HB 1073

CS

CHAMBER ACTION

1	The Committee on Appropriations recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to the Florida KidCare program; amending
7	s. 409.811, F.S.; defining the term "Florida KidCare
8	program"; deleting a definition to conform; amending s.
9	409.8132, F.S.; limiting when an applicant may apply for
10	Medikids program enrollment; deleting a special enrollment
11	period provision; amending s. 409.8134, F.S.; eliminating
12	the Agency for Health Care Administration's ability to
13	request an increase in the Florida KidCare program
14	enrollment ceiling; providing for open enrollment periods;
15	providing a timeframe for statewide announcement of open
16	enrollment periods; providing limitations; providing a
17	disenrollment process under certain circumstances;
18	providing additional data for certain agencies to collect
19	and analyze; amending s. 409.814, F.S.; revising Florida
20	KidCare program eligibility criteria; limiting coverage;
21	providing an exception for certain children otherwise
22	eligible or covered under a family member's employer
23	health coverage; restricting enrollment of children whose
24	coverage was voluntarily canceled; providing an age
25	limitation for certain components; requiring certain
26	transfers to be managed within authorized levels of
27	funding; requiring certain reserves to be established and
28	reviewed; requiring each applicant to provide certain
29	documentation; requiring the program to withhold benefits
30	from certain enrollees; providing additional fraudulent
31	activities; amending s. 409.815, F.S.; making dental
32	services contingent upon an annual appropriation; amending
33	s. 624.91, F.S.; removing the requirement for the Florida
34	Healthy Kids Corporation to work with the Florida
35	Partnership for School Readiness; limiting eligibility for
36	state-funded assistance in paying Florida Healthy Kids
37	premiums; providing for future repeal of certain
38	provisions; providing additional criteria for the
39	corporation to determine eligibility; eliminating
40	authority to establish an open enrollment period; revising
41	the corporation's purchasing criteria; removing a
42	restriction; eliminating authority to contract with
43	certain entities; eliminating authority to establish a
44	maximum number of participants; eliminating authority to
45	establish eligibility criteria or premium and cost-sharing
46	requirements; providing that contracted insurers are the
47	payors of last resort; requiring contracted insurers to
48	coordinate benefits with certain payors; requiring the
49	Auditor General to provide recommendations to prevent
50	enrollment of ineligible children in the Florida KidCare
51	program and report such recommendations to the Governor
52	and Legislature; requiring the Florida Healthy Kids
53	Corporation to use certain funds to contract for an
54	actuarial study; requiring the Auditor General to perform
55	audits to ensure the eligibility of children enrolled in
56	the Florida Healthy Kids program; authorizing the Auditor
57	General to require and receive any books, accounts,
58	records, or other documentation relating to the Florida
59	Healthy Kids Corporation; requiring the Office of Program
60	Policy Analysis and Government Accountability to perform a
61	study to determine the appropriate family premium for the
62	Florida KidCare program and report its findings to the
63	Legislature; amending s. 409.818, F.S.; deleting a cross
64	reference; repealing s. 409.819, F.S., relating to a
65	program identifying low-income, uninsured children for
66	certain purposes; providing appropriations; providing
67	effective dates.
68
69	Be It Enacted by the Legislature of the State of Florida:
70
71	Section 1.  Subsections (14) through (22) of section
72	409.811, Florida Statutes, are renumbered as subsections (15)
73	through (23), respectively, present subsection (23) of said
74	section is amended, and a new subsection (14) is added to said
75	section, to read:
76	409.811  Definitions relating to Florida KidCare Kidcare
77	Act.--As used in ss. 409.810-409.820, the term:
78	(14)  "Florida KidCare program," "KidCare program," or
79	"program" means the health benefits program administered through
80	ss. 409.810-409.820.
