Senate Bill 0212c1
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Florida Senate - 2000 CS for SB 212
By the Committee on Health, Aging and Long-Term Care; and
Senator Dawson
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1 A bill to be entitled
2 An act relating to health care assistance;
3 amending s. 216.136, F.S.; requiring the Social
4 Services Estimating Conference to develop
5 certain information relating to the Florida
6 Kidcare program; amending s. 409.8132, F.S.;
7 revising eligibility requirements for the
8 Medikids program component of the Florida
9 Kidcare program; removing the applicability of
10 the Medicaid third-party liability requirements
11 to the Medikids program; revising enrollment
12 procedures; allowing mandatory assignment;
13 amending s. 409.8134, F.S.; requiring agencies
14 that administer Florida Kidcare components to
15 collect certain information and report to the
16 Social Services Estimating Conference; amending
17 s. 409.814, F.S.; providing for
18 Medicaid-presumptive eligibility; providing for
19 expedited enrollment; revising eligibility for
20 certain children for services under the
21 Children's Medical Services network; allowing
22 premium assistance for certain children
23 ineligible for federal funding; extending the
24 period of continuous eligibility for the
25 Florida Kidcare program; amending s. 409.815,
26 F.S.; providing for dental benefits under the
27 Florida Kidcare program; amending s. 409.8177,
28 F.S.; requiring the Agency for Health Care
29 Administration to submit additional monthly
30 reports to the Governor and Legislature;
31 revising evaluation requirements; amending s.
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1 409.818, F.S.; extending the period of
2 continuous eligibility for the Florida Kidcare
3 program; requiring simplified eligibility
4 redetermination; amending s. 409.903, F.S.;
5 providing for presumptive eligibility for
6 children eligible for Medicaid; amending s.
7 409.904, F.S.; revising the eligibility
8 requirements for optional payments for medical
9 assistance and related services for certain
10 children; authorizing optional payments for
11 certain pregnant women; providing for
12 presumptive eligibility; requiring the Division
13 of State Group Insurance of the Department of
14 Management Services to develop a program to
15 subsidize health insurance coverage for
16 children of certain state employees; providing
17 applicability of the act to certain contracts;
18 providing an effective date.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. Subsection (6) of section 216.136, Florida
23 Statutes, is amended to read:
24 216.136 Consensus estimating conferences; duties and
25 principals.--
26 (6) SOCIAL SERVICES ESTIMATING CONFERENCE.--
27 (a) Duties.--
28 1. The Social Services Estimating Conference shall
29 develop such official information relating to the social
30 services system of the state, including forecasts of social
31 services caseloads, as the conference determines is needed for
2
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1 the state planning and budgeting system. Such official
2 information shall include, but not be limited to, subsidized
3 child care caseloads mandated by the Family Support Act of
4 1988.
5 2. In addition, the Social Services Estimating
6 Conference shall develop estimates and forecasts of the
7 unduplicated count of children eligible for subsidized child
8 care as defined in s. 402.3015(1). These estimates and
9 forecasts shall not include children enrolled in the
10 prekindergarten early intervention program established in s.
11 230.2305.
12 3. The Department of Children and Family Services and
13 the Department of Education shall provide information on
14 caseloads and waiting lists for the subsidized child care and
15 prekindergarten early intervention programs requested by the
16 Social Services Estimating Conference or individual conference
17 principals, in a timely manner.
18 4. The Social Services Estimating Conference shall
19 develop information relating to the Florida Kidcare program,
20 including, but not limited to, enrollment, caseload,
21 utilization, and expenditure information that the conference
22 determines is needed to plan for and project future budgets
23 and the drawdown of federal matching funds. The agencies
24 required to collect and analyze Florida Kidcare program data
25 under s. 409.8134 shall be participants in the Social Services
26 Estimating Conference for purposes of developing information
27 relating to the Florida Kidcare program.
28 (b) Principals.--The Executive Office of the Governor,
29 the coordinator of the Office of Economic and Demographic
30 Research, and professional staff, who have forecasting
31 expertise, from the Department of Children and Family
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1 Services, the Senate, and the House of Representatives, or
2 their designees, are the principals of the Social Services
3 Estimating Conference. The principal representing the
4 Executive Office of the Governor shall preside over sessions
5 of the conference.
