HB 1457

1
A bill to be entitled
2An act relating to the Florida Kidcare program; amending
3s. 409.8132, F.S.; requiring the Agency for Health Care
4Administration to assign family members to the same
5managed care plan or the same MediPass provider under
6certain circumstances; amending s. 409.8134, F.S.;
7revising provisions relating to funding for increased
8enrollment in the Florida Kidcare program; amending s.
9409.814, F.S.; providing for continuation of Florida
10Kidcare program eligibility under certain circumstances;
11removing obsolete provisions; revising the time limit for
12eligibility of children whose coverage was voluntarily
13canceled; requiring notice to health plans and providers
14when a child is no longer eligible for certain coverage;
15providing for electronic transmission of certain
16eligibility information; amending s. 409.816, F.S.;
17conforming a cross-reference; amending s. 409.818, F.S.;
18requiring the Department of Children and Family Services
19to develop a standardized Florida Kidcare program
20eligibility application form by a specified date; revising
21the timeframe for redetermination or reverification of
22eligibility; requiring the department, in consultation
23with the Florida Healthy Kids Corporation, to design and
24submit to the Governor and Legislature a plan for a
25nonduplicative application process for coverage; deleting
26duties of the Department of Health; revising duties of the
27agency to include establishing a toll-free telephone
28number, developing marketing strategies, and requesting
29certain federal assistance to implement ss. 409.810-
30409.820, F.S.; amending s. 624.91, F.S.; revising duties
31of the Florida Healthy Kids Corporation relating to
32marketing and assigning or transferring children to
33specified managed care plans; providing an effective date.
34
35Be It Enacted by the Legislature of the State of Florida:
36
37     Section 1.  Paragraph (b) of subsection (6) and subsection
38(7) of section 409.8132, Florida Statutes, are amended to read:
39     409.8132  Medikids program component.--
40     (6)  ELIGIBILITY.--
41     (b)  The provisions of s. 409.814(3), (4), and (5), and (6)
42shall be applicable to the Medikids program.
43     (7)  ENROLLMENT.--Enrollment in the Medikids program
44component may occur at any time throughout the year. A child may
45not receive services under the Medikids program until the child
46is enrolled in a managed care plan or MediPass. Once determined
47eligible, an applicant may receive choice counseling and select
48a managed care plan or MediPass. The agency may initiate
49mandatory assignment for a Medikids applicant who has not chosen
50a managed care plan or MediPass provider after the applicant's
51voluntary choice period ends; however, the agency shall ensure
52that family members are assigned to the same managed care plan
53or the same MediPass provider to the greatest extent possible,
54including in those situations in which some family members are
55enrolled in Medicaid and other family members are enrolled in a
56Title XXI-funded component of the Florida Kidcare program. An
57applicant may select MediPass under the Medikids program
58component only in counties that have fewer than two managed care
59plans available to serve Medicaid recipients and only if the
60federal Health Care Financing Administration determines that
61MediPass constitutes "health insurance coverage" as defined in
62Title XXI of the Social Security Act.
63     Section 2.  Subsection (2) of section 409.8134, Florida
64Statutes, is amended to read:
65     409.8134  Program expenditure ceiling.--
66     (2)  The Florida Kidcare program may conduct enrollment at
67any time throughout the year for the purpose of enrolling
68children eligible for all program components listed in s.
69409.813 except Medicaid. The four Florida Kidcare administrators
70shall work together to ensure that the year-round enrollment
71period is announced statewide. Eligible children shall be
72enrolled on a first-come, first-served basis using the date the
73enrollment application is received. Enrollment shall immediately
74cease when the expenditure ceiling is reached. Year-round
75enrollment shall only be held only if the Social Services
76Estimating Conference determines that sufficient federal and
77state funds will be available to finance the increased
78enrollment through federal fiscal year 2007. Any individual who
79is not enrolled must reapply by submitting a new application.
