HB 1275

1	A bill to be entitled
2	An act relating to the Florida Kidcare program; amending
3	s. 409.810, F.S.; correcting a cross-reference; amending
4	s. 409.811, F.S.; providing definitions; conforming cross-
5	references; amending s. 409.812, F.S.; expanding
6	application of the Florida Kidcare program to include all
7	uninsured, low-income children; amending s. 409.813, F.S.;
8	specifying funding sources for health benefits coverage
9	for certain children; specifying program components to be
10	marketed as the Florida Kidcare program; conforming cross-
11	references; amending s. 409.8132, F.S.; conforming a
12	cross-reference; revising provisions relating to penalties
13	for nonpayment of premiums and waiting periods for
14	reinstatement of coverage; amending s. 409.8134, F.S.;
15	revising provisions relating to enrollment in the Florida
16	Kidcare program; amending s. 409.814, F.S.; removing a
17	restriction on participation in the Florida Healthy Kids
18	program; authorizing certain enrollees to opt out of the
19	Children's Medical Services network; providing for
20	continuation of Florida Kidcare program eligibility under
21	certain circumstances; revising coverage limitations;
22	restricting enrollment of children whose coverage was
23	voluntarily canceled; providing exceptions; deleting
24	provisions that place a limit on enrollment in Medikids
25	and the Florida Healthy Kids program; revising age and
26	income limitations for Title XXI-funded Florida Kidcare
27	coverage; requiring notice to health plans and MediPass
28	providers when a child is no longer eligible for certain
29	coverage; providing for electronic verification of an
30	applicant's income; providing circumstances under which
31	written documentation is required; revising the timeframe
32	for an enrollee to resolve disputes regarding the
33	withholding of benefits; amending s. 409.815, F.S.;
34	permitting the Agency for Health Care Administration to
35	increase certain premium assistance payments for Florida
36	Kidcare Plus benefits under certain circumstances;
37	revising a limitation on certain covered maternity
38	services; conforming cross-references; amending s.
39	409.816, F.S.; providing limitations on premiums and cost-
40	sharing payments by enrollees covered under Title XIX of
41	the Social Security Act; conforming a cross-reference;
42	amending s. 409.817, F.S.; conforming a cross-reference;
43	amending s. 409.8177, F.S.; revising information to be
44	included in the annual program evaluation report to the
45	Governor and Legislature; amending s. 409.818, F.S.;
46	revising an age limitation for Florida Kidcare coverage;
47	requiring the Department of Health to chair a Florida
48	Kidcare coordinating council and adopt certain rules in
49	conjunction therewith; removing a provision requiring
50	establishment of a toll-free telephone line; conforming
51	cross-references; amending s. 409.821, F.S., relating to
52	the Florida Kidcare program public records exemption;
53	providing for disclosure of certain confidential and
54	exempt information relating to an enrollee's application
55	or coverage to an enrollee's parent or legal guardian;
56	amending s. 409.904, F.S.; revising provisions relating to
57	eligibility of certain children for the Medicaid program;
58	amending s. 624.91, F.S.; revising the duties of the
59	Florida Healthy Kids Corporation; deleting provisions
60	relating to publicizing the Florida Kidcare Corporation;
61	correcting a cross-reference; providing an effective date.
62
63	Be It Enacted by the Legislature of the State of Florida:
64
65	Section 1.  Section 409.810, Florida Statutes, is amended
66	to read:
67	409.810  Short title.--Sections 409.810-409.821 409.810-
68	409.820 may be cited as the "Florida Kidcare Act."
69	Section 2.  Section 409.811, Florida Statutes, is amended
70	to read:
71	409.811  Definitions relating to Florida Kidcare Act.--As
72	used in ss. 409.810-409.821 409.810-409.820, the term:
73	(1)  "Actuarially equivalent" means that:
74	(a)  The aggregate value of the benefits included in health
75	benefits coverage is equal to the value of the benefits in the
76	benchmark benefit plan; and
77	(b)  The benefits included in health benefits coverage are
78	substantially similar to the benefits included in the benchmark
79	benefit plan, except that preventive health services must be the
80	same as in the benchmark benefit plan.
81	(2)  "Agency" means the Agency for Health Care
82	Administration.
83	(3)  "Applicant" means a parent or guardian of a child or a
84	child whose disability of nonage has been removed under chapter
85	743, who applies for determination of eligibility for health
86	benefits coverage under ss. 409.810-409.821 409.810-409.820.
87	(4)  "Benchmark benefit plan" means the form and level of
88	health benefits coverage established in s. 409.815.
89	(5)  "Child" means any person under 19 years of age.
90	(6)  "Child with special health care needs" means a child
91	whose serious or chronic physical or developmental condition
92	requires extensive preventive and maintenance care beyond that
93	required by typically healthy children. Health care utilization
94	by such a child exceeds the statistically expected usage of the
95	normal child adjusted for chronological age, and such a child
96	often needs complex care requiring multiple providers,
97	rehabilitation services, and specialized equipment in a number
98	of different settings.
99	(7)  "Children's Medical Services network" or "network"
100	means a statewide managed care service system as defined in s.
101	391.021(1).
102	(8)  "Community rate" means a method used to develop
103	premiums for a health insurance plan that spreads financial risk
104	across a large population and allows adjustments only for age,
105	gender, family composition, and geographic area.
106	(9)  "Department" means the Department of Health.
107	(10)  "Enrollee" means a child who has been determined
108	eligible for and is receiving coverage under ss. 409.810-409.821
109	409.810-409.820.
110	(11)  "Family" means the group or the individuals whose
111	income is considered in determining eligibility for the Florida
112	Kidcare program. The family includes a child with a custodial
113	parent or caretaker relative who resides in the same house or
114	living unit or, in the case of a child whose disability of
115	nonage has been removed under chapter 743, the child. The family
116	may also include other individuals whose income and resources
117	are considered in whole or in part in determining eligibility of
118	the child.
119	(12)  "Family income" means cash received at periodic
120	intervals from any source, such as wages, benefits,
121	contributions, or rental property. Income also may include any
122	money that would have been counted as income under the Aid to
123	Families with Dependent Children (AFDC) state plan in effect
124	prior to August 22, 1996.
125	(13)  "Florida Kidcare Plus" means health benefits coverage
126	for children with special health care needs delivered through
127	the Children's Medical Services network.
128	(14)(13)  "Florida Kidcare program," "Kidcare program," or
129	"program" means the health benefits program administered through
130	ss. 409.810-409.821 409.810-409.820.
131	(15)(14)  "Guarantee issue" means that health benefits
132	coverage must be offered to an individual regardless of the
133	individual's health status, preexisting condition, or claims
134	history.
135	(16)(15)  "Health benefits coverage" means protection that
136	provides payment of benefits for covered health care services or
137	that otherwise provides, either directly or through arrangements
138	with other persons, covered health care services on a prepaid
139	per capita basis or on a prepaid aggregate fixed-sum basis.
