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

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