CS/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; requiring the corporation to establish
59	penalties or waiting periods for reinstatement of coverage
60	under certain circumstances and subject to an
61	appropriation; specifying venue for civil and
62	administrative actions against the corporation; providing
63	for future repeal; providing appropriations; providing an
64	effective date.
65
66	Be It Enacted by the Legislature of the State of Florida:
67
68	Section 1.  Subsection (4) of section 408.915, Florida
69	Statutes, is amended to read:
70	408.915  Eligibility pilot project.--The Agency for Health
71	Care Administration, in consultation with the steering committee
72	established in s. 408.916, shall develop and implement a pilot
73	project to integrate the determination of eligibility for health
74	care services with information and referral services.
75	(4)  The pilot project shall include eligibility
76	determinations for the following programs:
77	(a)  Medicaid under Title XIX of the Social Security Act.
78	(b)  Medikids as created in s. 409.8132.
79	(b)(c)  Florida Healthy Kids as described in s. 624.91 and
80	within eligibility guidelines provided in s. 409.814.
81	(c)(d)  Eligibility for Florida Kidcare services outside of
82	the scope of Title XIX or Title XXI of the Social Security Act
83	as provided in s. 409.814.
84	(d)(e)  State and local publicly funded health and social
85	services programs as determined appropriate by the steering
86	committee.
87	Section 2.  Paragraph (a) of subsection (9) of section
88	409.1451, Florida Statutes, is amended to read:
89	409.1451  Independent living transition services.--
90	(9)  MEDICAL ASSISTANCE FOR YOUNG ADULTS FORMERLY IN FOSTER
91	CARE.--The department shall enroll in the Florida Kidcare
92	program, outside the open enrollment period, each young adult
93	who is eligible as described in paragraph (2)(b) and who has not
94	yet reached his or her 19th birthday.
95	(a)  A young adult who was formerly in foster care at the
96	time of his or her 18th birthday and who is 18 years of age but
97	not yet 19, shall pay the premium for the Florida Kidcare
98	program as required in s. 409.8141 409.814.
99	Section 3.  Section 409.811, Florida Statutes, is amended
100	to read:
101	409.811  Definitions relating to Florida Kidcare Act.--As
102	used in ss. 409.810-409.820, the term:
103	(1)  "Actuarially equivalent" means that:
104	(a)  The aggregate value of the benefits included in health
105	benefits coverage is equal to the value of the benefits in the
106	benchmark benefit plan; and
107	(b)  The benefits included in health benefits coverage are
108	substantially similar to the benefits included in the benchmark
109	benefit plan, except that preventive health services must be the
110	same as in the benchmark benefit plan.
111	(1)(2)  "Agency" means the Agency for Health Care
112	Administration.
113	(2)(3)  "Applicant" means a parent or guardian of a child
114	or a child whose disability of nonage has been removed under
115	chapter 743, who applies for determination of eligibility for
116	health benefits coverage under ss. 409.810-409.820.
117	(4)  "Benchmark benefit plan" means the form and level of
118	health benefits coverage established in s. 409.815.
119	(3)(5)  "Child" means any person under 19 years of age.
120	(4)(6)  "Child with special health care needs" means a
121	child who has chronic physical, developmental, behavioral, or
122	emotional conditions and who also requires health care and
123	related services of a type or amount beyond that which is
124	generally required by a child whose serious or chronic physical
125	or developmental condition requires extensive preventive and
126	maintenance care beyond that required by typically healthy
127	children. Health care utilization by such a child exceeds the
128	statistically expected usage of the normal child adjusted for
129	chronological age, and such a child often needs complex care
130	requiring multiple providers, rehabilitation services, and
131	specialized equipment in a number of different settings.
132	(5)(7)  "Children's Medical Services Network" or "network"
133	means a statewide managed care service system as defined in s.
134	391.021(1).
135	(6)(8)  "Community rate" means a method used to develop
136	premiums for a health insurance plan that spreads financial risk
137	across a large population and allows adjustments only for age,
138	gender, family composition, and geographic area.
139	(7)(9)  "Department" means the Department of Health.
140	(8)(10)  "Enrollee" means a child who has been determined
141	eligible for and is receiving coverage under ss. 409.810-
142	409.820.
143	(9)(11)  "Family" means the group or the individuals whose
144	income is considered in determining eligibility for the Florida
145	Kidcare program. The family includes a child with a custodial
146	parent or caretaker relative who resides in the same house or
147	living unit or, in the case of a child whose disability of
148	nonage has been removed under chapter 743, the child. The family
149	may also include other individuals whose income and resources
150	are considered in whole or in part in determining eligibility of
151	the child.
152	(10)(12)  "Family income" means cash received at periodic
153	intervals from any source, such as wages, benefits,
154	contributions, or rental property. Income also may include any
155	money that would have been counted as income under the Aid to
156	Families with Dependent Children (AFDC) state plan in effect
157	prior to August 22, 1996.
158	(11)(13)  "Florida Kidcare program," "Kidcare program," or
159	"program" means the health benefits program administered through
160	ss. 409.810-409.820.
161	(12)(14)  "Guarantee issue" means that health benefits
162	coverage must be offered to an individual regardless of the
163	individual's health status, preexisting condition, or claims
164	history.
165	(13)(15)  "Health benefits coverage" means protection that
166	provides payment of benefits for covered health care services or
167	that otherwise provides, either directly or through arrangements
168	with other persons, covered health care services on a prepaid
169	per capita basis or on a prepaid aggregate fixed-sum basis.
170	(14)(16)  "Health insurance plan" means health benefits
171	coverage under the following:
172	(a)  A health plan offered by any certified health
173	maintenance organization or authorized health insurer, except a
174	plan that is limited to the following: a limited benefit,
175	specified disease, or specified accident; hospital indemnity;
176	accident only; limited benefit convalescent care; Medicare
177	supplement; credit disability; dental; vision; long-term care;
178	disability income; coverage issued as a supplement to another
179	health plan; workers' compensation liability or other insurance;
180	or motor vehicle medical payment only; or
181	(b)  An employee welfare benefit plan that includes health
182	benefits established under the Employee Retirement Income
183	Security Act of 1974, as amended.
184	(15)(17)  "Medicaid" means the medical assistance program
185	authorized by Title XIX of the Social Security Act, and
186	regulations thereunder, and ss. 409.901-409.920, as administered
187	in this state by the agency.
188	(16)(18)  "Medically necessary" means the use of any
189	medical treatment, service, equipment, or supply necessary to
190	palliate the effects of a terminal condition, or to prevent,
191	diagnose, correct, cure, alleviate, or preclude deterioration of
192	a condition that threatens life, causes pain or suffering, or
193	results in illness or infirmity and which is:
194	(a)  Consistent with the symptom, diagnosis, and treatment
195	of the enrollee's condition;
196	(b)  Provided in accordance with generally accepted
197	standards of medical practice;
198	(c)  Not primarily intended for the convenience of the
199	enrollee, the enrollee's family, or the health care provider;
200	(d)  The most appropriate level of supply or service for
201	the diagnosis and treatment of the enrollee's condition; and
202	(e)  Approved by the appropriate medical body or health
203	care specialty involved as effective, appropriate, and essential
204	for the care and treatment of the enrollee's condition.
205	(19)  "Medikids" means a component of the Florida Kidcare
206	program of medical assistance authorized by Title XXI of the
207	Social Security Act, and regulations thereunder, and s.
208	409.8132, as administered in the state by the agency.
209	(17)(20)  "Preexisting condition exclusion" means, with
210	respect to coverage, a limitation or exclusion of benefits
211	relating to a condition based on the fact that the condition was
212	present before the date of enrollment for such coverage, whether
213	or not any medical advice, diagnosis, care, or treatment was
214	recommended or received before such date.
