HB 1365

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

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