Senate Bill sb0930c3

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    Florida Senate - 2007              CS for CS for CS for SB 930

    By the Committees on Health and Human Services Appropriations;
    Governmental Operations; Health Policy; and Senators Dawson,
    Garcia, Crist, Saunders, Joyner, Dockery and Fasano



    603-2487-07

  1                      A bill to be entitled

  2         An act relating to medical assistance; amending

  3         s. 409.811, F.S.; revising and providing

  4         definitions relating to the Florida Kidcare

  5         Act; amending s. 409.812, F.S.; revising the

  6         purpose of the Florida Kidcare program;

  7         amending s. 409.813, F.S.; revising the funding

  8         sources for the health benefits coverage

  9         provided to children under the program;

10         amending s. 409.8132, F.S.; revising the

11         eligibility and enrollment requirements in the

12         Medikids program component; amending s.

13         409.8134, F.S.; revising enrollment procedures;

14         amending s. 409.814, F.S.; revising eligibility

15         requirements for the program; creating s.

16         409.8141, F.S.; specifying requirements for

17         premium assistance eligibility; creating s.

18         409.8142, F.S.; specifying penalties for

19         fraudulent actions, failure to verify

20         eligibility, and nonpayment of premiums;

21         creating s. 409.8149, F.S.; specifying

22         enrollment procedures and requirements for plan

23         choice; amending s. 409.815, F.S.; revising the

24         health benefits coverage of the Florida Kidcare

25         program; amending s. 409.816, F.S.; revising

26         the limitations on premiums and cost-sharing;

27         amending s. 409.817, F.S.; revising the

28         qualifications for health insurance plans

29         serving the program; amending s. 409.818, F.S.;

30         specifying the duties and responsibilities of

31         the Department of Children and Family Services,

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 1         the Department of Health, the Agency for Health

 2         Care Administration, the Florida Healthy Kids

 3         Corporation, and the Office of Insurance

 4         Regulation pertaining to the administration of

 5         the Florida Kidcare program; repealing s.

 6         409.820, F.S., relating to quality assurance

 7         and access standards; amending s. 409.821,

 8         F.S.; clarifying that provisions exempting

 9         certain records from public-records

10         requirements does not prevent an enrollee's

11         parent or guardian from obtaining records and

12         information concerning the enrollee; creating

13         s. 409.830, F.S.; establishing the Florida

14         Kidcare Program Consolidation Initiative, which

15         shall combine the administration of the

16         program; creating a deputy secretary of Florida

17         Kidcare within the Agency for Health Care

18         Administration; amending s. 624.91, F.S.;

19         revising provisions of the Florida Healthy Kids

20         Corporation Act; deleting certain eligibility

21         requirements; providing for the transfer of

22         functions to the Agency for Health Care

23         Administration and the Department of Children

24         and Family Services; repealing s. 624.91, F.S.,

25         relating to the Florida Healthy Kids

26         Corporation; requiring a consolidation

27         transition plan; providing an appropriation and

28         authorizing additional positions; providing

29         effective dates.

30  

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

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 1         Section 1.  Section 409.811, Florida Statutes, is

 2  amended to read:

 3         409.811  Definitions relating to Florida Kidcare

 4  Act.--As used in ss. 409.810-409.830 ss. 409.810-409.820, the

 5  term:

 6         (1)  "Actuarially equivalent" means that:

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

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

 9  in the benchmark benefit plan; and

10         (b)  The benefits included in health benefits coverage

11  are substantially similar to the benefits included in the

12  benchmark benefit plan, except that preventive health services

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

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

15  Administration.

16         (3)  "Applicant" means a parent or guardian of a child

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

18  chapter 743, who applies for determination of eligibility for

19  health benefits coverage under ss. 409.810-409.830 ss.

20  409.810-409.820.

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

22  of health benefits coverage established in s. 409.815.

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

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

25  child who has a chronic physical, developmental, behavioral,

26  or emotional condition and who also required health care and

27  related services of a type or amount beyond that which is

28  generally required by children. whose serious or chronic

29  physical or developmental condition requires extensive

30  preventive and maintenance care beyond that required by

31  typically healthy children. Health care utilization by such a

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 1  child exceeds the statistically expected usage of the normal

 2  child adjusted for chronological age, and such a child often

 3  needs complex care requiring multiple providers,

 4  rehabilitation services, and specialized equipment in a number

 5  of different settings.

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

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

 8  391.021(1).

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

10  premiums for a health insurance plan that spreads financial

11  risk across a large population and allows adjustments only for

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

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

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

15  eligible for and is receiving coverage under ss.

16  409.810-409.820.

17         (11)  "Family" means the group or the individuals whose

18  income is considered in determining eligibility for the

19  Florida Kidcare program. The family includes a child with a

20  custodial parent or caretaker relative who resides in the same

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

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

23  child. The family may also include other individuals whose

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

25  determining eligibility of the child.

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

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

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

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

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

31  prior to August 22, 1996.

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 1         (13)  "Florida Kidcare Plus" means health benefits

 2  coverage for children with special health care needs which

 3  benefits are delivered through the Children's Medical Services

 4  Network established in chapter 391.

 5         (14)(13)  "Florida Kidcare program," "Kidcare program,"

 6  or "program" means the health benefits program for children

 7  administered through ss. 409.810-409.830 ss. 409.810-409.820.

 8         (15)(14)  "Guarantee issue" means that health benefits

 9  coverage must be offered to an individual regardless of the

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

11  history.

12         (16)(15)  "Health benefits coverage" means protection

13  that provides payment of benefits for covered health care

14  services or that otherwise provides, either directly or

15  through arrangements with other persons, covered health care

16  services on a prepaid per capita basis or on a prepaid

17  aggregate fixed-sum basis.

18         (17)(16)  "Health insurance plan" means health benefits

19  coverage under the following:

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

21  maintenance organization or authorized health insurer, except

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

23  specified disease, or specified accident; hospital indemnity;

24  accident only; limited benefit convalescent care; Medicare

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

26  disability income; coverage issued as a supplement to another

27  health plan; workers' compensation liability or other

28  insurance; or motor vehicle medical payment only; or

29         (b)  An employee welfare benefit plan that includes

30  health benefits established under the Employee Retirement

31  Income Security Act of 1974, as amended.

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

 2  Kidcare program of medical assistance for children who are 5

 3  through 18 years of age and whose family or household incomes

 4  are above the Title XIX-income-eligibility threshold.

 5         (19)(17)  "Medicaid" means the medical assistance

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

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

 8  administered in this state by the agency.

 9         (20)(18)  "Medically necessary" means the use of any

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

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

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

13  of a condition that threatens life, causes pain or suffering,

14  or results in illness or infirmity and which is:

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

16  treatment of the enrollee's condition;

17         (b)  Provided in accordance with generally accepted

18  standards of medical practice;

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

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

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

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

23  and

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

25  care specialty involved as effective, appropriate, and

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

27  condition.

28         (21)(19)  "Medikids" means a component of the Florida

29  Kidcare program of medical assistance authorized by Title XXI

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

31  409.8132, as administered in the state by the agency.

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 1         (22)(20)  "Preexisting condition exclusion" means, with

 2  respect to coverage, a limitation or exclusion of benefits

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

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

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

 6  treatment was recommended or received before such date.

 7         (23)(21)  "Premium" means the entire cost of a health

 8  insurance plan, including the administration fee or the risk

 9  assumption charge.

10         (24)(22)  "Premium assistance payment" means the

11  monthly consideration paid by the agency per enrollee in the

12  Florida Kidcare program towards health insurance premiums.

13         (25)(23)  "Qualified alien" means an alien as defined

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

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

16         (26)(24)  "Resident" means a United States citizen, or

17  qualified alien, who is domiciled in this state.

18         (27)(25)  "Rural county" means a county having a

19  population density of fewer less than 100 persons per square

20  mile, or a county defined by the most recent United States

21  Census as rural, in which there is no prepaid health plan

22  participating in the Medicaid program as of July 1, 1998.

23         (28)(26)  "Substantially similar" means that, with

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

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

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

27  actuarial value of the coverage for that service in the

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

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

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

31  in the benchmark benefit plan.

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 1         Section 2.  Section 409.812, Florida Statutes, is

 2  amended to read:

 3         409.812  Program created; purpose.--The Florida Kidcare

 4  program is created to provide a defined set of health benefits

 5  to previously uninsured, low-income children through the

 6  establishment of a variety of affordable health benefits

 7  coverage options from which families may select coverage and

 8  through which families may contribute financially to the

 9  health care of their children.