140	(17)(16)  "Health insurance plan" means health benefits
141	coverage under the following:
142	(a)  A health plan offered by any certified health
143	maintenance organization or authorized health insurer, except a
144	plan that is limited to the following: a limited benefit,
145	specified disease, or specified accident; hospital indemnity;
146	accident only; limited benefit convalescent care; Medicare
147	supplement; credit disability; dental; vision; long-term care;
148	disability income; coverage issued as a supplement to another
149	health plan; workers' compensation liability or other insurance;
150	or motor vehicle medical payment only; or
151	(b)  An employee welfare benefit plan that includes health
152	benefits established under the Employee Retirement Income
153	Security Act of 1974, as amended.
154	(18)  "Maximum income threshold" means a percentage of the
155	current federal poverty level used to determine eligibility for
156	certain program components, as approved by federal waiver or an
157	amendment to the state plan.
158	(19)(17)  "Medicaid" means the medical assistance program
159	authorized by Title XIX of the Social Security Act, and
160	regulations thereunder, and ss. 409.901-409.920, as administered
161	in this state by the agency.
162	(20)(18)  "Medically necessary" means the use of any
163	medical treatment, service, equipment, or supply necessary to
164	palliate the effects of a terminal condition, or to prevent,
165	diagnose, correct, cure, alleviate, or preclude deterioration of
166	a condition that threatens life, causes pain or suffering, or
167	results in illness or infirmity and which is:
168	(a)  Consistent with the symptom, diagnosis, and treatment
169	of the enrollee's condition;
170	(b)  Provided in accordance with generally accepted
171	standards of medical practice;
172	(c)  Not primarily intended for the convenience of the
173	enrollee, the enrollee's family, or the health care provider;
174	(d)  The most appropriate level of supply or service for
175	the diagnosis and treatment of the enrollee's condition; and
176	(e)  Approved by the appropriate medical body or health
177	care specialty involved as effective, appropriate, and essential
178	for the care and treatment of the enrollee's condition.
179	(21)(19)  "Medikids" means a component of the Florida
180	Kidcare program of medical assistance authorized by Title XXI of
181	the Social Security Act, and regulations thereunder, and s.
182	409.8132, as administered in the state by the agency.
183	(22)(20)  "Preexisting condition exclusion" means, with
184	respect to coverage, a limitation or exclusion of benefits
185	relating to a condition based on the fact that the condition was
186	present before the date of enrollment for such coverage, whether
187	or not any medical advice, diagnosis, care, or treatment was
188	recommended or received before such date.
189	(23)(21)  "Premium" means the entire cost of a health
190	insurance plan, including the administration fee or the risk
191	assumption charge.
192	(24)(22)  "Premium assistance payment" means the monthly
193	consideration paid by the agency per enrollee in the Florida
194	Kidcare program towards health insurance premiums.
195	(25)(23)  "Qualified alien" means an alien as defined in s.
196	431 of the Personal Responsibility and Work Opportunity
197	Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
198	(26)(24)  "Resident" means a United States citizen, or
199	qualified alien, who is domiciled in this state.
200	(27)(25)  "Rural county" means a county having a population
201	density of less than 100 persons per square mile, or a county
202	defined by the most recent United States Census as rural, in
203	which there is no prepaid health plan participating in the
204	Medicaid program as of July 1, 1998.
205	(28)(26)  "Substantially similar" means that, with respect
206	to additional services as defined in s. 2103(c)(2) of Title XXI
207	of the Social Security Act, these services must have an
208	actuarial value equal to at least 75 percent of the actuarial
209	value of the coverage for that service in the benchmark benefit
210	plan and, with respect to the basic services as defined in s.
211	2103(c)(1) of Title XXI of the Social Security Act, these
212	services must be the same as the services in the benchmark
213	benefit plan.
214	Section 3.  Section 409.812, Florida Statutes, is amended
215	to read:
216	409.812  Program created; purpose.--The Florida Kidcare
217	program is created to provide a defined set of health benefits
218	to previously uninsured, low-income children through the
219	establishment of a variety of affordable health benefits
220	coverage options from which families may select coverage and
221	through which families may contribute financially to the health
222	care of their children.
223	Section 4.  Section 409.813, Florida Statutes, is amended
224	to read:
225	409.813  Health benefits coverage; program components;
226	entitlement and nonentitlement.--
227	(1)  The Florida Kidcare program includes health benefits
228	coverage provided to children as follows through:
229	(a)  For children with family incomes at or below the
230	applicable Medicaid eligibility level, health benefits coverage
231	is funded through Title XIX of the Social Security Act.
232	(b)  For children with family incomes above the applicable
233	Medicaid eligibility level up to the maximum income threshold,
234	health benefits coverage is funded through Title XXI of the
235	Social Security Act.
236	(c)  For children with family incomes up to the maximum
237	income threshold who do not qualify for health benefits coverage
238	under Title XXI of the Social Security Act, health benefits
239	coverage is funded through general revenue or local
240	contributions if a specific appropriation is provided for this
241	purpose.
242	(d)  For children with family incomes above the maximum
243	income threshold, health benefits coverage is funded through
244	family premiums.
245	(2)  The Florida Kidcare program includes health benefits
246	coverage provided to children through the following program
247	components, which shall be marketed as the Florida Kidcare
248	program:
249	(a)(1)  Medicaid;
250	(b)(2)  Medikids as created in s. 409.8132;
251	(c)(3)  The Florida Healthy Kids Corporation as created in
252	s. 624.91;
253	(d)(4)  Employer-sponsored group health insurance plans
254	approved under ss. 409.810-409.821 409.810-409.820; and
255	(e)(5)  The Children's Medical Services network established
256	in chapter 391.
257	(3)  Except for Title XIX-funded Florida Kidcare program
258	coverage under the Medicaid program, coverage under the Florida
259	Kidcare program is not an entitlement. No cause of action shall
260	arise against the state, the department, the Department of
261	Children and Family Services, or the agency for failure to make
262	health services available to any person under ss. 409.810-
263	409.821 409.810-409.820.
264	Section 5.  Paragraph (b) of subsection (6) and subsection
265	(8) of section 409.8132, Florida Statutes, are amended to read:
266	409.8132  Medikids program component.--
267	(6)  ELIGIBILITY.--
268	(b)  The provisions of s. 409.814(3), (4), and (5), (6),
269	and (7) shall be applicable to the Medikids program.
270	(8)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
271	shall establish enrollment criteria that must include penalties
272	or waiting periods of 30 not fewer than 60 days for
273	reinstatement of coverage upon voluntary cancellation for
274	nonpayment of premiums.
275	Section 6.  Section 409.8134, Florida Statutes, is amended
276	to read:
277	409.8134  Program expenditure ceiling; enrollment.--
278	(1)  Except for the Medicaid program, a ceiling shall be
279	placed on annual federal and state expenditures for the Florida
280	Kidcare program as provided each year in the General
281	Appropriations Act.
282	(2)  The Florida Kidcare program may conduct enrollment
283	continuously at any time throughout the year for the purpose of
284	enrolling children eligible for all program components listed in
285	s. 409.813 except Medicaid. The four Florida Kidcare
286	administrators shall work together to ensure that the year-round
287	enrollment period is announced statewide. Eligible Children
288	eligible for Title XXI-funded Florida Kidcare program coverage
289	shall be enrolled on a first-come, first-served basis using the
290	date the enrollment application is received. Enrollment shall
291	immediately cease when the expenditure ceiling is reached. Year-
292	round enrollment shall only be held if the Social Services
293	Estimating Conference determines that sufficient federal and
294	state funds will be available to finance the increased
295	enrollment through federal fiscal year 2007. Any individual who
296	is not enrolled must reapply by submitting a new application.
