House Bill 4415c1

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    Florida House of Representatives - 1998             CS/HB 4415

        By the Committees on Health & Human Services
    Appropriations, Health Care Services and Representative
    Albright




  1                      A bill to be entitled

  2         An act relating to children's health; amending

  3         s. 383.011, F.S.; directing the Agency for

  4         Health Care Administration to seek a federal

  5         waiver for the Healthy Start program; amending

  6         s. 391.011, F.S.; providing a short title;

  7         amending s. 391.016, F.S.; providing

  8         legislative intent relating to the Children's

  9         Medical Services program; amending s. 391.021,

10         F.S.; providing definitions; creating s.

11         391.025, F.S.; providing for applicability and

12         scope; amending s. 391.026, F.S.; providing

13         powers and duties of the Department of Health;

14         creating s. 391.028, F.S., and renumbering and

15         amending s. 391.051, F.S.; providing for

16         administration of the program; creating s.

17         391.029, F.S., and renumbering and amending ss.

18         391.046 and 391.07, F.S.; providing program

19         eligibility; creating s. 391.031, F.S.;

20         establishing benefits; creating s. 391.035,

21         F.S., and renumbering and amending ss. 391.036

22         and 391.041, F.S.; establishing provider

23         qualifications; creating s. 391.045, F.S.;

24         providing for provider reimbursement; creating

25         s. 391.047, F.S.; establishing responsibility

26         for payments on behalf of program participants

27         when other parties are liable; creating s.

28         391.055, F.S.; establishing service delivery

29         systems; creating s. 391.065, F.S.; providing

30         for health care provider agreements; creating

31         s. 391.071, F.S.; providing for quality of care

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  1         requirements; creating s. 391.081, F.S.;

  2         establishing grievance reporting and resolution

  3         requirements; creating s. 391.095, F.S.;

  4         providing for program integrity; renumbering

  5         and amending s. 391.061, F.S.; providing for

  6         research and evaluation; renumbering ss.

  7         391.201-391.217, F.S., relating to prescribed

  8         pediatric extended care centers; designating

  9         said sections as pt. IX of ch. 400, F.S.;

10         amending ss. 391.206 and 391.217, F.S.;

11         conforming cross references; designating ss.

12         391.221, 391.222, and 391.223, F.S., as pt. II

13         of ch. 391, F.S., entitled "Children's Medical

14         Services Councils and Panels"; creating s.

15         391.221, F.S.; establishing the Statewide

16         Children's Medical Services Network Advisory

17         Council; creating s. 391.222, F.S.;

18         establishing the Cardiac Advisory Council;

19         creating s. 391.223, F.S.; providing for

20         technical advisory panels; amending ss.

21         391.301, 391.303, 391.304, 391.305, and

22         391.307, F.S.; revising provisions relating to

23         developmental evaluation and intervention

24         programs; amending s. 408.701, F.S.; conforming

25         cross references; creating s. 409.810, F.S.;

26         providing a short title; creating s. 409.811,

27         F.S.; providing definitions; creating s.

28         409.812, F.S.; creating the Florida Children's

29         Healthy Bodies program; providing legislative

30         findings and intent; providing guiding

31         principles; creating s. 409.813, F.S.;

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  1         specifying program components; specifying that

  2         certain program components are not an

  3         entitlement; establishing an enrollment

  4         ceiling; creating s. 409.8131, F.S.; creating

  5         the Medikids program; providing legislative

  6         findings and intent; providing that the program

  7         is not an entitlement; providing for a

  8         marketing plan; providing for application to

  9         Medikids of specified sections of ch. 409,

10         F.S., relating to Medicaid; providing for

11         benefits; providing eligibility standards;

12         providing for enrollment; creating s. 409.8134,

13         F.S.; providing for delivery of services and

14         reimbursement of providers in a rural county;

15         creating s. 409.8135, F.S.; providing

16         behavioral health benefits to

17         non-Medicaid-eligible children with serious

18         emotional needs; creating s. 409.814, F.S.;

19         providing eligibility requirements; creating s.

20         409.815, F.S.; establishing health benefits

21         coverage requirements for the program; creating

22         s. 409.816, F.S.; providing for limitations on

23         premiums and cost-sharing; creating s. 409.817,

24         F.S.; providing for a health insurance pilot

25         project; requiring approval of health benefits

26         coverage as a condition of financial

27         assistance; creating s. 409.8175, F.S.;

28         directing the Agency for Health Care

29         Administration to seek federal approval to

30         establish a family coverage program; providing

31         conditions; creating s. 409.8177, F.S.;

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  1         providing for program evaluation; requiring

  2         annual reports; creating s. 409.818, F.S.;

  3         providing for program administration; providing

  4         responsibilities for the Department of Children

  5         and Family Services, the Department of Health,

  6         the Department of Insurance, the Agency for

  7         Health Care Administration, and the Florida

  8         Healthy Kids Corporation; authorizing program

  9         modifications to obtain federal approval of the

10         state's child health insurance plan;

11         renumbering and amending s. 154.508, F.S.,

12         relating to outreach activities; creating s.

13         409.8195, F.S.; requiring the development of

14         quality assurance and access standards;

15         creating s. 409.821, F.S.; establishing

16         performance measures and standards; providing

17         an enrollment ceiling; amending s. 409.904,

18         F.S.; expanding Medicaid optional eligibility

19         to certain children and providing for

20         continuous eligibility; amending s. 409.9126,

21         F.S.; relating to the provision of Children's

22         Medical Services network services for children

23         with special health care needs; deleting

24         definitions; deleting standards for referral of

25         certain children to the network; providing for

26         certain provider reimbursement; amending s.

27         624.91, F.S., relating to the Florida Healthy

28         Kids Corporation; providing legislative intent;

29         specifying that the program is not an

30         entitlement; revising standards; providing

31         additional duties; repealing ss. 391.031,

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  1         391.056, and 391.091, F.S., relating to patient

  2         care centers, district children's medical

  3         program supervisors, and the Cardiac Advisory

  4         Council which was advisory to the Children's

  5         Medical Services Program Office; repealing s.

  6         624.92, F.S., relating to application for a

  7         Medicaid waiver for funds to expand the Florida

  8         Health Kids Corporation; providing for future

  9         repeal and review of s. 409.814(3), F.S., and

10         ss. 409.810-409.821, F.S., relating to the

11         "Florida Children's Healthy Bodies Act," on

12         specified dates; providing a contingent

13         effective date.

14

15         WHEREAS, the bridge to opportunity for every child must

16  be anchored in a healthy body and a healthy mind and must lead

17  to the child's readiness to learn in school, and

18         WHEREAS, it is widely acknowledged that entering school

19  ready to learn is crucial to a child's success both in school

20  and in life, and

21         WHEREAS, the state's system of public education could

22  better perform its mission of educating its K-12 students if

23  more students enter school healthy and ready to learn, and

24         WHEREAS, as emphasized by the Governor, the President

25  of the Senate, and the Speaker of the House of

26  Representatives, a child's health in both body and mind is

27  essential to the child's ability to learn, and

28         WHEREAS, we can make great strides to improve school

29  readiness by addressing child care, child health, and school

30  readiness education in one single, accountable continuum, NOW,

31  THEREFORE,

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  1  Be It Enacted by the Legislature of the State of Florida:

  2

  3         Section 1.  Subsection (3) is added to section 383.011,

  4  Florida Statutes, to read:

  5         383.011  Administration of maternal and child health

  6  programs.--

  7         (3)  The Agency for Health Care Administration, working

  8  jointly with the Department of Health and the Florida

  9  Association of Healthy Start Coalitions, is directed to seek a

10  federal waiver to secure matching funds under Title XIX of the

11  Social Security Act for the Healthy Start program.  The

12  federal waiver application shall seek Medicaid matching funds

13  utilizing existing appropriated general revenue and any local

14  contributions.

15         Section 2.  Section 391.011, Florida Statutes, is

16  amended to read:

17         391.011  Short title.--The provisions of this chapter

18  This act shall be known and may be cited as the "Children's

19  Medical Services Act."

20         Section 3.  Section 391.016, Florida Statutes, is

21  amended to read:

22         391.016  Legislative intent.--The Legislature intends

23  that the Children's Medical Services program:

24         (1)  Provide to children with special health care needs

25  a family-centered, comprehensive, and coordinated statewide

26  managed system of care that links community-based health care

27  with multidisciplinary, regional, and tertiary pediatric

28  specialty care finds and declares that there is a need to

29  provide medical services for needy children, particularly

30  those with chronic, crippling or potentially crippling and

31  physically handicapping diseases or conditions, and to provide

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  1  leadership and direction in promoting, planning, and

  2  coordinating children's medical care programs so that the full

  3  development of each child's potential may be realized.

  4         (2)  Provide essential preventive, evaluative, and

  5  early intervention services for children at risk for or having

  6  special health care needs, in order to prevent or reduce long

  7  term disabilities.

  8         (3)  Serve as a principal provider for children with

  9  special health care needs under Titles XIX and XXI of the

10  Social Security Act.

11         (4)  Be complementary to children's health training

12  programs essential for the maintenance of a skilled pediatric

13  health care workforce for all Floridians.

14         Section 4.  Section 391.021, Florida Statutes, is

15  amended to read:

16         391.021  Definitions.--When used in this act, unless

17  the context clearly indicates otherwise:

18         (1)  "Children's Medical Services network" or "network"

19  means a statewide managed care service system that includes

20  health care providers, as defined in this section.

21         (2)  "Children with special health care needs" means

22  those children under age 21 years whose serious or chronic

23  physical or developmental conditions require extensive

24  preventive and maintenance care beyond that required by

25  typically healthy children.  Health care utilization by these

26  children exceeds the statistically expected usage of the

27  normal child adjusted for chronological age.  These children

28  often need complex care requiring multiple providers,

29  rehabilitation services, and specialized equipment in a number

30  of different settings.

31         (3)(1)  "Department" means the Department of Health.

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  1         (4)(2)  "Eligible individual" means a child with a

  2  special health care need or a female of any age with a

  3  high-risk pregnancy, or an individual below the age of 21

  4  years who has an organic disease, defect, or condition which

  5  may hinder the achievement of his or her normal growth and

  6  development,  and who meets the financial and medical

  7  eligibility standards established in s. 391.029. by the

  8  department.  In addition, where specific legislative

  9  appropriation exists, individuals with long-term chronic

10  diseases, such as cystic fibrosis, which originated during

11  childhood and who received services under this act before the

12  age of 21 years shall continue to be eligible beyond that age.

13         (5)  "Health care provider" means a health care

14  professional, health care facility, or entity licensed or

15  certified to provide health services in this state that meets

16  the criteria as established by the department.

17         (6)(3)  "Health Medical services" includes the

18  prevention, diagnosis, and treatment of human disease, pain,

19  injury, deformity, or disabling physical conditions.

20         (7)  "Participant" means an eligible individual who is

21  enrolled in the Children's Medical Services program.

22         (8)  "Program" means the Children's Medical Services

23  program established in the Division of Children's Medical

24  Services of the department.

25         Section 5.  Section 391.025, Florida Statutes, is

26  created to read:

27         391.025  Applicability and scope.--

28         (1)  This act applies to health services provided to

29  eligible individuals who are:

30         (a)  Enrolled in the Medicaid program;

31

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  1         (b)  Enrolled in the Florida Children's Healthy Bodies

  2  program; and

  3         (c)  Uninsured or underinsured, provided that they meet

  4  the financial eligibility requirements established in this

  5  act, and to the extent that resources are appropriated for

  6  their care.

  7         (2)  The Children's Medical Services program consists

  8  of the following components:

  9         (a)  The infant metabolic screening program established

10  in s. 383.14.

11         (b)  The regional perinatal intensive care centers

12  program established in ss. 383.15-383.21.

13         (c)  A federal or state program authorized by the

14  Legislature.

15         (d)  The developmental evaluation and intervention

16  program.

17         (e)  The Children's Medical Services network.

18         (3)  The Children's Medical Services program shall not

19  be deemed an insurer and is not subject to the licensing

20  requirements of the Florida Insurance Code or the rules of the

21  Department of Insurance, when providing services to children

22  who receive Medicaid benefits, other Medicaid-eligible

23  children with special health care needs, and children

24  participating in the Florida Children's Healthy Bodies

25  program.  This exemption shall not extend to contractors.

