Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. SB 1740
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CHAMBER ACTION
Senate House
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11 The Committee on Health Policy (Dockery) recommended the
12 following amendment:
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14 Senate Amendment
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Subsection (27) is added to section
19 409.811, Florida Statutes, to read:
20 409.811 Definitions relating to Florida Kidcare
21 Act.--As used in ss. 409.810-409.820, the term:
22 (27) "Maximum income threshold" means a percentage of
23 the current federal poverty level used to determine
24 eligibility for certain program components, as approved by
25 federal waiver or an amendment to the state plan.
26 Section 2. Paragraph (a) of subsection (6) and
27 subsection (7) of section 409.8132, Florida Statutes, are
28 amended to read:
29 409.8132 Medikids program component.--
30 (6) ELIGIBILITY.--
31 (a) A child who has attained the age of 1 year but who
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1 is under the age of 5 years is eligible to enroll in the
2 Medikids program component of the Florida Kidcare program, if
3 the child is a member of a family that has a family income
4 which exceeds the Medicaid applicable income level as
5 specified in s. 409.903, but which is equal to or below the
6 maximum income threshold 200 percent of the current federal
7 poverty level. In determining the eligibility of such a child,
8 an assets test is not required. A child who is eligible for
9 Medikids may elect to enroll in Florida Healthy Kids coverage
10 or employer-sponsored group coverage. However, a child who is
11 eligible for Medikids may participate in the Florida Healthy
12 Kids program only if the child has a sibling participating in
13 the Florida Healthy Kids program and the child's county of
14 residence permits such enrollment.
15 (7) ENROLLMENT.--Enrollment in the Medikids program
16 component may occur at any time throughout the year. A child
17 may not receive services under the Medikids program until the
18 child is enrolled in a managed care plan or MediPass. Once
19 determined eligible, an applicant may receive choice
20 counseling and select a managed care plan or MediPass. The
21 agency may initiate mandatory assignment for a Medikids
22 applicant who has not chosen a managed care plan or MediPass
23 provider after the applicant's voluntary choice period ends.
24 The Medikids mandatory assignment process shall assign
25 applicants to managed care plans or MediPass providers in
26 order to keep family members assigned to the came managed care
27 plan or MediPass provider to the greatest extent possible,
28 including situations in which some family members are enrolled
29 in Medicaid and others are enrolled in a Title XXI Kidcare
30 component. An applicant may select MediPass under the
31 Medikids program component only in counties that have fewer
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1 than two managed care plans available to serve Medicaid
2 recipients and only if the federal Health Care Financing
3 Administration determines that MediPass constitutes "health
4 insurance coverage" as defined in Title XXI of the Social
5 Security Act.
6 Section 3. Subsection (2) of section 409.8134, Florida
7 Statutes, is amended to read:
8 409.8134 Program expenditure ceiling.--
9 (2) The Florida Kidcare program may conduct enrollment
10 at any time throughout the year for the purpose of enrolling
11 children eligible for all program components listed in s.
12 409.813 except Medicaid. The four Florida Kidcare
13 administrators shall work together to ensure that the
14 year-round enrollment period is announced statewide. Eligible
15 children shall be enrolled on a first-come, first-served basis
16 using the date the enrollment application is received.
17 Enrollment shall immediately cease when the expenditure
18 ceiling is reached. Year-round enrollment shall only be held
19 only if the Social Services Estimating Conference determines
20 that sufficient federal and state funds will be available to
21 finance the increased enrollment through federal fiscal year
22 2007. Any individual who is not enrolled must reapply by
23 submitting a new application. The application for the Florida
24 Kidcare program shall be valid for a period of 120 days after
25 the date it was received. At the end of the 120-day period, if
26 the applicant has not been enrolled in the program, the
27 application shall be invalid and the applicant shall be
28 notified of the action. The applicant may reactivate resubmit
29 the application after notification of the action taken by the
30 program. Except for the Medicaid program, whenever the Social
31 Services Estimating Conference determines that there are
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1 presently, or will be by the end of the current fiscal year,
2 insufficient funds to finance the current or projected
3 enrollment in the Florida Kidcare program, all additional
4 enrollment must cease and additional enrollment may not resume
5 until sufficient funds are available to finance such
6 enrollment.
