CODING: Words stricken are deletions; words underlined are additions.
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Senator Brown-Waite moved the following amendment:
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Brown-Waite moved the following amendment:
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13 Senate Amendment (with title amendment)
14 Delete everything after the enacting clause
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16 and insert:
17 Section 1. Section 409.904, Florida Statutes, is
18 amended to read:
19 409.904 Optional payments for eligible persons.--The
20 agency may make payments for medical assistance and related
21 services on behalf of the following persons who are determined
22 to be eligible subject to the income, assets, and categorical
23 eligibility tests set forth in federal and state law. Payment
24 on behalf of these Medicaid eligible persons is subject to the
25 availability of moneys and any limitations established by the
26 General Appropriations Act or chapter 216.
27 (1) A person who is age 65 or older or is determined
28 to be disabled, whose income is at or below 100 percent of
29 federal poverty level, and whose assets do not exceed
30 established limitations.
31 (2) A family, a pregnant woman, a child under age 18,
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 a person age 65 or over, or a blind or disabled person who
2 would be eligible under any group listed in s. 409.903(1),
3 (2), or (3), except that the income or assets of such family
4 or person exceed established limitations. For a family or
5 person in this group, medical expenses are deductible from
6 income in accordance with federal requirements in order to
7 make a determination of eligibility. A family or person in
8 this group, which group is known as the "medically needy," is
9 eligible to receive the same services as other Medicaid
10 recipients, with the exception of services in skilled nursing
11 facilities and intermediate care facilities for the
12 developmentally disabled.
13 (3) A person who is in need of the services of a
14 licensed nursing facility, a licensed intermediate care
15 facility for the developmentally disabled, or a state mental
16 hospital, whose income does not exceed 300 percent of the SSI
17 income standard, and who meets the assets standards
18 established under federal and state law.
19 (4) A low-income person who meets all other
20 requirements for Medicaid eligibility except citizenship and
21 who is in need of emergency medical services. The eligibility
22 of such a recipient is limited to the period of the emergency,
23 in accordance with federal regulations.
24 (5) Subject to specific federal authorization, a
25 postpartum woman living in a family that has an income that is
26 at or below 185 percent of the most current federal poverty
27 level is eligible for family planning services as specified in
28 s. 409.905(3) for a period of up to 24 months following a
29 pregnancy for which Medicaid paid for pregnancy-related
30 services.
31 (6) A child under 1 year of age who lives in a family
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 whose income is above 185 percent of the most current federal
2 poverty level but equal to or below 200 percent of the most
3 current federal poverty level. In determining the eligibility
4 of such a child, an assets test is not required.
5 (7) A child under 19 years of age who is not eligible
6 for coverage under subsection (6) or under s. 409.903(5), (6),
7 or (7) and who lives in a family whose income is at or below
8 100 percent of the most current federal poverty level. In
9 determining the eligibility of such a child, an assets test is
10 not required.
11 Section 2. Section 409.9045, Florida Statutes, is
12 created to read:
13 409.9045 Continuous eligibility for children.--Once a
14 child is determined eligible for Medicaid coverage under s.
15 409.903 or s. 409.904, the child is eligible for coverage
16 under the Medicaid program for 6 months without a
17 redetermination or reverification of eligibility.
18 Section 3. Section 409.9126, Florida Statutes, is
19 amended to read:
20 409.9126 Children with special health care needs.--
21 (1) As used in this section, the term:
22 (a) "Behavioral health services" means specialized
23 behavioral and substance abuse services for children with
24 serious emotional disturbances or substance abuse problems.
25 (b)(a) "Children's Medical Services network" means an
26 alternative service network that includes health care
27 providers and health care facilities specified in chapter 391
28 and ss. 383.15-383.21, 383.216, and 415.5055.
29 (c)(b) "Children with special health care needs" means
30 those children whose serious or chronic physical, behavioral,
31 or developmental conditions require extensive preventive and
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 maintenance care beyond that required by typically healthy
2 children. Health care utilization by these children exceeds
3 the statistically expected usage of the normal child matched
4 for chronological age and often needs complex care requiring
5 multiple providers, rehabilitation services, and specialized
6 equipment in a number of different settings.
7 (2) The Legislature finds that Medicaid-eligible
8 children with special health care needs require a
9 comprehensive, continuous, and coordinated system of health
10 care that links community-based health care with
11 multidisciplinary, regional, and tertiary care. The
12 Legislature finds that Florida's Children's Medical Services
13 program provides a full continuum of coordinated,
14 comprehensive services for children with special health care
15 needs.
16 (3) Except as provided in subsections (8) and (9),
17 children eligible for Children's Medical Services who receive
18 Medicaid benefits, and other Medicaid-eligible children with
19 special health care needs, shall be exempt from the provisions
20 of s. 409.9122 and shall be served through the Children's
21 Medical Services network. The Children's Medical Services
22 network shall also be available to children with special
23 health care needs who are eligible for health benefits
24 coverage other than Medicaid through the Florida Kids Health
25 program.
26 (4) The Legislature directs the agency to apply to the
27 federal Health Care Financing Administration for a waiver to
28 assign to the Children's Medical Services network all
29 Medicaid-eligible children who meet the criteria for
30 participation in the Children's Medical Services program as
31 specified in s. 391.021(2), and other Medicaid-eligible
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 children with special health care needs.
2 (5) The Children's Medical Services program shall
3 assign a qualified MediPass primary care provider from the
4 Children's Medical Services network who shall serve as the
5 gatekeeper and who shall be responsible for the provision or
6 authorization of all health services to a child who has been
7 assigned to the Children's Medical Services network by the
8 Medicaid program.
9 (6) Services provided to Medicaid-eligible children
10 through the Children's Medical Services network shall be
11 reimbursed on a fee-for-service basis and shall utilize a
12 primary care case management process. Reimbursement to the
13 Children's Medical Services Network for services provided to
14 children with special health care needs who are enrolled in
15 the Florida Kids Health program and who are not Medicaid
16 recipients shall be on a capitated basis. The agency, in
17 consultation with the Department of Health, shall establish an
18 enhanced premium for services provided by the Children's
19 Medical Services network to children with special health care
20 needs who are enrolled in the Florida Kids Health program and
21 who are not Medicaid recipients.
22 (7) The agency, in consultation with the Children's
23 Medical Services program, shall develop by rule
24 quality-of-care and service integration standards.
25 (8) The agency may issue a request for proposals,
26 based on the quality-of-care and service integration
27 standards, to allow managed care plans that have contracts
28 with the Medicaid program to provide services to
29 Medicaid-eligible children with special health care needs.
30 (9) The agency shall approve requests to provide
31 services to Medicaid-eligible children with special health
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 care needs from managed care plans that meet quality-of-care
2 and service integration standards and are in good standing
3 with the agency. The agency shall monitor on a quarterly
4 basis managed care plans which have been approved to provide
5 services to Medicaid-eligible children with special health
6 care needs.