297	The application for the Florida Kidcare program is shall be
298	valid for a period of 120 days after the date it was received.
299	At the end of the 120-day period, if the applicant has not been
300	enrolled in the program, the application is shall be invalid and
301	the applicant shall be notified of the action. The applicant may
302	reactivate resubmit the application after notification of the
303	action taken by the program. Except for the Medicaid program,
304	whenever the Social Services Estimating Conference determines
305	that there are presently, or will be by the end of the current
306	fiscal year, insufficient funds to finance the current or
307	projected enrollment in the Florida Kidcare program, all
308	additional enrollment must cease and additional enrollment may
309	not resume until sufficient funds are available to finance such
310	enrollment.
311	(3)  Upon determination by the Social Services Estimating
312	Conference that there are insufficient funds to finance the
313	current enrollment in the Florida Kidcare program within current
314	appropriations, the program shall initiate disenrollment
315	procedures to remove enrollees, except those children enrolled
316	in Florida Kidcare Plus the Children's Medical Services Network,
317	on a last-in, first-out basis until the expenditure and
318	appropriation levels are balanced.
319	(4)  The agencies that administer the Florida Kidcare
320	program components shall collect and analyze the data needed to
321	project program enrollment costs, including price level
322	adjustments, participation and attrition rates, current and
323	projected caseloads, utilization, and current and projected
324	expenditures for the next 3 years. The agencies shall report
325	caseload and expenditure trends to the Social Services
326	Estimating Conference in accordance with chapter 216.
327	Section 7.  Section 409.814, Florida Statutes, is amended
328	to read:
329	409.814  Eligibility.--A child who has not reached 19 years
330	of age whose family income is equal to or below 200 percent of
331	the federal poverty level is eligible for the Florida Kidcare
332	program as provided in this section. For enrollment in Florida
333	Kidcare Plus the Children's Medical Services Network, a complete
334	application includes the medical or behavioral health screening.
335	If, subsequently, an individual is determined to be ineligible
336	for coverage, he or she must immediately be disenrolled from the
337	respective Florida Kidcare program component.
338	(1)  A child who is eligible for Medicaid coverage under s.
339	409.903 or s. 409.904 must be enrolled in Medicaid and is not
340	eligible to receive health benefits under any other health
341	benefits coverage authorized under the Florida Kidcare program.
342	(2)  A child who is not eligible for Medicaid, but who is
343	eligible for the Florida Kidcare program, may obtain health
344	benefits coverage under any of the other components listed in s.
345	409.813 if such coverage is approved and available in the county
346	in which the child resides. However, a child who is eligible for
347	Medikids may participate in the Florida Healthy Kids program
348	only if the child has a sibling participating in the Florida
349	Healthy Kids program and the child's county of residence permits
350	such enrollment.
351	(3)  A child who is eligible for the Florida Kidcare
352	program who is a child with special health care needs, as
353	determined through a medical or behavioral screening instrument,
354	shall receive Florida Kidcare Plus is eligible for health
355	benefits coverage and shall be assigned to and may opt out of
356	from and shall be referred to the Children's Medical Services
357	network.
358	(4)  A child who becomes ineligible for Title XIX-funded
359	Florida Kidcare program coverage due to exceeding income or age
360	limitations shall be presumed eligible for the Title XXI-funded
361	component of the Florida Kidcare program and shall have 60 days
362	of continued eligibility following redetermination before
363	premium payments are required in order to allow for a transition
364	to coverage under the Title XXI-funded component of the Florida
365	Kidcare program without a lapse in coverage. The state shall use
366	a Title XXI financing option for the 60 days of presumptive
367	eligibility. Potential Florida Kidcare Plus, Medikids, and
368	Florida Healthy Kids enrollees shall retain coverage with the
369	Children's Medical Services network or their Medicaid or managed
370	care providers during the transition period.
371	(5)(4)  The following children are not eligible to receive
372	Title XXI-funded premium assistance for health benefits coverage
373	under the Florida Kidcare program, except under Medicaid if the
374	child would have been eligible for Medicaid under s. 409.903 or
375	s. 409.904 as of June 1, 1997:
376	(a)  A child who is eligible for coverage under a state
377	health benefit plan on the basis of a family member's employment
378	with a public agency in the state.
379	(b)  A child who is currently eligible for or covered under
380	a family member's group health benefit plan or under other
381	private or employer health insurance coverage, excluding
382	coverage provided under the Florida Healthy Kids Corporation as
383	established under s. 624.91, provided that the cost of the
384	child's participation is not greater than 5 percent of the
385	family's income. If a child is otherwise eligible for a subsidy
386	in the Florida Kidcare program and the cost of the child's
387	participation in the family member's health insurance benefit
388	plan is greater than 5 percent of the family's income, this
389	section does not apply. This provision shall be applied during
390	redetermination for children who were enrolled prior to July 1,
391	2004. These enrollees shall have 6 months of eligibility
392	following redetermination to allow for a transition to the other
393	health benefit plan.
394	(c)  A child who is seeking premium assistance for the
395	Florida Kidcare program through employer-sponsored group
396	coverage, if the child has been covered by the same employer's
397	group coverage during the 90 days 6 months prior to the family's
398	submitting an application for determination of eligibility under
399	the program.
400	(d)  A child who is an alien, but who does not meet the
401	definition of qualified alien, in the United States.
402	(e)  A child who is an inmate of a public institution or a
403	patient in an institution for mental diseases.
404	(f)  A child who is otherwise eligible for premium
405	assistance for the Florida Kidcare program and has had his or
406	her coverage in an employer-sponsored or private health benefit
407	plan voluntarily canceled in the last 90 days 6 months, except
408	those children whose coverage was voluntarily canceled for good
409	cause, including, but not limited to, the following
410	circumstances:
411	1.  The cost of participation in an employer-sponsored
412	health benefit plan is greater than 5 percent of the family's
413	income;
414	2.  The parent lost a job that provided an employer-
415	sponsored health benefit plan for children;
416	3.  The parent with health benefits coverage for the child
417	is deceased;
418	4.  The child has a medical condition that, without medical
419	care, would cause serious disability, loss of function, or
420	death;
421	5.  The employer of the parent canceled health benefits
422	coverage for children;
423	6.  The child's health benefits coverage ended because the
424	child reached the maximum lifetime coverage amount;
425	7.  The child has exhausted coverage under a COBRA
426	continuation provision;
427	8.  The health benefits coverage does not cover the child's
428	health care needs; or
429	9.  Domestic violence led to loss of coverage who were on
430	the waiting list prior to March 12, 2004.