6 Section 2. Subsections (4), (6), (7), and (8) of
7 section 409.8132, Florida Statutes, are amended to read:
8 409.8132 Medikids program component.--
9 (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.--The
10 provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,
11 409.910, 409.912, 409.9121, 409.9122, 409.9123, 409.9124,
12 409.9127, 409.9128, 409.913, 409.916, 409.919, 409.920, and
13 409.9205 apply to the administration of the Medikids program
14 component of the Florida Kidcare program, except that s.
15 409.9122 applies to Medikids as modified by the provisions of
16 subsection (7).
17 (6) ELIGIBILITY.--
18 (a) A child who has attained the age of 1 year but who
19 is under the age of 5 years is eligible to enroll in the
20 Medikids program component of the Florida Kidcare program, if
21 the child is a member of a family that has a family income
22 which exceeds the Medicaid applicable income level as
23 specified in s. 409.903, but which is equal to or below 200
24 percent of the current federal poverty level. In determining
25 the eligibility of such a child, an assets test is not
26 required. A child who is eligible for Medikids may elect to
27 enroll in Florida Healthy Kids coverage or employer-sponsored
28 group coverage. However, a child who is eligible for Medikids
29 may participate in the Florida Healthy Kids program only if
30 the child has a sibling participating in the Florida Healthy
31
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1 Kids program and the child's county of residence permits such
2 enrollment.
3 (b) The provisions of s. 409.814(3), (4), and (5)
4 shall be applicable to the Medikids program.
5 (7) ENROLLMENT.--Enrollment in the Medikids program
6 component may only occur during periodic open enrollment
7 periods as specified by the agency. During the first 12 months
8 of the program, there shall be at least one, but no more than
9 three, open enrollment periods. The initial open enrollment
10 period shall be for 90 days, and subsequent open enrollment
11 periods during the first year of operation of the program
12 shall be for 30 days. After the first year of the program, the
13 agency shall determine the frequency and duration of open
14 enrollment periods. An applicant may apply for enrollment in
15 the Medikids program component and proceed through the
16 eligibility determination process at any time throughout the
17 year. However, enrollment in Medikids shall not begin until
18 the next open enrollment period; and a child may not receive
19 services under the Medikids program until the child is
20 enrolled in a managed care plan or MediPass. In addition, once
21 determined eligible, an applicant may receive choice
22 counseling and select a managed care plan or MediPass. The
23 agency may initiate mandatory assignment for a Medikids
24 applicant who has not chosen a managed care plan or MediPass
25 provider after the applicant's voluntary choice period ends.
26 An applicant may select MediPass under the Medikids program
27 component only in counties that have fewer than two managed
28 care plans available to serve Medicaid recipients and only if
29 the federal Health Care Financing Administration determines
30 that MediPass constitutes "health insurance coverage" as
31 defined in Title XXI of the Social Security Act.
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1 (8) SPECIAL ENROLLMENT PERIODS.--The agency shall
2 establish a special enrollment period of 30 days' duration for
3 any newborn child who is eligible for Medikids, or for any
4 child who is enrolled in Medicaid if such child loses Medicaid
5 eligibility and becomes eligible for Medikids, or for any
6 child who is enrolled in Medikids if such child moves to
7 another county that is not within the coverage area of the
8 child's Medikids managed care plan or MediPass provider.
9 Section 3. Subsection (3) of section 409.8134, Florida
10 Statutes, is amended to read:
11 409.8134 Program enrollment and expenditure
12 ceilings.--
13 (3) The agencies that administer the Florida Kidcare
14 program components agency shall collect and analyze the data
15 needed to project Florida Kidcare program enrollment,
16 including participation rates, caseloads, and expenditures.
17 The agencies agency shall report the caseload and expenditure
18 trends to the Social Services Estimating Conference in
19 accordance with chapter 216.