81	(23)  "Program" means the Florida Kidcare program, the
82	medical assistance program authorized by Title XXI of the Social
83	Security Act as part of the federal Balanced Budget Act of 1997.
84	Section 2.  Subsections (7), (8), and (9) of section
85	409.8132, Florida Statutes, are amended to read:
86	409.8132  Medikids program component.--
87	(7)  ENROLLMENT.--Enrollment in the Medikids program
88	component may only occur during periodic open enrollment periods
89	as specified in s. 409.8134 by the agency. An applicant may
90	apply for enrollment in the Medikids program component and
91	proceed through the eligibility determination process at any
92	time throughout the year. However, enrollment in Medikids shall
93	not begin until the next open enrollment period; and A child may
94	not receive services under the Medikids program until the child
95	is enrolled in a managed care plan or MediPass. In addition,
96	Once determined eligible, an applicant may receive choice
97	counseling and select a managed care plan or MediPass. The
98	agency may initiate mandatory assignment for a Medikids
99	applicant who has not chosen a managed care plan or MediPass
100	provider after the applicant's voluntary choice period ends. An
101	applicant may select MediPass under the Medikids program
102	component only in counties that have fewer than two managed care
103	plans available to serve Medicaid recipients and only if the
104	federal Health Care Financing Administration determines that
105	MediPass constitutes "health insurance coverage" as defined in
106	Title XXI of the Social Security Act.
107	(8)  SPECIAL ENROLLMENT PERIODS.--The agency shall
108	establish a special enrollment period of 30 days' duration for
109	any child who is enrolled in Medicaid if such child loses
110	Medicaid eligibility and becomes eligible for Medikids, or for
111	any child who is enrolled in Medikids if such child moves to
112	another county that is not within the coverage area of the
113	child's Medikids managed care plan or MediPass provider.
114	(8)(9)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
115	shall establish enrollment criteria that must include penalties
116	or waiting periods of not fewer than 60 days for reinstatement
117	of coverage upon voluntary cancellation for nonpayment of
118	premiums.
119	Section 3.  Section 409.8134, Florida Statutes, is amended
120	to read:
121	409.8134  Program enrollment and expenditure ceilings.--
122	(1)  Except for the Medicaid program, a ceiling shall be
123	placed on annual federal and state expenditures and on
124	enrollment in the Florida KidCare Kidcare program as provided
125	each year in the General Appropriations Act. The agency, in
126	consultation with the Department of Health, may propose to
127	increase the enrollment ceiling in accordance with chapter 216.
128	(2)  Upon a unanimous recommendation by representatives
129	from each of the four Florida KidCare administrators, the
130	Florida KidCare program may conduct an open enrollment period
131	for the purpose of enrolling children eligible for all program
132	components listed in s. 409.813 except Medicaid. The four
133	Florida KidCare administrators shall work together to ensure
134	that the open enrollment period is announced statewide at least
135	1 month before the open enrollment is to begin. Eligible
136	children shall be enrolled on a first-come, first-served basis
137	using the date the open enrollment application is received. Open
138	enrollment shall immediately cease when the enrollment ceiling
139	is reached. An open enrollment shall be held only if the Social
140	Services Estimating Conference determines that sufficient funds
141	have been appropriated to finance increased enrollment through
142	federal fiscal year 2007. Any individual who is not enrolled,
143	including those added to the waiting list after January 30,
144	2004, must reapply by submitting a new application during the
145	next open enrollment period Except for the Medicaid program,
146	whenever the Social Services Estimating Conference determines
147	that there is presently, or will be by the end of the current
148	fiscal year, insufficient funds to finance the current or
149	projected enrollment in the Florida Kidcare program, all
150	additional enrollment must cease and additional enrollment may
151	not resume until sufficient funds are available to finance such
152	enrollment.
153	(3)  Upon determination by the Social Services Estimating
154	Conference that there are insufficient funds to finance the
155	current enrollment in the Florida KidCare program within current
156	appropriations, the program shall initiate disenrollment
157	procedures to remove enrollees, except those children enrolled
158	in the Children's Medical Services network, on a last-in, first-
159	out basis until the expenditure and appropriation levels are
160	balanced.
161	(4)(3)  The agencies that administer the Florida KidCare
162	Kidcare program components shall collect and analyze the data
163	needed to project Florida Kidcare program enrollment costs,
164	including price level adjustments outreach impacts,
165	participation and attrition rates, current and projected
166	caseloads, utilization, and current and projected expenditures
167	for the next 3 years. The agencies shall report the caseload and
168	expenditure trends to the Social Services Estimating Conference
169	in accordance with chapter 216.