431	(6)(g)  A child who is otherwise eligible for the Florida
432	Kidcare program and who has a preexisting condition that
433	prevents coverage under another insurance plan as described in
434	paragraph (5)(b) that which would have disqualified the child
435	for the Florida Kidcare program if the child were able to enroll
436	in the plan shall be eligible for Florida Kidcare coverage when
437	enrollment is possible.
438	(7)(5)  A child whose family income is above 200 percent of
439	the federal poverty level or a child who is excluded under the
440	provisions of subsection (5) (4) may participate in the Florida
441	Kidcare program. However, Medikids program as provided in s.
442	409.8132 or, if the child is ineligible for Medikids by reason
443	of age, in the Florida Healthy Kids program, subject to the
444	following provisions:
445	(a)  the family is not eligible for premium assistance
446	payments and must pay the full cost of the premium, including
447	any administrative costs.
448	(a)(b)  The agency is authorized to place limits on
449	enrollment in Medikids by these children in order to avoid
450	adverse selection. The number of children participating in
451	Medikids whose family income exceeds 250 200 percent of the
452	federal poverty level must not exceed 25 10 percent of total
453	enrollees in the Medikids program.
454	(b)(c)  The board of directors of the Florida Healthy Kids
455	Corporation is authorized to place limits on enrollment of these
456	children in order to avoid adverse selection. In addition, the
457	board is authorized to offer a reduced benefit package to these
458	children in order to limit program costs for such families. The
459	number of children participating in the Florida Healthy Kids
460	program whose family income exceeds 250 200 percent of the
461	federal poverty level must not exceed 25 10 percent of total
462	enrollees in the Florida Healthy Kids program.
463	(c)  Except for families who are enrolled in the program on
464	July 1, 2008, or who are in transition from coverage in a
465	subsidized Kidcare program, a family whose income exceeds 250
466	percent of the federal poverty level must have been uninsured
467	for 6 consecutive months prior to enrollment in the program.
468	(8)(6)  Once a child is enrolled in the Florida Kidcare
469	program, the child is eligible for coverage under the program
470	for 12 months without a redetermination or reverification of
471	eligibility, if the family continues to pay the applicable
472	premium. Eligibility for Florida Kidcare coverage program
473	components funded through Title XXI of the Social Security Act
474	shall terminate when a child attains the age of 19. Effective
475	January 1, 1999, A child who has not attained the age of 19 5
476	and who has been determined eligible for the Medicaid program is
477	eligible for coverage for 12 months without a redetermination or
478	reverification of eligibility.
479	(9)(7)  When determining or reviewing a child's eligibility
480	under the Florida Kidcare program, the applicant shall be
481	provided with reasonable notice of changes in eligibility which
482	may affect enrollment in one or more of the program components.
483	When a transition from one program component to another is
484	authorized, there shall be cooperation between the program
485	components, and the affected family, the child's health plan,
486	and MediPass providers that which promotes continuity of health
487	care coverage. When a child is no longer eligible for Florida
488	Kidcare coverage funded through Title XIX or Title XXI of the
489	Social Security Act, the child's health plan and other MediPass
490	providers shall be notified so that the health plans and
491	providers may assist the family in obtaining coverage through
492	other available health care providers. Any authorized transfers
493	must be managed within the program's overall appropriated or
494	authorized levels of funding. Each component of the program
495	shall establish a reserve to ensure that transfers between
496	components will be accomplished within current year
497	appropriations. These reserves shall be reviewed by each
498	convening of the Social Services Estimating Conference to
499	determine the adequacy of such reserves to meet actual
500	experience.
501	(10)(8)  In determining the eligibility of a child, an
502	assets test is not required. Each applicant shall provide
503	written documentation During the application process and the
504	redetermination process, including, but not limited to, the
505	following:
506	(a)  Each applicant's Proof of family income shall be
507	verified electronically to determine financial eligibility for
508	the Florida Kidcare program. Written documentation, which may
509	must include wages and earnings statements (pay stubs), W-2
510	forms, or a copy of the applicant's most recent federal income
511	tax return, shall be required only if the electronic
512	verification is not available or does not substantiate the
513	applicant's income. In the absence of a federal income tax
514	return, an applicant may submit wages and earnings statements
515	(pay stubs), W-2 forms, or other appropriate documents.
516	(b)  Each applicant shall provide a statement from all
517	applicable, employed family members that:
518	1.  Their employers do employer does not sponsor a health
519	benefit plans plan for employees; or
520	2.  The potential enrollee is not covered by an the
521	employer-sponsored health benefit plan because the potential
522	enrollee is not eligible for coverage, or, if the potential
523	enrollee is eligible but not covered, a statement of the cost to
524	enroll the potential enrollee in the employer-sponsored health
525	benefit plan. If the cost of the employer-sponsored health
526	benefit plan is greater than 5 percent of the family's income
527	and the potential enrollee is otherwise eligible for premium
528	assistance, he or she may be enrolled in the appropriate Florida
529	Kidcare program component.
530	(11)(9)  Subject to paragraph (5)(b) (4)(b) and s.
531	624.91(4), the Florida Kidcare program shall withhold benefits
532	from an enrollee if the program obtains evidence that the
533	enrollee is no longer eligible, submitted incorrect or
534	fraudulent information in order to establish eligibility, or
535	failed to provide verification of eligibility. The applicant or
536	enrollee shall be notified that because of such evidence,
537	program benefits will be withheld unless the applicant or
538	enrollee contacts a designated representative of the program by
539	a specified date, which must be within 10 working days after the
540	date of notice, to discuss and resolve the matter. The program
541	shall make every effort to resolve the matter within a timeframe
542	that will not cause benefits to be withheld from an eligible
543	enrollee.
544	(12)(10)  The following individuals may be subject to
545	prosecution in accordance with s. 414.39:
546	(a)  An applicant obtaining or attempting to obtain
547	benefits for a potential enrollee under the Florida Kidcare
548	program when the applicant knows or should have known the
549	potential enrollee does not qualify for the Florida Kidcare
550	program.
551	(b)  An individual who assists an applicant in obtaining or
552	attempting to obtain benefits for a potential enrollee under the
553	Florida Kidcare program when the individual knows or should have
554	known the potential enrollee does not qualify for the Florida
555	Kidcare program.
556	Section 8.  Subsection (2) of section 409.815, Florida
557	Statutes, is amended to read:
558	409.815  Health benefits coverage; limitations.--
559	(2)  BENCHMARK BENEFITS.--In order for health benefits
560	coverage to qualify for premium assistance payments for an
561	eligible child under ss. 409.810-409.821 409.810-409.820, the
562	health benefits coverage, except for coverage under Medicaid and
563	Medikids, must include the following minimum benefits, as
564	medically necessary.
565	(a)  Preventive health services.--Covered services include:
566	1.  Well-child care, including services recommended in the
567	Guidelines for Health Supervision of Children and Youth as
568	developed by the American Academy of Pediatrics;
569	2.  Immunizations and injections;
570	3.  Health education counseling and clinical services;
571	4.  Vision screening; and
572	5.  Hearing screening.
