO, click here for instructions to become a licensed HMO, then follow steps 1-4
below.)
1. Review Chapter 409, Florida Statutes which is the enabling statute for the Medicaid
Program:
- Section 409.912 – Cost-effective purchasing of health care.
- Section 409.9122 – Mandatory Medicaid managed care enrollment; programs and
procedures.
- Section 409.91211 – Medicaid managed care pilot program.
- Section 409.91212 – Medicaid Managed Care Fraud.
- Section 409.913 – Oversight of the integrity of the Medicaid program.
- Section 409-9124 – Managed care reimbursement.
- Section 409.920 – Medicaid Provider Fraud.
- Section 409.9201 – Medicaid Fraud.
- Section 409.9203 – Rewards for reporting Medicaid Fraud.
2. Download these materials or Application tools:
- Medicaid Health Plan application [577KB PDF] (Updated 8/1/2011)
- Model Health Plan contract
- Additional required documents and resources for application submission
3. Contact the Division of Medicaid, Bureau of Health Systems Development at (850) 412-
4004, to schedule a teleconference or meeting with Agency staff.
4. Attend a Medicaid Health Plan application workshop(s). Click here to see the workshop
schedule.
5. Submit completed application and all required supporting documents.
Click on the following for more information about current Health Maintenance Organizations and
Provider Service Networks:
• Health Maintenance Organizations (HMOs)
• Provider Service Networks (PSNs)
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