170	Section 4.  Effective July 1, 2004, section 409.814,
171	Florida Statutes, is amended to read:
172	409.814  Eligibility.--A child who has not reached 19 years
173	of age whose family income is equal to or below 200 percent of
174	the federal poverty level is eligible for the Florida KidCare
175	Kidcare program as provided in this section. In determining the
176	eligibility of such a child, an assets test is not required. An
177	applicant under 19 years of age who, based on a complete
178	application, appears to be eligible for the Medicaid component
179	of the Florida Kidcare program is presumed eligible for coverage
180	under Medicaid, subject to federal rules. A child who has been
181	deemed presumptively eligible for Medicaid shall not be enrolled
182	in a managed care plan until the child's full eligibility
183	determination for Medicaid has been completed. The Florida
184	Healthy Kids Corporation may, subject to compliance with
185	applicable requirements of the Agency for Health Care
186	Administration and the Department of Children and Family
187	Services, be designated as an entity to conduct presumptive
188	eligibility determinations. An applicant under 19 years of age
189	who, based on a complete application, appears to be eligible for
190	the Medikids, Florida Healthy Kids, or Children's Medical
191	Services network program component, who is screened as
192	ineligible for Medicaid and prior to the monthly verification of
193	the applicant's enrollment in Medicaid or of eligibility for
194	coverage under the state employee health benefit plan, may be
195	enrolled in and begin receiving coverage from the appropriate
196	program component on the first day of the month following the
197	receipt of a completed application. For enrollment in the
198	Children's Medical Services network, a complete application
199	includes the medical or behavioral health screening. If,
200	subsequently after verification, an individual is determined to
201	be ineligible for coverage, he or she must immediately be
202	disenrolled from the respective Florida KidCare Title XXI-funded
203	Kidcare program component.
204	(1)  A child who is eligible for Medicaid coverage under s.
205	409.903 or s. 409.904 must be enrolled in Medicaid and is not
206	eligible to receive health benefits under any other health
207	benefits coverage authorized under the Florida KidCare program
208	ss. 409.810-409.820.
209	(2)  A child who is not eligible for Medicaid, but who is
210	eligible for the Florida KidCare Kidcare program, may obtain
211	health benefits coverage under any of the other components
212	listed in s. 409.813 types of health benefits coverage
213	authorized in ss. 409.810-409.820 if such coverage is approved
214	and available in the county in which the child resides. However,
215	a child who is eligible for Medikids may participate in the
216	Florida Healthy Kids program only if the child has a sibling
217	participating in the Florida Healthy Kids program and the
218	child's county of residence permits such enrollment.
219	(3)  A child who is eligible for the Florida KidCare
220	Kidcare program who is a child with special health care needs,
221	as determined through a medical or behavioral screening
222	instrument, is eligible for health benefits coverage from and
223	shall be referred to the Children's Medical Services network.
224	(4)  The following children are not eligible to receive
225	premium assistance for health benefits coverage under the
226	Florida KidCare program ss. 409.810-409.820, except under
227	Medicaid if the child would have been eligible for Medicaid
228	under s. 409.903 or s. 409.904 as of June 1, 1997:
229	(a)  A child who is eligible for coverage under a state
230	health benefit plan on the basis of a family member's employment
231	with a public agency in the state.
232	(b)  A child who is currently eligible for or covered under
233	a family member's group health benefit plan or under other
234	employer health insurance coverage, excluding coverage provided
235	under the Florida Healthy Kids Corporation as established under
236	s. 624.91, provided that the cost of the child's participation
237	is not greater than 7.5 percent of the family's income. This
238	provision shall be applied during redetermination for children
239	who were enrolled prior to July 1, 2004. These enrollees shall
240	have 6 months of eligibility following redetermination to allow
241	for a transition to the other health benefit plan.
242	(c)  A child who is seeking premium assistance for the
243	Florida KidCare program through employer-sponsored group
244	coverage, if the child has been covered by the same employer's
245	group coverage during the 6 months prior to the family's
246	submitting an application for determination of eligibility under
247	the Florida Kidcare program.
248	(d)  A child who is an alien, but who does not meet the
249	definition of qualified alien, in the United States.
250	(e)  A child who is an inmate of a public institution or a
251	patient in an institution for mental diseases.
252	(f)  A child who has had his or her coverage in an
253	employer-sponsored health benefit plan voluntarily canceled in
254	the last 6 months, except those children who were on the waiting
255	list prior to January 31, 2004.
256	(5)  A child whose family income is above 200 percent of
257	the federal poverty level or a child who is excluded under the
258	provisions of subsection (4) may participate in the Florida
259	KidCare Kidcare program, excluding the Medicaid program, but is
260	subject to the following provisions:
261	(a)  The family is not eligible for premium assistance
262	payments and must pay the full cost of the premium, including
263	any administrative costs.