10         Section 3.  Section 409.813, Florida Statutes, is

11  amended to read:

12         409.813  Program components; entitlement and

13  nonentitlement.--The Florida Kidcare program includes health

14  benefits coverage provided to children through the following

15  funding sources, which shall be marketed as the Florida

16  Kidcare program:

17         (1)  Title XIX of the Social Security Act Medicaid;

18         (2)  Title XXI of the Social Security Act Medikids as

19  created in s. 409.8132;

20         (3)  The Title V Program of the Social Security Act, as

21  it relates to children with special health care needs The

22  Florida Healthy Kids Corporation as created in s. 624.91;

23         (4)  Employer-sponsored group health insurance plans

24  approved under ss. 409.810-409.830 ss. 409.810-409.820; and

25         (5)  Full pay premiums for children with family incomes

26  above the maximum income threshold or children who are not

27  Title XXI-eligible pursuant to s. 409.8141; and The Children's

28  Medical Services network established in chapter 391.

29         (6)  General revenue or local contributions.

30  

31  

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 1  Except for Title XIX-funded Florida Kidcare coverage under the

 2  Medicaid program, coverage under the Florida Kidcare program

 3  is not an entitlement.  No cause of action shall arise against

 4  the state, the Department of Health, the Department of

 5  Children and Family Services, or the Florida Healthy Kids

 6  Corporation, or the Agency for Health Care Administration

 7  agency for failure to make health services available to any

 8  person under ss. 409.810-409.830 ss. 409.810-409.820.

 9         Section 4.  Section 409.8132, Florida Statutes, is

10  amended to read:

11         409.8132  Medikids program component.--

12         (1)  PROGRAM COMPONENT CREATED; PURPOSE.--The Medikids

13  program component is created in the Agency for Health Care

14  Administration to provide health care services under the

15  Florida Kidcare program to eligible children using the

16  administrative structure and provider network of the Medicaid

17  program.

18         (2)  ADMINISTRATION.--The secretary of the agency shall

19  appoint an administrator of the Medikids program component.

20  The Agency for Health Care Administration is designated as the

21  state agency authorized to make payments for medical

22  assistance and related services for the Medikids program

23  component of the Florida Kidcare program. Payments shall be

24  made, subject to any limitations or directions in the General

25  Appropriations Act, only for covered services provided to

26  eligible children by qualified health care providers under the

27  Florida Kidcare program.

28         (3)  INSURANCE LICENSURE NOT REQUIRED.--The Medikids

29  program component shall not be subject to the licensing

30  requirements of the Florida Insurance Code or rules adopted

31  thereunder.

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 1         (4)  APPLICABILITY OF LAWS RELATING TO MEDICAID.--The

 2  provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,

 3  409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127,

 4  409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205

 5  apply to the administration of the Medikids program component

 6  of the Florida Kidcare program, except that s. 409.9122

 7  applies to Medikids as modified by the provisions of

 8  subsection (7).

 9         (5)  BENEFITS.--Benefits provided under the Medikids

10  program component shall be the same benefits provided to

11  children as specified in ss. 409.905 and 409.906.

12         (6)  ELIGIBILITY.--

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

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

15  Medikids program component of the Florida Kidcare program, if

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

17  which exceeds the Medicaid applicable income level as

18  specified in s. 409.903, but which is equal to or below 200

19  percent of the current federal poverty level. In determining

20  the eligibility of such a child, an assets test is not

21  required. A child who is eligible for Medikids may elect to

22  enroll in Florida Healthy Kids coverage or employer-sponsored

23  group coverage. However, a child who is eligible for Medikids

24  may participate in the Florida Healthy Kids program only if

25  the child has a sibling participating in the Florida Healthy

26  Kids program and the child's county of residence permits such

27  enrollment.

28         (b)  The provisions of ss. 409.814, 409.8141, 409.8142,

29  and 409.8149 s. 409.814(3), (4), and (5) shall be applicable

30  to the Medikids program.

31  

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

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

 3  may not receive services under the Medikids program until the

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

 5  determined eligible, an applicant may receive choice

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

 7  agency may initiate mandatory assignment for a Medikids

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

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

10  An applicant may select MediPass under the Medikids program

11  component only in counties that have fewer than two managed

12  care plans available to serve Medicaid recipients and only if

13  the federal Health Care Financing Administration determines

14  that MediPass constitutes "health insurance coverage" as

15  defined in Title XXI of the Social Security Act.

16         (8)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency

17  shall establish enrollment criteria that must include

18  penalties or waiting periods of not fewer than 60 days for

19  reinstatement of coverage upon voluntary cancellation for

20  nonpayment of premiums.

21         Section 5.  Section 409.8134, Florida Statutes, is

22  amended to read:

23         409.8134  Program expenditure ceiling.--

24         (1)  Except for the Medicaid program, a ceiling shall

25  be placed on annual federal and state expenditures for the

26  Florida Kidcare program as provided each year in the General

27  Appropriations Act.

28         (2)  The Florida Kidcare program may conduct enrollment

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

30  children eligible for all program components listed in s.

31  409.813 except Medicaid. The four Florida Kidcare

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 1  administrators shall work together to ensure that the

 2  year-round enrollment period is announced statewide. Eligible

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

 4  using the date the enrollment application is received.

 5  Enrollment shall immediately cease when the expenditure

 6  ceiling is reached. Year-round enrollment shall only be held

 7  if the Social Services Estimating Conference determines that

 8  sufficient federal and state funds will be available to

 9  finance the increased enrollment through federal fiscal year

10  2007. Any individual who is not enrolled must reapply by

11  submitting a new application. The application for the Florida

12  Kidcare program shall be valid for a period of 120 days after

13  the date it was received. At the end of the 120-day period, if

14  the applicant has not been enrolled in the program, the

15  application shall be invalid and the applicant shall be

16  notified of the action. The applicant may resubmit the

17  application after notification of the action taken by the

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

19  Services Estimating Conference determines that there are

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

21  insufficient funds to finance the current or projected

22  enrollment in the Florida Kidcare program, all additional

23  enrollment must cease and additional enrollment may not resume

24  until sufficient funds are available to finance such

25  enrollment.

26         (3)  Upon determination by the Social Services

27  Estimating Conference that there are insufficient funds to

28  finance the current enrollment in the Florida Kidcare program

29  within current appropriations, the program shall initiate

30  disenrollment procedures to remove enrollees, except those

31  children who receive Florida Kidcare Plus benefits enrolled in

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 1  the Children's Medical Services Network, on a last-in,

 2  first-out basis until the expenditure and appropriation levels

 3  are balanced.

 4         (4)  The agencies that administer the Florida Kidcare

 5  program components shall collect and analyze the data needed

 6  to project program enrollment costs, including price level

 7  adjustments, participation and attrition rates, current and

 8  projected caseloads, utilization, and current and projected

 9  expenditures for the next 3 years. The agencies shall report

10  caseload and expenditure trends to the Social Services

11  Estimating Conference in accordance with chapter 216.

12         Section 6.  Section 409.814, Florida Statutes, is

13  amended to read:

14         (Substantial rewording of section. See

15         s. 409.814, F.S., for present text.)

16         409.814  Eligibility.--

17         (1)  ELIGIBILITY FOR THE FLORIDA KIDCARE PROGRAM.--To

18  be eligible for the Florida Kidcare program, a child must be:

19         (a)  A resident of the state.

20         (b)  Under 19 years of age.

21         (c)  Uninsured at the time of application, except for

22  children eligible for Medicaid.

23         (2)  ELIGIBILITY FOR FLORIDA KIDCARE PLUS.--To be

24  eligible for the Florida Kidcare Plus benefit delivered by the

25  Children's Medical Services Network in the Florida Kidcare

26  program, a child must meet the requirements of subsection (1)

27  and must be a child with special health care needs as

28  determined through a clinical-eligibility screening instrument

29  administered by the Department of Health pursuant to s.

30  409.818(2).

31  

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 1         Section 7.  Section 409.8141, Florida Statutes, is

 2  created to read:

 3         409.8141 Premium assistance.--

 4         (1)  The Florida Kidcare program may provide premium

 5  assistance to certain children enrolled in the program. To be

 6  eligible for premium assistance, the child must meet the

 7  requirements of s. 409.814 and must:

 8         (a)  Reside in a household where the family income is

 9  equal to or less than 200 percent of the federal poverty

10  level;

11         (b)  Be a United States citizen or a qualified alien as

12  defined in s. 409.811(24);

13         (c) Not be an inmate of a public institution or a

14  patient in an institution for mental diseases;

15         (d)  Not be eligible for coverage under a state health

16  benefit plan on the basis of a family member's employment with

17  a public agency in the state; and

18         (e)  Not be currently eligible for or covered under a

19  family member's group health benefit plan or under other

20  employer health insurance coverage, excluding full-pay Florida

21  Kidcare health benefits coverage, if the cost of the child's

22  participation is not greater than 5 percent of the family's

23  income.