7 (10) The agency, in consultation with the Department
8 of Health and Rehabilitative Services, shall adopt rules that
9 address Medicaid requirements for referral, enrollment, and
10 disenrollment of children with special health care needs who
11 are enrolled in Medicaid managed care plans and who may
12 benefit from the Children's Medical Services network.
13 (11) The Children's Medical Services network may
14 contract with school districts participating in the certified
15 school match program pursuant to ss. 236.0812 and 409.908(21)
16 for the provision of school-based services, as provided for in
17 s. 409.9071, for Medicaid-eligible children who are enrolled
18 in the Children's Medical Services network.
19 (12) The Children's Medical Services network, when
20 providing services to children who receive Medicaid benefits,
21 other Medicaid-eligible children with special health care
22 needs, and children participating in the Florida Kids Health
23 Program who have special health care needs, shall not be
24 subject to the licensing requirements of the Florida Insurance
25 Code or rules of the Department of Insurance.
26 (13)(12) After 1 complete year of operation, the
27 agency shall conduct an evaluation of the Children's Medical
28 Services network. The evaluation shall include, but not be
29 limited to, an assessment of whether the use of the Children's
30 Medical Services network is less costly than the provision of
31 the services would have been in the Medicaid fee-for-service
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 program. The evaluation also shall include an assessment of
2 patient satisfaction with the Children's Medical Services
3 network, an assessment of the quality of care delivered
4 through the network, and recommendations for further improving
5 the performance of the network. The agency shall report the
6 evaluation findings to the Governor and the chairpersons of
7 the appropriations and health care committees of each chamber
8 of the Legislature.
9 (14) In order to ensure a high level of integration of
10 physical and behavioral health care and to meet the more
11 intensive treatment needs of enrollees with the most serious
12 emotional disturbance or substance abuse problems, the
13 Department of Health shall contract with the Department of
14 Children and Family Services to provide behavioral health
15 services to children with special health care needs. The
16 Department of Children and Family Services in consultation
17 with the Department of Health, is authorized to establish the
18 following:
19 (a) The scope of behavioral health services, including
20 duration and frequency;
21 (b) Clinical guidelines for referral to behavioral
22 health services;
23 (c) Behavioral health services standards;
24 (d) Performance-based measures and outcomes for
25 behavioral health services;
26 (e) Practice guidelines for behavioral health services
27 to ensure cost-effective treatment and to prevent unnecessary
28 expenditures; and
29 (f) Rules to implement this subsection.
30 Section 4. Section 409.810, Florida Statutes, is
31 created to read:
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 409.810 Short title.--Sections 409.810-409.820 may be
2 cited as the "Florida Kids Health Act."
3 Section 5. Section 409.811, Florida Statutes, is
4 created to read:
5 409.811 Definitions.--As used in ss. 409.810-409.820,
6 the term:
7 (1) "Actuarially equivalent" means that:
8 (a) The aggregate value of the benefits included in
9 health benefits coverage is equal to the value of the benefits
10 in the benchmark benefit plan; and
11 (b) The benefits included in health benefits coverage
12 are substantially similar to the benefits included in the
13 benchmark benefit plan, except that preventive health services
14 must be the same as in the benchmark benefit plan.
15 (2) "Agency" means the Agency for Health Care
16 Administration.
17 (3) "Applicant" means a parent or guardian of a child
18 or a child whose disability of nonage has been removed under
19 chapter 743 who applies for determination of eligibility for
20 health benefits coverage under ss. 409.810-409.820.
21 (4) "Benchmark benefit plan" means the form and level
22 of health benefits coverage established in s. 409.815.
23 (5) "Child" means any person under 19 years of age.
24 (6) "Child with special health care needs" means a
25 child whose serious or chronic physical or developmental
26 condition requires extensive preventive and maintenance care
27 beyond that required by typically healthy children. Health
28 care utilization by such a child exceeds the statistically
29 expected usage of the normal child matched for chronological
30 age and such child often needs complex care requiring multiple
31 providers, rehabilitation services, and specialized equipment
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 in a number of different settings.
2 (7) "Community rate" means a method used to develop
3 premiums for a health insurance plan that spreads financial
4 risk across a large population and allows adjustments only for
5 age, gender, family composition, and geographic area.
6 (8) "Enrollee" means a child who has been determined
7 eligible for and is receiving coverage under ss.
8 409.810-409.820.
9 (9) "Enrollment ceiling" means the maximum number of
10 children receiving premium assistance payments, excluding
11 children enrolled in Medicaid, that may be enrolled at any
12 time in the Florida Kids Health program. The maximum number
13 shall be established annually in the General Appropriations
14 Act or by general law.
15 (10) "Family" means the group or the individuals whose
16 income is considered in determining eligibility for the
17 Florida Kids Health program. The family includes a child,
18 custodial parent, or caretaker relative who resides in the
19 same house or living unit or, in the case of a child whose
20 disability of nonage has been removed under chapter 473, the
21 child. The family may also include individuals whose income
22 and resources are considered in whole or in part in
23 determining eligibility of the child.
24 (11) "Family income" means cash received at periodic
25 intervals from any source, such as wages, benefits,
26 contributions, or rental property. Income also may include any
27 money that would have been counted as income under the AFDC
28 state plan in effect prior to August 22, 1996.
29 (12) "Guarantee issue" means that health benefits
30 coverage must be offered to an individual regardless of the
31 individual's health status, preexisting condition, or claims
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 history.
2 (13) "Health benefits coverage" means protection that
3 provides payment of benefits for covered health care services
4 or that otherwise provides, either directly or through
5 arrangements with other persons, covered health care services
6 on a prepaid per capita basis or on a prepaid aggregate
7 fixed-sum basis.
8 (14) "Health insurance plan" means health benefits
9 coverage under the following:
10 (a) A health plan offered by any certified health
11 maintenance organization or authorized health insurer, except
12 a plan that is limited to the following: a limited benefit,
13 specified disease, or specified accident; hospital indemnity;
14 accident only; limited benefit convalescent care; Medicare
15 supplement; credit disability; dental; vision; long-term care;
16 disability income; coverage issued as a supplement to another
17 health plan; workers' compensation liability or other
18 insurance; or motor vehicle medical payment only; or
19 (b) An employee welfare benefit plan that includes
20 health benefits established under the Employee Retirement
21 Income Security Act of 1974, as amended.
22 (15) "Medicaid" means the medical assistance program
23 authorized by Title XIX of the Social Security Act, and
24 regulations thereunder, and ss. 409.901-409.9205, as
25 administered in this state by the agency.
26 (16) "Medically necessary" means the use of any
27 medical treatment, service, equipment, or supply necessary to
28 palliate the effects of a terminal condition, or to prevent,
29 diagnose, correct, cure, alleviate, or preclude deterioration
30 of a condition that threatens life, causes pain or suffering,
31 or results in illness or infirmity and which is:
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Amendment No.