215	(18)(21)  "Premium" means the entire cost of a health
216	insurance plan, including the administration fee or the risk
217	assumption charge.
218	(19)(22)  "Premium assistance payment" means the monthly
219	consideration paid by the agency per enrollee in the Florida
220	Kidcare program towards health insurance premiums.
221	(20)(23)  "Qualified alien" means an alien as defined in s.
222	431 of the Personal Responsibility and Work Opportunity
223	Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
224	(21)(24)  "Resident" means a United States citizen, or
225	qualified alien, who is domiciled in this state.
226	(22)(25)  "Rural county" means a county having a population
227	density of fewer less than 100 persons per square mile, or a
228	county defined by the most recent United States Census as rural,
229	in which there is no prepaid health plan participating in the
230	Medicaid program as of July 1, 1998.
231	(26)  "Substantially similar" means that, with respect to
232	additional services as defined in s. 2103(c)(2) of Title XXI of
233	the Social Security Act, these services must have an actuarial
234	value equal to at least 75 percent of the actuarial value of the
235	coverage for that service in the benchmark benefit plan and,
236	with respect to the basic services as defined in s. 2103(c)(1)
237	of Title XXI of the Social Security Act, these services must be
238	the same as the services in the benchmark benefit plan.
239	Section 4.  Section 409.812, Florida Statutes, is amended
240	to read:
241	409.812  Program created; purpose.--The Florida Kidcare
242	program is created to provide a defined set of health benefits
243	to previously uninsured, low-income children through the
244	establishment of a variety of affordable health benefits
245	coverage options from which families may select coverage and
246	through which families may contribute financially to the health
247	care of their children.
248	Section 5.  Section 409.813, Florida Statutes, is amended
249	to read:
250	409.813  Program components; entitlement and
251	nonentitlement.--The Florida Kidcare program includes health
252	benefits coverage provided to children through the following
253	program components, which shall be marketed as the Florida
254	Kidcare program:
255	(1)  Medicaid;
256	(2)  Medikids as created in s. 409.8132;
257	(2)(3)  The Florida Healthy Kids Corporation as created in
258	s. 624.91; and
259	(4)  Employer-sponsored group health insurance plans
260	approved under ss. 409.810-409.820; and
261	(3)(5)  The Children's Medical Services network established
262	in chapter 391.
263
264	Except for Title XIX-funded Florida Kidcare coverage under the
265	Medicaid program, coverage under the Florida Kidcare program is
266	not an entitlement. No cause of action shall arise against the
267	state, the department, the Department of Children and Family
268	Services, or the agency, or the Florida Healthy Kids Corporation
269	for failure to make health services available to any person
270	under ss. 409.810-409.820.
271	Section 6.  Section 409.8132, Florida Statutes, is
272	repealed.
273	Section 7.  Subsection (2) of section 409.8134, Florida
274	Statutes, is amended to read:
275	409.8134  Program expenditure ceiling.--
276	(2)  The Florida Kidcare program may conduct enrollment at
277	any time throughout the year for the purpose of enrolling
278	children eligible for all program components listed in s.
279	409.813 except Medicaid. The four Florida Kidcare administrators
280	shall work together to ensure that the year-round enrollment
281	period is announced statewide. Eligible children shall be
282	enrolled on a first-come, first-served basis using the date the
283	enrollment application is received. Enrollment shall immediately
284	cease when the expenditure ceiling is reached. Year-round
285	enrollment shall only be held if the Social Services Estimating
286	Conference determines that sufficient federal and state funds
287	will be available to finance the increased enrollment through
288	federal fiscal year 2007. Any individual who is not enrolled
289	must reapply by submitting a new application. The application
290	for the Florida Kidcare program shall be valid for a period of
291	120 days after the date it was received. At the end of the 120-
292	day period, if the applicant has not been enrolled in the
293	program, the application shall be invalid and the applicant
294	shall be notified of the action. The applicant may resubmit the
295	application after notification of the action taken by the
296	program. Except for the Medicaid program, whenever the Social
297	Services Estimating Conference determines that there are
298	presently, or will be by the end of the current fiscal year,
299	insufficient funds to finance the current or projected
300	enrollment in the Florida Kidcare program, all additional
301	enrollment must cease and additional enrollment may not resume
302	until sufficient funds are available to finance the such
303	enrollment.
304	Section 8.  Section 409.814, Florida Statutes, is amended
305	to read:
306	(Substantial rewording of section. See s. 409.814, F.S.,
307	for present text.)
308	409.814  Eligibility.--
309	(1)  ELIGIBILITY FOR THE FLORIDA KIDCARE PROGRAM.--
310	(a)  To be eligible for the Florida Kidcare program, a
311	child must be:
312	1.  A resident of the state.
313	2.  Under 19 years of age.
314	3.  Uninsured at the time of application.
315	(b)  Once a child is enrolled in the Florida Kidcare
316	program, the child is eligible for coverage under the program
317	for 12 months without redetermination or reverification of
318	eligibility.
319	(2)  ELIGIBILITY FOR CHILDREN'S MEDICAL SERVICES.--To be
320	eligible for the Children's Medical Services component of the
321	Florida Kidcare program, a child must meet the requirements of
322	subsection (1) and must be a child with special health care
323	needs as determined through clinical eligibility screening by
324	the Department of Health pursuant to s. 409.818(2).
325	Section 9.  Section 409.8141, Florida Statutes, is created
326	to read:
327	409.8141  Premium assistance.--
328	(1)  The Florida Kidcare program may provide premium
329	assistance to certain children enrolled in the program. To be
330	eligible for premium assistance, the child must meet the
331	requirements of s. 409.814 and must:
332	(a)  Reside in a household where the family income is equal
333	to or less than 200 percent of the federal poverty level; and
334	(b)  Be a United States citizen or a qualified alien as
335	defined in s. 409.811(22).
336	(2)  The Florida Kidcare program may provide premium
337	assistance for enrollees who do not reside in a household where
338	the family income is equal to or less than 200 percent of the
339	federal poverty level, who are noncitizens, who are not
340	qualified aliens, or who are children of state employees. Such
341	premium assistance may be funded by general revenue or local
342	contributions pursuant to s. 624.91 and is subject to specific
343	appropriation. If the program does not provide such premium
344	assistance, enrollees not meeting the eligibility requirements
345	of subsection (1) shall pay the full cost of the premium and are
346	not required to document income.
347	(3)  Eligibility for premium assistance shall be verified
348	for each applicant and enrollee during the application and
349	reverification processes based on:
350	(a)  Family income verified electronically. If electronic
351	verification of income eligibility is not available, family
352	income shall be documented with a copy of the applicant's most
353	recent federal income tax return. In the absence of a federal
354	income tax return, an applicant's wages and earnings statements,
355	W-2 forms, or other appropriate documentation obtained from
356	other government sources, including electronic records, may be
357	considered. An assets test is not required.
358	(b)  A statement from the applicant or enrollee that the
359	child is not currently insured by an employer-sponsored or other
360	benefit plan.
361	(4)  Once a child is found eligible for premium assistance,
362	the child shall receive premium assistance for 12 months without
363	reverification of eligibility if the family continues to
364	participate in any applicable cost-sharing pursuant to s.
365	409.816. The Florida Kidcare program shall conduct an annual
366	eligibility reverification for each enrollee eligible for
367	premium assistance.
368	Section 10.  Section 409.8142, Florida Statutes, is created
369	to read:
370	409.8142  Penalties.--
371	(1)  Subject to s. 624.91(4), the Florida Kidcare program
372	shall withhold benefits from an enrollee if the program obtains
373	evidence that the enrollee is no longer eligible, submitted
374	incorrect or fraudulent information in order to establish
375	eligibility, or failed to provide verification of eligibility.
