HB 7189

1	A bill to be entitled
2	An act relating to Florida Kidcare; amending ss. 408.915
3	and 409.1451, F.S.; conforming provisions to changes made
4	by the act; amending s. 409.811, F.S.; revising and
5	deleting definitions; amending s. 409.812, F.S.; providing
6	for the Florida Kidcare program to provide health benefits
7	to certain uninsured children; amending s. 409.813, F.S.;
8	specifying components of the program; providing that no
9	cause of action shall arise against the Florida Healthy
10	Kids Corporation for failure to make certain services
11	available; repealing s. 409.8132, F.S., relating to the
12	Medikids program component; amending s. 409.8134, F.S.;
13	revising provisions relating to enrollment in the program;
14	amending s. 409.814, F.S.; revising eligibility
15	requirements for the program; creating s. 409.8141, F.S.;
16	authorizing the program to provide premium assistance to
17	certain children under certain circumstances; providing
18	for verification of assistance eligibility; creating s.
19	409.8142, F.S.; requiring the program to withhold benefits
20	under specified circumstances; providing penalties for
21	certain actions; creating s. 409.8149, F.S.; providing for
22	enrollment, plan choice, and choice counseling; amending
23	s. 409.815, F.S.; requiring health benefits coverage under
24	the Florida Kidcare program to meet specified Medicaid
25	standards; deleting provisions relating to benchmark and
26	minimum benefits included in the program; amending s.
27	409.816, F.S.; providing premium funding sources;
28	providing rate-setting requirements; providing for
29	seamless transition of premium assistance; revising
30	limitations on premiums and cost sharing; amending s.
31	409.817, F.S.; revising requirements for certain health
32	insurance coverage to qualify for premium assistance;
33	amending s. 409.8177, F.S.; conforming provisions to
34	changes made by the act; amending s. 409.818, F.S.;
35	revising duties of the Department of Children and Family
36	Services, the Department of Health, the Agency for Health
37	Care Administration, the Office of Insurance Regulation,
38	and the Florida Healthy Kids Corporation relating to
39	implementation and administration of the program; amending
40	s. 409.821, F.S., relating to the program's public records
41	exemption; revising applicability of consent provisions;
42	requiring the enrollee or parent or guardian of the
43	enrollee to provide written consent for release of certain
44	identifying information; creating s. 409.822, F.S.;
45	providing legislative intent; providing for consolidation
46	of the Florida Kidcare program; requiring the agency to
47	submit a consolidation plan to the Governor and
48	Legislature; defining duties of the Agency for Health Care
49	Administration and the Department of Children and Family
50	Services; requiring the Agency for Health Care
51	Administration to seek federal Medicaid waivers and state
52	plan amendments; providing for an evaluation of policy
53	changes; authorizing the appointment of a legislative
54	advisory committee; amending s. 624.91, F.S.; revising
55	legislative intent regarding the Florida Healthy Kids
56	Corporation; revising provisions relating to eligibility
57	for state-funded assistance; revising duties of the
58	corporation; specifying venue for civil and administrative
59	actions against the corporation; providing for future
60	repeal; providing an effective date.
61
62	Be It Enacted by the Legislature of the State of Florida:
63
64	Section 1.  Subsection (4) of section 408.915, Florida
65	Statutes, is amended to read:
66	408.915  Eligibility pilot project.--The Agency for Health
67	Care Administration, in consultation with the steering committee
68	established in s. 408.916, shall develop and implement a pilot
69	project to integrate the determination of eligibility for health
70	care services with information and referral services.
71	(4)  The pilot project shall include eligibility
72	determinations for the following programs:
73	(a)  Medicaid under Title XIX of the Social Security Act.
74	(b)  Medikids as created in s. 409.8132.
75	(b)(c)  Florida Healthy Kids as described in s. 624.91 and
76	within eligibility guidelines provided in s. 409.814.
77	(c)(d)  Eligibility for Florida Kidcare services outside of
78	the scope of Title XIX or Title XXI of the Social Security Act
79	as provided in s. 409.814.
80	(d)(e)  State and local publicly funded health and social
81	services programs as determined appropriate by the steering
82	committee.
83	Section 2.  Paragraph (a) of subsection (9) of section
84	409.1451, Florida Statutes, is amended to read:
85	409.1451  Independent living transition services.--
86	(9)  MEDICAL ASSISTANCE FOR YOUNG ADULTS FORMERLY IN FOSTER
87	CARE.--The department shall enroll in the Florida Kidcare
88	program, outside the open enrollment period, each young adult
89	who is eligible as described in paragraph (2)(b) and who has not
90	yet reached his or her 19th birthday.
91	(a)  A young adult who was formerly in foster care at the
92	time of his or her 18th birthday and who is 18 years of age but
93	not yet 19, shall pay the premium for the Florida Kidcare
94	program as required in s. 409.8141 409.814.
95	Section 3.  Section 409.811, Florida Statutes, is amended
96	to read:
97	409.811  Definitions relating to Florida Kidcare Act.--As
98	used in ss. 409.810-409.820, the term:
99	(1)  "Actuarially equivalent" means that:
100	(a)  The aggregate value of the benefits included in health
101	benefits coverage is equal to the value of the benefits in the
102	benchmark benefit plan; and
103	(b)  The benefits included in health benefits coverage are
104	substantially similar to the benefits included in the benchmark
105	benefit plan, except that preventive health services must be the
106	same as in the benchmark benefit plan.
107	(1)(2)  "Agency" means the Agency for Health Care
108	Administration.
109	(2)(3)  "Applicant" means a parent or guardian of a child
110	or a child whose disability of nonage has been removed under
111	chapter 743, who applies for determination of eligibility for
112	health benefits coverage under ss. 409.810-409.820.
113	(4)  "Benchmark benefit plan" means the form and level of
114	health benefits coverage established in s. 409.815.
115	(3)(5)  "Child" means any person under 19 years of age.
116	(4)(6)  "Child with special health care needs" means a
117	child who has chronic physical, developmental, behavioral, or
118	emotional conditions and who also requires health care and
119	related services of a type or amount beyond that which is
120	generally required by a child whose serious or chronic physical
121	or developmental condition requires extensive preventive and
122	maintenance care beyond that required by typically healthy
123	children. Health care utilization by such a child exceeds the
124	statistically expected usage of the normal child adjusted for
125	chronological age, and such a child often needs complex care
126	requiring multiple providers, rehabilitation services, and
127	specialized equipment in a number of different settings.
128	(5)(7)  "Children's Medical Services Network" or "network"
129	means a statewide managed care service system as defined in s.
130	391.021(1).
131	(6)(8)  "Community rate" means a method used to develop
132	premiums for a health insurance plan that spreads financial risk
133	across a large population and allows adjustments only for age,
134	gender, family composition, and geographic area.
135	(7)(9)  "Department" means the Department of Health.
136	(8)(10)  "Enrollee" means a child who has been determined
137	eligible for and is receiving coverage under ss. 409.810-
138	409.820.
139	(9)(11)  "Family" means the group or the individuals whose
140	income is considered in determining eligibility for the Florida
141	Kidcare program. The family includes a child with a custodial
142	parent or caretaker relative who resides in the same house or
143	living unit or, in the case of a child whose disability of
144	nonage has been removed under chapter 743, the child. The family
145	may also include other individuals whose income and resources
146	are considered in whole or in part in determining eligibility of
147	the child.
148	(10)(12)  "Family income" means cash received at periodic
149	intervals from any source, such as wages, benefits,
150	contributions, or rental property. Income also may include any
151	money that would have been counted as income under the Aid to
152	Families with Dependent Children (AFDC) state plan in effect
153	prior to August 22, 1996.
154	(11)(13)  "Florida Kidcare program," "Kidcare program," or
155	"program" means the health benefits program administered through
156	ss. 409.810-409.820.