20 Section 4. Section 409.814, Florida Statutes, is
21 amended to read:
22 409.814 Eligibility.--A child whose family income is
23 equal to or below 200 percent of the federal poverty level is
24 eligible for the Florida Kidcare program as provided in this
25 section. In determining the eligibility of such a child, an
26 assets test is not required. An applicant under 19 years of
27 age who, based on a complete application, appears to be
28 eligible for the Medicaid component of the Florida Kidcare
29 program is presumed eligible for coverage under Medicaid,
30 subject to federal rules. A child who has been deemed
31 presumptively eligible for Medicaid shall not be enrolled in a
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1 managed care plan until the child's full eligibility
2 determination for Medicaid has been completed. An applicant
3 under 19 years of age who, based on a complete application,
4 appears to be eligible for the Medikids, Florida Healthy Kids,
5 or Children's Medical Services network program component and
6 who is screened as ineligible for Medicaid may, prior to the
7 monthly verification of the applicant's enrollment in Medicaid
8 or of eligibility for coverage under the state employee health
9 benefit plan, be enrolled in and begin receiving coverage from
10 the appropriate program component on the first day of the
11 month following the receipt of a completed application. For
12 enrollment in the Children's Medical Services network, a
13 complete application includes the medical or behavioral health
14 screening. If, after verification, an individual is determined
15 to be ineligible for coverage, he or she must be disenrolled
16 from the respective Title-XXI-funded Kidcare program
17 component.
18 (1) A child who is eligible for Medicaid coverage
19 under s. 409.903 or s. 409.904 must be enrolled in Medicaid
20 and is not eligible to receive health benefits under any other
21 health benefits coverage authorized under ss. 409.810-409.820.
22 (2) A child who is not eligible for Medicaid, but who
23 is eligible for the Florida Kidcare program, may obtain
24 coverage under any of the other types of health benefits
25 coverage authorized in ss. 409.810-409.820 if such coverage is
26 approved and available in the county in which the child
27 resides. However, a child who is eligible for Medikids may
28 participate in the Florida Healthy Kids program only if the
29 child has a sibling participating in the Florida Healthy Kids
30 program and the child's county of residence permits such
31 enrollment.
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1 (3) A child who is eligible for the Florida Kidcare
2 program who is a child with special health care needs, as
3 determined through a medical or behavioral screening
4 risk-screening instrument, is eligible for health benefits
5 coverage from and must may be referred to the Children's
6 Medical Services network. When calculating income for purposes
7 of determining the financial eligibility of a child with
8 special health care needs, except for a child who is eligible
9 for Medicaid, the department and the Florida Healthy Kids
10 Corporation shall implement an income disregard for medical or
11 behavioral costs of the child.
12 (4) The following children are not eligible to receive
13 premium assistance for health benefits coverage under ss.
14 409.810-409.820, except under Medicaid if the child would have
15 been eligible for Medicaid under s. 409.903 or s. 409.904 as
16 of June 1, 1997:
17 (a) A child who is eligible for coverage under a state
18 health benefit plan on the basis of a family member's
19 employment with a public agency in the state.;
20 (b) A child who is covered under a group health
21 benefit plan or under other health insurance coverage,
22 excluding coverage provided under the Florida Healthy Kids
23 Corporation as established under s. 624.91.;
24 (c) A child who is seeking premium assistance for
25 employer-sponsored group coverage, if the child has been
26 covered by the same employer's group coverage during the 6
27 months prior to the family's submitting an application for
28 determination of eligibility under the Florida Kidcare
29 program.;
30 (d) A child who is an alien, but who does not meet the
31 definition of qualified alien, in the United States. However,
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1 such child may be enrolled, based on age and family income, in
2 the appropriate Florida Kidcare program, and premium
3 assistance must be provided only by state funds, subject to an
4 annual appropriation for this specific purpose.; or
5 (e) A child who is an inmate of a public institution
6 or a patient in an institution for mental diseases.
7 (5) Except for children enrolled in the Children's
8 Medical Services network who qualify under an income
9 disregard, a child whose family income is above 200 percent of
10 the federal poverty level or a child who is excluded under the
11 provisions of subsection (4) may participate in the Florida
12 Kidcare program, excluding the Medicaid program, but is
13 subject to the following provisions:
14 (a) The family is not eligible for premium assistance
15 payments and must pay the full cost of the premium, including
16 any administrative costs.
