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 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 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.
Florida Medicaid PSN Application and Contract Process
Two types of PSN applications are currently posted. One is for the Medicaid Managed Care Pilot Program currently operating in Broward, Duval, Baker, Clay, and Nassau counties (Medicaid Reform) and one is for the traditional Medicaid Managed Care Program in other areas of the state. Click here to proceed to the Medicaid Reform website, Provider Information page.
Medicaid Rolls Out the Provider Service Network (PSN) Application and Contract in Non-Reform Counties
Provider Service Network Rollout (PSN) Schedule: In furthering its commitment to providing choice to Florida's vulnerable Medicaid population, Medicaid is accepting applications for 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.
Applicants who intend to operate as a non-Reform capitated PSN may submit an application to provide services in any non-Reform county.
Applications for non-Reform Fee-for-Service (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) |
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. We do not have additional 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.
Medicaid Provider Service Network (PSN) Application - Non-Reform, July 2007 [355 KB PDF]
The Medicaid Health Plan Contract is provided the link below.
Provider Service Network (PSN) Policy Transmittals and Plan Letters
For Medicaid Provider Service Network Policy Transmittals click here. 
7/23/10
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]
Disclosure of Ownership and Control Interest Statement (CMS-1513) [550KB PDF]
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.
Medicaid Reform FFS PSN Conversion Application
Pursuant to s. 409.91211(3)(e), F.S. (as revised in the 2010 Legislative Session), a Reform FFS PSN must convert to capitation by no later than the beginning of the sixth year of operation under the Reform waiver extension, unless the PSN opts to convert to capitation earlier. Prerequisite to executing a capitated contract, the existing Reform FFS PSN must submit a comprehensive conversion work plan, complete and submit the Medicaid Reform FFS PSN Conversion Application, and successfully pass all phases of the conversion application review process.
Please click on the following link to view the prior policy transmittal PSN 09-03 and the conversion application which are located under year 2009 of the Provider Service Network (PSN) Policy Transmittals and Plan Letters. A new policy transmittal is being developed to reflect the new statutory requirements.
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
