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. The Agency for Health Care Administration,
18 working jointly with the Department of Health and the Florida
19 Association of Healthy Start Coalitions, is directed to seek a
20 federal waiver to secure matching funds under Title XIX of the
21 Social Security Act for the Healthy Start program. The federal
22 waiver application must seek Medicaid matching funds utilizing
23 appropriated general revenue and local contributions.
24 Section 2. Section 391.011, Florida Statutes, is
25 amended to read:
26 391.011 Short title.--The provisions of this chapter
27 This act shall be known and may be cited as the "Children's
28 Medical Services Act."
29 Section 3. Section 391.016, Florida Statutes, is
30 amended to read:
31 391.016 Legislative intent.--The Legislature intends
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 that the Children's Medical Services program:
2 (1) Provide to children with special health care needs
3 a family-centered, comprehensive, and coordinated statewide
4 managed system of care that links community-based health care
5 with multidisciplinary, regional, and tertiary pediatric
6 specialty care. The program may provide for the coordination
7 and maintenance of consistency of the medical home for
8 children in families with a Children's Medical Services
9 program participant, in order to achieve family-centered care
10 finds and declares that there is a need to provide medical
11 services for needy children, particularly those with chronic,
12 crippling or potentially crippling and physically handicapping
13 diseases or conditions, and to provide leadership and
14 direction in promoting, planning, and coordinating children's
15 medical care programs so that the full development of each
16 child's potential may be realized.
17 (2) Provide essential preventive, evaluative, and
18 early intervention services for children at risk for or having
19 special health care needs, in order to prevent or reduce long
20 term disabilities.
21 (3) Serve as a principal provider for children with
22 special health care needs under Titles XIX and XXI of the
23 Social Security Act.
24 (4) Be complementary to children's health training
25 programs essential for the maintenance of a skilled pediatric
26 health care workforce for all Floridians.
27 Section 4. Section 391.021, Florida Statutes, is
28 amended to read:
29 391.021 Definitions.--When used in this act, unless
30 the context clearly indicates otherwise:
31 (1) "Children's Medical Services network" or "network"
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 means a statewide managed care service system that includes
2 health care providers, as defined in this section.
3 (2) "Children with special health care needs" means
4 those children under age 21 years whose serious or chronic
5 physical or developmental conditions require extensive
6 preventive and maintenance care beyond that required by
7 typically healthy children. Health care utilization by these
8 children exceeds the statistically expected usage of the
9 normal child adjusted for chronological age. These children
10 often need complex care requiring multiple providers,
11 rehabilitation services, and specialized equipment in a number
12 of different settings.
13 (3)(1) "Department" means the Department of Health.
14 (4)(2) "Eligible individual" means a child with a
15 special health care need or a female of any age with a
16 high-risk pregnancy, or an individual below the age of 21
17 years who has an organic disease, defect, or condition which
18 may hinder the achievement of his or her normal growth and
19 development, and who meets the financial and medical
20 eligibility standards established in s. 391.029. by the
21 department. In addition, where specific legislative
22 appropriation exists, individuals with long-term chronic
23 diseases, such as cystic fibrosis, which originated during
24 childhood and who received services under this act before the
25 age of 21 years shall continue to be eligible beyond that age.
26 (5) "Health care provider" means a health care
27 professional, health care facility, or entity licensed or
28 certified to provide health services in this state that meets
29 the criteria as established by the department.
30 (6)(3) "Health Medical services" includes the
31 prevention, diagnosis, and treatment of human disease, pain,
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 injury, deformity, or disabling physical conditions.
2 (7) "Participant" means an eligible individual who is
3 enrolled in the Children's Medical Services program.
4 (8) "Program" means the Children's Medical Services
5 program established in the Division of Children's Medical
6 Services of the department.
7 Section 5. Section 391.025, Florida Statutes, is
8 created to read:
9 391.025 Applicability and scope.--
10 (1) This act applies to health services provided to
11 eligible individuals who are:
12 (a) Enrolled in the Medicaid program;
13 (b) Enrolled in the Florida Kidcare program; and
14 (c) Uninsured or underinsured, provided that they meet
15 the financial eligibility requirements established in this
16 act, and to the extent that resources are appropriated for
17 their care.
18 (2) The Children's Medical Services program consists
19 of the following components:
20 (a) The infant metabolic screening program established
21 in s. 383.14.
22 (b) The regional perinatal intensive care centers
23 program established in ss. 383.15-383.21.
24 (c) A federal or state program authorized by the
25 Legislature.
26 (d) The developmental evaluation and intervention
27 program.
28 (e) The Children's Medical Services network.
29 (3) The Children's Medical Services program shall not
30 be deemed an insurer and is not subject to the licensing
31 requirements of the Florida Insurance Code or the rules of the
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Department of Insurance, when providing services to children
2 who receive Medicaid benefits, other Medicaid-eligible
3 children with special health care needs, and children
4 participating in the Florida Kidcare program. This exemption
5 shall not extend to contractors.
6 Section 6. Section 391.026, Florida Statutes, is
7 amended to read:
8 391.026 Powers and duties of the department.--To
9 administer its programs of children's medical services, The
10 department shall have the following powers, duties, and
11 responsibilities:
12 (1) To provide or contract for the provision of health
13 medical services to eligible individuals.
14 (2) To determine the medical and financial eligibility
15 standards for the program and to determine the medical and
16 financial eligibility of individuals seeking health medical
17 services from the program.
18 (3) To recommend priorities for the implementation of
19 comprehensive plans and budgets.
20 (4) To coordinate a comprehensive delivery system for
21 eligible individuals to take maximum advantage of all
22 available federal funds.
23 (5) To promote, establish, and coordinate programs
24 relating to children's medical services in cooperation with
25 other public and private agencies and to coordinate funding of
26 health care programs with federal, state, or local indigent
27 health care funding mechanisms.
28 (6) To initiate, coordinate, and request review of
29 applications to federal and state agencies for funds,
30 services, or commodities relating to children's medical
31 programs.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (7) To sponsor or promote grants for projects,
2 programs, education, or research in the field of medical needs
3 of children, with an emphasis on early diagnosis and
4 treatment.
5 (8) To oversee and operate the Children's Medical
6 Services network contract or be contracted with.
7 (9) To establish reimbursement mechanisms for the
8 Children's Medical Services network standards of eligibility
9 for patients of children's medical services programs.
10 (10) To establish Children's Medical Services network
11 standards and credentialing requirements for health care
12 providers and health care services coordinate funding of
13 medical care programs with state or local indigent health care
14 funding mechanisms.
15 (11) To serve as a provider and principal case manager
16 for children with special health care needs under Titles XIX
17 and XXI of the Social Security Act establish standards for
18 patient care and facilities.
19 (12) To monitor the provision of health services in
20 the program, including the utilization and quality of health
21 services.
22 (13) To administer the Children with Special Health
23 Care Needs program in accordance with Title V of the Social
24 Security Act.
25 (14) To establish and operate a grievance resolution
26 process for participants and health care providers.
27 (15) To maintain program integrity in the Children's
28 Medical Services program.
29 (16) To receive and manage health care premiums,
30 capitation payments, and funds from federal, state, local, and
31 private entities for the program.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (17) To appoint health care consultants for the
2 purpose of providing peer review and making recommendations to
3 enhance the delivery and quality of services in the Children's
4 Medical Services program.
5 (18)(12) To make rules to carry out the provisions of
6 this act.
7 Section 7. Section 391.028, Florida Statutes, is
8 created, and section 391.051, Florida Statutes, is renumbered
9 as subsection (1) of said section and amended, to read:
10 391.028 Administration.--The Children's Medical
11 Services program shall have a central office and area offices.
12 (1) 391.051 Qualifications of director.--The Director
13 of the Division of for Children's Medical Services must be a
14 physician licensed under chapter 458 or chapter 459 who has
15 specialized training and experience in the provision of health
16 medical care to children and who has recognized skills in
17 leadership and the promotion of children's health programs.
18 The division director for Children's Medical Services shall be
19 the deputy secretary and the Deputy State Health Officer for
20 Children's Medical Services and is appointed by and reports to
21 the secretary.
22 (2) The division director shall designate Children's
23 Medical Services area offices to perform operational
24 activities, including, but not limited to:
25 (a) Providing case management services for the
26 network.
27 (b) Providing local oversight of the program.
28 (c) Determining an individual's medical and financial
29 eligibility for the program.
30 (d) Participating in the determination of a level of
31 care and medical complexity for long-term care services.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (e) Authorizing services in the program and developing
2 spending plans.
3 (f) Participating in the development of treatment
4 plans.
5 (g) Taking part in the resolution of complaints and
6 grievances from participants and health care providers.
7 (3) Each Children's Medical Services area office shall
8 be directed by a physician licensed under chapter 458 or
9 chapter 459 who has specialized training and experience in the
10 provision of health care to children. The director of a
11 Children's Medical Services area office shall be appointed by
12 the division director from the active panel of Children's
13 Medical Services physician consultants.
14 Section 8. Section 391.029, Florida Statutes, is
15 created, section 391.046, Florida Statutes, is renumbered as
16 subsection (3) of said section and amended, and section
17 391.07, Florida Statutes, is renumbered as subsection (4) of
18 said section and amended, to read:
19 391.029 Program eligibility.--
20 (1) The department shall establish the medical
21 criteria to determine if an applicant for the Children's
22 Medical Services program is an eligible individual.
23 (2) The following individuals are financially eligible
24 for the program:
25 (a) A high-risk pregnant female who is eligible for
26 Medicaid.
27 (b) A child with special health care needs from birth
28 to age 21 years who is eligible for Medicaid.
29 (c) A child with special health care needs from birth
30 to age 19 years who is eligible for a program under Title XXI
31 of the Social Security Act.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (d) A child with special health care needs from birth
2 to age 21 years whose projected annual cost of care adjusts
3 the family income to Medicaid financial criteria. In cases
4 where the family income is adjusted based on a projected
5 annual cost of care, the family shall participate financially
6 in the cost of care based on criteria established by the
7 department.
8 (e) A child with special health care needs as defined
9 in Title V of the Social Security Act relating to children
10 with special health care needs.
11
12 The department may continue to serve certain children with
13 special health care needs who are 21 years of age or older and
14 who were receiving services from the program prior to April 1,
15 1998. Such children may be served by the department until
16 July 1, 2000.
17 (3) 391.046 Financial determination.--The department
18 shall determine the financial and medical eligibility of
19 children for the program. The department shall also determine
20 ability of individuals seeking medical services, or the
21 financial ability of the parents, or persons or other agencies
22 having legal custody over such individuals, to pay the costs
23 of health such medical services under the program. The
24 department may pay reasonable travel expenses related to the
25 determination of eligibility for or the provision of health
26 medical services.
27 (4) 391.07 Indigent and semi-indigent cases.--Any
28 child who has been provided with surgical or medical care or
29 treatment under this act prior to being adopted shall continue
30 to be eligible to be provided with such care or treatment
31 after his or her adoption, regardless of the financial ability
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 of the persons adopting the child.
2 Section 9. Section 391.031, Florida Statutes, is
3 created to read:
4 391.031 Benefits.--Benefits provided under the program
5 shall be the same benefits provided to children as specified
6 in ss. 409.905 and 409.906. The department may offer
7 additional benefits for early intervention services, respite
8 services, genetic testing, genetic and nutritional counseling,
9 and parent support services, if such services are determined
10 to be medically necessary. No child or person determined
11 eligible for the program who is eligible under Title XIX or
12 Title XXI of the Social Security Act shall receive any service
13 other than an initial health care screening or treatment of an
14 emergency medical condition as defined in s. 395.002, until
15 such child or person is enrolled in Medicaid or a Title XXI
16 program.
17 Section 10. Section 391.035, Florida Statutes, is
18 created, section 391.036, Florida Statutes, is renumbered as
19 subsection (2) of said section and amended, and section
20 391.041, Florida Statutes, is renumbered as subsection (3) of
21 said section and amended, to read:
22 391.035 Provider qualifications.--
23 (1) The department shall establish the criteria to
24 designate health care providers to participate in the
25 Children's Medical Services network. The department shall
26 follow, whenever available, national guidelines for selecting
27 health care providers to serve children with special health
28 care needs.
29 (2) 391.036 Medical services providers;
30 qualifications.--The department shall require that all health
31 care providers under contract with the program of medical
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 services under this act be duly licensed in the state, if such
2 licensure is available, and meet such criteria as may be
3 established by the department.
4 (3) 391.041 Services to other state or local programs
5 or institutions.--The department may initiate agreements with
6 other state or local governmental programs or institutions for
7 the coordination of health medical care to eligible
8 individuals receiving services from such programs or
9 institutions.
