Senate Bill sb2050c1

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    Florida Senate - 2006                           CS for SB 2050

    By the Committee on Health Care; and Senators Peaden and Hill





    587-2187-06

  1                      A bill to be entitled

  2         An act relating to the Florida KidCare program;

  3         amending s. 409.811, F.S.; defining the terms

  4         "Healthy Kids" and "maximum income threshold";

  5         amending s. 409.8132, F.S.; providing that

  6         eligibility for the Florida KidCare program be

  7         at or below the maximum income threshold rather

  8         than a specified percentage of the federal

  9         poverty level; amending s. 409.8134, F.S.;

10         conforming provisions to changes made by the

11         act; amending s. 409.814, F.S.; requiring that

12         eligibility for the Florida KidCare program be

13         at or below the maximum income threshold rather

14         than a specified percentage of the federal

15         poverty level; providing that certain specified

16         children are eligible for nonfederal premium

17         assistance for health insurance; providing that

18         a child whose family income is above the

19         maximum income threshold may participate in the

20         Florida KidCare program but is subject to

21         certain conditions; amending s. 409.816, F.S.;

22         conforming a cross-reference; amending s.

23         409.818, F.S.; requiring the Agency for Health

24         Care Administration to seek approval from the

25         federal Centers for Medicare and Medicaid

26         Services to use the highest maximum income

27         threshold allowed by federal law or regulation,

28         which is up to 300 percent of the most recently

29         stated federal poverty limit; providing an

30         alternative eligibility standard pending

31         approval of the request; amending s. 409.821,

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    Florida Senate - 2006                           CS for SB 2050
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 1         F.S., relating to a public-records exemption;

 2         specifying that such provision does not

 3         prohibit an enrollee's parent or legal guardian

 4         from obtaining confirmation of coverage and

 5         dates of coverage; amending s. 624.91, F.S.;

 6         conforming provisions to changes made by the

 7         act; revising the powers of the Florida Healthy

 8         Kids Corporation; authorizing participating

 9         health and dental plans to develop marketing

10         and other promotional materials and to

11         participate in activities to promote the

12         Florida Healthy Kids Corporation; providing an

13         effective date.

14  

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

16  

17         Section 1.  Section 409.811, Florida Statutes, is

18  amended to read:

19         409.811  Definitions relating to Florida KidCare

20  Act.--As used in ss. 409.810-409.820, the term:

21         (1)  "Actuarially equivalent" means that:

22         (a)  The aggregate value of the benefits included in

23  health benefits coverage is equal to the value of the benefits

24  in the benchmark benefit plan; and

25         (b)  The benefits included in health benefits coverage

26  are substantially similar to the benefits included in the

27  benchmark benefit plan, except that preventive health services

28  must be the same as in the benchmark benefit plan.

29         (2)  "Agency" means the Agency for Health Care

30  Administration.

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1         (3)  "Applicant" means a parent or guardian of a child

 2  or a child whose disability of nonage has been removed under

 3  chapter 743, who applies for determination of eligibility for

 4  health benefits coverage under ss. 409.810-409.820.

 5         (4)  "Benchmark benefit plan" means the form and level

 6  of health benefits coverage established in s. 409.815.

 7         (5)  "Child" means any person under 19 years of age.

 8         (6)  "Child with special health care needs" means a

 9  child whose serious or chronic physical or developmental

10  condition requires extensive preventive and maintenance care

11  beyond that required by typically healthy children. Health

12  care utilization by such a child exceeds the statistically

13  expected usage of the normal child adjusted for chronological

14  age, and such a child often needs complex care requiring

15  multiple providers, rehabilitation services, and specialized

16  equipment in a number of different settings.

17         (7)  "Children's Medical Services Network" or "network"

18  means a statewide managed care service system as defined in s.

19  391.021(1).

20         (8)  "Community rate" means a method used to develop

21  premiums for a health insurance plan that spreads financial

22  risk across a large population and allows adjustments only for

23  age, gender, family composition, and geographic area.

24         (9)  "Department" means the Department of Health.

25         (10)  "Enrollee" means a child who has been determined

26  eligible for and is receiving coverage under ss.

27  409.810-409.820.

28         (11)  "Enrollment ceiling" means the maximum number of

29  children receiving premium assistance payments, excluding

30  children enrolled in Medicaid, that may be enrolled at any

31  time in the Florida KidCare program. The maximum number shall

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    Florida Senate - 2006                           CS for SB 2050
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 1  be established annually in the General Appropriations Act or

 2  by general law.

