Senate Bill sb1740c1
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By the Committee on Health Policy; and Senators Fasano and
Lynn
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1 A bill to be entitled
2 An act relating to the Florida Kidcare program;
3 amending s. 409.811, F.S.; defining the term
4 "maximum income threshold"; amending s.
5 409.8132, F.S.; revising the income eligibility
6 requirements for enrollment in the Medikids
7 program; specifying a mandatory assignment
8 process; amending s. 409.8134, F.S.; providing
9 for year-round enrollment only when funding is
10 available to finance increased enrollment;
11 allowing applicants to reactivate an
12 application; amending s. 409.814, F.S.;
13 revising the income eligibility requirements
14 for enrollment in the Florida Kidcare program
15 and the Florida Healthy Kids program;
16 establishing presumptive eligibility for
17 children transferring to title XXI-funded
18 Florida Kidcare coverage; repealing provisions
19 limiting eligibility for a child who had his or
20 her employer-based coverage voluntarily
21 canceled; requiring that plans and providers
22 are notified regarding a member's or patient's
23 loss of eligibility; requiring that eligibility
24 information be electronically verified;
25 specifying that full-pay enrollees are not
26 required to provide eligibility information;
27 amending s. 409.818, F.S.; requiring a
28 standardized application; requiring that the
29 Department of Children and Family Services
30 design a plan to change the eligibility
31 determination system; authorizing the Agency
1
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1 for Health Care Administration to seek a state
2 plan amendment and waiver authority if
3 necessary to increase the maximum income
4 threshold to 225 percent of the federal poverty
5 level; amending s. 624.91, F.S.; revising
6 legislative intent concerning eligibility for
7 the Florida Healthy Kids program; allowing
8 health and dental plans to develop and
9 distribute marketing materials; requiring the
10 Florida Healthy Kids Corporation to establish
11 an assignment process for Healthy Kids
12 enrollees; providing an effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Subsection (27) is added to section
17 409.811, Florida Statutes, to read:
18 409.811 Definitions relating to Florida Kidcare
19 Act.--As used in ss. 409.810-409.820, the term:
20 (27) "Maximum income threshold" means a percentage of
21 the current federal poverty level used to determine
22 eligibility for certain program components, as approved by
23 federal waiver or an amendment to the state plan.
24 Section 2. Paragraph (a) of subsection (6) and
25 subsection (7) of section 409.8132, Florida Statutes, are
26 amended to read:
27 409.8132 Medikids program component.--
28 (6) ELIGIBILITY.--
29 (a) A child who has attained the age of 1 year but who
30 is under the age of 5 years is eligible to enroll in the
31 Medikids program component of the Florida Kidcare program, if
2
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1 the child is a member of a family that has a family income
2 which exceeds the Medicaid applicable income level as
3 specified in s. 409.903, but which is equal to or below the
4 maximum income threshold 200 percent of the current federal
5 poverty level. In determining the eligibility of such a child,
6 an assets test is not required. A child who is eligible for
7 Medikids may elect to enroll in Florida Healthy Kids coverage
8 or employer-sponsored group coverage. However, a child who is
9 eligible for Medikids may participate in the Florida Healthy
10 Kids program only if the child has a sibling participating in
11 the Florida Healthy Kids program and the child's county of
12 residence permits such enrollment.
13 (7) ENROLLMENT.--Enrollment in the Medikids program
14 component may occur at any time throughout the year. A child
15 may not receive services under the Medikids program until the
16 child is enrolled in a managed care plan or MediPass. Once
17 determined eligible, an applicant may receive choice
18 counseling and select a managed care plan or MediPass. The
19 agency may initiate mandatory assignment for a Medikids
20 applicant who has not chosen a managed care plan or MediPass
21 provider after the applicant's voluntary choice period ends.