10 Section 11. Section 391.045, Florida Statutes, is
11 created to read:
12 391.045 Reimbursement.--
13 (1) The department shall reimburse health care
14 providers for services rendered through the Children's Medical
15 Services network using cost-effective methods, including, but
16 not limited to, capitation, discounted fee-for-service, unit
17 costs, and cost reimbursement. Medicaid reimbursement rates
18 shall be utilized to the maximum extent possible, where
19 applicable.
20 (2) Reimbursement to the Children's Medical Services
21 program for services provided to children with special health
22 care needs who participate in the Florida Kidcare program and
23 who are not Medicaid recipients shall be on a capitated basis.
24 Section 12. Section 391.047, Florida Statutes, is
25 created to read:
26 391.047 Responsibility for payments on behalf of
27 Children's Medical Services program participants when other
28 parties are liable.--The Children's Medical Services program
29 shall comply with s. 402.24, concerning third-party
30 liabilities and recovery of third-party payments for health
31 services.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Section 13. Section 391.055, Florida Statutes, is
2 created to read:
3 391.055 Service delivery systems.--
4 (1) The program shall apply managed care methods to
5 ensure the efficient operation of the Children's Medical
6 Services network. Such methods include, but are not limited
7 to, capitation payments, utilization management and review,
8 prior authorization, and case management.
9 (2) The components of the network are:
10 (a) Qualified primary care physicians who shall serve
11 as the gatekeepers and who shall be responsible for the
12 provision or authorization of health services to an eligible
13 individual who is enrolled in the Children's Medical Services
14 network.
15 (b) Comprehensive specialty care arrangements that
16 meet the requirements of s. 391.035 to provide acute care,
17 specialty care, long-term care, and chronic disease management
18 for eligible individuals.
19 (c) Case management services.
20 (3) The Children's Medical Services network may
21 contract with school districts participating in the certified
22 school match program pursuant to ss. 236.0812 and 409.908(21)
23 for the provision of school-based services, as provided for in
24 s. 409.9071, for Medicaid-eligible children who are enrolled
25 in the Children's Medical Services network.
26 Section 14. Section 391.065, Florida Statutes, is
27 created to read:
28 391.065 Health care provider agreements.--The
29 department is authorized to establish health care provider
30 agreements for participation in the Children's Medical
31 Services program.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Section 15. Section 391.071, Florida Statutes, is
2 created to read:
3 391.071 Quality of care requirements.--The Children's
4 Medical Services program shall develop quality of care and
5 service integration standards and reporting requirements for
6 health care providers that participate in the Children's
7 Medical Services program. The program shall ensure that these
8 standards are not duplicative of other standards and
9 requirements for health care providers.
10 Section 16. Section 391.081, Florida Statutes, is
11 created to read:
12 391.081 Grievance reporting and resolution
13 requirements.--The department shall adopt and implement a
14 system to provide assistance to eligible individuals and
15 health care providers to resolve complaints and grievances.
16 To the greatest extent possible, the department shall use
17 existing grievance reporting and resolution processes. The
18 department shall ensure that the system developed for the
19 Children's Medical Services program does not duplicate
20 existing grievance reporting and resolution processes.
21 Section 17. Section 391.095, Florida Statutes, is
22 created to read:
23 391.095 Program integrity.--The department shall
24 operate a system to oversee the activities of Children's
25 Medical Services program participants, and health care
26 providers and their representatives, to prevent fraudulent and
27 abusive behavior, overutilization and duplicative utilization,
28 and neglect of participants and to recover overpayments as
29 appropriate. For the purposes of this section, the terms
30 "abuse" and "fraud" have the meanings provided in s. 409.913.
31 The department shall refer incidents of suspected fraud and
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 abuse, and overutilization and duplicative utilization, to the
2 appropriate regulatory agency.
3 Section 18. Section 391.061, Florida Statutes, is
4 renumbered as section 391.097, Florida Statutes, and is
5 amended to read:
6 391.097 391.061 Research and evaluation.--
7 (1) The department may initiate, fund, and conduct
8 research and evaluation projects to improve the delivery of
9 children's medical services. The department may cooperate with
10 public and private agencies engaged in work of a similar
11 nature.
12 (2) The Children's Medical Services network shall be
13 included in any evaluation conducted in accordance with the
14 provisions of Title XXI of the Social Security Act as enacted
15 by the Legislature.
16 Section 19. Sections 391.201 through 391.217, Florida
17 Statutes, are renumbered as sections 400.901 through 400.917,
18 Florida Statutes, and designated as part IX of chapter 400,
19 Florida Statutes.
20 Section 20. Section 391.206, Florida Statutes, is
21 renumbered as section 400.906, Florida Statutes, and
22 subsection (1) of said section is amended to read:
23 400.906 391.206 Initial application for license.--
24 (1) Application for a license shall be made to the
25 agency on forms furnished by it and shall be accompanied by
26 the appropriate license fee unless the applicant is exempt
27 from payment of the fee as provided in s. 400.905 391.205.
28 Section 21. Section 391.217, Florida Statutes, is
29 renumbered as section 400.917, Florida Statutes, and amended
30 to read:
31 400.917 391.217 Disposition of moneys from fines and
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 fees.--All moneys received from administrative fines pursuant
2 to s. 400.908 391.208 and all moneys received from fees
3 collected pursuant to s. 400.905 391.205 shall be deposited in
4 the Health Care Trust Fund created in s. 408.16 455.2205.
5 Section 22. Sections 391.221, 391.222, and 391.223,
6 Florida Statutes, as created by this act, are designated as
7 part II of chapter 391, Florida Statutes, entitled "Children's
8 Medical Services Councils and Panels."
9 Section 23. Section 391.221, Florida Statutes, is
10 created to read:
11 391.221 Statewide Children's Medical Services Network
12 Advisory Council.--
13 (1) The secretary of the department may appoint a
14 Statewide Children's Medical Services Network Advisory Council
15 for the purpose of acting as an advisory body to the
16 department. Specifically, the duties of the council shall
17 include, but not be limited to:
18 (a) Recommending standards and credentialing
19 requirements for health care providers rendering health
20 services to Children's Medical Services network participants.
21 (b) Making recommendations to the Director of the
22 Division of Children's Medical Services concerning the
23 selection of health care providers for the Children's Medical
24 Services network.
25 (c) Reviewing and making recommendations concerning
26 network health care provider or participant disputes that are
27 brought to the attention of the advisory council.
28 (d) Providing input to the Children's Medical Services
29 program on the policies governing the Children's Medical
30 Services network.
31 (e) Reviewing the financial reports and financial
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 status of the network and making recommendations concerning
2 the methods of payment and cost controls for the network.
3 (f) Reviewing and recommending the scope of benefits
4 for the network.
5 (g) Reviewing network performance measures and
6 outcomes and making recommendations for improvements to the
7 network and its maintenance and collection of data and
8 information.
9 (2) The council shall be composed of 12 members
10 representing the private health care provider sector, families
11 with children who have special health care needs, the Agency
12 for Health Care Administration, the Department of Insurance,
13 the Florida Chapter of the American Academy of Pediatrics, an
14 academic health center pediatric program, and the health
15 insurance industry. Members shall be appointed for 4-year,
16 staggered terms. In no case shall an employee of the
17 Department of Health serve as a member or as an ex officio
18 member of the advisory council. A vacancy shall be filled for
19 the remainder of the unexpired term in the same manner as the
20 original appointment. A member may not be appointed to more
21 than two consecutive terms. However, a member may be
22 reappointed after being off the council for at least 2 years.
23 (3) Members shall receive no compensation, but shall
24 be reimbursed for per diem and travel expenses in accordance
25 with the provisions of s. 112.061.
26 Section 24. Section 391.091, Florida Statutes, is
27 renumbered as section 391.222, Florida Statutes, and amended
28 to read:
29 391.222 391.091 Cardiac Advisory Council.--
30 (1)(a) The secretary of the department may appoint a
31 Cardiac Advisory Council for the purpose of acting as the
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 advisory body to the Division of Children's Medical Services
2 Program Office in the delivery of cardiac services to
3 children. Specifically, the duties of the council shall
4 include, but not be limited to:
5 (a)1. Recommending standards for personnel and
6 facilities rendering cardiac services for the Division of
7 Children's Medical Services;
8 (b)2. Receiving reports of the periodic review of
9 cardiac personnel and facilities to determine if established
10 standards for the Division of Children's Medical Services
11 cardiac services are met;
12 (c)3. Making recommendations to the division
13 Children's Medical Services staff director as to the approval
14 or disapproval of reviewed personnel and facilities;
15 (d)4. Making recommendations as to the intervals for
16 reinspection of approved personnel and facilities; and
17 (e)5. Providing input to the Division of Children's
18 Medical Services on all aspects of Children's Medical Services
19 cardiac programs, including the rulemaking process.
20 (2) The council shall be composed of eight members
21 with technical expertise in cardiac medicine. Members shall
22 be appointed for 4-year, staggered terms. In no case shall an
23 employee of the Department of Health serve as a member or as
24 an ex officio member of the advisory council. A vacancy shall
25 be filled for the remainder of the unexpired term in the same
26 manner as the original appointment. A member may not be
27 appointed to more than two consecutive terms. However, a
28 member may be reappointed after being off the council for at
29 least 2 years.
30 (3)(b) Members shall receive no compensation, but
31 shall be reimbursed for per diem and travel expenses in
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 accordance with the provisions of s. 112.061.
2 (2) The Cardiac Advisory Council shall meet at the
3 call of the chair, at the request of a majority of its
4 membership, or at the call of the staff director of the
5 Children's Medical Services Program Office, but no more
6 frequently than quarterly. Minutes shall be recorded for all
7 meetings of such council and shall be kept on file in the
8 Children's Medical Services Program Office.
9 (3) No later than December 1 of each year preceding a
10 legislative session in which a biennial budget will be
11 adopted, the department shall present a summary report to the
12 President of the Senate and the Speaker of the House of
13 Representatives documenting compliance with this act and the
14 accomplishments and expenditures of the Cardiac Advisory
15 Council.
16 Section 25. Section 391.223, Florida Statutes, is
17 created to read:
18 391.223 Technical advisory panels.--The secretary of
19 the department may establish technical advisory panels to
20 assist the Division of Children's Medical Services in
21 developing specific policies and procedures for the Children's
22 Medical Services program.
23 Section 26. Section 391.301, Florida Statutes, is
24 amended to read:
25 391.301 Developmental evaluation and intervention
26 programs; legislative findings and intent.--
27 (1) The Legislature finds that the high-risk and
28 disabled newborn infants in this state need in-hospital and
29 outpatient developmental evaluation and intervention and that
30 their families need training and support services. The
31 Legislature further finds that there is an identifiable and
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 increasing number of infants who need developmental evaluation
2 and intervention and family support due to the fact that
3 increased numbers of low-birthweight and sick full-term
4 newborn infants are now surviving because of due to the
5 advances in neonatal intensive care medicine; increased
6 numbers of medically involved infants are remaining
7 inappropriately in hospitals because their parents lack the
8 confidence or skills to care for these infants without
9 support; and increased numbers of infants are at risk due to
10 parent risk factors, such as substance abuse, teenage
11 pregnancy, and other high-risk conditions.
12 (2) It is the intent of the Legislature to establish
13 developmental evaluation and intervention services programs at
14 all hospitals providing Level II or Level III neonatal
15 intensive care services, in order that families with high-risk
16 or disabled infants may gain the services and skills they need
17 to support their infants.
18 (3) It is the intent of the Legislature to provide a
19 statewide coordinated program to screen, diagnose, and manage
20 high-risk infants identified as hearing-impaired. The program
21 shall develop criteria to identify infants who are at risk of
22 having hearing impairments, and shall ensure that all parents
23 or guardians of newborn infants are provided with materials
24 regarding hearing impairments prior to discharge of the
25 newborn infants from the hospital.
26 (4) It is the intent of the Legislature that a
27 methodology be developed to integrate information on infants
28 with potentially disabling conditions with other early
29 intervention programs, including Part C of Pub. L. No. 105-17
30 and the reporting system to be established under the Healthy
31 Start program.
19
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Section 27. Section 391.303, Florida Statutes, is
2 amended to read:
3 391.303 Program requirements.--
4 (1) A Developmental evaluation and intervention
5 services program shall be established at each hospital that
6 provides Level II or Level III neonatal intensive care
7 services. Program services shall be made available to an
8 infant or toddler identified as being at risk for
9 developmental disabilities, or identified as medically
10 involved, who, along with his or her family, would benefit
11 from program services. Program services shall be made
12 available to infants or toddlers in a Level II or Level III
13 neonatal intensive care unit or in a pediatric intensive care
14 unit, infants who are identified as being at high risk for
15 hearing impairment or who are hearing-impaired, or infants who
16 have a metabolic or genetic disorder. The developmental
17 evaluation and intervention programs are subject to the
18 availability of moneys and the limitations established by the
19 General Appropriations Act or chapter 216. Hearing screening,
20 evaluation and referral services, and initial developmental
21 assessments services shall be provided to each infant or
22 toddler. Other program services may be provided to an infant
23 or toddler, and the family of the infant or toddler, who do
24 not meet the financial eligibility criteria for the Children's
25 Medical Services program based on the availability of funding,
26 including insurance and fees.
