HB 1365

1	A bill to be entitled
2	An act relating to the Florida Healthy Kids Corporation
3	Act; amending s. 624.91, F.S.; removing a limitation on
4	eligibility for state-funded assistance in paying Florida
5	Healthy Kids premiums; revising the date by which the
6	corporation must provide certain notification of the local
7	match amount to be remitted for the following year;
8	revising basis for calculation of a county's local match
9	contribution; amending s. 409.814, F.S.; conforming a
10	cross-reference; providing an effective date.
11
12	Be It Enacted by the Legislature of the State of Florida:
13
14	Section 1.  Subsections (5) through (8) of section 624.91,
15	Florida Statutes, are renumbered as subsections (4) through (7),
16	respectively, and present subsections (3) and (5) of that
17	section are amended to read:
18	624.91  The Florida Healthy Kids Corporation Act.--
19	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the
20	following individuals are eligible for state-funded assistance
21	in paying Florida Healthy Kids premiums:
22	(a)  Residents of this state who are eligible for the
23	Florida KidCare program pursuant to s. 409.814.
24	(b)  Notwithstanding s. 409.814, legal aliens who are
25	enrolled in the Florida Healthy Kids program as of January 31,
26	2004, who do not qualify for Title XXI federal funds because
27	they are not qualified aliens as defined in s. 409.811.
28	(c)  Notwithstanding s. 409.814, individuals who have
29	attained the age of 19 as of March 31, 2004, who were receiving
30	Florida Healthy Kids benefits prior to the enactment of the
31	Florida KidCare program. This paragraph shall be repealed March
32	31, 2005.
33	(d)  Notwithstanding s. 409.814, state employee dependents
34	who were enrolled in the Florida Healthy Kids program as of
35	January 31, 2004. Such individuals shall remain eligible until
36	January 1, 2005.
37	(4)(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
38	(b)  The Florida Healthy Kids Corporation shall:
39	1.  Arrange for the collection of any family, local
40	contributions, or employer payment or premium, in an amount to
41	be determined by the board of directors, to provide for payment
42	of premiums for comprehensive insurance coverage and for the
43	actual or estimated administrative expenses.
44	2.  Arrange for the collection of any voluntary
45	contributions to provide for payment of premiums for children
46	who are not eligible for medical assistance under Title XXI of
47	the Social Security Act. Each fiscal year, the corporation shall
48	establish a local match policy for the enrollment of non-Title-
49	XXI-eligible children in the Healthy Kids program. By June May 1
50	of each year, the corporation shall provide written notification
51	of the local match amount to be remitted to the corporation for
52	the following fiscal year under that policy. Local match sources
53	may include, but are not limited to, funds provided by
54	municipalities, counties, school boards, hospitals, health care
55	providers, charitable organizations, special taxing districts,
56	and private organizations. The minimum local match cash
57	contributions required each fiscal year and local match credits
58	shall be determined by the General Appropriations Act. The
59	corporation shall calculate a county's local match rate based
60	upon that county's enrollment of non-Title-XXI-eligible children
61	as of March 1, 2004. The local match contribution for any county
62	shall not exceed 30 percent of the monthly premium after the
63	family premium is deducted, and 70 percent of the remaining
64	premium is taken from the General Appropriations Act. If local
65	match amounts collected exceed expenditures during any fiscal
66	year, the corporation shall apply any year-end surpluses as a
67	credit to the contributing entity's local match obligation for
68	the subsequent fiscal year percentage of the state's total non-
69	Title-XXI expenditures as reported in the corporation's most
70	recently audited financial statement. In awarding the local
71	match credits, the corporation may consider factors including,
72	but not limited to, population density, per capita income, and
73	existing child-health-related expenditures and services.
74	3.  Subject to the provisions of s. 409.8134, accept
75	voluntary supplemental local match contributions that comply
76	with the requirements of Title XXI of the Social Security Act
77	for the purpose of providing additional coverage in contributing
78	counties under Title XXI.
79	4.  Establish the administrative and accounting procedures
80	for the operation of the corporation.
81	5.  Establish, with consultation from appropriate
82	professional organizations, standards for preventive health
83	services and providers and comprehensive insurance benefits
84	appropriate to children, provided that such standards for rural
85	areas shall not limit primary care providers to board-certified
86	pediatricians.