 3         (12)  "Family" means the group or the individuals whose

 4  income is considered in determining eligibility for the

 5  Florida KidCare program. The family includes a child with a

 6  custodial parent or caretaker relative who resides in the same

 7  house or living unit or, in the case of a child whose

 8  disability of nonage has been removed under chapter 743, the

 9  child. The family may also include other individuals whose

10  income and resources are considered in whole or in part in

11  determining eligibility of the child.

12         (13)  "Family income" means cash received at periodic

13  intervals from any source, such as wages, benefits,

14  contributions, or rental property. Income also may include any

15  money that would have been counted as income under the Aid to

16  Families with Dependent Children (AFDC) state plan in effect

17  prior to August 22, 1996.

18         (14)  "Florida KidCare program," "KidCare program," or

19  "program" means the health benefits program administered

20  through ss. 409.810-409.820.

21         (15)  "Guarantee issue" means that health benefits

22  coverage must be offered to an individual regardless of the

23  individual's health status, preexisting condition, or claims

24  history.

25         (16)  "Health benefits coverage" means protection that

26  provides payment of benefits for covered health care services

27  or that otherwise provides, either directly or through

28  arrangements with other persons, covered health care services

29  on a prepaid per capita basis or on a prepaid aggregate

30  fixed-sum basis.

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1         (17)  "Health insurance plan" means health benefits

 2  coverage under the following:

 3         (a)  A health plan offered by any certified health

 4  maintenance organization or authorized health insurer, except

 5  a plan that is limited to the following: a limited benefit,

 6  specified disease, or specified accident; hospital indemnity;

 7  accident only; limited benefit convalescent care; Medicare

 8  supplement; credit disability; dental; vision; long-term care;

 9  disability income; coverage issued as a supplement to another

10  health plan; workers' compensation liability or other

11  insurance; or motor vehicle medical payment only; or

12         (b)  An employee welfare benefit plan that includes

13  health benefits established under the Employee Retirement

14  Income Security Act of 1974, as amended.

15         (18)  "Healthy Kids" means a component of the Florida

16  KidCare program of medical assistance for children 5 through

17  18 years of age as authorized under s. 624.91 and administered

18  by the Florida Healthy Kids Corporation.

19         (19)  "Maximum income threshold" means a percentage of

20  the current federal poverty level used to determine

21  eligibility for certain program components, as approved by

22  federal waiver or an amendment to the state plan.

23         (20)(18)  "Medicaid" means the medical assistance

24  program authorized by Title XIX of the Social Security Act,

25  and regulations thereunder, and ss. 409.901-409.920, as

26  administered in this state by the agency.

27         (21)(19)  "Medically necessary" means the use of any

28  medical treatment, service, equipment, or supply necessary to

29  palliate the effects of a terminal condition, or to prevent,

30  diagnose, correct, cure, alleviate, or preclude deterioration

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1  of a condition that threatens life, causes pain or suffering,

 2  or results in illness or infirmity and which is:

 3         (a)  Consistent with the symptom, diagnosis, and

 4  treatment of the enrollee's condition;

 5         (b)  Provided in accordance with generally accepted

 6  standards of medical practice;

 7         (c)  Not primarily intended for the convenience of the

 8  enrollee, the enrollee's family, or the health care provider;

 9         (d)  The most appropriate level of supply or service

10  for the diagnosis and treatment of the enrollee's condition;

11  and

12         (e)  Approved by the appropriate medical body or health

13  care specialty involved as effective, appropriate, and

14  essential for the care and treatment of the enrollee's

15  condition.

16         (22)(20)  "Medikids" means a component of the Florida

17  KidCare program of medical assistance authorized by Title XXI

18  of the Social Security Act, and regulations thereunder, and s.

19  409.8132, as administered in the state by the agency.

20         (23)(21)  "Preexisting condition exclusion" means, with

21  respect to coverage, a limitation or exclusion of benefits

22  relating to a condition based on the fact that the condition

23  was present before the date of enrollment for such coverage,

24  whether or not any medical advice, diagnosis, care, or

25  treatment was recommended or received before such date.

26         (24)(22)  "Premium" means the entire cost of a health

27  insurance plan, including the administration fee or the risk

28  assumption charge.

29         (25)(23)  "Premium assistance payment" means the

30  monthly consideration paid by the agency per enrollee in the

31  Florida KidCare program towards health insurance premiums.

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    Florida Senate - 2006                           CS for SB 2050
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 1         (26)(24)  "Qualified alien" means an alien as defined

 2  in s. 431 of the Personal Responsibility and Work Opportunity

 3  Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.

 4         (27)(25)  "Resident" means a United States citizen, or

 5  qualified alien, who is domiciled in this state.