22 The Medikids mandatory assignment process shall assign
23 applicants to managed care plans or MediPass providers in
24 order to keep family members assigned to the same managed care
25 plan or MediPass provider to the greatest extent possible,
26 including situations in which some family members are enrolled
27 in Medicaid and others are enrolled in a Title XXI Kidcare
28 component. An applicant may select MediPass under the Medikids
29 program component only in counties that have fewer than two
30 managed care plans available to serve Medicaid recipients and
31 only if the federal Health Care Financing Administration
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1 determines that MediPass constitutes "health insurance
2 coverage" as defined in Title XXI of the Social Security Act.
3 Section 3. Subsection (2) of section 409.8134, Florida
4 Statutes, is amended to read:
5 409.8134 Program expenditure ceiling.--
6 (2) The Florida Kidcare program may conduct enrollment
7 at any time throughout the year for the purpose of enrolling
8 children eligible for all program components listed in s.
9 409.813 except Medicaid. The four Florida Kidcare
10 administrators shall work together to ensure that the
11 year-round enrollment period is announced statewide. Eligible
12 children shall be enrolled on a first-come, first-served basis
13 using the date the enrollment application is received.
14 Enrollment shall immediately cease when the expenditure
15 ceiling is reached. Year-round enrollment shall only be held
16 only if the Social Services Estimating Conference determines
17 that sufficient federal and state funds will be available to
18 finance the increased enrollment through federal fiscal year
19 2007. Any individual who is not enrolled must reapply by
20 submitting a new application. The application for the Florida
21 Kidcare program shall be valid for a period of 120 days after
22 the date it was received. At the end of the 120-day period, if
23 the applicant has not been enrolled in the program, the
24 application shall be invalid and the applicant shall be
25 notified of the action. The applicant may reactivate resubmit
26 the application after notification of the action taken by the
27 program. Except for the Medicaid program, whenever the Social
28 Services Estimating Conference determines that there are
29 presently, or will be by the end of the current fiscal year,
30 insufficient funds to finance the current or projected
31 enrollment in the Florida Kidcare program, all additional
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1 enrollment must cease and additional enrollment may not resume
2 until sufficient funds are available to finance such
3 enrollment.
4 Section 4. Section 409.814, Florida Statutes, is
5 amended to read:
6 409.814 Eligibility.--A child who has not reached 19
7 years of age and whose family income is equal to or below the
8 maximum income threshold 200 percent of the federal poverty
9 level is eligible for the Florida Kidcare program as provided
10 in this section. For enrollment in the Children's Medical
11 Services Network, a complete application includes the medical
12 or behavioral health screening. If, subsequently, an
13 individual is determined to be ineligible for coverage, he or
14 she must immediately be disenrolled from the respective
15 Florida Kidcare program component.
16 (1) A child who is eligible for Medicaid coverage
17 under s. 409.903 or s. 409.904 must be enrolled in Medicaid
18 and is not eligible to receive health benefits under any other
19 health benefits coverage authorized under the Florida Kidcare
20 program.
21 (2) A child who is not eligible for Medicaid, but who
22 is eligible for the Florida Kidcare program, may obtain health
23 benefits coverage under any of the other components listed in
24 s. 409.813 if such coverage is approved and available in the
25 county in which the child resides. However, a child who is
26 eligible for Medikids may participate in the Florida Healthy
27 Kids program only if the child has a sibling participating in
28 the Florida Healthy Kids program and the child's county of
29 residence permits such enrollment.
30 (3) A child who is eligible for the Florida Kidcare
31 program who is a child with special health care needs, as
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1 determined through a medical or behavioral screening
2 instrument, is eligible for health benefits coverage from and
3 shall be referred to the Children's Medical Services Network.