26         Section 6.  Section 391.026, Florida Statutes, is

27  amended to read:

28         391.026  Powers and duties of the department.--To

29  administer its programs of children's medical services, The

30  department shall have the following powers, duties, and

31  responsibilities:

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  1         (1)  To provide or contract for the provision of health

  2  medical services to eligible individuals.

  3         (2)  To determine the medical and financial eligibility

  4  standards for the program and to determine the medical and

  5  financial eligibility of individuals seeking health medical

  6  services from the program.

  7         (3)  To recommend priorities for the implementation of

  8  comprehensive plans and budgets.

  9         (4)  To coordinate a comprehensive delivery system for

10  eligible individuals to take maximum advantage of all

11  available federal funds.

12         (5)  To promote, establish, and coordinate programs

13  relating to children's medical services in cooperation with

14  other public and private agencies and to coordinate funding of

15  health care programs with state or local indigent health care

16  funding mechanisms.

17         (6)  To initiate, coordinate, and request review of

18  applications to federal and state agencies for funds,

19  services, or commodities relating to children's medical

20  programs.

21         (7)  To sponsor or promote grants for projects,

22  programs, education, or research in the field of medical needs

23  of children, with an emphasis on early diagnosis and

24  treatment.

25         (8)  To oversee and operate the Children's Medical

26  Services network contract or be contracted with.

27         (9)  To establish reimbursement mechanisms for the

28  Children's Medical Services network standards of eligibility

29  for patients of children's medical services programs.

30         (10)  To establish Children's Medical Services network

31  standards and credentialing requirements for health care

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  1  providers and health care services coordinate funding of

  2  medical care programs with state or local indigent health care

  3  funding mechanisms.

  4         (11)  To serve as a provider and principal case manager

  5  for children with special health care needs under Titles XIX

  6  and XXI of the Social Security Act establish standards for

  7  patient care and facilities.

  8         (12)  To monitor the provision of health services in

  9  the program, including the utilization and quality of health

10  services.

11         (13)  To administer the Children with Special Health

12  Care Needs program in accordance with Title V of the Social

13  Security Act.

14         (14)  To establish and operate a grievance resolution

15  process for participants and health care providers.

16         (15)  To maintain program integrity in the Children's

17  Medical Services program.

18         (16)  To receive and manage health care premiums,

19  capitation payments, and funds from federal, state, local, and

20  private entities for the program.

21         (17)  To appoint health care consultants for the

22  purpose of providing peer review and making recommendations to

23  enhance the delivery and quality of services in the Children's

24  Medical Services program.

25         (18)(12)  To make rules to carry out the provisions of

26  this act.

27         Section 7.  Section 391.028, Florida Statutes, is

28  created, and section 391.051, Florida Statutes, is renumbered

29  as subsection (1) of said section and amended, to read:

30         391.028  Administration.--The Children's Medical

31  Services program shall have a central office and area offices.

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  1         (1) 391.051  Qualifications of director.--The Director

  2  of the Division of for Children's Medical Services must be a

  3  physician licensed under chapter 458 or chapter 459 who has

  4  specialized training and experience in the provision of health

  5  medical care to children and who has recognized skills in

  6  leadership and the promotion of children's health programs.

  7  The division director for Children's Medical Services shall be

  8  the deputy secretary and the Deputy State Health Officer for

  9  Children's Medical Services and is appointed by and reports to

10  the secretary.

11         (2)  The division director shall designate Children's

12  Medical Services area offices to perform operational

13  activities, including, but not limited to:

14         (a)  Providing case management services for the

15  network.

16         (b)  Providing local oversight of the program.

17         (c)  Determining medical and financial eligibility for

18  the program.

19         (d)  Participating in the determination of a level of

20  care and medical complexity for long-term care services.

21         (e)  Authorizing services in the program and developing

22  spending plans.

23         (f)  Participating in the development of treatment

24  plans.

25         (g)  Taking part in the resolution of complaints and

26  grievances from participants and health care providers.

27         (3)  Each Children's Medical Services area office shall

28  be directed by a physician licensed under chapter 458 or

29  chapter 459 who has specialized training and experience in the

30  provision of health care to children.  The director of a

31  Children's Medical Services area office shall be appointed by

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  1  the division director from the active panel of Children's

  2  Medical Services physician consultants.

  3         Section 8.  Section 391.029, Florida Statutes, is

  4  created, section 391.046, Florida Statutes, is renumbered as

  5  subsection (3) of said section and amended, and section

  6  391.07, Florida Statutes, is renumbered as subsection (4) of

  7  said section and amended, to read:

  8         391.029  Program eligibility.--

  9         (1)  The department shall establish the medical

10  criteria to determine if an applicant for the Children's

11  Medical Services program is an eligible individual.

12         (2)  The following individuals are financially eligible

13  for the program:

14         (a)  A high-risk pregnant female who is eligible for

15  Medicaid.

16         (b)  A child with special health care needs from birth

17  to age 21 years who is eligible for Medicaid.

18         (c)  A child with special health care needs from birth

19  to age 19 years who is eligible for a program under Title XXI

20  of the Social Security Act.

21         (d)  A child with special health care needs from birth

22  to age 21 years whose projected annual cost of care adjusts

23  the family income to Medicaid financial criteria.  In cases

24  where the family income is adjusted based on a projected

25  annual cost of care, the family shall participate financially

26  in the cost of care based on criteria established by the

27  department.

28

29  The department may continue to serve certain children with

30  special health care needs who are 21 years of age or older and

31  who were receiving services from the program prior to April 1,

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  1  1998.  Such children may be served by the department until

  2  July 1, 2000.

  3         (3) 391.046  Financial determination.--The department

  4  shall determine the financial and medical eligibility of

  5  children for the program. The department shall also determine

  6  ability of individuals seeking medical services, or the

  7  financial ability of the parents, or persons or other agencies

  8  having legal custody over such individuals, to pay the costs

  9  of health such medical services under the program. The

10  department may pay reasonable travel expenses related to the

11  determination of eligibility for or the provision of health

12  medical services.

13         (4) 391.07  Indigent and semi-indigent cases.--Any

14  child who has been provided with surgical or medical care or

15  treatment under this act prior to being adopted shall continue

16  to be eligible to be provided with such care or treatment

17  after his or her adoption, regardless of the financial ability

18  of the persons adopting the child.

19         Section 9.  Section 391.031, Florida Statutes, is

20  created to read:

21         391.031  Benefits.--Benefits provided under the program

22  shall be the same benefits provided to children as specified

23  in ss. 409.905 and 409.906. The department may offer

24  additional benefits for early intervention services, respite

25  services, genetic testing, genetic and nutritional counseling,

26  and parent support services, if such services are determined

27  to be medically necessary. No child or person determined

28  eligible for the program who is eligible under Title XIX or

29  Title XXI of the Social Security Act shall receive any service

30  other than an initial health care screening or treatment of an

31  emergency medical condition as defined in s. 395.002, until

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  1  such child or person is enrolled in Medicaid or a Title XXI

  2  program.

  3         Section 10.  Section 391.035, Florida Statutes, is

  4  created, section 391.036, Florida Statutes, is renumbered as

  5  subsection (2) of said section and amended, and section

  6  391.041, Florida Statutes, is renumbered as subsection (3) of

  7  said section and amended, to read:

  8         391.035  Provider qualifications.--

  9         (1)  The department shall establish the criteria to

10  designate health care providers to participate in the

11  Children's Medical Services network.  The department shall

12  follow, whenever available, national guidelines for selecting

13  health care providers to serve children with special health

14  care needs.

15         (2) 391.036  Medical services providers;

16  qualifications.--The department shall require that all health

17  care providers under contract with the program of medical

18  services under this act be duly licensed in the state, if such

19  licensure is available, and meet such criteria as may be

20  established by the department.

21         (3) 391.041  Services to other state or local programs

22  or institutions.--The department may initiate agreements with

23  other state or local governmental programs or institutions for

24  the coordination of health medical care to eligible

25  individuals receiving services from such programs or

26  institutions.

27         Section 11.  Section 391.045, Florida Statutes, is

28  created to read:

29         391.045  Reimbursement.--

30         (1)  The department shall reimburse health care

31  providers for services rendered through the Children's Medical

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  1  Services network using cost-effective methods, including, but

  2  not limited to, capitation, discounted fee-for-service, unit

  3  costs, and cost reimbursement.  Medicaid reimbursement rates

  4  shall be utilized to the maximum extent possible, where

  5  applicable.

  6         (2)  Reimbursement to the Children's Medical Services

  7  program for services provided to children with special health

  8  care needs who participate in the Florida Children's Healthy

  9  Bodies program and who are not Medicaid recipients shall be on

10  a capitated basis.

11         Section 12.  Section 391.047, Florida Statutes, is

12  created to read:

13         391.047  Responsibility for payments on behalf of

14  Children's Medical Services program participants when other

15  parties are liable.--The Children's Medical Services program

16  shall comply with s. 402.24, concerning third-party

17  liabilities and recovery of third-party payments for health

18  services.

19         Section 13.  Section 391.055, Florida Statutes, is

20  created to read:

21         391.055  Service delivery systems.--

22         (1)  The program shall apply managed care methods to

23  ensure the efficient operation of the Children's Medical

24  Services network.  Such methods include, but are not limited

25  to, capitation payments, utilization management and review,

26  prior authorization, and case management.

27         (2)  The components of the network are:

28         (a)  Qualified primary care physicians who shall serve

29  as the gatekeepers and who shall be responsible for the

30  provision or authorization of health services to an eligible

31

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  1  individual who is enrolled in the Children's Medical Services

  2  network.

  3         (b)  Comprehensive specialty care arrangements that

  4  meet the requirements of s. 391.035 to provide acute care,

  5  specialty care, long-term care, and chronic disease management

  6  for eligible individuals.

  7         (c)  Case management services.

  8         (3)  The Children's Medical Services network may

  9  contract with school districts participating in the certified

10  school match program pursuant to ss. 236.0812 and 409.908(21)

11  for the provision of school-based services, as provided for in

12  s. 409.9071, for Medicaid-eligible children who are enrolled

13  in the Children's Medical Services network.

14         Section 14.  Section 391.065, Florida Statutes, is

15  created to read:

16         391.065  Health care provider agreements.--The

17  department is authorized to establish health care provider

18  agreements for participation in the Children's Medical

19  Services network.

20         Section 15.  Section 391.071, Florida Statutes, is

21  created to read:

22         391.071  Quality of care requirements.--The Children's

23  Medical Services program shall develop quality of care and

24  service integration standards and reporting requirements for

25  health care providers that participate in the Children's

26  Medical Services network.  The program shall ensure that these

27  standards are not duplicative of other standards and

28  requirements for health care providers.

29         Section 16.  Section 391.081, Florida Statutes, is

30  created to read:

31

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  1         391.081  Grievance reporting and resolution

  2  requirements.--The department shall adopt and implement a

  3  system to provide assistance to eligible individuals and

  4  health care providers to resolve complaints and grievances.

  5  To the greatest extent possible, the department shall use

  6  existing grievance reporting and resolution processes.  The

  7  department shall ensure that the system developed for the

  8  Children's Medical Services program does not duplicate

  9  existing grievance reporting and resolution processes.

10         Section 17.  Section 391.095, Florida Statutes, is

11  created to read:

12         391.095  Program integrity.--The department shall

13  operate a system to oversee the activities of Children's

14  Medical Services network participants, health care providers,

15  and their representatives to prevent fraudulent and abusive

16  behavior, overutilization and duplicative utilization, and

17  neglect of participants and to recover overpayments as

18  appropriate.  For the purposes of this section, the terms

19  "abuse" and "fraud" have the meanings provided in s. 409.913.

20  The department shall refer incidents of suspected fraud and

21  abuse, and overutilization and duplicative utilization, to the

22  appropriate regulatory agency.

23         Section 18.  Section 391.061, Florida Statutes, is

24  renumbered as section 391.097, Florida Statutes, and is

25  amended to read:

26         391.097 391.061  Research and evaluation.--

27         (1)  The department may initiate, fund, and conduct

28  research and evaluation projects to improve the delivery of

29  children's medical services. The department may cooperate with

30  public and private agencies engaged in work of a similar

31  nature.

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  1         (2)  The Children's Medical Services network shall be

  2  included in any evaluation conducted in accordance with the

  3  provisions of Title XXI of the Social Security Act as enacted

  4  by the Legislature.