24         (2)  A child seeking premium assistance for the Florida

25  Kidcare program is not eligible for premium assistance if the

26  child was covered through an employer-sponsored group coverage

27  6 months prior to the family submitting an application for

28  determination of eligibility under the program, unless the

29  employer-sponsored health coverage was discontinued for

30  good-cause reasons. Good-cause reasons for discontinued

31  employer-sponsored health coverage include:

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 1         (a)  The cost of participation in an employer-sponsored

 2  health benefit plan is greater than 5 percent of the family's

 3  income;

 4         (b)  The parent lost a job that provided an

 5  employer-sponsored health benefit plan for children;

 6         (c)  The parent who had health benefits coverage for

 7  the child is deceased;

 8         (d)  The child has a medical condition that, without

 9  medical care, would cause serious disability, loss of

10  function, or death;

11         (e)  The employer of the parent canceled health

12  benefits coverage for children;

13         (f)  The child's health benefits coverage ended because

14  the child reached the maximum lifetime coverage amount;

15         (g)  The child has exhausted coverage under a COBRA

16  continuation provision;

17         (h)  The health benefits coverage does not cover the

18  child's health care needs; or

19         (i)  Domestic violence led to loss of coverage.

20         (3)  Eligibility for premium assistance shall be

21  verified for each applicant and enrollee during the

22  application and reverification processes based on:

23         (a)  Family income documented with a copy of the

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

25  absence of a federal income tax return, an applicant's wages

26  and earnings statements, W-2 forms, or other appropriate

27  documentation obtained from other government sources,

28  including electronic records, may be considered. An assets

29  test is not required.

30  

31  

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 1         (b)  A statement from the applicant or enrollee that

 2  the child is not currently insured by an employer-sponsored or

 3  other benefit plan.

 4         (4)  Enrollees not meeting the eligibility requirements

 5  of subsection (1) shall pay the full cost of the premium and

 6  are not required to document income. The number of children

 7  participating in the non-Title XIX-funded Florida Kidcare

 8  program under this subsection whose family income exceeds 200

 9  percent of the federal poverty level must not exceed 10

10  percent of total enrollees in the non-title XIX-funded Florida

11  Kidcare program.

12         (5)(a)  A Title XIX-funded child enrolled in the

13  Florida Kidcare program is eligible for coverage for 6 months

14  without redetermination or reverification of eligibility.

15         (b)  A child found eligible for premium assistance in

16  the Florida Kidcare program shall receive premium assistance

17  for 12 months without reverification of eligibility if the

18  family continues to participate in any applicable cost-sharing

19  pursuant to s. 409.816. The Florida Kidcare program shall

20  conduct an annual eligibility reverification for each enrollee

21  eligible for premium assistance.

22         (6)  If a child loses eligibility for Florida Kidcare

23  health benefits coverage, the child's managed health care

24  provider shall be notified at the same time the family is

25  notified in order to facilitate necessary action to maintain

26  continuous health care coverage.

27         Section 8.  Section 409.8142, Florida Statutes, is

28  created to read:

29         409.8142  Penalties.--

30         (1)  Subject to s. 624.91(4), the Florida Kidcare

31  program shall withhold benefits from an enrollee if the

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 1  program obtains evidence that the enrollee is no longer

 2  eligible, submitted incorrect or fraudulent information in

 3  order to establish eligibility, or failed to provide

 4  verification of eligibility. The applicant or enrollee shall

 5  be notified that, because of such evidence, program benefits

 6  will be withheld unless the applicant or enrollee contacts a

 7  designated representative of the program by a specified date,

 8  which must be within 10 business days after the date of

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

10  make every effort to resolve the matter within a timeframe

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

12  enrollee.

13         (2)  If, subsequent to any eligibility determination,

14  an individual is determined to be ineligible for coverage, he

15  or she must immediately be disenrolled from the Florida

16  Kidcare program.

17         (3)  Waiting periods of not less than 60 days for

18  reinstatement of coverage upon voluntary cancellation for

19  nonpayment of premiums when applicable shall be established by

20  the agency.

21         Section 9.  Section 409.8149, Florida Statutes, is

22  created to read:

23         409.8149  Enrollment; plan choice.--

24         (1)  ENROLLMENT.--The Florida Kidcare program may

25  conduct enrollment at any time throughout the year for the

26  purpose of enrolling children eligible for all coverage funded

27  pursuant to s. 409.813, except Medicaid. Eligible children

28  shall be enrolled on a first-come, first-served basis, based

29  upon the date the enrollment application is received. The

30  application for the Florida Kidcare program is valid for a

31  period of 120 days after the date the application is received.

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 1  At the end of the 120-day period, if the applicant has not

 2  been enrolled in the program, the application is invalid and

 3  the applicant shall be notified of the action. The applicant

 4  may resubmit the application after notification of the action

 5  taken by the program.

 6         (2)  PLAN CHOICE.--

 7         (a)  Enrollees who do not voluntarily choose a benefit

 8  plan shall be assigned to a managed care plan by the Florida

 9  Kidcare program. The program shall assign enrollees eligible

10  for Medicaid to a Medicaid managed care plan or to the

11  Medicaid fee-for-service program if a Medicaid managed care

12  plan does not exist in the geographical area in which the

13  enrollee resides. The program shall assign all other enrollees

14  to plans selected pursuant to s. 624.91 in the geographical

15  area in which each enrollee resides.

16         (b)  Upon selection or assignment, an enrollee shall

17  have 90 days during which to voluntarily disenroll from a

18  benefit plan and select another.

19         (c)  Upon the anniversary of enrollment, each enrollee

20  may voluntarily select another benefit plan. The Florida

21  Kidcare program shall notify enrollees of their options with

22  respect to the annual open enrollment 60 days prior to the

23  anniversary of initial enrollment.

24         Section 10.  Section 409.815, Florida Statutes, is

25  amended to read:

26         409.815  Health benefits coverage; limitations.--

27         (1)  MEDICAID BENEFITS.--For purposes of the Florida

28  Kidcare program, benefits available under Medicaid and

29  Medikids include those goods and services provided under the

30  medical assistance program authorized by Title XIX of the

31  Social Security Act, and regulations thereunder, as

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 1  administered in this state by the agency. This includes those

 2  mandatory Medicaid services authorized under s. 409.905, and

 3  optional Medicaid services authorized under s. 409.906, and

 4  emergency services provided under s. 409.9128. Effective July

 5  1, 2008, health benefits available under the Florida Kidcare

 6  program shall include the same mandatory and optional Medicaid

 7  services as specified in s. 409.830(2)., rendered on behalf of

 8  eligible individuals by qualified providers, in accordance

 9  with federal requirements for Title XIX, subject to any

10  limitations or directions provided for in the General

11  Appropriations Act or chapter 216, and according to

12  methodologies and limitations set forth in agency rules and

13  policy manuals and handbooks incorporated by reference

14  thereto.

15         (2)  BENCHMARK BENEFITS.--In order for health benefits

16  coverage to qualify for premium assistance payments for an

17  eligible child under ss. 409.810-409.830 ss. 409.810-409.820,

18  the health benefits coverage, except for coverage under

19  Medicaid and Medikids, must include the following minimum

20  benefits, as medically necessary.

21         (a)  Preventive health services.--Covered services

22  include:

23         1.  Well-child care, including services recommended in

24  the Guidelines for Health Supervision of Children and Youth as

25  developed by the American Academy of Pediatrics;

26         2.  Immunizations and injections;

27         3.  Health education counseling and clinical services;

28         4.  Vision screening; and

29         5.  Hearing screening.

30         (b)  Inpatient hospital services.--All covered services

31  provided for the medical care and treatment of an enrollee who

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 1  is admitted as an inpatient to a hospital licensed under part

 2  I of chapter 395, with the following exceptions:

 3         1.  All admissions must be authorized by the enrollee's

 4  health benefits coverage provider.

 5         2.  The length of the patient stay shall be determined

 6  based on the medical condition of the enrollee in relation to

 7  the necessary and appropriate level of care.

 8         3.  Room and board may be limited to semiprivate

 9  accommodations, unless a private room is considered medically

10  necessary or semiprivate accommodations are not available.

11         4.  Admissions for rehabilitation and physical therapy

12  are limited to 15 days per contract year.

13         (c)  Emergency services.--Covered services include

14  visits to an emergency room or other licensed facility if

15  needed immediately due to an injury or illness and delay means

16  risk of permanent damage to the enrollee's health. Health

17  maintenance organizations shall comply with the provisions of

18  s. 641.513.