264	(b)  The agency is authorized to place limits on enrollment
265	in Medikids by these children in order to avoid adverse
266	selection. The number of children participating in Medikids
267	whose family income exceeds 200 percent of the federal poverty
268	level must not exceed 10 percent of total enrollees in the
269	Medikids program.
270	(c)  The board of directors of the Florida Healthy Kids
271	Corporation is authorized to place limits on enrollment of these
272	children in order to avoid adverse selection. In addition, the
273	board is authorized to offer a reduced benefit package to these
274	children in order to limit program costs for such families. The
275	number of children participating in the Florida Healthy Kids
276	program whose family income exceeds 200 percent of the federal
277	poverty level must not exceed 10 percent of total enrollees in
278	the Florida Healthy Kids program.
279	(d)  Children described in this subsection are not counted
280	in the annual enrollment ceiling for the Florida KidCare Kidcare
281	program.
282	(6)  Once a child is enrolled in the Florida KidCare
283	Kidcare program, the child is eligible for coverage under the
284	program for 6 months without a redetermination or reverification
285	of eligibility, if the family continues to pay the applicable
286	premium. Eligibility for program components funded through Title
287	XXI of the Social Security Act shall terminate when a child
288	attains the age of 19. Effective January 1, 1999, a child who
289	has not attained the age of 5 and who has been determined
290	eligible for the Medicaid program is eligible for coverage for
291	12 months without a redetermination or reverification of
292	eligibility.
293	(7)  When determining or reviewing a child's eligibility
294	under the Florida KidCare program, the applicant shall be
295	provided with reasonable notice of changes in eligibility which
296	may affect enrollment in one or more of the program components.
297	When a transition from one program component to another is
298	authorized appropriate, there shall be cooperation between the
299	program components and the affected family which promotes
300	continuity of health care coverage. Any authorized transfers
301	must be managed within the program's overall appropriated or
302	authorized levels of funding. Each component of the program
303	shall establish a reserve to ensure that transfers between
304	components will be accomplished within current year
305	appropriations. These reserves shall be reviewed by each
306	convening of the Social Services Estimating Conference to
307	determine the adequacy of such reserves to meet actual
308	experience.
309	(8)  In determining the eligibility of a child, an assets
310	test is not required. Each applicant shall provide written
311	documentation during the application process and the
312	redetermination process, including, but not limited to, the
313	following:
314	(a)  Proof of family income.
315	(b)  A statement from all employers of family members that:
316	1.  The employer does not sponsor a health benefit plan for
317	employees; or
318	2.  The potential enrollee is not covered by the employer-
319	sponsored health benefit plan because the potential enrollee is
320	not eligible for coverage, or, if the potential enrollee is
321	eligible but not covered, a statement of the cost to enroll the
322	potential enrollee in the employer-sponsored health benefit
323	plan.
324	(9)  Subject to paragraph (4)(b) and s. 624.91(3), the
325	Florida KidCare program shall withhold benefits from an enrollee
326	if the program obtains evidence that the enrollee is no longer
327	eligible, submitted incorrect or fraudulent information in order
328	to establish eligibility, or failed to provide verification of
329	eligibility. The applicant or enrollee shall be notified that
330	because of such evidence program benefits will be withheld
331	unless the applicant or enrollee contacts a designated
332	representative of the program by a specified date, which must be
333	within 10 days after the date of notice, to discuss and resolve
334	the matter. The program shall make every effort to resolve the
335	matter within a timeframe that will not cause benefits to be
336	withheld from an eligible enrollee.
337	(10)  The following individuals may be subject to
338	prosecution in accordance with s. 414.39:
339	(a)  An applicant obtaining or attempting to obtain
340	benefits for a potential enrollee under the Florida KidCare
341	program when the applicant knows or should have known the
342	potential enrollee does not qualify for the Florida KidCare
343	program.
344	(b)  An individual who assists an applicant in obtaining or
345	attempting to obtain benefits for a potential enrollee under the
346	Florida KidCare program when the individual knows or should have
347	known the potential enrollee does not qualify for the Florida
348	KidCare program.
349	Section 5.  Paragraph (q) of subsection (2) of section
350	409.815, Florida Statutes, is amended to read:
351	409.815  Health benefits coverage; limitations.--
352	(2)  BENCHMARK BENEFITS.--In order for health benefits
353	coverage to qualify for premium assistance payments for an
354	eligible child under ss. 409.810-409.820, the health benefits
355	coverage, except for coverage under Medicaid and Medikids, must
356	include the following minimum benefits, as medically necessary.
