HB 1365

CS

CHAMBER ACTION

1	The Health & Families Council recommends the following:
2
3	Council/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. 409.814, F.S.; providing for certain children who are
8	ineligible to participate in the Florida KidCare program
9	to be eligible for Medikids or the Florida Healthy Kids
10	program; specifying that 12 months of continuous
11	eligibility includes changes between program components;
12	amending s. 409.818, F.S.; providing for the
13	administration of the eligibility application process;
14	amending s. 409.821, F.S., relating to a public records
15	exemption; specifying that such provision does not
16	prohibit an enrollee's parent or legal guardian from
17	obtaining confirmation of coverage and dates of coverage;
18	amending s. 624.91, F.S.; authorizing participating health
19	and dental plans to develop marketing and other
20	promotional materials and to participate in activities to
21	promote the Florida KidCare program; requiring the Agency
22	for Health Care Administration to begin enrollment in
23	Medikids or the Florida Healthy Kids program by a certain
24	date; providing an effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1.  Subsections (5) and (6) of section 409.814,
29	Florida Statutes, are amended to read:
30	409.814  Eligibility.--A child who has not reached 19 years
31	of age whose family income is equal to or below 200 percent of
32	the federal poverty level is eligible for the Florida KidCare
33	program as provided in this section. For enrollment in the
34	Children's Medical Services Network, a complete application
35	includes the medical or behavioral health screening. If,
36	subsequently, an individual is determined to be ineligible for
37	coverage, he or she must immediately be disenrolled from the
38	respective Florida KidCare program component.
39	(5)  A child whose family income is above 200 percent of
40	the federal poverty level or a child who is excluded under the
41	provisions of subsection (4) may participate in the Medikids
42	program as provided in s. 409.8132 or, if the child is
43	ineligible for Medikids by reason of age, in the Florida Healthy
44	Kids program, Florida KidCare program, excluding the Medicaid
45	program, but is subject to the following provisions:
46	(a)  The family is not eligible for premium assistance
47	payments and must pay the full cost of the premium, including
48	any administrative costs.
49	(b)  The agency is authorized to place limits on enrollment
50	in Medikids by these children in order to avoid adverse
51	selection. The number of children participating in Medikids
52	whose family income exceeds 200 percent of the federal poverty
53	level must not exceed 10 percent of total enrollees in the
54	Medikids program.
55	(c)  The board of directors of the Florida Healthy Kids
56	Corporation is authorized to place limits on enrollment of these
57	children in order to avoid adverse selection. In addition, the
58	board is authorized to offer a reduced benefit package to these
59	children in order to limit program costs for such families. The
60	number of children participating in the Florida Healthy Kids
61	program whose family income exceeds 200 percent of the federal
62	poverty level must not exceed 10 percent of total enrollees in
63	the Florida Healthy Kids program.
64	(d)  Children described in this subsection are not counted
65	in the annual enrollment ceiling for the Florida KidCare
66	program.
67	(6)  Once a child is enrolled in the Florida KidCare
68	program, the child is eligible for coverage under the program
69	for 12 months without a redetermination or reverification of
70	eligibility even when switching from one component of the
71	program to another, if the family continues to pay the
72	applicable premium. Eligibility for program components funded
73	through Title XXI of the Social Security Act shall terminate
74	when a child attains the age of 19. Effective January 1, 1999, a
75	child who has not attained the age of 5 and who has been
76	determined eligible for the Medicaid program is eligible for
77	coverage for 12 months without a redetermination or
78	reverification of eligibility.
79	Section 2.  Paragraph (a) of subsection (1) of section
80	409.818, Florida Statutes, is amended to read:
81	409.818  Administration.--In order to implement ss.
