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. 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 actually occur.

All Medicaid covered services are available to PSN enrollees. PSN enrollees receive the majority of their health care through the PSN. PSN-managed services, including out-of-network 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.

Two types of PSN application are currently posted. One is for the Medicaid Reform Application process and one is for Medicaid counties not yet participating in Medicaid Reform.

Medicaid rolls out the Provider Service Network (PSN) Application and Contract in Non-Reform Counties

In furthering its commitment to providing choice to Florida 's vulnerable Medicaid population, Medicaid is accepting applications for Medicaid Provider Service Networks in certain Florida counties listed below. Priority in application review will be made for applicants that apply for the particular urban county and the noted counties surrounding it. Applications for these counties will be accepted beginning with the months below.

Interested applicants must complete and submit the revised Medicaid Provider Service Network (PSN) Application in order to facilitate a contract with the Agency.  Applications will only be accepted from applicants who wish to provide services in the counties listed above. Applicants may submit applications to become either a Fee-for-Service PSN or a capitated PSN. The draft Medicaid Fee-for-Service Provider Service Network (PSN) Model Contract is provided below.  The draft Medicaid Capitated Provider Service Network (PSN) Model Contract will be posted in the near future. 

Medicaid Provider Service Network (PSN) Application - Non-Reform, July 2007 [355 KB PDF]

Attachment II - Medicaid Provider Service Network (PSN) Fee-for-Service Model Contract - Non-Reform, January 2007 [616 KB PDF]

Provider Service Network (PSN) Policy Transmittals

For Medicaid Reform Provider Service Network Policy Transmittals click here. 5/2/08

Additional Tools and Information

Non-Reform Fee-for-Service Provider Service Network (PSN) Subcontract Checklist [204 KB Microsoft Word]

Forms

Marketing Agent Registration Template [19KB Microsoft Excel] 4/25/08

Medicaid Reform PSN Application and Contract Process

The application for PSNs to enter into a Reform County is located on the Medicaid Reform website under the Provider Information page. If a PSN has a Medicaid contract and wishes to expand to another county, it may complete the Expansion Application on the Medicaid Reform Website rather than submitting a new health plan application.

Click here to proceed to the Medicaid Reform website, Provider Information page

Rural Provider Service Network (PSN) Development Grant Application

The Florida Legislature appropriated $600,000 to help non-profit health providers develop Medicaid PSNs in rural counties. Individual grants can reach a maximum of $200,000. AHCA will award the grants to assist non-profit entities in creating the administrative and service infrastructure necessary to become Medicaid PSNs in rural counties. To be eligible to apply for the Medicaid Rural County PSN Development Grant funds, an entity must be:

• A non-profit organization authorized to do business in Florida;
• Intend to provide PSN services in rural Florida counties; and
• Demonstrate financial stability.

Counties defined as “rural” in accordance with Florida Statutes are Baker, Bradford, Calhoun, Columbia, Desoto, Dixie, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Highlands, Holmes, Jackson, Jefferson, Lafayette, Levy, Liberty, Madison, Monroe, Nassau, Okeechobee, Putnam, Sumter, Suwannee, Taylor, Union, Wakulla, Walton and Washington.

It is the Agency's intent to award at least one rural development grant for the rural Medicaid reform counties, which include Baker and Nassau.

The deadline to submit grant applications to the Agency is January 23, 2007. 

Medicaid Rural County Provider Service Network (PSN) Development Grant Application, 12/20/06 [73 KB PDF]

The Agency announces the following grant awards made to Rural County PSN Development Grant applicants:

The Agency anticipates entering into the agreement with the above entities by March 16, 2007. Award amounts are contingent upon meeting agreement deliverables.

Medicaid Recipient Enrollment Information

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

For Medicaid Reform Recipient Enrollment information click here.