7 Section 4. Section 409.814, Florida Statutes, is
8 amended to read:
9 409.814 Eligibility.--A child who has not reached 19
10 years of age and whose family income is equal to or below the
11 maximum income threshold 200 percent of the federal poverty
12 level is eligible for the Florida Kidcare program as provided
13 in this section. For enrollment in the Children's Medical
14 Services Network, a complete application includes the medical
15 or behavioral health screening. If, subsequently, an
16 individual is determined to be ineligible for coverage, he or
17 she must immediately be disenrolled from the respective
18 Florida Kidcare program component.
19 (1) A child who is eligible for Medicaid coverage
20 under s. 409.903 or s. 409.904 must be enrolled in Medicaid
21 and is not eligible to receive health benefits under any other
22 health benefits coverage authorized under the Florida Kidcare
23 program.
24 (2) A child who is not eligible for Medicaid, but who
25 is eligible for the Florida Kidcare program, may obtain health
26 benefits coverage under any of the other components listed in
27 s. 409.813 if such coverage is approved and available in the
28 county in which the child resides. However, a child who is
29 eligible for Medikids may participate in the Florida Healthy
30 Kids program only if the child has a sibling participating in
31 the Florida Healthy Kids program and the child's county of
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1 residence permits such enrollment.
2 (3) A child who is eligible for the Florida Kidcare
3 program who is a child with special health care needs, as
4 determined through a medical or behavioral screening
5 instrument, is eligible for health benefits coverage from and
6 shall be referred to the Children's Medical Services Network.
7 (4) A child who will lose eligibility for Florida
8 Kidcare coverage funded under Title XIX because the child has
9 exceeded income or age limits shall be presumed eligible for
10 the Florida Kidcare program and shall have 60 days of
11 continued eligibility within his or her existing plan or
12 coverage following redetermination in order to allow for a
13 transition to Title XXI-funded Florida Kidcare coverage
14 without a lapse in coverage. The Agency for Health Care
15 Administration shall seek federal waiver authority under Title
16 XIX or Title XXI for such continued eligibility with the goal
17 of securing federal matching funds consistent with the federal
18 SCHIP match for the additional 60 days of eligibility.
19 (5)(4) The following children are not eligible to
20 receive premium assistance for health benefits coverage under
21 the Florida Kidcare program, except under Medicaid if the
22 child would have been eligible for Medicaid under s. 409.903
23 or s. 409.904 as of June 1, 1997:
24 (a) A child who is eligible for coverage under a state
25 health benefit plan on the basis of a family member's
26 employment with a public agency in the state.
27 (b) A child who is currently eligible for or covered
28 under a family member's group health benefit plan or under
29 other employer health insurance coverage, excluding coverage
30 provided under the Florida Healthy Kids Corporation as
31 established under s. 624.91, provided that the cost of the
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1 child's participation is not greater than 5 percent of the
2 family's income. This provision shall be applied during
3 redetermination for children who were enrolled prior to July
4 1, 2004. These enrollees shall have 6 months of eligibility
5 following redetermination to allow for a transition to the
6 other health benefit plan.
7 (c) A child who is seeking premium assistance for the
8 Florida Kidcare program through employer-sponsored group
9 coverage, if the child has been covered by the same employer's
10 group coverage during the 6 months prior to the family's
11 submitting an application for determination of eligibility
12 under the program.
13 (d) A child who is an alien, but who does not meet the
14 definition of qualified alien, in the United States.
15 (e) A child who is an inmate of a public institution
16 or a patient in an institution for mental diseases.
17 (f) A child who has had his or her coverage in an
18 employer-sponsored health benefit plan voluntarily canceled in
19 the last 6 months, except those children who were on the
20 waiting list prior to March 12, 2004.