  5         Section 19.  Sections 391.201 through 391.217, Florida

  6  Statutes, are renumbered as sections 400.901 through 400.917,

  7  Florida Statutes, and designated as part IX of chapter 400,

  8  Florida Statutes.

  9         Section 20.  Section 391.206, Florida Statutes, is

10  renumbered as section 400.906, Florida Statutes, and

11  subsection (1) of said section is amended to read:

12         400.906 391.206  Initial application for license.--

13         (1)  Application for a license shall be made to the

14  agency on forms furnished by it and shall be accompanied by

15  the appropriate license fee unless the applicant is exempt

16  from payment of the fee as provided in s. 400.905 391.205.

17         Section 21.  Section 391.217, Florida Statutes, is

18  renumbered as section 400.917, Florida Statutes, and amended

19  to read:

20         400.917 391.217  Disposition of moneys from fines and

21  fees.--All moneys received from administrative fines pursuant

22  to s. 400.908 391.208 and all moneys received from fees

23  collected pursuant to s. 400.905 391.205 shall be deposited in

24  the Health Care Trust Fund created in s. 408.16 455.2205.

25         Section 22.  Sections 391.221, 391.222, and 391.223,

26  Florida Statutes, as created by this act, are designated as

27  part II of chapter 391, Florida Statutes, entitled "Children's

28  Medical Services Councils and Panels."

29         Section 23.  Section 391.221, Florida Statutes, is

30  created to read:

31

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  1         391.221  Statewide Children's Medical Services Network

  2  Advisory Council.--

  3         (1)  The secretary of the department may appoint a

  4  Statewide Children's Medical Services Network Advisory Council

  5  for the purpose of acting as an advisory body to the

  6  department.  Specifically, the duties of the council shall

  7  include, but not be limited to:

  8         (a)  Recommending standards and credentialing

  9  requirements for health care providers rendering health

10  services to Children's Medical Services network participants.

11         (b)  Making recommendations to the Director of the

12  Division of Children's Medical Services concerning the

13  selection of health care providers for the Children's Medical

14  Services network.

15         (c)  Reviewing and making recommendations concerning

16  network health care provider or participant disputes that are

17  brought to the attention of the advisory council.

18         (d)  Providing input to the Children's Medical Services

19  program on the policies governing the Children's Medical

20  Services network.

21         (e)  Reviewing the financial reports and financial

22  status of the network and making recommendations concerning

23  the methods of payment and cost controls for the network.

24         (f)  Reviewing and recommending the scope of benefits

25  for the network.

26         (g)  Reviewing network performance measures and

27  outcomes and making recommendations for improvements to the

28  network and its maintenance and collection of data and

29  information.

30         (2)  The council shall be composed of 12 members

31  representing the private health care provider sector, families

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  1  with children who have special health care needs, the Agency

  2  for Health Care Administration, the Department of Insurance,

  3  the Florida Chapter of the American Academy of Pediatrics, an

  4  academic health center pediatric program, and the health

  5  insurance industry.  Members shall be appointed for 4-year,

  6  staggered terms.  In no case shall an employee of the

  7  Department of Health serve as a member or as an ex officio

  8  member of the advisory council.  A vacancy shall be filled for

  9  the remainder of the unexpired term in the same manner as the

10  original appointment.  A member may not be appointed to more

11  than two consecutive terms.  However, a member may be

12  reappointed after being off the council for at least 2 years.

13         (3)  Members shall receive no compensation, but shall

14  be reimbursed for per diem and travel expenses in accordance

15  with the provisions of s. 112.061.

16         Section 24.  Section 391.222, Florida Statutes, is

17  created to read:

18         391.222  Cardiac Advisory Council.--

19         (1)  The secretary of the department may appoint a

20  Cardiac Advisory Council for the purpose of acting as the

21  advisory body to the Division of Children's Medical Services

22  in the delivery of cardiac services to children.

23  Specifically, the duties of the council shall include, but not

24  be limited to:

25         (a)  Recommending standards for personnel and

26  facilities rendering cardiac services for the Division of

27  Children's Medical Services.

28         (b)  Receiving reports of the periodic review of

29  cardiac personnel and facilities to determine if established

30  standards for Children's Medical Services cardiac services are

31  met.

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  1         (c)  Making recommendations to the division director as

  2  to the approval or disapproval of reviewed personnel and

  3  facilities.

  4         (d)  Making recommendations as to the intervals for

  5  reinspection of approved personnel and facilities.

  6         (e)  Providing input to the Division of Children's

  7  Medical Services on all aspects of Children's Medical Services

  8  cardiac programs, including the rulemaking process.

  9         (2)  The council shall be composed of eight members

10  with technical expertise in cardiac medicine.  Members shall

11  be appointed for 4-year, staggered terms.  In no case shall an

12  employee of the Department of Health serve as a member or as

13  an ex officio member of the advisory council.  A vacancy shall

14  be filled for the remainder of the unexpired term in the same

15  manner as the original appointment.  A member may not be

16  appointed to more than two consecutive terms.  However, a

17  member may be reappointed after being off the council for at

18  least 2 years.

19         (3)  Members shall receive no compensation, but shall

20  be reimbursed for per diem and travel expenses in accordance

21  with the provisions of s. 112.061.

22         Section 25.  Section 391.223, Florida Statutes, is

23  created to read:

24         391.223  Technical advisory panels.--The secretary of

25  the department may establish technical advisory panels to

26  assist the Division of Children's Medical Services in

27  developing specific policies and procedures for the Children's

28  Medical Services program.

29         Section 26.  Section 391.301, Florida Statutes, is

30  amended to read:

31

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  1         391.301  Developmental evaluation and intervention

  2  programs; legislative findings and intent.--

  3         (1)  The Legislature finds that the high-risk and

  4  disabled newborn infants in this state need in-hospital and

  5  outpatient developmental evaluation and intervention and that

  6  their families need training and support services. The

  7  Legislature further finds that there is an identifiable and

  8  increasing number of infants who need developmental evaluation

  9  and intervention and family support due to the fact that

10  increased numbers of low-birthweight and sick full-term

11  newborn infants are now surviving because of due to the

12  advances in neonatal intensive care medicine; increased

13  numbers of medically involved infants are remaining

14  inappropriately in hospitals because their parents lack the

15  confidence or skills to care for these infants without

16  support; and increased numbers of infants are at risk due to

17  parent risk factors, such as substance abuse, teenage

18  pregnancy, and other high-risk conditions.

19         (2)  It is the intent of the Legislature to establish

20  developmental evaluation and intervention services programs at

21  all hospitals providing Level II or Level III neonatal

22  intensive care services, in order that families with high-risk

23  or disabled infants may gain the services and skills they need

24  to support their infants.

25         (3)  It is the intent of the Legislature to provide a

26  statewide coordinated program to screen, diagnose, and manage

27  high-risk infants identified as hearing-impaired. The program

28  shall develop criteria to identify infants who are at risk of

29  having hearing impairments, and shall ensure that all parents

30  or guardians of newborn infants are provided with materials

31

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  1  regarding hearing impairments prior to discharge of the

  2  newborn infants from the hospital.

  3         (4)  It is the intent of the Legislature that a

  4  methodology be developed to integrate information on infants

  5  with potentially disabling conditions with other early

  6  intervention programs, including Part C of Pub. L. No. 105-17

  7  and the reporting system to be established under the Healthy

  8  Start program.

  9         Section 27.  Section 391.303, Florida Statutes, is

10  amended to read:

11         391.303  Program requirements.--

12         (1)  A Developmental evaluation and intervention

13  services program shall be established at each hospital that

14  provides Level II or Level III neonatal intensive care

15  services. Program services shall be made available to an

16  infant or toddler identified as being at risk for

17  developmental disabilities, or identified as medically

18  involved, who, along with his or her family, would benefit

19  from program services. Program services shall be made

20  available to infants or toddlers in a Level II or Level III

21  neonatal intensive care unit or in a pediatric intensive care

22  unit, infants who are identified as being at high risk for

23  hearing impairment or who are hearing-impaired, or infants who

24  have a metabolic or genetic disorder. The developmental

25  evaluation and intervention programs are subject to the

26  availability of moneys and the limitations established by the

27  General Appropriations Act or chapter 216. Hearing screening,

28  evaluation and referral services, and initial developmental

29  assessments services shall be provided to each infant or

30  toddler. Other program services may be provided to an infant

31  or toddler, and the family of the infant or toddler, who do

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  1  not meet the financial eligibility criteria for the Children's

  2  Medical Services program based on the availability of funding,

  3  including insurance and fees.

  4         (2)  Each developmental evaluation and intervention

  5  program shall have a program director, a medical director, and

  6  necessary staff to carry out the program. The program director

  7  shall establish and coordinate the developmental evaluation

  8  and intervention program. The program shall include, but is

  9  not limited to:

10         (a)  In-hospital evaluation and intervention services,

11  parent support and training, and family support planning and

12  case management.

13         (b)  Screening and evaluation services to identify each

14  infant at risk of hearing impairment, and a medical and

15  educational followup and care management program for an infant

16  who is identified as hearing-impaired, with management

17  beginning as soon after birth as practicable. The medical

18  management program must include the genetic evaluation of an

19  infant suspected to have genetically determined deafness and

20  an evaluation of the relative risk.

21         (c)  Regularly held multidisciplinary team meetings to

22  develop and update the family support plan. In addition to the

23  family, a multidisciplinary team may include a physician,

24  physician assistant, psychologist, psychotherapist, educator,

25  social worker, nurse, physical or occupational therapist,

26  speech pathologist, developmental evaluation and intervention

27  program director, case manager, and others who are involved

28  with the in-hospital and posthospital discharge care plan, and

29  anyone the family wishes to include as a member of the team.

30  The family support plan is a written plan that describes the

31  infant or toddler, and the therapies and services the infant

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  1  or toddler and his or her family need, and the intended

  2  outcomes of the services.

  3         (d)  Discharge planning by the multidisciplinary team,

  4  including referral and followup to primary medical care and

  5  modification of the family support plan.

  6         (e)  Education and training for neonatal and pediatric

  7  intensive care services staff, volunteers, and others, as

  8  needed, in order to expand the services provided to high-risk,

  9  developmentally disabled, medically involved, or

10  hearing-impaired infants and toddlers and their families.

11         (f)  Followup intervention services after hospital

12  discharge, to aid the family and the high-risk,

13  developmentally disabled, medically involved, or

14  hearing-impaired infant's or toddler's transition into the

15  community. These services shall include, but are not limited

16  to, home intervention services and other intervention

17  services, both contractual and voluntary. Support services

18  shall be coordinated at the request of the family and within

19  the context of the family support plan.

20         (g)  Referral to and coordination of services with

21  community providers.

22         (h)  Educational materials about infant care, infant

23  growth and development, community resources, medical

24  conditions and treatments, and family advocacy. Materials

25  regarding hearing impairments shall be provided to each parent

26  or guardian of a hearing-impaired infant or toddler.

27         (i)  Involvement of the parents and guardians of each

28  identified high-risk, developmentally disabled, medically

29  involved, or hearing-impaired infant or toddler.

30         Section 28.  Paragraph (a) of subsection (1) of section

31  391.304, Florida Statutes, is amended to read:

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  1         391.304  Program coordination.--

  2         (1)  The Department of Health shall:

  3         (a)  Coordinate with the Department of Education, the

  4  Offices of Prevention, Early Assistance, and Child

  5  Development, the Florida Interagency Coordinating Council for

  6  Infants and Toddlers, and the State Coordinating Council for

  7  Early Childhood Services in planning and administering ss.

  8  391.301-391.307. This coordination shall be in accordance with

  9  s. 411.222.

10         Section 29.  Subsection (1) of section 391.305, Florida

11  Statutes, is amended to read:

12         391.305  Program standards; rules.--The Department of

13  Health shall adopt rules for the administration of the

14  developmental evaluation and intervention program. The rules

15  shall specify standards for the development and operation of

16  the program, including, but not limited to:

17         (1)  Standards governing the eligibility need for

18  program services and the requirements of the population to be

19  served.

20         Section 30.  Subsection (1) of section 391.307, Florida

21  Statutes, is amended to read:

22         391.307  Program review.--

23         (1)  At least annually during the contract period, the

24  Department of Health shall evaluate each developmental

25  evaluation and intervention program. The department shall

26  develop criteria to evaluate child and family patient outcome,

27  program participation, service coordination case management,

28  and program effectiveness.