573	(b)  Inpatient hospital services.--All covered services
574	provided for the medical care and treatment of an enrollee who
575	is admitted as an inpatient to a hospital licensed under part I
576	of chapter 395, with the following exceptions:
577	1.  All admissions must be authorized by the enrollee's
578	health benefits coverage provider.
579	2.  The length of the patient stay shall be determined
580	based on the medical condition of the enrollee in relation to
581	the necessary and appropriate level of care.
582	3.  Room and board may be limited to semiprivate
583	accommodations, unless a private room is considered medically
584	necessary or semiprivate accommodations are not available.
585	4.  Admissions for rehabilitation and physical therapy are
586	limited to 15 days per contract year.
587	(c)  Emergency services.--Covered services include visits
588	to an emergency room or other licensed facility if needed
589	immediately due to an injury or illness and delay means risk of
590	permanent damage to the enrollee's health. Health maintenance
591	organizations shall comply with the provisions of s. 641.513.
592	(d)  Maternity services.--Covered services include
593	maternity and newborn care, including prenatal and postnatal
594	care, with the following limitations:
595	1.  Coverage may be limited to the fee for vaginal
596	deliveries, unless another method of delivery is determined to
597	be medically necessary or better for the health of the mother or
598	the child; and
599	2.  Initial inpatient care for newborn infants of enrolled
600	adolescents shall be covered, including normal newborn care,
601	nursery charges, and the initial pediatric or neonatal
602	examination, and the infant may be covered for up to 3 days
603	following birth.
604	(e)  Organ transplantation services.--Covered services
605	include pretransplant, transplant, and postdischarge services
606	and treatment of complications after transplantation for
607	transplants deemed necessary and appropriate within the
608	guidelines set by the Organ Transplant Advisory Council under s.
609	765.53 or the Bone Marrow Transplant Advisory Panel under s.
610	627.4236.
611	(f)  Outpatient services.--Covered services include
612	preventive, diagnostic, therapeutic, palliative care, and other
613	services provided to an enrollee in the outpatient portion of a
614	health facility licensed under chapter 395, except for the
615	following limitations:
616	1.  Services must be authorized by the enrollee's health
617	benefits coverage provider; and
618	2.  Treatment for temporomandibular joint disease (TMJ) is
619	specifically excluded.
620	(g)  Behavioral health services.--
621	1.  Mental health benefits include:
622	a.  Inpatient services, limited to not more than 30
623	inpatient days per contract year for psychiatric admissions, or
624	residential services in facilities licensed under s. 394.875(6)
625	or s. 395.003 in lieu of inpatient psychiatric admissions;
626	however, a minimum of 10 of the 30 days shall be available only
627	for inpatient psychiatric services when authorized by a
628	physician; and
629	b.  Outpatient services, including outpatient visits for
630	psychological or psychiatric evaluation, diagnosis, and
631	treatment by a licensed mental health professional, limited to a
632	maximum of 40 outpatient visits each contract year.
633	2.  Substance abuse services include:
634	a.  Inpatient services, limited to not more than 7
635	inpatient days per contract year for medical detoxification only
636	and 30 days of residential services; and
637	b.  Outpatient services, including evaluation, diagnosis,
638	and treatment by a licensed practitioner, limited to a maximum
639	of 40 outpatient visits per contract year.
640	(h)  Durable medical equipment.--Covered services include
641	equipment and devices that are medically indicated to assist in
642	the treatment of a medical condition and specifically prescribed
643	as medically necessary, with the following limitations:
644	1.  Low-vision and telescopic aides are not included.
645	2.  Corrective lenses and frames may be limited to one pair
646	every 2 years, unless the prescription or head size of the
647	enrollee changes.
648	3.  Hearing aids shall be covered only when medically
649	indicated to assist in the treatment of a medical condition.
650	4.  Covered prosthetic devices include artificial eyes and
651	limbs, braces, and other artificial aids.
652	(i)  Health practitioner services.--Covered services
653	include services and procedures rendered to an enrollee when
654	performed to diagnose and treat diseases, injuries, or other
655	conditions, including care rendered by health practitioners
656	acting within the scope of their practice, with the following
657	exceptions:
658	1.  Chiropractic services shall be provided in the same
659	manner as in the Florida Medicaid program.
660	2.  Podiatric services may be limited to one visit per day
661	totaling two visits per month for specific foot disorders.
662	(j)  Home health services.--Covered services include
663	prescribed home visits by both registered and licensed practical
664	nurses to provide skilled nursing services on a part-time
665	intermittent basis, subject to the following limitations:
666	1.  Coverage may be limited to include skilled nursing
667	services only;
668	2.  Meals, housekeeping, and personal comfort items may be
669	excluded; and
670	3.  Private duty nursing is limited to circumstances where
671	such care is medically necessary.
672	(k)  Hospice services.--Covered services include reasonable
673	and necessary services for palliation or management of an
674	enrollee's terminal illness, with the following exceptions:
675	1.  Once a family elects to receive hospice care for an
676	enrollee, other services that treat the terminal condition will
677	not be covered; and
678	2.  Services required for conditions totally unrelated to
679	the terminal condition are covered to the extent that the
680	services are included in this section.
681	(l)  Laboratory and X-ray services.--Covered services
682	include diagnostic testing, including clinical radiologic,
683	laboratory, and other diagnostic tests.
684	(m)  Nursing facility services.--Covered services include
685	regular nursing services, rehabilitation services, drugs and
686	biologicals, medical supplies, and the use of appliances and
687	equipment furnished by the facility, with the following
688	limitations:
689	1.  All admissions must be authorized by the health
690	benefits coverage provider.
691	2.  The length of the patient stay shall be determined
692	based on the medical condition of the enrollee in relation to
693	the necessary and appropriate level of care, but is limited to
694	not more than 100 days per contract year.
695	3.  Room and board may be limited to semiprivate
696	accommodations, unless a private room is considered medically
697	necessary or semiprivate accommodations are not available.
698	4.  Specialized treatment centers and independent kidney
699	disease treatment centers are excluded.
700	5.  Private duty nurses, television, and custodial care are
701	excluded.
702	6.  Admissions for rehabilitation and physical therapy are
703	limited to 15 days per contract year.
704	(n)  Prescribed drugs.--
705	1.  Coverage shall include drugs prescribed for the
706	treatment of illness or injury when prescribed by a licensed
707	health practitioner acting within the scope of his or her
708	practice.
709	2.  Prescribed drugs may be limited to generics if
710	available and brand name products if a generic substitution is
711	not available, unless the prescribing licensed health
712	practitioner indicates that a brand name is medically necessary.
713	3.  Prescribed drugs covered under this section shall
714	include all prescribed drugs covered under the Florida Medicaid
715	program.
716	(o)  Therapy services.--Covered services include
717	rehabilitative services, including occupational, physical,
718	respiratory, and speech therapies, with the following
719	limitations:
720	1.  Services must be for short-term rehabilitation where
721	significant improvement in the enrollee's condition will result;
722	and
723	2.  Services shall be limited to not more than 24 treatment
724	sessions within a 60-day period per episode or injury, with the
725	60-day period beginning with the first treatment.
726	(p)  Transportation services.--Covered services include
727	emergency transportation required in response to an emergency
728	situation.