157	(12)(14)  "Guarantee issue" means that health benefits
158	coverage must be offered to an individual regardless of the
159	individual's health status, preexisting condition, or claims
160	history.
161	(13)(15)  "Health benefits coverage" means protection that
162	provides payment of benefits for covered health care services or
163	that otherwise provides, either directly or through arrangements
164	with other persons, covered health care services on a prepaid
165	per capita basis or on a prepaid aggregate fixed-sum basis.
166	(14)(16)  "Health insurance plan" means health benefits
167	coverage under the following:
168	(a)  A health plan offered by any certified health
169	maintenance organization or authorized health insurer, except a
170	plan that is limited to the following: a limited benefit,
171	specified disease, or specified accident; hospital indemnity;
172	accident only; limited benefit convalescent care; Medicare
173	supplement; credit disability; dental; vision; long-term care;
174	disability income; coverage issued as a supplement to another
175	health plan; workers' compensation liability or other insurance;
176	or motor vehicle medical payment only; or
177	(b)  An employee welfare benefit plan that includes health
178	benefits established under the Employee Retirement Income
179	Security Act of 1974, as amended.
180	(15)(17)  "Medicaid" means the medical assistance program
181	authorized by Title XIX of the Social Security Act, and
182	regulations thereunder, and ss. 409.901-409.920, as administered
183	in this state by the agency.
184	(16)(18)  "Medically necessary" means the use of any
185	medical treatment, service, equipment, or supply necessary to
186	palliate the effects of a terminal condition, or to prevent,
187	diagnose, correct, cure, alleviate, or preclude deterioration of
188	a condition that threatens life, causes pain or suffering, or
189	results in illness or infirmity and which is:
190	(a)  Consistent with the symptom, diagnosis, and treatment
191	of the enrollee's condition;
192	(b)  Provided in accordance with generally accepted
193	standards of medical practice;
194	(c)  Not primarily intended for the convenience of the
195	enrollee, the enrollee's family, or the health care provider;
196	(d)  The most appropriate level of supply or service for
197	the diagnosis and treatment of the enrollee's condition; and
198	(e)  Approved by the appropriate medical body or health
199	care specialty involved as effective, appropriate, and essential
200	for the care and treatment of the enrollee's condition.
201	(19)  "Medikids" means a component of the Florida Kidcare
202	program of medical assistance authorized by Title XXI of the
203	Social Security Act, and regulations thereunder, and s.
204	409.8132, as administered in the state by the agency.
205	(17)(20)  "Preexisting condition exclusion" means, with
206	respect to coverage, a limitation or exclusion of benefits
207	relating to a condition based on the fact that the condition was
208	present before the date of enrollment for such coverage, whether
209	or not any medical advice, diagnosis, care, or treatment was
210	recommended or received before such date.
211	(18)(21)  "Premium" means the entire cost of a health
212	insurance plan, including the administration fee or the risk
213	assumption charge.
214	(19)(22)  "Premium assistance payment" means the monthly
215	consideration paid by the agency per enrollee in the Florida
216	Kidcare program towards health insurance premiums.
217	(20)(23)  "Qualified alien" means an alien as defined in s.
218	431 of the Personal Responsibility and Work Opportunity
219	Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
220	(21)(24)  "Resident" means a United States citizen, or
221	qualified alien, who is domiciled in this state.
222	(22)(25)  "Rural county" means a county having a population
223	density of fewer less than 100 persons per square mile, or a
224	county defined by the most recent United States Census as rural,
225	in which there is no prepaid health plan participating in the
226	Medicaid program as of July 1, 1998.
227	(26)  "Substantially similar" means that, with respect to
228	additional services as defined in s. 2103(c)(2) of Title XXI of
229	the Social Security Act, these services must have an actuarial
230	value equal to at least 75 percent of the actuarial value of the
231	coverage for that service in the benchmark benefit plan and,
232	with respect to the basic services as defined in s. 2103(c)(1)
233	of Title XXI of the Social Security Act, these services must be
234	the same as the services in the benchmark benefit plan.
235	Section 4.  Section 409.812, Florida Statutes, is amended
236	to read:
237	409.812  Program created; purpose.--The Florida Kidcare
238	program is created to provide a defined set of health benefits
239	to previously uninsured, low-income children through the
240	establishment of a variety of affordable health benefits
241	coverage options from which families may select coverage and
242	through which families may contribute financially to the health
243	care of their children.
244	Section 5.  Section 409.813, Florida Statutes, is amended
245	to read:
246	409.813  Program components; entitlement and
247	nonentitlement.--The Florida Kidcare program includes health
248	benefits coverage provided to children through the following
249	program components, which shall be marketed as the Florida
250	Kidcare program:
251	(1)  Medicaid;
252	(2)  Medikids as created in s. 409.8132;
253	(2)(3)  The Florida Healthy Kids Corporation as created in
254	s. 624.91; and
255	(4)  Employer-sponsored group health insurance plans
256	approved under ss. 409.810-409.820; and
257	(3)(5)  The Children's Medical Services network established
258	in chapter 391.
259
260	Except for Title XIX-funded Florida Kidcare coverage under the
261	Medicaid program, coverage under the Florida Kidcare program is
262	not an entitlement. No cause of action shall arise against the
263	state, the department, the Department of Children and Family
264	Services, or the agency, or the Florida Healthy Kids Corporation
265	for failure to make health services available to any person
266	under ss. 409.810-409.820.
267	Section 6.  Section 409.8132, Florida Statutes, is
268	repealed.
269	Section 7.  Subsection (2) of section 409.8134, Florida
270	Statutes, is amended to read:
271	409.8134  Program expenditure ceiling.--
272	(2)  The Florida Kidcare program may conduct enrollment at
273	any time throughout the year for the purpose of enrolling
274	children eligible for all program components listed in s.
275	409.813 except Medicaid. The four Florida Kidcare administrators
276	shall work together to ensure that the year-round enrollment
277	period is announced statewide. Eligible children shall be
278	enrolled on a first-come, first-served basis using the date the
279	enrollment application is received. Enrollment shall immediately
280	cease when the expenditure ceiling is reached. Year-round
281	enrollment shall only be held if the Social Services Estimating
282	Conference determines that sufficient federal and state funds
283	will be available to finance the increased enrollment through
284	federal fiscal year 2007. Any individual who is not enrolled
285	must reapply by submitting a new application. The application
286	for the Florida Kidcare program shall be valid for a period of
287	120 days after the date it was received. At the end of the 120-
288	day period, if the applicant has not been enrolled in the
289	program, the application shall be invalid and the applicant
290	shall be notified of the action. The applicant may resubmit the
291	application after notification of the action taken by the
292	program. Except for the Medicaid program, whenever the Social
293	Services Estimating Conference determines that there are
294	presently, or will be by the end of the current fiscal year,
295	insufficient funds to finance the current or projected
296	enrollment in the Florida Kidcare program, all additional
297	enrollment must cease and additional enrollment may not resume
298	until sufficient funds are available to finance the such
299	enrollment.
300	Section 8.  Section 409.814, Florida Statutes, is amended
301	to read:
302	(Substantial rewording of section. See s. 409.814, F.S.,
303	for present text.)
304	409.814  Eligibility.--
305	(1)  ELIGIBILITY FOR THE FLORIDA KIDCARE PROGRAM.--
306	(a)  To be eligible for the Florida Kidcare program, a
307	child must be:
308	1.  A resident of the state.
309	2.  Under 19 years of age.
310	3.  Uninsured at the time of application.
311	(b)  Once a child is enrolled in the Florida Kidcare
312	program, the child is eligible for coverage under the program
313	for 12 months without redetermination or reverification of
314	eligibility.
315	(2)  ELIGIBILITY FOR CHILDREN'S MEDICAL SERVICES.--To be
316	eligible for the Children's Medical Services component of the
317	Florida Kidcare program, a child must meet the requirements of
318	subsection (1) and must be a child with special health care
319	needs as determined through clinical eligibility screening by
320	the Department of Health pursuant to s. 409.818(2).
