Amendment

Bill No. 1073

Amendment No. 143501

CHAMBER ACTION
Senate		House
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1	Representative Sobel offered the following:
2
3	Amendment (with title amendment)
4	Remove lines 574-603 and insert:
5	Section 11.  Section 409.818, Florida Statutes, is amended
6	to read:
7	409.818  Administration.--In order to implement ss.
8	409.810-409.820, the following agencies shall have the following
9	duties:
10	(1)  The Department of Children and Family Services shall:
11	(a)  Develop a simplified eligibility application mail-in
12	form to be used for determining the eligibility of children for
13	coverage under the Florida KidCare Kidcare program, in
14	consultation with the agency, the Department of Health, and the
15	Florida Healthy Kids Corporation. The simplified eligibility
16	application form must include an item that provides an
17	opportunity for the applicant to indicate whether coverage is
18	being sought for a child with special health care needs.
19	Families applying for children's Medicaid coverage must also be
20	able to use the simplified application form without having to
21	pay a premium.
22	(b)  Establish and maintain the Medicaid eligibility
23	determination process under the program except as specified in
24	subsection (5). The department shall directly, or through the
25	services of a contracted third-party administrator, establish
26	and maintain a process for determining Medicaid eligibility of
27	children for coverage under the program. The eligibility
28	determination process must be used solely for determining
29	eligibility of applicants for health benefits coverage under the
30	program. The eligibility determination process must include an
31	initial determination of eligibility for any coverage offered
32	under the program, as well as a redetermination or
33	reverification of eligibility each subsequent 6 months.
34	Effective January 1, 1999, a child who has not attained the age
35	of 5 and who has been determined eligible for the Medicaid
36	program is eligible for coverage for 12 months without a
37	redetermination or reverification of eligibility. In conducting
38	an eligibility determination, the department shall determine if
39	the child has special health care needs. The department, in
40	consultation with the Agency for Health Care Administration and
41	the Florida Healthy Kids Corporation, shall develop procedures
42	for redetermining Medicaid eligibility which enable a family to
43	easily update any change in circumstances which could affect
44	eligibility. The department may accept changes in a family's
45	status as reported to the department by the Agency for Health
46	Care Administration or its contracted third-party administrator
47	Florida Healthy Kids Corporation without requiring a new
48	application from the family. Redetermination of a child's
49	eligibility for Medicaid may not be linked to a child's
50	eligibility determination for other programs.
51	(c)  Inform program applicants about eligibility
52	determinations and provide information about eligibility of
53	applicants to Medicaid, Medikids, the Children's Medical
54	Services network, and the Florida Healthy Kids Corporation, and
55	to insurers and their agents, through a centralized coordinating
56	office.
57	(d)  Adopt rules necessary for conducting Medicaid program
58	eligibility functions.
59	(2)  The Department of Health shall:
60	(a)  Design an eligibility intake process for the program,
61	in coordination with the Department of Children and Family
62	Services, the agency, and the Florida Healthy Kids Corporation.
63	The eligibility intake process may include local intake points
64	that are determined by the Department of Health in coordination
65	with the Department of Children and Family Services.
66	(b)  Design and implement program outreach activities under
67	s. 409.819.
68	(b)(c)  Chair a state-level coordinating council to review
69	and make recommendations concerning the implementation and
70	operation of the program. The coordinating council shall include
71	representatives from the department, the Department of Children
72	and Family Services, the agency, the Florida Healthy Kids
73	Corporation, the Office of Insurance Regulation of the Financial
74	Services Commission, local government, health insurers, health
75	maintenance organizations, health care providers, families
76	participating in the program, and organizations representing
77	low-income families.
78	(c)(d)  In consultation with the Florida Healthy Kids
79	Corporation and the Department of Children and Family Services,
80	establish establishing a toll-free telephone line to assist
81	families with questions about the program.
82	(d)(e)  Adopt rules necessary to implement outreach
83	activities.
84	(3)  The Agency for Health Care Administration, under the
85	authority granted in s. 409.914(1), shall:
86	(a)  Calculate the premium assistance payment necessary to
87	comply with the premium and cost-sharing limitations specified
88	in s. 409.816. The premium assistance payment for each enrollee
89	in a health insurance plan participating in the Florida Healthy
90	Kids Corporation shall equal the premium approved by the Florida
91	Healthy Kids Corporation and the Office of Insurance Regulation
92	of the Financial Services Commission pursuant to ss. 627.410 and
93	641.31, less any enrollee's share of the premium established
94	within the limitations specified in s. 409.816. The premium
95	assistance payment for each enrollee in an employer-sponsored
96	health insurance plan approved under ss. 409.810-409.820 shall
97	equal the premium for the plan adjusted for any benchmark
98	benefit plan actuarial equivalent benefit rider approved by the
99	Office of Insurance Regulation pursuant to ss. 627.410 and
100	641.31, less any enrollee's share of the premium established
101	within the limitations specified in s. 409.816. In calculating
102	the premium assistance payment levels for children with family
103	coverage, the agency shall set the premium assistance payment
