Florida's CHMOs are dually regulated by the Agency for Health Care Administration (Agency), and the Department of Financial Services (DFS), Office of Insurance Regulation (OIR). The Agency monitors quality of care-related issues and OIR monitors financial and contractual issues. To become a commercially licensed HMO, an organization must receive a certificate of authority from OIR and a health care provider certificate from the Agency. Additionally, an Health Maintenance Organization (HMO) must be accredited.
OIR's information and requirements for health plans can be accessed at the following links:
The Commercial Managed Care Unit conducts the following reviews as applicable to HMO, Prepaid Health Clinics (PHC) and Exclusive Provider Organizations (EPO): initial and biennial renewal Health Care Provider Certificates, expansion affidavits, annual risk management and triennial accreditation organizations approved by the Agency. On-site surveys are conducted for all initial applications involving HMOs and PHCs. Worker’s Compensation managed care arrangement’s main function is to conduct annual and semi-annual provider network reviews to ensure network adequacy for the injured employee and determine the ability of provider networks to provide an adequate supply of medical services that are reasonably accessible within a geographic area. The unit also manages the Subscriber Assistance Program and other programs/contracts; Health Flex Plan Program, and Statewide Provider and Health Plan Claim Dispute Resolution Program (Maximus).
For information on purchasing insurance coverage and to verify the license of agents and companies, please reference the OIR's Consumer Resources/How do I internet link: http://www.floir.com/Office/SearchableTools.aspx.