Florida Administrative Code
64 - DEPARTMENT OF HEALTH
64C - Division of Children's Medical Services
Chapter 64C-2 - APPLICATION/ELIGIBILITY FOR SERVICES
Section 64C-2.002 - Eligibility for CMS Network Services

(1) Clinical eligibility for the CMS Managed Care Plan may be established by an authorized representative of the Department through completion of the CMS Clinical Eligibility Screening Form, DH8000-CMS (12/2015), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06270.

(2) Clinical eligibility for the CMS Managed Care Plan may be established by a diagnosis of one or more of the health conditions listed on the CMS Clinical Eligibility Attestation form. The CMS Clinical Eligibility Attestation, Form DH8001-CMS (05/2016), is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-07444.

(3) If clinical eligibility is not established after the evaluations described in subsections (1) and (2), re-screening may be requested by contacting the CMS Plan office or at www.cmsplan.floridahealth.gov.

(4) Application may be made for children with a diagnosis of one or more health conditions not listed on the CMS Clinical Eligibility Attestation form, by requesting a review by a panel of medical professionals assigned by the CMS Managed Care Plan, to determine the child's clinical eligibility. The Medical Review Panel shall consist of the Deputy Secretary for CMS or designee, one CMS Regional Medical Director and one CMS Regional Nursing Director. The Medical Review Panel will complete the CMS Medical Panel Review for Clinical Eligibility Determination Form DH8002-CMS (05/2016), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-07445.

(5) Review Process for Clinical Eligibility Determinations.