4 (4) A child who will lose eligibility for Florida
5 Kidcare coverage funded under Title XIX because the child has
6 exceeded income or age limits shall be presumed eligible for
7 the Florida Kidcare program and shall have 60 days of
8 continued eligibility within his or her existing plan or
9 coverage following redetermination in order to allow for a
10 transition to Title XXI-funded Florida Kidcare coverage
11 without a lapse in coverage. The Agency for Health Care
12 Administration shall seek federal waiver authority under Title
13 XIX or Title XXI for such continued eligibility with the goal
14 of securing federal matching funds consistent with the federal
15 SCHIP match for the additional 60 days of eligibility.
16 (5)(4) The following children are not eligible to
17 receive premium assistance for health benefits coverage under
18 the Florida Kidcare program, except under Medicaid if the
19 child would have been eligible for Medicaid under s. 409.903
20 or s. 409.904 as of June 1, 1997:
21 (a) A child who is eligible for coverage under a state
22 health benefit plan on the basis of a family member's
23 employment with a public agency in the state.
24 (b) A child who is currently eligible for or covered
25 under a family member's group health benefit plan or under
26 other employer health insurance coverage, excluding coverage
27 provided under the Florida Healthy Kids Corporation as
28 established under s. 624.91, provided that the cost of the
29 child's participation is not greater than 5 percent of the
30 family's income. This provision shall be applied during
31 redetermination for children who were enrolled prior to July
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1 1, 2004. These enrollees shall have 6 months of eligibility
2 following redetermination to allow for a transition to the
3 other health benefit plan.
4 (c) A child who is seeking premium assistance for the
5 Florida Kidcare program through employer-sponsored group
6 coverage, if the child has been covered by the same employer's
7 group coverage during the 6 months prior to the family's
8 submitting an application for determination of eligibility
9 under the program.
10 (d) A child who is an alien, but who does not meet the
11 definition of qualified alien, in the United States.
12 (e) A child who is an inmate of a public institution
13 or a patient in an institution for mental diseases.
14 (f) A child who has had his or her coverage in an
15 employer-sponsored health benefit plan voluntarily canceled in
16 the last 6 months, except those children who were on the
17 waiting list prior to March 12, 2004.
18 (f)(g) A child who is otherwise eligible for Kidcare
19 and who has a preexisting condition that prevents coverage
20 under another insurance plan as described in paragraph (b)
21 which would have disqualified the child for Kidcare if the
22 child were able to enroll in the plan shall be eligible for
23 Kidcare coverage when enrollment is possible.
24 (6)(5) A child whose family income is above the
25 maximum income threshold 200 percent of the federal poverty
26 level or a child who is excluded under the provisions of
27 subsection (5) (4) may participate in the Medikids program as
28 provided in s. 409.8132 or, if the child is ineligible for
29 Medikids by reason of age, in the Florida Healthy Kids
30 program, subject to the following provisions:
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1 (a) The family is not eligible for premium assistance
2 payments and must pay the full cost of the premium, including
3 any administrative costs.
4 (b) The agency is authorized to place limits on
5 enrollment in Medikids by these children in order to avoid
6 adverse selection. The number of children participating in
7 Medikids whose family income exceeds the maximum income
8 threshold 200 percent of the federal poverty level must not
9 exceed 10 percent of total enrollees in the Medikids program.
10 (c) The board of directors of the Florida Healthy Kids
11 Corporation is authorized to place limits on enrollment of
12 these children in order to avoid adverse selection. In
13 addition, the board is authorized to offer a reduced benefit
14 package to these children in order to limit program costs for
15 such families. The number of children participating in the
16 Florida Healthy Kids program whose family income exceeds the
17 maximum income threshold 200 percent of the federal poverty
18 level must not exceed 10 percent of total enrollees in the
19 Florida Healthy Kids program.
20 (7)(6) Once a child is enrolled in the Florida Kidcare
21 program, the child is eligible for coverage under the program
22 for 12 months without a redetermination or reverification of
23 eligibility, if the family continues to pay the applicable
24 premium. Eligibility for program components funded through
25 Title XXI of the Social Security Act shall terminate when a
26 child attains the age of 19. Effective January 1, 1999, a
27 child who has not attained the age of 5 and who has been
28 determined eligible for the Medicaid program is eligible for
29 coverage for 12 months without a redetermination or
30 reverification of eligibility.