 6         (28)(26)  "Rural county" means a county having a

 7  population density of less than 100 persons per square mile,

 8  or a county defined by the most recent United States Census as

 9  rural, in which there is no prepaid health plan participating

10  in the Medicaid program as of July 1, 1998.

11         (29)(27)  "Substantially similar" means that, with

12  respect to additional services as defined in s. 2103(c)(2) of

13  Title XXI of the Social Security Act, these services must have

14  an actuarial value equal to at least 75 percent of the

15  actuarial value of the coverage for that service in the

16  benchmark benefit plan and, with respect to the basic services

17  as defined in s. 2103(c)(1) of Title XXI of the Social

18  Security Act, these services must be the same as the services

19  in the benchmark benefit plan.

20         Section 2.  Subsections (6) and (7) of section

21  409.8132, Florida Statutes, are amended to read:

22         409.8132  Medikids program component.--

23         (6)  ELIGIBILITY.--

24         (a)  A child who has attained the age of 1 year but who

25  is under the age of 5 years is eligible to enroll in the

26  Medikids program component of the Florida KidCare program, if

27  the child is a member of a family that has a family income

28  which exceeds the Medicaid applicable income level as

29  specified in s. 409.903, but which is equal to or below the

30  maximum income threshold 200 percent of the current federal

31  poverty level.  In determining the eligibility of such a

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    Florida Senate - 2006                           CS for SB 2050
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 1  child, an assets test is not required. A child who is eligible

 2  for Medikids may elect to enroll in Florida Healthy Kids

 3  coverage or employer-sponsored group coverage. However, a

 4  child who is eligible for Medikids may participate in the

 5  Florida Healthy Kids program only if the child has a sibling

 6  participating in the Florida Healthy Kids program and the

 7  child's county of residence permits such enrollment.

 8         (b)  The provisions of s. 409.814(3), (4), and (5), and

 9  (6) are shall be applicable to the Medikids program.

10         (7)  ENROLLMENT.--Enrollment in the Medikids program

11  component may occur at any time throughout the year. A child

12  may not receive services under the Medikids program until the

13  child is enrolled in a managed care plan or MediPass. Once

14  determined eligible, an applicant may receive choice

15  counseling and select a managed care plan or MediPass. The

16  agency may initiate mandatory assignment for a Medikids

17  applicant who has not chosen a managed care plan or MediPass

18  provider after the applicant's voluntary choice period ends.

19  An applicant may select MediPass under the Medikids program

20  component only in counties that have fewer than two managed

21  care plans available to serve Medicaid recipients and only if

22  the federal Centers for Medicare and Medicaid Services Health

23  Care Financing Administration determines that MediPass

24  constitutes "health insurance coverage" as defined in Title

25  XXI of the Social Security Act.

26         Section 3.  Subsection (2) of section 409.8134, Florida

27  Statutes, is amended to read:

28         409.8134  Program enrollment and expenditure

29  ceilings.--

30         (2)  The Florida KidCare program may conduct enrollment

31  at any time throughout the year for the purpose of enrolling

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    Florida Senate - 2006                           CS for SB 2050
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 1  children eligible for all program components listed in s.

 2  409.813 except Medicaid. The four Florida KidCare

 3  administrators shall work together to ensure that the

 4  year-round enrollment period is announced statewide. Eligible

 5  children shall be enrolled on a first-come, first-served basis

 6  using the date the enrollment application is received.

 7  Enrollment shall immediately cease when the enrollment ceiling

 8  is reached. Year-round enrollment shall only be held if the

 9  Social Services Estimating Conference determines that

10  sufficient federal and state funds will be available to

11  finance the increased enrollment through federal fiscal year

12  2007. Any individual who is not enrolled must reapply by

13  submitting a new application. The application for the Florida

14  KidCare program is shall be valid for a period of 120 days

15  after the date it was received. At the end of the 120-day

16  period, if the applicant has not been enrolled in the program,

17  the application is shall be invalid and the applicant shall be

18  notified of the action. The applicant may resubmit the

19  application after notification of the action taken by the

20  program. Except for the Medicaid program, whenever the Social

21  Services Estimating Conference determines that there are

22  presently, or will be by the end of the current fiscal year,

23  insufficient funds to finance the current or projected

24  enrollment in the Florida KidCare program, all additional

25  enrollment must cease and additional enrollment may not resume

26  until sufficient funds are available to finance the such

27  enrollment.