357	(q)  Dental services.--Covered services may include those
358	dental services provided to children by the Florida Medicaid
359	program under s. 409.906(5), contingent upon an annual
360	appropriation in the General Appropriations Act up to a maximum
361	benefit of $750 per enrollee per year.
362	Section 6.  Subsections (3) through (7) of section 624.91,
363	Florida Statutes, are renumbered as subsections (4) through (8),
364	respectively, present subsections (2) and (4) of said section
365	are amended, and a new subsection (3) is added to said section,
366	to read:
367	624.91  The Florida Healthy Kids Corporation Act.--
368	(2)  LEGISLATIVE INTENT.--
369	(a)  The Legislature finds that increased access to health
370	care services could improve children's health and reduce the
371	incidence and costs of childhood illness and disabilities among
372	children in this state. Many children do not have comprehensive,
373	affordable health care services available. It is the intent of
374	the Legislature that the Florida Healthy Kids Corporation
375	provide comprehensive health insurance coverage to such
376	children. The corporation is encouraged to cooperate with any
377	existing health service programs funded by the public or the
378	private sector and to work cooperatively with the Florida
379	Partnership for School Readiness.
380	(b)  It is the intent of the Legislature that the Florida
381	Healthy Kids Corporation serve as one of several providers of
382	services to children eligible for medical assistance under Title
383	XXI of the Social Security Act. Although the corporation may
384	serve other children, the Legislature intends the primary
385	recipients of services provided through the corporation be
386	school-age children with a family income below 200 percent of
387	the federal poverty level, who do not qualify for Medicaid. It
388	is also the intent of the Legislature that state and local
389	government Florida Healthy Kids funds be used to continue and
390	expand coverage, subject to specific appropriations in the
391	General Appropriations Act, to children not eligible for federal
392	matching funds under Title XXI.
393	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.-?Only the
394	following individuals are eligible for state-funded assistance
395	in paying Florida Healthy Kids premiums:
396	(a)  Residents of this state who are eligible for the
397	Florida KidCare program pursuant to s. 409.814.
398	(b)  Notwithstanding s. 409.814, legal aliens who are
399	enrolled in the Florida Healthy Kids program as of January 31,
400	2004, who do not qualify for Title XXI federal funds because
401	they are not qualified aliens as defined in s. 409.811.
402	(c)  Notwithstanding s. 409.814, individuals who have
403	attained the age of 19 as of March 31, 2004, who were receiving
404	Florida Healthy Kids benefits prior to the enactment of the
405	Florida KidCare program. This paragraph shall be repealed March
406	31, 2005.
407	(d)  Notwithstanding s. 409.814, state employee dependents
408	who were enrolled in the Florida Healthy Kids program as of
409	January 31, 2004. Such individuals shall remain eligible until
410	January 1, 2005.
411	(5)(4)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
412	(a)  There is created the Florida Healthy Kids Corporation,
413	a not-for-profit corporation.
414	(b)  The Florida Healthy Kids Corporation shall:
415	1.  Arrange for the collection of any family, local
416	contributions, or employer payment or premium, in an amount to
417	be determined by the board of directors, to provide for payment
418	of premiums for comprehensive insurance coverage and for the
419	actual or estimated administrative expenses.;
420	2.  Arrange for the collection of any voluntary
421	contributions to provide for payment of premiums for children
422	who are not eligible for medical assistance under Title XXI of
423	the Social Security Act. Each fiscal year, the corporation shall
424	establish a local match policy for the enrollment of non-Title-
425	XXI-eligible children in the Healthy Kids program. By May 1 of
426	each year, the corporation shall provide written notification of
427	the amount to be remitted to the corporation for the following
428	fiscal year under that policy. Local match sources may include,
429	but are not limited to, funds provided by municipalities,
430	counties, school boards, hospitals, health care providers,
431	charitable organizations, special taxing districts, and private
432	organizations. The minimum local match cash contributions
433	required each fiscal year and local match credits shall be
434	determined by the General Appropriations Act. The corporation
435	shall calculate a county's local match rate based upon that
436	county's percentage of the state's total non-Title-XXI
437	expenditures as reported in the corporation's most recently
438	audited financial statement. In awarding the local match
439	credits, the corporation may consider factors including, but not
440	limited to, population density, per capita income, and existing
441	child-health-related expenditures and services.;
442	3.  Subject to the provisions of s. 409.8134, accept