19         (d)  Maternity services.--Covered services include

20  maternity and newborn care, including prenatal and postnatal

21  care, with the following limitations:

22         1.  Coverage may be limited to the fee for vaginal

23  deliveries; and

24         2.  Initial inpatient care for newborn infants of

25  enrolled adolescents shall be covered, including normal

26  newborn care, nursery charges, and the initial pediatric or

27  neonatal examination, and the infant may be covered for up to

28  3 days following birth.

29         (e)  Organ transplantation services.--Covered services

30  include pretransplant, transplant, and postdischarge services

31  and treatment of complications after transplantation for

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 1  transplants deemed necessary and appropriate within the

 2  guidelines set by the Organ Transplant Advisory Council under

 3  s. 765.53 or the Bone Marrow Transplant Advisory Panel under

 4  s. 627.4236.

 5         (f)  Outpatient services.--Covered services include

 6  preventive, diagnostic, therapeutic, palliative care, and

 7  other services provided to an enrollee in the outpatient

 8  portion of a health facility licensed under chapter 395,

 9  except for the following limitations:

10         1.  Services must be authorized by the enrollee's

11  health benefits coverage provider; and

12         2.  Treatment for temporomandibular joint disease (TMJ)

13  is specifically excluded.

14         (g)  Behavioral health services.--

15         1.  Mental health benefits include:

16         a.  Inpatient services, limited to not more than 30

17  inpatient days per contract year for psychiatric admissions,

18  or residential services in facilities licensed under s.

19  394.875(8) or s. 395.003 in lieu of inpatient psychiatric

20  admissions; however, a minimum of 10 of the 30 days shall be

21  available only for inpatient psychiatric services when

22  authorized by a physician; and

23         b.  Outpatient services, including outpatient visits

24  for psychological or psychiatric evaluation, diagnosis, and

25  treatment by a licensed mental health professional, limited to

26  a maximum of 40 outpatient visits each contract year.

27         2.  Substance abuse services include:

28         a.  Inpatient services, limited to not more than 7

29  inpatient days per contract year for medical detoxification

30  only and 30 days of residential services; and

31  

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 1         b.  Outpatient services, including evaluation,

 2  diagnosis, and treatment by a licensed practitioner, limited

 3  to a maximum of 40 outpatient visits per contract year.

 4         (h)  Durable medical equipment.--Covered services

 5  include equipment and devices that are medically indicated to

 6  assist in the treatment of a medical condition and

 7  specifically prescribed as medically necessary, with the

 8  following limitations:

 9         1.  Low-vision and telescopic aides are not included.

10         2.  Corrective lenses and frames may be limited to one

11  pair every 2 years, unless the prescription or head size of

12  the enrollee changes.

13         3.  Hearing aids shall be covered only when medically

14  indicated to assist in the treatment of a medical condition.

15         4.  Covered prosthetic devices include artificial eyes

16  and limbs, braces, and other artificial aids.

17         (i)  Health practitioner services.--Covered services

18  include services and procedures rendered to an enrollee when

19  performed to diagnose and treat diseases, injuries, or other

20  conditions, including care rendered by health practitioners

21  acting within the scope of their practice, with the following

22  exceptions:

23         1.  Chiropractic services shall be provided in the same

24  manner as in the Florida Medicaid program.

25         2.  Podiatric services may be limited to one visit per

26  day totaling two visits per month for specific foot disorders.

27         (j)  Home health services.--Covered services include

28  prescribed home visits by both registered and licensed

29  practical nurses to provide skilled nursing services on a

30  part-time intermittent basis, subject to the following

31  limitations:

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 1         1.  Coverage may be limited to include skilled nursing

 2  services only;

 3         2.  Meals, housekeeping, and personal comfort items may

 4  be excluded; and

 5         3.  Private duty nursing is limited to circumstances

 6  where such care is medically necessary.

 7         (k)  Hospice services.--Covered services include

 8  reasonable and necessary services for palliation or management

 9  of an enrollee's terminal illness, with the following

10  exceptions:

11         1.  Once a family elects to receive hospice care for an

12  enrollee, other services that treat the terminal condition

13  will not be covered; and

14         2.  Services required for conditions totally unrelated

15  to the terminal condition are covered to the extent that the

16  services are included in this section.

17         (l)  Laboratory and X-ray services.--Covered services

18  include diagnostic testing, including clinical radiologic,

19  laboratory, and other diagnostic tests.

20         (m)  Nursing facility services.--Covered services

21  include regular nursing services, rehabilitation services,

22  drugs and biologicals, medical supplies, and the use of

23  appliances and equipment furnished by the facility, with the

24  following limitations:

25         1.  All admissions must be authorized by the health

26  benefits coverage provider.

27         2.  The length of the patient stay shall be determined

28  based on the medical condition of the enrollee in relation to

29  the necessary and appropriate level of care, but is limited to

30  not more than 100 days per contract year.

31  

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 1         3.  Room and board may be limited to semiprivate

 2  accommodations, unless a private room is considered medically

 3  necessary or semiprivate accommodations are not available.

 4         4.  Specialized treatment centers and independent

 5  kidney disease treatment centers are excluded.

 6         5.  Private duty nurses, television, and custodial care

 7  are excluded.

 8         6.  Admissions for rehabilitation and physical therapy

 9  are limited to 15 days per contract year.

10         (n)  Prescribed drugs.--

11         1.  Coverage shall include drugs prescribed for the

12  treatment of illness or injury when prescribed by a licensed

13  health practitioner acting within the scope of his or her

14  practice.

15         2.  Prescribed drugs may be limited to generics if

16  available and brand name products if a generic substitution is

17  not available, unless the prescribing licensed health

18  practitioner indicates that a brand name is medically

19  necessary.

20         3.  Prescribed drugs covered under this section shall

21  include all prescribed drugs covered under the Florida

22  Medicaid program.

23         (o)  Therapy services.--Covered services include

24  rehabilitative services, including occupational, physical,

25  respiratory, and speech therapies, with the following

26  limitations:

27         1.  Services must be for short-term rehabilitation

28  where significant improvement in the enrollee's condition will

29  result; and

30         2.  Services shall be limited to not more than 24

31  treatment sessions within a 60-day period per episode or

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 1  injury, with the 60-day period beginning with the first

 2  treatment.

 3         (p)  Transportation services.--Covered services include

 4  emergency transportation required in response to an emergency

 5  situation.

 6         (q)  Dental services.--Dental services shall be covered

 7  and may include those dental benefits provided to children by

 8  the Florida Medicaid program under s. 409.906(6).

 9         (r)  Lifetime maximum.--Health benefits coverage

10  obtained under ss. 409.810-409.820 shall pay an enrollee's

11  covered expenses at a lifetime maximum of $1 million per

12  covered child.

13         (s)  Cost-sharing.--Cost-sharing provisions must comply

14  with s. 409.816.

15         (t)  Exclusions.--

16         1.  Experimental or investigational procedures that

17  have not been clinically proven by reliable evidence are

18  excluded;

19         2.  Services performed for cosmetic purposes only or

20  for the convenience of the enrollee are excluded; and

21         3.  Abortion may be covered only if necessary to save

22  the life of the mother or if the pregnancy is the result of an

23  act of rape or incest.

24         (u)  Enhancements to minimum requirements.--

25         1.  This section sets the minimum benefits that must be

26  included in any health benefits coverage, other than Medicaid

27  or Medikids coverage, offered under ss. 409.810-409.820.

28  Health benefits coverage may include additional benefits not

29  included under this subsection, but may not include benefits

30  excluded under paragraph (s).

31  

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 1         2.  Health benefits coverage may extend any limitations

 2  beyond the minimum benefits described in this section.

 3  

 4  Except for the Children's Medical Services Network, the agency

 5  may not increase the premium assistance payment for either

 6  additional benefits provided beyond the minimum benefits

 7  described in this section or the imposition of less

 8  restrictive service limitations.

 9         (v)  Applicability of other state laws.--Health

10  insurers, health maintenance organizations, and their agents

11  are subject to the provisions of the Florida Insurance Code,

12  except for any such provisions waived in this section.

13         1.  Except as expressly provided in this section, a law

14  requiring coverage for a specific health care service or

15  benefit, or a law requiring reimbursement, utilization, or

16  consideration of a specific category of licensed health care

17  practitioner, does not apply to a health insurance plan policy

18  or contract offered or delivered under ss. 409.810-409.820

19  unless that law is made expressly applicable to such policies

20  or contracts.

21         2.  Notwithstanding chapter 641, a health maintenance

22  organization may issue contracts providing benefits equal to,

23  exceeding, or actuarially equivalent to the benchmark benefit

24  plan authorized by this section and may pay providers located

25  in a rural county negotiated fees or Medicaid reimbursement

26  rates for services provided to enrollees who are residents of

27  the rural county.