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1 (8)(7) When determining or reviewing a child's
2 eligibility under the Florida Kidcare program, the applicant
3 shall be provided with reasonable notice of changes in
4 eligibility which may affect enrollment in one or more of the
5 program components. When a transition from one program
6 component to another is authorized, there shall be cooperation
7 between the program components, and the affected family, the
8 child's health plan, and the child's health care providers to
9 promote which promotes continuity of health care coverage. The
10 agency, in coordination with the Department of Children and
11 Family Services, shall notify the Medicaid managed care plans
12 and MediPass providers concerning their members' or patients'
13 loss of eligibility for Medicaid or Medikids no less than 60
14 days in advance so that the health plans and providers may
15 assist the families in applying for the Florida Healthy Kids
16 program. Any authorized transfers must be managed within the
17 program's overall appropriated or authorized levels of
18 funding. Each component of the program shall establish a
19 reserve to ensure that transfers between components will be
20 accomplished within current year appropriations. These
21 reserves shall be reviewed by each convening of the Social
22 Services Estimating Conference to determine the adequacy of
23 such reserves to meet actual experience.
24 (9)(8) In determining the eligibility of a child, an
25 assets test is not required. Each applicant's family income,
26 birth certificate, and proof of identity shall be verified
27 electronically in order to determine eligibility for the
28 Florida Kidcare program. If electronic verification of
29 eligibility information is not available, an Each applicant
30 shall provide written documentation during the application
31
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1 process and the redetermination process, including, but not
2 limited to, the following:
3 (a) Proof of family income, which must include a copy
4 of the applicant's most recent federal income tax return. In
5 the absence of a federal income tax return, an applicant may
6 submit wages and earnings statements (pay stubs), W-2 forms,
7 or other appropriate documents.
8 (b) A statement from all employed family members that:
9 1. Their employer does not sponsor a health benefit
10 plan for employees; or
11 2. The potential enrollee is not covered by the
12 employer-sponsored health benefit plan because the potential
13 enrollee is not eligible for coverage, or, if the potential
14 enrollee is eligible but not covered, a statement of the cost
15 to enroll the potential enrollee in the employer-sponsored
16 health benefit plan.
17
18 Anyone applying for full-pay coverage under the Florida
19 Kidcare program is not required to provide the eligibility
20 information required under this section.
21 (10)(9) Subject to paragraph (5) (4)(b) and s.
22 624.91(4), the Florida Kidcare program shall withhold benefits
23 from an enrollee if the program obtains evidence that the
24 enrollee is no longer eligible, submitted incorrect or
25 fraudulent information in order to establish eligibility, or
26 failed to provide verification of eligibility. The applicant
27 or enrollee shall be notified that because of such evidence
28 program benefits will be withheld unless the applicant or
29 enrollee contacts a designated representative of the program
30 by a specified date, which must be within 10 days after the
31 date of notice, to discuss and resolve the matter. The program
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1 shall make every effort to resolve the matter within a
2 timeframe that will not cause benefits to be withheld from an
3 eligible enrollee.
4 (11)(10) The following individuals may be subject to
5 prosecution in accordance with s. 414.39:
6 (a) An applicant obtaining or attempting to obtain
7 benefits for a potential enrollee under the Florida Kidcare
8 program when the applicant knows or should have known the
9 potential enrollee does not qualify for the Florida Kidcare
10 program.
11 (b) An individual who assists an applicant in
12 obtaining or attempting to obtain benefits for a potential
13 enrollee under the Florida Kidcare program when the individual
14 knows or should have known the potential enrollee does not
15 qualify for the Florida Kidcare program.
16 Section 5. Subsection (1) of section 409.818, Florida
17 Statutes, is amended, and paragraph (g) is added to subsection
18 (3) of that section, to read:
19 409.818 Administration.--In order to implement ss.
20 409.810-409.820, the following agencies shall have the
21 following duties:
22 (1) The Department of Children and Family Services
23 shall:
24 (a) Develop a standardized simplified eligibility
25 application mail-in form to be used for determining the
26 eligibility of children for coverage for all components of
27 under the Florida Kidcare program, in consultation with the
28 agency, the Department of Health, and the Florida Healthy Kids
29 Corporation. The standardized simplified eligibility
30 application form must include an item that provides an
31 opportunity for the applicant to indicate whether coverage is
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1 being sought for a child with special health care needs.