21 (f)(g) A child who is otherwise eligible for Kidcare
22 and who has a preexisting condition that prevents coverage
23 under another insurance plan as described in paragraph (b)
24 which would have disqualified the child for Kidcare if the
25 child were able to enroll in the plan shall be eligible for
26 Kidcare coverage when enrollment is possible.
27 (6)(5) A child whose family income is above the
28 maximum income threshold 200 percent of the federal poverty
29 level or a child who is excluded under the provisions of
30 subsection (5) (4) may participate in the Medikids program as
31 provided in s. 409.8132 or, if the child is ineligible for
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1 Medikids by reason of age, in the Florida Healthy Kids
2 program, subject to the following provisions:
3 (a) The family is not eligible for premium assistance
4 payments and must pay the full cost of the premium, including
5 any administrative costs.
6 (b) The agency is authorized to place limits on
7 enrollment in Medikids by these children in order to avoid
8 adverse selection. The number of children participating in
9 Medikids whose family income exceeds the maximum income
10 threshold 200 percent of the federal poverty level must not
11 exceed 10 percent of total enrollees in the Medikids program.
12 (c) The board of directors of the Florida Healthy Kids
13 Corporation is authorized to place limits on enrollment of
14 these children in order to avoid adverse selection. In
15 addition, the board is authorized to offer a reduced benefit
16 package to these children in order to limit program costs for
17 such families. The number of children participating in the
18 Florida Healthy Kids program whose family income exceeds the
19 maximum income threshold 200 percent of the federal poverty
20 level must not exceed 10 percent of total enrollees in the
21 Florida Healthy Kids program.
22 (7)(6) Once a child is enrolled in the Florida Kidcare
23 program, the child is eligible for coverage under the program
24 for 12 months without a redetermination or reverification of
25 eligibility, if the family continues to pay the applicable
26 premium. Eligibility for program components funded through
27 Title XXI of the Social Security Act shall terminate when a
28 child attains the age of 19. Effective January 1, 1999, a
29 child who has not attained the age of 5 and who has been
30 determined eligible for the Medicaid program is eligible for
31 coverage for 12 months without a redetermination or
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1 reverification of eligibility.
2 (8)(7) When determining or reviewing a child's
3 eligibility under the Florida Kidcare program, the applicant
4 shall be provided with reasonable notice of changes in
5 eligibility which may affect enrollment in one or more of the
6 program components. When a transition from one program
7 component to another is authorized, there shall be cooperation
8 between the program components, and the affected family, the
9 child's health plan, and the child's health care providers to
10 promote which promotes continuity of health care coverage. The
11 agency, in coordination with the Department of Children and
12 Family Services, shall notify the Medicaid managed care plans
13 and MediPass providers concerning their members' or patients'
14 loss of eligibility for Medicaid or Medikids no less than 60
15 days in advance so that the health plans and providers may
16 assist the families in applying for the Florida Healthy Kids
17 program. Any authorized transfers must be managed within the
18 program's overall appropriated or authorized levels of
19 funding. Each component of the program shall establish a
20 reserve to ensure that transfers between components will be
21 accomplished within current year appropriations. These
22 reserves shall be reviewed by each convening of the Social
23 Services Estimating Conference to determine the adequacy of
24 such reserves to meet actual experience.
25 (9)(8) In determining the eligibility of a child, an
26 assets test is not required. Each applicant's family income,
27 birth certificate, and proof of identity shall be verified
28 electronically in order to determine eligibility for the
29 Florida Kidcare program. If electronic verification of
30 eligibility information is not available, an Each applicant
31 shall provide written documentation during the application
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1 process and the redetermination process, including, but not
2 limited to, the following:
3 (a) Proof of family income, which must include a copy
4 of the applicant's most recent federal income tax return. In
5 the absence of a federal income tax return, an applicant may
6 submit wages and earnings statements (pay stubs), W-2 forms,
7 or other appropriate documents.
8 (b) A statement from all employed family members that:
9 1. Their employer does not sponsor a health benefit
10 plan for employees; or
11 2. The potential enrollee is not covered by the
12 employer-sponsored health benefit plan because the potential
13 enrollee is not eligible for coverage, or, if the potential
14 enrollee is eligible but not covered, a statement of the cost
15 to enroll the potential enrollee in the employer-sponsored
16 health benefit plan.
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18 Anyone applying for full-pay coverage under the Florida
19 Kidcare program is not required to provide the eligibility
20 information required under this section.