80The application for the Florida Kidcare program shall be valid
81for a period of 120 days after the date it was received. At the
82end of the 120-day period, if the applicant has not been
83enrolled in the program, the application shall be invalid and
84the applicant shall be notified of the action. The applicant may
85reactivate resubmit the application after notification of the
86action taken by the program. Except for the Medicaid program,
87whenever the Social Services Estimating Conference determines
88that there are presently, or will be by the end of the current
89fiscal year, insufficient funds to finance the current or
90projected enrollment in the Florida Kidcare program, all
91additional enrollment must cease and additional enrollment may
92not resume until sufficient funds are available to finance such
93enrollment.
94     Section 3.  Section 409.814, Florida Statutes, is amended
95to read:
96     409.814  Eligibility.--A child who has not reached 19 years
97of age and whose family income is equal to or below 200 percent
98of the federal poverty level is eligible for the Florida Kidcare
99program as provided in this section. For enrollment in the
100Children's Medical Services Network, a complete application
101includes the medical or behavioral health screening. If,
102subsequently, an individual is determined to be ineligible for
103coverage, he or she must immediately be disenrolled from the
104respective Florida Kidcare program component.
105     (1)  A child who is eligible for Medicaid coverage under s.
106409.903 or s. 409.904 must be enrolled in Medicaid and is not
107eligible to receive health benefits under any other health
108benefits coverage authorized under the Florida Kidcare program.
109     (2)  A child who is not eligible for Medicaid, but who is
110eligible for the Florida Kidcare program, may obtain health
111benefits coverage under any of the other components listed in s.
112409.813 if such coverage is approved and available in the county
113in which the child resides. However, a child who is eligible for
114Medikids may participate in the Florida Healthy Kids program
115only if the child has a sibling participating in the Florida
116Healthy Kids program and the child's county of residence permits
117such enrollment.
118     (3)  A child who is eligible for the Florida Kidcare
119program who is a child with special health care needs, as
120determined through a medical or behavioral screening instrument,
121is eligible for health benefits coverage from and shall be
122referred to the Children's Medical Services Network.
123     (4)  A child who becomes ineligible for Title XIX-funded
124Florida Kidcare program coverage due to exceeding income or age
125limitations shall be presumed eligible for coverage under the
126Title XXI-funded component of the Florida Kidcare program and
127shall have 60 days of continued eligibility within his or her
128existing plan or coverage following redetermination in order to
129allow for a transition to coverage under the Title XXI-funded
130component of the Florida Kidcare program without a lapse in
131coverage. The agency is authorized to seek a Medicaid state plan
132amendment or federal waiver approval under Title XIX or Title
133XXI for such continued eligibility with the goal of securing
134federal matching funds in accordance with the federal State
135Children's Health Insurance Program (SCHIP) matching rate for
136the additional 60 days of eligibility.
137     (5)(4)  The following children are not eligible to receive
138premium assistance for health benefits coverage under the
139Florida Kidcare program, except under Medicaid if the child
140would have been eligible for Medicaid under s. 409.903 or s.
141409.904 as of June 1, 1997:
142     (a)  A child who is eligible for coverage under a state
143health benefit plan on the basis of a family member's employment
144with a public agency in the state.
145     (b)  A child who is currently eligible for or covered under
146a family member's group health benefit plan or under other
147employer health insurance coverage, excluding coverage provided
148under the Florida Healthy Kids Corporation as established under
149s. 624.91, provided that the cost of the child's participation
150is not greater than 5 percent of the family's income. This
151provision shall be applied during redetermination for children
152who were enrolled prior to July 1, 2004. These enrollees shall
153have 6 months of eligibility following redetermination to allow
154for a transition to the other health benefit plan.
155     (c)  A child who is seeking premium assistance for the
156Florida Kidcare program through employer-sponsored group
157coverage, if the child has been covered by the same employer's
158group coverage during the 6 months prior to the family's
159submitting an application for determination of eligibility under
160the program.
161     (d)  A child who is an alien, but who does not meet the
162definition of qualified alien, in the United States.
163     (e)  A child who is an inmate of a public institution or a
164patient in an institution for mental diseases.