104	levels for each child proportionately to the total cost of
105	family coverage.
106	(b)  Annually calculate the program enrollment ceiling
107	based on estimated per child premium assistance payments and the
108	estimated appropriation available for the program.
109	(c)  Make premium assistance payments to health insurance
110	plans on a periodic basis. The agency may use its Medicaid
111	fiscal agent or a contracted third-party administrator in making
112	these payments. The agency may require health insurance plans
113	that participate in the Medikids program or employer-sponsored
114	group health insurance to collect premium payments from an
115	enrollee's family. Participating health insurance plans shall
116	report premium payments collected on behalf of enrollees in the
117	program to the agency in accordance with a schedule established
118	by the agency.
119	(d)  Monitor compliance with quality assurance and access
120	standards developed under s. 409.820.
121	(e)  Establish a mechanism for investigating and resolving
122	complaints and grievances from program applicants, enrollees,
123	and health benefits coverage providers, and maintain a record of
124	complaints and confirmed problems. In the case of a child who is
125	enrolled in a health maintenance organization, the agency must
126	use the provisions of s. 641.511 to address grievance reporting
127	and resolution requirements.
128	(f)  Approve health benefits coverage for participation in
129	the program, following certification by the Office of Insurance
130	Regulation under subsection (4).
131	(g)  Adopt rules necessary for calculating premium
132	assistance payment levels, calculating the program enrollment
133	ceiling, making premium assistance payments, monitoring access
134	and quality assurance standards, investigating and resolving
135	complaints and grievances, administering the Medikids program,
136	and approving health benefits coverage.
137	(h)  Establish and maintain the eligibility determination
138	process under the Title XXI-funded program. The agency shall
139	directly, or through the services of a contracted third-party
140	administrator, establish and maintain a process for determining
141	eligibility of children for coverage under the program. The
142	eligibility determination process must be used solely for
143	determining eligibility of applicants for health benefits
144	coverage under the program. The eligibility determination
145	process must include an initial determination of eligibility for
146	any coverage offered under the program, as well as a
147	redetermination or reverification of eligibility each subsequent
148	6 months. In conducting an eligibility determination, the
149	Department of Health shall determine if the child has special
150	health care needs. The agency, in consultation with the
151	Department of Health and the Florida Healthy Kids Corporation,
152	shall develop procedures for redetermining eligibility that
153	enable a family to easily update any change in circumstances
154	that could affect eligibility.
155	(i)  Adopt rules pursuant to ss. 409.810-409.820,
156	including, at a minimum, rules specifying policies, procedures,
157	and criteria for the following Florida KidCare activities:
158	1.  Application requirements, including documentation
159	requirements.
160	2.  Eligibility determination.
161	3.  Eligibility redetermination.
162	4.  Premium payment requirements.
163	5.  Cancellation of coverage.
164	6.  Reinstatement of coverage.
165	7.  Open enrollment.
166	8.  Disenrollment procedures.
167	9.  Applicant and enrollee notification requirements.
168	10.  Application and enrollment time processing standards.
169
170	The agency is designated the lead state agency for Title XXI of
171	the Social Security Act for purposes of receipt of federal
172	funds, for reporting purposes, and for ensuring compliance with
173	federal and state regulations and rules.
174	(4)  The Office of Insurance Regulation shall certify that
175	health benefits coverage plans that seek to provide services
176	under the Florida KidCare Kidcare program, except those offered
177	through the Florida Healthy Kids Corporation or the Children's
178	Medical Services network, meet, exceed, or are actuarially
179	equivalent to the benchmark benefit plan and that health
180	insurance plans will be offered at an approved rate. In
181	determining actuarial equivalence of benefits coverage, the
182	Office of Insurance Regulation and health insurance plans must
183	comply with the requirements of s. 2103 of Title XXI of the
184	Social Security Act. The department shall adopt rules necessary
185	for certifying health benefits coverage plans.
186	(5)  The Florida Healthy Kids Corporation shall retain its
187	functions as authorized in s. 624.91, including eligibility
188	determination for participation in the non-Title-XXI-funded
189	portions of the Healthy Kids program.
190	(6)  The agency, the Department of Health, the Department
191	of Children and Family Services, the Florida Healthy Kids
192	Corporation, and the Office of Insurance Regulation, after
193	consultation with and approval of the Speaker of the House of
194	Representatives and the President of the Senate, are authorized
195	to make program modifications that are necessary to overcome any
196	objections of the United States Department of Health and Human
197	Services to obtain approval of the state's child health
198	insurance plan under Title XXI of the Social Security Act.
199
200	================ T I T L E  A M E N D M E N T =============
201	Remove lines 63 and 64 and insert:
202	Legislature; amending s. 409.818, F.S.; requiring the agency to
203	establish and maintain a process for determining the eligibility
204	of children for coverage under the Florida KidCare program;
205	providing requirements of the eligibility determination process
206	for certain programs; providing rulemaking authority to the
207	agency to govern the Florida KidCare program; repealing s.
208	409.819, F.S., relating to a

CODING: Words stricken are deletions; words underlined are additions.