1 (a) Consistent with the symptom, diagnosis, and
2 treatment of the enrollee's condition;
3 (b) Provided in accordance with generally accepted
4 standards of medical practice;
5 (c) Not primarily intended for the convenience of the
6 enrollee, the enrollee's family, or the health care provider;
7 (d) The most appropriate level of supply or service
8 for the diagnosis and treatment of the enrollee's condition;
9 and
10 (e) Approved by the appropriate medical body or health
11 care specialty involved as effective, appropriate, and
12 essential for the care and treatment of the enrollee's
13 condition.
14 (17) "Preexisting condition exclusion" means, with
15 respect to coverage, a limitation or exclusion of benefits
16 relating to a condition based on the fact that the condition
17 was present before the date of enrollment for such coverage,
18 whether or not any medical advice, diagnosis, care, or
19 treatment was recommended or received before such date.
20 (18) "Premium" means the entire cost of a health
21 insurance plan, including the administration fee or the risk
22 assumption charge.
23 (19) "Premium assistance payment" means the monthly
24 consideration paid by the agency per enrollee in the Florida
25 Kids Health program towards health insurance premiums.
26 (20) "Program" means the Florida Kids Health program,
27 the medical assistance program authorized by Title XXI of the
28 Social Security Act as part of the federal Balanced Budget Act
29 of 1997.
30 (21) "Qualified alien" means an alien as defined in s.
31 431 of the Personal Responsibility and Work Opportunity
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
2 (22) "Resident" means a United States citizen, or
3 qualified alien, who is domiciled in this state.
4 (23) "Rural county" means a county having a population
5 density of less than 100 persons per square mile, or a county
6 defined by the most recent United States Census as rural, in
7 which there is no prepaid health plan participating in the
8 Medicaid program as of July 1, 1998.
9 (24) "Substantially similar" means that, with respect
10 to additional services as defined in s. 2103(c)(2) of Title
11 XXI of the Social Security Act, these services must have an
12 actuarial value equal to at least 75 percent of the actuarial
13 value of the coverage for that service in the benchmark
14 benefit plan and, with respect to the basic services as
15 defined in s. 2103(c)(1) of Title XXI of the Social Security
16 Act, these services must be the same as the services in the
17 benchmark benefit plan.
18 Section 6. Section 409.812, Florida Statutes, is
19 created to read:
20 409.812 Program created; purpose.--The Florida Kids
21 Health program is created to provide a defined set of health
22 benefits to previously uninsured, low-income children through
23 the establishment of a variety of affordable health benefits
24 coverage options from which families may select coverage and
25 through which families may contribute financially to the
26 health care of their children.
27 Section 7. Section 409.813, Florida Statutes, is
28 created to read:
29 409.813 Program components; entitlement and
30 nonentitlement.--The Florida Kids Health program includes
31 health benefits coverage provided to children through:
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (1) Medicaid;
2 (2) Medikids as created in s. 409.8132;
3 (3) The Florida Healthy Kids Corporation as created in
4 s. 624.91;
5 (4) Employer-sponsored group health insurance plans
6 approved under ss. 409.810-409.820; and
7 (5) The Children's Medical Services network
8 established in s. 409.9126.
9
10 Except for coverage under the Medicaid program, coverage under
11 the Florida Kids Health program is not an entitlement.
12 Section 8. Section 409.8132, Florida Statutes, is
13 created to read:
14 409.8132 Medikids program component.--
15 (1) PROGRAM COMPONENT CREATED; PURPOSE.--The Medikids
16 program component is created in the Agency for Health Care
17 Administration to provide health care services under the
18 Florida Kids Health program to eligible children using the
19 administrative structure and provider network of the Medicaid
20 program.
21 (2) ADMINISTRATION.--The director of the agency shall
22 appoint an administrator of the Medikids program component,
23 which shall be located in the Division of State Health
24 Purchasing. The Agency for Health Care Administration is
25 designated as the state agency authorized to make payments for
26 medical assistance and related services for the Medikids
27 program component of the Florida Kids Health program. Payments
28 shall be made, subject to any limitations or directions in the
29 General Appropriations Act, only for covered services provided
30 to eligible children by qualified health care providers under
31 the Florida Kids Health program.
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (3) INSURANCE LICENSURE NOT REQUIRED.--The Medikids
2 program component shall not be subject to the licensing
3 requirements of the Florida Insurance Code or rules of the
4 Department of Insurance.
5 (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.--The
6 provisions of ss. 409.907, 409.908, 409.910, 409.912,
7 409.9121, 409.9122, 409.9123, 409.9124, 409.9127, 409.9128,
8 409.913, 409.916, 409.919, 409.920, and 409.9205, apply to the
9 administration of the Medikids program component of the
10 Florida Kids Health program, except that s. 409.9122 applies
11 to Medikids as modified by the provisions of subsection (7).
12 (5) BENEFITS.--Benefits provided under the Medikids
13 program component shall be the same benefits provided to
14 children as specified in ss. 409.905 and 409.906.
15 (6) ELIGIBILITY.--A child who has attained the age of
16 1 year, but has not attained the age of 4 years, is eligible
17 to enroll in the Medikids program component of the Florida
18 Kids Health program, if the child is a member of a family that
19 has a family income that exceeds 133 percent of the current
20 federal poverty level, but that is equal to or below 200
21 percent of the current federal poverty level. In determining
22 the eligibility of such a child, an assets test is not
23 required. A child who is eligible for Medikids may elect to
24 enroll in Florida Healthy Kids coverage or employer-sponsored
25 group coverage.
26 (7) ENROLLMENT.--Enrollment in the Medikids program
27 component may only occur during periodic open enrollment
28 periods as specified by the agency. During the first 12 months
29 of the program, there shall be at least one, but no more than
30 three, open enrollment periods. The initial open enrollment
31 period shall be for 60 days, and subsequent open enrollment
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Amendment No.
1 periods during the first year of operation of the program
2 shall be for 30 days. After the first year of the program, the
3 agency shall determine the frequency and duration of open
4 enrollment periods. A child may apply for enrollment in the
5 Medikids program component and proceed through the eligibility
6 determination process at any time throughout the year.
7 However, enrollment in Medikids shall not begin until the next
8 open enrollment period; and a child may not receive services
9 under the Medikids program until the child is enrolled in a
10 managed care plan or MediPass. In addition, once a child is
11 determined eligible, the child may receive choice counseling
12 and select a managed care plan or MediPass. A child may select
13 MediPass under the Medikids program component only in counties
14 that have fewer than two managed care plans available to serve
15 Medicaid recipients and only if the federal Health Care
16 Financing Administration determines that MediPass constitutes
17 "health insurance coverage" as defined in Title XXI of the
18 Social Security Act.
19 (8) SPECIAL ENROLLMENT PERIODS.--The agency shall
20 establish a special enrollment period of 30 days' duration for
21 any child who is enrolled in Medicaid if such child loses
22 Medicaid eligibility and becomes eligible for Medikids or if
23 such child moves to another county that is not within the
24 coverage area of the child's Medikids managed care plan or
25 MediPass provider.
26 (9) PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
27 shall establish enrollment criteria that must include
28 penalties or waiting periods of not fewer than 60 days for
29 reinstatement of coverage upon voluntary cancellation for
30 nonpayment of premiums.