443	voluntary supplemental local match contributions that comply
444	with the requirements of Title XXI of the Social Security Act
445	for the purpose of providing additional coverage in contributing
446	counties under Title XXI.;
447	4.  Establish the administrative and accounting procedures
448	for the operation of the corporation.;
449	5.  Establish, with consultation from appropriate
450	professional organizations, standards for preventive health
451	services and providers and comprehensive insurance benefits
452	appropriate to children,; provided that such standards for rural
453	areas shall not limit primary care providers to board-certified
454	pediatricians.;
455	6.  Determine Establish eligibility for criteria which
456	children seeking must meet in order to participate in the Title
457	XXI-funded components of the Florida KidCare program consistent
458	with the requirements specified in s. 409.814, as well as the
459	non-Title-XXI-eligible children as provided in subsection (3).;
460	7.  Establish procedures under which providers of local
461	match to, applicants to and participants in the program may have
462	grievances reviewed by an impartial body and reported to the
463	board of directors of the corporation.;
464	8.  Establish participation criteria and, if appropriate,
465	contract with an authorized insurer, health maintenance
466	organization, or third-party insurance administrator to provide
467	administrative services to the corporation.;
468	9.  Establish enrollment criteria which shall include
469	penalties or waiting periods of not fewer than 60 days for
470	reinstatement of coverage upon voluntary cancellation for
471	nonpayment of family premiums.;
472	10.  If a space is available, establish a special open
473	enrollment period of 30 days' duration for any child who is
474	enrolled in Medicaid or Medikids if such child loses Medicaid or
475	Medikids eligibility and becomes eligible for the Florida
476	Healthy Kids program;
477	10.11.  Contract with authorized insurers or any provider
478	of health care services, meeting standards established by the
479	corporation, for the provision of comprehensive insurance
480	coverage to participants. Such standards shall include criteria
481	under which the corporation may contract with more than one
482	provider of health care services in program sites. Health plans
483	shall be selected through a competitive bid process. The Florida
484	Healthy Kids Corporation shall purchase goods and services in
485	the most cost-effective manner consistent with the delivery of
486	quality medical care. The maximum administrative cost for a
487	Florida Healthy Kids Corporation contract shall be 15 percent.
488	The minimum medical loss ratio for a Florida Healthy Kids
489	Corporation contract shall be 85 percent. The selection of
490	health plans shall be based primarily on quality criteria
491	established by the board. The health plan selection criteria and
492	scoring system, and the scoring results, shall be available upon
493	request for inspection after the bids have been awarded.;
494	11.12.  Establish disenrollment criteria in the event local
495	matching funds are insufficient to cover enrollments.;
496	12.13.  Develop and implement a plan to publicize the
497	Florida Healthy Kids Corporation, the eligibility requirements
498	of the program, and the procedures for enrollment in the program
499	and to maintain public awareness of the corporation and the
500	program.;
501	13.14.  Secure staff necessary to properly administer the
502	corporation. Staff costs shall be funded from state and local
503	matching funds and such other private or public funds as become
504	available. The board of directors shall determine the number of
505	staff members necessary to administer the corporation.;
506	15.  As appropriate, enter into contracts with local school
507	boards or other agencies to provide onsite information,
508	enrollment, and other services necessary to the operation of the
509	corporation;
510	14.16.  Provide a report annually to the Governor, Chief
511	Financial Officer, Commissioner of Education, Senate President,
512	Speaker of the House of Representatives, and Minority Leaders of
513	the Senate and the House of Representatives.;
514	17.  Each fiscal year, establish a maximum number of
515	participants, on a statewide basis, who may enroll in the
516	program; and
517	15.18.  Establish eligibility criteria, premium and cost-
518	sharing requirements, and benefit packages which conform to the
519	provisions of the Florida KidCare Kidcare program, as created in
520	ss. 409.810-409.820.
521	(c)  Coverage under the corporation's program is secondary
522	to any other available private coverage held by, or applicable
523	to, the participant child or family member. Insurers under
524	contract with the corporation are the payors of last resort and
525	must coordinate benefits with any other third-party payor that
526	may be liable for the participant's medical care The corporation
527	may establish procedures for coordinating benefits under this
528	program with benefits under other public and private coverage.