17 (b) The agency is authorized to place limits on
18 enrollment in Medikids by these children in order to avoid
19 adverse selection. The number of children participating in
20 Medikids whose family income exceeds 200 percent of the
21 federal poverty level must not exceed 10 percent of total
22 enrollees in the Medikids program.
23 (c) The board of directors of the Florida Healthy Kids
24 Corporation is authorized to place limits on enrollment of
25 these children in order to avoid adverse selection. In
26 addition, the board is authorized to offer a reduced benefit
27 package to these children in order to limit program costs for
28 such families. The number of children participating in the
29 Florida Healthy Kids program whose family income exceeds 200
30 percent of the federal poverty level must not exceed 10
31
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1 percent of total enrollees in the Florida Healthy Kids
2 program.
3 (d) Children described in this subsection are not
4 counted in the annual enrollment ceiling for the Florida
5 Kidcare program.
6 (6) Once a child is enrolled in determined eligible
7 for the Florida Kidcare program, the child is eligible for
8 coverage under the program for 12 6 months without a
9 redetermination or reverification of eligibility, if the
10 family continues to pay the applicable premium. Effective
11 January 1, 1999, a child who has not attained the age of 5 and
12 who has been determined eligible for the Medicaid program is
13 eligible for coverage for 12 months without a redetermination
14 or reverification of eligibility.
15 Section 5. Paragraph (v) is added to subsection (2) of
16 section 409.815, Florida Statutes, to read:
17 409.815 Health benefits coverage; limitations.--
18 (2) BENCHMARK BENEFITS.--In order for health benefits
19 coverage to qualify for premium assistance payments for an
20 eligible child under ss. 409.810-409.820, the health benefits
21 coverage, except for coverage under Medicaid and Medikids,
22 must include the following minimum benefits, as medically
23 necessary.
24 (v) Dental services.--Dental services must include
25 those services specified in s. 409.906(6).
26 Section 6. Section 409.8177, Florida Statutes, is
27 amended to read:
28 409.8177 Program evaluation.--The agency, in
29 consultation with the Department of Health, the Department of
30 Children and Family Services, and the Florida Healthy Kids
31 Corporation, shall:
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1 (1) Monthly submit to the Governor and the Legislature
2 a report of enrollment for each program component of the
3 Florida Kidcare program.
4 (2) By January 1 of each year, submit to the Governor
5 and the Legislature a report of the Florida Kidcare program.
6 In addition to the items specified under s. 2108 of Title XXI
7 of the Social Security Act, the report shall include an
8 assessment of crowd-out and access to health care, as well as
9 the following:
10 (a)(1) An assessment of the operation of the program,
11 including the progress made in reducing the number of
12 uncovered low-income children.
13 (b)(2) An assessment of the effectiveness in
14 increasing the number of children with creditable health
15 coverage, including an assessment of the impact of outreach.
16 (c)(3) The characteristics of the children and
17 families assisted under the program, including ages of the
18 children, family income, and access to or coverage by other
19 health insurance prior to the program and after disenrollment
20 from the program.
21 (d)(4) The quality of health coverage provided,
22 including the types of benefits provided.
23 (e)(5) The amount and level, including payment of part
24 or all of any premium, of assistance provided.
25 (f)(6) The average length of coverage of a child under
26 the program.
27 (g)(7) The program's choice of health benefits
28 coverage and other methods used for providing child health
29 assistance.
30 (h)(8) The sources of nonfederal funding used in the
31 program.
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1 (i)(9) An assessment of the effectiveness of Medikids,
2 Children's Medical Services network, and other public and
3 private programs in the state in increasing the availability
4 of affordable quality health insurance and health care for
5 children.
6 (j)(10) A review and assessment of state activities to
7 coordinate the program with other public and private programs.
8 (k)(11) An analysis of changes and trends in the state
9 that affect the provision of health insurance and health care
10 to children.
11 (l)(12) A description of any plans the state has for
12 improving the availability of health insurance and health care
13 for children.
