Senate Bill sb0210c1

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    Florida Senate - 2004                            CS for SB 210

    By the Committee on Banking and Insurance; and Senators
    Wasserman Schultz and Siplin




    311-1158-04

  1                      A bill to be entitled

  2         An act relating to the Florida Kidcare program;

  3         amending s. 391.026, F.S.; requiring the

  4         Department of Health to provide a 30-day grace

  5         period for late payment of premium relating to

  6         Children's Medical Services and to establish a

  7         waiting period for reinstatement of coverage

  8         upon cancellation for nonpayment of premium;

  9         amending s. 409.8132, F.S.; requiring the

10         Agency for Health Care Administration to

11         provide a 30-day grace period for late payment

12         of premiums for coverage under the Medikids

13         program; revising the waiting period for

14         reinstatement of coverage upon cancellation for

15         nonpayment of premium; creating s. 409.8141,

16         F.S.; providing that an uninsured parent,

17         guardian, or relative caretaker of a child

18         enrolled in the Florida Kidcare program is

19         eligible for coverage under the program,

20         subject to certain limitations; requiring

21         separate premiums or cost-sharing requirements

22         for the parent, guardian, or relative

23         caretaker; providing that nonpayment of

24         premiums or cost-sharing requirements for an

25         adult is not grounds for disenrolling a child

26         in that family from the program; providing for

27         coverage of a parent, guardian, or relative

28         caretaker whose income is above a specified

29         level if the adult pays the full cost of the

30         premium, including administrative costs;

31         providing that the eligibility for coverage

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1         provided by the act is not an entitlement;

 2         authorizing the Agency for Health Care

 3         Administration and the board of directors of

 4         the Florida Healthy Kids Corporation to limit

 5         enrollment under the act; exempting the adults

 6         enrolled under the act from the enrollment

 7         limitations of the Florida Kidcare program;

 8         amending s. 624.91, F.S.; requiring the Agency

 9         for Health Care Administration to provide a

10         30-day grace period for late payment of premium

11         and to establish a waiting period for

12         reinstatement of coverage upon cancellation for

13         nonpayment of premium; requiring the Agency for

14         Health Care Administration to submit a plan

15         amendment to the United States Department of

16         Health and Human Services which would implement

17         the employer-sponsored group health insurance

18         plans specified in s. 409.813, F.S.; providing

19         an effective date.

20  

21  Be It Enacted by the Legislature of the State of Florida:

22  

23         Section 1.  Subsection (19) is added to section

24  391.026, Florida Statutes, to read:

25         391.026  Powers and duties of the department.--The

26  department shall have the following powers, duties, and

27  responsibilities:

28         (19)  To provide a 30-day grace period for the late

29  payment of premium, meaning that coverage is not terminated if

30  the premium is paid within the 30-day period after the payment

31  is due. The department shall establish a penalty or waiting

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1  period of not greater than 60 days for reinstatement of

 2  coverage upon cancellation for nonpayment of premium.

 3         Section 2.  Subsection (9) of section 409.8132, Florida

 4  Statutes, is amended to read:

 5         409.8132  Medikids program component.--

 6         (9)  GRACE PERIOD; PENALTIES FOR VOLUNTARY

 7  CANCELLATION.--The agency shall provide a 30-day grace period

 8  for late payment of premium, meaning that coverage is not

 9  terminated if the premium is paid within the 30-day period

10  after the payment is due. The agency shall establish

11  enrollment criteria that must include penalties or waiting

12  periods of not greater fewer than 60 days for reinstatement of

13  coverage upon voluntary cancellation for nonpayment of

14  premiums.

15         Section 3.  Section 409.8141, Florida Statutes, is

16  created to read:

17         409.8141  Eligibility for a parent, guardian, or

18  relative caretaker.--

19         (1)  An uninsured parent, guardian, or relative

20  caretaker of a child enrolled in the Florida Kidcare program

21  is eligible for coverage under the Florida Kidcare program,

22  subject to the availability of moneys and any limitations

23  established in the General Appropriations Act or chapter 216.