165     (f)  A child who has had his or her coverage in an
166employer-sponsored health benefit plan voluntarily canceled in
167the last 90 days 6 months, except those children who were on the
168waiting list prior to March 12, 2004.
169     (g)  A child who is otherwise eligible for Kidcare and who
170has a preexisting condition that prevents coverage under another
171insurance plan as described in paragraph (b) which would have
172disqualified the child for Kidcare if the child were able to
173enroll in the plan shall be eligible for Kidcare program
174coverage when enrollment is possible.
175     (6)(5)  A child whose family income is above 200 percent of
176the federal poverty level or a child who is excluded under the
177provisions of subsection (5) (4) may participate in the Medikids
178program as provided in s. 409.8132 or, if the child is
179ineligible for Medikids by reason of age, in the Florida Healthy
180Kids program, subject to the following provisions:
181     (a)  The family is not eligible for premium assistance
182payments and must pay the full cost of the premium, including
183any administrative costs.
184     (b)  The agency is authorized to place limits on enrollment
185in Medikids by these children in order to avoid adverse
186selection. The number of children participating in Medikids
187whose family income exceeds 200 percent of the federal poverty
188level must not exceed 10 percent of total enrollees in the
189Medikids program.
190     (c)  The board of directors of the Florida Healthy Kids
191Corporation is authorized to place limits on enrollment of these
192children in order to avoid adverse selection. In addition, the
193board is authorized to offer a reduced benefit package to these
194children in order to limit program costs for such families. The
195number of children participating in the Florida Healthy Kids
196program whose family income exceeds 200 percent of the federal
197poverty level must not exceed 10 percent of total enrollees in
198the Florida Healthy Kids program.
199     (7)(6)  Once a child is enrolled in the Florida Kidcare
200program, the child is eligible for coverage under the program
201for 12 months without a redetermination or reverification of
202eligibility, if the family continues to pay the applicable
203premium. Eligibility for program components funded through Title
204XXI of the Social Security Act shall terminate when a child
205attains the age of 19. Effective January 1, 1999, a child who
206has not attained the age of 5 and who has been determined
207eligible for the Medicaid program is eligible for coverage for
20812 months without a redetermination or reverification of
209eligibility.
210     (8)(7)  When determining or reviewing a child's eligibility
211under the Florida Kidcare program, the applicant shall be
212provided with reasonable notice of changes in eligibility that
213which may affect enrollment in one or more of the program
214components. When a transition from one program component to
215another is authorized, there shall be cooperation between the
216program components, and the affected family, the child's health
217insurance plan, and the child's health care providers to promote
218which promotes continuity of health care coverage. If a child is
219determined ineligible for Medicaid or Medikids, the agency, in
220coordination with the Department of Children and Family
221Services, shall notify that child's Medicaid managed care plan
222or MediPass provider of such determination no less than 60 days
223before the child's eligibility is scheduled to be terminated so
224that the Medicaid managed care plan or MediPass provider can
225assist the child's family in applying for Florida Kidcare
226program coverage. Any authorized transfers must be managed
227within the program's overall appropriated or authorized levels
228of funding. Each component of the program shall establish a
229reserve to ensure that transfers between components will be
230accomplished within current year appropriations. These reserves
231shall be reviewed by each convening of the Social Services
232Estimating Conference to determine the adequacy of such reserves
233to meet actual experience.
234     (9)(8)  In determining the eligibility of a child for the
235Florida Kidcare program, an assets test is not required. The
236information required under this section from each applicant
237shall be obtained electronically to the extent possible. If such
238information cannot be obtained electronically, the each
239applicant shall provide written documentation during the
240application process and the redetermination process, including,
241but not limited to, the following:
242     (a)  Proof of family income, which must include a copy of
243the applicant's most recent federal income tax return. In the
244absence of a federal income tax return, an applicant may submit
245wages and earnings statements (pay stubs), W-2 forms, or other
246appropriate documents.