28         Section 11.  Section 409.816, Florida Statutes, is

29  amended to read:

30         409.816  Limitations on premiums and cost-sharing;

31  penalties for nonpayment of premiums.--The following

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 1  limitations on premiums and cost-sharing are established for

 2  the program.

 3         (1)  Enrollees who receive coverage under Title XIX of

 4  the Social Security Act the Medicaid program may not be

 5  required to pay:

 6         (a)  Enrollment fees, premiums, or similar charges; or

 7         (b)  Copayments, deductibles, coinsurance, or similar

 8  charges.

 9         (2)  Enrollees in families with a family income equal

10  to or below 150 percent of the federal poverty level, who are

11  not receiving coverage under the Medicaid program, may not be

12  required to pay:

13         (a)  Enrollment fees, premiums, or similar charges that

14  exceed the maximum monthly charge permitted under s.

15  1916(b)(1) of the Social Security Act; or

16         (b)  Copayments, deductibles, coinsurance, or similar

17  charges that exceed a nominal amount, as determined consistent

18  with regulations referred to in s. 1916(a)(3) of the Social

19  Security Act. However, such charges may not be imposed for

20  preventive services, including well-baby and well-child care,

21  age-appropriate immunizations, and routine hearing and vision

22  screenings.

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

24  150 percent of the federal poverty level, who are not

25  receiving coverage under Title XIX of the Social Security Act

26  the Medicaid program or who are not eligible under s. 409.814

27  s. 409.814(5), may be required to pay enrollment fees,

28  premiums, copayments, deductibles, coinsurance, or similar

29  charges on a sliding scale related to income, except that the

30  total annual aggregate cost-sharing with respect to all

31  children in a family may not exceed 5 percent of the family's

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 1  income. However, copayments, deductibles, coinsurance, or

 2  similar charges may not be imposed for preventive services,

 3  including well-baby and well-child care, age-appropriate

 4  immunizations, and routine hearing and vision screenings.

 5         Section 12.  Section 409.817, Florida Statutes, is

 6  amended to read:

 7         409.817  Approval of health benefits coverage;

 8  financial assistance.--In order for health insurance coverage

 9  to qualify for premium assistance payments for an eligible

10  child under ss. 409.810-409.830 ss. 409.810-409.820, the

11  health benefits coverage must:

12         (1)  Be certified by the Office of Insurance Regulation

13  of the Financial Services Commission under s. 409.818 as

14  meeting, exceeding, or being actuarially equivalent to the

15  benchmark benefit plan;

16         (1)(2)  Be guarantee issued;

17         (2)(3)  Be community rated;

18         (3)(4)  Not impose any preexisting condition exclusion

19  for covered benefits; however, group health insurance plans

20  may permit the imposition of a preexisting condition

21  exclusion, but only insofar as it is permitted under s.

22  627.6561;

23         (4)(5)  Comply with the applicable limitations on

24  premiums and cost-sharing in s. 409.816;

25         (5)(6)  Comply with the quality assurance and access

26  standards developed under s. 409.818 s. 409.820; and

27         (6)(7)  Establish periodic open enrollment periods,

28  which may not occur more frequently than quarterly.

29         Section 13.  Section 409.818, Florida Statutes, is

30  amended to read:

31  

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 1         409.818  Administration.--In order to implement ss.

 2  409.810-409.830 ss. 409.810-409.820, the following agencies

 3  shall have the following duties:

 4         (1)  The Department of Children and Family Services

 5  shall:

 6         (a)  Develop a standardized intake process for all

 7  Community Access Network partners which informs applicants

 8  about coverage and services available through the Florida

 9  Kidcare program and collects all information necessary to

10  assess eligibility for any premium assistance.

11         (b)(a)  Develop a standardized simplified eligibility

12  application process mail-in form to be used for determining

13  the eligibility of children for coverage for all funding

14  sources through under the Florida Kidcare program, in

15  consultation with the agency, the Department of Health, and

16  the Florida Healthy Kids Corporation. The department shall

17  collect all information necessary to determine eligibility for

18  premium assistance and provide simplified eligibility

19  application form must include an item that provides an

20  opportunity for the applicant to indicate whether coverage is

21  being sought for a child with special health care needs.

22  Families applying for children's Medicaid coverage must also

23  be able to use the standardized simplified application process

24  form without having to pay a premium.

25         (c)(b)  Establish and maintain the eligibility

26  determination process under the program except as specified in

27  subsection (5). No later than July 1, 2008, the department

28  shall directly, or through the services of a contracted

29  third-party administrator, establish and maintain a process

30  for determining eligibility of children for coverage under the

31  entire Florida Kidcare program. The eligibility determination

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 1  process must be used solely for determining eligibility of

 2  applicants for health benefits coverage under the program. The

 3  eligibility determination process must include an initial

 4  determination of eligibility for any coverage offered under

 5  the program, as well as a redetermination or reverification of

 6  eligibility each subsequent 6 months. Effective January 1,

 7  1999, A child who has not attained the age of 5 and who has

 8  been determined eligible for the Medicaid program is eligible

 9  for coverage for 12 months without a redetermination or

10  reverification of eligibility. In conducting an eligibility

11  determination, the department shall determine if the child has

12  special health care needs. The department, in consultation

13  with the Agency for Health Care Administration and the Florida

14  Healthy Kids Corporation, shall develop procedures for

15  redetermining eligibility which enable a family to easily

16  update any change in circumstances which could affect

17  eligibility. The department may accept changes in a family's

18  status as reported to the department by the Florida Healthy

19  Kids Corporation without requiring a new application from the

20  family. Redetermination of a child's eligibility for Medicaid

21  may not be linked to a child's eligibility determination for

22  other programs.

23         (d)(c)  Inform program applicants about eligibility

24  determinations and ensure appropriate followup procedures for

25  plan enrollment provide information about eligibility of

26  applicants to Medicaid, Medikids, the Children's Medical

27  Services Network, and the Florida Healthy Kids Corporation,

28  and to insurers and their agents, through a centralized

29  coordinating office.

30         (e)  No later than, July 1, 2008, in consultation with

31  the Agency for Health Care Administration, establish a single

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 1  toll-free telephone line to assist families that have

 2  questions about the Florida Kidcare program. The single

 3  toll-free line shall also connect the applicant or enrollee

 4  with customer service for account information established

 5  under s. 409.830(1)(b).

 6         (f)(d)  Adopt such rules as may be necessary for

 7  conducting program eligibility functions.

 8         (2)  The Department of Health shall:

 9         (a)  In consultation with the agency, develop a minimum

10  set of pediatric quality assurance and access standards,

11  including reporting requirements, for the Florida Kidcare

12  program. The standards must include a process for granting

13  exceptions to specific requirements for quality assurance and

14  access. Compliance with the standards shall be a condition of

15  program participation by health benefits coverage providers.

16  These standards shall comply with the provisions of this

17  chapter and chapter 641 and Title XXI of the Social Security

18  Act.

19         (b)  Determine clinical eligibility for and administer

20  the Florida Kidcare Plus health benefits coverage. Design an

21  eligibility intake process for the program, in coordination

22  with the Department of Children and Family Services, the

23  agency, and the Florida Healthy Kids Corporation. The

24  eligibility intake process may include local intake points

25  that are determined by the Department of Health in

26  coordination with the Department of Children and Family

27  Services.

28         (b)  Chair a state-level coordinating council to review

29  and make recommendations concerning the implementation and

30  operation of the program. The coordinating council shall

31  include representatives from the department, the Department of

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 1  Children and Family Services, the agency, the Florida Healthy

 2  Kids Corporation, the Office of Insurance Regulation of the

 3  Financial Services Commission, local government, health

 4  insurers, health maintenance organizations, health care

 5  providers, families participating in the program, and

 6  organizations representing low-income families.

 7         (c)  In consultation with the Florida Healthy Kids

 8  Corporation and the Department of Children and Family

 9  Services, establish a toll-free telephone line to assist

10  families with questions about the program.

11         (c)(d)  Adopt such rules as may be necessary to

12  implement this subsection outreach activities.

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

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

15         (a)  Calculate the premium assistance payment necessary

16  to comply with the premium and cost-sharing limitations

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

18  each enrollee in a health insurance plan participating in the

19  Florida Healthy Kids Corporation shall equal the premium

20  approved by the Florida Healthy Kids Corporation and the

21  Office of Insurance Regulation of the Financial Services

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

23  enrollee's share of the premium established within the

24  limitations specified in s. 409.816. The premium assistance

25  payment for each enrollee in an employer-sponsored health

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

27  the premium for the plan adjusted for any benchmark benefit

28  plan actuarial equivalent benefit rider approved by the Office

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

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

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

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 1  premium assistance payment levels for children with family

 2  coverage, the agency shall set the premium assistance payment

 3  levels for each child proportionately to the total cost of

 4  family coverage.

