HB 1073

1	A bill to be entitled
2	An act relating to the Florida KidCare program; amending
3	s. 409.811, F.S.; defining the term "Florida KidCare
4	program"; deleting a definition to conform; amending s.
5	409.8132, F.S.; limiting when an applicant may apply for
6	Medikids program enrollment; deleting a special enrollment
7	period provision; amending s. 409.8134, F.S.; eliminating
8	the Agency for Health Care Administration's ability to
9	request an increase in the Florida KidCare program
10	enrollment ceiling; providing for open enrollment periods;
11	providing a timeframe for statewide announcement of open
12	enrollment periods; providing limitations; providing a
13	disenrollment process under certain circumstances;
14	providing additional data for certain agencies to collect
15	and analyze; amending s. 409.814, F.S.; revising Florida
16	KidCare program eligibility criteria; limiting coverage;
17	providing an exception for certain children otherwise
18	eligible or covered under a family member's employer
19	health coverage; restricting enrollment of children whose
20	coverage was voluntarily canceled; providing an age
21	limitation for certain components; requiring certain
22	transfers to be managed within authorized levels of
23	funding; requiring certain reserves to be established and
24	reviewed; requiring each applicant to provide certain
25	documentation; requiring the program to withhold benefits
26	from certain enrollees; providing additional fraudulent
27	activities; amending s. 409.815, F.S.; making dental
28	services contingent upon an annual appropriation; amending
29	s. 624.91, F.S.; removing the requirement for the Florida
30	Healthy Kids Corporation to work with the Florida
31	Partnership for School Readiness; limiting eligibility for
32	state-funded assistance in paying Florida Healthy Kids
33	premiums; providing for future repeal of certain
34	provisions; providing additional criteria for the
35	corporation to determine eligibility; eliminating
36	authority to establish an open enrollment period; revising
37	the corporation's purchasing criteria; removing a
38	restriction; eliminating authority to contract with
39	certain entities; eliminating authority to establish a
40	maximum number of participants; eliminating authority to
41	establish eligibility criteria or premium and cost-sharing
42	requirements; providing that contracted insurers are the
43	payors of last resort; requiring contracted insurers to
44	coordinate benefits with certain payors; requiring the
45	Auditor General to perform an analysis on certain children
46	enrolled in the Florida KidCare program and report such
47	findings to the Governor and Legislature; requiring the
48	Florida Healthy Kids Corporation to use certain funds to
49	contract for an actuarial study; requiring the Auditor
50	General to perform random audits to determine eligibility
51	of children enrolled in the Florida Healthy Kids program;
52	requiring the Office of Program Policy Analysis and
53	Government Accountability to perform a study to determine
54	the appropriate family premium for the Florida KidCare
55	program and report its findings to the Legislature;
56	amending s. 409.818, F.S.; deleting a cross reference;
57	repealing s. 409.819, F.S., relating to a program
58	identifying low-income, uninsured children for certain
59	purposes; providing appropriations; providing effective
60	dates.
61
62	Be It Enacted by the Legislature of the State of Florida:
63
64	Section 1.  Subsections (14) through (22) of section
65	409.811, Florida Statutes, are renumbered as subsections (15)
66	through (23), respectively, present subsection (23) of said
67	section is amended, and a new subsection (14) is added to said
68	section, to read:
69	409.811  Definitions relating to Florida KidCare Kidcare
70	Act.--As used in ss. 409.810-409.820, the term:
71	(14)  "Florida KidCare program," "KidCare program," or
72	"program" means the health benefits program administered through
73	ss. 409.810-409.820.