729	(q)  Dental services.--Dental services shall be covered and
730	may include those dental benefits provided to children by the
731	Florida Medicaid program under s. 409.906(6).
732	(r)  Lifetime maximum.--Health benefits coverage obtained
733	under ss. 409.810-409.821 409.810-409.820 shall pay an
734	enrollee's covered expenses at a lifetime maximum of $1 million
735	per covered child.
736	(s)  Cost-sharing.--Cost-sharing provisions must comply
737	with s. 409.816.
738	(t)  Exclusions.--
739	1.  Experimental or investigational procedures that have
740	not been clinically proven by reliable evidence are excluded;
741	2.  Services performed for cosmetic purposes only or for
742	the convenience of the enrollee are excluded; and
743	3.  Abortion may be covered only if necessary to save the
744	life of the mother or if the pregnancy is the result of an act
745	of rape or incest.
746	(u)  Enhancements to minimum requirements.--
747	1.  This section sets the minimum benefits that must be
748	included in any health benefits coverage, other than Medicaid or
749	Medikids coverage, offered under ss. 409.810-409.821 409.810-
750	409.820. Health benefits coverage may include additional
751	benefits not included under this subsection, but may not include
752	benefits excluded under paragraph (s).
753	2.  Health benefits coverage may extend any limitations
754	beyond the minimum benefits described in this section.
755
756	Except for Florida Kidcare Plus benefits the Children's Medical
757	Services Network, the agency may not increase the premium
758	assistance payment for either additional benefits provided
759	beyond the minimum benefits described in this section or the
760	imposition of less restrictive service limitations.
761	(v)  Applicability of other state laws.--Health insurers,
762	health maintenance organizations, and their agents are subject
763	to the provisions of the Florida Insurance Code, except for any
764	such provisions waived in this section.
765	1.  Except as expressly provided in this section, a law
766	requiring coverage for a specific health care service or
767	benefit, or a law requiring reimbursement, utilization, or
768	consideration of a specific category of licensed health care
769	practitioner, does not apply to a health insurance plan policy
770	or contract offered or delivered under ss. 409.810-409.821
771	409.810-409.820 unless that law is made expressly applicable to
772	such policies or contracts.
773	2.  Notwithstanding chapter 641, a health maintenance
774	organization may issue contracts providing benefits equal to,
775	exceeding, or actuarially equivalent to the benchmark benefit
776	plan authorized by this section and may pay providers located in
777	a rural county negotiated fees or Medicaid reimbursement rates
778	for services provided to enrollees who are residents of the
779	rural county.
780	Section 9.  Subsections (1) and (3) of section 409.816,
781	Florida Statutes, are amended to read:
782	409.816  Limitations on premiums and cost-sharing.--The
783	following limitations on premiums and cost-sharing are
784	established for the program.
785	(1)  Enrollees who receive coverage under Title XIX of the
786	Social Security Act the Medicaid program may not be required to
787	pay:
788	(a)  Enrollment fees, premiums, or similar charges; or
789	(b)  Copayments, deductibles, coinsurance, or similar
790	charges.
791	(3)  Enrollees in families with a family income above 150
792	percent of the federal poverty level, who are not receiving
793	coverage under the Medicaid program or who are not eligible
794	under s. 409.814(7)(5), may be required to pay enrollment fees,
795	premiums, copayments, deductibles, coinsurance, or similar
796	charges on a sliding scale related to income, except that the
797	total annual aggregate cost-sharing with respect to all children
798	in a family may not exceed 5 percent of the family's income.
799	However, copayments, deductibles, coinsurance, or similar
800	charges may not be imposed for preventive services, including
801	well-baby and well-child care, age-appropriate immunizations,
802	and routine hearing and vision screenings.
803	Section 10.  Section 409.817, Florida Statutes, is amended
804	to read:
805	409.817  Approval of health benefits coverage; financial
806	assistance.--In order for health insurance coverage to qualify
807	for premium assistance payments for an eligible child under ss.
808	409.810-409.821 409.810-409.820, the health benefits coverage
809	must:
810	(1)  Be certified by the Office of Insurance Regulation of
811	the Financial Services Commission under s. 409.818 as meeting,
812	exceeding, or being actuarially equivalent to the benchmark
813	benefit plan;
814	(2)  Be guarantee issued;
815	(3)  Be community rated;
816	(4)  Not impose any preexisting condition exclusion for
817	covered benefits; however, group health insurance plans may
818	permit the imposition of a preexisting condition exclusion, but
819	only insofar as it is permitted under s. 627.6561;
820	(5)  Comply with the applicable limitations on premiums and
821	cost-sharing in s. 409.816;
822	(6)  Comply with the quality assurance and access standards
823	developed under s. 409.820; and
824	(7)  Establish periodic open enrollment periods, which may
825	not occur more frequently than quarterly.
826	Section 11.  Paragraph (i) of subsection (1) of section
827	409.8177, Florida Statutes, is amended to read:
828	409.8177  Program evaluation.--
829	(1)  The agency, in consultation with the Department of
830	Health, the Department of Children and Family Services, and the
831	Florida Healthy Kids Corporation, shall contract for an
832	evaluation of the Florida Kidcare program and shall by January 1
833	of each year submit to the Governor, the President of the
834	Senate, and the Speaker of the House of Representatives a report
835	of the program. In addition to the items specified under s. 2108
836	of Title XXI of the Social Security Act, the report shall
837	include an assessment of crowd-out and access to health care, as
838	well as the following:
839	(i)  An assessment of the effectiveness of the Florida
840	Kidcare program Medikids, Children's Medical Services network,
841	and other public and private programs in the state in increasing
842	the availability of affordable quality health insurance and
843	health care for children.
844	Section 12.  Section 409.818, Florida Statutes, is amended
845	to read:
846	409.818  Administration.--In order to implement ss.
847	409.810-409.821 409.810-409.820, the following agencies shall
848	have the following duties:
849	(1)  The Department of Children and Family Services shall:
850	(a)  Develop a simplified eligibility application mail-in
851	form to be used for determining the eligibility of children for
852	coverage under the Florida Kidcare program, in consultation with
853	the agency, the Department of Health, and the Florida Healthy
854	Kids Corporation. The simplified eligibility application form
855	must include an item that provides an opportunity for the
856	applicant to indicate whether coverage is being sought for a
857	child with special health care needs. Families applying for
858	children's Medicaid coverage must also be able to use the
859	simplified application form without having to pay a premium.
860	(b)  Establish and maintain the eligibility determination
861	process under the program except as specified in subsection (5).
862	The department shall directly, or through the services of a
863	contracted third-party administrator, establish and maintain a
864	process for determining eligibility of children for coverage
865	under the program. The eligibility determination process must be
866	used solely for determining eligibility of applicants for health
867	benefits coverage under the program and. The eligibility
868	determination process must include an initial determination of
869	eligibility for any coverage offered under the program, as well
870	as a redetermination or reverification of eligibility each
871	subsequent 6 months. Effective July 1, 2008 January 1, 1999, a
872	child who has not attained the age of 19 5 and who has been
873	determined eligible for the Medicaid program is eligible for
874	coverage for 12 months without a redetermination or
875	reverification of eligibility. In conducting an eligibility
876	determination, the department shall determine if the child has
877	special health care needs. The department, in consultation with
878	the Agency for Health Care Administration and the Florida
879	Healthy Kids Corporation, shall develop procedures for
880	redetermining eligibility which enable a family to easily update
881	any change in circumstances which could affect eligibility. The
882	department may accept changes in a family's status as reported
883	to the department by the Florida Healthy Kids Corporation
884	without requiring a new application from the family.