31 Section 9. Section 409.8135, Florida Statutes, is
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 created to read:
2 409.8135 Program enrollment and expenditure
3 ceilings.--
4 (1) Except for the Medicaid program, a ceiling shall
5 be placed on annual federal and state expenditures and on
6 enrollment in the Florida Kids Health program as provided each
7 year in the General Appropriations Act. The agency, in
8 consultation with the Department of Health, may propose to
9 increase the enrollment ceiling in accordance with chapter
10 216.
11 (2) Except for the Medicaid program, whenever the
12 Social Services Estimating Conference determines that there is
13 presently, or will be by the end of the current fiscal year,
14 insufficient funds to finance the current or projected
15 enrollment in the program, all additional enrollment must
16 cease and additional enrollment may not resume until
17 sufficient funds are available to finance such enrollment.
18 (3) The agency shall collect and analyze the data
19 needed to project program enrollment, including participation
20 rates, caseloads, and expenditures. The agency shall report
21 the caseload and expenditure trends to the Social Services
22 Estimating Conference in accordance with chapter 216.
23 Section 10. Section 409.814, Florida Statutes, is
24 created to read:
25 409.814 Eligibility.--A child whose family income is
26 equal to or below 200 percent of the federal poverty level is
27 eligible for the Florida Kids Health program as provided in
28 this section. In determining the eligibility of such a child,
29 an assets test is not required.
30 (1) A child who is eligible for Medicaid coverage
31 under s. 409.903 or s. 409.904 must be enrolled in Medicaid
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 and is not eligible to receive health benefits under any other
2 health benefits coverage authorized under ss. 409.810-409.820.
3 (2) A child who is not eligible for Medicaid, but who
4 is eligible for the program, may obtain coverage under any of
5 the other types of health benefits coverage authorized in ss.
6 409.810-409.820 if such coverage is approved and available in
7 the county in which the child resides.
8 (3) A child who is eligible for the program under
9 subsection (1) or (2) and who is a child with special health
10 care needs, as determined through a risk-screening instrument,
11 is eligible for health benefits coverage from and may be
12 referred to the Children's Medical Services network.
13 (4) The following children are not eligible to receive
14 health benefits coverage under ss. 409.810-409.820, except
15 under Medicaid if the child would have been eligible for
16 Medicaid under s. 409.903 or s. 409.904 as of June 1, 1997:
17 (a) A child who is eligible for coverage under a state
18 health benefits plan on the basis of a family member's
19 employment with a public agency in the state;
20 (b) A child who is covered under a group health
21 benefit plan or under other health insurance coverage,
22 excluding coverage provided under the Florida Healthy Kids
23 Corporation as established under s. 624.91;
24 (c) A child who is seeking premium assistance for
25 employer-sponsored group coverage, if the child has been
26 covered by the same employer's group coverage during the 6
27 months prior to the family's submitting an application for
28 determination of eligibility under the program;
29 (d) A child who is an alien, but who does not meet the
30 definition of qualified alien, in the United States; or
31 (e) A child who is an inmate of a public institution
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 or a patient in an institution for mental diseases.
2 (5) A child whose family income is above 200 percent
3 of the federal poverty level may participate in the program,
4 excluding the Medicaid program, but is subject to the
5 following provisions:
6 (a) The family is not eligible for premium assistance
7 payments and must pay the full cost of the premium, including
8 any administrative costs. Children described in this
9 subsection are not counted in the annual enrollment ceiling
10 for the Florida Kids Health program.
11 (b) The agency is authorized to place limits on
12 enrollment in Medikids by these children in order to avoid
13 adverse selection. The number of children participating in
14 Medikids whose family income exceeds 200 percent of the
15 federal poverty level must not exceed 10 percent of total
16 enrollees in the Medikids program.
17 (c) The board of directors of the Florida Healthy Kids
18 Corporation is authorized to place limits on enrollment of
19 these children in order to avoid adverse selection. In
20 addition, the board is authorized to offer a reduced benefit
21 package to these children in order to limit program costs for
22 such families. The number of children participating in Healthy
23 Kids whose family income exceeds 200 percent of the federal
24 poverty level must not exceed 10 percent of total enrollees in
25 the Healthy Kids program.
26 (6) Once a child is determined eligible for the
27 program, the child is eligible for coverage under the program
28 for 6 months without a redetermination or reverification of
29 eligibility if the family continues to pay the applicable
30 premium.
31 Section 11. Section 409.815, Florida Statutes, is
18
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 created to read:
2 409.815 Health benefits coverage; limitations.--
3 (1) MEDICAID BENEFITS.--For purposes of this program,
4 benefits available under the Medicaid program include those
5 goods and services provided under the medical assistance
6 program authorized by Title XIX of the Social Security Act,
7 and regulations thereunder, as administered in this state by
8 the agency. This includes those mandatory Medicaid services
9 authorized under s. 409.905 and optional Medicaid services
10 authorized under s. 409.906, rendered on behalf of eligible
11 individuals by qualified providers, in accordance with federal
12 requirements for Title XIX, subject to any limitations or
13 directions provided for in the General Appropriations Act or
14 chapter 216, and according to methodologies and limitations
15 set forth in agency rules and policy manuals and handbooks
16 incorporated by reference thereto.
17 (2) BENCHMARK BENEFITS.--In order for health benefits
18 coverage to qualify for premium assistance payments for an
19 eligible child under ss. 409.810-409.820, the health benefits
20 coverage, except for coverage under Medicaid and Medikids,
21 must include the following minimum benefits as medically
22 necessary.
23 (a) Preventive health services.--Covered services
24 include:
25 1. Well-child care, including services recommended in
26 the Guidelines for Health Supervision of Children and Youth as
27 developed by the American Academy of Pediatrics;
28 2. Immunizations and injections;
29 3. Health education counseling and clinical services;
30 4. Vision screening; and
31 5. Hearing screening.
19
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (b) Inpatient hospital services.--All covered services
2 provided for the medical care and treatment of an enrollee who
3 is admitted as an inpatient to a hospital licensed under part
4 I of chapter 395, with the following exceptions:
5 1. All admissions must be authorized by the enrollee's
6 health benefits coverage provider.
7 2. The length of the patient stay shall be determined
8 on the medical condition of the enrollee in relation to the
9 necessary and appropriate level of care.
10 3. Room and board may be limited to semiprivate
11 accommodations unless a private room is considered medically
12 necessary or semiprivate accommodations are not available.
13 4. Admissions for rehabilitation and physical therapy
14 are limited to 15 days per contract year.
15 (c) Emergency services.--Covered services include
16 visits to an emergency room or other licensed facility if
17 needed immediately due to an injury or illness and delay means
18 risk of permanent damage to the enrollee's health.