376	The applicant or enrollee shall be notified that, because of
377	such evidence, program benefits will be withheld unless the
378	applicant or enrollee contacts a designated representative of
379	the program by a specified date, which must be within 10 days
380	after the date of notice, to discuss and resolve the matter. The
381	program shall make every effort to resolve the matter within a
382	timeframe that will not cause benefits to be withheld from an
383	eligible enrollee.
384	(2)  The following individuals may be subject to
385	prosecution in accordance with s. 414.39:
386	(a)  An applicant obtaining or attempting to obtain
387	benefits for a potential enrollee under the Florida Kidcare
388	program when the applicant knows or should have known the
389	potential enrollee does not qualify for the Florida Kidcare
390	program.
391	(b)  An individual who assists an applicant in obtaining or
392	attempting to obtain benefits for a potential enrollee under the
393	Florida Kidcare program when the individual knows or should have
394	known the potential enrollee does not qualify for the Florida
395	Kidcare program.
396	Section 11.  Section 409.8149, Florida Statutes, is created
397	to read:
398	409.8149  Enrollment; plan choice; choice counseling.--
399	(1)  ENROLLMENT.--The Florida Kidcare program may conduct
400	enrollment at any time throughout the year for the purpose of
401	enrolling children eligible for all program components listed in
402	s. 409.813 except Medicaid. The four Florida Kidcare
403	administrators shall work together to ensure that the year-round
404	enrollment period is announced statewide. Eligible children
405	shall be enrolled on a first-come, first-served basis, based
406	upon the date the enrollment application is received. The
407	application for the Florida Kidcare program is valid for a
408	period of 120 days after the date the application is received.
409	At the end of the 120-day period, if the applicant has not been
410	enrolled in the program, the application is invalid and the
411	applicant shall be notified of the action. The applicant may
412	resubmit the application after notification of the action taken
413	by the program.
414	(2)  PLAN CHOICE.--
415	(a)  Each enrollee shall have 30 days after the date of
416	enrollment to voluntarily choose a benefit plan. A child with
417	special health care needs as determined through clinical
418	eligibility screening by the Department of Health pursuant to s.
419	409.818(2) shall be assigned to the Children's Medical Services
420	Network and may opt out of the Children's Medical Services
421	Network. Enrollees may choose the Children's Medical Services
422	Network or any managed care plan operating in the Medicaid
423	program or any plan selected pursuant to s. 624.91 in the
424	geographical area in which the enrollee resides. An enrollee
425	eligible for Medicaid may also choose the Medicaid fee-for-
426	service program.
427	(b)  Enrollees who do not voluntarily choose a benefit plan
428	shall be assigned to a managed care plan by the Florida Kidcare
429	program. The program shall assign enrollees eligible for
430	Medicaid to a Medicaid managed care plan or to the Medicaid fee-
431	for-service program if a Medicaid managed care plan does not
432	exist in the geographical area in which the enrollee resides.
433	The program shall assign all other enrollees to plans selected
434	pursuant to s. 624.91 in the geographical area in which each
435	enrollee resides.
436	(c)  Upon selection or assignment, an enrollee shall have
437	90 days during which to voluntarily disenroll from a benefit
438	plan and select another.
439	(d)  Upon the anniversary of enrollment, each enrollee may
440	voluntarily select another benefit plan. The Florida Kidcare
441	program shall notify enrollees of their annual open enrollment
442	options 60 days prior to the anniversary of initial enrollment.
443	(3)  CHOICE COUNSELING.--The Florida Kidcare program shall
444	provide education on the available benefit plans pursuant to s.
445	409.818(4). The program shall provide choice counseling upon
446	initial enrollment and prior to an enrollee's annual optional
447	reselection. The program shall coordinate with Medicaid to
448	provide choice counseling regarding Medicaid fee-for-service and
449	managed care options.
450	Section 12.  Section 409.815, Florida Statutes, is amended
451	to read:
452	409.815  Health benefits coverage; limitations.--
453	(1)  MEDICAID BENEFITS.--For purposes of the Florida
454	Kidcare program, Benefits available under all Florida Kidcare
455	components shall meet the federal Medicaid Early and Periodic
456	Screening, Diagnosis, and Treatment (EPSDT) program standards
457	and Medikids include those goods and services provided under the
458	medical assistance program authorized by Title XIX of the Social
459	Security Act, and regulations thereunder, as administered in
460	this state by the agency. This includes those mandatory Medicaid
461	services authorized under s. 409.905 and optional Medicaid
462	services authorized under s. 409.906, rendered on behalf of
463	eligible individuals by qualified providers, in accordance with
464	federal requirements for Title XIX, subject to any limitations
465	or directions provided for in the General Appropriations Act or
466	chapter 216, and according to methodologies and limitations set
467	forth in agency rules and policy manuals and handbooks
468	incorporated by reference thereto.
469	(2)  BENCHMARK BENEFITS.--In order for health benefits
470	coverage to qualify for premium assistance payments for an
471	eligible child under ss. 409.810-409.820, the health benefits
472	coverage, except for coverage under Medicaid and Medikids, must
473	include the following minimum benefits, as medically necessary.
474	(a)  Preventive health services.--Covered services include:
475	1.  Well-child care, including services recommended in the
476	Guidelines for Health Supervision of Children and Youth as
477	developed by the American Academy of Pediatrics;
478	2.  Immunizations and injections;
479	3.  Health education counseling and clinical services;
480	4.  Vision screening; and
481	5.  Hearing screening.
482	(b)  Inpatient hospital services.--All covered services
483	provided for the medical care and treatment of an enrollee who
484	is admitted as an inpatient to a hospital licensed under part I
485	of chapter 395, with the following exceptions:
486	1.  All admissions must be authorized by the enrollee's
487	health benefits coverage provider.
488	2.  The length of the patient stay shall be determined
489	based on the medical condition of the enrollee in relation to
490	the necessary and appropriate level of care.
491	3.  Room and board may be limited to semiprivate
492	accommodations, unless a private room is considered medically
493	necessary or semiprivate accommodations are not available.
494	4.  Admissions for rehabilitation and physical therapy are
495	limited to 15 days per contract year.
496	(c)  Emergency services.--Covered services include visits
497	to an emergency room or other licensed facility if needed
498	immediately due to an injury or illness and delay means risk of
499	permanent damage to the enrollee's health. Health maintenance
500	organizations shall comply with the provisions of s. 641.513.
501	(d)  Maternity services.--Covered services include
502	maternity and newborn care, including prenatal and postnatal
503	care, with the following limitations:
504	1.  Coverage may be limited to the fee for vaginal
505	deliveries; and
506	2.  Initial inpatient care for newborn infants of enrolled
507	adolescents shall be covered, including normal newborn care,
508	nursery charges, and the initial pediatric or neonatal
509	examination, and the infant may be covered for up to 3 days
510	following birth.
511	(e)  Organ transplantation services.--Covered services
512	include pretransplant, transplant, and postdischarge services
513	and treatment of complications after transplantation for
514	transplants deemed necessary and appropriate within the
515	guidelines set by the Organ Transplant Advisory Council under s.
516	765.53 or the Bone Marrow Transplant Advisory Panel under s.
517	627.4236.
518	(f)  Outpatient services.--Covered services include
519	preventive, diagnostic, therapeutic, palliative care, and other
520	services provided to an enrollee in the outpatient portion of a
521	health facility licensed under chapter 395, except for the
522	following limitations:
523	1.  Services must be authorized by the enrollee's health
524	benefits coverage provider; and
525	2.  Treatment for temporomandibular joint disease (TMJ) is
526	specifically excluded.