28         Section 4.  Section 409.814, Florida Statutes, is

29  amended to read:

30         409.814  Eligibility.--A child who has not reached 19

31  years of age whose family income is equal to or below the

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    Florida Senate - 2006                           CS for SB 2050
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 1  maximum income threshold 200 percent of the federal poverty

 2  level is eligible for the Florida KidCare program as provided

 3  in this section. For enrollment in the Children's Medical

 4  Services Network, a complete application includes the medical

 5  or behavioral health screening. If, subsequently, an

 6  individual is determined to be ineligible for coverage, he or

 7  she must immediately be disenrolled from the respective

 8  Florida KidCare program component.

 9         (1)  A child who is eligible for Medicaid coverage

10  under s. 409.903 or s. 409.904 must be enrolled in Medicaid

11  and is not eligible to receive health benefits under any other

12  health benefits coverage authorized under the Florida KidCare

13  program.

14         (2)  A child who is not eligible for Medicaid, but who

15  is eligible for the Florida KidCare program, may obtain health

16  benefits coverage under any of the other components listed in

17  s. 409.813 if such coverage is approved and available in the

18  county in which the child resides. However, a child who is

19  eligible for Medikids may participate in the Florida Healthy

20  Kids program only if the child has a sibling participating in

21  the Florida Healthy Kids program and the child's county of

22  residence permits such enrollment.

23         (3)  A child who is eligible for the Florida KidCare

24  program who is a child with special health care needs, as

25  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  federal premium assistance for health benefits coverage under

30  the Florida KidCare program, except under Medicaid if the

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1  child would have been eligible for Medicaid under s. 409.903

 2  or s. 409.904 as of June 1, 1997:

 3         (a)  A child who is eligible for coverage under a state

 4  health benefit plan on the basis of a family member's

 5  employment with a public agency in the state.

 6         (b)  A child who is currently eligible for or covered

 7  under a family member's group health benefit plan or under

 8  other employer health insurance coverage, excluding coverage

 9  provided under the Florida Healthy Kids Corporation as

10  established under s. 624.91, provided that the cost of the

11  child's participation is not greater than 5 percent of the

12  family's income. This provision shall be applied during

13  redetermination for children who were enrolled prior to July

14  1, 2004. These enrollees shall have 6 months of eligibility

15  following redetermination to allow for a transition to the

16  other health benefit plan.

17         (c)  A child who is seeking premium assistance for the

18  Florida KidCare program through employer-sponsored group

19  coverage, if the child has been covered by the same employer's

20  group coverage during the 6 months prior to the family's

21  submitting an application for determination of eligibility

22  under the program.

23         (d)  A child who is an alien, but who does not meet the

24  definition of qualified alien, in the United States.

25         (e)  A child who is an inmate of a public institution

26  or a patient in an institution for mental diseases.

27         (f)  A child who has had his or her coverage in an

28  employer-sponsored health benefit plan voluntarily canceled in

29  the last 6 months, except those children who were on the

30  waiting list prior to March 12, 2004.

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1         (g)  A child who is otherwise eligible for KidCare and

 2  who has a preexisting condition that prevents coverage under

 3  another insurance plan as described in paragraph (b) which

 4  would have disqualified the child for KidCare if the child

 5  were able to enroll in the plan shall be eligible for KidCare

 6  coverage when enrollment is possible.

 7         (5)  Subject to a specific appropriation for this

 8  purpose, the following children are eligible to receive

 9  nonfederal premium assistance for health benefits coverage

10  under the Florida KidCare program, except under Medicaid, if

11  the child would have been eligible for Medicaid under s.

12  409.903 or s. 409.904 as of June 1, 1997:

13         (a)  A child who is eligible for coverage under a state

14  health benefit plan on the basis of a family member's

15  employment with a public agency in the state.

16         (b)  A child who is an alien, but who does not meet the

17  definition of qualified alien, in the United States.

18         (6)(5)  A child whose family income is above the

19  maximum income threshold 200 percent of the federal poverty

20  level or a child who is excluded under the provisions of

21  subsection (4) may participate in the Florida KidCare program,

22  excluding the Medicaid program, but is subject to the

23  following provisions:

24         (a)  The family is not eligible for premium assistance

25  payments and must pay the full cost of the premium, including

26  any administrative costs.

27         (b)  The agency is authorized to place limits on

28  enrollment in Medikids by these children in order to avoid

29  adverse selection. The number of children participating in

30  Medikids whose family income exceeds the maximum income

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1  threshold 200 percent of the federal poverty level must not

 2  exceed 10 percent of total enrollees in the Medikids program.