247     (b)  A statement from each employed all family member
248members that:
249     1.  His or her Their employer does not sponsor a health
250benefit plan for employees; or
251     2.  The potential enrollee is not covered by the employer-
252sponsored health benefit plan because the potential enrollee is
253not eligible for coverage, or, if the potential enrollee is
254eligible but not covered, a statement of the cost to enroll the
255potential enrollee in the employer-sponsored health benefit
256plan.
257
258A person who applies for coverage under the Florida Kidcare
259program and who pays the full cost of the premium is exempt from
260the requirements of this subsection.
261     (10)(9)  Subject to paragraph (5)(4)(b) and s. 624.91(4),
262the Florida Kidcare program shall withhold benefits from an
263enrollee if the program obtains evidence that the enrollee is no
264longer eligible, submitted incorrect or fraudulent information
265in order to establish eligibility, or failed to provide
266verification of eligibility. The applicant or enrollee shall be
267notified that because of such evidence program benefits will be
268withheld unless the applicant or enrollee contacts a designated
269representative of the program by a specified date, which must be
270within 10 days after the date of notice, to discuss and resolve
271the matter. The program shall make every effort to resolve the
272matter within a timeframe that will not cause benefits to be
273withheld from an eligible enrollee.
274     (11)(10)  The following individuals may be subject to
275prosecution in accordance with s. 414.39:
276     (a)  An applicant obtaining or attempting to obtain
277benefits for a potential enrollee under the Florida Kidcare
278program when the applicant knows or should have known the
279potential enrollee does not qualify for the Florida Kidcare
280program.
281     (b)  An individual who assists an applicant in obtaining or
282attempting to obtain benefits for a potential enrollee under the
283Florida Kidcare program when the individual knows or should have
284known the potential enrollee does not qualify for the Florida
285Kidcare program.
286     Section 4.  Subsection (3) of section 409.816, Florida
287Statutes, is amended to read:
288     409.816  Limitations on premiums and cost-sharing.--The
289following limitations on premiums and cost-sharing are
290established for the program.
291     (3)  Enrollees in families with a family income above 150
292percent of the federal poverty level, who are not receiving
293coverage under the Medicaid program or who are not eligible
294under s. 409.814(6)(5), may be required to pay enrollment fees,
295premiums, copayments, deductibles, coinsurance, or similar
296charges on a sliding scale related to income, except that the
297total annual aggregate cost-sharing with respect to all children
298in a family may not exceed 5 percent of the family's income.
299However, copayments, deductibles, coinsurance, or similar
300charges may not be imposed for preventive services, including
301well-baby and well-child care, age-appropriate immunizations,
302and routine hearing and vision screenings.
303     Section 5.  Section 409.818, Florida Statutes, is amended
304to read:
305     409.818  Administration.--In order to implement ss.
306409.810-409.820, the following agencies shall have the following
307duties:
308     (1)  The Department of Children and Family Services shall:
309     (a)  No later than July 1, 2009, develop and implement a
310standardized simplified eligibility application mail-in form to
311be used for determining the eligibility of children for coverage
312for all components of under the Florida Kidcare program, in
313consultation with the agency, the Department of Health, and the
314Florida Healthy Kids Corporation. The standardized simplified
315eligibility application form must include an item that provides
316an opportunity for the applicant to indicate whether coverage is
317being sought for a child with special health care needs.
318Families applying for children's Medicaid coverage must also be
319able to use the standardized simplified application form without
320having to pay a premium.
321     (b)  Establish and maintain the eligibility determination
322process under the program except as specified in subsection (4)
323(5). The department shall directly, or through the services of a
324contracted third-party administrator, establish and maintain a
325process for determining eligibility of children for coverage
326under the program. The eligibility determination process must be
327used solely for determining eligibility of applicants for health
328benefits coverage under the program. The eligibility
329determination process must include an initial determination of
330eligibility for any coverage offered under the program, as well
331as a redetermination or reverification of eligibility each
332subsequent 12 6 months. Effective January 1, 1999, a child who
333has not attained the age of 5 and who has been determined
334eligible for the Medicaid program is eligible for coverage for
33512 months without a redetermination or reverification of
336eligibility. In conducting an eligibility determination, the
337department shall determine if the child has special health care
338needs. The department, in consultation with the Agency for
339Health Care Administration and the Florida Healthy Kids
340Corporation, shall develop procedures for redetermining
341eligibility which enable a family to easily update any change in
342circumstances which could affect eligibility. The department may
343accept changes in a family's status as reported to the
344department by the Florida Healthy Kids Corporation without
345requiring a new application from the family. Redetermination of
346a child's eligibility for Medicaid may not be linked to a
347child's eligibility determination for other programs.