74	(23)  "Program" means the Florida Kidcare program, the
75	medical assistance program authorized by Title XXI of the Social
76	Security Act as part of the federal Balanced Budget Act of 1997.
77	Section 2.  Subsections (7), (8), and (9) of section
78	409.8132, Florida Statutes, are amended to read:
79	409.8132  Medikids program component.--
80	(7)  ENROLLMENT.--Enrollment in the Medikids program
81	component may only occur during periodic open enrollment periods
82	as specified in s. 409.8134 by the agency. An applicant may
83	apply for enrollment in the Medikids program component and
84	proceed through the eligibility determination process at any
85	time throughout the year. However, enrollment in Medikids shall
86	not begin until the next open enrollment period; and A child may
87	not receive services under the Medikids program until the child
88	is enrolled in a managed care plan or MediPass. In addition,
89	Once determined eligible, an applicant may receive choice
90	counseling and select a managed care plan or MediPass. The
91	agency may initiate mandatory assignment for a Medikids
92	applicant who has not chosen a managed care plan or MediPass
93	provider after the applicant's voluntary choice period ends. An
94	applicant may select MediPass under the Medikids program
95	component only in counties that have fewer than two managed care
96	plans available to serve Medicaid recipients and only if the
97	federal Health Care Financing Administration determines that
98	MediPass constitutes "health insurance coverage" as defined in
99	Title XXI of the Social Security Act.
100	(8)  SPECIAL ENROLLMENT PERIODS.--The agency shall
101	establish a special enrollment period of 30 days' duration for
102	any child who is enrolled in Medicaid if such child loses
103	Medicaid eligibility and becomes eligible for Medikids, or for
104	any child who is enrolled in Medikids if such child moves to
105	another county that is not within the coverage area of the
106	child's Medikids managed care plan or MediPass provider.
107	(8)(9)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
108	shall establish enrollment criteria that must include penalties
109	or waiting periods of not fewer than 60 days for reinstatement
110	of coverage upon voluntary cancellation for nonpayment of
111	premiums.
112	Section 3.  Section 409.8134, Florida Statutes, is amended
113	to read:
114	409.8134  Program enrollment and expenditure ceilings.--
115	(1)  Except for the Medicaid program, a ceiling shall be
116	placed on annual federal and state expenditures and on
117	enrollment in the Florida KidCare Kidcare program as provided
118	each year in the General Appropriations Act. The agency, in
119	consultation with the Department of Health, may propose to
120	increase the enrollment ceiling in accordance with chapter 216.
121	(2)  Upon a unanimous recommendation by representatives
122	from each of the four Florida KidCare administrators, the
123	Florida KidCare program may conduct an open enrollment period
124	for the purpose of enrolling children eligible for all program
125	components listed in s. 409.813 except Medicaid. The four
126	Florida KidCare administrators shall work together to ensure
127	that the open enrollment period is announced statewide at least
128	1 month before the open enrollment is to begin. Eligible
129	children shall be enrolled on a first-come, first-served basis
130	using the date the open enrollment application is received. Open
131	enrollment shall immediately cease when the enrollment ceiling
132	is reached. An open enrollment shall be held only if the Social
133	Services Estimating Conference determines that sufficient funds
134	have been appropriated to finance increased enrollment through
135	federal fiscal year 2007. Individuals, including those on a
136	waiting list after January 30, 2004, must reapply by submitting
137	a new application during each new open enrollment period Except
138	for the Medicaid program, whenever the Social Services
139	Estimating Conference determines that there is presently, or
140	will be by the end of the current fiscal year, insufficient
141	funds to finance the current or projected enrollment in the
142	Florida Kidcare program, all additional enrollment must cease
143	and additional enrollment may not resume until sufficient funds
144	are available to finance such enrollment.
145	(3)  Upon determination by the Social Services Estimating
146	Conference that there are insufficient funds to finance the
147	current enrollment in the Florida KidCare program within current
148	appropriations, the program shall initiate disenrollment
149	procedures to remove enrollees, except those children enrolled
150	in the Children's Medical Services network, on a last-in, first-
151	out basis until the expenditure and appropriation levels are
152	balanced.
153	(4)(3)  The agencies that administer the Florida KidCare
154	Kidcare program components shall collect and analyze the data
155	needed to project Florida Kidcare program enrollment costs,
156	including price level adjustments outreach impacts,
157	participation and attrition rates, current and projected
158	caseloads, utilization, and current and projected expenditures
159	for the next 3 years. The agencies shall report the caseload and
160	expenditure trends to the Social Services Estimating Conference
161	in accordance with chapter 216.