 5         (b)  Provide fiscal management for Title XIX and Title

 6  XXI funding for the Florida Kidcare program, distributing

 7  funds among Florida Healthy Kids, the Department of Children

 8  and Family Services, and the Department of Health based on

 9  costs and the participation of children in the plans and

10  programs available to Florida Kidcare program participants.

11         (c)(b)  Make premium assistance payments to health

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

13  Medicaid fiscal agent or a contracted third-party

14  administrator in making these payments.  The agency may

15  require health insurance plans that participate in the

16  Medikids program or employer-sponsored group health insurance

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

18  Participating health insurance plans shall report premium

19  payments collected on behalf of enrollees in the program to

20  the agency in accordance with a schedule established by the

21  agency.

22         (d)(c)  Monitor compliance with quality assurance and

23  access standards developed under paragraph (2)(a) s. 409.820.

24         (e)(d)  Establish a mechanism for investigating and

25  resolving complaints and grievances from program applicants,

26  enrollees, and health benefits coverage providers, and

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

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

29  organization, the agency must use the provisions of s. 641.511

30  to address grievance reporting and resolution requirements.

31  

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 1         (e)  Approve health benefits coverage for participation

 2  in the program, following certification by the Office of

 3  Insurance Regulation under subsection (4).

 4         (f)  Adopt rules necessary for calculating premium

 5  assistance payment levels, making premium assistance payments,

 6  monitoring access and quality assurance standards,

 7  investigating and resolving complaints and grievances,

 8  administering the Medikids program, and approving health

 9  benefits coverage. The agency is designated the lead state

10  agency for Title XXI of the Social Security Act for purposes

11  of receipt of federal funds, for reporting purposes, and for

12  ensuring compliance with federal and state regulations and

13  rules.

14         (g)  Develop and implement an outreach and marketing

15  program that educates the public about the Florida Kidcare

16  program, explains procedures for enrolling in Florida Kidcare,

17  and maintains public awareness of the program.

18         (h)  Seek and implement federal waivers or state plan

19  amendments necessary to implement this section and ss.

20  409.810-409.830.

21         (4)  The Office of Insurance Regulation shall certify

22  that health benefits coverage plans that seek to provide

23  services under the Florida Kidcare program, except those

24  offered through the Florida Healthy Kids Corporation or the

25  Children's Medical Services Network, meet, exceed, or are

26  actuarially equivalent to the benchmark benefit plan and that

27  health insurance plans will be offered at an approved rate. In

28  determining actuarial equivalence of benefits coverage, the

29  Office of Insurance Regulation and health insurance plans must

30  comply with the requirements of s. 2103 of Title XXI of the

31  

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 1  Social Security Act. The department shall adopt rules

 2  necessary for certifying health benefits coverage plans.

 3         (5)  The Florida Healthy Kids Corporation shall retain

 4  its functions as authorized in s. 624.91, including

 5  eligibility determination for participation in the Healthy

 6  Kids program.

 7         (4)(6)  The agency, in consultation with the Department

 8  of Health, the Department of Children and Family Services, the

 9  Florida Healthy Kids Corporation, and the Office of Insurance

10  Regulation, after consultation with and approval of the

11  Speaker of the House of Representatives and the President of

12  the Senate, is are authorized to make program modifications

13  that are necessary to overcome any objections of the United

14  States Department of Health and Human Services to obtain

15  approval of the state's child health insurance plan under

16  Title XXI of the Social Security Act.

17         Section 14.  Section 409.820, Florida Statutes, is

18  repealed.

19         Section 15.  Section 409.821, Florida Statutes, is

20  amended to read:

21         409.821  Florida Kidcare program public records

22  exemption.--Notwithstanding any other law to the contrary, Any

23  information identifying a Florida Kidcare program applicant or

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

25  Health Care Administration, the Department of Children and

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

27  Healthy Kids Corporation is confidential and exempt from s.

28  119.07(1) and s. 24(a), Art. I of the State Constitution. Such

29  information may be disclosed to another governmental entity

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

31  duties and responsibilities under the Florida Kidcare program

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 1  and shall be disclosed to the Department of Revenue for

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

 3  receiving governmental entity must maintain the confidential

 4  and exempt status of such information. Furthermore, such

 5  information may not be released to any person without the

 6  written consent of the program enrollee or the parent or

 7  guardian of the enrollee applicant. This exemption applies to

 8  any information identifying a Florida Kidcare program

 9  applicant or enrollee held by the Agency for Health Care

10  Administration, the Department of Children and Family

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

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

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

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

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

16  parent or legal guardian from obtaining confirmation of

17  coverage, dates of coverage, name of the enrollee's health

18  plan, and amount of premium being paid.

19         Section 16.  Section 409.830, Florida Statutes, is

20  created to read:

21         409.830  Florida Kidcare Program Consolidation

22  Initiative.--The Florida Kidcare Program Consolidation

23  Initiative is created to provide a seamless delivery system of

24  health benefits to uninsured, low-income children. The

25  initiative shall consolidate the administration of the Florida

26  Kidcare program under the fewest entities necessary for the

27  purpose of conducting marketing and outreach, eligibility

28  determination, premium collection, contract management of

29  health plans and fiscal agents, quality assurance and

30  grievance resolution, and fiscal management of all the

31  components of the Florida Kidcare program. The initiative

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 1  shall consolidate the Florida Kidcare program's administrative

 2  structure and align polices by no later than July 1, 2009. The

 3  Agency for Health Care Administration shall manage the

 4  consolidation of the Florida Kidcare program. A deputy

 5  secretary of Florida Kidcare is created within the agency to

 6  represent the interest of children in obtaining necessary

 7  health care services and health care coverage. The deputy

 8  secretary of Florida Kidcare shall develop policies and

 9  strategies for issues related to children's lack of access to

10  high-quality and affordable health care services and coverage.

11  The deputy secretary shall identify and provide

12  recommendations for ways to improve the delivery of services

13  for children through the Florida Kidcare program.

14         (1)  ADMINISTRATION.--

15         (a)  The Agency for Health Care Administration is

16  designated as the single state agency authorized to make

17  payments for medical assistance and related services; to

18  conduct contract management of health plans, providers, and

19  fiscal agents; to collect premiums; to develop and implement

20  quality assurance and grievance-resolution processes; to

21  conduct marketing and outreach programs; and to conduct other

22  fiscal-management activities relating to all the components of

23  the Florida Kidcare program no later than July 1, 2008.

24         1.  The agency, in consultation with the Department of

25  Children and Family Services, shall adopt a standardized

26  application form for the purpose of collecting all information

27  necessary to determine eligibility for all components of the

28  Florida Kidcare program. All eligibility information shall be

29  electronically verified to the extent possible. Each applicant

30  shall supply written documentation of any eligibility

31  information that cannot be electronically verified.

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 1         2.  The agency may contract with capitated managed care

 2  plans and other providers to deliver health benefits as

 3  necessary under this section and to begin providing services

 4  by July 1, 2008.

 5         3.  No later than July 1, 2008, the agency is

 6  responsible for developing and distributing marketing and

 7  outreach materials that educate families about the Florida

 8  Kidcare program as a whole, including eligibility

 9  requirements, application procedures, benefit design, and

10  other information considered necessary to assist families in

11  applying for and remaining in the Florida Kidcare program.

12  Marketing and outreach materials shall present the Florida

13  Kidcare program as a single program and explain that the

14  family's information is collected in order to determine if the

15  family is eligible for a premium discount or for no premium

16  requirement.

17         4.  The agency may adopt rules as necessary to

18  administer the Florida Kidcare program, except as specified in

19  s. 409.818.

20         (b)  The Department of Children and Family Services is

21  responsible for conducting eligibility determination for all

22  components of the Florida Kidcare program no later than July

23  1, 2008.

24         1.  No later than July 1, 2008, the Department of

25  Children and Family Services, in coordination with the agency,

26  shall be responsible for eligibility determination, including

27  receiving and processing applications for all program

28  components, determining eligibility for all program

29  components, receiving electronic verification, and

30  transmitting and receiving all correspondence related to the

31  

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 1  eligibility-determination process. All correspondence shall be

 2  identified solely with the Florida Kidcare program as a whole.

 3         2.  No later than July 1, 2008, the Department of

 4  Children and family Services is responsible to provide a

 5  single toll-free line for a customer service call center to

 6  access account information and provide general information

 7  concerning the Florida Kidcare program.

 8         (c)  The Florida Healthy Kids Corporation's remaining

 9  roles and responsibilities as defined in s. 624.91 shall be

10  transferred to the agency no later than July 1, 2009.

