Provider Service Network (PSN)

A Provider Service Network (PSN) is a network established or organized and operated by a health care provider or group of affiliated health care providers, including minority physician networks and emergency room diversion programs that meet the requirements of Section 409.912 (4) (d) , F.S. In addition, to be approved for a Medicaid health plan contract, the PSN applicant must meet all applicable health plan requirements specified throughout ss. 409.908, 409.912, 409.91211, 409.913, 409.9122, and 409.9124, and applicable requirements specified in Chapter 641, Florida Statutes. PSNs provide a substantial portion of the health care items and services contracted directly through the provider or affiliated group of providers. The health care providers must have a controlling interest in the governing body of the PSN. A PSN may be reimbursed on a fee-for-service or capitated basis.

The Agency awards PSN contracts based on an open application process, meaning that the Agency will offer a PSN contract to every applicant that applies for and meets the state's standards for Medicaid PSN contracts. PSNs provide cost predictability to the Agency as they are required to demonstrate cost effectiveness. For Fee-for-Service PSNs, the Agency conducts periodic financial reconciliations to review whether cost-savings occur.

All Medicaid covered services are available to PSN enrollees. PSN enrollees receive the majority of their health care through the PSN. PSN covered services, including out-of-network covered services, rendered to PSN enrollees must be authorized by the PSN. As such, providers of these services must submit claims for these services to the PSN for approval. Although the PSN services cannot be more restrictive than those provided under Medicaid fee-for-service, all services must be prior authorized by the PSN except for the following:

  • Emergency services;
  • Family planning services regardless of whether the provider is a plan provider;
  • The diagnosis and treatment of sexually transmitted diseases and other communicable diseases such as tuberculosis and human immunodeficiency rendered by county health departments;
  • OB/GYN services for one annual visit and the medically-necessary follow-up care for a condition(s) detected at that visit (the recipient must use a plan provider for these services);
  • Chiropractic, podiatry, and some dermatology services (the recipient must use a plan provider for these services); and
  • Immunizations provided by county health departments.

Florida Medicaid PSN Application and Contracting Process

For information on how to become, please visit the Florida Medicaid Health Plan page.

Medicaid Counties Available for Medicaid PSN Application

Fee-for-Service PSN-Availability in Non-Reform Counties: In furthering its commitment to providing choice to Florida's vulnerable Medicaid population, Medicaid is accepting applications for Fee-for-Service Medicaid Provider Service Networks in certain non-Reform Florida counties. Priority in application review will be made for applicants that apply for the particular urban county and the noted counties surrounding it. Interested applicants must complete and submit the Medicaid Health Plan Application in order to facilitate a contract with the Agency. 

Applications for non-Reform FFS PSNs are currently being accepted for the following counties below:

Hillsborough County (including the surrounding counties of Pasco, Pinellas, Polk, Hardee and Manatee)
Palm Beach County (including the surrounding counties of Martin, Glades and Hendry)
Collier County (including the surrounding counties of Lee, Hendry and Monroe)
Alachua County (including the surrounding counties of Levy, Gilchrist, Columbia, Putnam, Union, Bradford and Marion)
Orange County (including the surrounding counties of Polk, Lake, Seminole, Osceola and Brevard)
 

Applications will only be accepted from applicants who wish to provide services under a FFS arrangement in the counties listed above. We do not have additional county expansion roll-out dates for the FFS PSNs at present. A staggered roll-out of counties is required to allow for the Agency workload to be distributed in a manageable way. Please check this website periodically for the latest information on county availability.

Capitated (Prepaid) PSN-Availability in Non-Reform Counties: Applicants who intend to operate as a non-Reform capitated PSN may submit an application to provide services in any non-Reform county.

PSN Availability in Reform Counties:Applications for all Reform counties are currently being accepted. For relative information, please visit the Medicaid Reform page.

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.

The Medicaid Health Plan Contract is provided the link below.

Provider Information

As part of the Agency’s commitment to enhancing the implementation of reform, the Agency continues to expand its communication with providers that are considering developing a benefit package and submitting an application as a Medicaid HMO or Provider Service Network. This is one of many ways that the Agency communicates with potential plan applicants and current health plan contractors to provide the tools needed to complete the application and contracting processes. We encourage you to visit this site regularly.

For more reform provider information, please visit the the Reform Provider Information page.

Provider Service Network (PSN) Policy Transmittals and Dear Health Plan Letters

For information on the transmittals and letters, please visit the PSN transmittal and Dear Health Plan Letter page.

Forms

Disclosure of Ownership and Control Interest Statement (CMS-1513) [550KB]

PSN Expansions

Please be advised that health plan expansion requests received after June 1, 2012, are not likely to be fully reviewed and approved prior to the release of the procurement documents for Statewide Medicaid Managed Care.

For existing Reform PSNs expanding to non-Reform counties, plans must complete the Medicaid Provider Enrollment Application and submit a cover letter (to include enrollment levels and any nuances that differ from Reform to Non-Reform) to their Agency contract manager.

For existing non-Reform PSNs expanding to Reform counties, plans must complete the following application and submit to their Agency contract manager.

Florida Medicaid Application for an Existing Non-Reform Health Plan Expansion into Reform County, July 2011 [187KB]

For all other PSN expansion requests, plans must submit a cover letter (to include requested enrollment levels and specified counties) to their Agency contract manager.

Medicaid FFS PSN Conversion Application

Pursuant to s. 409.912(4)(d)1., F.S., the FFS option is only available for the first two years of operations, unless the PSN opts to convert to capitation earlier.  Prior to executing a capitated contract, existing FFS PSNs must complete and submit the Florida Medicaid Fee-for-Service (FFS) PSN Conversion Application (conversion application) and successfully pass all phases of the conversion application review process.

FFS PSNs in operation on or before September 1, 2012, must submit their completed conversion applications to the Agency’s Bureau of Health Systems Development (HSD) by September 1, 2013.  For FFS PSNs that begin operations after September 1, 2012, the deadline for conversion application submission is the first day of the second year of operation.

The following timeline applies to all current FFS PSNs:

09/01/2013: Deadline for the FFS PSN to submit its conversion application to the Agency for Health Care Administration (Agency)

06/01/2014: Successful conversion applicants and the Agency to execute contract amendments for fully capitated services to begin 09/01/2014.

The PSN must submit its Conversion Application to its HSD contract manager at the following address:

Agency for Health Care Administration
PSN Contracting and Policy Unit
Bureau of Medicaid Health Systems Development
2727 Mahan Drive, MS 50
Tallahassee, Florida  32308

These tools may be helpful to you:

Policy Transmittal PSN 11-05 located under year 2011 on the Provider Service Network (PSN) Policy Transmittals and Plan Letters page.

April 2012 FFS PSN Conversion Application [792KB]

Medicaid Recipient Enrollment Information

Information is available about Medicaid managed care choices through Florida Medicaid's Enrollment Broker, Medicaid Options or call the toll-free Medicaid Options HelpLine at 1-888-367-6554 for enrollment information and choices. 

For Medicaid Reform Recipient Enrollment information and choices, call the toll-free Choice Counseling HelpLine
at 1-866-454-3959.

For Medicaid enrollment statistics, please visit the Comprehensive Medicaid Managed Care Enrollment Reports page.




Reporting Medicaid Fraud