SENATE AMENDMENT
Bill No. CS for SB 2000
Amendment No. ___ Barcode 190726
CHAMBER ACTION
Senate House
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11 Senators Peaden and Dockery moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 2, line 22, through
15 page 15, line 4, delete those lines
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17 and insert:
18 Section 1. Subsections (14) through (22) of section
19 409.811, Florida Statutes, are renumbered as subsections (15)
20 through (23), respectively, present subsection (23) of that
21 section is amended, and a new subsection (14) is added to that
22 section, to read:
23 409.811 Definitions relating to Florida KidCare
24 Kidcare Act.--As used in ss. 409.810-409.820, the term:
25 (14) "Florida KidCare program," "KidCare program," or
26 "program" means the health benefits program administered
27 through ss. 409.810-409.820.
28 (23) "Program" means the Florida Kidcare program, the
29 medical assistance program authorized by Title XXI of the
30 Social Security Act as part of the federal Balanced Budget Act
31 of 1997.
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SENATE AMENDMENT
Bill No. CS for SB 2000
Amendment No. ___ Barcode 190726
1 Section 2. Subsections (7), (8), and (9) of section
2 409.8132, Florida Statutes, are amended to read:
3 409.8132 Medikids program component.--
4 (7) ENROLLMENT.--Enrollment in the Medikids program component
5 may only occur during periodic open enrollment periods as
6 specified in s. 409.8134 by the agency. An applicant may apply
7 for enrollment in the Medikids program component and proceed
8 through the eligibility determination process at any time
9 throughout the year. However, enrollment in Medikids shall not
10 begin until the next open enrollment period; and A child may
11 not receive services under the Medikids program until the
12 child is enrolled in a managed care plan or MediPass. In
13 addition, Once determined eligible, an applicant may receive
14 choice counseling and select a managed care plan or MediPass.
15 The agency may initiate mandatory assignment for a Medikids
16 applicant who has not chosen a managed care plan or MediPass
17 provider after the applicant's voluntary choice period ends.
18 An applicant may select MediPass under the Medikids program
19 component only in counties that have fewer than two managed
20 care plans available to serve Medicaid recipients and only if
21 the federal Health Care Financing Administration determines
22 that MediPass constitutes "health insurance coverage" as
23 defined in Title XXI of the Social Security Act.
24 (8) SPECIAL ENROLLMENT PERIODS.--The agency shall
25 establish a special enrollment period of 30 days' duration for
26 any child who is enrolled in Medicaid if such child loses
27 Medicaid eligibility and becomes eligible for Medikids, or for
28 any child who is enrolled in Medikids if such child moves to
29 another county that is not within the coverage area of the
30 child's Medikids managed care plan or MediPass provider.
31 (8)(9) PENALTIES FOR VOLUNTARY CANCELLATION.--The
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SENATE AMENDMENT
Bill No. CS for SB 2000
Amendment No. ___ Barcode 190726
1 agency shall establish enrollment criteria that must include
2 penalties or waiting periods of not fewer than 60 days for
3 reinstatement of coverage upon voluntary cancellation for
4 nonpayment of premiums.
5 Section 3. Section 409.8134, Florida Statutes, is
6 amended to read:
7 409.8134 Program enrollment and expenditure
8 ceilings.--
9 (1) Except for the Medicaid program, a ceiling shall
10 be placed on annual federal and state expenditures and on
11 enrollment in the Florida KidCare Kidcare program as provided
12 each year in the General Appropriations Act. The agency, in
13 consultation with the Department of Health, may propose to
14 increase the enrollment ceiling in accordance with chapter
15 216.
16 (2) Upon a unanimous recommendation by representatives
17 from each of the four Florida KidCare administrators, the
18 Florida KidCare program may conduct an open enrollment period
19 for the purpose of enrolling children eligible for all program
20 components listed in s. 409.813 except Medicaid. The four
21 Florida KidCare administrators shall work together to ensure
22 that the open enrollment period is announced statewide at
23 least 1 month before the open enrollment is to begin. Eligible
24 children shall be enrolled on a first-come, first-served basis
25 using the date the open enrollment application is received.
26 The potential open enrollment periods shall be January 1st
27 through January 30th and September 1st through September 30th.