162	Section 4.  Effective July 1, 2004, section 409.814,
163	Florida Statutes, is amended to read:
164	409.814  Eligibility.--A child who has not reached 19 years
165	of age whose family income is equal to or below 200 percent of
166	the federal poverty level is eligible for the Florida KidCare
167	Kidcare program as provided in this section. In determining the
168	eligibility of such a child, an assets test is not required. An
169	applicant under 19 years of age who, based on a complete
170	application, appears to be eligible for the Medicaid component
171	of the Florida Kidcare program is presumed eligible for coverage
172	under Medicaid, subject to federal rules. A child who has been
173	deemed presumptively eligible for Medicaid shall not be enrolled
174	in a managed care plan until the child's full eligibility
175	determination for Medicaid has been completed. The Florida
176	Healthy Kids Corporation may, subject to compliance with
177	applicable requirements of the Agency for Health Care
178	Administration and the Department of Children and Family
179	Services, be designated as an entity to conduct presumptive
180	eligibility determinations. An applicant under 19 years of age
181	who, based on a complete application, appears to be eligible for
182	the Medikids, Florida Healthy Kids, or Children's Medical
183	Services network program component, who is screened as
184	ineligible for Medicaid and prior to the monthly verification of
185	the applicant's enrollment in Medicaid or of eligibility for
186	coverage under the state employee health benefit plan, may be
187	enrolled in and begin receiving coverage from the appropriate
188	program component on the first day of the month following the
189	receipt of a completed application. For enrollment in the
190	Children's Medical Services network, a complete application
191	includes the medical or behavioral health screening. If,
192	subsequently after verification, an individual is determined to
193	be ineligible for coverage, he or she must immediately be
194	disenrolled from the respective KidCare Title XXI-funded Kidcare
195	program component.
196	(1)  A child who is eligible for Medicaid coverage under s.
197	409.903 or s. 409.904 must be enrolled in Medicaid and is not
198	eligible to receive health benefits under any other health
199	benefits coverage authorized under the Florida KidCare program
200	ss. 409.810-409.820.
201	(2)  A child who is not eligible for Medicaid, but who is
202	eligible for the Florida KidCare Kidcare program, may obtain
203	health benefits coverage under any of the other components
204	listed in s. 409.813 types of health benefits coverage
205	authorized in ss. 409.810-409.820 if such coverage is approved
206	and available in the county in which the child resides. However,
207	a child who is eligible for Medikids may participate in the
208	Florida Healthy Kids program only if the child has a sibling
209	participating in the Florida Healthy Kids program and the
210	child's county of residence permits such enrollment.
211	(3)  A child who is eligible for the Florida KidCare
212	Kidcare program who is a child with special health care needs,
213	as determined through a medical or behavioral screening
214	instrument, is eligible for health benefits coverage from and
215	shall be referred to the Children's Medical Services network.
216	(4)  The following children are not eligible to receive
217	premium assistance for health benefits coverage under the
218	Florida KidCare program ss. 409.810-409.820, except under
219	Medicaid if the child would have been eligible for Medicaid
220	under s. 409.903 or s. 409.904 as of June 1, 1997:
221	(a)  A child who is eligible for coverage under a state
222	health benefit plan on the basis of a family member's employment
223	with a public agency in the state.
224	(b)  A child who is currently eligible for or covered under
225	a family member's group health benefit plan or under other
226	employer health insurance coverage, excluding coverage provided
227	under the Florida Healthy Kids Corporation as established under
228	s. 624.91, provided that the cost of the child's participation
229	is not greater than 7.5 percent of the family's income. This
230	provision shall be applied during redetermination for children
231	who were enrolled prior to July 1, 2004. These enrollees shall
232	have 6 months of eligibility following redetermination to allow
233	for a transition to the other health benefit plan.
234	(c)  A child who is seeking premium assistance for the
235	Florida KidCare program through employer-sponsored group
236	coverage, if the child has been covered by the same employer's
237	group coverage during the 6 months prior to the family's
238	submitting an application for determination of eligibility under
239	the Florida Kidcare program.
240	(d)  A child who is an alien, but who does not meet the
241	definition of qualified alien, in the United States.
242	(e)  A child who is an inmate of a public institution or a
243	patient in an institution for mental diseases.
244	(f)  A child who has had his or her coverage in an
245	employer-sponsored health benefit plan voluntarily canceled in
246	the last 6 months, except those children who were on the waiting
247	list prior to January 31, 2004.
248	(5)  A child whose family income is above 200 percent of
249	the federal poverty level or a child who is excluded under the
250	provisions of subsection (4) may participate in the Florida
251	KidCare Kidcare program, excluding the Medicaid program, but is
252	subject to the following provisions:
253	(a)  The family is not eligible for premium assistance
254	payments and must pay the full cost of the premium, including
255	any administrative costs.