2 Families applying for children's Medicaid coverage must also
3 be able to use the simplified application form without having
4 to pay a premium.
5 (b) Establish and maintain the eligibility
6 determination process under the program except as specified in
7 subsection (5). The department shall directly, or through the
8 services of a contracted third-party administrator, establish
9 and maintain a process for determining eligibility of children
10 for coverage under the program. The eligibility determination
11 process must be used solely for determining eligibility of
12 applicants for health benefits coverage under the program. The
13 eligibility determination process must include an initial
14 determination of eligibility for any coverage offered under
15 the program, as well as a redetermination or reverification of
16 eligibility, 12 months after enrollment each subsequent 6
17 months. Effective January 1, 1999, a child who has not
18 attained the age of 5 and who has been determined eligible for
19 the Medicaid program is eligible for coverage for 12 months
20 without a redetermination or reverification of eligibility. In
21 conducting an eligibility determination, the department shall
22 determine if the child has special health care needs. The
23 department, in consultation with the Agency for Health Care
24 Administration and the Florida Healthy Kids Corporation, shall
25 develop procedures for redetermining eligibility which enable
26 a family to easily update any change in circumstances which
27 could affect eligibility. The department may accept changes in
28 a family's status as reported to the department by the Florida
29 Healthy Kids Corporation without requiring a new application
30 from the family. Redetermination of a child's eligibility for
31
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1 Medicaid may not be linked to a child's eligibility
2 determination for other programs.
3 (c) Inform program applicants about eligibility
4 determinations and provide information about eligibility of
5 applicants to Medicaid, Medikids, the Children's Medical
6 Services Network, and the Florida Healthy Kids Corporation,
7 and to insurers and their agents, through a centralized
8 coordinating office.
9 (d) Design a plan, in consultation with the Florida
10 Healthy Kids Corporation, for determining eligibility for
11 public assistance or Medicaid which will enable applicants
12 with children who apply to the department for Medicaid or
13 other public assistance to apply for the Healthy Kids program
14 using the same application information in the event they are
15 found ineligible for Medicaid. The plan must be sufficient to
16 enable such applicants to submit all information necessary for
17 enrollment in the Healthy Kids program, including the
18 opportunity for such applicants to indicate whether coverage
19 is being sought for a child with special health care needs.
20 The plan shall allow the department to forward such
21 application information, together with accompanying
22 documentation as necessary, to the Florida Healthy Kids
23 Corporation, and the plan shall allow such application
24 information and documents to be processed for Healthy Kids
25 program enrollment by the Florida Healthy Kids Corporation in
26 accordance with eligibility criteria then in effect without
27 requiring the applicant to submit a separate application for
28 the Healthy Kids program. The department shall submit such
29 plan to the President of the Senate, the Speaker of the House
30 of Representatives, and the Governor no later than December
31 31, 2007.
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1 (e)(d) Adopt rules necessary for conducting program
2 eligibility functions.
3 (3) The Agency for Health Care Administration, under
4 the authority granted in s. 409.914(1), shall:
5 (g) The agency shall seek a state plan amendment and
6 waiver authority, if necessary, from the federal Centers for
7 Medicare and Medicaid Services for a maximum income threshold
8 of up to 225 percent of the federal poverty level. Until the
9 federal agency approves the request, the maximum income
10 threshold used for the Florida Kidcare program shall be 200
11 percent of the federal poverty level or the highest income
12 threshold allowed under current federal law and state plan
13 amendment, whichever is higher, up to 225 percent of the
14 federal poverty level. Any such expansion under this
15 subsection is subject to a specified appropriation for such
16 purpose and the availability of federal matching funds for
17 children in families above 200 percent of the federal poverty
18 level.