21 (10)(9) Subject to paragraph (5) (4)(b) and s.
22 624.91(4), the Florida Kidcare program shall withhold benefits
23 from an enrollee if the program obtains evidence that the
24 enrollee is no longer eligible, submitted incorrect or
25 fraudulent information in order to establish eligibility, or
26 failed to provide verification of eligibility. The applicant
27 or enrollee shall be notified that because of such evidence
28 program benefits will be withheld unless the applicant or
29 enrollee contacts a designated representative of the program
30 by a specified date, which must be within 10 days after the
31 date of notice, to discuss and resolve the matter. The program
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1 shall make every effort to resolve the matter within a
2 timeframe that will not cause benefits to be withheld from an
3 eligible enrollee.
4 (11)(10) The following individuals may be subject to
5 prosecution in accordance with s. 414.39:
6 (a) An applicant obtaining or attempting to obtain
7 benefits for a potential enrollee under the Florida Kidcare
8 program when the applicant knows or should have known the
9 potential enrollee does not qualify for the Florida Kidcare
10 program.
11 (b) An individual who assists an applicant in
12 obtaining or attempting to obtain benefits for a potential
13 enrollee under the Florida Kidcare program when the individual
14 knows or should have known the potential enrollee does not
15 qualify for the Florida Kidcare program.
16 Section 5. Subsection (1) of section 409.818, Florida
17 Statutes, is amended, and paragraph (g) is added to subsection
18 (3) of that section, to read:
19 409.818 Administration.--In order to implement ss.
20 409.810-409.820, the following agencies shall have the
21 following duties:
22 (1) The Department of Children and Family Services
23 shall:
24 (a) Develop a standardized simplified eligibility
25 application mail-in form to be used for determining the
26 eligibility of children for coverage for all components of
27 under the Florida Kidcare program, in consultation with the
28 agency, the Department of Health, and the Florida Healthy Kids
29 Corporation. The standardized simplified eligibility
30 application form must include an item that provides an
31 opportunity for the applicant to indicate whether coverage is
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1 being sought for a child with special health care needs.
2 Families applying for children's Medicaid coverage must also
3 be able to use the simplified application form without having
4 to pay a premium.
5 (b) Establish and maintain the eligibility
6 determination process under the program except as specified in
7 subsection (5). The department shall directly, or through the
8 services of a contracted third-party administrator, establish
9 and maintain a process for determining eligibility of children
10 for coverage under the program. The eligibility determination
11 process must be used solely for determining eligibility of
12 applicants for health benefits coverage under the program. The
13 eligibility determination process must include an initial
14 determination of eligibility for any coverage offered under
15 the program, as well as a redetermination or reverification of
16 eligibility, 12 months after enrollment each subsequent 6
17 months. Effective January 1, 1999, a child who has not
18 attained the age of 5 and who has been determined eligible for
19 the Medicaid program is eligible for coverage for 12 months
20 without a redetermination or reverification of eligibility. In
21 conducting an eligibility determination, the department shall
22 determine if the child has special health care needs. The
23 department, in consultation with the Agency for Health Care
24 Administration and the Florida Healthy Kids Corporation, shall
25 develop procedures for redetermining eligibility which enable
26 a family to easily update any change in circumstances which
27 could affect eligibility. The department may accept changes in
28 a family's status as reported to the department by the Florida
29 Healthy Kids Corporation without requiring a new application
30 from the family. Redetermination of a child's eligibility for
31 Medicaid may not be linked to a child's eligibility
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1 determination for other programs.
2 (c) Inform program applicants about eligibility
3 determinations and provide information about eligibility of
4 applicants to Medicaid, Medikids, the Children's Medical
5 Services Network, and the Florida Healthy Kids Corporation,
6 and to insurers and their agents, through a centralized
7 coordinating office.
8 (d) Design a plan, in consultation with the Florida
9 Healthy Kids Corporation, for determining eligibility for
10 public assistance or Medicaid which will enable applicants
11 with children who apply to the department for Medicaid or
12 other public assistance to apply for the Healthy Kids program
13 using the same application information in the event they are
14 found ineligible for Medicaid. The plan must be sufficient to
15 enable such applicants to submit all information necessary for
16 enrollment in the Healthy Kids program, including the
17 opportunity for such applicants to indicate whether coverage
18 is being sought for a child with special health care needs.