256	(b)  The agency is authorized to place limits on enrollment
257	in Medikids by these children in order to avoid adverse
258	selection. The number of children participating in Medikids
259	whose family income exceeds 200 percent of the federal poverty
260	level must not exceed 10 percent of total enrollees in the
261	Medikids program.
262	(c)  The board of directors of the Florida Healthy Kids
263	Corporation is authorized to place limits on enrollment of these
264	children in order to avoid adverse selection. In addition, the
265	board is authorized to offer a reduced benefit package to these
266	children in order to limit program costs for such families. The
267	number of children participating in the Florida Healthy Kids
268	program whose family income exceeds 200 percent of the federal
269	poverty level must not exceed 10 percent of total enrollees in
270	the Florida Healthy Kids program.
271	(d)  Children described in this subsection are not counted
272	in the annual enrollment ceiling for the Florida KidCare Kidcare
273	program.
274	(6)  Once a child is enrolled in the Florida KidCare
275	Kidcare program, the child is eligible for coverage under the
276	program for 6 months without a redetermination or reverification
277	of eligibility, if the family continues to pay the applicable
278	premium. Eligibility for program components funded through Title
279	XXI of the Social Security Act shall terminate when a child
280	attains the age of 19. Effective January 1, 1999, a child who
281	has not attained the age of 5 and who has been determined
282	eligible for the Medicaid program is eligible for coverage for
283	12 months without a redetermination or reverification of
284	eligibility.
285	(7)  When determining or reviewing a child's eligibility
286	under the Florida KidCare program, the applicant shall be
287	provided with reasonable notice of changes in eligibility which
288	may affect enrollment in one or more of the program components.
289	When a transition from one program component to another is
290	authorized appropriate, there shall be cooperation between the
291	program components and the affected family which promotes
292	continuity of health care coverage. Any authorized transfers
293	must be managed within the program's overall appropriated or
294	authorized levels of funding. Each component of the program
295	shall establish a reserve to ensure that transfers between
296	components will be accomplished within current year
297	appropriations. These reserves shall be reviewed by each
298	convening of the Social Services Estimating Conference to
299	determine the adequacy of such reserves to meet actual
300	experience.
301	(8)  In determining the eligibility of a child, an assets
302	test is not required. Each applicant shall provide written
303	documentation during the application process and the
304	redetermination process, including, but not limited to, the
305	following:
306	(a)  Proof of family income.
307	(b)  A statement from all employers of family members that:
308	1.  The employer does not sponsor a health benefit plan for
309	employees; or
310	2.  The potential enrollee is not covered by the employer-
311	sponsored health benefit plan because the potential enrollee is
312	not eligible for coverage, or, if the potential enrollee is
313	eligible but not covered, a statement of the cost to enroll the
314	potential enrollee in the employer-sponsored health benefit
315	plan.
316	(9)  Subject to paragraph (4)(b) and s. 624.91(3), the
317	Florida KidCare program shall withhold benefits from an enrollee
318	if the program obtains evidence that the enrollee is no longer
319	eligible, submitted incorrect or fraudulent information in order
320	to establish eligibility, or failed to provide verification of
321	eligibility. The applicant or enrollee shall be notified that
322	because of such evidence program benefits will be withheld
323	unless the applicant or enrollee contacts a designated
324	representative of the program by a specified date, which must be
325	within 10 days after the date of notice, to discuss and resolve
326	the matter. The program shall make every effort to resolve the
327	matter within a timeframe that will not cause benefits to be
328	withheld from an eligible enrollee.
329	(10)  The following individuals may be subject to
330	prosecution in accordance with s. 414.39:
331	(a)  An applicant obtaining or attempting to obtain
332	benefits for a potential enrollee under the Florida KidCare
333	program when the applicant knows or should have known the
334	potential enrollee does not qualify for the Florida KidCare
335	program.
336	(b)  An individual who assists an applicant in obtaining or
337	attempting to obtain benefits for a potential enrollee under the
338	Florida KidCare program when the individual knows or should have
339	known the potential enrollee does not qualify for the Florida
340	KidCare program.
341	Section 5.  Paragraph (q) of subsection (2) of section
342	409.815, Florida Statutes, is amended to read:
343	409.815  Health benefits coverage; limitations.--
344	(2)  BENCHMARK BENEFITS.--In order for health benefits
345	coverage to qualify for premium assistance payments for an
346	eligible child under ss. 409.810-409.820, the health benefits
347	coverage, except for coverage under Medicaid and Medikids, must
348	include the following minimum benefits, as medically necessary.