321	Section 9.  Section 409.8141, Florida Statutes, is created
322	to read:
323	409.8141  Premium assistance.--
324	(1)  The Florida Kidcare program may provide premium
325	assistance to certain children enrolled in the program. To be
326	eligible for premium assistance, the child must meet the
327	requirements of s. 409.814 and must:
328	(a)  Reside in a household where the family income is equal
329	to or less than 200 percent of the federal poverty level; and
330	(b)  Be a United States citizen or a qualified alien as
331	defined in s. 409.811(22).
332	(2)  The Florida Kidcare program may provide premium
333	assistance for enrollees who do not reside in a household where
334	the family income is equal to or less than 200 percent of the
335	federal poverty level, who are noncitizens, who are not
336	qualified aliens, or who are children of state employees. Such
337	premium assistance may be funded by general revenue or local
338	contributions pursuant to s. 624.91 and is subject to specific
339	appropriation. If the program does not provide such premium
340	assistance, enrollees not meeting the eligibility requirements
341	of subsection (1) shall pay the full cost of the premium and are
342	not required to document income.
343	(3)  Eligibility for premium assistance shall be verified
344	for each applicant and enrollee during the application and
345	reverification processes based on:
346	(a)  Family income verified electronically. If electronic
347	verification of income eligibility is not available, family
348	income shall be documented with a copy of the applicant's most
349	recent federal income tax return. In the absence of a federal
350	income tax return, an applicant's wages and earnings statements,
351	W-2 forms, or other appropriate documentation obtained from
352	other government sources, including electronic records, may be
353	considered. An assets test is not required.
354	(b)  A statement from the applicant or enrollee that the
355	child is not currently insured by an employer-sponsored or other
356	benefit plan.
357	(4)  Once a child is found eligible for premium assistance,
358	the child shall receive premium assistance for 12 months without
359	reverification of eligibility if the family continues to
360	participate in any applicable cost-sharing pursuant to s.
361	409.816. The Florida Kidcare program shall conduct an annual
362	eligibility reverification for each enrollee eligible for
363	premium assistance.
364	Section 10.  Section 409.8142, Florida Statutes, is created
365	to read:
366	409.8142  Penalties.--
367	(1)  Subject to s. 624.91(4), the Florida Kidcare program
368	shall withhold benefits from an enrollee if the program obtains
369	evidence that the enrollee is no longer eligible, submitted
370	incorrect or fraudulent information in order to establish
371	eligibility, or failed to provide verification of eligibility.
372	The applicant or enrollee shall be notified that, because of
373	such evidence, program benefits will be withheld unless the
374	applicant or enrollee contacts a designated representative of
375	the program by a specified date, which must be within 10 days
376	after the date of notice, to discuss and resolve the matter. The
377	program shall make every effort to resolve the matter within a
378	timeframe that will not cause benefits to be withheld from an
379	eligible enrollee.
380	(2)  The following individuals may be subject to
381	prosecution in accordance with s. 414.39:
382	(a)  An applicant obtaining or attempting to obtain
383	benefits for a potential enrollee under the Florida Kidcare
384	program when the applicant knows or should have known the
385	potential enrollee does not qualify for the Florida Kidcare
386	program.
387	(b)  An individual who assists an applicant in obtaining or
388	attempting to obtain benefits for a potential enrollee under the
389	Florida Kidcare program when the individual knows or should have
390	known the potential enrollee does not qualify for the Florida
391	Kidcare program.
392	Section 11.  Section 409.8149, Florida Statutes, is created
393	to read:
394	409.8149  Enrollment; plan choice; choice counseling.--
395	(1)  ENROLLMENT.--The Florida Kidcare program may conduct
396	enrollment at any time throughout the year for the purpose of
397	enrolling children eligible for all program components listed in
398	s. 409.813 except Medicaid. The four Florida Kidcare
399	administrators shall work together to ensure that the year-round
400	enrollment period is announced statewide. Eligible children
401	shall be enrolled on a first-come, first-served basis, based
402	upon the date the enrollment application is received. The
403	application for the Florida Kidcare program is valid for a
404	period of 120 days after the date the application is received.
405	At the end of the 120-day period, if the applicant has not been
406	enrolled in the program, the application is invalid and the
407	applicant shall be notified of the action. The applicant may
408	resubmit the application after notification of the action taken
409	by the program.
410	(2)  PLAN CHOICE.--
411	(a)  Each enrollee shall have 30 days after the date of
412	enrollment to voluntarily choose a benefit plan. A child with
413	special health care needs as determined through clinical
414	eligibility screening by the Department of Health pursuant to s.
415	409.818(2) shall be assigned to the Children's Medical Services
416	Network and may opt out of the Children's Medical Services
417	Network. Enrollees may choose the Children's Medical Services
418	Network or any managed care plan operating in the Medicaid
419	program or any plan selected pursuant to s. 624.91 in the
420	geographical area in which the enrollee resides. An enrollee
421	eligible for Medicaid may also choose the Medicaid fee-for-
422	service program.
423	(b)  Enrollees who do not voluntarily choose a benefit plan
424	shall be assigned to a managed care plan by the Florida Kidcare
425	program. The program shall assign enrollees eligible for
426	Medicaid to a Medicaid managed care plan or to the Medicaid fee-
427	for-service program if a Medicaid managed care plan does not
428	exist in the geographical area in which the enrollee resides.
429	The program shall assign all other enrollees to plans selected
430	pursuant to s. 624.91 in the geographical area in which each
431	enrollee resides.
432	(c)  Upon selection or assignment, an enrollee shall have
433	90 days during which to voluntarily disenroll from a benefit
434	plan and select another.
435	(d)  Upon the anniversary of enrollment, each enrollee may
436	voluntarily select another benefit plan. The Florida Kidcare
437	program shall notify enrollees of their annual open enrollment
438	options 60 days prior to the anniversary of initial enrollment.
439	(3)  CHOICE COUNSELING.--The Florida Kidcare program shall
440	provide education on the available benefit plans pursuant to s.
441	409.818(4). The program shall provide choice counseling upon
442	initial enrollment and prior to an enrollee's annual optional
443	reselection. The program shall coordinate with Medicaid to
444	provide choice counseling regarding Medicaid fee-for-service and
445	managed care options.
446	Section 12.  Section 409.815, Florida Statutes, is amended
447	to read:
448	409.815  Health benefits coverage; limitations.--
449	(1)  MEDICAID BENEFITS.--For purposes of the Florida
450	Kidcare program, Benefits available under all Florida Kidcare
451	components shall meet the federal Medicaid Early and Periodic
452	Screening, Diagnosis, and Treatment (EPSDT) program standards
453	and Medikids include those goods and services provided under the
454	medical assistance program authorized by Title XIX of the Social
455	Security Act, and regulations thereunder, as administered in
456	this state by the agency. This includes those mandatory Medicaid
457	services authorized under s. 409.905 and optional Medicaid
458	services authorized under s. 409.906, rendered on behalf of
459	eligible individuals by qualified providers, in accordance with
460	federal requirements for Title XIX, subject to any limitations
461	or directions provided for in the General Appropriations Act or
462	chapter 216, and according to methodologies and limitations set
463	forth in agency rules and policy manuals and handbooks
464	incorporated by reference thereto.
465	(2)  BENCHMARK BENEFITS.--In order for health benefits
466	coverage to qualify for premium assistance payments for an
467	eligible child under ss. 409.810-409.820, the health benefits
468	coverage, except for coverage under Medicaid and Medikids, must
469	include the following minimum benefits, as medically necessary.
470	(a)  Preventive health services.--Covered services include:
471	1.  Well-child care, including services recommended in the
472	Guidelines for Health Supervision of Children and Youth as
473	developed by the American Academy of Pediatrics;
474	2.  Immunizations and injections;
475	3.  Health education counseling and clinical services;
476	4.  Vision screening; and
477	5.  Hearing screening.