28 Open enrollment shall immediately cease when the enrollment
29 ceiling is reaches. An open enrollment shall only be held if
30 the Social Services Estimating Conference determines that
31 sufficient federal and state funds will be available to
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1 finance the increased enrollment through federal fiscal year
2 2007. Any individual who is not enrolled, including those
3 added to the waiting list after January 30, 2004, must reapply
4 by submitting a new application during the next open
5 enrollment period. However, the Children's Medical Services
6 Network may annually enroll up to 120 additional children
7 based on emergency disability criteria outside of the open
8 enrollment periods and the cost of serving these children must
9 be managed within the KidCare program's appropriated or
10 authorized levels of funding. Except for the Medicaid program,
11 whenever the Social Services Estimating Conference determines
12 that there is presently, or will be by the end of the current
13 fiscal year, insufficient funds to finance the current or
14 projected enrollment in the Florida Kidcare program, all
15 additional enrollment must cease and additional enrollment may
16 not resume until sufficient funds are available to finance
17 such enrollment.
18 (3) Upon determination by the Social Services
19 Estimating Conference that there are insufficient funds to
20 finance the current enrollment in the Florida KidCare program
21 within current appropriations, the program shall initiate
22 disenrollment procedures to remove enrollees, except those
23 children enrolled in the Children's Medical Services network,
24 on a last-in, first-out basis until the expenditure and
25 appropriation levels are balanced.
26 (4)(3) The agencies that administer the Florida
27 KidCare Kidcare program components shall collect and analyze
28 the data needed to project Florida Kidcare program enrollment
29 costs, including price level adjustments outreach impacts,
30 participation and attrition rates, current and projected
31 caseloads, utilization, and current and projected expenditures
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1 for the next 3 years. The agencies shall report the caseload
2 and expenditure trends to the Social Services Estimating
3 Conference in accordance with chapter 216.
4 Section 4. Effective July 1, 2004, section 409.814,
5 Florida Statutes, is amended to read:
6 409.814 Eligibility.--A child who has not reached 19
7 years of age whose family income is equal to or below 200
8 percent of the federal poverty level is eligible for the
9 Florida KidCare Kidcare program as provided in this section.
10 In determining the eligibility of such a child, an assets test
11 is not required. An applicant under 19 years of age who, based
12 on a complete application, appears to be eligible for the
13 Medicaid component of the Florida Kidcare program is presumed
14 eligible for coverage under Medicaid, subject to federal
15 rules. A child who has been deemed presumptively eligible for
16 Medicaid shall not be enrolled in a managed care plan until
17 the child's full eligibility determination for Medicaid has
18 been completed. The Florida Healthy Kids Corporation may,
19 subject to compliance with applicable requirements of the
20 Agency for Health Care Administration and the Department of
21 Children and Family Services, be designated as an entity to
22 conduct presumptive eligibility determinations. An applicant
23 under 19 years of age who, based on a complete application,
24 appears to be eligible for the Medikids, Florida Healthy Kids,
25 or Children's Medical Services network program component, who
26 is screened as ineligible for Medicaid and prior to the
27 monthly verification of the applicant's enrollment in Medicaid
28 or of eligibility for coverage under the state employee health
29 benefit plan, may be enrolled in and begin receiving coverage
30 from the appropriate program component on the first day of the
31 month following the receipt of a completed application. For
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1 enrollment in the Children's Medical Services network, a
2 complete application includes the medical or behavioral health
3 screening. If, subsequently after verification, an individual
4 is determined to be ineligible for coverage, he or she must
5 immediately be disenrolled from the respective Florida KidCare
6 Title XXI-funded Kidcare program component.
7 (1) A child who is eligible for Medicaid coverage
8 under s. 409.903 or s. 409.904 must be enrolled in Medicaid
9 and is not eligible to receive health benefits under any other
10 health benefits coverage authorized under the Florida KidCare
11 program ss. 409.810-409.820.
12 (2) A child who is not eligible for Medicaid, but who
13 is eligible for the Florida KidCare Kidcare program, may
14 obtain health benefits coverage under any of the other
15 components listed in s. 409.813 types of health benefits
16 coverage authorized in ss. 409.810-409.820 if such coverage is
17 approved and available in the county in which the child
18 resides. However, a child who is eligible for Medikids may
19 participate in the Florida Healthy Kids program only if the
20 child has a sibling participating in the Florida Healthy Kids
21 program and the child's county of residence permits such
22 enrollment.
23 (3) A child who is eligible for the Florida KidCare
24 Kidcare program who is a child with special health care needs,
25 as determined through a medical or behavioral screening
26 instrument, is eligible for health benefits coverage from and
27 shall be referred to the Children's Medical Services network.