349	(q)  Dental services.--Covered services may include those
350	dental services provided to children by the Florida Medicaid
351	program under s. 409.906(5), contingent upon an annual
352	appropriation in the General Appropriations Act up to a maximum
353	benefit of $750 per enrollee per year.
354	Section 6.  Subsections (3) through (7) of section 624.91,
355	Florida Statutes, are renumbered as subsections (4) through (8),
356	respectively, present subsections (2) and (4) of said section
357	are amended, and a new subsection (3) is added to said section,
358	to read:
359	624.91  The Florida Healthy Kids Corporation Act.--
360	(2)  LEGISLATIVE INTENT.--
361	(a)  The Legislature finds that increased access to health
362	care services could improve children's health and reduce the
363	incidence and costs of childhood illness and disabilities among
364	children in this state. Many children do not have comprehensive,
365	affordable health care services available. It is the intent of
366	the Legislature that the Florida Healthy Kids Corporation
367	provide comprehensive health insurance coverage to such
368	children. The corporation is encouraged to cooperate with any
369	existing health service programs funded by the public or the
370	private sector and to work cooperatively with the Florida
371	Partnership for School Readiness.
372	(b)  It is the intent of the Legislature that the Florida
373	Healthy Kids Corporation serve as one of several providers of
374	services to children eligible for medical assistance under Title
375	XXI of the Social Security Act. Although the corporation may
376	serve other children, the Legislature intends the primary
377	recipients of services provided through the corporation be
378	school-age children with a family income below 200 percent of
379	the federal poverty level, who do not qualify for Medicaid. It
380	is also the intent of the Legislature that state and local
381	government Florida Healthy Kids funds be used to continue and
382	expand coverage, subject to specific appropriations in the
383	General Appropriations Act, to children not eligible for federal
384	matching funds under Title XXI.
385	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.-?Only the
386	following individuals are eligible for state-funded assistance
387	in paying Florida Healthy Kids premiums:
388	(a)  Residents of this state who are eligible for the
389	Florida KidCare program pursuant to s. 409.814.
390	(b)  Notwithstanding s. 409.814, legal aliens who are
391	enrolled in the Florida Healthy Kids program as of January 31,
392	2004, who do not qualify for Title XXI federal funds because
393	they are not qualified aliens as defined in s. 409.811.
394	(c)  Notwithstanding s. 409.814, individuals who have
395	attained the age of 19 as of March 31, 2004, who were receiving
396	Florida Healthy Kids benefits prior to the enactment of the
397	Florida KidCare program. This paragraph shall be repealed March
398	31, 2005.
399	(d)  Notwithstanding s. 409.814, state employee dependents
400	who were enrolled in the Florida Healthy Kids program as of
401	January 31, 2004. Such individuals shall remain eligible until
402	January 1, 2005.
403	(5)(4)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
404	(a)  There is created the Florida Healthy Kids Corporation,
405	a not-for-profit corporation.