529	(d)  The Florida Healthy Kids Corporation shall be a
530	private corporation not for profit, organized pursuant to
531	chapter 617, and shall have all powers necessary to carry out
532	the purposes of this act, including, but not limited to, the
533	power to receive and accept grants, loans, or advances of funds
534	from any public or private agency and to receive and accept from
535	any source contributions of money, property, labor, or any other
536	thing of value, to be held, used, and applied for the purposes
537	of this act.
538	Section 7.  The Auditor General shall provide
539	recommendations to implement mechanisms to prevent enrollment of
540	children in the Florida KidCare program who are ineligible
541	pursuant to the requirements of s. 409.814(4), Florida Statutes.
542	Such recommendations shall be reported to the Governor, the
543	President of the Senate, and the Speaker of the House of
544	Representatives by March 1, 2005.
545	Section 8.  The Florida Healthy Kids Corporation shall use
546	existing funds from their operating fund established by s.
547	624.915, Florida Statutes, to contract for an actuarial study on
548	the impact of full-pay enrollees on the cost of services for
549	each Florida KidCare program component.
550	Section 9.  The Auditor General shall perform periodic
551	audits through the 2005-2006 fiscal year to ensure that children
552	enrolled in the Florida Healthy Kids program are eligible
553	pursuant to ss. 409.814 and 624.91, Florida Statutes. The
554	Auditor General shall have the authority to require and receive
555	from the Florida Healthy Kids Corporation or from its
556	independent auditor any books, accounts, records, or other
557	documentation relating to the corporation. Any contract entered
558	into by the corporation pursuant to s. 624.91(4)(b)11. or s.
559	624.91(4)(b)15., Florida Statutes, shall specify that the
560	records of the contractor relating to the contract or its
561	performance must be available for review and audit by the
562	Auditor General.
563	Section 10.  The Office of Program Policy Analysis and
564	Government Accountability shall perform a study to determine the
565	appropriate family premium for the Florida KidCare program and
566	submit a report to the President of the Senate and the Speaker
567	of the House of Representatives by January 1, 2005. The report
568	shall set out no fewer than three options and shall make a
569	recommendation as to the appropriate family premium for the
570	Florida KidCare program. Each option shall include a detailed
571	explanation of the analysis that led to the conclusion. A
572	discussion of family premiums collected by Title XXI programs in
573	other states shall be part of the report.
574	Section 11.  Subsection (2) of section 409.818, Florida
575	Statutes, is amended to read:
576	409.818  Administration.--In order to implement ss.
577	409.810-409.820, the following agencies shall have the following
578	duties:
579	(2)  The Department of Health shall:
580	(a)  Design an eligibility intake process for the program,
581	in coordination with the Department of Children and Family
582	Services, the agency, and the Florida Healthy Kids Corporation.
583	The eligibility intake process may include local intake points
584	that are determined by the Department of Health in coordination
585	with the Department of Children and Family Services.
586	(b)  Design and implement program outreach activities under
587	s. 409.819.
588	(b)(c)  Chair a state-level coordinating council to review
589	and make recommendations concerning the implementation and
590	operation of the program. The coordinating council shall include
591	representatives from the department, the Department of Children
592	and Family Services, the agency, the Florida Healthy Kids
593	Corporation, the Office of Insurance Regulation of the Financial
594	Services Commission, local government, health insurers, health
595	maintenance organizations, health care providers, families
596	participating in the program, and organizations representing
597	low-income families.
598	(c)(d)  In consultation with the Florida Healthy Kids
599	Corporation and the Department of Children and Family Services,
600	establish establishing a toll-free telephone line to assist
601	families with questions about the program.
602	(d)(e)  Adopt rules necessary to implement outreach
603	activities.
604	Section 12.  Section 409.819, Florida Statutes, is
605	repealed.
606	Section 13.  The sums of $6,566,073 from the General
607	Revenue Fund, $454,687 from the Grants and Donations Trust Fund,
608	and $16,272,440 from the Medical Quality Assurance Trust Fund
609	are appropriated to the Agency for Health Care Administration,
610	and the sum of $1,984,113 is appropriated from the Grants and
611	Donations Trust Fund to the Department of Health, for the 2003-
612	2004 fiscal year for the purpose of serving children on whose
613	behalf applications are submitted to the Florida KidCare program
614	as of January 30, 2004, and who are determined to be eligible
615	for program components funded under Title XXI of the Social
616	Security Act.
617	Section 14.  Except as otherwise provided herein, this act
618	shall take effect upon becoming a law.

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