87	6.  Determine eligibility for children seeking to
88	participate in the Title XXI-funded components of the Florida
89	KidCare program consistent with the requirements specified in s.
90	409.814, as well as the non-Title-XXI-eligible children as
91	provided in subsection (3).
92	7.  Establish procedures under which providers of local
93	match to, applicants to and participants in the program may have
94	grievances reviewed by an impartial body and reported to the
95	board of directors of the corporation.
96	8.  Establish participation criteria and, if appropriate,
97	contract with an authorized insurer, health maintenance
98	organization, or third-party administrator to provide
99	administrative services to the corporation.
100	9.  Establish enrollment criteria which shall include
101	penalties or waiting periods of not fewer than 60 days for
102	reinstatement of coverage upon voluntary cancellation for
103	nonpayment of family premiums.
104	10.  Contract with authorized insurers or any provider of
105	health care services, meeting standards established by the
106	corporation, for the provision of comprehensive insurance
107	coverage to participants. Such standards shall include criteria
108	under which the corporation may contract with more than one
109	provider of health care services in program sites. Health plans
110	shall be selected through a competitive bid process. The Florida
111	Healthy Kids Corporation shall purchase goods and services in
112	the most cost-effective manner consistent with the delivery of
113	quality medical care. The maximum administrative cost for a
114	Florida Healthy Kids Corporation contract shall be 15 percent.
115	For health care contracts, the minimum medical loss ratio for a
116	Florida Healthy Kids Corporation contract shall be 85 percent.
117	For dental contracts, the remaining compensation to be paid to
118	the authorized insurer or provider under a Florida Healthy Kids
119	Corporation contract shall be no less than an amount which is 85
120	percent of premium; to the extent any contract provision does
121	not provide for this minimum compensation, this section shall
122	prevail. The health plan selection criteria and scoring system,
123	and the scoring results, shall be available upon request for
124	inspection after the bids have been awarded.
125	11.  Establish disenrollment criteria in the event local
126	matching funds are insufficient to cover enrollments.
127	12.  Develop and implement a plan to publicize the Florida
128	Healthy Kids Corporation, the eligibility requirements of the
129	program, and the procedures for enrollment in the program and to
130	maintain public awareness of the corporation and the program.
131	13.  Secure staff necessary to properly administer the
132	corporation. Staff costs shall be funded from state and local
133	matching funds and such other private or public funds as become
134	available. The board of directors shall determine the number of
135	staff members necessary to administer the corporation.
136	14.  Provide a report annually to the Governor, Chief
137	Financial Officer, Commissioner of Education, Senate President,
138	Speaker of the House of Representatives, and Minority Leaders of
139	the Senate and the House of Representatives.
140	15.  Establish benefit packages which conform to the
141	provisions of the Florida KidCare program, as created in ss.
142	409.810-409.820.
143	Section 2.  Subsection (9) of section 409.814, Florida
144	Statutes, is amended to read:
145	409.814  Eligibility.--A child who has not reached 19 years
146	of age whose family income is equal to or below 200 percent of
147	the federal poverty level is eligible for the Florida KidCare
148	program as provided in this section. For enrollment in the
149	Children's Medical Services Network, a complete application
150	includes the medical or behavioral health screening. If,
151	subsequently, an individual is determined to be ineligible for
152	coverage, he or she must immediately be disenrolled from the
153	respective Florida KidCare program component.
154	(9)  Subject to paragraph (4)(b) and s. 624.91(3), the
155	Florida KidCare program shall withhold benefits from an enrollee
156	if the program obtains evidence that the enrollee is no longer
157	eligible, submitted incorrect or fraudulent information in order
158	to establish eligibility, or failed to provide verification of
159	eligibility. The applicant or enrollee shall be notified that
160	because of such evidence program benefits will be withheld
161	unless the applicant or enrollee contacts a designated
162	representative of the program by a specified date, which must be
163	within 10 days after the date of notice, to discuss and resolve
164	the matter. The program shall make every effort to resolve the
165	matter within a timeframe that will not cause benefits to be
166	withheld from an eligible enrollee.
167	Section 3.  This act shall take effect July 1, 2006.

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