28 (4) The following children are not eligible to receive
29 premium assistance for health benefits coverage under the
30 Florida KidCare program ss. 409.810-409.820, except under
31 Medicaid if the child would have been eligible for Medicaid
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Bill No. CS for SB 2000
Amendment No. ___ Barcode 190726
1 under s. 409.903 or s. 409.904 as of June 1, 1997:
2 (a) A child who is eligible for coverage under a state
3 health benefit plan on the basis of a family member's
4 employment with a public agency in the state.
5 (b) A child who is currently eligible for or covered
6 under a family member's group health benefit plan or under
7 other employer health insurance coverage, excluding coverage
8 provided under the Florida Healthy Kids Corporation as
9 established under s. 624.91, provided that the cost of the
10 child's participation is not greater than 5 percent of the
11 family's income. This provision shall be applied during
12 redetermination for children who were enrolled prior to July
13 1, 2004. These enrollees shall have 6 months of eligibility
14 following redetermination to allow for a transition to the
15 other health benefit plan.
16 (c) A child who is seeking premium assistance for the
17 Florida KidCare program through employer-sponsored group
18 coverage, if the child has been covered by the same employer's
19 group coverage during the 6 months prior to the family's
20 submitting an application for determination of eligibility
21 under the Florida Kidcare program.
22 (d) A child who is an alien, but who does not meet the
23 definition of qualified alien, in the United States.
24 (e) A child who is an inmate of a public institution
25 or a patient in an institution for mental diseases.
26 (f) A child who has had his or her coverage in an
27 employer-sponsored health benefit plan voluntarily canceled in
28 the last 6 months, except those children who were on the
29 waiting list prior to January 31, 2004.
30 (5) A child whose family income is above 200 percent
31 of the federal poverty level or a child who is excluded under
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Bill No. CS for SB 2000
Amendment No. ___ Barcode 190726
1 the provisions of subsection (4) may participate in the
2 Florida KidCare Kidcare program, excluding the Medicaid
3 program, but is subject to the following provisions:
4 (a) The family is not eligible for premium assistance
5 payments and must pay the full cost of the premium, including
6 any administrative costs.
7 (b) The agency is authorized to place limits on
8 enrollment in Medikids by these children in order to avoid
9 adverse selection. The number of children participating in
10 Medikids whose family income exceeds 200 percent of the
11 federal poverty level must not exceed 10 percent of total
12 enrollees in the Medikids program.
13 (c) The board of directors of the Florida Healthy Kids
14 Corporation is authorized to place limits on enrollment of
15 these children in order to avoid adverse selection. In
16 addition, the board is authorized to offer a reduced benefit
17 package to these children in order to limit program costs for
18 such families. The number of children participating in the
19 Florida Healthy Kids program whose family income exceeds 200
20 percent of the federal poverty level must not exceed 10
21 percent of total enrollees in the Florida Healthy Kids
22 program.
23 (d) Children described in this subsection are not
24 counted in the annual enrollment ceiling for the Florida
25 KidCare Kidcare program.
26 (6) Once a child is enrolled in the Florida KidCare
27 Kidcare program, the child is eligible for coverage under the
28 program for 6 months without a redetermination or
29 reverification of eligibility, if the family continues to pay
30 the applicable premium. Eligibility for program components
31 funded through Title XXI of the Social Security Act shall
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1 terminate when a child attains the age of 19. Effective
2 January 1, 1999, a child who has not attained the age of 5 and
3 who has been determined eligible for the Medicaid program is
4 eligible for coverage for 12 months without a redetermination
5 or reverification of eligibility.
6 (7) When determining or reviewing a child's
7 eligibility under the Florida KidCare program, the applicant
8 shall be provided with reasonable notice of changes in
9 eligibility which may affect enrollment in one or more of the
10 program components. When a transition from one program
11 component to another is authorized appropriate, there shall be
12 cooperation between the program components and the affected
13 family which promotes continuity of health care coverage. Any
14 authorized transfers must be managed within the program's
15 overall appropriated or authorized levels of funding. Each
16 component of the program shall establish a reserve to ensure
17 that transfers between components will be accomplished within
18 current year appropriations. These reserves shall be reviewed
19 by each convening of the Social Services Estimating Conference
20 to determine the adequacy of such reserves to meet actual
21 experience.