19 The plan shall allow the department to forward such
20 application information, together with accompanying
21 documentation as necessary, to the Florida Healthy Kids
22 Corporation, and the plan shall allow such application
23 information and documents to be processed for Healthy Kids
24 program enrollment by the Florida Healthy Kids Corporation in
25 accordance with eligibility criteria then in effect without
26 requiring the applicant to submit a separate application for
27 the Healthy Kids program. The department shall submit such
28 plan to the President of the Senate, the Speaker of the House
29 of Representatives, and the Governor no later than December
30 31, 2007.
31 (e)(d) Adopt rules necessary for conducting program
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1 eligibility functions.
2 (3) The Agency for Health Care Administration, under
3 the authority granted in s. 409.914(1), shall:
4 (g) The agency shall seek a state plan amendment and
5 waiver authority, if necessary, from the federal Centers for
6 Medicare and Medicaid Services for a maximum income threshold
7 of up to 225 percent of the federal poverty level. Until the
8 federal agency approves the request, the maximum income
9 threshold used for the Florida KidCare program shall be 200
10 percent of the federal poverty level or the highest income
11 threshold allowed under current federal law and state plan
12 amendment, whichever is higher, up to 225 percent of the
13 federal poverty level. Any such expansion under this
14 subsection is subject to a specified appropriation for such
15 purpose and the availability of federal matching funds for
16 children in families above 200 percent of the federal poverty
17 level.
18
19 The agency is designated the lead state agency for Title XXI
20 of the Social Security Act for purposes of receipt of federal
21 funds, for reporting purposes, and for ensuring compliance
22 with federal and state regulations and rules.
23 Section 6. Paragraph (b) of subsection (2) and
24 paragraph (b) of subsection (5) of section 624.91, Florida
25 Statutes, are amended to read:
26 624.91 The Florida Healthy Kids Corporation Act.--
27 (2) LEGISLATIVE INTENT.--
28 (b) It is the intent of the Legislature that the
29 Florida Healthy Kids Corporation serve as one of several
30 providers of services to children eligible for medical
31 assistance under Title XXI of the Social Security Act.
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1 Although the corporation may serve other children, the
2 Legislature intends that the primary recipients of services
3 provided through the corporation be school-age children with a
4 family income below the maximum income threshold as defined in
5 s. 409.811(27) 200 percent of the federal poverty level, who
6 do not qualify for Medicaid. It is also the intent of the
7 Legislature that state and local government Florida Healthy
8 Kids funds be used to continue coverage, subject to specific
9 appropriations in the General Appropriations Act, to children
10 not eligible for federal matching funds under Title XXI.
11 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
12 (b) The Florida Healthy Kids Corporation shall:
13 1. Arrange for the collection of any family, local
14 contributions, or employer payment or premium, in an amount to
15 be determined by the board of directors, to provide for
16 payment of premiums for comprehensive insurance coverage and
17 for the actual or estimated administrative expenses.
18 2. Arrange for the collection of any voluntary
19 contributions to provide for payment of premiums for children
20 who are not eligible for medical assistance under Title XXI of
21 the Social Security Act.
22 3. Subject to the provisions of s. 409.8134, accept
23 voluntary supplemental local match contributions that comply
24 with the requirements of Title XXI of the Social Security Act
25 for the purpose of providing additional coverage in
26 contributing counties under Title XXI.
27 4. Establish the administrative and accounting
28 procedures for the operation of the corporation.
29 5. Establish, with consultation from appropriate
30 professional organizations, standards for preventive health
31 services and providers and comprehensive insurance benefits
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1 appropriate to children, provided that such standards for
2 rural areas shall not limit primary care providers to
3 board-certified pediatricians.
4 6. Determine eligibility for children seeking to
5 participate in the Title XXI-funded components of the Florida
6 Kidcare program consistent with the requirements specified in
7 s. 409.814, as well as the non-Title-XXI-eligible children as
8 provided in subsection (3).