 3         (c)  The board of directors of the Florida Healthy Kids

 4  Corporation is authorized to place limits on enrollment of

 5  these children in order to avoid adverse selection. In

 6  addition, the board is authorized to offer a reduced benefit

 7  package to these children in order to limit program costs for

 8  such families. The number of children participating in the

 9  Florida Healthy Kids program whose family income exceeds the

10  maximum income threshold 200 percent of the federal poverty

11  level must not exceed 10 percent of total enrollees in the

12  Florida Healthy Kids program.

13         (d)  Children described in this subsection are not

14  counted in the annual enrollment ceiling for the Florida

15  KidCare program.

16         (7)(6)  Once a child is enrolled in the Florida KidCare

17  program, the child is eligible for coverage under the program

18  for 12 months without a redetermination or reverification of

19  eligibility, if the family continues to pay the applicable

20  premium. Eligibility for program components funded through

21  Title XXI of the Social Security Act shall terminate when a

22  child attains the age of 19. Effective January 1, 1999, a

23  child who has not attained the age of 5 and who has been

24  determined eligible for the Medicaid program is eligible for

25  coverage for 12 months without a redetermination or

26  reverification of eligibility.

27         (8)(7)  When determining or reviewing a child's

28  eligibility under the Florida KidCare program, the applicant

29  shall be provided with reasonable notice of changes in

30  eligibility which may affect enrollment in one or more of the

31  program components. When a transition from one program

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 1  component to another is authorized, there shall be cooperation

 2  between the program components and the affected family which

 3  promotes continuity of health care coverage. Any authorized

 4  transfers must be managed within the program's overall

 5  appropriated or authorized levels of funding. Each component

 6  of the program shall establish a reserve to ensure that

 7  transfers between components will be accomplished within

 8  current year appropriations. These reserves shall be reviewed

 9  by each convening of the Social Services Estimating Conference

10  to determine the adequacy of such reserves to meet actual

11  experience.

12         (9)(8)  In determining the eligibility of a child, an

13  assets test is not required. Each applicant shall provide

14  written documentation during the application process and the

15  redetermination process, including, but not limited to, the

16  following:

17         (a)  Proof of family income, which must include a copy

18  of the applicant's most recent federal income tax return. In

19  the absence of a federal income tax return, an applicant may

20  submit wages and earnings statements (pay stubs), W-2 forms,

21  or other appropriate documents.

22         (b)  A statement from all family members that:

23         1.  Their employer does not sponsor a health benefit

24  plan for employees; or

25         2.  The potential enrollee is not covered by the

26  employer-sponsored health benefit plan because the potential

27  enrollee is not eligible for coverage, or, if the potential

28  enrollee is eligible but not covered, a statement of the cost

29  to enroll the potential enrollee in the employer-sponsored

30  health benefit plan.

31  

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 1         (10)(9)  Subject to paragraph (4)(b) and s. 624.91(3),

 2  the Florida KidCare program shall withhold benefits from an

 3  enrollee if the program obtains evidence that the enrollee is

 4  no longer eligible, submitted incorrect or fraudulent

 5  information in order to establish eligibility, or failed to

 6  provide verification of eligibility. The applicant or enrollee

 7  shall be notified that because of such evidence program

 8  benefits will be withheld unless the applicant or enrollee

 9  contacts a designated representative of the program by a

10  specified date, which must be within 10 days after the date of

11  notice, to discuss and resolve the matter. The program shall

12  make every effort to resolve the matter within a timeframe

13  that will not cause benefits to be withheld from an eligible

14  enrollee.

15         (11)(10)  The following individuals may be subject to

16  prosecution in accordance with s. 414.39:

17         (a)  An applicant obtaining or attempting to obtain

18  benefits for a potential enrollee under the Florida KidCare

19  program when the applicant knows or should have known the

20  potential enrollee does not qualify for the Florida KidCare

21  program.

22         (b)  An individual who assists an applicant in

23  obtaining or attempting to obtain benefits for a potential

24  enrollee under the Florida KidCare program when the individual

25  knows or should have known the potential enrollee does not

26  qualify for the Florida KidCare program.

27         Section 5.  Subsection (3) of section 409.816, Florida

28  Statutes, is amended to read:

29         409.816  Limitations on premiums and cost-sharing.--The

30  following limitations on premiums and cost-sharing are

31  established for the program.

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 1         (3)  Enrollees in families with a family income above

 2  150 percent of the federal poverty level, who are not

 3  receiving coverage under the Medicaid program or who are not

 4  eligible under s. 409.814(6) s. 409.814(5), may be required to

 5  pay enrollment fees, premiums, copayments, deductibles,

 6  coinsurance, or similar charges on a sliding scale related to

 7  income, except that the total annual aggregate cost-sharing

 8  with respect to all children in a family may not exceed 5

 9  percent of the family's income. However, copayments,

10  deductibles, coinsurance, or similar charges may not be

11  imposed for preventive services, including well-baby and

12  well-child care, age-appropriate immunizations, and routine

13  hearing and vision screenings.