348     (c)  Inform program applicants about eligibility
349determinations and provide information about eligibility of
350applicants to Medicaid, Medikids, the Children's Medical
351Services Network, and the Florida Healthy Kids Corporation, and
352to insurers and their agents, through a centralized coordinating
353office.
354     (d)  Design a plan, in consultation with the Florida
355Healthy Kids Corporation, that shall:
356     1.  Determine the eligibility of children for Medicaid
357coverage or other public assistance and allow an applicant who
358applies but is determined ineligible for Medicaid coverage or
359other public assistance to apply for the Florida Kidcare program
360using the same application information.
361     2.  Enable the applicant to submit all information
362necessary for enrollment in the Florida Kidcare program,
363including whether coverage is being sought for a child with
364special health care needs.
365     3.  Permit the department to forward the application
366information, together with accompanying documentation, to the
367Florida Healthy Kids Corporation and permit the application
368information and documentation to be processed for enrollment in
369the Florida Kidcare program by the Florida Healthy Kids
370Corporation in accordance with current eligibility criteria
371without requiring the applicant to submit a separate application
372for the Florida Kidcare program.
373
374The department shall submit the plan to the President of the
375Senate, the Speaker of the House of Representatives, and the
376Governor no later than December 31, 2008.
377     (e)(d)  Adopt rules necessary for conducting program
378eligibility functions.
379     (2)  The Department of Health shall:
380     (a)  Design an eligibility intake process for the program,
381in coordination with the Department of Children and Family
382Services, the agency, and the Florida Healthy Kids Corporation.
383The eligibility intake process may include local intake points
384that are determined by the Department of Health in coordination
385with the Department of Children and Family Services.
386     (b)  Chair a state-level coordinating council to review and
387make recommendations concerning the implementation and operation
388of the program. The coordinating council shall include
389representatives from the department, the Department of Children
390and Family Services, the agency, the Florida Healthy Kids
391Corporation, the Office of Insurance Regulation of the Financial
392Services Commission, local government, health insurers, health
393maintenance organizations, health care providers, families
394participating in the program, and organizations representing
395low-income families.
396     (c)  In consultation with the Florida Healthy Kids
397Corporation and the Department of Children and Family Services,
398establish a toll-free telephone line to assist families with
399questions about the program.
400     (d)  Adopt rules necessary to implement outreach
401activities.
402     (2)(3)  The Agency for Health Care Administration, under
403the authority granted in s. 409.914(1), shall:
404     (a)  Calculate the premium assistance payment necessary to
405comply with the premium and cost-sharing limitations specified
406in s. 409.816. The premium assistance payment for each enrollee
407in a health insurance plan participating in the Florida Healthy
408Kids Corporation shall equal the premium approved by the Florida
409Healthy Kids Corporation and the Office of Insurance Regulation
410of the Financial Services Commission pursuant to ss. 627.410 and
411641.31, less any enrollee's share of the premium established
412within the limitations specified in s. 409.816. The premium
413assistance payment for each enrollee in an employer-sponsored
414health insurance plan approved under ss. 409.810-409.820 shall
415equal the premium for the plan adjusted for any benchmark
416benefit plan actuarial equivalent benefit rider approved by the
417Office of Insurance Regulation pursuant to ss. 627.410 and
418641.31, less any enrollee's share of the premium established
419within the limitations specified in s. 409.816. In calculating
420the premium assistance payment levels for children with family
421coverage, the agency shall set the premium assistance payment
422levels for each child proportionately to the total cost of
423family coverage.