527	(g)  Behavioral health services.--
528	1.  Mental health benefits include:
529	a.  Inpatient services, limited to not more than 30
530	inpatient days per contract year for psychiatric admissions, or
531	residential services in facilities licensed under s. 394.875(8)
532	or s. 395.003 in lieu of inpatient psychiatric admissions;
533	however, a minimum of 10 of the 30 days shall be available only
534	for inpatient psychiatric services when authorized by a
535	physician; and
536	b.  Outpatient services, including outpatient visits for
537	psychological or psychiatric evaluation, diagnosis, and
538	treatment by a licensed mental health professional, limited to a
539	maximum of 40 outpatient visits each contract year.
540	2.  Substance abuse services include:
541	a.  Inpatient services, limited to not more than 7
542	inpatient days per contract year for medical detoxification only
543	and 30 days of residential services; and
544	b.  Outpatient services, including evaluation, diagnosis,
545	and treatment by a licensed practitioner, limited to a maximum
546	of 40 outpatient visits per contract year.
547	(h)  Durable medical equipment.--Covered services include
548	equipment and devices that are medically indicated to assist in
549	the treatment of a medical condition and specifically prescribed
550	as medically necessary, with the following limitations:
551	1.  Low-vision and telescopic aides are not included.
552	2.  Corrective lenses and frames may be limited to one pair
553	every 2 years, unless the prescription or head size of the
554	enrollee changes.
555	3.  Hearing aids shall be covered only when medically
556	indicated to assist in the treatment of a medical condition.
557	4.  Covered prosthetic devices include artificial eyes and
558	limbs, braces, and other artificial aids.
559	(i)  Health practitioner services.--Covered services
560	include services and procedures rendered to an enrollee when
561	performed to diagnose and treat diseases, injuries, or other
562	conditions, including care rendered by health practitioners
563	acting within the scope of their practice, with the following
564	exceptions:
565	1.  Chiropractic services shall be provided in the same
566	manner as in the Florida Medicaid program.
567	2.  Podiatric services may be limited to one visit per day
568	totaling two visits per month for specific foot disorders.
569	(j)  Home health services.--Covered services include
570	prescribed home visits by both registered and licensed practical
571	nurses to provide skilled nursing services on a part-time
572	intermittent basis, subject to the following limitations:
573	1.  Coverage may be limited to include skilled nursing
574	services only;
575	2.  Meals, housekeeping, and personal comfort items may be
576	excluded; and
577	3.  Private duty nursing is limited to circumstances where
578	such care is medically necessary.
579	(k)  Hospice services.--Covered services include reasonable
580	and necessary services for palliation or management of an
581	enrollee's terminal illness, with the following exceptions:
582	1.  Once a family elects to receive hospice care for an
583	enrollee, other services that treat the terminal condition will
584	not be covered; and
585	2.  Services required for conditions totally unrelated to
586	the terminal condition are covered to the extent that the
587	services are included in this section.
588	(l)  Laboratory and X-ray services.--Covered services
589	include diagnostic testing, including clinical radiologic,
590	laboratory, and other diagnostic tests.
591	(m)  Nursing facility services.--Covered services include
592	regular nursing services, rehabilitation services, drugs and
593	biologicals, medical supplies, and the use of appliances and
594	equipment furnished by the facility, with the following
595	limitations:
596	1.  All admissions must be authorized by the health
597	benefits coverage provider.
598	2.  The length of the patient stay shall be determined
599	based on the medical condition of the enrollee in relation to
600	the necessary and appropriate level of care, but is limited to
601	not more than 100 days per contract year.
602	3.  Room and board may be limited to semiprivate
603	accommodations, unless a private room is considered medically
604	necessary or semiprivate accommodations are not available.
605	4.  Specialized treatment centers and independent kidney
606	disease treatment centers are excluded.
607	5.  Private duty nurses, television, and custodial care are
608	excluded.
609	6.  Admissions for rehabilitation and physical therapy are
610	limited to 15 days per contract year.
611	(n)  Prescribed drugs.--
612	1.  Coverage shall include drugs prescribed for the
613	treatment of illness or injury when prescribed by a licensed
614	health practitioner acting within the scope of his or her
615	practice.
616	2.  Prescribed drugs may be limited to generics if
617	available and brand name products if a generic substitution is
618	not available, unless the prescribing licensed health
619	practitioner indicates that a brand name is medically necessary.
620	3.  Prescribed drugs covered under this section shall
621	include all prescribed drugs covered under the Florida Medicaid
622	program.
623	(o)  Therapy services.--Covered services include
624	rehabilitative services, including occupational, physical,
625	respiratory, and speech therapies, with the following
626	limitations:
627	1.  Services must be for short-term rehabilitation where
628	significant improvement in the enrollee's condition will result;
629	and
630	2.  Services shall be limited to not more than 24 treatment
631	sessions within a 60-day period per episode or injury, with the
632	60-day period beginning with the first treatment.
633	(p)  Transportation services.--Covered services include
634	emergency transportation required in response to an emergency
635	situation.
636	(q)  Dental services.--Dental services shall be covered and
637	may include those dental benefits provided to children by the
638	Florida Medicaid program under s. 409.906(6).
639	(r)  Lifetime maximum.--Health benefits coverage obtained
640	under ss. 409.810-409.820 shall pay an enrollee's covered
641	expenses at a lifetime maximum of $1 million per covered child.
642	(s)  Cost-sharing.--Cost-sharing provisions must comply
643	with s. 409.816.
644	(t)  Exclusions.--
645	1.  Experimental or investigational procedures that have
646	not been clinically proven by reliable evidence are excluded;
647	2.  Services performed for cosmetic purposes only or for
648	the convenience of the enrollee are excluded; and
649	3.  Abortion may be covered only if necessary to save the
650	life of the mother or if the pregnancy is the result of an act
651	of rape or incest.
652	(2)(u)  ENHANCEMENTS TO BENEFITS minimum requirements.--
653	(a)1.  This section sets the minimum benefits that must be
654	included in any health benefits coverage, other than Medicaid or
655	Medikids coverage, offered under ss. 409.810-409.820. Health
656	benefits coverage may include additional benefits not included
657	under this subsection (1), but may not include benefits excluded
658	under paragraph (s).
659	(b)2.  Health benefits coverage may extend any limitations
660	beyond the minimum benefits described in this section.
661
662	Except for the Children's Medical Services Network, the agency
663	may not increase the premium assistance payment for either
664	additional benefits provided beyond the minimum benefits
665	described in this section or the imposition of less restrictive
666	service limitations.
667	(3)(v)  APPLICABILITY OF OTHER STATE LAWS.--Health
668	insurers, health maintenance organizations, and their agents are
669	subject to the provisions of the Florida Insurance Code, except
670	for any such provisions waived in this section.
671	(a)1.  Except as expressly provided in this section, a law
672	requiring coverage for a specific health care service or
673	benefit, or a law requiring reimbursement, utilization, or
674	consideration of a specific category of licensed health care
675	practitioner, does not apply to a health insurance plan policy
676	or contract offered or delivered under ss. 409.810-409.820
677	unless that law is made expressly applicable to such policies or
678	contracts.
679	(b)2.  Notwithstanding chapter 641, a health maintenance
680	organization may issue contracts providing benefits equal to,
681	exceeding, or actuarially equivalent to the benchmark benefit
682	plan required authorized by this section and may pay providers
683	located in a rural county negotiated fees or Medicaid
684	reimbursement rates for services provided to enrollees who are
685	residents of the rural county.
686	Section 13.  Section 409.816, Florida Statutes, is amended
687	to read:
688	(Substantial rewording of section. See s. 409.816, F.S.,
689	for present text.)