478	(b)  Inpatient hospital services.--All covered services
479	provided for the medical care and treatment of an enrollee who
480	is admitted as an inpatient to a hospital licensed under part I
481	of chapter 395, with the following exceptions:
482	1.  All admissions must be authorized by the enrollee's
483	health benefits coverage provider.
484	2.  The length of the patient stay shall be determined
485	based on the medical condition of the enrollee in relation to
486	the necessary and appropriate level of care.
487	3.  Room and board may be limited to semiprivate
488	accommodations, unless a private room is considered medically
489	necessary or semiprivate accommodations are not available.
490	4.  Admissions for rehabilitation and physical therapy are
491	limited to 15 days per contract year.
492	(c)  Emergency services.--Covered services include visits
493	to an emergency room or other licensed facility if needed
494	immediately due to an injury or illness and delay means risk of
495	permanent damage to the enrollee's health. Health maintenance
496	organizations shall comply with the provisions of s. 641.513.
497	(d)  Maternity services.--Covered services include
498	maternity and newborn care, including prenatal and postnatal
499	care, with the following limitations:
500	1.  Coverage may be limited to the fee for vaginal
501	deliveries; and
502	2.  Initial inpatient care for newborn infants of enrolled
503	adolescents shall be covered, including normal newborn care,
504	nursery charges, and the initial pediatric or neonatal
505	examination, and the infant may be covered for up to 3 days
506	following birth.
507	(e)  Organ transplantation services.--Covered services
508	include pretransplant, transplant, and postdischarge services
509	and treatment of complications after transplantation for
510	transplants deemed necessary and appropriate within the
511	guidelines set by the Organ Transplant Advisory Council under s.
512	765.53 or the Bone Marrow Transplant Advisory Panel under s.
513	627.4236.
514	(f)  Outpatient services.--Covered services include
515	preventive, diagnostic, therapeutic, palliative care, and other
516	services provided to an enrollee in the outpatient portion of a
517	health facility licensed under chapter 395, except for the
518	following limitations:
519	1.  Services must be authorized by the enrollee's health
520	benefits coverage provider; and
521	2.  Treatment for temporomandibular joint disease (TMJ) is
522	specifically excluded.
523	(g)  Behavioral health services.--
524	1.  Mental health benefits include:
525	a.  Inpatient services, limited to not more than 30
526	inpatient days per contract year for psychiatric admissions, or
527	residential services in facilities licensed under s. 394.875(8)
528	or s. 395.003 in lieu of inpatient psychiatric admissions;
529	however, a minimum of 10 of the 30 days shall be available only
530	for inpatient psychiatric services when authorized by a
531	physician; and
532	b.  Outpatient services, including outpatient visits for
533	psychological or psychiatric evaluation, diagnosis, and
534	treatment by a licensed mental health professional, limited to a
535	maximum of 40 outpatient visits each contract year.
536	2.  Substance abuse services include:
537	a.  Inpatient services, limited to not more than 7
538	inpatient days per contract year for medical detoxification only
539	and 30 days of residential services; and
540	b.  Outpatient services, including evaluation, diagnosis,
541	and treatment by a licensed practitioner, limited to a maximum
542	of 40 outpatient visits per contract year.
543	(h)  Durable medical equipment.--Covered services include
544	equipment and devices that are medically indicated to assist in
545	the treatment of a medical condition and specifically prescribed
546	as medically necessary, with the following limitations:
547	1.  Low-vision and telescopic aides are not included.
548	2.  Corrective lenses and frames may be limited to one pair
549	every 2 years, unless the prescription or head size of the
550	enrollee changes.
551	3.  Hearing aids shall be covered only when medically
552	indicated to assist in the treatment of a medical condition.
553	4.  Covered prosthetic devices include artificial eyes and
554	limbs, braces, and other artificial aids.
555	(i)  Health practitioner services.--Covered services
556	include services and procedures rendered to an enrollee when
557	performed to diagnose and treat diseases, injuries, or other
558	conditions, including care rendered by health practitioners
559	acting within the scope of their practice, with the following
560	exceptions:
561	1.  Chiropractic services shall be provided in the same
562	manner as in the Florida Medicaid program.
563	2.  Podiatric services may be limited to one visit per day
564	totaling two visits per month for specific foot disorders.
565	(j)  Home health services.--Covered services include
566	prescribed home visits by both registered and licensed practical
567	nurses to provide skilled nursing services on a part-time
568	intermittent basis, subject to the following limitations:
569	1.  Coverage may be limited to include skilled nursing
570	services only;
571	2.  Meals, housekeeping, and personal comfort items may be
572	excluded; and
573	3.  Private duty nursing is limited to circumstances where
574	such care is medically necessary.
575	(k)  Hospice services.--Covered services include reasonable
576	and necessary services for palliation or management of an
577	enrollee's terminal illness, with the following exceptions:
578	1.  Once a family elects to receive hospice care for an
579	enrollee, other services that treat the terminal condition will
580	not be covered; and
581	2.  Services required for conditions totally unrelated to
582	the terminal condition are covered to the extent that the
583	services are included in this section.
584	(l)  Laboratory and X-ray services.--Covered services
585	include diagnostic testing, including clinical radiologic,
586	laboratory, and other diagnostic tests.
587	(m)  Nursing facility services.--Covered services include
588	regular nursing services, rehabilitation services, drugs and
589	biologicals, medical supplies, and the use of appliances and
590	equipment furnished by the facility, with the following
591	limitations:
592	1.  All admissions must be authorized by the health
593	benefits coverage provider.
594	2.  The length of the patient stay shall be determined
595	based on the medical condition of the enrollee in relation to
596	the necessary and appropriate level of care, but is limited to
597	not more than 100 days per contract year.
598	3.  Room and board may be limited to semiprivate
599	accommodations, unless a private room is considered medically
600	necessary or semiprivate accommodations are not available.
601	4.  Specialized treatment centers and independent kidney
602	disease treatment centers are excluded.
603	5.  Private duty nurses, television, and custodial care are
604	excluded.
605	6.  Admissions for rehabilitation and physical therapy are
606	limited to 15 days per contract year.
607	(n)  Prescribed drugs.--
608	1.  Coverage shall include drugs prescribed for the
609	treatment of illness or injury when prescribed by a licensed
610	health practitioner acting within the scope of his or her
611	practice.
612	2.  Prescribed drugs may be limited to generics if
613	available and brand name products if a generic substitution is
614	not available, unless the prescribing licensed health
615	practitioner indicates that a brand name is medically necessary.
616	3.  Prescribed drugs covered under this section shall
617	include all prescribed drugs covered under the Florida Medicaid
618	program.
619	(o)  Therapy services.--Covered services include
620	rehabilitative services, including occupational, physical,
621	respiratory, and speech therapies, with the following
622	limitations:
623	1.  Services must be for short-term rehabilitation where
624	significant improvement in the enrollee's condition will result;
625	and
626	2.  Services shall be limited to not more than 24 treatment
627	sessions within a 60-day period per episode or injury, with the
628	60-day period beginning with the first treatment.
629	(p)  Transportation services.--Covered services include
630	emergency transportation required in response to an emergency
631	situation.
632	(q)  Dental services.--Dental services shall be covered and
633	may include those dental benefits provided to children by the
634	Florida Medicaid program under s. 409.906(6).
635	(r)  Lifetime maximum.--Health benefits coverage obtained
636	under ss. 409.810-409.820 shall pay an enrollee's covered
637	expenses at a lifetime maximum of $1 million per covered child.
638	(s)  Cost-sharing.--Cost-sharing provisions must comply
639	with s. 409.816.
640	(t)  Exclusions.--
641	1.  Experimental or investigational procedures that have
642	not been clinically proven by reliable evidence are excluded;
643	2.  Services performed for cosmetic purposes only or for
644	the convenience of the enrollee are excluded; and
645	3.  Abortion may be covered only if necessary to save the
646	life of the mother or if the pregnancy is the result of an act
647	of rape or incest.