406	(b)  The Florida Healthy Kids Corporation shall:
407	1.  Arrange for the collection of any family, local
408	contributions, or employer payment or premium, in an amount to
409	be determined by the board of directors, to provide for payment
410	of premiums for comprehensive insurance coverage and for the
411	actual or estimated administrative expenses.;
412	2.  Arrange for the collection of any voluntary
413	contributions to provide for payment of premiums for children
414	who are not eligible for medical assistance under Title XXI of
415	the Social Security Act. Each fiscal year, the corporation shall
416	establish a local match policy for the enrollment of non-Title-
417	XXI-eligible children in the Healthy Kids program. By May 1 of
418	each year, the corporation shall provide written notification of
419	the amount to be remitted to the corporation for the following
420	fiscal year under that policy. Local match sources may include,
421	but are not limited to, funds provided by municipalities,
422	counties, school boards, hospitals, health care providers,
423	charitable organizations, special taxing districts, and private
424	organizations. The minimum local match cash contributions
425	required each fiscal year and local match credits shall be
426	determined by the General Appropriations Act. The corporation
427	shall calculate a county's local match rate based upon that
428	county's percentage of the state's total non-Title-XXI
429	expenditures as reported in the corporation's most recently
430	audited financial statement. In awarding the local match
431	credits, the corporation may consider factors including, but not
432	limited to, population density, per capita income, and existing
433	child-health-related expenditures and services.;
434	3.  Subject to the provisions of s. 409.8134, accept
435	voluntary supplemental local match contributions that comply
436	with the requirements of Title XXI of the Social Security Act
437	for the purpose of providing additional coverage in contributing
438	counties under Title XXI.;
439	4.  Establish the administrative and accounting procedures
440	for the operation of the corporation.;
441	5.  Establish, with consultation from appropriate
442	professional organizations, standards for preventive health
443	services and providers and comprehensive insurance benefits
444	appropriate to children,; provided that such standards for rural
445	areas shall not limit primary care providers to board-certified
446	pediatricians.;
447	6.  Determine Establish eligibility for criteria which
448	children seeking must meet in order to participate in the Title
449	XXI-funded components of the Florida KidCare program consistent
450	with the requirements specified in s. 409.814, as well as the
451	non-Title-XXI-eligible children as provided in subsection (3).;
452	7.  Establish procedures under which providers of local
453	match to, applicants to and participants in the program may have
454	grievances reviewed by an impartial body and reported to the
455	board of directors of the corporation.;
456	8.  Establish participation criteria and, if appropriate,
457	contract with an authorized insurer, health maintenance
458	organization, or third-party insurance administrator to provide
459	administrative services to the corporation.;
460	9.  Establish enrollment criteria which shall include
461	penalties or waiting periods of not fewer than 60 days for
462	reinstatement of coverage upon voluntary cancellation for
463	nonpayment of family premiums.;
464	10.  If a space is available, establish a special open
465	enrollment period of 30 days' duration for any child who is
466	enrolled in Medicaid or Medikids if such child loses Medicaid or
467	Medikids eligibility and becomes eligible for the Florida
468	Healthy Kids program;
469	10.11.  Contract with authorized insurers or any provider
470	of health care services, meeting standards established by the
471	corporation, for the provision of comprehensive insurance
472	coverage to participants. Such standards shall include criteria
473	under which the corporation may contract with more than one
474	provider of health care services in program sites. Health plans
475	shall be selected through a competitive bid process. The Florida
476	Healthy Kids Corporation shall purchase goods and services in
477	the most cost-effective manner consistent with the delivery of
478	quality medical care. The maximum administrative cost for a
479	Florida Healthy Kids Corporation contract shall be 15 percent.
480	The minimum medical loss ratio for a Florida Healthy Kids
481	Corporation contract shall be 85 percent. The selection of
482	health plans shall be based primarily on quality criteria
483	established by the board. The health plan selection criteria and
484	scoring system, and the scoring results, shall be available upon
485	request for inspection after the bids have been awarded.;
486	11.12.  Establish disenrollment criteria in the event local
487	matching funds are insufficient to cover enrollments.;
488	12.13.  Develop and implement a plan to publicize the
489	Florida Healthy Kids Corporation, the eligibility requirements
490	of the program, and the procedures for enrollment in the program
491	and to maintain public awareness of the corporation and the
492	program.;
493	13.14.  Secure staff necessary to properly administer the
494	corporation. Staff costs shall be funded from state and local
495	matching funds and such other private or public funds as become
496	available. The board of directors shall determine the number of
497	staff members necessary to administer the corporation.;
498	15.  As appropriate, enter into contracts with local school
499	boards or other agencies to provide onsite information,
500	enrollment, and other services necessary to the operation of the
501	corporation;
502	14.16.  Provide a report annually to the Governor, Chief
503	Financial Officer, Commissioner of Education, Senate President,
504	Speaker of the House of Representatives, and Minority Leaders of
505	the Senate and the House of Representatives.;
506	17.  Each fiscal year, establish a maximum number of
507	participants, on a statewide basis, who may enroll in the
508	program; and
509	15.18.  Establish eligibility criteria, premium and cost-
510	sharing requirements, and benefit packages which conform to the
511	provisions of the Florida KidCare Kidcare program, as created in
512	ss. 409.810-409.820.