690	409.816  Premiums.--
691	(1)  SOURCES OF FUNDING.--
692	(a)  Premiums for children eligible for Medicaid shall be
693	funded by Medicaid.
694	(b)  Premiums for children eligible for medical assistance
695	under Title XXI of the Social Security Act shall be funded by
696	Title XXI federal funds.
697	(c)  Premiums for children not eligible for Medicaid or
698	medical assistance under Title XXI of the Social Security Act
699	shall be fully paid by the children's families. However, such
700	premiums may be funded by general revenue or local contributions
701	pursuant to s. 624.91 and subject to specific appropriation.
702	(2)  RATES.--The Florida Kidcare program shall set premium
703	rates based on the age, gender, and geographic location of the
704	child and the child's eligibility for enrollment in the
705	Children's Medical Services Network.
706	(3)  SEAMLESS TRANSITION.--Enrollees may participate in any
707	managed care plan operating under the Florida Kidcare program or
708	Medicaid regardless of any change in eligibility for premium
709	assistance. If an enrollee's eligibility for premium assistance
710	changes, the program shall change the premium funding source in
711	accordance with the enrollee's new eligibility status and
712	continue to apply the enrollee's premium to the chosen plan. If
713	an enrollee chooses a different plan during the annual plan
714	selection period provided under s. 409.8149, the program shall
715	ensure that the premium funding follows the enrollee to the new
716	plan.
717	(4)  COST SHARING.--
718	(a)  Enrollees who are eligible for Medicaid shall not pay
719	enrollment fees, premiums, copayments, deductibles, coinsurance,
720	or similar charges.
721	(b)  Enrollees who are not eligible for Medicaid and have a
722	family income below 150 percent of the federal poverty level
723	shall pay a share of the premium cost and shall pay $15 per
724	family per month. Cost sharing may be waived by the Florida
725	Kidcare program when required by Title XXI of the Social
726	Security Act.
727	(c)  Enrollees who are not eligible for Medicaid and have a
728	family income below 200 percent of the federal poverty level
729	shall pay a share of the premium cost and shall pay $20 per
730	family per month. Cost sharing may be waived by the Florida
731	Kidcare program when required by Title XXI of the Social
732	Security Act.
733	(d)  Enrollees who are not receiving premium assistance
734	shall pay the full cost of the premium.
735	Section 14.  Section 409.817, Florida Statutes, is amended
736	to read:
737	409.817  Approval of health benefits coverage; financial
738	assistance.--In order for health insurance coverage other than
739	Medicaid managed care plans to qualify for premium assistance
740	payments for an eligible child under ss. 409.810-409.820, the
741	health benefits coverage must:
742	(1)  Be certified by the Office of Insurance Regulation of
743	the Financial Services Commission under s. 409.818 as meeting,
744	exceeding, or being actuarially equivalent to the benchmark
745	benefit plan;
746	(1)(2)  Be guarantee issued;
747	(2)(3)  Be community rated;
748	(3)(4)  Not impose any preexisting condition exclusion for
749	covered benefits; however, group health insurance plans may
750	permit the imposition of a preexisting condition exclusion, but
751	only insofar as it is permitted under s. 627.6561;
752	(4)(5)  Comply with the applicable limitations on premiums
753	and cost-sharing in s. 409.816;
754	(5)(6)  Comply with the quality assurance and access
755	standards developed under s. 409.820; and
756	(6)(7)  Establish periodic open enrollment periods, which
757	may not occur more frequently than quarterly.
758	Section 15.  Paragraph (i) of subsection (1) of section
759	409.8177, Florida Statutes, is amended to read:
760	409.8177  Program evaluation.--
761	(1)  The agency, in consultation with the Department of
762	Health, the Department of Children and Family Services, and the
763	Florida Healthy Kids Corporation, shall contract for an
764	evaluation of the Florida Kidcare program and shall by January 1
765	of each year submit to the Governor, the President of the
766	Senate, and the Speaker of the House of Representatives a report
767	of the program. In addition to the items specified under s. 2108
768	of Title XXI of the Social Security Act, the report shall
769	include an assessment of crowd-out and access to health care, as
770	well as the following:
771	(i)  An assessment of the effectiveness of the Medikids,
772	Children's Medical Services network, and other public and
773	private programs in the state in increasing the availability of
774	affordable quality health insurance and health care for
775	children.
776	Section 16.  Section 409.818, Florida Statutes, is amended
777	to read:
778	409.818  Administration.--In order to implement ss.
779	409.810-409.820, the following agencies shall have the following
780	duties:
781	(1)  The Department of Children and Family Services shall:
782	(a)  Develop a comprehensive, statewide outreach program
783	through the Community Access Network developed by the department
784	that increases enrollment in the Florida Kidcare program by
785	providing multiple access points throughout the state,
786	maximizing shared resources, and partnering with a broad variety
787	of providers, schools, community-based organizations, and local
788	and state agencies.
789	(b)  Develop a standardized intake process for all
790	Community Access Network partners that informs applicants about
791	coverage and services available through the Florida Kidcare
792	program and collects all information necessary to assess
793	eligibility for any premium assistance.
794	(c)(a)  Develop a simplified eligibility application
795	process mail-in form to be used for determining the eligibility
796	of children for coverage through under the Florida Kidcare
797	program, in consultation with the agency, the Department of
798	Health, and the Florida Healthy Kids Corporation. The department
799	shall collect all information necessary to determine eligibility
800	for premium assistance and provide simplified eligibility
801	application form must include an item that provides an
802	opportunity for the applicant to indicate whether coverage is
803	being sought for a child with special health care needs.
804	Families applying for children's Medicaid coverage must also be
805	able to use the simplified application form without having to
806	pay a premium.
807	(d)  Determine eligibility for Medicaid. The department may
808	perform this function either directly or through the services of
809	a contracted third-party administrator. The eligibility
810	determination process must include redetermination or
811	reverification of eligibility every 12 months.
812	(e)  Coordinate with the Florida Healthy Kids Corporation
813	to establish a seamless eligibility process for children
814	regardless of funding source.
815	(b)  Establish and maintain the eligibility determination
816	process under the program except as specified in subsection (5).
817	The department shall directly, or through the services of a
818	contracted third-party administrator, establish and maintain a
819	process for determining eligibility of children for coverage
820	under the program. The eligibility determination process must be
821	used solely for determining eligibility of applicants for health
822	benefits coverage under the program. The eligibility
823	determination process must include an initial determination of
824	eligibility for any coverage offered under the program, as well
825	as a redetermination or reverification of eligibility each
826	subsequent 6 months. Effective January 1, 1999, a child who has
827	not attained the age of 5 and who has been determined eligible
828	for the Medicaid program is eligible for coverage for 12 months
829	without a redetermination or reverification of eligibility. In
830	conducting an eligibility determination, the department shall
831	determine if the child has special health care needs. The
832	department, in consultation with the Agency for Health Care
833	Administration and the Florida Healthy Kids Corporation, shall
834	develop procedures for redetermining eligibility which enable a
835	family to easily update any change in circumstances which could
836	affect eligibility. The department may accept changes in a
837	family's status as reported to the department by the Florida
838	Healthy Kids Corporation without requiring a new application
839	from the family. Redetermination of a child's eligibility for
840	Medicaid may not be linked to a child's eligibility
841	determination for other programs.
842	(f)(c)  Inform program applicants about eligibility
843	determinations and ensure appropriate followup procedures for
844	choice counseling and plan enrollment provide information about
845	eligibility of applicants to Medicaid, Medikids, the Children's
846	Medical Services Network, and the Florida Healthy Kids
847	Corporation, and to insurers and their agents, through a
848	centralized coordinating office.