29         Section 31.  Subsection (13) of section 408.701,

30  Florida Statutes, is amended to read:

31

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  1         408.701  Community health purchasing; definitions.--As

  2  used in ss. 408.70-408.706, the term:

  3         (13)  "Health care provider" or "provider" means a

  4  state-licensed or state-authorized facility, a facility

  5  principally supported by a local government or by funds from a

  6  charitable organization that holds a current exemption from

  7  federal income tax under s. 501(c)(3) of the Internal Revenue

  8  Code, a licensed practitioner, a county health department

  9  established under part I of chapter 154, a patient care center

10  described in s. 391.031, a prescribed pediatric extended care

11  center defined in s. 400.902 391.202, a federally supported

12  primary care program such as a migrant health center or a

13  community health center authorized under s. 329 or s. 330 of

14  the United States Public Health Services Act that delivers

15  health care services to individuals, or a community facility

16  that receives funds from the state under the Community

17  Alcohol, Drug Abuse, and Mental Health Services Act and

18  provides mental health services to individuals.

19         Section 32.  Section 409.810, Florida Statutes, is

20  created to read:

21         409.810  Short title.--Sections 409.810-409.821 may be

22  cited as the "Florida Children's Healthy Bodies Act."

23         Section 33.  Section 409.811, Florida Statutes, is

24  created to read:

25         409.811  Definitions.--

26         (1)  "Agency" means the Agency for Health Care

27  Administration.

28         (2)  "Applicant" means a parent or guardian of a child

29  or, in the case of a child whose disability of nonage has been

30  removed under chapter 743, a child who applies for

31

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  1  determination of eligibility under Title XXI of the Social

  2  Security Act for health benefits coverage under this act.

  3         (3)  "Benchmark benefit plan" means the form and level

  4  of health benefits coverage established in s. 409.815.

  5         (4)  "Child" means an individual under the age of 19

  6  years.

  7         (5)  "Child with special health care needs" means the

  8  term as defined in chapter 391.

  9         (6)  "Children's Medical Services network" means the

10  term as defined in chapter 391.

11         (7)  "Department" means the Department of Health.

12         (8)  "Community rate" means a method used to develop

13  premiums for a health insurance plan which spreads risk across

14  a large population.

15         (9)  "Enrollee" means a child who has been determined

16  eligible for and is receiving health benefits coverage under

17  this act.

18         (10)  "Enrollment ceiling" means the maximum number of

19  non-Medicaid children eligible for premium assistance payments

20  who may be enrolled at any time in the Florida Children's

21  Healthy Bodies program.  The maximum number shall be

22  established annually in the General Appropriations Act or in

23  provisions of general law.

24         (11)  "Family" means the group or the individuals whose

25  income is considered in determining eligibility for the

26  Florida Children's Healthy Bodies program.  The family

27  includes a child with a custodial parent or caretaker relative

28  who resides in the same house or living unit, or in the case

29  of a child whose disability of nonage has been removed under

30  chapter 743, the child.  The family may also include

31  individuals who are not eligible for medical assistance under

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  1  Title XXI of the Social Security Act, but whose income and

  2  resources are considered in whole or in part in determining

  3  eligibility of the child.

  4         (12)  "Florida Children's Healthy Bodies program" means

  5  the medical assistance program authorized by Title XXI of the

  6  Social Security Act as part of the federal Balanced Budget Act

  7  of 1997.

  8         (13)  "Family coverage" means purchase of health

  9  benefits coverage that is cost-effective as authorized under

10  s. 2105(c)(3) of Title XXI of the Social Security Act, subject

11  to federal approval of a waiver request.

12         (14)  "Family income" means cash received at periodic

13  intervals from any source, such as wages, benefits,

14  contributions, and rental property.  Income also may include

15  any money which would have been counted as income under the

16  Aid to Families with Dependent Children state plan in effect

17  prior to August 22, 1996.

18         (15)  "Guarantee issue" means that health benefits

19  coverage must be offered to an individual regardless of the

20  individual's health status, preexisting conditions, or claims

21  history.

22         (16)  "Health benefits coverage" means covered health

23  care services that are provided to enrollees by a health

24  insurance plan.

25         (17)  "Health insurance plan" means health benefits

26  coverage under the following:

27         (a)  A health plan offered by any certified health

28  maintenance organization, except plans that are limited to the

29  following:  a limited benefit, specified disease, or specified

30  accident; hospital indemnity; accident only; limited benefit

31  convalescent care; Medicare supplement; credit disability;

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  1  dental; vision; long-term care; disability income; coverage

  2  issued as a supplement to another health plan; workers'

  3  compensation liability or similar insurance; or automobile

  4  medical-payment insurance;

  5         (b)  A health insurer licensed under chapter 624;

  6         (c)  An employee welfare benefit plan that includes

  7  health benefits established under the Employee Retirement

  8  Income Security Act of 1974, as amended; or

  9         (d)  The Children's Medical Services network.

10         (18)  "Medicaid" means the medical assistance program

11  authorized by Title XIX of the Social Security Act, and

12  regulations thereunder, and ss. 409.901-409.920, as

13  administered in the state by the agency.

14         (19)  "Medically necessary" means the use of any

15  medical treatment, service, equipment, or supply necessary to

16  palliate the effects of a terminal condition, or to prevent,

17  diagnose, correct, cure, alleviate, or preclude deterioration

18  of a condition that threatens life, causes pain or suffering,

19  or results in illness or infirmity and which is:

20         (a)  Consistent with the symptom, diagnosis, and

21  treatment of the enrollee's condition.

22         (b)  Provided in accordance with generally accepted

23  standards of medical practice.

24         (c)  Not primarily intended for the convenience of the

25  enrollee's family or the health care provider.

26         (d)  The most appropriate level of supply or service

27  for the diagnosis and treatment of the enrollee's condition.

28         (e)  Approved by the appropriate medical body or health

29  care specialty involved as effective, appropriate, and

30  essential for the care and treatment of the enrollee's

31  condition.

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  1         (20)  "Medikids" means a component of the Florida

  2  Children's Healthy Bodies program of medical assistance

  3  authorized by Title XXI of the Social Security Act, and

  4  regulations thereunder, and s. 409.8131, as administered in

  5  the state by the agency.

  6         (21)  "Preexisting condition exclusion" means, with

  7  respect to coverage, a limitation or exclusion of benefits

  8  relating to a condition based on the fact that the condition

  9  was present before the date of enrollment for such coverage,

10  whether or not any medical advice, diagnosis, care, or

11  treatment was recommended or received before such date.

12         (22)  "Premium" means the entire cost of a health

13  insurance plan, including the administration fee or the risk

14  assumption charge.

15         (23)  "Premium assistance payment" means the monthly

16  consideration paid by the agency per enrollee in the Florida

17  Children's Healthy Bodies program towards health insurance

18  premiums.

19         (24)  "Program" means the Florida Children's Healthy

20  Bodies program.

21         (25)  "Qualified alien" means an alien as defined in s.

22  431 of the Personal Responsibility and Work Opportunity

23  Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.

24         (26)  "Resident" means a United States citizen or

25  qualified alien who is domiciled in Florida.

26         (27)  "Rural county" means either a county with a

27  population density of less than 100 persons per square mile or

28  a county defined by the most recent United States census as

29  rural, and where there is no prepaid health plan participating

30  in the Medicaid program as of July 1, 1998.

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  1         (28)  "Space" means an allocation of a Florida

  2  Children's Healthy Bodies program enrollee opening, subject to

  3  the enrollment ceiling established in general law or the

  4  General Appropriations Act each year.

  5         Section 34.  Section 409.812, Florida Statutes, is

  6  created to read:

  7         409.812  Florida Children's Healthy Bodies program.--

  8         (1)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature

  9  finds that a significant number of Florida children are

10  uninsured at any one time and these children do not receive

11  necessary health care services. Further, the Legislature finds

12  that the lack of access to a regular and ongoing source of

13  medical care causes families to use health care resources

14  inappropriately. The Legislature hereby creates the Florida

15  Children's Healthy Bodies program to provide a defined set of

16  health benefits to low-income children through the

17  establishment of a variety of affordable health benefits

18  coverage options from which families may select coverage and

19  through which families may contribute financially to the

20  health care of their children.

21         (2)  GUIDING PRINCIPLES.--In creating the Florida

22  Children's Healthy Bodies program, the Legislature establishes

23  the following guiding principles:

24         (a)  No new entitlements to government services shall

25  be created. The Legislature reserves the right to discontinue

26  the program any time revenue shortfalls occur in program

27  funding or any time the Legislature determines the program is

28  no longer meeting the needs it was designed to fulfill.

29         (b)  Individual choice of plans, physicians, and other

30  health care providers must be emphasized.

31

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  1         (c)  Interference in the private insurance market must

  2  be minimized, and "crowd-out," that is, moving children from

  3  the private insurance market into a government-subsidized

  4  market, must be avoided.

  5         (d)  Children in families with incomes above

  6  eligibility levels for the program may be permitted to

  7  participate in the program through the payment of premiums and

  8  other coinsurance payments that cover the policy's full costs.

  9         (e)  Quality assurance mechanisms must be included as

10  an integral component of the program.

11         (f)  Special emphasis must be placed on ensuring

12  participation in the program by members of the minority

13  community.

14         Section 35.  Section 409.813, Florida Statutes, is

15  created to read:

16         409.813  Components; nonentitlement; enrollment

17  ceilings.--

18         (1)  The Florida Children's Healthy Bodies program

19  includes health benefits coverage provided to children

20  through:

21         (a)  The Medicaid program as established under s.

22  409.904(6);

23         (b)  The Medikids program established under s.

24  409.8131;

25         (c)  The Florida Healthy Kids program as created in s.

26  624.91;

27         (d)  Health insurance plans certified and approved to

28  participate in the health insurance pilot project established

29  pursuant to s. 409.817;

30         (e)  The Children's Medical Services network; and

31         (f)  Family coverage authorized under s. 409.8175.

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  1

  2  Except for coverage under the Medicaid program, nothing in

  3  this act provides an individual with an entitlement to

  4  government-sponsored health care services. No cause of action

  5  shall arise against the state, the department, or the agency

  6  for failure to make health services available to any person

  7  under this act.

  8         (2)  Except for the Medicaid program, a ceiling shall

  9  be placed on annual federal and state expenditures and

10  enrollment in the Florida Children's Healthy Bodies program

11  based on the General Appropriations Act each year, or as

12  specified in general law. The agency, in consultation with the

13  department, may propose to increase the enrollment ceiling in

14  accordance with the provisions of chapter 216.

15         (3)  Except for the Medicaid program, whenever the

16  Social Services Estimating Conference determines that there is

17  presently, or will be by the end of the current fiscal year,

18  insufficient funds to finance the current or projected

19  enrollment in the program, all additional enrollment must

20  cease and additional enrollment may not resume until

21  sufficient funds are available to finance such enrollment.

22         (4)  The agency shall collect and analyze the data

23  needed to project the Florida Children's Healthy Bodies

24  program enrollment, including participation rates, caseloads

25  and expenditures. The agency shall report the caseload and

26  expenditure trends to the Social Services Estimating

27  Conference in accordance with the provisions of chapter 216.

28         Section 36.  Section 409.8131, Florida Statutes, is

29  created to read:

30         409.8131  Medikids program.--

31

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  1         (1)  LEGISLATIVE FINDINGS AND INTENT.--It is the intent

  2  of the Legislature through the creation of the Medikids

  3  program to provide health services to eligible children

  4  utilizing the administrative structure and provider network of

  5  the Medicaid program while avoiding the creation of an

  6  entitlement program. The Legislature intends that children

  7  participating in the Medikids program be provided health

  8  benefits in the same manner as children participating in the

  9  Medicaid program, including the benefit package, except as

10  otherwise specified in this act. Differences between Medikids

11  and Medicaid include, but are not limited to, the use of

12  periodic open enrollment periods for Medikids beneficiaries,

13  and the fact that Medikids is not an entitlement program and

14  may be discontinued any time the Legislature determines the

15  program is no longer needed, or through the provisions of

16  chapter 216 during the occurrence of a funding shortfall.