648	(2)(u)  ENHANCEMENTS TO BENEFITS minimum requirements.--
649	(a)1.  This section sets the minimum benefits that must be
650	included in any health benefits coverage, other than Medicaid or
651	Medikids coverage, offered under ss. 409.810-409.820. Health
652	benefits coverage may include additional benefits not included
653	under this subsection (1), but may not include benefits excluded
654	under paragraph (s).
655	(b)2.  Health benefits coverage may extend any limitations
656	beyond the minimum benefits described in this section.
657
658	Except for the Children's Medical Services Network, the agency
659	may not increase the premium assistance payment for either
660	additional benefits provided beyond the minimum benefits
661	described in this section or the imposition of less restrictive
662	service limitations.
663	(3)(v)  APPLICABILITY OF OTHER STATE LAWS.--Health
664	insurers, health maintenance organizations, and their agents are
665	subject to the provisions of the Florida Insurance Code, except
666	for any such provisions waived in this section.
667	(a)1.  Except as expressly provided in this section, a law
668	requiring coverage for a specific health care service or
669	benefit, or a law requiring reimbursement, utilization, or
670	consideration of a specific category of licensed health care
671	practitioner, does not apply to a health insurance plan policy
672	or contract offered or delivered under ss. 409.810-409.820
673	unless that law is made expressly applicable to such policies or
674	contracts.
675	(b)2.  Notwithstanding chapter 641, a health maintenance
676	organization may issue contracts providing benefits equal to,
677	exceeding, or actuarially equivalent to the benchmark benefit
678	plan required authorized by this section and may pay providers
679	located in a rural county negotiated fees or Medicaid
680	reimbursement rates for services provided to enrollees who are
681	residents of the rural county.
682	Section 13.  Section 409.816, Florida Statutes, is amended
683	to read:
684	(Substantial rewording of section. See s. 409.816, F.S.,
685	for present text.)
686	409.816  Premiums.--
687	(1)  SOURCES OF FUNDING.--
688	(a)  Premiums for children eligible for Medicaid shall be
689	funded by Medicaid.
690	(b)  Premiums for children eligible for medical assistance
691	under Title XXI of the Social Security Act shall be funded by
692	Title XXI federal funds.
693	(c)  Premiums for children not eligible for Medicaid or
694	medical assistance under Title XXI of the Social Security Act
695	shall be fully paid by the children's families. However, such
696	premiums may be funded by general revenue or local contributions
697	pursuant to s. 624.91 and subject to specific appropriation.
698	(2)  RATES.--The Florida Kidcare program shall set premium
699	rates based on the age, gender, and geographic location of the
700	child and the child's eligibility for enrollment in the
701	Children's Medical Services Network.
702	(3)  SEAMLESS TRANSITION.--Enrollees may participate in any
703	managed care plan operating under the Florida Kidcare program or
704	Medicaid regardless of any change in eligibility for premium
705	assistance. If an enrollee's eligibility for premium assistance
706	changes, the program shall change the premium funding source in
707	accordance with the enrollee's new eligibility status and
708	continue to apply the enrollee's premium to the chosen plan. If
709	an enrollee chooses a different plan during the annual plan
710	selection period provided under s. 409.8149, the program shall
711	ensure that the premium funding follows the enrollee to the new
712	plan.
713	(4)  COST SHARING.--
714	(a)  Enrollees who are eligible for Medicaid shall not pay
715	enrollment fees, premiums, copayments, deductibles, coinsurance,
716	or similar charges.
717	(b)  Enrollees who are not eligible for Medicaid and have a
718	family income below 150 percent of the federal poverty level
719	shall pay a share of the premium cost and shall pay $15 per
720	family per month. Cost sharing may be waived by the Florida
721	Kidcare program when required by Title XXI of the Social
722	Security Act.
723	(c)  Enrollees who are not eligible for Medicaid and have a
724	family income below 200 percent of the federal poverty level
725	shall pay a share of the premium cost and shall pay $20 per
726	family per month. Cost sharing may be waived by the Florida
727	Kidcare program when required by Title XXI of the Social
728	Security Act.
729	(d)  Enrollees who are not receiving premium assistance
730	shall pay the full cost of the premium.
731	Section 14.  Section 409.817, Florida Statutes, is amended
732	to read:
733	409.817  Approval of health benefits coverage; financial
734	assistance.--In order for health insurance coverage other than
735	Medicaid managed care plans to qualify for premium assistance
736	payments for an eligible child under ss. 409.810-409.820, the
737	health benefits coverage must:
738	(1)  Be certified by the Office of Insurance Regulation of
739	the Financial Services Commission under s. 409.818 as meeting,
740	exceeding, or being actuarially equivalent to the benchmark
741	benefit plan;
742	(1)(2)  Be guarantee issued;
743	(2)(3)  Be community rated;
744	(3)(4)  Not impose any preexisting condition exclusion for
745	covered benefits; however, group health insurance plans may
746	permit the imposition of a preexisting condition exclusion, but
747	only insofar as it is permitted under s. 627.6561;
748	(4)(5)  Comply with the applicable limitations on premiums
749	and cost-sharing in s. 409.816;
750	(5)(6)  Comply with the quality assurance and access
751	standards developed under s. 409.820; and
752	(6)(7)  Establish periodic open enrollment periods, which
753	may not occur more frequently than quarterly.
754	Section 15.  Paragraph (i) of subsection (1) of section
755	409.8177, Florida Statutes, is amended to read:
756	409.8177  Program evaluation.--
757	(1)  The agency, in consultation with the Department of
758	Health, the Department of Children and Family Services, and the
759	Florida Healthy Kids Corporation, shall contract for an
760	evaluation of the Florida Kidcare program and shall by January 1
761	of each year submit to the Governor, the President of the
762	Senate, and the Speaker of the House of Representatives a report
763	of the program. In addition to the items specified under s. 2108
764	of Title XXI of the Social Security Act, the report shall
765	include an assessment of crowd-out and access to health care, as
766	well as the following:
767	(i)  An assessment of the effectiveness of the Medikids,
768	Children's Medical Services network, and other public and
769	private programs in the state in increasing the availability of
770	affordable quality health insurance and health care for
771	children.
772	Section 16.  Section 409.818, Florida Statutes, is amended
773	to read:
774	409.818  Administration.--In order to implement ss.
775	409.810-409.820, the following agencies shall have the following
776	duties:
777	(1)  The Department of Children and Family Services shall:
778	(a)  Develop a comprehensive, statewide outreach program
779	through the Community Access Network developed by the department
780	that increases enrollment in the Florida Kidcare program by
781	providing multiple access points throughout the state,
782	maximizing shared resources, and partnering with a broad variety
783	of providers, schools, community-based organizations, and local
784	and state agencies.
785	(b)  Develop a standardized intake process for all
786	Community Access Network partners that informs applicants about
787	coverage and services available through the Florida Kidcare
788	program and collects all information necessary to assess
789	eligibility for any premium assistance.
790	(c)(a)  Develop a simplified eligibility application
791	process mail-in form to be used for determining the eligibility
792	of children for coverage through under the Florida Kidcare
793	program, in consultation with the agency, the Department of
794	Health, and the Florida Healthy Kids Corporation. The department
795	shall collect all information necessary to determine eligibility
796	for premium assistance and provide simplified eligibility
797	application form must include an item that provides an
798	opportunity for the applicant to indicate whether coverage is
799	being sought for a child with special health care needs.
800	Families applying for children's Medicaid coverage must also be
801	able to use the simplified application form without having to
802	pay a premium.
803	(d)  Determine eligibility for Medicaid. The department may
804	perform this function either directly or through the services of
805	a contracted third-party administrator. The eligibility
806	determination process must include redetermination or
807	reverification of eligibility every 12 months.