14         Section 6.  Subsection (3) of section 409.818, Florida

15  Statutes, is amended to read:

16         409.818  Administration.--In order to implement ss.

17  409.810-409.820, the following agencies shall have the

18  following duties:

19         (3)  The Agency for Health Care Administration, under

20  the authority granted in s. 409.914(1), shall:

21         (a)  Calculate the premium assistance payment necessary

22  to comply with the premium and cost-sharing limitations

23  specified in s. 409.816. The premium assistance payment for

24  each enrollee in a health insurance plan participating in the

25  Florida Healthy Kids Corporation shall equal the premium

26  approved by the Florida Healthy Kids Corporation and the

27  Office of Insurance Regulation of the Financial Services

28  Commission pursuant to ss. 627.410 and 641.31, less any

29  enrollee's share of the premium established within the

30  limitations specified in s. 409.816. The premium assistance

31  payment for each enrollee in an employer-sponsored health

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 1  insurance plan approved under ss. 409.810-409.820 shall equal

 2  the premium for the plan adjusted for any benchmark benefit

 3  plan actuarial equivalent benefit rider approved by the Office

 4  of Insurance Regulation pursuant to ss. 627.410 and 641.31,

 5  less any enrollee's share of the premium established within

 6  the limitations specified in s. 409.816. In calculating the

 7  premium assistance payment levels for children with family

 8  coverage, the agency shall set the premium assistance payment

 9  levels for each child proportionately to the total cost of

10  family coverage.

11         (b)  Annually calculate the program enrollment ceiling

12  based on estimated per child premium assistance payments and

13  the estimated appropriation available for the program.

14         (c)  Make premium assistance payments to health

15  insurance plans on a periodic basis. The agency may use its

16  Medicaid fiscal agent or a contracted third-party

17  administrator in making these payments.  The agency may

18  require health insurance plans that participate in the

19  Medikids program or employer-sponsored group health insurance

20  to collect premium payments from an enrollee's family.

21  Participating health insurance plans shall report premium

22  payments collected on behalf of enrollees in the program to

23  the agency in accordance with a schedule established by the

24  agency.

25         (d)  Monitor compliance with quality assurance and

26  access standards developed under s. 409.820.

27         (e)  Establish a mechanism for investigating and

28  resolving complaints and grievances from program applicants,

29  enrollees, and health benefits coverage providers, and

30  maintain a record of complaints and confirmed problems. In the

31  case of a child who is enrolled in a health maintenance

                                  17

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    Florida Senate - 2006                           CS for SB 2050
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 1  organization, the agency must use the provisions of s. 641.511

 2  to address grievance reporting and resolution requirements.

 3         (f)  Approve health benefits coverage for participation

 4  in the program, following certification by the Office of

 5  Insurance Regulation under subsection (4).

 6         (g)  Adopt rules necessary for calculating premium

 7  assistance payment levels, calculating the program enrollment

 8  ceiling, making premium assistance payments, monitoring access

 9  and quality assurance standards, investigating and resolving

10  complaints and grievances, administering the Medikids program,

11  and approving health benefits coverage.

12  

13  The agency is designated the lead state agency for Title XXI

14  of the Social Security Act for purposes of receipt of federal

15  funds, for reporting purposes, and for ensuring compliance

16  with federal and state regulations and rules. The agency shall

17  seek approval from the federal Centers for Medicare and

18  Medicaid Services for the highest maximum income threshold of

19  up to 300 percent of the most recently stated federal poverty

20  limit. Until the federal agency approves the request, the

21  maximum income threshold used for the Florida KidCare program

22  shall be 200 percent of the most recently stated federal

23  poverty limit or the highest income threshold allowed under

24  current federal law. Any such expansion under this subsection

25  is subject to a specified appropriation for such purpose.

