The department shall have the following powers, duties, and responsibilities:
(1) To provide or contract for the provision of health services to eligible individuals.
(2) To determine the medical and financial eligibility standards for the program and to determine the medical and financial eligibility of individuals seeking health services from the program.
(3) To recommend priorities for the implementation of comprehensive plans and budgets.
(4) To coordinate a comprehensive delivery system for eligible individuals to take maximum advantage of all available funds.
(5) To promote, establish, and coordinate programs relating to children’s medical services in cooperation with other public and private agencies and to coordinate funding of health care programs with federal, state, or local indigent health care funding mechanisms.
(6) To initiate, coordinate, and request review of applications to federal and state agencies for funds, services, or commodities relating to children’s medical programs.
(7) To sponsor or promote grants for projects, programs, education, or research in the field of medical needs of children, with an emphasis on early diagnosis and treatment.
(8) To oversee and operate the Children’s Medical Services network.
(9) To establish reimbursement mechanisms for the Children’s Medical Services network.
(10) To establish Children’s Medical Services network standards and credentialing requirements for health care providers and health care services.
(11) To serve as a provider and principal case manager for children with special health care needs under Titles XIX and XXI of the Social Security Act.
(12) To monitor the provision of health services in the program, including the utilization and quality of health services.
(13) To administer the Children with Special Health Care Needs program in accordance with Title V of the Social Security Act.
(14) To establish and operate a grievance resolution process for participants and health care providers.
(15) To maintain program integrity in the Children’s Medical Services program.
(16) To receive and manage health care premiums, capitation payments, and funds from federal, state, local, and private entities for the program. The department may contract with a third-party administrator for processing claims, monitoring medical expenses, and other related services necessary to the efficient and cost-effective operation of the Children’s Medical Services network. The department is authorized to maintain a minimum reserve for the Children’s Medical Services network in an amount that is the greater of:
(a) Ten percent of total projected expenditures for Title XIX-funded and Title XXI-funded children; or
(b) Two percent of total annualized payments from the Agency for Health Care Administration for Title XIX and Title XXI of the Social Security Act.
(17) To appoint health care consultants for the purpose of providing peer review and making recommendations to enhance the delivery and quality of services in the Children’s Medical Services program.
(18) To adopt rules pursuant to ss. 120.536(1) and 120.54 to administer the Children’s Medical Services Act. The rules may include requirements for definitions of terms, program organization, and program description; a process for selecting an area medical director; responsibilities of applicants and clients; requirements for service applications, including required medical and financial information; eligibility requirements for initial treatment and for continued eligibility, including financial and custody issues; methodologies for resource development and allocation, including medical and financial considerations; requirements for reimbursement services rendered to a client; billing and payment requirements for providers; requirements for qualification, appointments, verification, and emergency exceptions for health-professional consultants; general and diagnostic-specific standards for diagnostic and treatment facilities; and standards for the method of service delivery, including consultant services, respect-for-privacy considerations, examination requirements, family support plans, and clinic design.