19
20 The agency is designated the lead state agency for Title XXI
21 of the Social Security Act for purposes of receipt of federal
22 funds, for reporting purposes, and for ensuring compliance
23 with federal and state regulations and rules.
24 Section 6. Paragraph (b) of subsection (2) and
25 paragraph (b) of subsection (5) of section 624.91, Florida
26 Statutes, are amended to read:
27 624.91 The Florida Healthy Kids Corporation Act.--
28 (2) LEGISLATIVE INTENT.--
29 (b) It is the intent of the Legislature that the
30 Florida Healthy Kids Corporation serve as one of several
31 providers of services to children eligible for medical
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1 assistance under Title XXI of the Social Security Act.
2 Although the corporation may serve other children, the
3 Legislature intends that the primary recipients of services
4 provided through the corporation be school-age children with a
5 family income below the maximum income threshold as defined in
6 s. 409.811(27) 200 percent of the federal poverty level, who
7 do not qualify for Medicaid. It is also the intent of the
8 Legislature that state and local government Florida Healthy
9 Kids funds be used to continue coverage, subject to specific
10 appropriations in the General Appropriations Act, to children
11 not eligible for federal matching funds under Title XXI.
12 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
13 (b) The Florida Healthy Kids Corporation shall:
14 1. Arrange for the collection of any family, local
15 contributions, or employer payment or premium, in an amount to
16 be determined by the board of directors, to provide for
17 payment of premiums for comprehensive insurance coverage and
18 for the actual or estimated administrative expenses.
19 2. Arrange for the collection of any voluntary
20 contributions to provide for payment of premiums for children
21 who are not eligible for medical assistance under Title XXI of
22 the Social Security Act.
23 3. Subject to the provisions of s. 409.8134, accept
24 voluntary supplemental local match contributions that comply
25 with the requirements of Title XXI of the Social Security Act
26 for the purpose of providing additional coverage in
27 contributing counties under Title XXI.
28 4. Establish the administrative and accounting
29 procedures for the operation of the corporation.
30 5. Establish, with consultation from appropriate
31 professional organizations, standards for preventive health
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1 services and providers and comprehensive insurance benefits
2 appropriate to children, provided that such standards for
3 rural areas shall not limit primary care providers to
4 board-certified pediatricians.
5 6. Determine eligibility for children seeking to
6 participate in the Title XXI-funded components of the Florida
7 Kidcare program consistent with the requirements specified in
8 s. 409.814, as well as the non-Title-XXI-eligible children as
9 provided in subsection (3).
10 7. Establish procedures under which providers of local
11 match to, applicants to and participants in the program may
12 have grievances reviewed by an impartial body and reported to
13 the board of directors of the corporation.
14 8. Establish participation criteria and, if
15 appropriate, contract with an authorized insurer, health
16 maintenance organization, or third-party administrator to
17 provide administrative services to the corporation.
18 9. Establish enrollment criteria which shall include
19 penalties or waiting periods of not fewer than 60 days for
20 reinstatement of coverage upon voluntary cancellation for
21 nonpayment of family premiums.
22 10. Contract with authorized insurers or any provider
23 of health care services, meeting standards established by the
24 corporation, for the provision of comprehensive insurance
25 coverage to participants. Such standards shall include
26 criteria under which the corporation may contract with more
27 than one provider of health care services in program sites.
28 Health plans shall be selected through a competitive bid
29 process. The Florida Healthy Kids Corporation shall purchase
30 goods and services in the most cost-effective manner
31 consistent with the delivery of quality medical care. The
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1 maximum administrative cost for a Florida Healthy Kids
2 Corporation contract shall be 15 percent. For health care
3 contracts, the minimum medical loss ratio for a Florida
4 Healthy Kids Corporation contract shall be 85 percent. For
5 dental contracts, the remaining compensation to be paid to the
6 authorized insurer or provider under a Florida Healthy Kids
7 Corporation contract shall be no less than an amount which is
8 85 percent of premium; to the extent any contract provision
9 does not provide for this minimum compensation, this section
10 shall prevail. The health plan selection criteria and scoring
11 system, and the scoring results, shall be available upon
12 request for inspection after the bids have been awarded.
