Florida Senate - 2016 SB 1240
By Senator Sobel
33-01250-16 20161240__
1 A bill to be entitled
2 An act relating to Children’s Medical Services
3 eligibility and enrollment; amending s. 391.021, F.S.;
4 revising the definition of the term “children with
5 special health care needs”; defining the term
6 “clinical eligibility”; amending s. 391.029, F.S.;
7 revising eligibility requirements for the Children’s
8 Medical Services program; requiring the Department of
9 Health to use an assessment instrument to determine
10 clinical eligibility for the Children’s Medical
11 Services program; specifying minimum requirements for
12 an assessment instrument; amending s. 391.081, F.S.;
13 requiring the department to provide notice to a parent
14 or guardian of a child who has been determined
15 clinically ineligible for the Children’s Medical
16 Services program of the parent's or guardian’s appeal
17 rights under ch. 120, F.S.; amending s. 409.974, F.S.;
18 providing an exemption from regional specialty plan
19 enrollment limits for the Children’s Medical Services
20 Network; providing an effective date.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
24 Section 1. Subsection (2) of section 391.021, Florida
25 Statutes, is amended, present subsections (3) through (8) of
26 that section are redesignated as subsections (4) through (9),
27 respectively, and a new subsection (3) is added to that section,
28 to read:
29 391.021 Definitions.—When used in this act, the term:
30 (2) “Children with special health care needs” means those
31 children younger than 21 years of age who have a chronic or and
32 serious physical, developmental, behavioral, or emotional
33 condition conditions and who require health care and related
34 services of a type or amount beyond that which is generally
35 required by children.
36 (3) “Clinical eligibility” means a determination based on
37 an assessment instrument and a clinical evaluation that a child
38 has special health care needs as defined in this chapter and is
39 eligible to receive services through the Children’s Medical
40 Services program.
41 Section 2. Section 391.029, Florida Statutes, is amended to
42 read:
43 391.029 Program eligibility.—
44 (1) Eligibility for the Children’s Medical Services program
45 is based on the diagnosis of one or more chronic and serious
46 medical conditions and the family’s need for specialized
47 services.
48 (1)(2) The following individuals are eligible to receive
49 services through the Children’s Medical Services program:
50 (a) A high-risk pregnant female who is enrolled in
51 Medicaid.
52 (b) Children with serious special health care needs from
53 birth to 21 years of age who are enrolled in Medicaid.
54 (c) Children with serious special health care needs from
55 birth to 19 years of age who are enrolled in a program under
56 Title XXI of the Social Security Act.
57 (2)(3) Subject to the availability of funds, the following
58 individuals may receive services through the program:
59 (a) Children with serious special health care needs from
60 birth to 21 years of age who do not qualify for Medicaid or
61 Title XXI of the Social Security Act but who are unable to
62 access, due to lack of providers or lack of financial resources,
63 specialized services that are medically necessary or essential
64 family support services. Families shall participate financially
65 in the cost of care based on a sliding fee scale established by
66 the department.
67 (b) Children with special health care needs from birth to
68 21 years of age, as provided in Title V of the Social Security
69 Act.
70 (c) An infant who receives an award of compensation under
71 s. 766.31(1). The Florida Birth-Related Neurological Injury
72 Compensation Association shall reimburse the Children’s Medical
73 Services Network the state’s share of funding, which must
74 thereafter be used to obtain matching federal funds under Title
75 XXI of the Social Security Act.
76 (3)(4) Any child who has been provided with surgical or
77 medical care or treatment under this act prior to being adopted
78 and has a chronic or serious and chronic special health care
79 need needs shall continue to be eligible to be provided with
80 such care or treatment after his or her adoption, regardless of
81 the financial ability of the persons adopting the child.
82 (4) The department must use an assessment instrument to
83 determine a child’s clinical eligibility for the Children’s
84 Medical Services program. At a minimum, the instrument must
85 identify chronic or serious physical, developmental, behavioral,
86 or emotional conditions in the child which require health care
87 and related services of a type or to an extent greater than that
88 generally required by children or which, when used as part of a
89 clinical evaluation of the child by a licensed health care
90 professional, indicate the child meets the definition of a child
91 with special health care needs under s. 391.021.
92 Section 3. Section 391.081, Florida Statutes, is amended to
93 read:
94 391.081 Grievance reporting and resolution requirements.
95 The department shall adopt and implement a system to provide
96 assistance to eligible individuals and health care providers to
97 resolve complaints and grievances. To the greatest extent
98 possible, the department shall use existing grievance reporting
99 and resolution processes. The department shall ensure that the
100 system developed for the Children’s Medical Services program
101 does not duplicate existing grievance reporting and resolution
102 processes. The department must notify a parent or guardian of a
103 child who has been determined clinically ineligible for the
104 Children’s Medical Services program of the parent's or
105 guardian’s right to appeal such determination on behalf of his
106 or her child, in accordance with the requirements of chapter
107 120.
108 Section 4. Subsection (3) of section 409.974, Florida
109 Statutes, is amended to read:
110 409.974 Eligible plans.—
111 (3) SPECIALTY PLANS.—Participation by specialty plans shall
112 be subject to the procurement requirements of this section. The
113 aggregate number of enrollees in enrollment of all specialty
114 plans in a region, not including enrollees in the Children’s
115 Medical Services Network, may not exceed 10 percent of the total
116 number of enrollees in of that region. Enrollment in the
117 Children’s Medical Services Network is not subject to the
118 enrollment limit requirement of this subsection.
119 Section 5. This act shall take effect upon becoming a law.