885	Redetermination of a child's eligibility for Medicaid may not be
886	linked to a child's eligibility determination for other
887	programs.
888	(c)  Inform program applicants about eligibility
889	determinations and provide information about eligibility of
890	applicants to Medicaid, Medikids, the Children's Medical
891	Services Network, and the Florida Kidcare program Healthy Kids
892	Corporation, and to insurers and their agents, through a
893	centralized coordinating office.
894	(d)  Adopt rules necessary for conducting program
895	eligibility functions.
896	(2)  The Department of Health shall:
897	(a)  Design an eligibility intake process for the program,
898	in coordination with the Department of Children and Family
899	Services, the agency, and the Florida Healthy Kids Corporation.
900	The eligibility intake process may include local intake points
901	that are determined by the Department of Health in coordination
902	with the Department of Children and Family Services.
903	(b)  Chair a state-level Florida Kidcare coordinating
904	council to review and make recommendations concerning the
905	implementation and operation of the program. The coordinating
906	council shall include representatives from the department, the
907	Department of Children and Family Services, the agency, the
908	Florida Healthy Kids Corporation, the Office of Insurance
909	Regulation of the Financial Services Commission, local
910	government, health insurers, health maintenance organizations,
911	health care providers, families participating in the program,
912	and organizations representing low-income families.
913	(c)  In consultation with the Florida Healthy Kids
914	Corporation and the Department of Children and Family Services,
915	establish a toll-free telephone line to assist families with
916	questions about the program.
917	(c)(d)  In consultation with the Florida Kidcare
918	coordinating council, adopt rules and policies necessary to
919	implement Florida Kidcare program outreach activities.
920	(3)  The Agency for Health Care Administration, under the
921	authority granted in s. 409.914(1), shall:
922	(a)  Calculate the premium assistance payment necessary to
923	comply with the premium and cost-sharing limitations specified
924	in s. 409.816. The premium assistance payment for each enrollee
925	in a health insurance plan participating in the Florida Healthy
926	Kids Corporation shall equal the premium approved by the Florida
927	Healthy Kids Corporation and the Office of Insurance Regulation
928	of the Financial Services Commission pursuant to ss. 627.410 and
929	641.31, less any enrollee's share of the premium established
930	within the limitations specified in s. 409.816. The premium
931	assistance payment for each enrollee in an employer-sponsored
932	health insurance plan approved under ss. 409.810-409.821
933	409.810-409.820 shall equal the premium for the plan adjusted
934	for any benchmark benefit plan actuarial equivalent benefit
935	rider approved by the Office of Insurance Regulation pursuant to
936	ss. 627.410 and 641.31, less any enrollee's share of the premium
937	established within the limitations specified in s. 409.816. In
938	calculating the premium assistance payment levels for children
939	with family coverage, the agency shall set the premium
940	assistance payment levels for each child proportionately to the
941	total cost of family coverage.
942	(b)  Make premium assistance payments to health insurance
943	plans on a periodic basis. The agency may use its Medicaid
944	fiscal agent or a contracted third-party administrator in making
945	these payments. The agency may require health insurance plans
946	that participate in the Medikids program or employer-sponsored
947	group health insurance to collect premium payments from an
948	enrollee's family. Participating health insurance plans shall
949	report premium payments collected on behalf of enrollees in the
950	program to the agency in accordance with a schedule established
951	by the agency.
952	(c)  Monitor compliance with quality assurance and access
953	standards developed under s. 409.820.
954	(d)  Establish a mechanism for investigating and resolving
955	complaints and grievances from program applicants, enrollees,
956	and health benefits coverage providers, and maintain a record of
957	complaints and confirmed problems. In the case of a child who is
958	enrolled in a health maintenance organization, the agency must
959	use the provisions of s. 641.511 to address grievance reporting
960	and resolution requirements.
961	(e)  Approve health benefits coverage for participation in
962	the program, following certification by the Office of Insurance
963	Regulation under subsection (4).
964	(f)  Adopt rules necessary for calculating premium
965	assistance payment levels, making premium assistance payments,
966	monitoring access and quality assurance standards, investigating
967	and resolving complaints and grievances, administering the
968	Medikids program, and approving health benefits coverage.
969
970	The agency is designated the lead state agency for Title XXI of
971	the Social Security Act for purposes of receipt of federal
972	funds, for reporting purposes, and for ensuring compliance with
973	federal and state regulations and rules.
974	(4)  The Office of Insurance Regulation shall certify that
975	health benefits coverage plans that seek to provide services
976	under the Florida Kidcare program, except those offered through
977	the Florida Healthy Kids Corporation or the Children's Medical
978	Services network, meet, exceed, or are actuarially equivalent to
979	the benchmark benefit plan and that health insurance plans will
980	be offered at an approved rate. In determining actuarial
981	equivalence of benefits coverage, the Office of Insurance
982	Regulation and health insurance plans must comply with the
983	requirements of s. 2103 of Title XXI of the Social Security Act.
984	The department shall adopt rules necessary for certifying health
985	benefits coverage plans.
986	(5)  The Florida Healthy Kids Corporation shall retain its
987	functions as authorized in s. 624.91, including eligibility
988	determination for participation in the Healthy Kids program.
989	(6)  The agency, the Department of Health, the Department
990	of Children and Family Services, the Florida Healthy Kids
991	Corporation, and the Office of Insurance Regulation, after
992	consultation with and approval of the Speaker of the House of
993	Representatives and the President of the Senate, are authorized
994	to make program modifications that are necessary to overcome any
995	objections of the United States Department of Health and Human
996	Services to obtain approval of the state's child health
997	insurance plan under Title XXI of the Social Security Act.
998	Section 13.  Section 409.821, Florida Statutes, is amended
999	to read:
1000	409.821  Florida Kidcare program public records
1001	exemption.--Notwithstanding any other law to the contrary, any
1002	information identifying a Florida Kidcare program applicant or
1003	enrollee, as defined in s. 409.811, held by the Agency for
1004	Health Care Administration, the Department of Children and
1005	Family Services, the Department of Health, or the Florida
1006	Healthy Kids Corporation is confidential and exempt from s.
1007	119.07(1) and s. 24(a), Art. I of the State Constitution. Such
1008	information may be disclosed to another governmental entity only
1009	if disclosure is necessary for the entity to perform its duties
1010	and responsibilities under the Florida Kidcare program and shall
1011	be disclosed to the Department of Revenue for purposes of
1012	administering the state Title IV-D program. The receiving
1013	governmental entity must maintain the confidential and exempt
1014	status of such information. Furthermore, such information may
1015	not be released to any person without the written consent of the
1016	program applicant. This exemption applies to any information
1017	identifying a Florida Kidcare program applicant or enrollee held
1018	by the Agency for Health Care Administration, the Department of
1019	Children and Family Services, the Department of Health, or the
1020	Florida Healthy Kids Corporation before, on, or after the
1021	effective date of this exemption. A violation of this section is
1022	a misdemeanor of the second degree, punishable as provided in s.