9 7. Establish procedures under which providers of local
10 match to, applicants to and participants in the program may
11 have grievances reviewed by an impartial body and reported to
12 the board of directors of the corporation.
13 8. Establish participation criteria and, if
14 appropriate, contract with an authorized insurer, health
15 maintenance organization, or third-party administrator to
16 provide administrative services to the corporation.
17 9. Establish enrollment criteria which shall include
18 penalties or waiting periods of not fewer than 60 days for
19 reinstatement of coverage upon voluntary cancellation for
20 nonpayment of family premiums.
21 10. Contract with authorized insurers or any provider
22 of health care services, meeting standards established by the
23 corporation, for the provision of comprehensive insurance
24 coverage to participants. Such standards shall include
25 criteria under which the corporation may contract with more
26 than one provider of health care services in program sites.
27 Health plans shall be selected through a competitive bid
28 process. The Florida Healthy Kids Corporation shall purchase
29 goods and services in the most cost-effective manner
30 consistent with the delivery of quality medical care. The
31 maximum administrative cost for a Florida Healthy Kids
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1 Corporation contract shall be 15 percent. For health care
2 contracts, the minimum medical loss ratio for a Florida
3 Healthy Kids Corporation contract shall be 85 percent. For
4 dental contracts, the remaining compensation to be paid to the
5 authorized insurer or provider under a Florida Healthy Kids
6 Corporation contract shall be no less than an amount which is
7 85 percent of premium; to the extent any contract provision
8 does not provide for this minimum compensation, this section
9 shall prevail. The health plan selection criteria and scoring
10 system, and the scoring results, shall be available upon
11 request for inspection after the bids have been awarded.
12 11. Establish disenrollment criteria in the event
13 local matching funds are insufficient to cover enrollments.
14 12. Develop and implement a plan to publicize the
15 Florida Healthy Kids Corporation, the eligibility requirements
16 of the program, and the procedures for enrollment in the
17 program and to maintain public awareness of the corporation
18 and the program. Health and dental plans participating in the
19 Florida Healthy Kids program may develop and distribute
20 marketing and other promotional materials and participate in
21 activities, such as health fairs and public events, as
22 approved by the corporation. The health and dental plans may
23 also contact their current and former enrollees to encourage
24 continued participation in the program and to assist the
25 enrollee in transferring from a Title XIX-financed plan to a
26 Title XXI-financed plan.
27 13. Secure staff necessary to properly administer the
28 corporation. Staff costs shall be funded from state and local
29 matching funds and such other private or public funds as
30 become available. The board of directors shall determine the
31 number of staff members necessary to administer the
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1 corporation.
2 14. Provide a report annually to the Governor, Chief
3 Financial Officer, Commissioner of Education, Senate
4 President, Speaker of the House of Representatives, and
5 Minority Leaders of the Senate and the House of
6 Representatives.
7 15. Establish benefit packages which conform to the
8 provisions of the Florida Kidcare program, as created in ss.
9 409.810-409.820.
10 16. Establish an assignment process for Healthy Kids
11 enrollees in order to keep family members assigned to the same
12 managed care plan to the greatest extent possible, including
13 situations in which some family members are enrolled in a
14 Medicaid managed care plan and others are enrolled in a
15 Healthy Kids plan. The Agency for Health Care Administration
16 shall work together with the corporation to implement this
17 subparagraph.
18 (c) Coverage under the corporation's program is
19 secondary to any other available private coverage held by, or
20 applicable to, the participant child or family member.
21 Insurers under contract with the corporation are the payors of
22 last resort and must coordinate benefits with any other
23 third-party payor that may be liable for the participant's
24 medical care.
25 (d) The Florida Healthy Kids Corporation shall be a
26 private corporation not for profit, organized pursuant to
27 chapter 617, and shall have all powers necessary to carry out
28 the purposes of this act, including, but not limited to, the
29 power to receive and accept grants, loans, or advances of
30 funds from any public or private agency and to receive and
31 accept from any source contributions of money, property,
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1 labor, or any other thing of value, to be held, used, and
2 applied for the purposes of this act.
3 Section 7. This act shall take effect upon becoming a
4 law.
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