424     (b)  Make premium assistance payments to health insurance
425plans on a periodic basis. The agency may use its Medicaid
426fiscal agent or a contracted third-party administrator in making
427these payments. The agency may require health insurance plans
428that participate in the Medikids program or employer-sponsored
429group health insurance to collect premium payments from an
430enrollee's family. Participating health insurance plans shall
431report premium payments collected on behalf of enrollees in the
432program to the agency in accordance with a schedule established
433by the agency.
434     (c)  Monitor compliance with quality assurance and access
435standards developed under s. 409.820.
436     (d)  Establish a mechanism for investigating and resolving
437complaints and grievances from program applicants, enrollees,
438and health benefits coverage providers, and maintain a record of
439complaints and confirmed problems. In the case of a child who is
440enrolled in a health maintenance organization, the agency must
441use the provisions of s. 641.511 to address grievance reporting
442and resolution requirements.
443     (e)  Approve health benefits coverage for participation in
444the program, following certification by the Office of Insurance
445Regulation under subsection (3) (4).
446     (f)  No later than July 1, 2009, in consultation with the
447Department of Children and Family Services and the Florida
448Healthy Kids Corporation, establish a toll-free telephone number
449to assist families that have questions about the Florida Kidcare
450program. The toll-free telephone number shall ensure that
451eligibility, enrollment, benefit, and other information for all
452components of the Florida Kidcare program is available or easily
453accessible.
454     (g)  Develop and implement an outreach and marketing
455program that educates the public about the Florida Kidcare
456program, explains procedures for enrolling in the program, and
457maintains public awareness of the program.
458     (h)  Seek a Medicaid state plan amendment or federal waiver
459approval to implement this section and ss. 409.810-409.820.
460     (i)(f)  Adopt rules necessary for calculating premium
461assistance payment levels, making premium assistance payments,
462monitoring access and quality assurance standards, investigating
463and resolving complaints and grievances, administering the
464Medikids program, and approving health benefits coverage.
465
466The agency is designated the lead state agency for Title XXI of
467the Social Security Act for purposes of receipt of federal
468funds, for reporting purposes, and for ensuring compliance with
469federal and state regulations and rules.
470     (3)(4)  The Office of Insurance Regulation shall certify
471that health benefits coverage plans that seek to provide
472services under the Florida Kidcare program, except those offered
473through the Florida Healthy Kids Corporation or the Children's
474Medical Services Network, meet, exceed, or are actuarially
475equivalent to the benchmark benefit plan and that health
476insurance plans will be offered at an approved rate. In
477determining actuarial equivalence of benefits coverage, the
478Office of Insurance Regulation and health insurance plans must
479comply with the requirements of s. 2103 of Title XXI of the
480Social Security Act. The department shall adopt rules necessary
481for certifying health benefits coverage plans.
482     (4)(5)  The Florida Healthy Kids Corporation shall retain
483its functions as authorized in s. 624.91, including eligibility
484determination for participation in the Healthy Kids program.
485     (5)(6)  The agency, the Department of Health, the
486Department of Children and Family Services, the Florida Healthy
487Kids Corporation, and the Office of Insurance Regulation, after
488consultation with and approval of the Speaker of the House of
489Representatives and the President of the Senate, are authorized
490to make program modifications that are necessary to overcome any
491objections of the United States Department of Health and Human
492Services to obtain approval of the state's child health
493insurance plan under Title XXI of the Social Security Act.
494     Section 6.  Paragraph (b) of subsection (5) of section
495624.91, Florida Statutes, is amended to read:
496     624.91  The Florida Healthy Kids Corporation Act.--
497     (5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
498     (b)  The Florida Healthy Kids Corporation shall:
499     1.  Arrange for the collection of any family, local
500contributions, or employer payment or premium, in an amount to
501be determined by the board of directors, to provide for payment
502of premiums for comprehensive insurance coverage and for the
503actual or estimated administrative expenses.