17         (2)  PROGRAM CREATION.--

18         (a)  There is hereby created the Medikids program to be

19  administered by the agency. The Medikids program shall not be

20  subject to the requirements of the Department of Insurance or

21  chapter 627. The director of the agency shall appoint an

22  administrator of the Medikids program, which shall be located

23  in the Division of State Health Purchasing.

24         (b)  The agency is designated as the state agency

25  authorized to make payments for medical assistance and related

26  services for the Medikids program under Title XXI of the

27  Social Security Act. These payments shall be made, subject to

28  any limitations or directions provided for in the General

29  Appropriations Act, only for services included in the program,

30  shall be made only on behalf of eligible individuals, and

31  shall be made only to qualified providers in accordance with

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  1  federal requirements for Title XXI of the Social Security Act

  2  and the provisions of state law.

  3         (3)  NONENTITLEMENT.--Nothing in this section shall be

  4  construed as providing an individual with an entitlement to

  5  health care services. No cause of action shall arise against

  6  the state or the agency for failure to make health services

  7  available under this section.

  8         (4)  MARKETING.--The agency, in consultation with the

  9  Department of Health, shall develop and implement a plan to

10  publicize the Medikids program, the eligibility requirements

11  for the program, and the procedures for enrolling in the

12  program, and to maintain public awareness of the program.

13         (5)  APPLICABILITY.--The provisions of ss. 409.902,

14  409.905, 409.906, 409.907, 409.908, 409.910, 409.912,

15  409.9121, 409.9122, 409.9123, 409.9124, 409.9127, 409.9128,

16  409.913, 409.916, 409.919, 409.920, and 409.9205, apply to the

17  Medikids program to the same extent such sections apply to the

18  Medicaid program; except the applicability of the provisions

19  of s. 409.9122 to the Medikids program shall be subject to the

20  provisions of subsection (7).

21         (6)  BENEFITS.--Benefits provided under the Medikids

22  program shall be the same benefits provided to children as

23  specified in ss. 409.905 and 409.906.

24         (7)  ELIGIBILITY.--

25         (a)  A child who is under the age of 6 years is

26  eligible to participate in the Medikids program if the child

27  is a member of a family that has a family income which exceeds

28  the Medicaid applicable income level as specified in s.

29  409.903, but which is equal to or below 200 percent of the

30  federal poverty level. No assets test shall be required.

31

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  1         (b)  The provisions of s. 409.814(3), (4), and (5)

  2  shall be applicable to the Medikids program.

  3         (8)  ENROLLMENT.--Enrollment in the Medikids program

  4  may only occur during periodic open enrollment periods as

  5  specified by the agency. During the first 12 months of the

  6  program, there shall be at least one, but no more than three,

  7  open enrollment periods. The initial open enrollment period

  8  shall be for 60 days, and subsequent open enrollment periods

  9  during the first year of the program shall be for 30 days.

10  After the first year of the program, the agency shall

11  determine the frequency and duration of open enrollment

12  periods. A child may apply for participation in the Medikids

13  program and proceed through the eligibility determination

14  process at any time throughout the year. In addition, once

15  determined eligible, a child may receive choice counseling and

16  select a managed care plan or MediPass. However, enrollment in

17  Medikids shall not begin until the next open enrollment

18  period; nor shall a child be eligible for services under the

19  Medikids program until the child is enrolled in a managed care

20  plan or MediPass. Enrollment in MediPass shall be an option

21  for a child participating in the Medikids program only in

22  counties which have fewer than two managed care plans

23  available to serve Medicaid recipients. Participants shall not

24  have the option of enrolling in MediPass if the federal Health

25  Care Financing Administration determines that MediPass does

26  not constitute "health insurance coverage" as defined in Title

27  XXI of the Social Security Act.

28         (9)  SPECIAL ENROLLMENT PERIODS.--The agency shall

29  establish a special enrollment period of 30 days' duration for

30  any child who is enrolled in Medicaid if such child loses

31  Medicaid eligibility and becomes eligible for Medikids, for

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  1  any newborn child who is eligible for Medikids, or for any

  2  child who is enrolled in Medikids if such child moves to

  3  another county which is not within the coverage area of the

  4  child's Medikids managed care plan or MediPass provider. The

  5  provisions of this subsection shall apply only if a space is

  6  available within the Medikids program.

  7         (10)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency

  8  shall establish enrollment criteria which shall include

  9  penalties or waiting periods of not fewer than 60 days for

10  reinstatement of coverage upon voluntary cancellation for

11  nonpayment of premiums.

12         Section 37.  Section 409.8134, Florida Statutes, is

13  created to read:

14         409.8134  Delivery of services in rural counties.--In a

15  rural county, the Florida Healthy Kids Corporation may offer

16  Healthy Kids coverage through a health insurer licensed under

17  chapter 624.  The indemnity or preferred provider organization

18  product offered by the health insurer must use the Medicaid

19  fee schedule to reimburse providers.

20         Section 38.  Section 409.8135, Florida Statutes, is

21  created to read:

22         409.8135  Behavioral health services.--In order to

23  ensure a high level of integration of physical and behavioral

24  health care and to meet the more intensive treatment needs of

25  enrollees with the most serious emotional disturbances or

26  substance abuse problems, the Department of Health shall

27  contract with the Department of Children and Family Services

28  to provide behavioral health services to non-Medicaid-eligible

29  children with special health care needs. The Department of

30  Children and Family Services, in consultation with the

31

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  1  Department of Health and the agency, is authorized to

  2  establish the following:

  3         (1)  The scope of behavioral health services, including

  4  duration and frequency.

  5         (2)  Clinical guidelines for referral to behavioral

  6  health services.

  7         (3)  Behavioral health services standards.

  8         (4)  Performance-based measures and outcomes for

  9  behavioral health services.

10         (5)  Practice guidelines for behavioral health services

11  to ensure cost-effective treatment and to prevent unnecessary

12  expenditures.

13         (6)  Rules to implement this subsection.

14         Section 39.  Section 409.814, Florida Statutes, is

15  created to read:

16         409.814  Eligibility.--Except for the Medicaid program,

17  a child whose family income is at or below 200 percent of the

18  federal poverty level is eligible for financial assistance

19  under the Florida Children's Healthy Bodies program as

20  provided in this section.  In determining the eligibility of

21  such a child, an assets test is not required.

22         (1)  A child who is eligible for Medicaid coverage

23  under s. 409.903 or s. 409.904, is not eligible to receive

24  health benefits under any other health benefits coverage

25  authorized under this act.

26         (2)  A child who is not eligible for Medicaid, but who

27  is eligible for the program, may obtain coverage under any of

28  the other types of health benefits coverage authorized in this

29  act, if such health benefits coverage is approved and space is

30  available in the county in which the child resides. However, a

31  child who is eligible for Medikids may participate in the

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  1  Florida Healthy Kids program only if the child has a sibling

  2  participating in the Florida Healthy Kids program and the

  3  child's county of residence permits such enrollment.

  4         (3)  A child who is eligible for the program and who is

  5  a child with special health care needs, as determined through

  6  a risk screening instrument, is eligible for health benefits

  7  coverage from and may be referred to the Children's Medical

  8  Services network established in chapter 391.

  9         (4)  The following children are not eligible to receive

10  financial assistance for health benefits coverage under this

11  act, except under Medicaid if the child would have been

12  eligible for Medicaid services under s. 409.903 or s. 409.904

13  as of June 1, 1997:

14         (a)  A child who is eligible for coverage under a state

15  health benefits plan on the basis of a family member's

16  employment with a public agency in the state;

17         (b)  A child who is covered under a group health

18  benefit plan or under other health insurance coverage,

19  excluding coverage provided under the Florida Healthy Kids

20  Corporation as established under s. 624.91;

21         (c)  A child who is an alien, but who does not meet the

22  definition of qualified alien, in the United States; or

23         (d)  A child who is an inmate of a public institution

24  or a patient in an institution for mental diseases.

25         (5)  A child whose family income is above 200 percent

26  of the federal poverty level may participate in the program,

27  excluding the Medicaid program; but is subject to the

28  following provisions:

29         (a)  The family is not eligible for premium assistance

30  payments and must pay the full cost of the premium, including

31  any administrative costs. Children described in this

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  1  subsection are not counted in the annual enrollment ceiling

  2  for the Florida Children's Healthy Bodies program.

  3         (b)  The agency is authorized to place limits on

  4  enrollment in Medikids by these children in order to avoid

  5  adverse selection. The number of children participating in

  6  Medikids whose family income exceeds 200 percent of the

  7  federal poverty level must not exceed 10 percent of total

  8  enrollees in the Medikids program.

  9         (c)  The board of directors of the Florida Healthy Kids

10  Corporation is authorized to place limits on enrollment of

11  these children in order to avoid adverse selection. In

12  addition, the board is authorized to offer a reduced benefit

13  package to these children in order to limit program costs for

14  such families. The number of children participating in Healthy

15  Kids whose family income exceeds 200 percent of the federal

16  poverty level must not exceed 10 percent of total enrollees in

17  the Healthy Kids program.

18         Section 40.  Section 409.815, Florida Statutes, is

19  created to read:

20         409.815  Health benefits coverage; limitations.--

21         (1)  For purposes of the Florida Children's Healthy

22  Bodies program, benefits available under the Medicaid program

23  and the Medikids program include those goods and services

24  provided under the medical assistance program authorized by

25  Title XIX of the Social Security Act, and regulations

26  thereunder, as administered in this state by the agency.  This

27  includes those mandatory Medicaid services authorized under s.

28  409.905 and optional services authorized under s. 409.906,

29  rendered on behalf of eligible individuals and qualified

30  providers, and subject to any limitations or directions

31  provided for in the General Appropriations Act or chapter 216

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  1  and according to methodologies and limitations set forth in

  2  agency rules and policy manuals and handbooks incorporated by

  3  reference thereto.

  4         (2)  Except for coverage under the Medicaid program and

  5  the Medikids program, health benefits coverage must include

  6  the following minimum benefits of the benchmark benefit plan

  7  as determined medically necessary when provided by a

  8  participating provider in the enrollee's health insurance

  9  plan.

10         (a)  Behavioral health services.--

11         1.  Mental health benefits include:

12         a.  Inpatient services, limited each contract year to

13  no more than 30 inpatient days for psychiatric admissions or

14  30 days of residential services in lieu of inpatient

15  psychiatric admission; and

16         b.  Outpatient services, including outpatient visits

17  for psychological or psychiatric evaluation, diagnosis, and

18  treatment by a licensed mental health professional, limited to

19  a maximum of 40 outpatient visits each contract year.

20         2.  Substance abuse services include:

21         a.  Inpatient services, limited each contract year to

22  no more than 7 inpatient days for medical detoxification only

23  and 30 days of residential services; and

24         b.  Outpatient services, including evaluation,

25  diagnosis, and treatment by a licensed practitioner, limited

26  to a maximum of 40 outpatient visits each contract year.

27         (b)  Durable medical equipment.--Covered services

28  include equipment and devices that are medically indicated to

29  assist in the treatment of a medical condition and

30  specifically prescribed as medically necessary with the

31  following limitations:

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  1         1.  Low-vision and telescopic aides are not included.

  2         2.  Corrective lenses and frames may be limited to one

  3  pair every year, unless the prescription or head size of the

  4  enrollee changes.

  5         3.  Hearing aids shall be covered only when medically

  6  indicated to assist in the treatment of a medical condition.

  7         4.  Covered prosthetic devices include only artificial

  8  eyes and limbs; braces; and other artificial aids.

  9         (c)  Emergency services.--Covered services include

10  visits to an emergency room or other licensed facility where

11  needed immediately due to an injury or illness where delay

12  means risk of permanent damage to the participant's health, in

13  accordance with the provisions of s. 641.513.

14         (d)  Health practitioner services.--Covered services

15  include services and procedures rendered to an enrollee when

16  performed to diagnose and treat diseases, injuries, or other

17  conditions, including care rendered by health practitioners

18  acting within the scope of their practice, with the following

19  exceptions:

20         1.  Chiropractic services, which shall be provided in

21  the same manner as in the state Medicaid program.

22         2.  Podiatric services, which may be limited to one

23  visit per day totaling two visits per month for specific foot

24  disorders.

25         (e)  Home health services.--Covered services include

26  prescribed home visits by both registered and licensed

27  practical nurses to provide skilled nursing services on a

28  part-time, intermittent basis, with the following limitations:

29         1.  Coverage may be limited to include skilled nursing

30  services only.