19 (d) Maternity services.--Covered services include
20 maternity and newborn care, including prenatal and postnatal
21 care with the following limitations:
22 1. Coverage may be limited to the fee for vaginal
23 deliveries; and
24 2. Initial inpatient care for newborn infants of
25 enrolled adolescents shall be covered, including normal
26 newborn care, nursery charges, and the initial pediatric or
27 neonatal examination, and the infant may be covered for up to
28 3 days following birth.
29 (e) Organ transplantation services.--Covered services
30 include pretransplant, transplant, and postdischarge services
31 and treatment of complications after transplantation for
20
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 transplants deemed necessary and appropriate within the
2 guidelines set by the Agency for Health Care Administration
3 Organ Transplant Advisory Council under s. 381.0602 or the
4 Agency for Health Care Administration Bone Marrow Transplant
5 Advisory Panel under s. 627.4236.
6 (f) Outpatient services.--Covered services include
7 preventive, diagnostic, therapeutic, palliative care, and
8 other services provided to an enrollee in the outpatient
9 portion of a health facility licensed under chapter 395,
10 except for the following limitations:
11 1. Services must be authorized by the enrollee's
12 health benefits coverage provider; and
13 2. Treatment for temporomandibular joint disease (TMJ)
14 is specifically excluded.
15 (g) Behavioral health services.--
16 1. Mental health benefits include:
17 a. Inpatient services, limited to not more than 30
18 inpatient days per contract year for psychiatric admissions;
19 and
20 b. Outpatient services, including outpatient visits
21 for psychological or psychiatric evaluation, diagnosis, and
22 treatment by a licensed mental health professional, limited to
23 a maximum of 40 outpatient visits each contract year.
24 2. Substance abuse services include:
25 a. Inpatient services limited to no more than 7
26 inpatient days per contract year for medical detoxification
27 only and 30 days of residential services; and
28 b. Outpatient services, including evaluation,
29 diagnosis, and treatment by a licensed practitioner, limited
30 to a maximum of 40 outpatient visits per contract year.
31 (h) Durable medical equipment.--Covered services
21
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 include equipment and devices that are medically indicated to
2 assist in the treatment of a medical condition and
3 specifically prescribed as medically necessary, with the
4 following limitations:
5 1. Low vision and telescopic aides are not included.
6 2. Corrective lenses and frames may be limited to one
7 pair every 2 years, unless the prescription or head size of
8 the enrollee changes.
9 3. Hearing aids shall be covered only when medically
10 indicated to assist in the treatment of a medical condition.
11 4. Covered prosthetic devices include artificial eyes
12 and limbs, braces, and other artificial aids.
13 (i) Health practitioner services.--Covered services
14 include services and procedures rendered to an enrollee when
15 performed to diagnose and treat diseases, injuries, or other
16 conditions, including care rendered by health practitioners
17 acting within the scope of their practice, with the following
18 exceptions:
19 1. Chiropractic services shall be provided in the same
20 manner as in the Florida Medicaid Program.
21 2. Podiatric services may be limited to one visit per
22 day totaling two visits per month for specific foot disorders.
23 (j) Home health services.--Covered services include
24 prescribed home visits by both registered and licensed
25 practical nurses to provide skilled nursing services on a
26 part-time intermittent basis, subject to the following
27 limitations:
28 1. Coverage may be limited to include skilled nursing
29 services only;
30 2. Meals, housekeeping, and personal comfort items may
31 be excluded; and
22
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 3. Private duty nursing is limited to circumstances
2 where such care is medically necessary.
3 (k) Hospice services.--Covered services include
4 reasonable and necessary services for palliation or management
5 of an enrollee's terminal illness, with the following
6 exceptions:
7 1. Once a family elects to receive hospice care for an
8 enrollee, other services that treat the terminal condition
9 will not be covered; and
10 2. Services required for conditions totally unrelated
11 to the terminal condition are covered to the extent that the
12 services are included in this section.
13 (l) Laboratory and X-ray services.--Covered services
14 include diagnostic testing, including clinical radiologic,
15 laboratory, and other diagnostic tests.
16 (m) Nursing facility services.--Covered services
17 include regular nursing services, rehabilitation services,
18 drugs and biologicals, medical supplies, and the use of
19 appliances and equipment furnished by the facility, with the
20 following limitations:
21 1. All admissions must be authorized by the health
22 benefits coverage provider.
23 2. The length of the patient stay shall be determined
24 on the medical condition of the enrollee in relation to the
25 necessary and appropriate level of care, but is limited to not
26 more than 100 days per contract year.
27 3. Room and board may be limited to semiprivate
28 accommodations, unless a private room is considered medically
29 necessary or semiprivate accommodations are not available.
30 4. Specialized treatment centers and independent
31 kidney disease treatment centers are excluded.
23
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 5. Private duty nurses, television, and custodial care
2 are excluded.
3 6. Admissions for rehabilitation and physical therapy
4 are limited to 15 days per contract year.
5 (n) Prescribed drugs.--
6 1. Coverage shall include drugs prescribed for the
7 treatment of illness or injury when prescribed by a licensed
8 health practitioner acting within the scope of his or her
9 practice.
10 2. Prescribed drugs may be limited to generics if
11 available and brand name products if a generic substitution is
12 not available, unless the prescribing licensed health
13 practitioner indicates that a brand name is medically
14 necessary.
15 3. Prescribed drugs covered under this section shall
16 include all prescribed drugs covered under the Florida
17 Medicaid program.
18 (o) Therapy services.--Covered services include
19 rehabilitative services, including occupational, physical,
20 respiratory, and speech therapies, with the following
21 limitations:
22 1. Services must be for short-term rehabilitation
23 where significant improvement in the enrollee's condition will
24 result; and
25 2. Services shall be no more than twenty-four
26 treatment sessions within a 60-day period per episode or
27 injury, with the 60-day period beginning with the first
28 treatment.
29 (p) Transportation services.--Covered services include
30 emergency transportation required in response to an emergency
31 situation.
24
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (q) Lifetime maximum.--Health benefits coverage
2 obtained under ss. 409.810-409.820 shall pay an enrollee's
3 covered expenses at a lifetime maximum of $1 million per
4 covered child.
5 (r) Cost-sharing.--Cost-sharing provisions must comply
6 with s. 409.816.
7 (s) Exclusions.--
8 1. Experimental or investigational procedures that
9 have not been clinically proven by reliable evidence are
10 excluded;
11 2. Services performed for cosmetic purposes only or
12 for the convenience of the enrollee are excluded; and
13 3. Abortion may be covered only if necessary to save
14 the life of the mother or if the pregnancy is the result of an
15 act of rape or incest.
16 (t) Enhancements to minimum requirements.--
17 1. This section sets the minimum benefits that must be
18 included in any health benefits coverage, other than Medicaid
19 or Medikids coverage, offered under ss. 409.810-409.820.
20 Health benefits coverage may include additional benefits not
21 included under this subsection, but may not include benefits
22 excluded under paragraph (s).
23 2. Health benefits coverage may extend any limitations
24 beyond the minimum benefits described in this section.