849	(g)(d)  Adopt such rules as may be necessary for conducting
850	program eligibility and outreach functions.
851	(2)  The Department of Health shall determine eligibility
852	for the Children's Medical Services component of the Florida
853	Kidcare program based on a clinical eligibility screening.:
854	(a)  Design an eligibility intake process for the program,
855	in coordination with the Department of Children and Family
856	Services, the agency, and the Florida Healthy Kids Corporation.
857	The eligibility intake process may include local intake points
858	that are determined by the Department of Health in coordination
859	with the Department of Children and Family Services.
860	(b)  Chair a state-level coordinating council to review and
861	make recommendations concerning the implementation and operation
862	of the program. The coordinating council shall include
863	representatives from the department, the Department of Children
864	and Family Services, the agency, the Florida Healthy Kids
865	Corporation, the Office of Insurance Regulation of the Financial
866	Services Commission, local government, health insurers, health
867	maintenance organizations, health care providers, families
868	participating in the program, and organizations representing
869	low-income families.
870	(c)  In consultation with the Florida Healthy Kids
871	Corporation and the Department of Children and Family Services,
872	establish a toll-free telephone line to assist families with
873	questions about the program.
874	(d)  Adopt rules necessary to implement outreach
875	activities.
876	(3)  The Agency for Health Care Administration, under the
877	authority granted in s. 409.914(1), shall:
878	(a)  Calculate the premium assistance payment necessary to
879	comply with the premium and cost-sharing limitations specified
880	in s. 409.816. The premium assistance payment for each enrollee
881	in a health insurance plan participating in the Florida Healthy
882	Kids Corporation shall equal the premium approved by the Florida
883	Healthy Kids Corporation and the Office of Insurance Regulation
884	of the Financial Services Commission pursuant to ss. 627.410 and
885	641.31, less any enrollee's share of the premium established
886	within the limitations specified in s. 409.816. The premium
887	assistance payment for each enrollee in an employer-sponsored
888	health insurance plan approved under ss. 409.810-409.820 shall
889	equal the premium for the plan adjusted for any benchmark
890	benefit plan actuarial equivalent benefit rider approved by the
891	Office of Insurance Regulation pursuant to ss. 627.410 and
892	641.31, less any enrollee's share of the premium established
893	within the limitations specified in s. 409.816. In calculating
894	the premium assistance payment levels for children with family
895	coverage, the agency shall set the premium assistance payment
896	levels for each child proportionately to the total cost of
897	family coverage.
898	(b)  Provide fiscal management for Title XIX and Title XXI
899	funding for the Florida Kidcare program, distributing funds
900	among Florida Healthy Kids, the Department of Children and
901	Family Services, and the Department of Health based on costs and
902	the participation of children in the plans and programs
903	available to Florida Kidcare program participants.
904	(c)(b)  Make premium assistance payments to health
905	insurance plans on a periodic basis. The agency may use its
906	Medicaid fiscal agent or a contracted third-party administrator
907	in making these payments. The agency may require health
908	insurance plans that participate in the Medikids program or
909	employer-sponsored group health insurance to collect premium
910	payments from an enrollee's family. Participating health
911	insurance plans shall report premium payments collected on
912	behalf of enrollees in the program to the agency in accordance
913	with a schedule established by the agency.
914	(d)(c)  Monitor compliance with quality assurance and
915	access standards developed under s. 409.820.
916	(e)(d)  Establish a mechanism for investigating and
917	resolving complaints and grievances from program applicants,
918	enrollees, and health benefits coverage providers, and maintain
919	a record of complaints and confirmed problems. In the case of a
920	child who is enrolled in a health maintenance organization, the
921	agency must use the provisions of s. 641.511 to address
922	grievance reporting and resolution requirements.
923	(e)  Approve health benefits coverage for participation in
924	the program, following certification by the Office of Insurance
925	Regulation under subsection (4).
926	(f)  Adopt rules, as necessary, for calculating premium
927	assistance payment levels, making premium assistance payments,
928	monitoring access and quality assurance standards, investigating
929	and resolving complaints and grievances, administering the
930	Medikids program, and approving health benefits coverage.
931	(g)  Seek and implement federal waivers necessary to
932	implement this section and ss. 409.810-409.820.
933
934	The agency is designated the lead state agency for Title XXI of
935	the Social Security Act for purposes of receipt of federal
936	funds, for reporting purposes, and for ensuring compliance with
937	federal and state regulations and rules.
938	(4)  The Office of Insurance Regulation shall certify that
939	health benefits coverage plans that seek to provide services
940	under the Florida Kidcare program, except those offered through
941	the Florida Healthy Kids Corporation or the Children's Medical
942	Services Network, meet, exceed, or are actuarially equivalent to
943	the benchmark benefit plan and that health insurance plans will
944	be offered at an approved rate. In determining actuarial
945	equivalence of benefits coverage, the Office of Insurance
946	Regulation and health insurance plans must comply with the
947	requirements of s. 2103 of Title XXI of the Social Security Act.
948	The department shall adopt rules necessary for certifying health
949	benefits coverage plans.
950	(4)(5)  The Florida Healthy Kids Corporation shall retain
951	its functions as authorized in s. 624.91, including eligibility
952	determination for participation in the Florida Kidcare Healthy
953	Kids program. Additionally, the Florida Healthy Kids Corporation
954	shall:
955	(a)  Develop and implement a statewide marketing program to
956	promote the Florida Kidcare program. The corporation may
957	contract for marketing services to the extent funds are made
958	available for that specific purpose.
959	(b)  Provide comprehensive choice counseling to assist
960	families with eligible children to select and enroll in
961	available plans.
962	(5)(6)  The agency, the Department of Health, the
963	Department of Children and Family Services, the Florida Healthy
964	Kids Corporation, and the Office of Insurance Regulation, after
965	consultation with and approval of the Speaker of the House of
966	Representatives and the President of the Senate, are authorized
967	to make program modifications that are necessary to overcome any
968	objections of the United States Department of Health and Human
969	Services to obtain approval of the state's child health
970	insurance plan under Title XXI of the Social Security Act.
971	Section 17.  Section 409.821, Florida Statutes, is amended
972	to read:
973	409.821  Florida Kidcare program public records
974	exemption.--Notwithstanding any other law to the contrary, Any
975	information identifying a Florida Kidcare program applicant or
976	enrollee, as defined in s. 409.811, held by the Agency for
977	Health Care Administration, the Department of Children and
978	Family Services, the Department of Health, or the Florida
979	Healthy Kids Corporation is confidential and exempt from s.
980	119.07(1) and s. 24(a), Art. I of the State Constitution. Such
981	information may be disclosed to another governmental entity only
982	if disclosure is necessary for the entity to perform its duties
983	and responsibilities under the Florida Kidcare program and shall
984	be disclosed to the Department of Revenue for purposes of
985	administering the state Title IV-D program. The receiving
986	governmental entity must maintain the confidential and exempt
987	status of such information. Furthermore, such information may
988	not be released to any person without the written consent of the
989	program enrollee or the parent or guardian of the enrollee
990	applicant. This exemption applies to any information identifying
991	a Florida Kidcare program applicant or enrollee held by the
992	Agency for Health Care Administration, the Department of
993	Children and Family Services, the Department of Health, or the
994	Florida Healthy Kids Corporation before, on, or after the
995	effective date of this exemption. A violation of this section is
996	a misdemeanor of the second degree, punishable as provided in s.
997	775.082 or s. 775.083.