27 (2) Each developmental evaluation and intervention
28 program shall have a program director, a medical director, and
29 necessary staff to carry out the program. The program director
30 shall establish and coordinate the developmental evaluation
31 and intervention program. The program shall include, but is
20
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 not limited to:
2 (a) In-hospital evaluation and intervention services,
3 parent support and training, and family support planning and
4 case management.
5 (b) Screening and evaluation services to identify each
6 infant at risk of hearing impairment, and a medical and
7 educational followup and care management program for an infant
8 who is identified as hearing-impaired, with management
9 beginning as soon after birth as practicable. The medical
10 management program must include the genetic evaluation of an
11 infant suspected to have genetically determined deafness and
12 an evaluation of the relative risk.
13 (c) Regularly held multidisciplinary team meetings to
14 develop and update the family support plan. In addition to the
15 family, a multidisciplinary team may include a physician,
16 physician assistant, psychologist, psychotherapist, educator,
17 social worker, nurse, physical or occupational therapist,
18 speech pathologist, developmental evaluation and intervention
19 program director, case manager, and others who are involved
20 with the in-hospital and posthospital discharge care plan, and
21 anyone the family wishes to include as a member of the team.
22 The family support plan is a written plan that describes the
23 infant or toddler, and the therapies and services the infant
24 or toddler and his or her family need, and the intended
25 outcomes of the services.
26 (d) Discharge planning by the multidisciplinary team,
27 including referral and followup to primary medical care and
28 modification of the family support plan.
29 (e) Education and training for neonatal and pediatric
30 intensive care services staff, volunteers, and others, as
31 needed, in order to expand the services provided to high-risk,
21
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 developmentally disabled, medically involved, or
2 hearing-impaired infants and toddlers and their families.
3 (f) Followup intervention services after hospital
4 discharge, to aid the family and the high-risk,
5 developmentally disabled, medically involved, or
6 hearing-impaired infant's or toddler's transition into the
7 community. These services shall include, but are not limited
8 to, home intervention services and other intervention
9 services, both contractual and voluntary. Support services
10 shall be coordinated at the request of the family and within
11 the context of the family support plan.
12 (g) Referral to and coordination of services with
13 community providers.
14 (h) Educational materials about infant care, infant
15 growth and development, community resources, medical
16 conditions and treatments, and family advocacy. Materials
17 regarding hearing impairments shall be provided to each parent
18 or guardian of a hearing-impaired infant or toddler.
19 (i) Involvement of the parents and guardians of each
20 identified high-risk, developmentally disabled, medically
21 involved, or hearing-impaired infant or toddler.
22 Section 28. Paragraph (a) of subsection (1) of section
23 391.304, Florida Statutes, is amended to read:
24 391.304 Program coordination.--
25 (1) The Department of Health shall:
26 (a) Coordinate with the Department of Education, the
27 Offices of Prevention, Early Assistance, and Child
28 Development, the Florida Interagency Coordinating Council for
29 Infants and Toddlers, and the State Coordinating Council for
30 Early Childhood Services in planning and administering ss.
31 391.301-391.307. This coordination shall be in accordance with
22
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 s. 411.222.
2 Section 29. Subsection (1) of section 391.305, Florida
3 Statutes, is amended to read:
4 391.305 Program standards; rules.--The Department of
5 Health shall adopt rules for the administration of the
6 developmental evaluation and intervention program. The rules
7 shall specify standards for the development and operation of
8 the program, including, but not limited to:
9 (1) Standards governing the eligibility need for
10 program services and the requirements of the population to be
11 served.
12 Section 30. Subsection (1) of section 391.307, Florida
13 Statutes, is amended to read:
14 391.307 Program review.--
15 (1) At least annually during the contract period, the
16 Department of Health shall evaluate each developmental
17 evaluation and intervention program. The department shall
18 develop criteria to evaluate child and family outcomes patient
19 outcome, program participation, service coordination case
20 management, and program effectiveness.
21 Section 31. Subsection (13) of section 408.701,
22 Florida Statutes, is amended to read:
23 408.701 Community health purchasing; definitions.--As
24 used in ss. 408.70-408.706, the term:
25 (13) "Health care provider" or "provider" means a
26 state-licensed or state-authorized facility, a facility
27 principally supported by a local government or by funds from a
28 charitable organization that holds a current exemption from
29 federal income tax under s. 501(c)(3) of the Internal Revenue
30 Code, a licensed practitioner, a county health department
31 established under part I of chapter 154, a patient care center
23
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 described in s. 391.031, a prescribed pediatric extended care
2 center defined in s. 400.902 391.202, a federally supported
3 primary care program such as a migrant health center or a
4 community health center authorized under s. 329 or s. 330 of
5 the United States Public Health Services Act that delivers
6 health care services to individuals, or a community facility
7 that receives funds from the state under the Community
8 Alcohol, Drug Abuse, and Mental Health Services Act and
9 provides mental health services to individuals.
10 Section 32. Section 409.810, Florida Statutes, is
11 created to read:
12 409.810 Short title.--Sections 409.810-409.820 may be
13 cited as the "Florida Kidcare Act."
14 Section 33. Section 409.811, Florida Statutes, is
15 created to read:
16 409.811 Definitions.--As used in ss. 409.810-409.820,
17 the term:
18 (1) "Actuarially equivalent" means that:
19 (a) The aggregate value of the benefits included in
20 health benefits coverage is equal to the value of the benefits
21 in the benchmark benefit plan; and
22 (b) The benefits included in health benefits coverage
23 are substantially similar to the benefits included in the
24 benchmark benefit plan, except that preventive health services
25 must be the same as in the benchmark benefit plan.
26 (2) "Agency" means the Agency for Health Care
27 Administration.
28 (3) "Applicant" means a parent or guardian of a child
29 or a child whose disability of nonage has been removed under
30 chapter 743, who applies for determination of eligibility for
31 health benefits coverage under ss. 409.810-409.820.
24
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (4) "Benchmark benefit plan" means the form and level
2 of health benefits coverage established in s. 409.815.
3 (5) "Child" means any person under 19 years of age.
4 (6) "Child with special health care needs" means a
5 child whose serious or chronic physical or developmental
6 condition requires extensive preventive and maintenance care
7 beyond that required by typically healthy children. Health
8 care utilization by such a child exceeds the statistically
9 expected usage of the normal child adjusted for chronological
10 age, and such a child often needs complex care requiring
11 multiple providers, rehabilitation services, and specialized
12 equipment in a number of different settings.
13 (7) "Children's Medical Services network" or "network"
14 means a statewide managed care service system as defined in s.
15 391.021(1).
16 (8) "Community rate" means a method used to develop
17 premiums for a health insurance plan that spreads financial
18 risk across a large population and allows adjustments only for
19 age, gender, family composition, and geographic area.
20 (9) "Department" means the Department of Health.
21 (10) "Enrollee" means a child who has been determined
22 eligible for and is receiving coverage under ss.
23 409.810-409.820.
24 (11) "Enrollment ceiling" means the maximum number of
25 children receiving premium assistance payments, excluding
26 children enrolled in Medicaid, that may be enrolled at any
27 time in the Florida Kidcare program. The maximum number shall
28 be established annually in the General Appropriations Act or
29 by general law.
30 (12) "Family" means the group or the individuals whose
31 income is considered in determining eligibility for the
25
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Florida Kidcare program. The family includes a child with a
2 custodial parent or caretaker relative who resides in the same
3 house or living unit or, in the case of a child whose
4 disability of nonage has been removed under chapter 743, the
5 child. The family may also include other individuals whose
6 income and resources are considered in whole or in part in
7 determining eligibility of the child.
8 (13) "Family income" means cash received at periodic
9 intervals from any source, such as wages, benefits,
10 contributions, or rental property. Income also may include any
11 money that would have been counted as income under the Aid to
12 Families with Dependent Children (AFDC) state plan in effect
13 prior to August 22, 1996.
14 (14) "Guarantee issue" means that health benefits
15 coverage must be offered to an individual regardless of the
16 individual's health status, preexisting condition, or claims
17 history.
18 (15) "Health benefits coverage" means protection that
19 provides payment of benefits for covered health care services
20 or that otherwise provides, either directly or through
21 arrangements with other persons, covered health care services
22 on a prepaid per capita basis or on a prepaid aggregate
23 fixed-sum basis.
24 (16) "Health insurance plan" means health benefits
25 coverage under the following:
26 (a) A health plan offered by any certified health
27 maintenance organization or authorized health insurer, except
28 a plan that is limited to the following: a limited benefit,
29 specified disease, or specified accident; hospital indemnity;
30 accident only; limited benefit convalescent care; Medicare
31 supplement; credit disability; dental; vision; long-term care;
26
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 disability income; coverage issued as a supplement to another
2 health plan; workers' compensation liability or other
3 insurance; or motor vehicle medical payment only; or
4 (b) An employee welfare benefit plan that includes
5 health benefits established under the Employee Retirement
6 Income Security Act of 1974, as amended.
7 (17) "Medicaid" means the medical assistance program
8 authorized by Title XIX of the Social Security Act, and
9 regulations thereunder, and ss. 409.901-409.920, as
10 administered in this state by the agency.
11 (18) "Medically necessary" means the use of any
12 medical treatment, service, equipment, or supply necessary to
13 palliate the effects of a terminal condition, or to prevent,
14 diagnose, correct, cure, alleviate, or preclude deterioration
15 of a condition that threatens life, causes pain or suffering,
16 or results in illness or infirmity and which is:
17 (a) Consistent with the symptom, diagnosis, and
18 treatment of the enrollee's condition;
19 (b) Provided in accordance with generally accepted
20 standards of medical practice;
21 (c) Not primarily intended for the convenience of the
22 enrollee, the enrollee's family, or the health care provider;
23 (d) The most appropriate level of supply or service
24 for the diagnosis and treatment of the enrollee's condition;
25 and
26 (e) Approved by the appropriate medical body or health
27 care specialty involved as effective, appropriate, and
28 essential for the care and treatment of the enrollee's
29 condition.
30 (19) "Medikids" means a component of the Florida
31 Kidcare program of medical assistance authorized by Title XXI
27
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 of the Social Security Act, and regulations thereunder, and s.
2 409.8132, as administered in the state by the agency.
3 (20) "Preexisting condition exclusion" means, with
4 respect to coverage, a limitation or exclusion of benefits
5 relating to a condition based on the fact that the condition
6 was present before the date of enrollment for such coverage,
7 whether or not any medical advice, diagnosis, care, or
8 treatment was recommended or received before such date.
9 (21) "Premium" means the entire cost of a health
10 insurance plan, including the administration fee or the risk
11 assumption charge.
12 (22) "Premium assistance payment" means the monthly
13 consideration paid by the agency per enrollee in the Florida
14 Kidcare program towards health insurance premiums.
15 (23) "Program" means the Florida Kidcare program, the
16 medical assistance program authorized by Title XXI of the
17 Social Security Act as part of the federal Balanced Budget Act
18 of 1997.
19 (24) "Qualified alien" means an alien as defined in s.
20 431 of the Personal Responsibility and Work Opportunity
21 Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
22 (25) "Resident" means a United States citizen, or
23 qualified alien, who is domiciled in this state.
24 (26) "Rural county" means a county having a population
25 density of less than 100 persons per square mile, or a county
26 defined by the most recent United States Census as rural, in
27 which there is no prepaid health plan participating in the
28 Medicaid program as of July 1, 1998.
29 (27) "Substantially similar" means that, with respect
30 to additional services as defined in s. 2103(c)(2) of Title
31 XXI of the Social Security Act, these services must have an
28
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 actuarial value equal to at least 75 percent of the actuarial
2 value of the coverage for that service in the benchmark
3 benefit plan and, with respect to the basic services as
4 defined in s. 2103(c)(1) of Title XXI of the Social Security
5 Act, these services must be the same as the services in the
6 benchmark benefit plan.
7 Section 34. Section 409.812, Florida Statutes, is
8 created to read:
9 409.812 Program created; purpose.--The Florida Kidcare
10 program is created to provide a defined set of health benefits
11 to previously uninsured, low-income children through the
12 establishment of a variety of affordable health benefits
13 coverage options from which families may select coverage and
14 through which families may contribute financially to the
15 health care of their children.
16 Section 35. Section 409.813, Florida Statutes, is
17 created to read:
18 409.813 Program components; entitlement and
19 nonentitlement.--The Florida Kidcare program includes health
20 benefits coverage provided to children through:
21 (1) Medicaid;
22 (2) Medikids as created in s. 409.8132;
23 (3) The Florida Healthy Kids Corporation as created in
24 s. 624.91;
25 (4) Employer-sponsored group health insurance plans
26 approved under ss. 409.810-409.820; and
27 (5) The Children's Medical Services network
28 established in chapter 391.