25
26 Except for the Children's Medical Services network, the agency
27 may not increase the premium assistance payment for either
28 additional benefits provided beyond the minimum benefits
29 described in this section or the imposition of less
30 restrictive service limitations.
31 (u) Applicability of other state laws.--Health
25
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 insurers, health maintenance organizations, and their agents
2 are subject to the provisions of the Florida Insurance Code,
3 except for any such provisions waived in this section.
4 1. Except as expressly provided in this section, a law
5 requiring coverage for a specific health care service or
6 benefit, or a law requiring reimbursement, utilization, or
7 consideration of a specific category of licensed health care
8 practitioner, does not apply to an insurance health plan
9 policy or contract offered or delivered under ss.
10 409.810-409.820 unless that law is made expressly applicable
11 to such policies or contracts.
12 2. Notwithstanding chapter 641, a health maintenance
13 organization may issue contracts providing benefits equal to,
14 exceeding, or actuarially equivalent to the benchmark benefit
15 plan authorized by this section and may pay providers located
16 in a rural county negotiated fees or Medicaid reimbursement
17 rates for services provided to enrollees who are residents of
18 the rural county.
19 Section 12. Section 409.816, Florida Statutes, is
20 created to read:
21 409.816 Limitations on premiums and cost-sharing.--The
22 following limitations on premiums and cost-sharing are
23 established for the program.
24 (1) Enrollees who receive coverage under the Medicaid
25 program may not be required to pay:
26 (a) Enrollment fees, premiums, or similar charges; or
27 (b) Copayments, deductibles, coinsurance, or similar
28 charges.
29 (2) Enrollees in families with a family income equal
30 to or below 150 percent of the federal poverty level and who
31 are not receiving coverage under the Medicaid program may not
26
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 be required to pay:
2 (a) Enrollment fees, premiums, or similar charges that
3 exceed the maximum monthly charge permitted under s.
4 1916(b)(1) of the Social Security Act; or
5 (b) Copayments, deductibles, coinsurance, or similar
6 charges that exceed a nominal amount, as determined consistent
7 with regulations referred to in s. 1916(a)(3) of the Social
8 Security Act. However, such charges may not be imposed for
9 preventive services, including well-baby and well-child care,
10 age-appropriate immunizations, and routine hearing and vision
11 screenings.
12 (3) Enrollees in families with a family income above
13 150 percent of the federal poverty level and who are not
14 receiving coverage under the Medicaid program, or who are not
15 eligible under s. 409.814(5), may be required to pay
16 enrollment fees, premiums, copayments, deductibles,
17 coinsurance, or similar charges on a sliding scale related to
18 income, except that the total annual aggregate cost-sharing
19 with respect to all children in a family may not exceed 5
20 percent of the family's income. However, copayments,
21 deductibles, coinsurance, or similar charges may not be
22 imposed for preventive services, including well-baby and
23 well-child care, age-appropriate immunizations, and routine
24 hearing and vision screenings.
25 Section 13. Section 409.817, Florida Statutes, is
26 created to read:
27 409.817 Approval of health benefits coverage;
28 financial assistance.--In order for health insurance coverage
29 to qualify for premium assistance payments for an eligible
30 child under ss. 409.810-409.820, the health benefits coverage
31 must:
27
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (1) Be certified by the Department of Insurance under
2 s. 409.818 as meeting, exceeding, or being actuarially
3 equivalent to the benchmark benefit plan;
4 (2) Be guarantee issued;
5 (3) Be community rated;
6 (4) Not impose any preexisting condition exclusion for
7 covered benefits; however, group health insurance plans may
8 permit the imposition of a preexisting condition exclusion,
9 but only insofar as it is permitted under s. 627.6561;
10 (5) Comply with the applicable limitations on premiums
11 and cost-sharing in s. 409.816;
12 (6) Comply with the quality assurance and access
13 standards developed under s. 409.820; and
14 (7) Establish periodic open enrollment periods, which
15 may not occur more frequently than quarterly.
16 Section 14. Section 409.8175, Florida Statutes, is
17 created to read:
18 409.8175 Delivery of services in rural counties.--A
19 health maintenance organization or a health insurer may
20 reimburse providers located in a rural county according to the
21 Medicaid fee schedule for services provided to enrollees in
22 rural counties if the provider agrees to accept such fee
23 schedule.
24 Section 15. Section 409.818, Florida Statutes, is
25 created to read:
26 409.818 Administration.--In order to implement ss.
27 409.810-409.820, the following agencies shall have the
28 following duties:
29 (1) The Department of Children and Family Services
30 shall:
31 (a) Develop a simplified eligibility application
28
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 mail-in form to be used for determining the eligibility of
2 children for coverage under the program in consultation with
3 the agency, the Department of Health, and the Florida Healthy
4 Kids Corporation. The simplified eligibility application form
5 must include an item that provides an opportunity for the
6 applicant to indicate whether coverage is being sought for a
7 child with special health care needs. Families applying for
8 the program must also be able to use the simplified
9 application form without having to pay a premium.
10 (b) Establish and maintain the eligibility
11 determination process under the program. The department shall
12 directly, or through the services of a contracted third-party
13 administrator, establish and maintain a process for
14 determining eligibility of children for coverage under the
15 program. The eligibility determination process must be used
16 solely for determining eligibility of applicants for health
17 benefits coverage under the program. The eligibility
18 determination process must include an initial determination of
19 eligibility for any coverage offered under the program, as
20 well as a redetermination or reverification of eligibility
21 each subsequent 6 months. In conducting an eligibility
22 determination, the department shall determine if the child has
23 special health care needs.
24 (c) Inform program applicants about eligibility
25 determinations and provide information about eligibility of
26 applicants to the Medicaid program, Medikids, the Children's
27 Medical Services network, the Florida Healthy Kids
28 Corporation, and insurers and their agents through a
29 centralized coordinating office.
30 (d) Adopt rules necessary for conducting program
31 eligibility functions.
29
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (2) The Department of Health shall:
2 (a) Design an eligibility intake process for the
3 program, in coordination with the Department of Children and
4 Family Services, the agency, and the Florida Healthy Kids
5 Corporation. The eligibility intake process may include local
6 intake points that are determined by the Department of Health
7 in coordination with the Department of Children and Family
8 Services.
9 (b) Design and implement program outreach activities
10 under s. 409.819.
11 (c) Chair a state-level coordinating council for the
12 program to review and make recommendations concerning the
13 implementation and operation of the program. The coordinating
14 council shall include representatives from the department, the
15 Department of Children and Family Services, the agency, the
16 Florida Healthy Kids Corporation, the Department of Insurance,
17 health insurers, families participating in the program, and
18 organizations representing low-income families.
19 (d) Adopt rules necessary to implement outreach
20 activities.