998	Section 18.  Section 409.822, Florida Statutes, is created
999	to read:
1000	409.822  Florida Kidcare program consolidation.--
1001	(1)  It is the intent of the Legislature to consolidate the
1002	administration of the Florida Kidcare program to provide a
1003	seamless delivery system of health benefits to uninsured, low-
1004	income children. It is the further intent of the Legislature
1005	that administration of the program be consolidated under the
1006	fewest entities necessary for the purpose of conducting
1007	marketing and outreach, eligibility determination, premium
1008	collection, contract management of health plans and fiscal
1009	agents, quality assurance and grievance resolution, and fiscal
1010	management of all the components of the Florida Kidcare program.
1011	(2)  The agency shall manage the consolidation of all
1012	components of the Florida Kidcare program. The agency shall
1013	develop a comprehensive plan for consolidation and shall submit
1014	the plan to the Governor, the President of the Senate, and the
1015	Speaker of the House of Representatives by November 1, 2009.
1016	(3)  Effective July 1, 2010, the agency shall make payments
1017	for medical assistance and related services; manage health plan,
1018	provider, and fiscal agent contracts; collect premiums; develop
1019	and implement quality assurance and grievance resolution
1020	processes; and conduct other fiscal-management activities
1021	relating to all components of the Florida Kidcare program. The
1022	agency shall perform all other functions necessary to administer
1023	the program, except that:
1024	(a)  The department shall conduct eligibility determination
1025	for all components of the Florida Kidcare program. All
1026	correspondence regarding eligibility shall be identified solely
1027	with the Florida Kidcare program.
1028	(b)  The department shall develop and distribute marketing
1029	and outreach materials to educate families about the Florida
1030	Kidcare program. Marketing and outreach materials shall present
1031	the Florida Kidcare program as a single program and explain that
1032	the family's information is collected in order to determine
1033	whether the family is eligible for a premium discount or for
1034	full premium assistance.
1035	(c)  The department shall provide a single toll-free
1036	telephone line for a customer service call center to access
1037	account information and provide general Florida Kidcare program
1038	information.
1039	(4)  The agency shall seek federal waiver approval or
1040	amendments to the Medicaid state plan and Title XXI state plan
1041	that are necessary to implement the initiative as specified in
1042	this section.
1043	(5)  The agency shall contract with an independent third
1044	party to evaluate the effects of the policy changes provided by
1045	this section. The evaluation shall specifically include an
1046	assessment of enrollment expansion, enrollment process
1047	simplification, component transition simplification, increased
1048	choice, and administrative simplification. The evaluation shall
1049	analyze the organizational structure of the Florida Kidcare
1050	program and make recommendations regarding specific changes that
1051	should be made, including statutory changes. The evaluation
1052	shall assess whether an independent entity should exist to
1053	monitor and review administration of the Kidcare program and, if
1054	so, make recommendations as to the makeup and functions of such
1055	an entity. The agency shall submit the evaluation to the
1056	Governor, the President of the Senate, and the Speaker of the
1057	House of Representatives by November 1, 2009.
1058	(6)  The Senate and the House of Representatives may,
1059	pursuant to the rules of each house, appoint a select
1060	legislative advisory committee to advise the Legislature
1061	regarding the expiration of the Florida Healthy Kids Corporation
1062	Act.
1063	Section 19.  Section 624.91, Florida Statutes, is amended
1064	to read:
1065	624.91  The Florida Healthy Kids Corporation Act.--
1066	(1)  SHORT TITLE.--This section may be cited as the
1067	"William G. 'Doc' Myers Healthy Kids Corporation Act."
1068	(2)  LEGISLATIVE INTENT.--
1069	(a)  The Legislature finds that increased access to health
1070	care services could improve children's health and reduce the
1071	incidence and costs of childhood illness and disabilities among
1072	children in this state. Many children do not have comprehensive,
1073	affordable health care services available. It is the intent of
1074	the Legislature that the Florida Healthy Kids Corporation
1075	provide quality comprehensive health insurance coverage to such
1076	children. The corporation is encouraged to cooperate with any
1077	existing health service programs funded by the public or the
1078	private sector.
1079	(b)  It is the intent of the Legislature that the Florida
1080	Healthy Kids Corporation serve as one of several providers of
1081	services to children eligible for medical assistance under Title
1082	XXI of the Social Security Act. Although the corporation may
1083	serve other children, the Legislature intends the primary
1084	recipients of services provided through the corporation be
1085	school-age children with a family income below 200 percent of
1086	the federal poverty level, who do not qualify for Medicaid. It
1087	is also the intent of the Legislature that state and local
1088	government Florida Healthy Kids funds be used to continue
1089	coverage, subject to specific appropriations in the General
1090	Appropriations Act, to children not eligible for federal
1091	matching funds under Title XIX and Title XXI.
1092	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the
1093	following Individuals are eligible for premium state-funded
1094	assistance with in paying Florida Kidcare program Healthy Kids
1095	premiums:
1096	(a)  Residents of this state who are eligible for the
1097	Florida Kidcare program pursuant to s. 409.814.
1098	(b)  Notwithstanding s. 409.814, legal aliens who are
1099	enrolled in the Florida Healthy Kids program as of January 31,
1100	2004, who do not qualify for Title XXI federal funds because
1101	they are not qualified aliens as defined in s. 409.811.
1102	(4)  NONENTITLEMENT.--Nothing in this section shall be
1103	construed as providing an individual with an entitlement to
1104	health care services. No cause of action shall arise against the
1105	state, the Florida Healthy Kids Corporation, or a unit of local
1106	government for failure to make health services available under
1107	this section.
1108	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1109	(a)  There is created the Florida Healthy Kids Corporation,
1110	a not-for-profit corporation.
1111	(b)  The Florida Healthy Kids Corporation shall:
1112	1.  Arrange for the collection of any family, local
1113	contributions, or employer payment or premium, in an amount to
1114	be determined by the board of directors, to provide for payment
1115	of premiums for comprehensive insurance coverage and for the
1116	actual or estimated administrative expenses.
1117	2.  Arrange for the collection of any voluntary
1118	contributions to provide for payment of premiums for children
1119	who are not eligible for premium medical assistance in
1120	accordance with ss. 409.8141 and 409.816 under Title XXI of the
1121	Social Security Act.
1122	3.  Subject to the provisions of s. 409.8134, accept
1123	voluntary supplemental local match contributions that comply
1124	with the requirements of Title XXI of the Social Security Act
1125	for the purpose of providing additional coverage in contributing
1126	counties under Title XXI.
1127	4.  Establish the administrative and accounting procedures
1128	for the operation of the corporation.
1129	5.  Establish, with consultation from appropriate
1130	professional organizations, standards for preventive health
1131	services and providers and comprehensive insurance benefits
1132	appropriate to children, provided that such standards for rural
1133	areas shall not limit primary care providers to board-certified
1134	pediatricians.
1135	6.  Determine eligibility for premium assistance financed
1136	by any source other than Title XIX of the Social Security Act
1137	children seeking to participate in the Title XXI-funded
1138	components of the Florida Kidcare program consistent with the
1139	requirements specified in s. 409.814, as well as the non-Title-
1140	XXI-eligible children as provided in subsection (3).
1141	7.  Establish procedures under which providers of local
1142	match to, applicants to and participants in the program may have
1143	grievances reviewed by an impartial body and reported to the
1144	board of directors of the corporation.
1145	8.  Establish participation criteria and, if appropriate,
1146	contract with an authorized insurer, health maintenance
1147	organization, or third-party administrator to provide
1148	administrative services to the corporation.
1149	9.  Establish enrollment criteria which shall include
1150	penalties or waiting periods of not fewer than 60 days for
1151	reinstatement of coverage upon voluntary cancellation for
1152	nonpayment of family premiums. Subject to a specific
1153	appropriation in the General Appropriations Act for this
1154	purpose, the Florida Healthy Kids Corporation shall establish
1155	penalties or waiting periods of not fewer than 30 days for
1156	reinstatement of coverage upon voluntary cancellation for
1157	nonpayment of family premiums.