14 (m)(13) Recommendations for improving the program.
15 (n)(14) Other studies as necessary.
16 Section 7. Subsection (1) of section 409.818, Florida
17 Statutes, is amended to read:
18 409.818 Administration.--In order to implement ss.
19 409.810-409.820, the following agencies shall have the
20 following duties:
21 (1) The Department of Children and Family Services
22 shall:
23 (a) Develop a simplified eligibility application
24 mail-in form to be used for determining the eligibility of
25 children for coverage under the Florida Kidcare program, in
26 consultation with the agency, the Department of Health, and
27 the Florida Healthy Kids Corporation. The simplified
28 eligibility application form must include an item that
29 provides an opportunity for the applicant to indicate whether
30 coverage is being sought for a child with special health care
31 needs. Families applying for children's Medicaid coverage must
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1 also be able to use the simplified application form without
2 having to pay a premium.
3 (b) Establish and maintain the eligibility
4 determination process under the program except as specified in
5 subsection (5). The department shall directly, or through the
6 services of a contracted third-party administrator, establish
7 and maintain a process for determining eligibility of children
8 for coverage under the program. The eligibility determination
9 process must be used solely for determining eligibility of
10 applicants for health benefits coverage under the program. The
11 eligibility determination process must include an initial
12 determination of eligibility for any coverage offered under
13 the program, as well as a redetermination or reverification of
14 eligibility each subsequent 12 6 months. Effective January 1,
15 1999, a child who has not attained the age of 5 and who has
16 been determined eligible for the Medicaid program is eligible
17 for coverage for 12 months without a redetermination or
18 reverification of eligibility. In conducting an eligibility
19 determination, the department shall determine if the child has
20 special health care needs. The department, in consultation
21 with the Agency for Health Care Administration and the Florida
22 Healthy Kids Corporation, shall develop procedures for
23 redetermining eligibility which enable a family to easily
24 update any change in circumstances which could affect
25 eligibility without requiring the family to submit a new
26 application. Redetermination of a child's eligibility for
27 Medicaid may not be linked to a child's eligibility
28 determination for other programs.
29 (c) Inform program applicants about eligibility
30 determinations and provide information about eligibility of
31 applicants to Medicaid, Medikids, the Children's Medical
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1 Services network, and the Florida Healthy Kids Corporation,
2 and to insurers and their agents, through a centralized
3 coordinating office.
4 (d) Adopt rules necessary for conducting program
5 eligibility functions.
6 Section 8. Subsections (6) and (7) of section 409.903,
7 Florida Statutes, are amended to read:
8 409.903 Mandatory payments for eligible persons.--The
9 agency shall make payments for medical assistance and related
10 services on behalf of the following persons who the agency
11 determines to be eligible, subject to the income, assets, and
12 categorical eligibility tests set forth in federal and state
13 law. Payment on behalf of these Medicaid eligible persons is
14 subject to the availability of moneys and any limitations
15 established by the General Appropriations Act or chapter 216.
16 (6) A child born after September 30, 1983, living in a
17 family that has an income which is at or below 100 percent of
18 the current federal poverty level, who has attained the age of
19 6, but has not attained the age of 19. In determining the
20 eligibility of such a child, an assets test is not required. A
21 child who is eligible for Medicaid under this subsection must
22 be offered the opportunity, subject to federal rules, to be
23 made presumptively eligible. A child who has been deemed
24 presumptively eligible for Medicaid shall not be enrolled in a
25 managed care plan until the child's full eligibility
26 determination for Medicaid has been completed.
27 (7) A child living in a family that has an income
28 which is at or below 133 percent of the current federal
29 poverty level, who has attained the age of 1, but has not
30 attained the age of 6. In determining the eligibility of such
31 a child, an assets test is not required. A child who is
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1 eligible for Medicaid under this subsection must be offered
2 the opportunity, subject to federal rules, to be made
3 presumptively eligible. A child who has been deemed
4 presumptively eligible for Medicaid shall not be enrolled in a
5 managed care plan until the child's full eligibility
6 determination for Medicaid has been completed.