11         (2)  BENEFITS.--No later than July 1, 2008, health

12  benefits, as specified in paragraphs (a) and (b), shall be

13  provided to eligible children under the Florida Kidcare

14  program, except those children with special health care needs

15  who shall be provided benefits under the Florida Kidcare Plus

16  Plan.

17         (a)  No later than July 1, 2008, the Florida Kidcare

18  program shall contain the same benefits as specified in ss.

19  409.905 and 409.906 and emergency services provided under s.

20  409.9128.

21         (b)  The Florida Kidcare Plus Plan as defined in s.

22  409.811(13) shall contain the same benefits as specified in

23  ss. 409.905 and 409.906 and emergency services provided under

24  s. 409.9128.

25         (3)  SERVICE DELIVERY SYSTEMS.--No later than July 1,

26  2008, health care services under the Florida Kidcare program

27  shall be delivered through managed care plans, primary care

28  case management providers, and fee-for-service providers under

29  contract or other arrangement with the agency. Title XXI

30  enrollees, excluding those enrolled in the Florida Kidcare

31  Plus Plan, shall enroll in a managed care plan if two or more

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 1  plans are available. Florida Healthy Kids Corporation shall

 2  extend health plan contracts through June 30, 2009, for

 3  children enrolled in the Florida Healthy Kids program as of

 4  July 1, 2008.

 5         (4)  ELIGIBILITY.--Effective July 1, 2008, children

 6  eligible to participate in the Florida Kidcare program are

 7  those qualified under the eligibility standards specified in

 8  ss. 409.8132, 409.814, 409.8141, 409.903, and 409.904.

 9         (5)  ENROLLMENT.--Effective July 1, 2008, the parents,

10  guardians or persons applying on behalf of children determined

11  eligible after June 30, 2008, shall choose a Florida Kidcare

12  Plan providing the benefits as described in s. 409.830(2)(a)

13  and (b). Children enrolled in Florida Healthy Kids plans on

14  June 30, 2008, shall transfer to a Florida Kidcare Plan

15  providing the benefits as described in s. 409.830(2)(a) and

16  (b) no later than June 30, 2009.

17         (6)  CAPITATION RATES.--No later than July 1, 2008, any

18  managed care plan that participates in the Florida Kidcare

19  program shall be compensated in accordance with s. 409.9124,

20  except in counties compensated in accordance with s.

21  409.91211.

22         (7)  WAIVER AUTHORITY.--The agency shall seek federal

23  waiver approval or amendments to the Medicaid state plan and

24  Title XXI state plan which are necessary to implement the

25  initiative as specified in this section.

26         Section 17.  Section 624.91, Florida Statutes, is

27  amended to read:

28         624.91  The Florida Healthy Kids Corporation Act.--

29         (1)  SHORT TITLE.--This section may be cited as the

30  "William G. 'Doc' Myers Healthy Kids Corporation Act."

31         (2)  LEGISLATIVE INTENT.--

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 1         (a)  The Legislature finds that increased access to

 2  health care services could improve children's health and

 3  reduce the incidence and costs of childhood illness and

 4  disabilities among children in this state. Many children do

 5  not have comprehensive, affordable health care services

 6  available. It is the intent of the Legislature that the

 7  Florida Healthy Kids Corporation provide comprehensive health

 8  insurance coverage to such children. The corporation is

 9  encouraged to cooperate with any existing health service

10  programs funded by the public or the private sector.

11         (b)  It is the intent of the Legislature that the

12  Florida Healthy Kids Corporation serve as one of several

13  providers of services to children eligible for medical

14  assistance under Title XXI of the Social Security Act.

15  Although the corporation may serve other children, the

16  Legislature intends the primary recipients of services

17  provided through the corporation be school-age children with a

18  family income below 200 percent of the federal poverty level,

19  who do not qualify for Medicaid. It is also the intent of the

20  Legislature that state and local government Florida Healthy

21  Kids funds be used to continue coverage, subject to specific

22  appropriations in the General Appropriations Act, to children

23  not eligible for federal matching funds under Title XXI.

24         (3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the

25  following individuals are eligible for state-funded assistance

26  in paying Florida Healthy Kids premiums:

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

28  Florida Kidcare program pursuant to s. 409.814.

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

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

31  

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 1  2004, who do not qualify for Title XXI federal funds because

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

 3         (3)(4)  NONENTITLEMENT.--Nothing in this section shall

 4  be construed as providing an individual with an entitlement to

 5  health care services.  No cause of action shall arise against

 6  the state, the Florida Healthy Kids Corporation, or a unit of

 7  local government for failure to make health services available

 8  under this section.

 9         (4)(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--

10         (a)  There is created the Florida Healthy Kids

11  Corporation, a not-for-profit corporation.

12         (b)  The Florida Healthy Kids Corporation shall:

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

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

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

16  payment of premiums for health benefits comprehensive

17  insurance coverage and for the actual or estimated

18  administrative expenses. No later than July 1, 2009, the

19  collection of family premiums shall be transferred to the

20  Agency for Health Care Administration.

21         2.  Arrange for the collection of any voluntary

22  contributions to provide for payment of Florida Kidcare

23  premiums for children who are not eligible for medical

24  assistance under Title XXI of the Social Security Act. No

25  later than July 1, 2009, this function shall be transferred to

26  the Agency for Health Care Administration.

27         3.  Subject to the provisions of s. 409.8134, accept

28  voluntary supplemental local match contributions that comply

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

30  for the purpose of providing additional Florida Kidcare

31  coverage in contributing counties under Title XXI. No later

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 1  than July 1, 2009, this function shall be transferred to the

 2  Agency for Health Care Administration.

 3         4.  Establish the administrative and accounting

 4  procedures for the operation of the corporation.

 5         5.  Establish, with consultation from appropriate

 6  professional organizations, standards for preventive health

 7  services and providers and comprehensive insurance benefits

 8  appropriate to children, provided that the such standards for

 9  rural areas do shall not limit primary care providers to

10  board-certified pediatricians.

11         6.  Determine eligibility for children seeking to

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

13  Kidcare program consistent with the requirements specified in

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

15  provided in subsection (3). No later than July 1, 2008, this

16  function shall be transferred to the Department of Children

17  and Family Services.

18         7.  Establish procedures under which providers of local

19  match to, applicants to and participants in the program may

20  have grievances reviewed by an impartial body and reported to

21  the board of directors of the corporation. No later than July

22  1, 2009, this function shall be transferred to the Agency for

23  Health Care Administration.

24         8.  Establish participation criteria and, if

25  appropriate, contract with an authorized insurer, health

26  maintenance organization, or third-party administrator to

27  provide administrative services to the corporation.

28         9.  Establish enrollment criteria which shall include

29  penalties or waiting periods of not fewer than 60 days for

30  reinstatement of coverage upon voluntary cancellation for

31  nonpayment of family premiums.

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 1         10.  Contract with authorized insurers or any provider

 2  of health care services, meeting standards established by the

 3  corporation, for the provision of comprehensive insurance

 4  coverage to participants. Such standards shall include

 5  criteria under which the corporation may contract with more

 6  than one provider of health care services in program sites.

 7  Health plans shall be selected through a competitive bid

 8  process. The Florida Healthy Kids Corporation shall purchase

 9  goods and services in the most cost-effective manner

10  consistent with the delivery of quality medical care. The

11  maximum administrative cost for a Florida Healthy Kids

12  Corporation contract shall be 15 percent. For health care

13  contracts, the minimum medical loss ratio for a Florida

14  Healthy Kids Corporation contract shall be 85 percent. For

15  dental contracts, the remaining compensation to be paid to the

16  authorized insurer or provider under a Florida Healthy Kids

17  Corporation contract shall be no less than an amount which is

18  85 percent of premium; to the extent any contract provision

19  does not provide for this minimum compensation, this section

20  shall prevail. The health plan selection criteria and scoring

21  system, and the scoring results, shall be available upon

22  request for inspection after the bids have been awarded.

23         11.  Establish disenrollment criteria in the event

24  local matching funds are insufficient to cover enrollments.

25         12.  Health and dental plans participating in the

26  Florida Healthy Kids program may develop and distribute

27  marketing and other promotional materials and participate in

28  activities, such as health fairs and public events, as

29  approved by the corporation. The health and dental plans may

30  also contact their current and former enrollees to encourage

31  continued participation in the program and to assist the

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 1  enrollee in transferring from a Title XIX-financed plan to a

 2  Title XXI-financed plan. No later than July 1, 2008, this

 3  function shall be transferred to the Department of Children

 4  and Family Services. Develop and implement a plan to publicize

 5  the Florida Healthy Kids Corporation, the eligibility

 6  requirements of the program, and the procedures for enrollment

 7  in the program and to maintain public awareness of the

 8  corporation and the program.

 9         13.  Secure staff necessary to properly administer the

10  corporation. Staff costs shall be funded from state and local

11  matching funds and such other private or public funds as

12  become available. The board of directors shall determine the

13  number of staff members necessary to administer the

14  corporation.