29
30 Except for coverage under the Medicaid program, coverage under
31 the Florida Kidcare program is not an entitlement. No cause
29
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 of action shall arise against the state, the department, the
2 Department of Children and Family Services, or the agency for
3 failure to make health services available to any person under
4 ss. 409.810-409.820.
5 Section 36. Section 409.8132, Florida Statutes, is
6 created to read:
7 409.8132 Medikids program component.--
8 (1) PROGRAM COMPONENT CREATED; PURPOSE.--The Medikids
9 program component is created in the Agency for Health Care
10 Administration to provide health care services under the
11 Florida Kidcare program to eligible children using the
12 administrative structure and provider network of the Medicaid
13 program.
14 (2) ADMINISTRATION.--The director of the agency shall
15 appoint an administrator of the Medikids program component,
16 which shall be located in the Division of State Health
17 Purchasing. The Agency for Health Care Administration is
18 designated as the state agency authorized to make payments for
19 medical assistance and related services for the Medikids
20 program component of the Florida Kidcare program. Payments
21 shall be made, subject to any limitations or directions in the
22 General Appropriations Act, only for covered services provided
23 to eligible children by qualified health care providers under
24 the Florida Kidcare program.
25 (3) INSURANCE LICENSURE NOT REQUIRED.--The Medikids
26 program component shall not be subject to the licensing
27 requirements of the Florida Insurance Code or rules of the
28 Department of Insurance.
29 (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.--The
30 provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,
31 409.910, 409.912, 409.9121, 409.9122, 409.9123, 409.9124,
30
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 409.9127, 409.9128, 409.913, 409.916, 409.919, 409.920, and
2 409.9205 apply to the administration of the Medikids program
3 component of the Florida Kidcare program, except that s.
4 409.9122 applies to Medikids as modified by the provisions of
5 subsection (7).
6 (5) BENEFITS.--Benefits provided under the Medikids
7 program component shall be the same benefits provided to
8 children as specified in ss. 409.905 and 409.906.
9 (6) ELIGIBILITY.--
10 (a) A child who is under the age of 5 years is
11 eligible to enroll in the Medikids program component of the
12 Florida Kidcare program, if the child is a member of a family
13 that has a family income which exceeds the Medicaid applicable
14 income level as specified in s. 409.903, but which is equal to
15 or below 200 percent of the current federal poverty level. In
16 determining the eligibility of such a child, an assets test is
17 not required. A child who is eligible for Medikids may elect
18 to enroll in Florida Healthy Kids coverage or
19 employer-sponsored group coverage. However, a child who is
20 eligible for Medikids may participate in the Florida Healthy
21 Kids program only if the child has a sibling participating in
22 the Florida Healthy Kids program and the child's county of
23 residence permits such enrollment.
24 (b) The provisions of s. 409.814(3), (4), and (5)
25 shall be applicable to the Medikids program.
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 90 days, and subsequent open enrollment
31
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
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. An applicant may apply for enrollment in
5 the Medikids program component and proceed through the
6 eligibility determination process at any time throughout the
7 year. However, enrollment in Medikids shall not begin until
8 the next open enrollment period; and a child may not receive
9 services under the Medikids program until the child is
10 enrolled in a managed care plan or MediPass. In addition, once
11 determined eligible, an applicant may receive choice
12 counseling and select a managed care plan or MediPass. An
13 applicant may select MediPass under the Medikids program
14 component only in counties that have fewer than two managed
15 care plans available to serve Medicaid recipients and only if
16 the federal Health Care Financing Administration determines
17 that MediPass constitutes "health insurance coverage" as
18 defined in Title XXI of the Social Security Act.
19 (8) SPECIAL ENROLLMENT PERIODS.--The agency shall
20 establish a special enrollment period of 30 days' duration for
21 any newborn child who is eligible for Medikids, or for any
22 child who is enrolled in Medicaid if such child loses Medicaid
23 eligibility and becomes eligible for Medikids, or for any
24 child who is enrolled in Medikids if such child moves to
25 another county that is not within the coverage area of the
26 child's Medikids managed care plan or MediPass provider.
27 (9) PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
28 shall establish enrollment criteria that must include
29 penalties or waiting periods of not fewer than 60 days for
30 reinstatement of coverage upon voluntary cancellation for
31 nonpayment of premiums.
32
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Section 37. Section 409.8134, Florida Statutes, is
2 created to read:
3 409.8134 Program enrollment and expenditure
4 ceilings.--
5 (1) Except for the Medicaid program, a ceiling shall
6 be placed on annual federal and state expenditures and on
7 enrollment in the Florida Kidcare program as provided each
8 year in the General Appropriations Act. The agency, in
9 consultation with the Department of Health, may propose to
10 increase the enrollment ceiling in accordance with chapter
11 216.
12 (2) Except for the Medicaid program, whenever the
13 Social Services Estimating Conference determines that there is
14 presently, or will be by the end of the current fiscal year,
15 insufficient funds to finance the current or projected
16 enrollment in the Florida Kidcare program, all additional
17 enrollment must cease and additional enrollment may not resume
18 until sufficient funds are available to finance such
19 enrollment.
20 (3) The agency shall collect and analyze the data
21 needed to project Florida Kidcare program enrollment,
22 including participation rates, caseloads, and expenditures.
23 The agency shall report the caseload and expenditure trends to
24 the Social Services Estimating Conference in accordance with
25 chapter 216.
26 Section 38. Section 409.8135, Florida Statutes, is
27 created to read:
28 409.8135 Behavioral health services.--In order to
29 ensure a high level of integration of physical and behavioral
30 health care and to meet the more intensive treatment needs of
31 enrollees with the most serious emotional disturbances or
33
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 substance abuse problems, the Department of Health shall
2 contract with the Department of Children and Family Services
3 to provide behavioral health services to non-Medicaid-eligible
4 children with special health care needs. The Department of
5 Children and Family Services, in consultation with the
6 Department of Health and the agency, is authorized to
7 establish the following:
8 (1) The scope of behavioral health services, including
9 duration and frequency.
10 (2) Clinical guidelines for referral to behavioral
11 health services.
12 (3) Behavioral health services standards.
13 (4) Performance-based measures and outcomes for
14 behavioral health services.
15 (5) Practice guidelines for behavioral health services
16 to ensure cost-effective treatment and to prevent unnecessary
17 expenditures.
18 (6) Rules to implement this section.
19 Section 39. Section 409.814, Florida Statutes, is
20 created to read:
21 409.814 Eligibility.--A child whose family income is
22 equal to or below 200 percent of the federal poverty level is
23 eligible for the Florida Kidcare program as provided in this
24 section. In determining the eligibility of such a child, an
25 assets test is not required.
26 (1) A child who is eligible for Medicaid coverage
27 under s. 409.903 or s. 409.904 must be enrolled in Medicaid
28 and is not eligible to receive health benefits under any other
29 health benefits coverage authorized under ss. 409.810-409.820.
30 (2) A child who is not eligible for Medicaid, but who
31 is eligible for the Florida Kidcare program, may obtain
34
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 coverage under any of the other types of health benefits
2 coverage authorized in ss. 409.810-409.820 if such coverage is
3 approved and available in the county in which the child
4 resides. However, a child who is eligible for Medikids may
5 participate in the Florida Healthy Kids program only if the
6 child has a sibling participating in the Florida Healthy Kids
7 program and the child's county of residence permits such
8 enrollment.
9 (3) A child who is eligible for the Florida Kidcare
10 program who is a child with special health care needs, as
11 determined through a risk-screening instrument, is eligible
12 for health benefits coverage from and may be referred to the
13 Children's Medical Services network.
14 (4) The following children are not eligible to receive
15 premium assistance for health benefits coverage under ss.
16 409.810-409.820, except under Medicaid if the child would have
17 been eligible for Medicaid under s. 409.903 or s. 409.904 as
18 of June 1, 1997:
19 (a) A child who is eligible for coverage under a state
20 health benefit plan on the basis of a family member's
21 employment with a public agency in the state;
22 (b) A child who is covered under a group health
23 benefit plan or under other health insurance coverage,
24 excluding coverage provided under the Florida Healthy Kids
25 Corporation as established under s. 624.91;
26 (c) A child who is seeking premium assistance for
27 employer-sponsored group coverage, if the child has been
28 covered by the same employer's group coverage during the 6
29 months prior to the family's submitting an application for
30 determination of eligibility under the Florida Kidcare
31 program;
35
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (d) A child who is an alien, but who does not meet the
2 definition of qualified alien, in the United States; or
3 (e) A child who is an inmate of a public institution
4 or a patient in an institution for mental diseases.
5 (5) A child whose family income is above 200 percent
6 of the federal poverty level or a child who is excluded under
7 the provisions of subsection (4) may participate in the
8 Florida Kidcare program, excluding the Medicaid program, but
9 is subject to the following provisions:
10 (a) The family is not eligible for premium assistance
11 payments and must pay the full cost of the premium, including
12 any administrative costs.
13 (b) The agency is authorized to place limits on
14 enrollment in Medikids by these children in order to avoid
15 adverse selection. The number of children participating in
16 Medikids whose family income exceeds 200 percent of the
17 federal poverty level must not exceed 10 percent of total
18 enrollees in the Medikids program.
19 (c) The board of directors of the Florida Healthy Kids
20 Corporation is authorized to place limits on enrollment of
21 these children in order to avoid adverse selection. In
22 addition, the board is authorized to offer a reduced benefit
23 package to these children in order to limit program costs for
24 such families. The number of children participating in the
25 Florida Healthy Kids program whose family income exceeds 200
26 percent of the federal poverty level must not exceed 10
27 percent of total enrollees in the Florida Healthy Kids
28 program.
29 (d) Children described in this subsection are not
30 counted in the annual enrollment ceiling for the Florida
31 Kidcare program.
36
2:05 PM 04/28/98 h4415c1c-10c9i
SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (6) Once a child is determined eligible for the
2 Florida Kidcare program, the child is eligible for coverage
3 under the program for 6 months without a redetermination or
4 reverification of eligibility, if the family continues to pay
5 the applicable premium. Effective January 1, 1999, a child who
6 has not attained the age of 5 and who has been determined
7 eligible for the Medicaid program is eligible for coverage for
8 12 months without a redetermination or reverification of
9 eligibility.
10 Section 40. Section 409.815, Florida Statutes, is
11 created to read:
12 409.815 Health benefits coverage; limitations.--
13 (1) MEDICAID BENEFITS.--For purposes of the Florida
14 Kidcare program, benefits available under Medicaid and
15 Medikids include those goods and services provided under the
16 medical assistance program authorized by Title XIX of the
17 Social Security Act, and regulations thereunder, as
18 administered in this state by the agency. This includes those
19 mandatory Medicaid services authorized under s. 409.905 and
20 optional Medicaid services authorized under s. 409.906,
21 rendered on behalf of eligible individuals by qualified
22 providers, in accordance with federal requirements for Title
23 XIX, subject to any limitations or directions provided for in
24 the General Appropriations Act or chapter 216, and according
25 to methodologies and limitations set forth in agency rules and
26 policy manuals and handbooks incorporated by reference
27 thereto.
28 (2) BENCHMARK BENEFITS.--In order for health benefits
29 coverage to qualify for premium assistance payments for an
30 eligible child under ss. 409.810-409.820, the health benefits
31 coverage, except for coverage under Medicaid and Medikids,
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 must include the following minimum benefits, as medically
2 necessary.
3 (a) Preventive health services.--Covered services
4 include:
5 1. Well-child care, including services recommended in
6 the Guidelines for Health Supervision of Children and Youth as
7 developed by the American Academy of Pediatrics;
8 2. Immunizations and injections;
9 3. Health education counseling and clinical services;
10 4. Vision screening; and
11 5. Hearing screening.
12 (b) Inpatient hospital services.--All covered services
13 provided for the medical care and treatment of an enrollee who
14 is admitted as an inpatient to a hospital licensed under part
15 I of chapter 395, with the following exceptions:
16 1. All admissions must be authorized by the enrollee's
17 health benefits coverage provider.
18 2. The length of the patient stay shall be determined
19 based on the medical condition of the enrollee in relation to
20 the necessary and appropriate level of care.
21 3. Room and board may be limited to semiprivate
22 accommodations, unless a private room is considered medically
23 necessary or semiprivate accommodations are not available.
24 4. Admissions for rehabilitation and physical therapy
25 are limited to 15 days per contract year.