7 Section 9. Subsections (6) and (7) of section 409.904,
8 Florida Statutes, are amended, and subsections (8) and (9) are
9 added to that section, to read:
10 409.904 Optional payments for eligible persons.--The
11 agency may make payments for medical assistance and related
12 services on behalf of the following persons who are determined
13 to be eligible subject to the income, assets, and categorical
14 eligibility tests set forth in federal and state law. Payment
15 on behalf of these Medicaid eligible persons is subject to the
16 availability of moneys and any limitations established by the
17 General Appropriations Act or chapter 216.
18 (6) A child born before October 1, 1983, living in a
19 family that has an income which is at or below 100 percent of
20 the current federal poverty level, who has attained the age of
21 6, but has not attained the age of 19, and who would be
22 eligible in s. 409.903(6), if the child had been born on or
23 after such date. In determining the eligibility of such a
24 child, an assets test is not required. A child who is eligible
25 for Medicaid under this subsection must be offered the
26 opportunity, subject to federal rules, to be made
27 presumptively eligible.
28 (7) A child who has not attained the age of 19 who has
29 been determined eligible for the Medicaid program is deemed to
30 be eligible for a total of 12 6 months, regardless of changes
31 in circumstances other than attainment of the maximum age.
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1 Effective January 1, 1999, a child who has not attained the
2 age of 5 and who has been determined eligible for the Medicaid
3 program is deemed to be eligible for a total of 12 months
4 regardless of changes in circumstances other than attainment
5 of the maximum age.
6 (8) A child under 1 year of age who lives in a family
7 that has an income above 185 percent of the most recently
8 published federal poverty level, but which is at or below 200
9 percent of such poverty level. In determining the eligibility
10 of such child, an assets test is not required. A child who is
11 eligible for Medicaid under this subsection must be offered
12 the opportunity, subject to federal rules, to be made
13 presumptively eligible.
14 (9) A pregnant woman for the duration of her pregnancy
15 and for the postpartum period, as defined in federal law and
16 rule, who lives in a family that has an income above 185
17 percent of the current federal poverty level, but which is at
18 or below 200 percent of the most current federal poverty
19 level. A pregnant woman who applies for eligibility for the
20 Medicaid program through a qualified Medicaid provider must be
21 offered the opportunity, subject to federal rules, to be made
22 presumptively eligible for the Medicaid program.
23 Section 10. The Division of State Group Insurance of
24 the Department of Management Services shall develop a program
25 to subsidize health insurance coverage for children of state
26 employees if funds are made available for this purpose in the
27 General Appropriations Act. Premium subsidies must be
28 available only to state employees who have children under 19
29 years of age and whose family income is equal to or below 200
30 percent of the federal poverty level. The amount of the
31 subsidy is to be determined by subtracting from the cost of
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1 the employee family premium the cost for the individual state
2 employee and the amount of the premium paid by Title
3 XXI-subsidized families in the Florida Kidcare program.
4 Eligibility for subsidized health insurance coverage for
5 children of state employees must be determined, to the extent
6 possible, using procedures and forms of the Florida Kidcare
7 program.
8 Section 11. The provisions of this act which would
9 require changes to contracts in existence on June 30, 2000,
10 between the Florida Healthy Kids Corporation and its
11 contracted providers shall be applied to such contracts upon
12 renewal of the contracts, but no later than July 1, 2002.
13 Section 12. This act shall take effect upon becoming a
14 law.
15
16 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
17 Senate Bill 212
18
19 The Committee Substitute removes the applicability of the
Medicaid third party liability requirements to the Medikids
20 program; allows mandatory assignment of Medikids applicants
who do not make a voluntary choice of providers; requires that
21 presumptively eligible children not be enrolled in managed
care plans until the child's full eligibility for Medicaid has
22 been completed; deletes the creation of a separate Kidcare
dental program and adds dental services to the benchmark
23 benefits for Kidcare; adds a requirement that the Kidcare
annual report assess the impact of outreach; and allows the
24 Healthy Kids Corporation to apply the provisions of the bill
which require changes to provider contracts to those contracts
25 as they are renewed, but no later than July 1, 2002.
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