21 (3) The Agency for Health Care Administration, under
22 the authority granted in s. 409.914(1), shall:
23 (a) Calculate the premium assistance payment necessary
24 to comply with the premium and cost-sharing limitations
25 specified in s. 409.816. The premium assistance payment for
26 each enrollee in an insurance plan participating in the
27 Florida Healthy Kids Corporation shall equal the premium
28 approved by the Florida Healthy Kids Corporation and the
29 Department of Insurance pursuant to ss. 627.410 and 641.31,
30 less any enrollee's share of the premium established within
31 the limitations specified in s. 409.816. The premium
30
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 assistance payment for each enrollee in employer-sponsored
2 health insurance plans approved under ss. 409.810-409.820
3 shall equal the premium for the plan adjusted for any
4 benchmark benefit plan actuarial equivalent benefit rider
5 approved by the Department of Insurance pursuant to ss.
6 627.410 and 641.31, less any enrollee's share of the premium
7 established within the limitations specified in s. 409.816. In
8 calculating the premium assistance payment levels for children
9 with family coverage, the agency shall set the premium
10 assistance payment levels for each child proportionately to
11 the total cost of family coverage.
12 (b) Annually calculate the program enrollment ceiling
13 based on estimated per-child premium assistance payments and
14 the estimated appropriation available for the program.
15 (c) Make premium assistance payments to health
16 insurance plans on a periodic basis. The agency may use its
17 Medicaid fiscal agent or a contracted third-party
18 administrator in making these payments.
19 (d) Monitor compliance with quality assurance and
20 access standards developed under s. 409.820.
21 (e) Establish a mechanism for investigating and
22 resolving complaints and grievances from program applicants,
23 enrollees, and health benefits coverage providers, and
24 maintain a record of complaints and confirmed problems. In the
25 case of a child who is enrolled in a health maintenance
26 organization, the agency must use the provisions of s. 641.511
27 to address grievance reporting and resolution requirements.
28 (f) Approve health benefits coverage for participation
29 in the program, following certification by the Department of
30 Insurance under subsection (4).
31 (g) Adopt rules necessary for calculating premium
31
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 assistance payment levels, calculating the program enrollment
2 ceiling, making premium assistance payments, monitoring access
3 and quality assurance standards, investigating and resolving
4 complaints and grievances, administering the Medikids program,
5 and approving health benefits coverage.
6 (4) The Department of Insurance shall certify that
7 health benefits coverage plans that seek to provide services
8 under the program, except those offered through the Florida
9 Healthy Kids Corporation or the Children's Medical Services
10 network, meet, exceed, or are actuarially equivalent to the
11 benchmark benefit plan and that health insurance plans will be
12 offered at an approved rate. In determining actuarial
13 equivalence of benefits coverage, the Department of Insurance
14 and health insurance plans must comply with the requirements
15 of section 2103 of Title XXI of the Social Security Act. The
16 department shall adopt rules necessary for certifying health
17 benefits coverage plans.
18 (5) The Florida Healthy Kids Corporation shall retain
19 its functions as authorized in s. 624.91, with the exception
20 of its eligibility determination functions relating to
21 coverage under the Florida Kids Health program which shall be
22 assumed by the Department of Children and Family Services.
23 Each fiscal year, the corporation shall establish a maximum
24 number of children by county on a statewide basis who may
25 enroll in the program without requiring local matching funds.
26 Thereafter, the corporation may establish local government
27 matching requirements for supplemental participation in the
28 program. The corporation may vary local matching requirements
29 and enrollment by county depending on factors that may
30 influence the generation of local match, including, but not
31 limited to, population density, per capita income, existing
32
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 local tax effort and other factors.
2 (6) The Agency for Health Care Administration, the
3 Department of Health, the Department of Children and Family
4 Services, and the Department of Insurance have the authority
5 to make program modifications and adopt rules not inconsistent
6 with the administrative responsibilities and rulemaking
7 authority granted in this section which are necessary to
8 overcome any objections of the federal Department of Health
9 and Human Services and obtain approval of the state's child
10 health plan under Title XXI of the Social Security Act.
11 Section 16. Section 154.508, Florida Statutes, is
12 transferred, renumbered as section 409.819, Florida Statutes,
13 and amended to read:
14 409.819 154.508 Identification of low-income,
15 uninsured children; determination of Medicaid eligibility for
16 the Florida Kids Health program; alternative health care
17 information.--The Department of Health Agency for Health Care
18 Administration shall develop a program, in conjunction with
19 the Department of Education, the Department of Children and
20 Family Services, the Agency for Health Care Administration,
21 the Florida Healthy Kids Corporation the Department of Health,
22 local governments, employers school districts, and other
23 stakeholders to identify low-income, uninsured children and,
24 to the extent possible and subject to appropriation, refer
25 them to the Department of Children and Family Services for a
26 Medicaid eligibility determination and provide parents with
27 information about choices alternative sources of health
28 benefits coverage under the Florida Kids Health program care.
29 These activities shall include, but not be limited to:
30 training community providers in effective methods of outreach;
31 conducting public information campaigns designed to publicize
33
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 the Florida Kids Health program, the eligibility requirements
2 of the program, and the procedures for enrollment in the
3 program; and maintaining public awareness of the Florida Kids
4 Health program.
5 Section 17. Section 409.820, Florida Statutes, is
6 created to read:
7 409.820 Quality assurance and access standards.--The
8 Department of Health, in consultation with the agency and the
9 Florida Healthy Kids Corporation, shall develop a common set
10 of quality assurance and access standards for all program
11 components. The standards must include a process for granting
12 exceptions to specific requirements for quality assurance and
13 access. Compliance with the standards shall be a condition of
14 program participation by health benefits coverage providers.
15 Section 18. The following performance measures and
16 standards are adopted for the Florida Kids Health program.--
17 (1) The total number of previously uninsured children
18 who receive health benefits coverage as a result of state
19 activities under Title XXI of the Social Security Act: 254,000
20 uninsured children expected to obtain coverage during the
21 1998-1999 fiscal year.
22 (a) The number of children enrolled in the Medicaid
23 program as a result of eligibility expansions under Title XXI
24 of the Social Security Act: 31,000 children enrolled in
25 Medicaid under new eligibility groups during the 1998-1999
26 fiscal year.
27 (b) The number of children enrolled in the Medicaid
28 program as a result of outreach efforts under Title XXI of the
29 Social Security Act who are eligible for Medicaid but who have
30 not enrolled in the program: 80,000 children previously
31 eligible for Medicaid, but not enrolled in Medicaid, who
34
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 enroll in Medicaid during the 1998-1999 fiscal year.
2 (c) The number of uninsured children enrolled in
3 Medikids under Title XXI of the Social Security Act: 15,500
4 children enrolled in Medikids during the 1998-1999 fiscal
5 year.
6 (d) The number of uninsured children added to the
7 enrollment for the Florida Healthy Kids Corporation program
8 under Title XXI of the Social Security Act: 70,000 additional
9 children enrolled in the Florida Healthy Kids Corporation
10 program during the 1998-1999 fiscal year.
11 (e) The number of uninsured children enrolled in
12 employer-sponsored group health insurance coverage under Title
13 XXI of the Social Security Act: 48,000 uninsured children
14 enrolled in health insurance coverage during the 1998-1999
15 fiscal year.