26 (c) Emergency services.--Covered services include
27 visits to an emergency room or other licensed facility if
28 needed immediately due to an injury or illness and delay means
29 risk of permanent damage to the enrollee's health. Health
30 maintenance organizations shall comply with the provisions of
31 s. 641.513.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (d) Maternity services.--Covered services include
2 maternity and newborn care, including prenatal and postnatal
3 care, with the following limitations:
4 1. Coverage may be limited to the fee for vaginal
5 deliveries; and
6 2. Initial inpatient care for newborn infants of
7 enrolled adolescents shall be covered, including normal
8 newborn care, nursery charges, and the initial pediatric or
9 neonatal examination, and the infant may be covered for up to
10 3 days following birth.
11 (e) Organ transplantation services.--Covered services
12 include pretransplant, transplant, and postdischarge services
13 and treatment of complications after transplantation for
14 transplants deemed necessary and appropriate within the
15 guidelines set by the Organ Transplant Advisory Council under
16 s. 381.0602 or the Bone Marrow Transplant Advisory Panel under
17 s. 627.4236.
18 (f) Outpatient services.--Covered services include
19 preventive, diagnostic, therapeutic, palliative care, and
20 other services provided to an enrollee in the outpatient
21 portion of a health facility licensed under chapter 395,
22 except for the following limitations:
23 1. Services must be authorized by the enrollee's
24 health benefits coverage provider; and
25 2. Treatment for temporomandibular joint disease (TMJ)
26 is specifically excluded.
27 (g) Behavioral health services.--
28 1. Mental health benefits include:
29 a. Inpatient services, limited to not more than 30
30 inpatient days per contract year for psychiatric admissions,
31 or residential services in facilities licensed under s.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 394.875(8) or s. 395.003 in lieu of inpatient psychiatric
2 admissions; however, a minimum of 10 of the 30 days shall be
3 available only for inpatient psychiatric services when
4 authorized by a physician; and
5 b. Outpatient services, including outpatient visits
6 for psychological or psychiatric evaluation, diagnosis, and
7 treatment by a licensed mental health professional, limited to
8 a maximum of 40 outpatient visits each contract year.
9 2. Substance abuse services include:
10 a. Inpatient services, limited to not more than 7
11 inpatient days per contract year for medical detoxification
12 only and 30 days of residential services; and
13 b. Outpatient services, including evaluation,
14 diagnosis, and treatment by a licensed practitioner, limited
15 to a maximum of 40 outpatient visits per contract year.
16 (h) Durable medical equipment.--Covered services
17 include equipment and devices that are medically indicated to
18 assist in the treatment of a medical condition and
19 specifically prescribed as medically necessary, with the
20 following limitations:
21 1. Low-vision and telescopic aides are not included.
22 2. Corrective lenses and frames may be limited to one
23 pair every 2 years, unless the prescription or head size of
24 the enrollee changes.
25 3. Hearing aids shall be covered only when medically
26 indicated to assist in the treatment of a medical condition.
27 4. Covered prosthetic devices include artificial eyes
28 and limbs, braces, and other artificial aids.
29 (i) Health practitioner services.--Covered services
30 include services and procedures rendered to an enrollee when
31 performed to diagnose and treat diseases, injuries, or other
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 conditions, including care rendered by health practitioners
2 acting within the scope of their practice, with the following
3 exceptions:
4 1. Chiropractic services shall be provided in the same
5 manner as in the Florida Medicaid program.
6 2. Podiatric services may be limited to one visit per
7 day totaling two visits per month for specific foot disorders.
8 (j) Home health services.--Covered services include
9 prescribed home visits by both registered and licensed
10 practical nurses to provide skilled nursing services on a
11 part-time intermittent basis, subject to the following
12 limitations:
13 1. Coverage may be limited to include skilled nursing
14 services only;
15 2. Meals, housekeeping, and personal comfort items may
16 be excluded; and
17 3. Private duty nursing is limited to circumstances
18 where such care is medically necessary.
19 (k) Hospice services.--Covered services include
20 reasonable and necessary services for palliation or management
21 of an enrollee's terminal illness, with the following
22 exceptions:
23 1. Once a family elects to receive hospice care for an
24 enrollee, other services that treat the terminal condition
25 will not be covered; and
26 2. Services required for conditions totally unrelated
27 to the terminal condition are covered to the extent that the
28 services are included in this section.
29 (l) Laboratory and X-ray services.--Covered services
30 include diagnostic testing, including clinical radiologic,
31 laboratory, and other diagnostic tests.
41
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (m) Nursing facility services.--Covered services
2 include regular nursing services, rehabilitation services,
3 drugs and biologicals, medical supplies, and the use of
4 appliances and equipment furnished by the facility, with the
5 following limitations:
6 1. All admissions must be authorized by the health
7 benefits coverage provider.
8 2. The length of the patient stay shall be determined
9 based on the medical condition of the enrollee in relation to
10 the necessary and appropriate level of care, but is limited to
11 not more than 100 days per contract year.
12 3. Room and board may be limited to semiprivate
13 accommodations, unless a private room is considered medically
14 necessary or semiprivate accommodations are not available.
15 4. Specialized treatment centers and independent
16 kidney disease treatment centers are excluded.
17 5. Private duty nurses, television, and custodial care
18 are excluded.
19 6. Admissions for rehabilitation and physical therapy
20 are limited to 15 days per contract year.
21 (n) Prescribed drugs.--
22 1. Coverage shall include drugs prescribed for the
23 treatment of illness or injury when prescribed by a licensed
24 health practitioner acting within the scope of his or her
25 practice.
26 2. Prescribed drugs may be limited to generics if
27 available and brand name products if a generic substitution is
28 not available, unless the prescribing licensed health
29 practitioner indicates that a brand name is medically
30 necessary.
31 3. Prescribed drugs covered under this section shall
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 include all prescribed drugs covered under the Florida
2 Medicaid program.
3 (o) Therapy services.--Covered services include
4 rehabilitative services, including occupational, physical,
5 respiratory, and speech therapies, with the following
6 limitations:
7 1. Services must be for short-term rehabilitation
8 where significant improvement in the enrollee's condition will
9 result; and
10 2. Services shall be limited to not more than 24
11 treatment sessions within a 60-day period per episode or
12 injury, with the 60-day period beginning with the first
13 treatment.
14 (p) Transportation services.--Covered services include
15 emergency transportation required in response to an emergency
16 situation.
17 (q) Lifetime maximum.--Health benefits coverage
18 obtained under ss. 409.810-409.820 shall pay an enrollee's
19 covered expenses at a lifetime maximum of $1 million per
20 covered child.
21 (r) Cost-sharing.--Cost-sharing provisions must comply
22 with s. 409.816.
23 (s) Exclusions.--
24 1. Experimental or investigational procedures that
25 have not been clinically proven by reliable evidence are
26 excluded;
27 2. Services performed for cosmetic purposes only or
28 for the convenience of the enrollee are excluded; and
29 3. Abortion may be covered only if necessary to save
30 the life of the mother or if the pregnancy is the result of an
31 act of rape or incest.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (t) Enhancements to minimum requirements.--
2 1. This section sets the minimum benefits that must be
3 included in any health benefits coverage, other than Medicaid
4 or Medikids coverage, offered under ss. 409.810-409.820.
5 Health benefits coverage may include additional benefits not
6 included under this subsection, but may not include benefits
7 excluded under paragraph (s).
8 2. Health benefits coverage may extend any limitations
9 beyond the minimum benefits described in this section.
10
11 Except for the Children's Medical Services network, the agency
12 may not increase the premium assistance payment for either
13 additional benefits provided beyond the minimum benefits
14 described in this section or the imposition of less
15 restrictive service limitations.
16 (u) Applicability of other state laws.--Health
17 insurers, health maintenance organizations, and their agents
18 are subject to the provisions of the Florida Insurance Code,
19 except for any such provisions waived in this section.
20 1. Except as expressly provided in this section, a law
21 requiring coverage for a specific health care service or
22 benefit, or a law requiring reimbursement, utilization, or
23 consideration of a specific category of licensed health care
24 practitioner, does not apply to a health insurance plan policy
25 or contract offered or delivered under ss. 409.810-409.820
26 unless that law is made expressly applicable to such policies
27 or contracts.
28 2. Notwithstanding chapter 641, a health maintenance
29 organization may issue contracts providing benefits equal to,
30 exceeding, or actuarially equivalent to the benchmark benefit
31 plan authorized by this section and may pay providers located
44
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 in a rural county negotiated fees or Medicaid reimbursement
2 rates for services provided to enrollees who are residents of
3 the rural county.
4 Section 41. Section 409.816, Florida Statutes, is
5 created to read:
6 409.816 Limitations on premiums and cost-sharing.--The
7 following limitations on premiums and cost-sharing are
8 established for the program.
9 (1) Enrollees who receive coverage under the Medicaid
10 program may not be required to pay:
11 (a) Enrollment fees, premiums, or similar charges; or
12 (b) Copayments, deductibles, coinsurance, or similar
13 charges.
14 (2) Enrollees in families with a family income equal
15 to or below 150 percent of the federal poverty level, who are
16 not receiving coverage under the Medicaid program, may not be
17 required to pay:
18 (a) Enrollment fees, premiums, or similar charges that
19 exceed the maximum monthly charge permitted under s.
20 1916(b)(1) of the Social Security Act; or
21 (b) Copayments, deductibles, coinsurance, or similar
22 charges that exceed a nominal amount, as determined consistent
23 with regulations referred to in s. 1916(a)(3) of the Social
24 Security Act. However, such charges may not be imposed for
25 preventive services, including well-baby and well-child care,
26 age-appropriate immunizations, and routine hearing and vision
27 screenings.
28 (3) Enrollees in families with a family income above
29 150 percent of the federal poverty level, who are not
30 receiving coverage under the Medicaid program or who are not
31 eligible under s. 409.814(5), may be required to pay
45
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 enrollment fees, premiums, copayments, deductibles,
2 coinsurance, or similar charges on a sliding scale related to
3 income, except that the total annual aggregate cost-sharing
4 with respect to all children in a family may not exceed 5
5 percent of the family's income. However, copayments,
6 deductibles, coinsurance, or similar charges may not be
7 imposed for preventive services, including well-baby and
8 well-child care, age-appropriate immunizations, and routine
9 hearing and vision screenings.
10 Section 42. Section 409.817, Florida Statutes, is
11 created to read:
12 409.817 Approval of health benefits coverage;
13 financial assistance.--In order for health insurance coverage
14 to qualify for premium assistance payments for an eligible
15 child under ss. 409.810-409.820, the health benefits coverage
16 must:
17 (1) Be certified by the Department of Insurance under
18 s. 409.818 as meeting, exceeding, or being actuarially
19 equivalent to the benchmark benefit plan;
20 (2) Be guarantee issued;
21 (3) Be community rated;
22 (4) Not impose any preexisting condition exclusion for
23 covered benefits; however, group health insurance plans may
24 permit the imposition of a preexisting condition exclusion,
25 but only insofar as it is permitted under s. 627.6561;
26 (5) Comply with the applicable limitations on premiums
27 and cost-sharing in s. 409.816;
28 (6) Comply with the quality assurance and access
29 standards developed under s. 409.820; and
30 (7) Establish periodic open enrollment periods, which
31 may not occur more frequently than quarterly.
46
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Section 43. Section 409.8175, Florida Statutes, is
2 created to read:
3 409.8175 Delivery of services in rural counties.--A
4 health maintenance organization or a health insurer may
5 reimburse providers located in a rural county according to the
6 Medicaid fee schedule for services provided to enrollees in
7 rural counties if the provider agrees to accept such fee
8 schedule.
9 Section 44. Section 409.8177, Florida Statutes, is
10 created to read:
11 409.8177 Program evaluation.--The agency, in
12 consultation with the Department of Health, the Department of
13 Children and Family Services, and the Florida Healthy Kids
14 Corporation, shall by January 1 of each year submit to the
15 Governor and the Legislature a report of the Florida Kidcare
16 program. In addition to the items specified under s. 2108 of
17 Title XXI of the Social Security Act, the report shall include
18 an assessment of crowd-out and access to health care, as well
19 as the following:
20 (1) An assessment of the operation of the program,
21 including the progress made in reducing the number of
22 uncovered low-income children.
23 (2) An assessment of the effectiveness in increasing
24 the number of children with creditable health coverage.
25 (3) The characteristics of the children and families
26 assisted under the program, including ages of the children,
27 family income, and access to or coverage by other health
28 insurance prior to the program and after disenrollment from
29 the program.
30 (4) The quality of health coverage provided, including
31 the types of benefits provided.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (5) The amount and level, including payment of part or
2 all of any premium, of assistance provided.
3 (6) The average length of coverage of a child under
4 the program.
5 (7) The program's choice of health benefits coverage
6 and other methods used for providing child health assistance.
7 (8) The sources of nonfederal funding used in the
8 program.