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  1         2.  Meals, housekeeping, and personal comfort items may

  2  be excluded.

  3         3.  Private duty nursing is limited to circumstances

  4  where such care is medically necessary.

  5         (f)  Hospice services.--Covered services include

  6  reasonable and necessary services for palliation or management

  7  of an enrollee's terminal illness, with the following

  8  exceptions:

  9         1.  Once a family elects to receive hospice care for an

10  enrollee, other services that treat the terminal condition

11  shall not be covered.

12         2.  Services required for conditions totally unrelated

13  to the terminal condition are covered to the extent that the

14  services are included in this section.

15         (g)  Hospital inpatient services.--All covered services

16  provided for the medical care and treatment of an enrollee who

17  is admitted as an inpatient to a hospital licensed under part

18  I of chapter 395, with the following exceptions:

19         1.  All admissions must be authorized by the enrollee's

20  health insurance plan.

21         2.  The length of the patient stay shall be determined

22  based on the medical condition of the enrollee in relation to

23  the necessary and appropriate level of care.

24         3.  Room and board may be limited to semiprivate

25  accommodations, unless a private room is considered medically

26  necessary or semiprivate accommodations are not available.

27         4.  Admissions for rehabilitation and physical therapy

28  are limited to 15 days per contract year.

29         (h)  Hospital outpatient and ambulatory surgical

30  services.--Covered services include preventive, diagnostic,

31  therapeutic, palliative care, and other services provided to

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  1  an enrollee in the outpatient portion of a health facility

  2  licensed under chapter 395, except for the following

  3  limitations:

  4         1.  Services must be authorized by the enrollee's

  5  health insurance plan.

  6         2.  Treatment for Temporomandibular Joint disease (TMJ)

  7  is specifically excluded.

  8         (i)  Laboratory and X-ray services.--Covered services

  9  include diagnostic testing, including clinical radiologic,

10  laboratory, and other diagnostic tests.

11         (j)  Maternity services.--Covered services include

12  maternity and newborn care, including prenatal and postnatal

13  care, with the following limitations:

14         1.  Coverage may be limited to vaginal deliveries.

15         2.  Initial inpatient care for newborn infants of

16  enrolled adolescents shall be covered, including normal

17  newborn care, nursery charges, and the initial pediatric or

18  neonatal examination, and the infant may be covered for up to

19  3 days following birth.

20         (k)  Nursing facility services.--Covered services

21  include regular nursing services, rehabilitation services,

22  drugs and biologicals, medical supplies, and the use of

23  appliances and equipment furnished by the facility, with the

24  following limitations:

25         1.  All admissions must be authorized by the health

26  insurance plan.

27         2.  The length of stay may be limited to 100 days per

28  contract year and shall be determined based on the medical

29  condition of the enrollee in relation to the necessary and

30  appropriate level of care.

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  1         3.  Room and board may be limited to semiprivate

  2  accommodations, unless a private room is considered medically

  3  necessary or semiprivate accommodations are not available.

  4         4.  Admissions for rehabilitation and physical therapy

  5  are limited to 15 days per contract year.

  6         5.  Specialized treatment centers and independent

  7  kidney disease treatment centers are excluded.

  8         (l)  Organ transplantation services.--Covered services

  9  include pretransplant services for donor and recipient,

10  transplant and postdischarge services and treatment of

11  complications after transplantation for transplants deemed

12  necessary and appropriate within the guidelines set by the

13  Organ Transplant Advisory Council under s. 381.0602 or the

14  Bone Marrow Transplant Advisory Panel under s. 627.4236.

15         (m)  Prescribed drugs.--

16         1.  Coverage shall include prescribed drugs prescribed

17  for the medically indicated treatment of illness or injury

18  when prescribed by a licensed health practitioner acting

19  within the scope of his or her practice.

20         2.  Prescribed drugs may be limited to generics where

21  available and brand name products where a generic substitution

22  is not available, unless the prescribing licensed health

23  practitioner indicates that a brand name is medically

24  necessary.

25         3.  Prescribed drugs covered under this section shall

26  include all prescribed drugs covered under the Florida

27  Medicaid program.

28         (n)  Preventive health services.--Covered services

29  include:

30

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  1         1.  Well-child care, including services recommended in

  2  the Guidelines for Health Supervision of Children and Youth as

  3  developed by the American Academy of Pediatrics.

  4         2.  Immunizations and injections.

  5         3.  Health education counseling and clinical services.

  6         4.  Vision screening.

  7         5.  Hearing screening.

  8         (o)  Therapy services.--Covered services include

  9  rehabilitative services, including occupational, physical,

10  respiratory, and speech therapies, with the following

11  limitations:

12         1.  Services must be for short-term rehabilitation

13  where significant improvement in the enrollee will result.

14         2.  Services shall be no more than 24 treatment

15  sessions within a 60-day period per episode or injury, with

16  the 60-day period beginning with the first treatment.

17         (p)  Transportation services.--Covered services include

18  emergency transportation required in response to an emergency

19  situation.

20         (q)  Lifetime maximum.--Health benefits coverage

21  obtained under this act shall pay an enrollee's covered

22  expenses at a lifetime maximum of $1 million per covered

23  child.

24         (r)  Cost-sharing.--Cost-sharing provisions must comply

25  with s. 409.816.

26         (s)  Exclusions.--

27         1.  Abortion, unless necessary to save the life of the

28  mother or if the pregnancy is the result of an act of rape or

29  incest, is excluded.

30

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  1         2.  Experimental or investigational procedures that

  2  have not been clinically proved by reliable evidence are

  3  excluded.

  4         3.  Services performed for cosmetic purposes only or

  5  for the convenience of the enrollee are excluded.

  6         (t)  Enhancements to minimum requirements.--

  7         1.  This section sets the minimum benefits that must be

  8  included in any health benefits coverage, other than Medicaid

  9  coverage, offered under this act.  Health benefits coverage

10  may include additional benefits not included under this

11  section, but may not include benefits excluded under paragraph

12  (s).

13         2.  Health benefits coverage may exceed the service

14  limitations established in the benchmark benefit plan

15  described under this section. Any additional benefits,

16  however, shall not be eligible for an increase in the premium

17  assistance payment.

18         (u)  Applicability to other state laws.--

19         1.  Except as expressly provided in this section, a law

20  requiring coverage for a specific health care service or

21  benefit, or a law requiring reimbursement, utilization, or

22  consideration of a specific category of licensed health

23  practitioner in chapter 627 or chapter 641, does not apply to

24  a health insurance plan policy or contract offered or

25  delivered under this act, unless that law is made expressly

26  applicable to such policies or contracts.

27         2.  Notwithstanding chapter 641, a health maintenance

28  organization is authorized to issue contracts providing

29  benefits included in the benchmark benefit plan authorized by

30  this section.

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  1         Section 41.  Section 409.816, Florida Statutes, is

  2  created to read:

  3         409.816  Limitations on premiums and cost-sharing.--The

  4  following limitations on premiums and cost-sharing are

  5  established for the Florida Children's Healthy Bodies program.

  6         (1)  Enrollees who receive coverage under the Medicaid

  7  program shall not be required to pay:

  8         (a)  Enrollment fees, premiums, or similar charges; or

  9         (b)  Copayments, deductibles, coinsurance, or similar

10  charges.

11         (2)  Enrollees in the program whose family income is at

12  or below 150 percent of the federal poverty level and who are

13  not receiving coverage under the Medicaid program may not be

14  required to pay:

15         (a)  Enrollment fees, premiums, or similar charges that

16  exceed the maximum monthly charge permitted under s.

17  1916(b)(1) of the Social Security Act; or

18         (b)  Copayments, deductibles, coinsurance, or similar

19  charges that exceed a nominal amount as determined consistent

20  with regulations referred to in s. 1916(a)(3) of the Social

21  Security Act.  However, no such charges may be imposed for

22  preventive health services.

23         (3)  Enrollees in the program whose family income is

24  above 150 percent of the federal poverty level and who are not

25  receiving coverage under the Medicaid program, or who are not

26  enrolled pursuant to the provisions of s. 409.814(5), may be

27  required to pay enrollment fees, premiums, copayments,

28  deductibles, coinsurance, or similar charges on a sliding

29  scale related to income, except that the total annual

30  aggregate cost-sharing with respect to all children in a

31  family may not exceed 5 percent of the family's income.

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  1  However, copayments, deductibles, coinsurance, or similar

  2  charges may not be imposed for preventive health services.

  3         Section 42.  Section 409.817, Florida Statutes, is

  4  created to read:

  5         409.817  Health insurance pilot project; approval of

  6  health benefits coverage; financial assistance.--There is

  7  created a health insurance pilot project in one urban county

  8  to be administered by the agency. The agency shall select the

  9  county for the pilot project demonstration site. Any licensed

10  health insurer or health maintenance organization which meets

11  the qualifications of this section may participate in the

12  pilot project.  A health plan participating in the pilot

13  project may serve any child eligible to participate in the

14  Florida Healthy Kids program. It is the intent of the

15  Legislature that the Florida Healthy Kids program serve

16  children in the pilot county to determine if these two program

17  types are compatible.

18         (1)  For families to receive financial assistance to

19  purchase health benefits coverage for an eligible child under

20  this section, the health benefits coverage must:

21         (a)  Be certified by the Department of Insurance under

22  s. 409.818 as meeting or exceeding the benchmark benefit plan;

23         (b)  Be guarantee issued;

24         (c)  Be community-rated for health insurance coverage;

25         (d)  Not impose any preexisting condition exclusion for

26  covered benefits;

27         (e)  Comply with the applicable limitations on premiums

28  and cost-sharing in s. 409.816; and

29         (f)  Comply with the quality assurance and access

30  standards developed under s. 409.8195.

31

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  1         (2)  The Florida Healthy Kids Corporation and health

  2  insurance plans approved under this act shall provide to the

  3  agency enrollment information and other information necessary

  4  to comply with the requirements of Title XXI of the Social

  5  Security Act and related federal regulations.

  6         (3)  This section is repealed effective October 1,

  7  2001.

  8         Section 43.  Section 409.8175, Florida Statutes, is

  9  created to read:

10         409.8175  Family coverage.--The agency is directed to

11  seek federal approval to establish a program for the purchase

12  of family coverage consistent with the requirements of s.

13  2105(b)(3) of Title XXI of the Social Security Act. In

14  providing reimbursement for such coverage, the agency shall

15  ensure that the following conditions are met:

16         (1)  The child must not have had workplace coverage

17  within the previous 6 months.

18         (2)  The monthly premium for family coverage must be no

19  more than the cumulative cost of serving all children in a

20  family eligible for Medikids, the Florida Healthy Kids

21  program, or the health insurance pilot project.

22         (3)  The agency must monitor the program to avoid

23  substitution effects.

24         Section 44.  Section 409.8177, Florida Statutes, is

25  created to read:

26         409.8177  Program evaluation.--The agency, in

27  consultation with the Department of Health, the Department of

28  Children and Family Services, and the Florida Healthy Kids

29  Corporation, shall by January 1 of each year submit to the

30  Governor and the Legislature an evaluation of the Florida

31  Children's Healthy Bodies program. For the first 5 years of

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  1  the program, the agency shall contract with the Institute for

  2  Child Health Policy to prepare annual reports and the

  3  evaluation in accordance with the provisions of s. 2108 of the

  4  Social Security Act.  In conducting the evaluation, the

  5  contractor shall create an evaluation team which includes

  6  individuals with expertise in child health from outside the

  7  institute.  The evaluation report shall be prepared by the

  8  contractor and shall be submitted as prepared, except for

  9  written comments, if any, by the consulting agencies.  In

10  addition to the items specified under s. 2108 of the Social

11  Security Act, the evaluation shall include an assessment of

12  crowd-out and access to health care, as well as the following:

13         (1)  An assessment of the operation of the program,

14  including the progress made in reducing the number of

15  uncovered low-income children.

16         (2)  An assessment of the effectiveness in increasing

17  the number of children with creditable health coverage.

18         (3)  The characteristics of the children and families

19  assisted under the program, including ages of the children,

20  family income, and access to or coverage by other health

21  insurance prior to the program and after disenrollment from

22  the program.

23         (4)  The quality of health coverage provided, including

24  the types of benefits provided.

25         (5)  The amount and level, including payment of part or

26  all of any premium, of assistance provided.