513	(c)  Coverage under the corporation's program is secondary
514	to any other available private coverage held by, or applicable
515	to, the participant child or family member. Insurers under
516	contract with the corporation are the payors of last resort and
517	must coordinate benefits with any other third-party payor that
518	may be liable for the participant's medical care The corporation
519	may establish procedures for coordinating benefits under this
520	program with benefits under other public and private coverage.
521	(d)  The Florida Healthy Kids Corporation shall be a
522	private corporation not for profit, organized pursuant to
523	chapter 617, and shall have all powers necessary to carry out
524	the purposes of this act, including, but not limited to, the
525	power to receive and accept grants, loans, or advances of funds
526	from any public or private agency and to receive and accept from
527	any source contributions of money, property, labor, or any other
528	thing of value, to be held, used, and applied for the purposes
529	of this act.
530	Section 7.  The Auditor General shall perform an analysis
531	of children enrolled in the Florida KidCare program who are
532	ineligible pursuant to the requirements of s. 409.814, Florida
533	Statutes, to obtain recommendations to implement mechanisms to
534	prevent such enrollment. The results of such analysis and the
535	consequent recommendations shall be reported to the Governor,
536	the President of the Senate, and the Speaker of the House of
537	Representatives by December 31, 2004.
538	Section 8.  The Florida Healthy Kids Corporation shall use
539	existing funds from their operating fund established by s.
540	624.915, Florida Statutes, to contract for an actuarial study on
541	the impact of full-pay enrollees on the cost of services for
542	each KidCare program component.
543	Section 9.  The Auditor General shall perform random audits
544	to ensure that all children enrolled in the Florida Healthy Kids
545	program are eligible pursuant to ss. 409.814 and 624.91, Florida
546	Statutes.
547	Section 10.  The Office of Program Policy Analysis and
548	Government Accountability shall perform a study to determine the
549	appropriate family premium for the Florida KidCare program and
550	submit a report to the President of the Senate and the Speaker
551	of the House of Representatives by January 1, 2005. The report
552	shall set out no fewer than three options and shall make a
553	recommendation as to the appropriate family premium for the
554	Florida KidCare program. Each option shall include a detailed
555	explanation of the analysis that led to the conclusion. A
556	discussion of family premiums collected by Title XXI programs in
557	other states shall be part of the report.
558	Section 11.  Subsection (2) of section 409.818, Florida
559	Statutes, is amended to read:
560	409.818  Administration.--In order to implement ss.
561	409.810-409.820, the following agencies shall have the following
562	duties:
563	(2)  The Department of Health shall:
564	(a)  Design an eligibility intake process for the program,
565	in coordination with the Department of Children and Family
566	Services, the agency, and the Florida Healthy Kids Corporation.
567	The eligibility intake process may include local intake points
568	that are determined by the Department of Health in coordination
569	with the Department of Children and Family Services.
570	(b)  Design and implement program outreach activities under
571	s. 409.819.
572	(b)(c)  Chair a state-level coordinating council to review
573	and make recommendations concerning the implementation and
574	operation of the program. The coordinating council shall include
575	representatives from the department, the Department of Children
576	and Family Services, the agency, the Florida Healthy Kids
577	Corporation, the Office of Insurance Regulation of the Financial
578	Services Commission, local government, health insurers, health
579	maintenance organizations, health care providers, families
580	participating in the program, and organizations representing
581	low-income families.
582	(c)(d)  In consultation with the Florida Healthy Kids
583	Corporation and the Department of Children and Family Services,
584	establish establishing a toll-free telephone line to assist
585	families with questions about the program.
586	(d)(e)  Adopt rules necessary to implement outreach
587	activities.
588	Section 12.  Section 409.819, Florida Statutes, is
589	repealed.
590	Section 13.  The sums of $6,566,073 from the General
591	Revenue Fund, $454,687 from the Grants and Donations Trust Fund,
592	and $16,272,440 from the Medical Quality Assurance Trust Fund
593	are appropriated to the Agency for Health Care Administration,
594	and the sum of $1,984,113 is appropriated from the Grants and
595	Donations Trust Fund to the Department of Health, for the 2003-
596	2004 fiscal year for the purpose of serving children on whose
597	behalf applications are submitted to the Florida KidCare program
598	as of January 30, 2004, and who are determined to be eligible
599	for program components funded under Title XXI of the Social
600	Security Act.
601	Section 14.  Except as otherwise provided herein, this act
602	shall take effect upon becoming a law.

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