9 (9) An assessment of the effectiveness of Medikids,
10 Children's Medical Services network, and other public and
11 private programs in the state in increasing the availability
12 of affordable quality health insurance and health care for
13 children.
14 (10) A review and assessment of state activities to
15 coordinate the program with other public and private programs.
16 (11) An analysis of changes and trends in the state
17 that affect the provision of health insurance and health care
18 to children.
19 (12) A description of any plans the state has for
20 improving the availability of health insurance and health care
21 for children.
22 (13) Recommendations for improving the program.
23 (14) Other studies as necessary.
24 Section 45. 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
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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 Florida Kidcare program, in
3 consultation with the agency, the Department of Health, and
4 the Florida Healthy Kids Corporation. The simplified
5 eligibility application form must include an item that
6 provides an opportunity for the applicant to indicate whether
7 coverage is being sought for a child with special health care
8 needs. Families applying for children's Medicaid coverage must
9 also be able to use the simplified application form without
10 having to pay a premium.
11 (b) Establish and maintain the eligibility
12 determination process under the program except as specified in
13 subsection (5). The department shall directly, or through the
14 services of a contracted third-party administrator, establish
15 and maintain a process for determining eligibility of children
16 for coverage under the program. The eligibility determination
17 process must be used solely for determining eligibility of
18 applicants for health benefits coverage under the program. The
19 eligibility determination process must include an initial
20 determination of eligibility for any coverage offered under
21 the program, as well as a redetermination or reverification of
22 eligibility each subsequent 6 months. Effective January 1,
23 1999, a child who has not attained the age of 5 and who has
24 been determined eligible for the Medicaid program is eligible
25 for coverage for 12 months without a redetermination or
26 reverification of eligibility. In conducting an eligibility
27 determination, the department shall determine if the child has
28 special health care needs.
29 (c) Inform program applicants about eligibility
30 determinations and provide information about eligibility of
31 applicants to Medicaid, Medikids, the Children's Medical
49
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Services network, and the Florida Healthy Kids Corporation,
2 and to insurers and their agents, through a centralized
3 coordinating office.
4 (d) Adopt rules necessary for conducting program
5 eligibility functions.
6 (2) The Department of Health shall:
7 (a) Design an eligibility intake process for the
8 program, in coordination with the Department of Children and
9 Family Services, the agency, and the Florida Healthy Kids
10 Corporation. The eligibility intake process may include local
11 intake points that are determined by the Department of Health
12 in coordination with the Department of Children and Family
13 Services.
14 (b) Design and implement program outreach activities
15 under s. 409.819.
16 (c) Chair a state-level coordinating council to review
17 and make recommendations concerning the implementation and
18 operation of the program. The coordinating council shall
19 include representatives from the department, the Department of
20 Children and Family Services, the agency, the Florida Healthy
21 Kids Corporation, the Department of Insurance, local
22 government, health insurers, health maintenance organizations,
23 health care providers, families participating in the program,
24 and organizations representing low-income families.
25 (d) In consultation with the Florida Healthy Kids
26 Corporation and the Department of Children and Family
27 Services, establishing a toll-free telephone line to assist
28 families with questions about the program.
29 (e) Adopt rules necessary to implement outreach
30 activities.
31 (3) The Agency for Health Care Administration, under
50
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 the authority granted in s. 409.914(1), shall:
2 (a) Calculate the premium assistance payment necessary
3 to comply with the premium and cost-sharing limitations
4 specified in s. 409.816. The premium assistance payment for
5 each enrollee in a health insurance plan participating in the
6 Florida Healthy Kids Corporation shall equal the premium
7 approved by the Florida Healthy Kids Corporation and the
8 Department of Insurance pursuant to ss. 627.410 and 641.31,
9 less any enrollee's share of the premium established within
10 the limitations specified in s. 409.816. The premium
11 assistance payment for each enrollee in an employer-sponsored
12 health insurance plan approved under ss. 409.810-409.820 shall
13 equal the premium for the plan adjusted for any benchmark
14 benefit plan actuarial equivalent benefit rider approved by
15 the Department of Insurance pursuant to ss. 627.410 and
16 641.31, less any enrollee's share of the premium established
17 within the limitations specified in s. 409.816. In calculating
18 the premium assistance payment levels for children with family
19 coverage, the agency shall set the premium assistance payment
20 levels for each child proportionately to the total cost of
21 family coverage.
22 (b) Annually calculate the program enrollment ceiling
23 based on estimated per-child premium assistance payments and
24 the estimated appropriation available for the program.
25 (c) Make premium assistance payments to health
26 insurance plans on a periodic basis. The agency may use its
27 Medicaid fiscal agent or a contracted third-party
28 administrator in making these payments. The agency may
29 require health insurance plans that participate in the
30 Medikids program or employer-sponsored group health insurance
31 to collect premium payments from an enrollee's family.
51
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Participating health insurance plans shall report premium
2 payments collected on behalf of enrollees in the program to
3 the agency in accordance with a schedule established by the
4 agency.
5 (d) Monitor compliance with quality assurance and
6 access standards developed under s. 409.820.
7 (e) Establish a mechanism for investigating and
8 resolving complaints and grievances from program applicants,
9 enrollees, and health benefits coverage providers, and
10 maintain a record of complaints and confirmed problems. In the
11 case of a child who is enrolled in a health maintenance
12 organization, the agency must use the provisions of s. 641.511
13 to address grievance reporting and resolution requirements.
14 (f) Approve health benefits coverage for participation
15 in the program, following certification by the Department of
16 Insurance under subsection (4).
17 (g) Adopt rules necessary for calculating premium
18 assistance payment levels, calculating the program enrollment
19 ceiling, making premium assistance payments, monitoring access
20 and quality assurance standards, investigating and resolving
21 complaints and grievances, administering the Medikids program,
22 and approving health benefits coverage.
23
24 The agency is designated the lead state agency for Title XXI
25 of the Social Security Act for purposes of receipt of federal
26 funds, for reporting purposes, and for ensuring compliance
27 with federal and state regulations and rules.
28 (4) The Department of Insurance shall certify that
29 health benefits coverage plans that seek to provide services
30 under the Florida Kidcare program, except those offered
31 through the Florida Healthy Kids Corporation or the Children's
52
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Medical Services network, meet, exceed, or are actuarially
2 equivalent to the benchmark benefit plan and that health
3 insurance plans will be offered at an approved rate. In
4 determining actuarial equivalence of benefits coverage, the
5 Department of Insurance and health insurance plans must comply
6 with the requirements of s. 2103 of Title XXI of the Social
7 Security Act. The department shall adopt rules necessary for
8 certifying health benefits coverage plans.
9 (5) The Florida Healthy Kids Corporation shall retain
10 its functions as authorized in s. 624.91, including
11 eligibility determination for participation in the Healthy
12 Kids program.
13 (6) The agency, the Department of Health, the
14 Department of Children and Family Services, the Florida
15 Healthy Kids Corporation, and the Department of Insurance,
16 after consultation with and approval of the Speaker of the
17 House of Representatives and the President of the Senate, are
18 authorized to make program modifications that are necessary to
19 overcome any objections of the United States Department of
20 Health and Human Services to obtain approval of the state's
21 child health insurance plan under Title XXI of the Social
22 Security Act.
23 Section 46. Section 154.508, Florida Statutes, is
24 transferred, renumbered as section 409.819, Florida Statutes,
25 and amended to read:
26 409.819 154.508 Identification of low-income,
27 uninsured children; determination of Medicaid eligibility for
28 the Florida Kidcare program; alternative health care
29 information.--The Department of Health Agency for Health Care
30 Administration shall develop a program, in conjunction with
31 the Department of Education, the Department of Children and
53
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Family Services, the Agency for Health Care Administration,
2 the Florida Healthy Kids Corporation the Department of Health,
3 local governments, employers school districts, and other
4 stakeholders to identify low-income, uninsured children and,
5 to the extent possible and subject to appropriation, refer
6 them to the Department of Children and Family Services for a
7 Medicaid eligibility determination and provide parents with
8 information about choices alternative sources of health
9 benefits coverage under the Florida Kidcare program care.
10 These activities shall include, but not be limited to:
11 training community providers in effective methods of outreach;
12 conducting public information campaigns designed to publicize
13 the Florida Kidcare program, the eligibility requirements of
14 the program, and the procedures for enrollment in the program;
15 and maintaining public awareness of the Florida Kidcare
16 program. Special emphasis shall be placed on the
17 identification of minority children for referral to and
18 participation in the Florida Kidcare program.
19 Section 47. Section 409.820, Florida Statutes, is
20 created to read:
21 409.820 Quality assurance and access
22 standards.--Except for Medicaid, the Department of Health, in
23 consultation with the agency and the Florida Healthy Kids
24 Corporation, shall develop a minimum set of quality assurance
25 and access standards for all program components. The standards
26 must include a process for granting exceptions to specific
27 requirements for quality assurance and access. Compliance with
28 the standards shall be a condition of program participation by
29 health benefits coverage providers. These standards shall
30 comply with the provisions of chapters 409 and 641 and Title
31 XXI of the Social Security Act.
54
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Section 48. The following performance measures and
2 standards are adopted for the Florida Kidcare program:
3 (1) The total number of previously uninsured children
4 who receive health benefits coverage as a result of state
5 activities under Title XXI of the Social Security Act: 254,000
6 uninsured children expected to obtain coverage during the
7 1998-1999 fiscal year.
8 (a) The number of children enrolled in the Medicaid
9 program as a result of eligibility expansions under Title XXI
10 of the Social Security Act: 29,500 children enrolled in
11 Medicaid under new eligibility groups during the 1998-1999
12 fiscal year.
13 (b) The number of children enrolled in the Medicaid
14 program as a result of outreach efforts under Title XXI of the
15 Social Security Act who are eligible for Medicaid but who have
16 not enrolled in the program: 80,000 children previously
17 eligible for Medicaid, but not enrolled in Medicaid, who
18 enroll in Medicaid during the 1998-1999 fiscal year.
19 (c) The number of uninsured children enrolled in
20 Medikids under Title XXI of the Social Security Act: 17,000
21 children enrolled in Medikids during the 1998-1999 fiscal
22 year.
23 (d) The number of uninsured children added to the
24 enrollment for the Florida Healthy Kids Corporation program
25 under Title XXI of the Social Security Act: 70,000 additional
26 children enrolled in the Florida Healthy Kids Corporation
27 program during the 1998-1999 fiscal year.
28 (e) The number of uninsured children enrolled in
29 employer-sponsored group health insurance coverage under Title
30 XXI of the Social Security Act: 48,000 uninsured children
31 enrolled in health insurance coverage during the 1998-1999
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 fiscal year.
2 (f) The number of uninsured children enrolled in the
3 Children's Medical Services network under Title XXI of the
4 Social Security Act: 9,500 uninsured children enrolled in the
5 Children's Medical Services network during the 1998-1999
6 fiscal year.
7 (2) The percentage of uninsured children in this state
8 as of July 1, 1998, who receive health benefits coverage under
9 the Florida Kidcare program: 30.9 percent of uninsured
10 children enrolled in the Florida Kidcare program during the
11 1998-1999 fiscal year.
12 (3) The percentage of children enrolled in the Florida
13 Kidcare program with up-to-date immunizations: 80 percent of
14 enrolled children with up-to-date immunizations.
15 (4) The percentage of compliance with the standards
16 established in the Guidelines for Health Supervision of
17 Children and Youth as developed by the American Academy of
18 Pediatrics for children eligible for the Florida Kidcare
19 program and served under:
20 (a) Medicaid;
21 (b) Medikids;
22 (c) The Florida Healthy Kids Corporation program;
23 (d) Employer-sponsored group health insurance plans;
24 and
25 (e) The Children's Medical Services network.
26
27 For each category of coverage, the health care provided is in
28 compliance with the health supervision standards for 80
29 percent of enrolled children.
30 (5) The perception of the enrollee or the enrollee's
31 family concerning coverage provided to children enrolled in
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 the Florida Kidcare program and served under:
2 (a) Medicaid;
3 (b) Medikids;
4 (c) Florida Healthy Kids Corporation;
5 (d) Employer-sponsored group health insurance plans;
6 and
7 (e) The Children's Medical Services network.
8
9 For each category of coverage, 90 percent of the enrollees or
10 the enrollee families indicate satisfaction with the care
11 provided under the program.
12 Section 49. The Agency for Health Care Administration
13 shall conduct a study of the feasibility of extending
14 presumptive eligibility for Medicaid to children who have not
15 attained the age of 19. The study shall assess whether
16 families delay seeking health care services or health care
17 coverage because of the lack of presumptive eligibility. The
18 agency shall report its findings to the President of the
19 Senate, the Speaker of the House of Representatives, and the
20 chairpersons of the respective health care committees no later
21 than December 31, 1998.