26         Section 7.  Section 409.821, Florida Statutes, is

27  amended to read:

28         409.821  Florida KidCare program public records

29  exemption.--Notwithstanding any other law to the contrary, any

30  information identifying a Florida KidCare program applicant or

31  enrollee, as defined in s. 409.811, held by the Agency for

                                  18

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    Florida Senate - 2006                           CS for SB 2050
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 1  Health Care Administration, the Department of Children and

 2  Family Services, the Department of Health, or the Florida

 3  Healthy Kids Corporation is confidential and exempt from s.

 4  119.07(1) and s. 24(a), Art. I of the State Constitution. Such

 5  information may be disclosed to another governmental entity

 6  only if disclosure is necessary for the entity to perform its

 7  duties and responsibilities under the Florida KidCare program

 8  and shall be disclosed to the Department of Revenue for

 9  purposes of administering the state Title IV-D program. The

10  receiving governmental entity must maintain the confidential

11  and exempt status of such information. Furthermore, such

12  information may not be released to any person without the

13  written consent of the program applicant. This exemption

14  applies to any information identifying a Florida KidCare

15  program applicant or enrollee held by the Agency for Health

16  Care Administration, the Department of Children and Family

17  Services, the Department of Health, or the Florida Healthy

18  Kids Corporation before, on, or after the effective date of

19  this exemption. A violation of this section is a misdemeanor

20  of the second degree, punishable as provided in s. 775.082 or

21  s. 775.083. This section does not prohibit an enrollee's

22  parent or legal guardian from obtaining confirmation of

23  coverage and dates of coverage.

24         Section 8.  Subsections (3) and (5) of section 624.91,

25  Florida Statutes, are amended to read:

26         624.91  The Florida Healthy Kids Corporation Act.--

27         (3)  ELIGIBILITY FOR NONFEDERAL STATE-FUNDED

28  ASSISTANCE.--Only residents of this state between 5 and 18

29  years of age who meet the qualifications for the Florida

30  KidCare program under s. 409.814 are eligible for nonfederal

31  assistance in the Florida Healthy Kids program. the following

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    Florida Senate - 2006                           CS for SB 2050
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 1  individuals are eligible for state-funded assistance in paying

 2  Florida Healthy Kids premiums:

 3         (a)  Residents of this state who are eligible for the

 4  Florida KidCare program pursuant to s. 409.814.

 5         (b)  Notwithstanding s. 409.814, legal aliens who are

 6  enrolled in the Florida Healthy Kids program as of January 31,

 7  2004, who do not qualify for Title XXI federal funds because

 8  they are not qualified aliens as defined in s. 409.811.

 9         (c)  Notwithstanding s. 409.814, individuals who have

10  attained the age of 19 as of March 31, 2004, who were

11  receiving Florida Healthy Kids benefits prior to the enactment

12  of the Florida KidCare program. This paragraph shall be

13  repealed March 31, 2005.

14         (d)  Notwithstanding s. 409.814, state employee

15  dependents who were enrolled in the Florida Healthy Kids

16  program as of January 31, 2004. Such individuals shall remain

17  eligible until January 1, 2005.

18         (5)  CORPORATION AUTHORIZATION, DUTIES, PROMOTION,

19  POWERS.--

20         (a)  There is created the Florida Healthy Kids

21  Corporation, a not-for-profit corporation.

22         (b)  The Florida Healthy Kids Corporation shall:

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

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

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

26  payment of premiums for comprehensive insurance coverage and

27  for the actual or estimated administrative expenses.

28         2.  Arrange for the collection of any voluntary

29  contributions to provide for payment of premiums for children

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

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

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    Florida Senate - 2006                           CS for SB 2050
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 1  shall establish a local match policy for the enrollment of

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

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

 4  notification of the amount to be remitted to the corporation

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

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

 7  municipalities, counties, school boards, hospitals, health

 8  care providers, charitable organizations, special taxing

 9  districts, and private organizations. The minimum local match

10  cash contributions required each fiscal year and local match

11  credits shall be determined by the General Appropriations Act.

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

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

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

15  most recently audited financial statement. In awarding the

16  local match credits, the corporation may consider factors

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

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

19  services.

20         2.3.  Subject to the provisions of s. 409.8134, accept

21  voluntary supplemental local match contributions that comply

22  with the requirements of Title XXI of the Social Security Act

23  for the purpose of providing additional coverage in

24  contributing counties under Title XXI.

25         3.4.  Establish the administrative and accounting

26  procedures for the operation of the corporation.

27         4.5.  Establish, with consultation from appropriate

28  professional organizations, standards for preventive health

29  services and providers and comprehensive insurance benefits

30  appropriate to children, provided that the such standards for

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1  rural areas do shall not limit primary care providers to

 2  board-certified pediatricians.

 3         5.6.  Determine eligibility for children seeking to

 4  participate in the Title XXI-funded components of the Florida

 5  KidCare program consistent with the requirements specified in

 6  s. 409.814, as well as the non-Title-XXI-eligible children as

 7  provided in subsection (3).

 8         6.7.  Establish procedures under which providers of

 9  local match to, applicants to and participants in the program

10  may have grievances reviewed by an impartial body and reported

11  to the board of directors of the corporation.