1023	775.082 or s. 775.083. This section does not prohibit an
1024	enrollee's parent or legal guardian from obtaining any record
1025	relating to the enrollee's Florida Kidcare program application
1026	or coverage, including, but not limited to, confirmation of
1027	coverage, the dates of coverage, the name of the enrollee's
1028	health plan, and the amount of premium.
1029	Section 14.  Subsection (6) of section 409.904, Florida
1030	Statutes, is amended to read:
1031	409.904  Optional payments for eligible persons.--The
1032	agency may make payments for medical assistance and related
1033	services on behalf of the following persons who are determined
1034	to be eligible subject to the income, assets, and categorical
1035	eligibility tests set forth in federal and state law. Payment on
1036	behalf of these Medicaid eligible persons is subject to the
1037	availability of moneys and any limitations established by the
1038	General Appropriations Act or chapter 216.
1039	(6)  A child who has not attained the age of 19 who has
1040	been determined eligible for the Medicaid program is deemed to
1041	be eligible for a total of 12 6 months, regardless of changes in
1042	circumstances other than attainment of the maximum age.
1043	Effective January 1, 1999, a child who has not attained the age
1044	of 5 and who has been determined eligible for the Medicaid
1045	program is deemed to be eligible for a total of 12 months
1046	regardless of changes in circumstances other than attainment of
1047	the maximum age.
1048	Section 15.  Subsection (5) of section 624.91, Florida
1049	Statutes, is amended to read:
1050	624.91  The Florida Healthy Kids Corporation Act.--
1051	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1052	(a)  There is created the Florida Healthy Kids Corporation,
1053	a not-for-profit corporation.
1054	(b)  The Florida Healthy Kids Corporation shall:
1055	1.  Arrange for the collection of any family, local
1056	contributions, or employer payment or premium, in an amount to
1057	be determined by the board of directors, to provide for payment
1058	of premiums for comprehensive insurance coverage and for the
1059	actual or estimated administrative expenses.
1060	2.  Arrange for the collection of any voluntary
1061	contributions to provide for payment of Florida Kidcare program
1062	premiums for children who are not eligible for medical
1063	assistance under Title XIX or Title XXI of the Social Security
1064	Act.
1065	3.  Subject to the provisions of s. 409.8134, accept
1066	voluntary supplemental local match contributions that comply
1067	with the requirements of Title XXI of the Social Security Act
1068	for the purpose of providing additional Florida Kidcare coverage
1069	in contributing counties under Title XXI.
1070	4.  Establish the administrative and accounting procedures
1071	for the operation of the corporation.
1072	5.  Establish, with consultation from appropriate
1073	professional organizations, standards for preventive health
1074	services and providers and comprehensive insurance benefits
1075	appropriate to children, provided that such standards for rural
1076	areas shall not limit primary care providers to board-certified
1077	pediatricians.
1078	6.  Determine eligibility for children seeking to
1079	participate in the Title XXI-funded components of the Florida
1080	Kidcare program consistent with the requirements specified in s.
1081	409.814, as well as the non-Title-XXI-eligible children as
1082	provided in subsection (3).
1083	7.  Establish procedures under which providers of local
1084	match to, applicants to and participants in the program may have
1085	grievances reviewed by an impartial body and reported to the
1086	board of directors of the corporation.
1087	8.  Establish participation criteria and, if appropriate,
1088	contract with an authorized insurer, health maintenance
1089	organization, or third-party administrator to provide
1090	administrative services to the corporation.
1091	9.  Establish enrollment criteria that which shall include
1092	penalties or waiting periods of 30 not fewer than 60 days for
1093	reinstatement of coverage upon voluntary cancellation for
1094	nonpayment of family premiums.
1095	10.  Contract with authorized insurers or any provider of
1096	health care services, meeting standards established by the
1097	corporation, for the provision of comprehensive insurance
1098	coverage to participants. Such standards shall include criteria
1099	under which the corporation may contract with more than one
1100	provider of health care services in program sites. Health plans
1101	shall be selected through a competitive bid process. The Florida
1102	Healthy Kids Corporation shall purchase goods and services in
1103	the most cost-effective manner consistent with the delivery of
1104	quality medical care. The maximum administrative cost for a
1105	Florida Healthy Kids Corporation contract shall be 15 percent.
1106	For health care contracts, the minimum medical loss ratio for a
1107	Florida Healthy Kids Corporation contract shall be 85 percent.
1108	For dental contracts, the remaining compensation to be paid to
1109	the authorized insurer or provider under a Florida Healthy Kids
1110	Corporation contract shall be no less than an amount which is 85
1111	percent of premium; to the extent any contract provision does
1112	not provide for this minimum compensation, this section shall
1113	prevail. The health plan selection criteria and scoring system,
1114	and the scoring results, shall be available upon request for
1115	inspection after the bids have been awarded.
1116	11.  Establish disenrollment criteria in the event local
1117	matching funds are insufficient to cover enrollments.
1118	12.  Develop and implement a plan to publicize the Florida
1119	Healthy Kids Corporation, the eligibility requirements of the
1120	program, and the procedures for enrollment in the program and to
1121	maintain public awareness of the corporation and the program.
1122	12.13.  Secure staff necessary to properly administer the
1123	corporation. Staff costs shall be funded from state and local
1124	matching funds and such other private or public funds as become
1125	available. The board of directors shall determine the number of
1126	staff members necessary to administer the corporation.
1127	13.14.  In consultation with the Florida Kidcare
1128	coordinating council and all partner agencies, provide a report
1129	on the Florida Kidcare program annually to the Governor, Chief
1130	Financial Officer, Commissioner of Education, Senate President
1131	of the Senate, Speaker of the House of Representatives, and
1132	Minority Leaders of the Senate and the House of Representatives.
1133	14.15.  Establish benefit packages that which conform to
1134	the provisions of the Florida Kidcare program, as created in ss.
1135	409.810-409.821 409.810-409.820.
1136	(c)  Coverage under the corporation's program is secondary
1137	to any other available private coverage held by, or applicable
1138	to, the participant child or family member. Insurers under
1139	contract with the corporation are the payors of last resort and
1140	must coordinate benefits with any other third-party payor that
1141	may be liable for the participant's medical care.
1142	(d)  The Florida Healthy Kids Corporation shall be a
1143	private corporation not for profit, organized pursuant to
1144	chapter 617, and shall have all powers necessary to carry out
1145	the purposes of this act, including, but not limited to, the
1146	power to receive and accept grants, loans, or advances of funds
1147	from any public or private agency and to receive and accept from
1148	any source contributions of money, property, labor, or any other
1149	thing of value, to be held, used, and applied for the purposes
1150	of this act.
1151	Section 16.  This act shall take effect July 1, 2008.

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