22 Section 50. For fiscal year 1998-1999, the enrollment
23 ceiling for the non-Medicaid portion of the Florida Kidcare
24 program is 270,000 children. Thereafter, the enrollment
25 ceiling shall be established in the General Appropriations Act
26 or general law.
27 Section 51. Subsections (6) and (7) are added to
28 section 409.904, Florida Statutes, to read:
29 409.904 Optional payments for eligible persons.--The
30 agency may make payments for medical assistance and related
31 services on behalf of the following persons who are determined
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 to be eligible subject to the income, assets, and categorical
2 eligibility tests set forth in federal and state law. Payment
3 on behalf of these Medicaid eligible persons is subject to the
4 availability of moneys and any limitations established by the
5 General Appropriations Act or chapter 216.
6 (6) A child born before October 1, 1983, living in a
7 family that has an income which is at or below 100 percent of
8 the current federal poverty level, who has attained the age of
9 6, but has not attained the age of 19, and who would be
10 eligible in s. 409.903(6), if the child had been born on or
11 after such date. In determining the eligibility of such a
12 child, an assets test is not required.
13 (7) A child who has not attained the age of 19 who has
14 been determined eligible for the Medicaid program is deemed to
15 be eligible for a total of 6 months, regardless of changes in
16 circumstances other than attainment of the maximum age.
17 Effective January 1, 1999, a child who has not attained the
18 age of 5 and who has been determined eligible for the Medicaid
19 program is deemed to be eligible for a total of 12 months
20 regardless of changes in circumstances other than attainment
21 of the maximum age.
22 Section 52. Subsections (11) through (22) of section
23 409.906, Florida Statutes, are renumbered as subsections (12)
24 through (23), respectively, and a new subsection (11) is added
25 to that section to read:
26 409.906 Optional Medicaid services.--Subject to
27 specific appropriations, the agency may make payments for
28 services which are optional to the state under Title XIX of
29 the Social Security Act and are furnished by Medicaid
30 providers to recipients who are determined to be eligible on
31 the dates on which the services were provided. Any optional
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 service that is provided shall be provided only when medically
2 necessary and in accordance with state and federal law.
3 Nothing in this section shall be construed to prevent or limit
4 the agency from adjusting fees, reimbursement rates, lengths
5 of stay, number of visits, or number of services, or making
6 any other adjustments necessary to comply with the
7 availability of moneys and any limitations or directions
8 provided for in the General Appropriations Act or chapter 216.
9 Optional services may include:
10 (11) HEALTHY START SERVICES.--The agency may pay for a
11 continuum of risk-appropriate medical and psychosocial
12 services for the Healthy Start program in accordance with a
13 federal waiver. The agency may not implement the federal
14 waiver unless the waiver permits the state to limit enrollment
15 or the amount, duration, and scope of services to ensure that
16 expenditures will not exceed funds appropriated by the
17 Legislature or available from local sources.
18 Section 53. 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:
22 (a) "Children's Medical Services network" means an
23 alternative service network that includes health care
24 providers and health care facilities specified in chapter 391
25 and ss. 383.15-383.21, 383.216, and 415.5055.
26 (b) "Children with special health care needs" means
27 those children whose serious or chronic physical or
28 developmental conditions require extensive preventive and
29 maintenance care beyond that required by typically healthy
30 children. Health care utilization by these children exceeds
31 the statistically expected usage of the normal child matched
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 for chronological age and often needs complex care requiring
2 multiple providers, rehabilitation services, and specialized
3 equipment in a number of different settings.
4 (2) The Legislature finds that Medicaid-eligible
5 children with special health care needs require a
6 comprehensive, continuous, and coordinated system of health
7 care that links community-based health care with
8 multidisciplinary, regional, and tertiary care. The
9 Legislature finds that Florida's Children's Medical Services
10 program provides a full continuum of coordinated,
11 comprehensive services for children with special health care
12 needs.
13 (1)(3) Except as provided in subsection (4)
14 subsections (8) and (9), children eligible for Children's
15 Medical Services who receive Medicaid benefits, and other
16 Medicaid-eligible children with special health care needs,
17 shall be exempt from the provisions of s. 409.9122 and shall
18 be served through the Children's Medical Services network
19 established in chapter 391.
20 (2)(4) The Legislature directs the agency to apply to
21 the federal Health Care Financing Administration for a waiver
22 to assign to the Children's Medical Services network all
23 Medicaid-eligible children who meet the criteria for
24 participation in the Children's Medical Services program as
25 specified in s. 391.021(2), and other Medicaid-eligible
26 children with special health care needs.
27 (5) The Children's Medical Services program shall
28 assign a qualified MediPass primary care provider from the
29 Children's Medical Services network who shall serve as the
30 gatekeeper and who shall be responsible for the provision or
31 authorization of all health services to a child who has been
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 assigned to the Children's Medical Services network by the
2 Medicaid program.
3 (3)(6) Services provided through the Children's
4 Medical Services network shall be reimbursed on a
5 fee-for-service basis and shall utilize a primary care case
6 management process. However, effective July 1, 1999,
7 reimbursement to the Children's Medical Services program for
8 services provided to Medicaid-eligible children with special
9 health care needs through the Children's Medical Services
10 network shall be on a capitated basis.
11 (7) The agency, in consultation with the Children's
12 Medical Services program, shall develop by rule
13 quality-of-care and service integration standards.
14 (8) The agency may issue a request for proposals,
15 based on the quality-of-care and service integration
16 standards, to allow managed care plans that have contracts
17 with the Medicaid program to provide services to
18 Medicaid-eligible children with special health care needs.
19 (4)(9) The agency may shall approve requests to
20 provide services to Medicaid-eligible children with special
21 health care needs from managed care plans that meet access,
22 quality-of-care, network, and service integration standards
23 and are in good standing with the agency. The agency shall
24 monitor on a quarterly basis managed care plans which have
25 been approved to provide services to Medicaid-eligible
26 children with special health care needs. The agency may
27 determine the number of enrollment slots approved for a
28 managed care plan based on the managed care plan's network
29 capacity to serve children with special health care needs.
30 (5)(10) The agency, in consultation with the
31 Department of Health and Rehabilitative Services, shall adopt
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 rules that address Medicaid requirements for referral,
2 enrollment, and disenrollment of children with special health
3 care needs who are enrolled in Medicaid managed care plans and
4 who may benefit from the Children's Medical Services network.
5 (11) The Children's Medical Services network may
6 contract with school districts participating in the certified
7 school match program pursuant to ss. 236.0812 and 409.908(21)
8 for the provision of school-based services, as provided for in
9 s. 409.9071, for Medicaid-eligible children who are enrolled
10 in the Children's Medical Services network.
11 (12) After 1 complete year of operation, the agency
12 shall conduct an evaluation of the Children's Medical Services
13 network. The evaluation shall include, but not be limited to,
14 an assessment of whether the use of the Children's Medical
15 Services network is less costly than the provision of the
16 services would have been in the Medicaid fee-for-service
17 program. The evaluation also shall include an assessment of
18 patient satisfaction with the Children's Medical Services
19 network, an assessment of the quality of care delivered
20 through the network, and recommendations for further improving
21 the performance of the network. The agency shall report the
22 evaluation findings to the Governor and the chairpersons of
23 the appropriations and health care committees of each chamber
24 of the Legislature.
25 Section 54. Section 624.91, Florida Statutes, is
26 amended to read:
27 624.91 The Florida Healthy Kids Corporation Act.--
28 (1) SHORT TITLE.--This section may be cited as the
29 "William G. 'Doc' Myers Healthy Kids Corporation Act."
30 (2) LEGISLATIVE INTENT.--
31 (a) The Legislature finds that increased access to
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 health care services could improve children's health and
2 reduce the incidence and costs of childhood illness and
3 disabilities among children in this state. Many children do
4 not have comprehensive, affordable health care preventive
5 services available or funded, and for those who do, lack of
6 access is a restriction to getting service. It is the intent
7 of the Legislature that the Florida Healthy Kids a nonprofit
8 Corporation be organized to facilitate a program to bring
9 preventive health care services to children, if necessary
10 through the use of school facilities in this state when more
11 appropriate sites are unavailable, and to provide
12 comprehensive health insurance coverage to such children. A
13 goal for The corporation is encouraged to cooperate with any
14 existing health preventive service programs funded by the
15 public or the private sector.
16 (b) It is the intent of the Legislature that the
17 Florida Healthy Kids Corporation serve as one of several
18 providers of services to children eligible for medical
19 assistance under Title XXI of the Social Security Act.
20 Although the corporation may serve other children, the
21 Legislature intends the primary recipients of services
22 provided through the corporation be school-age children with a
23 family income below 200 percent of the federal poverty level,
24 who do not qualify for Medicaid. It is also the intent of the
25 Legislature that state and local government Florida Healthy
26 Kids funds, to the extent permissible under federal law, be
27 used to obtain matching federal dollars.
28 (3) NONENTITLEMENT.--Nothing in this section shall be
29 construed as providing an individual with an entitlement to
30 health care services. No cause of action shall arise against
31 the state, the Florida Healthy Kids Corporation, or a unit of
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 local government for failure to make health services available
2 under this section.
3 (4)(3) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
4 (a) There is created The Legislature hereby creates
5 the Florida Healthy Kids Corporation, a not-for-profit
6 corporation which operates shall operate on sites to be
7 designated by the corporation.
8 (b) The Florida Healthy Kids Corporation shall phase
9 in a program to:
10 1. Organize school children groups to facilitate the
11 provision of preventive health care services to children and
12 to provide comprehensive health insurance coverage to
13 children;
14 2. 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, from all participant
17 families or employers to provide for payment of for preventive
18 health care services or premiums for comprehensive insurance
19 coverage and for the actual or estimated administrative
20 expenses incurred during the period for which family or
21 employer payments are made;
22 3. Establish the administrative and accounting
23 procedures for the operation of the corporation;
24 4. Establish, with consultation from appropriate
25 professional organizations, standards for preventive health
26 services and providers and comprehensive insurance benefits
27 appropriate to children; provided that such standards for
28 rural areas shall not limit primary care providers to
29 board-certified pediatricians;
30 5. Establish eligibility criteria which children must
31 meet in order to participate in the program;
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 6. Establish procedures under which applicants to and
2 participants in the program may have grievances reviewed by an
3 impartial body and reported to the board of directors of the
4 corporation;
5 7. Establish participation criteria and, if
6 appropriate, contract with an authorized insurer, health
7 maintenance organization, or insurance administrator to
8 provide administrative services to the corporation;
9 8. Establish enrollment criteria which shall include
10 penalties or waiting periods of not fewer than 60 days for
11 reinstatement of coverage upon voluntary cancellation for
12 nonpayment of family premiums;
13 9. If a space is available, establish a special open
14 enrollment period of 30 days' duration for any child who is
15 enrolled in Medicaid or Medikids if such child loses Medicaid
16 or Medikids eligibility and becomes eligible for the Florida
17 Healthy Kids program;
18 10.8. Contract with authorized insurers or any
19 provider of health care services, meeting standards
20 established by the corporation, for the provision of
21 comprehensive insurance coverage and preventive health care
22 services to participants. Such standards shall include
23 criteria under which the corporation may contract with more
24 than one provider of health care services in program sites.
25 Health plans shall be selected through a competitive bid
26 process. The selection of health plans shall be based
27 primarily on quality criteria established by the board. The
28 health plan selection criteria and scoring system, and the
29 scoring results, shall be available upon request for
30 inspection after the bids have been awarded;
31 11.9. Develop and implement a plan to publicize the
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Florida Healthy Kids Corporation, the eligibility requirements
2 of the program, and the procedures for enrollment in the
3 program and to maintain public awareness of the corporation
4 and the program;
5 12.10. Secure staff necessary to properly administer
6 the corporation. Staff costs shall be funded from state and
7 local matching funds and such other private or public funds as
8 become available. The board of directors shall determine the
9 number of staff members necessary to administer the
10 corporation;
11 13.11. As appropriate, enter into contracts with local
12 school boards or other agencies to provide onsite information,
13 enrollment, and other services necessary to the operation of
14 the corporation; and
15 14.12. Provide a report on an annual basis to the
16 Governor, Insurance Commissioner, Commissioner of Education,
17 Senate President, Speaker of the House of Representatives, and
18 Minority Leaders of the Senate and the House of
19 Representatives;.
20 15.13. Each fiscal year, establish a maximum number of
21 participants by county, on a statewide basis, who may enroll
22 in the program without the benefit of local matching funds.
23 Thereafter, the corporation may establish local matching
24 requirements for supplemental participation in the program.
25 The corporation may vary local matching requirements and
26 enrollment by county depending on factors which may influence
27 the generation of local match, including, but not limited to,
28 population density, per capita income, existing local tax
29 effort, and other factors. The corporation also may accept
30 in-kind match in lieu of cash for the local match requirement
31 to the extent allowed by Title XXI of the Social Security Act;
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 and For the 1996-1997 fiscal year only, funds may be
2 appropriated to the Florida Healthy Kids Corporation to
3 organize school children groups to facilitate the provision of
4 preventive health care services to children at sites in
5 addition to those allowed in subparagraph 1. This
6 subparagraph is repealed on July 1, 1997.