15         14.  Provide a report annually to the Governor, Chief

16  Financial Officer, Commissioner of Education, Senate

17  President, Speaker of the House of Representatives, and

18  Minority Leaders of the Senate and the House of

19  Representatives.

20         15.  Establish benefit packages which conform to the

21  provisions of the Florida Kidcare program, as created in ss.

22  409.810-409.830 ss. 409.810-409.820.

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

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

25  applicable to, the participant child or family member.

26  Insurers under contract with the corporation are the payors of

27  last resort and must coordinate benefits with any other

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

29  medical care.

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

31  private corporation not for profit, organized under pursuant

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

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

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

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

 5  accept from any source contributions of money, property,

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

 7  applied for the purposes of this section act.

 8         (5)(6)  BOARD OF DIRECTORS.--

 9         (a)  The Florida Healthy Kids Corporation shall operate

10  subject to the supervision and approval of a board of

11  directors chaired by the Chief Financial Officer or her or his

12  designee, and composed of 10 other members selected for 3-year

13  terms of office as follows:

14         1.  The Secretary of Health Care Administration, or his

15  or her designee;

16         2.  One member appointed by the Commissioner of

17  Education from the Office of School Health Programs of the

18  Florida Department of Education;

19         3.  One member appointed by the Chief Financial Officer

20  from among three members nominated by the Florida Pediatric

21  Society;

22         4.  One member, appointed by the Governor, who

23  represents the Children's Medical Services Program;

24         5.  One member appointed by the Chief Financial Officer

25  from among three members nominated by the Florida Hospital

26  Association;

27         6.  One member, appointed by the Governor, who is an

28  expert on child health policy;

29         7.  One member, appointed by the Chief Financial

30  Officer, from among three members nominated by the Florida

31  Academy of Family Physicians;

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 1         8.  One member, appointed by the Governor, who

 2  represents the state Medicaid program;

 3         9.  One member, appointed by the Chief Financial

 4  Officer, from among three members nominated by the Florida

 5  Association of Counties; and

 6         10.  The State Health Officer or her or his designee.

 7         (b)  A member of the board of directors may be removed

 8  by the official who appointed that member.  The board shall

 9  appoint an executive director, who is responsible for other

10  staff authorized by the board.

11         (c)  Board members are entitled to receive, from funds

12  of the corporation, reimbursement for per diem and travel

13  expenses as provided by s. 112.061.

14         (d)  There shall be no liability on the part of, and no

15  cause of action shall arise against, any member of the board

16  of directors, or its employees or agents, for any action they

17  take in the performance of their powers and duties under this

18  act.

19         (6)(7)  LICENSING NOT REQUIRED; FISCAL OPERATION.--

20         (a)  The corporation shall not be deemed an insurer.

21  The officers, directors, and employees of the corporation

22  shall not be deemed to be agents of an insurer. Neither the

23  corporation nor any officer, director, or employee of the

24  corporation is subject to the licensing requirements of the

25  insurance code or the rules of the Department of Financial

26  Services. However, any marketing representative utilized and

27  compensated by the corporation must be appointed as a

28  representative of the insurers or health services providers

29  with which the corporation contracts.

30         (b)  The board has complete fiscal control over the

31  corporation and is responsible for all corporate operations.

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 1         (c)  The Department of Financial Services shall

 2  supervise any liquidation or dissolution of the corporation

 3  and shall have, with respect to such liquidation or

 4  dissolution, all power granted to it pursuant to the insurance

 5  code.

 6         (7)(8)  ACCESS TO RECORDS; CONFIDENTIALITY;

 7  PENALTIES.--Notwithstanding any other laws to the contrary,

 8  the Florida Healthy Kids Corporation shall have access to the

 9  medical records of a student upon receipt of permission from a

10  parent or guardian of the student. Such medical records may be

11  maintained by state and local agencies. Any identifying

12  information, including medical records and family financial

13  information, obtained by the corporation pursuant to this

14  subsection is confidential and is exempt from the provisions

15  of s. 119.07(1). Neither the corporation nor the staff or

16  agents of the corporation may release, without the written

17  consent of the participant or the parent or guardian of the

18  participant, to any state or federal agency, to any private

19  business or person, or to any other entity, any confidential

20  information received pursuant to this subsection. A violation

21  of this subsection is a misdemeanor of the second degree,

22  punishable as provided in s. 775.082 or s. 775.083.

23         (8)  The venue for all civil and administrative actions

24  against the Florida Healthy Kids Corporation shall be in Leon

25  County.

26         Section 18.  Effective July 1, 2009, section 624.91,

27  Florida Statutes, as amended by this act, is repealed.

28         Section 19.  The Agency for Health Care Administration

29  shall provide a consolidation transition plan that identifies

30  budget, statutory, and administrative issues that need to be

31  addressed in order to implement the provisions of s. 409.830,

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 1  Florida Statutes. The transition plan shall be provided to the

 2  Governor, the President of the Senate, and the Speaker of the

 3  House of Representatives by January 1, 2008.

 4         Section 20.  The sum of $333,049 in nonrecurring funds

 5  from the General Revenue Fund and $780,082 in nonrecurring

 6  funds from the Administrative Trust Fund are appropriated to

 7  the Agency for Health Care Administration, and 10 full time

 8  equivalent positions and associated salary rate of 519,766 is

 9  authorized to implement the provisions of this act during the

10  2007-2008 fiscal year.

11         Section 21.  The sum of $1,233,995 in nonrecurring

12  funds from the General Revenue Fund and $2,890,319 in

13  nonrecurring funds from the Federal Grants Trust Fund are

14  appropriated to the Department of Children and Family Services

15  and 115 full-time equivalent positions and associated salary

16  rate of 948,602 is authorized to implement the provisions of

17  this act during the 2007-2008 fiscal year.

18         Section 22.  Except as otherwise expressly provided in

19  this act, this act shall take effect July 1, 2007.

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

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    603-2487-07




 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         CS/CS for SB 930

 3                                 

 4  The bill makes the following changes related to the Florida
    KidCare Program:
 5  
         Clarifies and adds definitions relating to the Florida
 6       Kidcare Program.

 7       Revises language referring to the components of the
         program and the expenditure ceiling of the program.
 8  
         Clarifies eligibility criteria, including who is eligible
 9       for premium assistance in the program.

10       Provides good-cause reasons, to allow a child to receive
         premium assistance if their employer-sponsored health
11       insurance was canceled 6 months prior to submitting an
         application.
12  
         Maintains current eligibility documentation requirements
13       and requires eligibility information to be electronically
         verified to the extent possible.
14  
         Requires health plans and other providers to be notified
15       of their members losing Medicaid or Medikids eligibility
         so they may assist them in maintaining continuous
16       coverage in the Florida Kidcare Program.

17       Provides penalties for use of fraudulent information to
         qualify for the program.
18  
         Redefines the benchmark benefit package for the program,
19       effective July 1, 2008.

20       Requires the Department of Children and Family Services
         (DCF) to develop a standard intake process for all
21       Community Access Network partners to inform applicants
         about coverage and services offered through the program.
22  
         Requires DCF to develop a standardized application
23       process.

24       Requires DCF to conduct eligibility determination for all
         components of the program no later than July 1, 2008.
25  
         Requires DCF, in consultation with the Agency for Health
26       Care Administration (AHCA), to establish a toll-free
         hotline no later than July 1, 2008.
27  
         Requires the Department of Health (DOH), in consultation
28       with AHCA, to develop a minimum set of pediatric quality
         assurance and access standards for the program.
29  
         Designates AHCA as the single state agency and transfers
30       and consolidates most administrative functions in the
         entire Florida Kidcare program under the AHCA no later
31       than July 1,2008.

                                  50

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






    Florida Senate - 2007              CS for CS for CS for SB 930
    603-2487-07




 1       Requires AHCA to develop and implement a marketing and
         outreach program no later than July 1, 2008.
 2  
         Clarifies that parents and legal guardians have access to
 3       certain enrollment information.

 4       Requires that benefits are delivered through the "Florida
         KidCare Program" and the "KidCare Plus Plan" (defined as
 5       children with special health care needs).

 6       Requires managed care plans participating in the KidCare
         program to be compensated in accordance with the current
 7       capitation rate methodologies used in Medicaid, effective
         July 1, 2008.
 8  
         Eliminates the current coordinating council chaired by
 9       the Department of Health.

10       Repeals the Florida Healthy Kids Corporation, effective
         June 30, 2009.
11  
         Requires AHCA to provide a consolidation transition plan
12       to the Governor, Senate President and Speaker of the
         House of Representatives by January 1, 2008.
13  
         Provides an appropriation.
14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  51

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