22 (8) In determining the eligibility of a child, an
23 assets test is not required. Each applicant shall provide
24 written documentation during the application process and the
25 redetermination process, including, but not limited to, the
26 following:
27 (a) Proof of family income.
28 (b) A statement from all family members that:
29 1. Their employer does not sponsor a health benefit
30 plan for employees; or
31 2. The potential enrollee is not covered by the
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1 employer-sponsored health benefit plan because the potential
2 enrollee is not eligible for coverage, or, if the potential
3 enrollee is eligible but not covered, a statement of the cost
4 to enroll the potential enrollee in the employer-sponsored
5 health benefit plan.
6 (9) Subject to paragraph (4)(b) and s. 624.91(3), the
7 Florida KidCare program shall withhold benefits from an
8 enrollee if the program obtains evidence that the enrollee is
9 no longer eligible, submitted incorrect or fraudulent
10 information in order to establish eligibility, or failed to
11 provide verification of eligibility. The applicant or enrollee
12 shall be notified that because of such evidence program
13 benefits will be withheld unless the applicant or enrollee
14 contacts a designated representative of the program by a
15 specified date, which must be within 10 days after the date of
16 notice, to discuss and resolve the matter. The program shall
17 make every effort to resolve the matter within a timeframe
18 that will not cause benefits to be withheld from an eligible
19 enrollee.
20 (10) The following individuals may be subject to
21 prosecution in accordance with s. 414.39:
22 (a) An applicant obtaining or attempting to obtain
23 benefits for a potential enrollee under the Florida KidCare
24 program when the applicant knows or should have known the
25 potential enrollee does not qualify for the Florida KidCare
26 program.
27 (b) An individual who assists an applicant in
28 obtaining or attempting to obtain benefits for a potential
29 enrollee under the Florida KidCare program when the individual
30 knows or should have known the potential enrollee does not
31 qualify for the Florida KidCare program.
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Amendment No. ___ Barcode 190726
1 Section 5. Effective July 1, 2004, paragraph (q) of
2 subsection (2) of section 409.815, Florida Statutes, is
3 amended to read:
4 409.815 Health benefits coverage; limitations.--
5 (2) BENCHMARK BENEFITS.--In order for health benefits
6 coverage to qualify for premium assistance payments for an
7 eligible child under ss. 409.810-409.820, the health benefits
8 coverage, except for coverage under Medicaid and Medikids,
9 must include the following minimum benefits, as medically
10 necessary.
11 (q) Dental services.--Dental services shall be covered
12 and may services include those dental benefits services
13 provided to children by the Florida Medicaid program under s.
14 409.906(6) s. 409.906(5) up to a maximum benefit of $750 per
15 enrollee per year.
16
17 (Redesignate subsequent sections.)
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20 ================ T I T L E A M E N D M E N T ===============
21 And the title is amended as follows:
22 On page 1, line 1, through
23 page 2, line 7, delete those lines
24
25 and insert:
26 An act relating to the Florida KidCare program;
27 amending s. 409.811, F.S.; defining the term
28 "Florida KidCare program"; deleting a
29 definition to conform; amending s. 409.8132,
30 F.S.; limiting when an applicant may apply for
31 Medikids program enrollment; deleting a special
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Bill No. CS for SB 2000
Amendment No. ___ Barcode 190726
1 enrollment period provision; amending s.
2 409.8134, F.S.; eliminating the Agency for
3 Health Care Administration's ability to request
4 an increase in the Florida KidCare program
5 enrollment ceiling; providing for open
6 enrollment periods; providing a timeframe for
7 statewide announcement of open enrollment
8 periods; providing for the enrollment of
9 certain children on an emergency basis;
10 providing limitations; providing a
11 disenrollment process under certain
12 circumstances; providing additional data for
13 certain agencies to collect and analyze;
14 amending s. 409.814, F.S.; revising Florida
15 KidCare program eligibility criteria; limiting
16 coverage; providing an exception for certain
17 children otherwise eligible or covered under a
18 family member's employer health coverage;
19 restricting enrollment of children whose
20 coverage was voluntarily canceled; providing an
21 age limitation for certain components;
22 requiring certain transfers to be managed
23 within authorized levels of funding; requiring
24 certain reserves to be established and
25 reviewed; requiring each applicant to provide
26 certain documentation; requiring the program to
27 withhold benefits from certain enrollees;
28 providing additional fraudulent activities;
29 amending s. 409.815, F.S.; revising coverage
30 requirements for dental services;
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