82	409.810-409.820, the following agencies shall have the following
83	duties:
84	(1)  The Department of Children and Family Services shall:
85	(a)  Develop a simplified eligibility application process,
86	including the use of mail-in forms and electronic information
87	intake methods, mail-in form to be used for determining the
88	eligibility of children for coverage under the Florida KidCare
89	program, in consultation with the agency, the Department of
90	Health, and the Florida Healthy Kids Corporation. The simplified
91	eligibility application process form must include an item that
92	provides an opportunity for the applicant to indicate whether
93	coverage is being sought for a child with special health care
94	needs. Families applying for children's Medicaid coverage must
95	also be able to use the simplified application form without
96	having to pay a premium. When a child is found ineligible due to
97	income for Medicaid, the department shall forward all of the
98	child's information, including the date the child was enrolled
99	in the Medicaid program and the income level of the family when
100	the child was determined to be ineligible due to income, to the
101	Healthy Kids Corporation. The child's information shall be
102	processed for enrollment in another KidCare program component
103	without requiring an additional KidCare application.
104	Section 3.  Section 409.821, Florida Statutes, is amended
105	to read:
106	409.821  Florida KidCare program public records
107	exemption.--Notwithstanding any other law to the contrary, any
108	information identifying a Florida KidCare program applicant or
109	enrollee, as defined in s. 409.811, held by the Agency for
110	Health Care Administration, the Department of Children and
111	Family Services, the Department of Health, or the Florida
112	Healthy Kids Corporation is confidential and exempt from s.
113	119.07(1) and s. 24(a), Art. I of the State Constitution. Such
114	information may be disclosed to another governmental entity only
115	if disclosure is necessary for the entity to perform its duties
116	and responsibilities under the Florida KidCare program and shall
117	be disclosed to the Department of Revenue for purposes of
118	administering the state Title IV-D program. The receiving
119	governmental entity must maintain the confidential and exempt
120	status of such information. Furthermore, such information may
121	not be released to any person without the written consent of the
122	program applicant. This exemption applies to any information
123	identifying a Florida KidCare program applicant or enrollee held
124	by the Agency for Health Care Administration, the Department of
125	Children and Family Services, the Department of Health, or the
126	Florida Healthy Kids Corporation before, on, or after the
127	effective date of this exemption. A violation of this section is
128	a misdemeanor of the second degree, punishable as provided in s.
129	775.082 or s. 775.083. This section does not prohibit an
130	enrollee's parent or legal guardian from obtaining confirmation
131	of coverage and dates of coverage.
132	Section 4.  Subsection (5) of section 624.91, Florida
133	Statutes, is amended to read:
134	624.91  The Florida Healthy Kids Corporation Act.--
135	(5)  CORPORATION AUTHORIZATION, DUTIES, PROMOTION,
136	POWERS.--
137	(a)  There is created the Florida Healthy Kids Corporation,
138	a not-for-profit corporation.
139	(b)  The Florida Healthy Kids Corporation shall:
140	1.  Arrange for the collection of any family, local
141	contributions, or employer payment or premium, in an amount to
142	be determined by the board of directors, to provide for payment
143	of premiums for comprehensive insurance coverage and for the
144	actual or estimated administrative expenses.
145	2.  Arrange for the collection of any voluntary
146	contributions to provide for payment of premiums for children
147	who are not eligible for medical assistance under Title XXI of
148	the Social Security Act. Each fiscal year, the corporation shall
149	establish a local match policy for the enrollment of non-Title-
150	XXI-eligible children in the Healthy Kids program. By May 1 of
151	each year, the corporation shall provide written notification of
152	the amount to be remitted to the corporation for the following
153	fiscal year under that policy. Local match sources may include,
154	but are not limited to, funds provided by municipalities,
155	counties, school boards, hospitals, health care providers,
156	charitable organizations, special taxing districts, and private
157	organizations. The minimum local match cash contributions
158	required each fiscal year and local match credits shall be
159	determined by the General Appropriations Act. The corporation
160	shall calculate a county's local match rate based upon that
161	county's percentage of the state's total non-Title-XXI
162	expenditures as reported in the corporation's most recently
163	audited financial statement. In awarding the local match
164	credits, the corporation may consider factors including, but not
165	limited to, population density, per capita income, and existing
166	child-health-related expenditures and services.
167	3.  Subject to the provisions of s. 409.8134, accept
168	voluntary supplemental local match contributions that comply
169	with the requirements of Title XXI of the Social Security Act
170	for the purpose of providing additional coverage in contributing
171	counties under Title XXI.
172	4.  Establish the administrative and accounting procedures
173	for the operation of the corporation.
