(1) CMS Physician Providers: Participation
Criteria. The CMS physician provider approval process is not a licensure
process. It is a quality assurance process to ensure that prospective and
participating CMS physician providers, who are interested in providing health
care services to children with special health care needs, meet minimum
standards deemed necessary by the Deputy Secretary for CMS for the provision of
quality medical services to CMS participants. The CMS physician provider
approval process is based on National Committee for Quality Assessment (NCQA)
Standards in addition to recommendations from CMS Medical Directors. Physicians
interested in participating in the CMS Program must comply with the CMS
approval and re-approval process and criteria. The approval and reapproval
process requires physicians to provide current information with regard to the
following:
(a) State of Florida medical
licensure status;
(b) Board
certification status in area of practice;
(c) Drug Enforcement Agency (DEA) or
Controlled Dangerous Substance (CDS) certificate of registration;
(d) Hospital admitting privileges at a CMS
approved hospital(s) or a Letter of Transfer Agreement with a CMS approved
physician who has admitting privileges at a CMS approved facility;
(e) Medical education and training;
(f) Work history;
(g) Active and closed professional liability
claim(s); and,
(h) Existence of
Medicaid and Medicare sanctions.
Exceptions: The Deputy Secretary for Children's Medical
Services shall grant, upon recommendation from the area CMS Medical Director,
provisional CMS approved provider status to any licensed physician, in order to
provide participants access to health care not immediately available through
CMS approved physician providers.
(2) CMS Non-Physician Providers.
(a) CMS may secure the services of
non-physician providers in any field of knowledge deemed necessary to aid in
its provision of services.
(b) CMS
Non-Physician providers must meet applicable licensing and certification
requirements of governmental agencies and professional associations in their
specialty areas.
(c) Individuals
performing genetic evaluations and counseling must be under the direction of a
CMS approved physician certified by the American Board of Medical Genetics or
the American Osteopathic Association in the area of
genetics.
Notes
Fla. Admin.
Code Ann. R. 64C-4.001
Rulemaking Authority 391.026(18) FS. Law Implemented
391.026(10), 391.035 FS.
New 1-1-77, Amended
2-11-85, Formerly 10J-5.07, Amended 3-28-96, Formerly 10J-5.007, Amended
2-2-03.
New 1-1-77, Amended 2-11-85, Formerly 10J-5.07, Amended
3-28-96, Formerly 10J-5.007, Amended
2-2-03.