7 16. Establish eligibility criteria, premium and
8 cost-sharing requirements, and benefit packages which conform
9 to the provisions of the Florida Kidcare program, as created
10 in ss. 409.810-409.820.
11 (c) Coverage under the corporation's program is
12 secondary to any other available private coverage held by the
13 participant child or family member. The corporation may
14 establish procedures for coordinating benefits under this
15 program with benefits under other public and private coverage.
16 (d) The Florida Healthy Kids Corporation shall be a
17 private corporation not for profit, organized pursuant to
18 chapter 617, and shall have all powers necessary to carry out
19 the purposes of this act, including, but not limited to, the
20 power to receive and accept grants, loans, or advances of
21 funds from any public or private agency and to receive and
22 accept from any source contributions of money, property,
23 labor, or any other thing of value, to be held, used, and
24 applied for the purposes of this act.
25 (5)(4) BOARD OF DIRECTORS.--
26 (a) The Florida Healthy Kids Corporation shall operate
27 subject to the supervision and approval of a board of
28 directors chaired by the Insurance Commissioner or her or his
29 designee, and composed of 12 other members selected for 3-year
30 terms of office as follows:
31 1. One member appointed by the Commissioner of
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Education from among three persons nominated by the Florida
2 Association of School Administrators;
3 2. One member appointed by the Commissioner of
4 Education from among three persons nominated by the Florida
5 Association of School Boards;
6 3. One member appointed by the Commissioner of
7 Education from the Office of School Health Programs of the
8 Florida Department of Education;
9 4. One member appointed by the Governor from among
10 three members nominated by the Florida Pediatric Society;
11 5. One member, appointed by the Governor, who
12 represents the Children's Medical Services Program;
13 6. One member appointed by the Insurance Commissioner
14 from among three members nominated by the Florida Hospital
15 Association;
16 7. Two members, appointed by the Insurance
17 Commissioner, who are representatives of authorized health
18 care insurers or health maintenance organizations;
19 8. One member, appointed by the Insurance
20 Commissioner, who represents the Institute for Child Health
21 Policy;
22 9. One member, appointed by the Governor, from among
23 three members nominated by the Florida Academy of Family
24 Physicians;
25 10. One member, appointed by the Governor, who
26 represents the Agency for Health Care Administration; and
27 11. The State Health Officer or her or his designee.
28
29 In order to provide for staggered terms, the initial term of
30 the members appointed under subparagraphs 1., 4., and 6. shall
31 be for 2 years and the initial term of the members appointed
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 under subparagraphs 2., 5., 8., and 10. shall be for 4 years.
2 (b) A member of the board of directors may be removed
3 by the official who appointed that member. The board shall
4 appoint an executive director, who is responsible for other
5 staff authorized by the board.
6 (c) Board members are entitled to receive, from funds
7 of the corporation, reimbursement for per diem and travel
8 expenses as provided by s. 112.061.
9 (d) There shall be no liability on the part of, and no
10 cause of action shall arise against, any member of the board
11 of directors, or its employees or agents, for any action they
12 take in the performance of their powers and duties under this
13 act.
14 (6)(5) LICENSING NOT REQUIRED; FISCAL OPERATION.--
15 (a) The corporation shall not be deemed an insurer.
16 The officers, directors, and employees of the corporation
17 shall not be deemed to be agents of an insurer. Neither the
18 corporation nor any officer, director, or employee of the
19 corporation is subject to the licensing requirements of the
20 insurance code or the rules of the Department of Insurance.
21 However, the Department of Insurance may require that any
22 marketing representative utilized and compensated by the
23 corporation must be appointed as a representative of the
24 insurers or health services providers with which the
25 corporation contracts.
26 (b) The board has complete fiscal control over the
27 corporation and is responsible for all corporate operations.
28 (c) The Department of Insurance shall supervise any
29 liquidation or dissolution of the corporation and shall have,
30 with respect to such liquidation or dissolution, all power
31 granted to it pursuant to the insurance code.
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 (7)(6) ACCESS TO RECORDS; CONFIDENTIALITY;
2 PENALTIES.--Notwithstanding any other laws to the contrary,
3 the Florida Healthy Kids Corporation shall have access to the
4 medical records of a student upon receipt of permission from a
5 parent or guardian of the student. Such medical records may
6 be maintained by state and local agencies. Any identifying
7 information, including medical records and family financial
8 information, obtained by the corporation pursuant to this
9 subsection is confidential and is exempt from the provisions
10 of s. 119.07(1). Neither the corporation nor the staff or
11 agents of the corporation may release, without the written
12 consent of the participant or the parent or guardian of the
13 participant, to any state or federal agency, to any private
14 business or person, or to any other entity, any confidential
15 information received pursuant to this subsection. A violation
16 of this subsection is a misdemeanor of the second degree,
17 punishable as provided in s. 775.082 or s. 775.083.
18 Section 55. (1) Sections 391.031 and 391.056, Florida
19 Statutes, are hereby repealed.
20 (2) Section 624.92, Florida Statutes, as created by
21 section 9 of chapter 97-260, Laws of Florida, is hereby
22 repealed.
23 Section 56. The provisions of this act which would
24 require changes to contracts in existence on June 30, 1998,
25 between the Florida Healthy Kids Corporation and its
26 contracted providers shall be applied to such contracts upon
27 the renewal of the contracts, but not later than July 1, 2000.
28 Section 57. Sections 409.810 through 409.820, Florida
29 Statutes, as created by this act, are repealed, subject to
30 prior legislative review, on the first July 1 occurring at
31 least 1 year after the effective date of an act of the United
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 States Congress or the federal Health Care Financing
2 Administration which:
3 (1) Reduces Florida's federal matching rate under
4 Title XXI of the Social Security Act to less than 65 percent
5 federal match; or
6 (2) Reduces the federal funds allotted to Florida
7 under Title XXI of the Social Security Act to less than $250
8 million annually.
9 Section 58. This act shall take effect July 1 of the
10 year in which enacted.
11
12
13 ================ T I T L E A M E N D M E N T ===============
14 And the title is amended as follows:
15 Delete everything before the enacting clause
16
17 and insert:
18 A bill to be entitled
19 An act relating to health care; directing the
20 Agency for Health Care Administration to seek a
21 federal waiver for the Healthy Start Program;
22 amending s. 391.011, F.S.; providing a short
23 title; amending s. 391.016, F.S.; providing
24 legislative intent relating to the Children's
25 Medical Services program; amending s. 391.021,
26 F.S.; providing definitions; creating s.
27 391.025, F.S.; providing for applicability and
28 scope; amending s. 391.026, F.S.; providing
29 powers and duties of the Department of Health;
30 creating s. 391.028, F.S., and renumbering and
31 amending s. 391.051, F.S.; providing for
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Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 administration of the program; creating s.
2 391.029, F.S., and renumbering and amending ss.
3 391.046 and 391.07, F.S.; providing program
4 eligibility; creating s. 391.031, F.S.;
5 establishing benefits; creating s. 391.035,
6 F.S., and renumbering and amending ss. 391.036
7 and 391.041, F.S.; establishing provider
8 qualifications; creating s. 391.045, F.S.;
9 providing for provider reimbursement; creating
10 s. 391.047, F.S.; establishing responsibility
11 for payments on behalf of program participants
12 when other parties are liable; creating s.
13 391.055, F.S.; establishing service delivery
14 systems; creating s. 391.065, F.S.; providing
15 for health care provider agreements; creating
16 s. 391.071, F.S.; providing for quality of care
17 requirements; creating s. 391.081, F.S.;
18 establishing grievance reporting and resolution
19 requirements; creating s. 391.095, F.S.;
20 providing for program integrity; renumbering
21 and amending s. 391.061, F.S.; providing for
22 research and evaluation; renumbering ss.
23 391.201-391.217, F.S., relating to prescribed
24 pediatric extended care centers; designating
25 said sections as pt. IX of ch. 400, F.S.;
26 amending ss. 391.206 and 391.217, F.S.;
27 conforming cross-references; designating ss.
28 391.221, 391.222, and 391.223, F.S., as pt. II
29 of ch. 391, F.S., entitled "Children's Medical
30 Services Councils and Panels"; creating s.
31 391.221, F.S.; establishing the Statewide
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Children's Medical Services Network Advisory
2 Council; renumbering and amending s. 391.091,
3 F.S., relating to the Cardiac Advisory Council;
4 deleting meeting and reporting requirements;
5 creating s. 391.223, F.S.; providing for
6 technical advisory panels; amending ss.
7 391.301, 391.303, 391.304, 391.305, and
8 391.307, F.S.; revising provisions relating to
9 developmental evaluation and intervention
10 programs; amending s. 408.701, F.S.; conforming
11 cross-references; creating s. 409.810, F.S.;
12 providing a short title; creating s. 409.811,
13 F.S.; providing definitions; creating s.
14 409.812, F.S.; creating and establishing the
15 purpose of the Florida Kidcare program;
16 creating s. 409.813, F.S.; specifying program
17 components; specifying that certain program
18 components are not an entitlement; creating s.
19 409.8132, F.S.; creating and establishing the
20 purpose of the Medikids program component;
21 providing for administration by the Agency for
22 Health Care Administration; exempting Medikids
23 from licensure under the Florida Insurance
24 Code; providing applicability of certain
25 Medicaid requirements; establishing benefit
26 requirements; providing for eligibility;
27 providing enrollment requirements; authorizing
28 penalties for nonpayment of premiums; creating
29 s. 409.8134, F.S.; providing for program
30 enrollment and expenditure ceilings; creating
31 s. 409.8135, F.S., providing behavior health
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 benefits to non-Medicaid-eligible children with
2 serious emotional needs; creating s. 409.814,
3 F.S.; providing eligibility requirements;
4 creating s. 409.815, F.S.; establishing
5 requirements for health benefits coverage under
6 the Florida Kidcare program; creating s.
7 409.816, F.S.; providing for limitations on
8 premiums and cost-sharing; creating s. 409.817,
9 F.S.; providing for approval of health benefits
10 coverage as a condition of financial
11 assistance; creating s. 409.8175, F.S.;
12 authorizing health maintenance organizations
13 and health insurers to reimburse providers in
14 rural counties according to the Medicaid fee
15 schedule; creating 409.8177, F.S.; providing
16 for program evaluation; requiring annual
17 reports; creating s. 409.818, F.S.; providing
18 for program administration; specifying duties
19 of the Department of Children and Family
20 Services, the Department of Health, the Agency
21 for Health Care Administration, the Department
22 of Insurance, and the Florida Healthy Kids
23 Corporation; authorizing certain program
24 modifications related to federal approval;
25 renumbering and amending s. 154.508, F.S.,
26 relating to outreach activities to identify
27 low-income, uninsured children; creating s.
28 409.820, F.S.; requiring the Department of
29 Health to develop standards for quality
30 assurance and program access; establishing
31 performance measures and standards for the
74
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 Florida Kidcare program; directing the Agency
2 for Health Care Administration to conduct a
3 study of Medicaid presumptive eligibility and
4 report its findings to the Legislature;
5 providing an enrollment ceiling; amending s.
6 409.904, F.S.; expanding Medicaid optional
7 eligibility to certain children and providing
8 for continuous eligibility; amending s.
9 409.906, F.S.; authorizing the Agency for
10 Health Care Administration to pay for certain
11 services for the Healthy Start program pursuant
12 to a federal waiver; providing for limitations;
13 amending s. 409.9126, F.S., relating to the
14 provision of Children's Medical Services
15 network services for children with special
16 health care needs; deleting definitions;
17 deleting standards for referral of certain
18 children to the network; providing for certain
19 provider reimbursement; amending s. 624.91,
20 F.S., relating to the Florida Healthy Kids
21 Corporation; providing legislative intent;
22 specifying that the program is not an
23 entitlement; revising standards; providing for
24 competitive bids for health plans; providing
25 additional duties; repealing ss. 391.031 and
26 391.056, F.S., relating to patient care centers
27 and district children's medical program
28 supervisors; repealing s. 624.92, F.S.,
29 relating to application for a Medicaid waiver
30 for funds to expand the Florida Healthy Kids
31 Corporation; providing that the provisions of
75
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SENATE AMENDMENT
Bill No. CS/HB 4415, 1st Eng.
Amendment No.
1 this act do not apply to certain existing
2 contracts; providing for future repeal and
3 review of ss. 409.810-409.820, F.S., relating
4 to the "Florida Kidcare Act," based on
5 specified changes in federal policy; providing
6 an effective date.
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9
10
11
12
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15
16
17
18
19
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21
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25
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31
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