13 11. Establish disenrollment criteria in the event
14 local matching funds are insufficient to cover enrollments.
15 12. Develop and implement a plan to publicize the
16 Florida Healthy Kids Corporation, the eligibility requirements
17 of the program, and the procedures for enrollment in the
18 program and to maintain public awareness of the corporation
19 and the program. Health and dental plans participating in the
20 Florida Healthy Kids program may develop and distribute
21 marketing and other promotional materials and participate in
22 activities, such as health fairs and public events, as
23 approved by the corporation. The health and dental plans may
24 also contact their current and former enrollees to encourage
25 continued participation in the program and to assist the
26 enrollee in transferring from a Title XIX-financed plan to a
27 Title XXI-financed plan.
28 13. Secure staff necessary to properly administer the
29 corporation. Staff costs shall be funded from state and local
30 matching funds and such other private or public funds as
31 become available. The board of directors shall determine the
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1 number of staff members necessary to administer the
2 corporation.
3 14. Provide a report annually to the Governor, Chief
4 Financial Officer, Commissioner of Education, Senate
5 President, Speaker of the House of Representatives, and
6 Minority Leaders of the Senate and the House of
7 Representatives.
8 15. Establish benefit packages which conform to the
9 provisions of the Florida Kidcare program, as created in ss.
10 409.810-409.820.
11 16. Establish an assignment process for Healthy Kids
12 enrollees in order to keep family members assigned to the same
13 managed care plan to the greatest extent possible, including
14 situations in which some family members are enrolled in a
15 Medicaid managed care plan and others are enrolled in a
16 Healthy Kids plan. The Agency for Health Care Administration
17 shall work together with the corporation to implement this
18 subparagraph.
19 (c) Coverage under the corporation's program is
20 secondary to any other available private coverage held by, or
21 applicable to, the participant child or family member.
22 Insurers under contract with the corporation are the payors of
23 last resort and must coordinate benefits with any other
24 third-party payor that may be liable for the participant's
25 medical care.
26 (d) The Florida Healthy Kids Corporation shall be a
27 private corporation not for profit, organized pursuant to
28 chapter 617, and shall have all powers necessary to carry out
29 the purposes of this act, including, but not limited to, the
30 power to receive and accept grants, loans, or advances of
31 funds from any public or private agency and to receive and
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1 accept from any source contributions of money, property,
2 labor, or any other thing of value, to be held, used, and
3 applied for the purposes of this act.
4 Section 7. This act shall take effect upon becoming a
5 law.
6
7 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
8 Senate Bill 1740
9
10 The committee substitute requires the Agency for Health Care
Administration to seek a state plan amendment and waiver
11 authority, if necessary, from the federal Centers for Medicare
and Medicaid Services to establish the highest "maximum income
12 threshold" of up to 225 percent of the most recently stated
federal poverty limit for eligibility in Florida Kidcare
13 programs like Medikids and Florida Healthy Kids.
14 The committee substitute modifies the Medikids mandatory
assignment process; establishes presumptive eligibility for a
15 child transitioning from Medicaid to Title XXI-funded program
components; repeals the requirement that a child who is
16 dropped from employer-sponsored coverage is ineligible for
Florida Kidcare for 6 months; requires plans and providers to
17 be notified that their members' or patients' eligibility
status is changing; requires eligibility information to be
18 electronically verified; specifies that full-pay applicants
are not required to provide eligibility information; requires
19 the Department of Children and Families to design a plan for
determining eligibility for public assistance and Medicaid
20 that will allow children to also apply for the Healthy Kids
program using the same application; allows health and dental
21 plans to develop and distribute marketing and other
promotional materials; and requires the Florida Healthy Kids
22 Corporation to establish an assignment process to keep family
members assigned to the same managed care plan to the greatest
23 extent possible.
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CODING: Words stricken are deletions; words underlined are additions.