16 (f) The number of uninsured children enrolled in the
17 Children's Medical Services network under Title XXI of the
18 Social Security Act: 9,500 uninsured children enrolled in the
19 Children's Medical Services network during the 1998-1999
20 fiscal year.
21 (2) The percentage of uninsured children in this state
22 as of July 1, 1998, who receive health benefits coverage under
23 the Florida Kids Health program: 30.9 percent of uninsured
24 children enrolled in the Florida Kids Health program during
25 the 1998-1999 fiscal year.
26 (3) The percentage of children enrolled in the Florida
27 Kids Health program with up-to-date immunizations: 80 percent
28 of enrolled children with up-to-date immunizations.
29 (4) The percentage of compliance with the standards
30 established in the Guidelines for Health Supervision of
31 Children and Youth as developed by the American Academy of
35
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Pediatrics for children eligible for the Florida Kids Health
2 program and served under:
3 (a) Medicaid;
4 (b) Medikids;
5 (c) The Florida Healthy Kids Corporation program; and
6 (d) Health insurance products.
7
8 For each category of coverage, the health care provided is in
9 compliance with the health supervision standards for 80
10 percent of enrolled children.
11 (5) The perception of the enrollee or the enrollee's
12 family concerning coverage provided to children enrolled in
13 the Florida Kids Health program and served under:
14 (a) Medicaid;
15 (b) Medikids;
16 (c) Florida Healthy Kids Corporation;
17 (d) Health insurance products; and
18 (e) Children's Medical Services network.
19
20 For each category of coverage, 90 percent of the enrollees or
21 the enrollee families indicate satisfaction with the care
22 provided under the program.
23 Section 19. The Agency for Health Care Administration
24 shall conduct a study of the feasibility of extending
25 presumptive eligibility for Medicaid to children who have not
26 attained the age of 19. The study shall assess whether
27 families delay seeking health care services or health care
28 coverage because of the lack of presumptive eligibility. The
29 agency shall report its findings to the President of the
30 Senate, the Speaker of the House of Representatives, and the
31 chairpersons of the respective health care committees no later
36
12:26 PM 04/14/98 h4415c1c-10j02
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 than December 31, 1998.
2 Section 20. Section 624.92, Florida Statutes, as
3 created by section 9 of chapter 97-260, Laws of Florida, is
4 repealed.
5 Section 21. For the 1998-1999 fiscal year, the
6 enrollment ceiling for the non-Medicaid portion of the Florida
7 Kids Health program is 270,000 children. Thereafter, the
8 enrollment ceiling shall be established in the General
9 Appropriations Act or by general law.
10 Section 22. The sum of $2 million is appropriated from
11 funds available under Title XXI of the Social Security Act and
12 shall be used for school health services during the 1998-1999
13 fiscal year.
14 Section 23. The provisions of this act which would
15 require changes to contracts in existence on June 30, 1998,
16 between the Florida Healthy Kids Corporation and its
17 contracted providers shall be applied to such contracts upon
18 the renewal of the contracts, but not later than July 1, 2000.
19 Section 24. This act shall take effect July 1, 1998.
20
21
22 ================ T I T L E A M E N D M E N T ===============
23 And the title is amended as follows:
24 Delete everything before the enacting clause
25
26 and insert:
27 A bill to be entitled
28 An act relating to children's health care;
29 amending s. 409.904, F.S.; providing for
30 children under specified ages who are not
31 otherwise eligible for the Medicaid program to
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 be eligible for optional payments for medical
2 assistance; creating s. 409.9045, F.S.;
3 providing for a period of continuous
4 eligibility for Medicaid for children; amending
5 s. 409.9126, F.S.; making the Children's
6 Medical Services network available to certain
7 children who are eligible for the Florida Kids
8 Health program; authorizing the inclusion of
9 behavioral health services as part of the
10 Children's Medical Services network;
11 establishing the reimbursement methodology for
12 services provided to certain children through
13 the Children's Medical Services network;
14 specifying that the Children's Medical Services
15 network is not subject to licensure under the
16 insurance code or rules of the Department of
17 Insurance; directing the Department of Health
18 to contract with the Department of Children and
19 Family Services for certain services for
20 children with special health care needs;
21 authorizing the Department of Children and
22 Family Services to establish certain standards
23 and guidelines; revising provisions to reflect
24 the transfer of duties to the Department of
25 Health; creating s. 409.810, F.S.; providing a
26 short title; creating s. 409.811, F.S.;
27 providing definitions; creating s. 409.812,
28 F.S.; creating and providing the purpose for
29 the Florida Kids Health program; creating s.
30 409.813, F.S.; specifying program components;
31 specifying that certain program components are
38
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 not an entitlement; creating s. 409.8132, F.S.;
2 creating and establishing the purpose of the
3 Medikids program component; providing for
4 administration of Medikids by the Agency for
5 Health Care Administration; exempting Medikids
6 from licensure under the Florida Insurance
7 Code; providing applicability of certain
8 Medicaid requirements; establishing benefit
9 requirements; providing for eligibility;
10 providing enrollment requirements; authorizing
11 penalties for nonpayment of premiums; creating
12 s. 409.8135, F.S.; providing for program
13 enrollment and expenditure ceilings; creating
14 s. 409.814, F.S.; providing eligibility
15 requirements; creating s. 409.815, F.S.;
16 establishing requirements for health benefits
17 coverage under the Florida Kids Health program;
18 creating s. 409.816, F.S.; providing for
19 limitations on premiums and cost-sharing;
20 creating s. 409.817, F.S.; providing for
21 approval of health benefits coverage as a
22 condition of financial assistance; creating s.
23 409.8175, F.S.; authorizing health maintenance
24 organizations and health insurers to reimburse
25 providers in rural counties according to the
26 Medicaid Fee schedule; creating s. 409.818,
27 F.S.; providing for program administration;
28 specifying duties of the Department of Children
29 and Family Services, the Department of Health,
30 the Agency for Health Care Administration, the
31 Department of Insurance, and the Florida
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Healthy Kids Corporation; authorizing certain
2 program modifications related to federal
3 approval; transferring, renumbering, and
4 amending s. 154.508, F.S., relating to outreach
5 activities to identify low-income, uninsured
6 children; creating s. 409.820, F.S.; requiring
7 that the Department of Health develop standards
8 for quality assurance and program access;
9 establishing performance measures and standards
10 for the Florida Kids Health program; directing
11 the Agency for Health Care Administration to
12 conduct a study of Medicaid presumptive
13 eligibility and report its findings to the
14 Legislature; repealing s. 624.92, F.S.;
15 deleting the requirement that the Agency for
16 Health Care Administration apply for a Medicaid
17 federal waiver relating to the Healthy Kids
18 Corporation; providing an appropriation;
19 providing for application of the act to certain
20 contracts between providers and the Florida
21 Healthy Kids Corporation; providing an
22 effective date.
23
24
25
26
27
28
29
30
31
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