12         7.8.  Establish participation criteria and, if

13  appropriate, contract with an authorized insurer, health

14  maintenance organization, or third-party administrator to

15  provide administrative services to the corporation.

16         8.9.  Establish enrollment criteria that which shall

17  include penalties or waiting periods of not fewer than 60 days

18  for reinstatement of coverage upon voluntary cancellation for

19  nonpayment of family premiums.

20         9.10.  Contract with authorized insurers or any

21  provider of health care services, meeting standards

22  established by the corporation, for the provision of

23  comprehensive insurance coverage to participants. Such

24  standards shall include criteria under which the corporation

25  may contract with more than one provider of health care

26  services in program sites. Health plans shall be selected

27  through a competitive bid process. The Florida Healthy Kids

28  Corporation shall purchase goods and services in the most

29  cost-effective manner consistent with the delivery of quality

30  medical care. The maximum administrative cost for a Florida

31  Healthy Kids Corporation contract shall be 15 percent. For

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    Florida Senate - 2006                           CS for SB 2050
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 1  health care contracts, the minimum medical loss ratio for a

 2  Florida Healthy Kids Corporation contract shall be 85 percent.

 3  For dental contracts, the remaining compensation to be paid to

 4  the authorized insurer or provider under a Florida Healthy

 5  Kids Corporation contract shall be no less than an amount

 6  which is 85 percent of premium; to the extent any contract

 7  provision does not provide for this minimum compensation, this

 8  section shall prevail. The health plan selection criteria and

 9  scoring system, and the scoring results, shall be available

10  upon request for inspection after the bids have been awarded.

11         11.  Establish disenrollment criteria in the event

12  local matching funds are insufficient to cover enrollments.

13         10.12.  Develop and implement a plan to publicize the

14  Florida Healthy Kids Corporation, the eligibility requirements

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

16  program and to maintain public awareness of the corporation

17  and the program. Participating health and dental plans may

18  develop marketing and other promotional materials and

19  participate in activities, such as health fairs and public

20  events, as approved by the corporation. The health and dental

21  plans may also contact their enrollees and former enrollees to

22  encourage continued participation in the plan.

23         11.13.  Secure staff necessary to properly administer

24  the corporation. Staff costs shall be funded from state and

25  local matching funds and such other private or public funds as

26  become available. The board of directors shall determine the

27  number of staff members necessary to administer the

28  corporation.

29         12.14.  Provide a report annually to the Governor,

30  Chief Financial Officer, Commissioner of Education, Senate

31  President, Speaker of the House of Representatives, and

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    Florida Senate - 2006                           CS for SB 2050
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 1  Minority Leaders of the Senate and the House of

 2  Representatives.

 3         13.15.  Establish benefit packages which conform to the

 4  provisions of the Florida KidCare program, as created in ss.

 5  409.810-409.820.

 6         (c)  Coverage under the corporation's program is

 7  secondary to any other available private coverage held by, or

 8  applicable to, the participant child or family member.

 9  Insurers under contract with the corporation are the payors of

10  last resort and must coordinate benefits with any other

11  third-party payor that may be liable for the participant's

12  medical care.

13         (d)  The Florida Healthy Kids Corporation shall be a

14  private corporation not for profit, organized under pursuant

15  to chapter 617, and shall have all powers necessary to carry

16  out the purposes of this act, including, but not limited to,

17  the power to receive and accept grants, loans, or advances of

18  funds from any public or private agency and to receive and

19  accept from any source contributions of money, property,

20  labor, or any other thing of value, to be held, used, and

21  applied for the purposes of this section act.

22         Section 9.  This act shall take effect July 1, 2006.

23  

24  

25  

26  

27  

28  

29  

30  

31  

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    Florida Senate - 2006                           CS for SB 2050
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 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         Senate Bill 2050

 3                                 

 4  The committee substitute changes eligibility requirements in
    the Florida KidCare Program to allow a child who is an alien
 5  and a chid who is eligible for coverage under a state health
    benefit plan to receive non-federal premium assistance. The
 6  bill also repeals the requirement of local match for
    non-federal premium assistance.
 7  
    The bill directs the Agency for Health Care Administration to
 8  pursue a federal waiver to increase the financial eligibility
    threshold for Title XXI premium assistance to up to 300
 9  percent of the federal poverty level. The bill defines the
    maximum income threshold for federal premium assistance at a
10  mimimum of 200 percent of the federal poverty level until an
    approved federal waiver authorizes a higher threshold.
11  
    The bill allows health and dental plans participating in the
12  Healthy Kids Program to market the program and clarifies that
    Florida Healthy Kids Corporation may release certain
13  information concerning a child's application to parents or
    legal guardians.
14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

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