808	(e)  Coordinate with the Florida Healthy Kids Corporation
809	to establish a seamless eligibility process for children
810	regardless of funding source.
811	(b)  Establish and maintain the eligibility determination
812	process under the program except as specified in subsection (5).
813	The department shall directly, or through the services of a
814	contracted third-party administrator, establish and maintain a
815	process for determining eligibility of children for coverage
816	under the program. The eligibility determination process must be
817	used solely for determining eligibility of applicants for health
818	benefits coverage under the program. The eligibility
819	determination process must include an initial determination of
820	eligibility for any coverage offered under the program, as well
821	as a redetermination or reverification of eligibility each
822	subsequent 6 months. Effective January 1, 1999, a child who has
823	not attained the age of 5 and who has been determined eligible
824	for the Medicaid program is eligible for coverage for 12 months
825	without a redetermination or reverification of eligibility. In
826	conducting an eligibility determination, the department shall
827	determine if the child has special health care needs. The
828	department, in consultation with the Agency for Health Care
829	Administration and the Florida Healthy Kids Corporation, shall
830	develop procedures for redetermining eligibility which enable a
831	family to easily update any change in circumstances which could
832	affect eligibility. The department may accept changes in a
833	family's status as reported to the department by the Florida
834	Healthy Kids Corporation without requiring a new application
835	from the family. Redetermination of a child's eligibility for
836	Medicaid may not be linked to a child's eligibility
837	determination for other programs.
838	(f)(c)  Inform program applicants about eligibility
839	determinations and ensure appropriate followup procedures for
840	choice counseling and plan enrollment provide information about
841	eligibility of applicants to Medicaid, Medikids, the Children's
842	Medical Services Network, and the Florida Healthy Kids
843	Corporation, and to insurers and their agents, through a
844	centralized coordinating office.
845	(g)(d)  Adopt such rules as may be necessary for conducting
846	program eligibility and outreach functions.
847	(2)  The Department of Health shall determine eligibility
848	for the Children's Medical Services component of the Florida
849	Kidcare program based on a clinical eligibility screening.:
850	(a)  Design an eligibility intake process for the program,
851	in coordination with the Department of Children and Family
852	Services, the agency, and the Florida Healthy Kids Corporation.
853	The eligibility intake process may include local intake points
854	that are determined by the Department of Health in coordination
855	with the Department of Children and Family Services.
856	(b)  Chair a state-level coordinating council to review and
857	make recommendations concerning the implementation and operation
858	of the program. The coordinating council shall include
859	representatives from the department, the Department of Children
860	and Family Services, the agency, the Florida Healthy Kids
861	Corporation, the Office of Insurance Regulation of the Financial
862	Services Commission, local government, health insurers, health
863	maintenance organizations, health care providers, families
864	participating in the program, and organizations representing
865	low-income families.
866	(c)  In consultation with the Florida Healthy Kids
867	Corporation and the Department of Children and Family Services,
868	establish a toll-free telephone line to assist families with
869	questions about the program.
870	(d)  Adopt rules necessary to implement outreach
871	activities.
872	(3)  The Agency for Health Care Administration, under the
873	authority granted in s. 409.914(1), shall:
874	(a)  Calculate the premium assistance payment necessary to
875	comply with the premium and cost-sharing limitations specified
876	in s. 409.816. The premium assistance payment for each enrollee
877	in a health insurance plan participating in the Florida Healthy
878	Kids Corporation shall equal the premium approved by the Florida
879	Healthy Kids Corporation and the Office of Insurance Regulation
880	of the Financial Services Commission pursuant to ss. 627.410 and
881	641.31, less any enrollee's share of the premium established
882	within the limitations specified in s. 409.816. The premium
883	assistance payment for each enrollee in an employer-sponsored
884	health insurance plan approved under ss. 409.810-409.820 shall
885	equal the premium for the plan adjusted for any benchmark
886	benefit plan actuarial equivalent benefit rider approved by the
887	Office of Insurance Regulation pursuant to ss. 627.410 and
888	641.31, less any enrollee's share of the premium established
889	within the limitations specified in s. 409.816. In calculating
890	the premium assistance payment levels for children with family
891	coverage, the agency shall set the premium assistance payment
892	levels for each child proportionately to the total cost of
893	family coverage.
894	(b)  Provide fiscal management for Title XIX and Title XXI
895	funding for the Florida Kidcare program, distributing funds
896	among Florida Healthy Kids, the Department of Children and
897	Family Services, and the Department of Health based on costs and
898	the participation of children in the plans and programs
899	available to Florida Kidcare program participants.
900	(c)(b)  Make premium assistance payments to health
901	insurance plans on a periodic basis. The agency may use its
902	Medicaid fiscal agent or a contracted third-party administrator
903	in making these payments. The agency may require health
904	insurance plans that participate in the Medikids program or
905	employer-sponsored group health insurance to collect premium
906	payments from an enrollee's family. Participating health
907	insurance plans shall report premium payments collected on
908	behalf of enrollees in the program to the agency in accordance
909	with a schedule established by the agency.
910	(d)(c)  Monitor compliance with quality assurance and
911	access standards developed under s. 409.820.
912	(e)(d)  Establish a mechanism for investigating and
913	resolving complaints and grievances from program applicants,
914	enrollees, and health benefits coverage providers, and maintain
915	a record of complaints and confirmed problems. In the case of a
916	child who is enrolled in a health maintenance organization, the
917	agency must use the provisions of s. 641.511 to address
918	grievance reporting and resolution requirements.
919	(e)  Approve health benefits coverage for participation in
920	the program, following certification by the Office of Insurance
921	Regulation under subsection (4).
922	(f)  Adopt rules, as necessary, for calculating premium
923	assistance payment levels, making premium assistance payments,
924	monitoring access and quality assurance standards, investigating
925	and resolving complaints and grievances, administering the
926	Medikids program, and approving health benefits coverage.
927	(g)  Seek and implement federal waivers necessary to
928	implement this section and ss. 409.810-409.820.
929
930	The agency is designated the lead state agency for Title XXI of
931	the Social Security Act for purposes of receipt of federal
932	funds, for reporting purposes, and for ensuring compliance with
933	federal and state regulations and rules.
934	(4)  The Office of Insurance Regulation shall certify that
935	health benefits coverage plans that seek to provide services
936	under the Florida Kidcare program, except those offered through
937	the Florida Healthy Kids Corporation or the Children's Medical
938	Services Network, meet, exceed, or are actuarially equivalent to
939	the benchmark benefit plan and that health insurance plans will
940	be offered at an approved rate. In determining actuarial
941	equivalence of benefits coverage, the Office of Insurance
942	Regulation and health insurance plans must comply with the
943	requirements of s. 2103 of Title XXI of the Social Security Act.
944	The department shall adopt rules necessary for certifying health
945	benefits coverage plans.
946	(4)(5)  The Florida Healthy Kids Corporation shall retain
947	its functions as authorized in s. 624.91, including eligibility
948	determination for participation in the Florida Kidcare Healthy
949	Kids program. Additionally, the Florida Healthy Kids Corporation
950	shall:
951	(a)  Develop and implement a statewide marketing program to
952	promote the Florida Kidcare program. The corporation may
953	contract for marketing services to the extent funds are made
954	available for that specific purpose.
955	(b)  Provide comprehensive choice counseling to assist
956	families with eligible children to select and enroll in
957	available plans.
958	(5)(6)  The agency, the Department of Health, the
959	Department of Children and Family Services, the Florida Healthy
960	Kids Corporation, and the Office of Insurance Regulation, after
961	consultation with and approval of the Speaker of the House of
962	Representatives and the President of the Senate, are authorized
963	to make program modifications that are necessary to overcome any
964	objections of the United States Department of Health and Human
965	Services to obtain approval of the state's child health
966	insurance plan under Title XXI of the Social Security Act.