24         (2)  Cost-sharing requirements or premiums charged for

25  coverage for a parent, guardian, or relative caretaker shall

26  be separate from and in addition to the cost-sharing

27  provisions imposed for child coverage. Nonpayment of the

28  premiums or cost-sharing requirements for a parent, guardian,

29  or relative caretaker may not be grounds for disenrollment of

30  a child in that family.

31  

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1         (3)  A parent, guardian, or relative caretaker of a

 2  child enrolled in the Florida Kidcare program whose income is

 3  above 200 percent of the federal poverty level may participate

 4  in the Florida Kidcare program; however, the adult is not

 5  eligible for premium-assistance payments and must pay the full

 6  cost of the premium, including any administrative costs.

 7         (4)  The eligibility created in this section is not an

 8  entitlement. The agency and the board of directors of the

 9  Florida Healthy Kids Corporation may place limits on

10  enrollment of parents, guardians, or relative caretakers in

11  order to avoid adverse selection or to comply with limitations

12  in the General Appropriations Act.

13         (5)  A parent, guardian, or relative caretaker who

14  participates in the Florida Kidcare program as provided in

15  this section is not included in the annual limitations on

16  enrollment established for the Florida Kidcare program.

17         Section 4.  Paragraph (b) of subsection (4) of section

18  624.91, Florida Statutes, is amended to read:

19         624.91  The Florida Healthy Kids Corporation Act.--

20         (4)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--

21         (b)  The Florida Healthy Kids Corporation shall:

22         1.  Arrange for the collection of any family, local

23  contributions, or employer payment or premium, in an amount to

24  be determined by the board of directors, to provide for

25  payment of premiums for comprehensive insurance coverage and

26  for the actual or estimated administrative expenses;

27         2.  Arrange for the collection of any voluntary

28  contributions to provide for payment of premiums for children

29  who are not eligible for medical assistance under Title XXI of

30  the Social Security Act. Each fiscal year, the corporation

31  shall establish a local match policy for the enrollment of

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1  non-Title-XXI-eligible children in the Healthy Kids program.

 2  By May 1 of each year, the corporation shall provide written

 3  notification of the amount to be remitted to the corporation

 4  for the following fiscal year under that policy. Local match

 5  sources may include, but are not limited to, funds provided by

 6  municipalities, counties, school boards, hospitals, health

 7  care providers, charitable organizations, special taxing

 8  districts, and private organizations. The minimum local match

 9  cash contributions required each fiscal year and local match

10  credits shall be determined by the General Appropriations Act.

11  The corporation shall calculate a county's local match rate

12  based upon that county's percentage of the state's total

13  non-Title-XXI expenditures as reported in the corporation's

14  most recently audited financial statement. In awarding the

15  local match credits, the corporation may consider factors

16  including, but not limited to, population density, per capita

17  income, and existing child-health-related expenditures and

18  services;

19         3.  Accept voluntary supplemental local match

20  contributions that comply with the requirements of Title XXI

21  of the Social Security Act for the purpose of providing

22  additional coverage in contributing counties under Title XXI;

23         4.  Establish the administrative and accounting

24  procedures for the operation of the corporation;

25         5.  Establish, with consultation from appropriate

26  professional organizations, standards for preventive health

27  services and providers and comprehensive insurance benefits

28  appropriate to children; provided that such standards for

29  rural areas shall not limit primary care providers to

30  board-certified pediatricians;

31  

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1         6.  Establish eligibility criteria which children must

 2  meet in order to participate in the program;

 3         7.  Establish procedures under which providers of local

 4  match to, applicants to and participants in the program may

 5  have grievances reviewed by an impartial body and reported to

 6  the board of directors of the corporation;

 7         8.  Establish participation criteria and, if

 8  appropriate, contract with an authorized insurer, health

 9  maintenance organization, or insurance administrator to

10  provide administrative services to the corporation;