174	5.  Establish, with consultation from appropriate
175	professional organizations, standards for preventive health
176	services and providers and comprehensive insurance benefits
177	appropriate to children, provided that the such standards for
178	rural areas do shall not limit primary care providers to board-
179	certified pediatricians.
180	6.  Determine eligibility for children seeking to
181	participate in the Title XXI-funded components of the Florida
182	KidCare program consistent with the requirements specified in s.
183	409.814, as well as the non-Title-XXI-eligible children as
184	provided in subsection (3).
185	7.  Establish procedures under which providers of local
186	match to, applicants to and participants in the program may have
187	grievances reviewed by an impartial body and reported to the
188	board of directors of the corporation.
189	8.  Establish participation criteria and, if appropriate,
190	contract with an authorized insurer, health maintenance
191	organization, or third-party administrator to provide
192	administrative services to the corporation.
193	9.  Establish enrollment criteria that which shall include
194	penalties or waiting periods of not fewer than 60 days for
195	reinstatement of coverage upon voluntary cancellation for
196	nonpayment of family premiums.
197	10.  Contract with authorized insurers or any provider of
198	health care services, meeting standards established by the
199	corporation, for the provision of comprehensive insurance
200	coverage to participants. Such standards shall include criteria
201	under which the corporation may contract with more than one
202	provider of health care services in program sites. Health plans
203	shall be selected through a competitive bid process. The Florida
204	Healthy Kids Corporation shall purchase goods and services in
205	the most cost-effective manner consistent with the delivery of
206	quality medical care. The maximum administrative cost for a
207	Florida Healthy Kids Corporation contract shall be 15 percent.
208	For health care contracts, the minimum medical loss ratio for a
209	Florida Healthy Kids Corporation contract shall be 85 percent.
210	For dental contracts, the remaining compensation to be paid to
211	the authorized insurer or provider under a Florida Healthy Kids
212	Corporation contract shall be no less than an amount which is 85
213	percent of premium; to the extent any contract provision does
214	not provide for this minimum compensation, this section shall
215	prevail. The health plan selection criteria and scoring system,
216	and the scoring results, shall be available upon request for
217	inspection after the bids have been awarded.
218	11.  Establish disenrollment criteria in the event local
219	matching funds are insufficient to cover enrollments.
220	12.  Develop and implement a plan to publicize the Florida
221	Healthy Kids Corporation, the eligibility requirements of the
222	program, and the procedures for enrollment in the program and to
223	maintain public awareness of the corporation and the program.
224	Participating health and dental plans may develop marketing and
225	other promotional materials and participate in activities, such
226	as health fairs and public events, as approved by the
227	corporation. The health and dental plans may also contact their
228	enrollees and former enrollees to encourage continued
229	participation in the plan.
230	13.  Secure staff necessary to properly administer the
231	corporation. Staff costs shall be funded from state and local
232	matching funds and such other private or public funds as become
233	available. The board of directors shall determine the number of
234	staff members necessary to administer the corporation.
235	14.  Provide a report annually to the Governor, Chief
236	Financial Officer, Commissioner of Education, Senate President,
237	Speaker of the House of Representatives, and Minority Leaders of
238	the Senate and the House of Representatives.
239	15.  Establish benefit packages which conform to the
240	provisions of the Florida KidCare program, as created in ss.
241	409.810-409.820.
242	(c)  Coverage under the corporation's program is secondary
243	to any other available private coverage held by, or applicable
244	to, the participant child or family member. Insurers under
245	contract with the corporation are the payors of last resort and
246	must coordinate benefits with any other third-party payor that
247	may be liable for the participant's medical care.
248	(d)  The Florida Healthy Kids Corporation shall be a
249	private corporation not for profit, organized under pursuant to
250	chapter 617, and shall have all powers necessary to carry out
251	the purposes of this act, including, but not limited to, the
252	power to receive and accept grants, loans, or advances of funds
253	from any public or private agency and to receive and accept from
254	any source contributions of money, property, labor, or any other
255	thing of value, to be held, used, and applied for the purposes
256	of this section act.
257	Section 5.  The Agency for Health Care Administration shall
258	begin enrollment under s. 409.814(5), Florida Statutes, as
259	amended by this act, by July 1, 2006.
260	Section 6.  This act shall take effect July 1, 2006.

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