967	Section 17.  Section 409.821, Florida Statutes, is amended
968	to read:
969	409.821  Florida Kidcare program public records
970	exemption.--Notwithstanding any other law to the contrary, Any
971	information identifying a Florida Kidcare program applicant or
972	enrollee, as defined in s. 409.811, held by the Agency for
973	Health Care Administration, the Department of Children and
974	Family Services, the Department of Health, or the Florida
975	Healthy Kids Corporation is confidential and exempt from s.
976	119.07(1) and s. 24(a), Art. I of the State Constitution. Such
977	information may be disclosed to another governmental entity only
978	if disclosure is necessary for the entity to perform its duties
979	and responsibilities under the Florida Kidcare program and shall
980	be disclosed to the Department of Revenue for purposes of
981	administering the state Title IV-D program. The receiving
982	governmental entity must maintain the confidential and exempt
983	status of such information. Furthermore, such information may
984	not be released to any person without the written consent of the
985	program enrollee or the parent or guardian of the enrollee
986	applicant. This exemption applies to any information identifying
987	a Florida Kidcare program applicant or enrollee held by the
988	Agency for Health Care Administration, the Department of
989	Children and Family Services, the Department of Health, or the
990	Florida Healthy Kids Corporation before, on, or after the
991	effective date of this exemption. A violation of this section is
992	a misdemeanor of the second degree, punishable as provided in s.
993	775.082 or s. 775.083.
994	Section 18.  Section 409.822, Florida Statutes, is created
995	to read:
996	409.822  Florida Kidcare program consolidation.--
997	(1)  It is the intent of the Legislature to consolidate the
998	administration of the Florida Kidcare program to provide a
999	seamless delivery system of health benefits to uninsured, low-
1000	income children. It is the further intent of the Legislature
1001	that administration of the program be consolidated under the
1002	fewest entities necessary for the purpose of conducting
1003	marketing and outreach, eligibility determination, premium
1004	collection, contract management of health plans and fiscal
1005	agents, quality assurance and grievance resolution, and fiscal
1006	management of all the components of the Florida Kidcare program.
1007	(2)  The agency shall manage the consolidation of all
1008	components of the Florida Kidcare program. The agency shall
1009	develop a comprehensive plan for consolidation and shall submit
1010	the plan to the Governor, the President of the Senate, and the
1011	Speaker of the House of Representatives by November 1, 2009.
1012	(3)  Effective July 1, 2010, the agency shall make payments
1013	for medical assistance and related services; manage health plan,
1014	provider, and fiscal agent contracts; collect premiums; develop
1015	and implement quality assurance and grievance resolution
1016	processes; and conduct other fiscal-management activities
1017	relating to all components of the Florida Kidcare program. The
1018	agency shall perform all other functions necessary to administer
1019	the program, except that:
1020	(a)  The department shall conduct eligibility determination
1021	for all components of the Florida Kidcare program. All
1022	correspondence regarding eligibility shall be identified solely
1023	with the Florida Kidcare program.
1024	(b)  The department shall develop and distribute marketing
1025	and outreach materials to educate families about the Florida
1026	Kidcare program. Marketing and outreach materials shall present
1027	the Florida Kidcare program as a single program and explain that
1028	the family's information is collected in order to determine
1029	whether the family is eligible for a premium discount or for
1030	full premium assistance.
1031	(c)  The department shall provide a single toll-free
1032	telephone line for a customer service call center to access
1033	account information and provide general Florida Kidcare program
1034	information.
1035	(4)  The agency shall seek federal waiver approval or
1036	amendments to the Medicaid state plan and Title XXI state plan
1037	that are necessary to implement the initiative as specified in
1038	this section.
1039	(5)  The agency shall contract with an independent third
1040	party to evaluate the effects of the policy changes provided by
1041	this section. The evaluation shall specifically include an
1042	assessment of enrollment expansion, enrollment process
1043	simplification, component transition simplification, increased
1044	choice, and administrative simplification. The evaluation shall
1045	analyze the organizational structure of the Florida Kidcare
1046	program and make recommendations regarding specific changes that
1047	should be made, including statutory changes. The agency shall
1048	submit the evaluation to the Governor, the President of the
1049	Senate, and the Speaker of the House of Representatives by
1050	November 1, 2009.
1051	(6)  The Senate and the House of Representatives may,
1052	pursuant to the rules of each house, appoint a select
1053	legislative advisory committee to advise the Legislature
1054	regarding the expiration of the Florida Healthy Kids Corporation
1055	Act.
1056	Section 19.  Section 624.91, Florida Statutes, is amended
1057	to read:
1058	624.91  The Florida Healthy Kids Corporation Act.--
1059	(1)  SHORT TITLE.--This section may be cited as the
1060	"William G. 'Doc' Myers Healthy Kids Corporation Act."
1061	(2)  LEGISLATIVE INTENT.--
1062	(a)  The Legislature finds that increased access to health
1063	care services could improve children's health and reduce the
1064	incidence and costs of childhood illness and disabilities among
1065	children in this state. Many children do not have comprehensive,
1066	affordable health care services available. It is the intent of
1067	the Legislature that the Florida Healthy Kids Corporation
1068	provide quality comprehensive health insurance coverage to such
1069	children. The corporation is encouraged to cooperate with any
1070	existing health service programs funded by the public or the
1071	private sector.
1072	(b)  It is the intent of the Legislature that the Florida
1073	Healthy Kids Corporation serve as one of several providers of
1074	services to children eligible for medical assistance under Title
1075	XXI of the Social Security Act. Although the corporation may
1076	serve other children, the Legislature intends the primary
1077	recipients of services provided through the corporation be
1078	school-age children with a family income below 200 percent of
1079	the federal poverty level, who do not qualify for Medicaid. It
1080	is also the intent of the Legislature that state and local
1081	government Florida Healthy Kids funds be used to continue
1082	coverage, subject to specific appropriations in the General
1083	Appropriations Act, to children not eligible for federal
1084	matching funds under Title XIX and Title XXI.
1085	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the
1086	following Individuals are eligible for premium state-funded
1087	assistance with in paying Florida Kidcare program Healthy Kids
1088	premiums:
1089	(a)  Residents of this state who are eligible for the
1090	Florida Kidcare program pursuant to s. 409.814.
1091	(b)  Notwithstanding s. 409.814, legal aliens who are
1092	enrolled in the Florida Healthy Kids program as of January 31,
1093	2004, who do not qualify for Title XXI federal funds because
1094	they are not qualified aliens as defined in s. 409.811.
1095	(4)  NONENTITLEMENT.--Nothing in this section shall be
1096	construed as providing an individual with an entitlement to
1097	health care services. No cause of action shall arise against the
1098	state, the Florida Healthy Kids Corporation, or a unit of local
1099	government for failure to make health services available under
1100	this section.
1101	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1102	(a)  There is created the Florida Healthy Kids Corporation,
1103	a not-for-profit corporation.
1104	(b)  The Florida Healthy Kids Corporation shall:
1105	1.  Arrange for the collection of any family, local
1106	contributions, or employer payment or premium, in an amount to
1107	be determined by the board of directors, to provide for payment
1108	of premiums for comprehensive insurance coverage and for the
1109	actual or estimated administrative expenses.
1110	2.  Arrange for the collection of any voluntary
1111	contributions to provide for payment of premiums for children
1112	who are not eligible for premium medical assistance in
1113	accordance with ss. 409.8141 and 409.816 under Title XXI of the
1114	Social Security Act.
1115	3.  Subject to the provisions of s. 409.8134, accept
1116	voluntary supplemental local match contributions that comply
1117	with the requirements of Title XXI of the Social Security Act
1118	for the purpose of providing additional coverage in contributing
1119	counties under Title XXI.
1120	4.  Establish the administrative and accounting procedures
1121	for the operation of the corporation.
1122	5.  Establish, with consultation from appropriate
1123	professional organizations, standards for preventive health
1124	services and providers and comprehensive insurance benefits
1125	appropriate to children, provided that such standards for rural
1126	areas shall not limit primary care providers to board-certified
1127	pediatricians.