27         (6)  The average length of coverage of a child under

28  the program.

29         (7)  The program's choice of health benefits coverage

30  and other methods used for providing child health assistance.

31

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  1         (8)  The sources of nonfederal funding used in the

  2  program.

  3         (9)  An assessment of the effectiveness of Medikids,

  4  Children's Medical Services network, and other public and

  5  private programs in the state in increasing the availability

  6  of affordable quality health insurance and health care for

  7  children.

  8         (10)  A review and assessment of state activities to

  9  coordinate the program with other public and private programs.

10         (11)  An analysis of changes and trends in the state

11  that affect the provision of health insurance and health care

12  to children.

13         (12)  A description of any plans the state has for

14  improving the availability of health insurance and health care

15  for children.

16         (13)  Recommendations for improving the program.

17         (14)  Other studies as necessary.

18         Section 45.  Section 409.818, Florida Statutes, is

19  created to read:

20         409.818  Administration.--

21         (1)  In order to implement the provisions of the

22  Florida Children's Healthy Bodies Act, the following agencies

23  shall have the following specified duties:

24         (a)  The Department of Children and Family Services is

25  responsible for developing, in consultation with the agency,

26  the Department of Health, and the Florida Healthy Kids

27  Corporation, a simplified eligibility application form to be

28  used for determining the eligibility of children for coverage

29  under the program. The simplified eligibility application form

30  may include an item that provides an opportunity for the

31  applicant to indicate whether coverage is being sought for a

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  1  child with special health care needs.  In addition, the

  2  department is responsible for establishing and maintaining the

  3  eligibility determination process for the Medikids program.

  4         (b)  The Department of Health is responsible for:

  5         1.  Designing and implementing program outreach

  6  activities under s. 409.819.

  7         2.  Adopting rules necessary for implementing outreach

  8  activities.

  9         3.  In consultation with the Florida Healthy Kids

10  Corporation and the Department of Children and Family

11  Services, establishing a toll-free telephone line to assist

12  families with questions about the program.

13         4.  Chairing a state-level coordinating council for the

14  program, to review and make recommendations concerning the

15  implementation and operation of the program. The coordinating

16  council shall include representatives from the department, the

17  Department of Children and Family Services, the agency, the

18  Florida Healthy Kids Corporation, the Department of Insurance,

19  health care providers, health insurers, health maintenance

20  organizations, representatives of local government, and

21  representatives of associations advocating the interests of

22  participants in the Florida Children's Healthy Bodies program.

23         (c)  The agency, under the authority granted in s.

24  409.914(1), is responsible for:

25         1.  Calculating the premium assistance payment

26  necessary to comply with the premium and cost-sharing

27  limitations specified in subparagraph 8. and s. 409.816.  In

28  calculating the premium assistance payment levels for children

29  with family coverage, the agency shall set the premium

30  assistance payment levels for each child proportionately to

31  the total cost of family coverage. The agency, in consultation

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  1  with the department, shall establish an enhanced benchmark

  2  premium for services provided by the Children's Medical

  3  Services network to non-Medicaid-eligible children with

  4  special health care needs who participate in the Florida

  5  Children's Healthy Bodies program.

  6         2.  Annually calculating the program enrollment ceiling

  7  based on estimated per-child premium assistance payments and

  8  the estimated appropriation available for the program.

  9         3.  Making premium assistance payments to health

10  insurance plans under ss. 409.817 and 409.8175 and Medikids

11  providers, on a periodic basis. The agency may use its

12  Medicaid fiscal agent or a contracted third-party

13  administrator in making these payments. The agency may require

14  health insurance plans that participate in the Medikids

15  program, the health insurance pilot project, or the family

16  coverage program to collect premium payments from an

17  enrollee's family.  Participating health insurance plans shall

18  report premium payments collected on behalf of enrollees in

19  the program to the agency in accordance with a schedule

20  established by the agency.

21         4.  Monitoring compliance with quality assurance and

22  access standards developed under s. 409.8195.

23         5.  Establishing a mechanism for investigating and

24  resolving complaints and grievances from program applicants,

25  enrollees, and health benefits coverage providers, and

26  maintaining a record of complaints and confirmed problems.  In

27  the case of a child who is enrolled in a health maintenance

28  organization, the agency must use the provisions of s. 641.511

29  to address grievance reporting and resolution requirements.

30         6.  Approving health benefits coverage for

31  participation in the program.

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  1         7.  Administering the Medikids program as created in s.

  2  409.8131.

  3         8.  Adopting rules necessary for calculating premium

  4  assistance payment levels, calculating the program enrollment

  5  ceiling, making premium assistance payments, monitoring access

  6  and quality assurance standards, investigating and resolving

  7  complaints and grievances, approving health benefits coverage,

  8  and administering the Medikids program.  The premium

  9  assistance for each enrollee in an insurance plan shall equal

10  the premium approved by the Florida Healthy Kids Corporation

11  and the Department of Insurance in accordance with ss. 627.410

12  and 641.31, less any enrollee's share of the premium

13  established within the limitations specified in s. 409.816.

14         (d)  The Department of Insurance is responsible for

15  certifying that health benefits coverage plans, except those

16  offered through the Florida Healthy Kids Corporation, seeking

17  to provide services under the program meet or exceed the

18  benchmark benefit plan, and that health insurance plans will

19  be offered at an approved rate.  The department shall adopt

20  rules necessary for certifying health benefits coverage plans.

21         (e)  The Florida Healthy Kids program shall retain its

22  functions as authorized in s. 624.91. In addition, the Florida

23  Healthy Kids Corporation shall be responsible for:

24         1.  Establishing and maintaining the eligibility

25  determination process under the program, excluding Medicaid

26  and Medikids eligibility determination.  The Florida Healthy

27  Kids Corporation shall directly, or through the services of a

28  contracted third-party administrator, establish and maintain a

29  process for determining eligibility of children for coverage

30  under the program.  The eligibility determination process must

31  include initial determination of eligibility for any coverage

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  1  offered under the program, as well as periodic redetermination

  2  or reverification of eligibility.  In conducting eligibility

  3  determination, the Florida Healthy Kids Corporation shall

  4  include methods to determine if a child has special health

  5  care needs.

  6         2.  Informing program applicants about eligibility

  7  determinations and sharing eligibility information with the

  8  Medicaid program, the Department of Children and Family

  9  Services, and insurers and their agents, through a centralized

10  coordinating office.

11         (2)  The agency, the Department of Health, the

12  Department of Children and Family Services, the Florida

13  Healthy Kids Corporation, and the Department of Insurance,

14  after consultation and approval of the Speaker of the House of

15  Representatives and the President of the Senate, are

16  authorized to make program modifications that are necessary to

17  overcome any objections of the federal Department of Health

18  and Human Services to obtain approval of the state's child

19  health insurance plan under Title XXI of the Social Security

20  Act.

21         Section 46.  Section 154.508, Florida Statutes, is

22  renumbered as section 409.819, Florida Statutes, and amended

23  to read:

24         409.819 154.508  Identification of low-income,

25  uninsured children; determination of Medicaid eligibility for

26  the Florida Children's Healthy Bodies program; alternative

27  health care information.--The department Agency for Health

28  Care Administration shall develop a program, in conjunction

29  with the Department of Education, the Department of Children

30  and Family Services, the Agency for Health Care

31  Administration, the Florida Healthy Kids Corporation,

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  1  Department of Health, local governments school districts,

  2  employers, and other stakeholders to identify low-income,

  3  uninsured children and, to the extent possible and subject to

  4  appropriation, refer them to the appropriate state agency or

  5  entity for Department of Children and Family Services for a

  6  Medicaid eligibility determination and provide parents with

  7  information about choices of health benefits coverage under

  8  the Florida Children's Healthy Bodies program alternative

  9  sources of health care. Special emphasis shall be placed on

10  the identification of minority children for referral to and

11  participation in the Florida Children's Healthy Bodies

12  program.

13         Section 47.  Section 409.8195, Florida Statutes, is

14  created to read:

15         409.8195  Quality assurance and access

16  standards.--Except for the Medicaid program, the department,

17  in consultation with the agency, shall develop quality

18  assurance and access standards for the Florida Children's

19  Healthy Bodies program.  These standards shall comply with the

20  provisions of chapters 409 and 641 and Title XXI of the Social

21  Security Act.

22         Section 48.  Section 409.821, Florida Statutes, is

23  created to read:

24         409.821  Performance measures and standards.--The

25  following performance measures and standards are adopted for

26  the Florida Children's Healthy Bodies program:

27         (1)  The total number of previously uninsured children

28  who receive health benefits coverage as a result of state

29  activities under Title XXI of the Social Security Act--235,000

30  uninsured children expected to obtain coverage during fiscal

31  year 1998-1999.

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  1         (a)  The number of children enrolled in the Medicaid

  2  program as a result of eligibility expansions under Title XXI

  3  of the Social Security Act--35,000 children enrolled in

  4  Medicaid under new eligibility groups during fiscal year

  5  1998-1999.

  6         (b)  The number of children enrolled in the Medicaid

  7  program as a result of outreach efforts under Title XXI of the

  8  Social Security Act who have been eligible for Medicaid, but

  9  who have not enrolled in the program--80,000 children

10  previously eligible for Medicaid, but not enrolled in

11  Medicaid, who enroll in Medicaid during fiscal year 1998-1999.

12         (c)  The number of uninsured children added to the

13  Florida Healthy Kids program enrollment under Title XXI of the

14  Social Security Act--60,000 additional children enrolled in

15  the Florida Healthy Kids program during fiscal year 1998-1999.

16         (d)  The number of uninsured children enrolled in

17  health insurance coverage under Title XXI of the Social

18  Security Act--50,000 uninsured children enrolled in health

19  insurance coverage during fiscal year 1998-1999.

20         (e)  The number of uninsured children enrolled in

21  Medikids coverage offered under Title XXI of the Social

22  Security Act--10,000 uninsured children enrolled in Medikids

23  coverage during fiscal year 1998-1999.

24         (2)  The percentage of uninsured children in Florida as

25  of July 1, 1998, who receive health benefits coverage under

26  the Florida Children's Healthy Bodies program--28.5 percent of

27  uninsured children who enroll in the Florida Children's

28  Healthy Bodies program during fiscal year 1998-1999.

29         (3)  The percentage of children enrolled in the Florida

30  Children's Healthy Bodies program with up-to-date

31

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  1  immunizations--80 percent of enrolled children with up-to-date

  2  immunizations.

  3         (4)  The percentage of compliance with the standards

  4  established in the Guidelines for Health Supervision of

  5  Children and Youth as developed by the American Academy of

  6  Pediatrics for Florida Children's Healthy Bodies program

  7  eligible children served under:

  8         (a)  The Medicaid program as established under s.

  9  409.904(6);

10         (b)  The Medikids program established under s.

11  409.8131;

12         (c)  The Florida Healthy Kids program as created in s.

13  624.91;

14         (d)  Health insurance plans certified and approved to

15  participate in the health insurance pilot project established

16  pursuant to s. 409.817;

17         (e)  The Children's Medical Services network; and

18         (f)  Family coverage authorized under s. 409.8175.

19

20  For each category of coverage, the health care provided is in

21  compliance with the health supervision standards for 80

22  percent of enrolled children.

23         Section 49.  For fiscal year 1998-1999, the enrollment

24  ceiling for the non-Medicaid portion of the Florida Children's

25  Healthy Bodies program is 270,000 children.  Thereafter, the

26  enrollment ceiling shall be established in the General

27  Appropriations Act or general law.

28         Section 50.  Subsections (6) and (7) are added to

29  section 409.904, Florida Statutes, to read:

30         409.904  Optional payments for eligible persons.--The

31  agency may make payments for medical assistance and related

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  1  services on behalf of the following persons who are determined

  2  to be eligible subject to the income, assets, and categorical

  3  eligibility tests set forth in federal and state law.  Payment

  4  on behalf of these Medicaid eligible persons is subject to the

  5  availability of moneys and any limitations established by the

  6  General Appropriations Act or chapter 216.

  7         (6)  A child born before October 1, 1983, living in a

  8  family that has an income which is at or below 100 percent of

  9  the current federal poverty level, who has attained the age of

10  6, but has not attained the age of 19, and who would be

11  eligible in s. 409.903(6), if the child had been born on or

12  after such date.  In determining the eligibility of such a

13  child, an assets test is not required.