11         9.  Establish enrollment criteria which shall include a

12  30-day grace period for late payment of premium, meaning that

13  coverage is not terminated if the premium is paid within the

14  30-day period after the payment is due, and establish

15  penalties or waiting periods of not greater fewer than 60 days

16  for reinstatement of coverage upon voluntary cancellation for

17  nonpayment of family premiums;

18         10.  If a space is available, establish a special open

19  enrollment period of 30 days' duration for any child who is

20  enrolled in Medicaid or Medikids if such child loses Medicaid

21  or Medikids eligibility and becomes eligible for the Florida

22  Healthy Kids program;

23         11.  Contract with authorized insurers or any provider

24  of health care services, meeting standards established by the

25  corporation, for the provision of comprehensive insurance

26  coverage to participants.  Such standards shall include

27  criteria under which the corporation may contract with more

28  than one provider of health care services in program sites.

29  Health plans shall be selected through a competitive bid

30  process. The maximum administrative cost for a Florida Healthy

31  Kids Corporation contract shall be 15 percent. The minimum

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1  medical loss ratio for a Florida Healthy Kids Corporation

 2  contract shall be 85 percent. The selection of health plans

 3  shall be based primarily on quality criteria established by

 4  the board. The health plan selection criteria and scoring

 5  system, and the scoring results, shall be available upon

 6  request for inspection after the bids have been awarded;

 7         12.  Establish disenrollment criteria in the event

 8  local matching funds are insufficient to cover enrollments;

 9         13.  Develop and implement a plan to publicize the

10  Florida Healthy Kids Corporation, the eligibility requirements

11  of the program, and the procedures for enrollment in the

12  program and to maintain public awareness of the corporation

13  and the program;

14         14.  Secure staff necessary to properly administer the

15  corporation. Staff costs shall be funded from state and local

16  matching funds and such other private or public funds as

17  become available. The board of directors shall determine the

18  number of staff members necessary to administer the

19  corporation;

20         15.  As appropriate, enter into contracts with local

21  school boards or other agencies to provide onsite information,

22  enrollment, and other services necessary to the operation of

23  the corporation;

24         16.  Provide a report annually to the Governor, Chief

25  Financial Officer, Commissioner of Education, Senate

26  President, Speaker of the House of Representatives, and

27  Minority Leaders of the Senate and the House of

28  Representatives;

29         17.  Each fiscal year, establish a maximum number of

30  participants, on a statewide basis, who may enroll in the

31  program; and

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    Florida Senate - 2004                            CS for SB 210
    311-1158-04




 1         18.  Establish eligibility criteria, premium and

 2  cost-sharing requirements, and benefit packages which conform

 3  to the provisions of the Florida Kidcare program, as created

 4  in ss. 409.810-409.820.

 5         Section 5.  By October 1, 2004, the Agency for Health

 6  Care Administration shall submit to the United States

 7  Department of Health and Human Services a proposed amendment

 8  to Florida's Children's Health Insurance Program State plan

 9  under Title XXI of the Social Security Act which would

10  implement the employer-sponsored group health insurance plans

11  specified in section 409.813, Florida Statutes.

12         Section 6.  This act shall take effect October 1, 2004.

13  

14          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
15                         Senate Bill 210

16                                 

17  This committee substitute does the following:

18  -    Establishes a 30-day grace period for the late payment of
         a premium for Florida Healthy Kids, Children Medical
19       Services, and Medikids.

20  -    Revises the waiting period for reinstatement of coverage
         upon cancellation for nonpayment of premium for Florida
21       Healthy Kids, Children Medical Services, and Medikids, to
         no more that 60 days rather than at least 60 days.
22  
    -    Requires the Agency for Health Care Administration to
23       submit to the United States Department of Health and
         Human Services a proposed amendment to the Children's
24       Health Insurance State plan under Title XXI of the Social
         Security Act which would implement the employer-sponsored
25       group health insurance plans specified in s. 409.813,
         F.S.
26  

27  

28  

29  

30  

31  

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