1128	6.  Determine eligibility for premium assistance financed
1129	by any source other than Title XIX of the Social Security Act
1130	children seeking to participate in the Title XXI-funded
1131	components of the Florida Kidcare program consistent with the
1132	requirements specified in s. 409.814, as well as the non-Title-
1133	XXI-eligible children as provided in subsection (3).
1134	7.  Establish procedures under which providers of local
1135	match to, applicants to and participants in the program may have
1136	grievances reviewed by an impartial body and reported to the
1137	board of directors of the corporation.
1138	8.  Establish participation criteria and, if appropriate,
1139	contract with an authorized insurer, health maintenance
1140	organization, or third-party administrator to provide
1141	administrative services to the corporation.
1142	9.  Establish enrollment criteria which shall include
1143	penalties or waiting periods of not fewer than 60 days for
1144	reinstatement of coverage upon voluntary cancellation for
1145	nonpayment of family premiums.
1146	10.  Contract with authorized insurers or any provider of
1147	health care services, meeting standards established by the
1148	corporation, for the provision of comprehensive insurance
1149	coverage to participants. Such standards shall include criteria
1150	under which the corporation may contract with more than one
1151	provider of health care services in program sites. Health plans
1152	shall be selected through a competitive bid process. The Florida
1153	Healthy Kids Corporation shall purchase goods and services in
1154	the most cost-effective manner consistent with the delivery of
1155	quality medical care. The maximum administrative cost for a
1156	Florida Healthy Kids Corporation contract shall be 15 percent.
1157	For health care contracts, the minimum medical loss ratio for a
1158	Florida Healthy Kids Corporation contract shall be 85 percent.
1159	For dental contracts, the remaining compensation to be paid to
1160	the authorized insurer or provider under a Florida Healthy Kids
1161	Corporation contract shall be no less than an amount which is 85
1162	percent of premium; to the extent any contract provision does
1163	not provide for this minimum compensation, this section shall
1164	prevail. The health plan selection criteria and scoring system,
1165	and the scoring results, shall be available upon request for
1166	inspection after the bids have been awarded.
1167	11.  Establish disenrollment criteria in the event local
1168	matching funds are insufficient to cover enrollments.
1169	12.  Develop and implement a plan to publicize the Florida
1170	Kidcare program Healthy Kids Corporation, the eligibility
1171	requirements of the program, and the procedures for enrollment
1172	in the program and to maintain public awareness of the
1173	corporation and the program.
1174	13.  Secure staff necessary to properly administer the
1175	corporation. Staff costs shall be funded from state and local
1176	matching funds and such other private or public funds as become
1177	available. The board of directors shall determine the number of
1178	staff members necessary to administer the corporation.
1179	14.  Provide a report annually to the Governor, Chief
1180	Financial Officer, Commissioner of Education, Senate President,
1181	Speaker of the House of Representatives, and Minority Leaders of
1182	the Senate and the House of Representatives.
1183	15.  Establish benefit packages which conform to the
1184	provisions of the Florida Kidcare program, as created in ss.
1185	409.810-409.820.
1186	(c)  Coverage under the corporation's program is secondary
1187	to any other available private coverage held by, or applicable
1188	to, the participant child or family member. Insurers under
1189	contract with the corporation are the payors of last resort and
1190	must coordinate benefits with any other third-party payor that
1191	may be liable for the participant's medical care.
1192	(d)  The Florida Healthy Kids Corporation shall be a
1193	private corporation not for profit, organized pursuant to
1194	chapter 617, and shall have all powers necessary to carry out
1195	the purposes of this act, including, but not limited to, the
1196	power to receive and accept grants, loans, or advances of funds
1197	from any public or private agency and to receive and accept from
1198	any source contributions of money, property, labor, or any other
1199	thing of value, to be held, used, and applied for the purposes
1200	of this act.
1201	(6)  BOARD OF DIRECTORS.--
1202	(a)  The Florida Healthy Kids Corporation shall operate
1203	subject to the supervision and approval of a board of directors
1204	chaired by the Chief Financial Officer or her or his designee,
1205	and composed of 10 other members selected for 3-year terms of
1206	office as follows:
1207	1.  The Secretary of Health Care Administration, or his or
1208	her designee;
1209	2.  One member appointed by the Commissioner of Education
1210	from the Office of School Health Programs of the Florida
1211	Department of Education;
1212	3.  One member appointed by the Chief Financial Officer
1213	from among three members nominated by the Florida Pediatric
1214	Society;
1215	4.  One member, appointed by the Governor, who represents
1216	the Children's Medical Services Program;
1217	5.  One member appointed by the Chief Financial Officer
1218	from among three members nominated by the Florida Hospital
1219	Association;
1220	6.  One member, appointed by the Governor, who is an expert
1221	on child health policy;
1222	7.  One member, appointed by the Chief Financial Officer,
1223	from among three members nominated by the Florida Academy of
1224	Family Physicians;
1225	8.  One member, appointed by the Governor, who represents
1226	the state Medicaid program;
1227	9.  One member, appointed by the Chief Financial Officer,
1228	from among three members nominated by the Florida Association of
1229	Counties; and
1230	10.  The State Health Officer or her or his designee.
1231	(b)  A member of the board of directors may be removed by
1232	the official who appointed that member. The board shall appoint
1233	an executive director, who is responsible for other staff
1234	authorized by the board.
1235	(c)  Board members are entitled to receive, from funds of
1236	the corporation, reimbursement for per diem and travel expenses
1237	as provided by s. 112.061.
1238	(d)  There shall be no liability on the part of, and no
1239	cause of action shall arise against, any member of the board of
1240	directors, or its employees or agents, for any action they take
1241	in the performance of their powers and duties under this act.
1242	(7)  LICENSING NOT REQUIRED; FISCAL OPERATION.--
1243	(a)  The corporation shall not be deemed an insurer. The
1244	officers, directors, and employees of the corporation shall not
1245	be deemed to be agents of an insurer. Neither the corporation
1246	nor any officer, director, or employee of the corporation is
1247	subject to the licensing requirements of the insurance code or
1248	the rules of the Department of Financial Services. However, any
1249	marketing representative utilized and compensated by the
1250	corporation must be appointed as a representative of the
1251	insurers or health services providers with which the corporation
1252	contracts.
1253	(b)  The board has complete fiscal control over the
1254	corporation and is responsible for all corporate operations.
1255	(c)  The Department of Financial Services shall supervise
1256	any liquidation or dissolution of the corporation and shall
1257	have, with respect to such liquidation or dissolution, all power
1258	granted to it pursuant to the insurance code.
1259	(8)  ACCESS TO RECORDS; CONFIDENTIALITY;
1260	PENALTIES.--Notwithstanding any other laws to the contrary, the
1261	Florida Healthy Kids Corporation shall have access to the
1262	medical records of a student upon receipt of permission from a
1263	parent or guardian of the student. Such medical records may be
1264	maintained by state and local agencies. Any identifying
1265	information, including medical records and family financial
1266	information, obtained by the corporation pursuant to this
1267	subsection is confidential and is exempt from the provisions of
1268	s. 119.07(1). Neither the corporation nor the staff or agents of
1269	the corporation may release, without the written consent of the
1270	participant or the parent or guardian of the participant, to any
1271	state or federal agency, to any private business or person, or
1272	to any other entity, any confidential information received
1273	pursuant to this subsection. A violation of this subsection is a
1274	misdemeanor of the second degree, punishable as provided in s.
1275	775.082 or s. 775.083.
1276	(9)  VENUE.--The venue for all civil and administrative
1277	actions against the Florida Healthy Kids Corporation shall be in
1278	Leon County.
1279	Section 20.  Effective July 1, 2010, section 624.91,
1280	Florida Statutes, as amended by this act, is repealed.
1281	Section 21.  This act shall take effect July 1, 2007.

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