1158	10.  Contract with authorized insurers or any provider of
1159	health care services, meeting standards established by the
1160	corporation, for the provision of comprehensive insurance
1161	coverage to participants. Such standards shall include criteria
1162	under which the corporation may contract with more than one
1163	provider of health care services in program sites. Health plans
1164	shall be selected through a competitive bid process. The Florida
1165	Healthy Kids Corporation shall purchase goods and services in
1166	the most cost-effective manner consistent with the delivery of
1167	quality medical care. The maximum administrative cost for a
1168	Florida Healthy Kids Corporation contract shall be 15 percent.
1169	For health care contracts, the minimum medical loss ratio for a
1170	Florida Healthy Kids Corporation contract shall be 85 percent.
1171	For dental contracts, the remaining compensation to be paid to
1172	the authorized insurer or provider under a Florida Healthy Kids
1173	Corporation contract shall be no less than an amount which is 85
1174	percent of premium; to the extent any contract provision does
1175	not provide for this minimum compensation, this section shall
1176	prevail. The health plan selection criteria and scoring system,
1177	and the scoring results, shall be available upon request for
1178	inspection after the bids have been awarded.
1179	11.  Establish disenrollment criteria in the event local
1180	matching funds are insufficient to cover enrollments.
1181	12.  Develop and implement a plan to publicize the Florida
1182	Kidcare program Healthy Kids Corporation, the eligibility
1183	requirements of the program, and the procedures for enrollment
1184	in the program and to maintain public awareness of the
1185	corporation and the program.
1186	13.  Secure staff necessary to properly administer the
1187	corporation. Staff costs shall be funded from state and local
1188	matching funds and such other private or public funds as become
1189	available. The board of directors shall determine the number of
1190	staff members necessary to administer the corporation.
1191	14.  Provide a report annually to the Governor, Chief
1192	Financial Officer, Commissioner of Education, Senate President,
1193	Speaker of the House of Representatives, and Minority Leaders of
1194	the Senate and the House of Representatives.
1195	15.  Establish benefit packages which conform to the
1196	provisions of the Florida Kidcare program, as created in ss.
1197	409.810-409.820.
1198	(c)  Coverage under the corporation's program is secondary
1199	to any other available private coverage held by, or applicable
1200	to, the participant child or family member. Insurers under
1201	contract with the corporation are the payors of last resort and
1202	must coordinate benefits with any other third-party payor that
1203	may be liable for the participant's medical care.
1204	(d)  The Florida Healthy Kids Corporation shall be a
1205	private corporation not for profit, organized pursuant to
1206	chapter 617, and shall have all powers necessary to carry out
1207	the purposes of this act, including, but not limited to, the
1208	power to receive and accept grants, loans, or advances of funds
1209	from any public or private agency and to receive and accept from
1210	any source contributions of money, property, labor, or any other
1211	thing of value, to be held, used, and applied for the purposes
1212	of this act.
1213	(6)  BOARD OF DIRECTORS.--
1214	(a)  The Florida Healthy Kids Corporation shall operate
1215	subject to the supervision and approval of a board of directors
1216	chaired by the Chief Financial Officer or her or his designee,
1217	and composed of 10 other members selected for 3-year terms of
1218	office as follows:
1219	1.  The Secretary of Health Care Administration, or his or
1220	her designee;
1221	2.  One member appointed by the Commissioner of Education
1222	from the Office of School Health Programs of the Florida
1223	Department of Education;
1224	3.  One member appointed by the Chief Financial Officer
1225	from among three members nominated by the Florida Pediatric
1226	Society;
1227	4.  One member, appointed by the Governor, who represents
1228	the Children's Medical Services Program;
1229	5.  One member appointed by the Chief Financial Officer
1230	from among three members nominated by the Florida Hospital
1231	Association;
1232	6.  One member, appointed by the Governor, who is an expert
1233	on child health policy;
1234	7.  One member, appointed by the Chief Financial Officer,
1235	from among three members nominated by the Florida Academy of
1236	Family Physicians;
1237	8.  One member, appointed by the Governor, who represents
1238	the state Medicaid program;
1239	9.  One member, appointed by the Chief Financial Officer,
1240	from among three members nominated by the Florida Association of
1241	Counties; and
1242	10.  The State Health Officer or her or his designee.
1243	(b)  A member of the board of directors may be removed by
1244	the official who appointed that member. The board shall appoint
1245	an executive director, who is responsible for other staff
1246	authorized by the board.
1247	(c)  Board members are entitled to receive, from funds of
1248	the corporation, reimbursement for per diem and travel expenses
1249	as provided by s. 112.061.
1250	(d)  There shall be no liability on the part of, and no
1251	cause of action shall arise against, any member of the board of
1252	directors, or its employees or agents, for any action they take
1253	in the performance of their powers and duties under this act.
1254	(7)  LICENSING NOT REQUIRED; FISCAL OPERATION.--
1255	(a)  The corporation shall not be deemed an insurer. The
1256	officers, directors, and employees of the corporation shall not
1257	be deemed to be agents of an insurer. Neither the corporation
1258	nor any officer, director, or employee of the corporation is
1259	subject to the licensing requirements of the insurance code or
1260	the rules of the Department of Financial Services. However, any
1261	marketing representative utilized and compensated by the
1262	corporation must be appointed as a representative of the
1263	insurers or health services providers with which the corporation
1264	contracts.
1265	(b)  The board has complete fiscal control over the
1266	corporation and is responsible for all corporate operations.
1267	(c)  The Department of Financial Services shall supervise
1268	any liquidation or dissolution of the corporation and shall
1269	have, with respect to such liquidation or dissolution, all power
1270	granted to it pursuant to the insurance code.
1271	(8)  ACCESS TO RECORDS; CONFIDENTIALITY;
1272	PENALTIES.--Notwithstanding any other laws to the contrary, the
1273	Florida Healthy Kids Corporation shall have access to the
1274	medical records of a student upon receipt of permission from a
1275	parent or guardian of the student. Such medical records may be
1276	maintained by state and local agencies. Any identifying
1277	information, including medical records and family financial
1278	information, obtained by the corporation pursuant to this
1279	subsection is confidential and is exempt from the provisions of
1280	s. 119.07(1). Neither the corporation nor the staff or agents of
1281	the corporation may release, without the written consent of the
1282	participant or the parent or guardian of the participant, to any
1283	state or federal agency, to any private business or person, or
1284	to any other entity, any confidential information received
1285	pursuant to this subsection. A violation of this subsection is a
1286	misdemeanor of the second degree, punishable as provided in s.
1287	775.082 or s. 775.083.
1288	(9)  VENUE.--The venue for all civil and administrative
1289	actions against the Florida Healthy Kids Corporation shall be in
1290	Leon County.
1291	Section 20.  Effective July 1, 2010, section 624.91,
1292	Florida Statutes, as amended by this act, is repealed.
1293	Section 21.  The sum of $8,967,334 in recurring funds from
1294	the General Revenue Fund and $11,843,373 from the Medical Care
1295	Trust Fund is appropriated to the Agency for Health Care
1296	Administration for the purpose of implementing s. 409.814(1)(b),
1297	Florida Statutes, and the sum of $464,407 in recurring funds
1298	from the General Revenue Fund, $107,829 from the Grant and
1299	Donations Trust Fund, and $1,089,833 from the Medical Care Trust
1300	Fund is appropriated to the Agency for Health Care
1301	Administration for the purpose of implementing s.
1302	409.8141(3)(b), Florida Statutes.
1303	Section 22.  This act shall take effect July 1, 2007.

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