14         (7)  A child who has not attained the age of 19 who has

15  been determined eligible for the Medicaid program is deemed to

16  be eligible for a total of 6 months, regardless of changes in

17  circumstances other than attainment of the maximum age.

18         Section 51.  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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  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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  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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  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 52.  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

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  1         (a)  The Legislature finds that increased access to

  2  health care services could improve children's health and

  3  reduce the incidence and costs of childhood illness and

  4  disabilities among children in this state.  Many children do

  5  not have comprehensive, affordable health care preventive

  6  services available or funded, and for those who do, lack of

  7  access is a restriction to getting service.  It is the intent

  8  of the Legislature that the Florida Healthy Kids a nonprofit

  9  Corporation be organized to facilitate a program to bring

10  preventive health care services to children, if necessary

11  through the use of school facilities in this state when more

12  appropriate sites are unavailable, and to provide

13  comprehensive health insurance coverage to such children. A

14  goal for The corporation is encouraged to cooperate with any

15  existing health preventive service programs funded by the

16  public or the private sector.

17         (b)  It is the intent of the Legislature that the

18  Florida Healthy Kids Corporation serve as one of several

19  providers of services to children eligible for medical

20  assistance under Title XXI of the Social Security Act.

21  Although the corporation may serve other children, the

22  Legislature intends the primary recipients of services

23  provided through the corporation be school-age children with a

24  family income below 200 percent of the federal poverty level,

25  who do not qualify for Medicaid.  It is also the intent of the

26  Legislature that state and local government Florida Healthy

27  Kids funds, to the extent permissible under federal law, be

28  used to obtain matching federal dollars.

29         (3)  NONENTITLEMENT.--Nothing in this section shall be

30  construed as providing an individual with an entitlement to

31  health care services.  No cause of action shall arise against

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  1  the state, the Florida Healthy Kids Corporation, or a unit of

  2  local government for failure to make health services available

  3  under this section.

  4         (4)(3)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--

  5         (a)  There is created The Legislature hereby creates

  6  the Florida Healthy Kids Corporation, a not-for-profit

  7  corporation which operates shall operate on sites to be

  8  designated by the corporation.

  9         (b)  The Florida Healthy Kids Corporation shall phase

10  in a program to:

11         1.  Organize school children groups to facilitate the

12  provision of preventive health care services to children and

13  to provide comprehensive health insurance coverage to

14  children;

15         2.  Arrange for the collection of any family, local

16  government, or employer payment or premium, in an amount to be

17  determined by the board of directors, from all participant

18  families or employers to provide for payment of for preventive

19  health care services or premiums for comprehensive insurance

20  coverage and for the actual or estimated administrative

21  expenses incurred during the period for which family or

22  employer payments are made;

23         3.  Establish the administrative and accounting

24  procedures for the operation of the corporation;

25         4.  Establish, with consultation from appropriate

26  professional organizations, standards for preventive health

27  services and providers and comprehensive insurance benefits

28  appropriate to children; provided that such standards for

29  rural areas shall not limit primary care providers to

30  board-certified pediatricians;

31

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  1         5.  Establish eligibility criteria which children must

  2  meet in order to participate in the program;

  3         6.  Establish procedures under which applicants to and

  4  participants in the program may have grievances reviewed by an

  5  impartial body and reported to the board of directors of the

  6  corporation;

  7         7.  Establish participation criteria and, if

  8  appropriate, contract with an authorized insurer, health

  9  maintenance organization, or insurance administrator to

10  provide administrative services to the corporation;

11         8.  Establish enrollment criteria which shall include

12  penalties or waiting periods of not fewer than 60 days for

13  reinstatement of coverage upon voluntary cancellation for

14  nonpayment of family premiums.

15         9.  If a space is available, establish a special open

16  enrollment period of 30 days' duration for any child who is

17  enrolled in Medicaid or Medikids if such child loses Medicaid

18  or Medikids eligibility and becomes eligible for the Florida

19  Healthy Kids program.

20         10.8.  Contract with authorized insurers or any

21  provider of health care services, meeting standards

22  established by the corporation, for the provision of

23  comprehensive insurance coverage and preventive health care

24  services to participants.  Such standards shall include

25  criteria under which the corporation may contract with more

26  than one provider of health care services in program sites;

27         11.9.  Develop and implement a plan to publicize the

28  Florida Healthy Kids Corporation, the eligibility requirements

29  of the program, and the procedures for enrollment in the

30  program and to maintain public awareness of the corporation

31  and the program;

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  1         12.10.  Secure staff necessary to properly administer

  2  the corporation. Staff costs shall be funded from state and

  3  local matching funds and such other private or public funds as

  4  become available.  The board of directors shall determine the

  5  number of staff members necessary to administer the

  6  corporation;

  7         13.11.  As appropriate, enter into contracts with local

  8  school boards or other agencies to provide onsite information,

  9  enrollment, and other services necessary to the operation of

10  the corporation; and

11         14.12.  Provide a report on an annual basis to the

12  Governor, Insurance Commissioner, Commissioner of Education,

13  Senate President, Speaker of the House of Representatives, and

14  Minority Leaders of the Senate and the House of

15  Representatives;.

16         15.13.  Each fiscal year, establish a maximum number of

17  participants by county, on a statewide basis, who may enroll

18  in the program without the benefit of local matching funds.

19  Thereafter, the corporation may establish local government

20  matching requirements for supplemental participation in the

21  program.  The corporation may vary local matching requirements

22  and enrollment by county depending on factors which may

23  influence the local government's ability to provide local

24  match, including, but not limited to, population density, per

25  capita income, existing local tax effort, and other factors.

26  The corporation also may accept in-kind match in lieu of cash

27  for the local match requirement to the extent allowed by Title

28  XXI of the Social Security Act; and For the 1996-1997 fiscal

29  year only, funds may be appropriated to the Florida Healthy

30  Kids Corporation to organize school children groups to

31  facilitate the provision of preventive health care services to

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  1  children at sites in addition to those allowed in subparagraph

  2  1.  This subparagraph is repealed on July 1, 1997.

  3         16.  Establish eligibility criteria, premium and

  4  cost-sharing requirements, and benefit packages which conform

  5  to the provisions of this act when serving children eligible

  6  for the Florida Children's Healthy Bodies program, as created

  7  in this act.

  8         (c)  Contracts in existence on June 30, 1998, that

  9  comply with cost-sharing provisions approved by the federal

10  Health Care Financing Administration as conforming with Title

11  XXI of the Social Security Act shall be deemed to conform with

12  the Florida Children's Healthy Bodies program until renewal of

13  the contract but no later than 2 years after the effective

14  date of the contract.

15         (d)(c)  Coverage under the corporation's program is

16  secondary to any other available private coverage held by the

17  participant child or family member.  The corporation may

18  establish procedures for coordinating benefits under this

19  program with benefits under other public and private coverage.

20         (e)(d)  The Florida Healthy Kids Corporation shall be a

21  private corporation not for profit, organized pursuant to

22  chapter 617, and shall have all powers necessary to carry out

23  the purposes of this act, including, but not limited to, the

24  power to receive and accept grants, loans, or advances of

25  funds from any public or private agency and to receive and

26  accept from any source contributions of money, property,

27  labor, or any other thing of value, to be held, used, and

28  applied for the purposes of this act.

29         (5)(4)  BOARD OF DIRECTORS.--

30         (a)  The Florida Healthy Kids Corporation shall operate

31  subject to the supervision and approval of a board of

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  1  directors chaired by the Insurance Commissioner or her or his

  2  designee, and composed of 12 other members selected for 3-year

  3  terms of office as follows:

  4         1.  One member appointed by the Commissioner of

  5  Education from among three persons nominated by the Florida

  6  Association of School Administrators;

  7         2.  One member appointed by the Commissioner of

  8  Education from among three persons nominated by the Florida

  9  Association of School Boards;

10         3.  One member appointed by the Commissioner of

11  Education from the Office of School Health Programs of the

12  Florida Department of Education;

13         4.  One member appointed by the Governor from among

14  three members nominated by the Florida Pediatric Society;

15         5.  One member, appointed by the Governor, who

16  represents the Children's Medical Services Program;

17         6.  One member appointed by the Insurance Commissioner

18  from among three members nominated by the Florida Hospital

19  Association;

20         7.  Two members, appointed by the Insurance

21  Commissioner, who are representatives of authorized health

22  care insurers or health maintenance organizations;

23         8.  One member, appointed by the Insurance

24  Commissioner, who represents the Institute for Child Health

25  Policy;

26         9.  One member, appointed by the Governor, from among

27  three members nominated by the Florida Academy of Family

28  Physicians;

29         10.  One member, appointed by the Governor, who

30  represents the Agency for Health Care Administration; and

31         11.  The State Health Officer or her or his designee.

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  1

  2  In order to provide for staggered terms, the initial term of

  3  the members appointed under subparagraphs 1., 4., and 6. shall

  4  be for 2 years and the initial term of the members appointed

  5  under subparagraphs 2., 5., 8., and 10. shall be for 4 years.

  6         (b)  A member of the board of directors may be removed

  7  by the official who appointed that member.  The board shall

  8  appoint an executive director, who is responsible for other

  9  staff authorized by the board.

10         (c)  Board members are entitled to receive, from funds

11  of the corporation, reimbursement for per diem and travel

12  expenses as provided by s. 112.061.

13         (d)  There shall be no liability on the part of, and no

14  cause of action shall arise against, any member of the board

15  of directors, or its employees or agents, for any action they

16  take in the performance of their powers and duties under this

17  act.

18         (6)(5)  LICENSING NOT REQUIRED; FISCAL OPERATION.--

19         (a)  The corporation shall not be deemed an insurer.

20  The officers, directors, and employees of the corporation

21  shall not be deemed to be agents of an insurer. Neither the

22  corporation nor any officer, director, or employee of the

23  corporation is subject to the licensing requirements of the

24  insurance code or the rules of the Department of Insurance.

25  However, the Department of Insurance may require that any

26  marketing representative utilized and compensated by the

27  corporation must be appointed as a representative of the

28  insurers or health services providers with which the

29  corporation contracts.

30         (b)  The board has complete fiscal control over the

31  corporation and is responsible for all corporate operations.

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  1         (c)  The Department of Insurance shall supervise any

  2  liquidation or dissolution of the corporation and shall have,

  3  with respect to such liquidation or dissolution, all power

  4  granted to it pursuant to the insurance code.

  5         (7)(6)  ACCESS TO RECORDS; CONFIDENTIALITY;

  6  PENALTIES.--Notwithstanding any other laws to the contrary,

  7  the Florida Healthy Kids Corporation shall have access to the

  8  medical records of a student upon receipt of permission from a

  9  parent or guardian of the student.  Such medical records may

10  be maintained by state and local agencies.  Any identifying

11  information, including medical records and family financial

12  information, obtained by the corporation pursuant to this

13  subsection is confidential and is exempt from the provisions

14  of s. 119.07(1).  Neither the corporation nor the staff or

15  agents of the corporation may release, without the written

16  consent of the participant or the parent or guardian of the

17  participant, to any state or federal agency, to any private

18  business or person, or to any other entity, any confidential

19  information received pursuant to this subsection.  A violation

20  of this subsection is a misdemeanor of the second degree,

21  punishable as provided in s. 775.082 or s. 775.083.

22         Section 53.  Sections 391.031, 391.056, 391.091, and

23  624.92, Florida Statutes, are hereby repealed.

24         Section 54.  Subsection (3) of section 409.814, Florida

25  Statutes, as created by this act, shall stand repealed

26  effective October 1, 2000.  It is the intent of the

27  Legislature that these provisions be reviewed on an annual

28  basis prior to that date.

29         Section 55.  Sections 409.810 through 409.821, Florida

30  Statutes, as created by this act, shall stand repealed

31  effective October 1, 2003.  It is the intent of the

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  1  Legislature that these sections be reviewed on an annual basis

  2  prior to that date.

  3         Section 56.  This act shall take effect only if

  4  Committee Substitute for Committee Substitute for House Bills

  5  683 and 2131, relating to school readiness, and Committee

  6  Substitute for Committee Substitute for House Bill 4383,

  7  relating to the healthy opportunity for school readiness

  8  voucher program, are adopted, or similar legislation having

  9  substantially the same intent and purpose is adopted, in the

10  same legislative session or an extension thereof.

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