504     2.  Arrange for the collection of any voluntary
505contributions to provide for payment of premiums for children
506who are not eligible for medical assistance under Title XXI of
507the Social Security Act.
508     3.  Subject to the provisions of s. 409.8134, accept
509voluntary supplemental local match contributions that comply
510with the requirements of Title XXI of the Social Security Act
511for the purpose of providing additional coverage in contributing
512counties under Title XXI.
513     4.  Establish the administrative and accounting procedures
514for the operation of the corporation.
515     5.  Establish, with consultation from appropriate
516professional organizations, standards for preventive health
517services and providers and comprehensive insurance benefits
518appropriate to children, provided that such standards for rural
519areas shall not limit primary care providers to board-certified
520pediatricians.
521     6.  Determine eligibility for children seeking to
522participate in the Title XXI-funded components of the Florida
523Kidcare program consistent with the requirements specified in s.
524409.814, as well as the non-Title-XXI-eligible children as
525provided in subsection (3).
526     7.  Establish procedures under which providers of local
527match to, applicants to, and participants in the program may
528have grievances reviewed by an impartial body and reported to
529the board of directors of the corporation.
530     8.  Establish participation criteria and, if appropriate,
531contract with an authorized insurer, health maintenance
532organization, or third-party administrator to provide
533administrative services to the corporation.
534     9.  Establish enrollment criteria which shall include
535penalties or waiting periods of not fewer than 60 days for
536reinstatement of coverage upon voluntary cancellation for
537nonpayment of family premiums.
538     10.  Contract with authorized insurers or any provider of
539health care services, meeting standards established by the
540corporation, for the provision of comprehensive insurance
541coverage to participants. Such standards shall include criteria
542under which the corporation may contract with more than one
543provider of health care services in program sites. Health plans
544shall be selected through a competitive bid process. The Florida
545Healthy Kids Corporation shall purchase goods and services in
546the most cost-effective manner consistent with the delivery of
547quality medical care. The maximum administrative cost for a
548Florida Healthy Kids Corporation contract shall be 15 percent.
549For health care contracts, the minimum medical loss ratio for a
550Florida Healthy Kids Corporation contract shall be 85 percent.
551For dental contracts, the remaining compensation to be paid to
552the authorized insurer or provider under a Florida Healthy Kids
553Corporation contract shall be no less than an amount which is 85
554percent of premium; to the extent any contract provision does
555not provide for this minimum compensation, this section shall
556prevail. The health plan selection criteria and scoring system,
557and the scoring results, shall be available upon request for
558inspection after the bids have been awarded.
559     11.  Establish disenrollment criteria in the event local
560matching funds are insufficient to cover enrollments.
561     12.  Develop and implement a plan to publicize the Florida
562Healthy Kids Corporation, the eligibility requirements of the
563program, and the procedures for enrollment in the program and to
564maintain public awareness of the corporation and the program.
565Health care and dental health plans participating in the program
566may develop and distribute marketing and other promotional
567materials and participate in activities, such as health fairs
568and public events, as approved by the corporation. Health care
569and dental health plans may also contact their current and
570former enrollees to encourage continued participation in the
571program and assist the enrollee in transferring from a Title
572XIX-funded plan to a Title XXI-funded plan.
573     13.  Secure staff necessary to properly administer the
574corporation. Staff costs shall be funded from state and local
575matching funds and such other private or public funds as become
576available. The board of directors shall determine the number of
577staff members necessary to administer the corporation.
578     14.  Provide a report annually to the Governor, Chief
579Financial Officer, Commissioner of Education, Senate President,
580Speaker of the House of Representatives, and Minority Leaders of
581the Senate and the House of Representatives.
582     15.  Establish benefit packages which conform to the
583provisions of the Florida Kidcare program, as created in ss.
584409.810-409.820.
585     16.  Establish an assignment process for Florida Healthy
586Kids program enrollees to ensure that family members are
587assigned to the same managed care plan to the greatest extent
588possible, including in those situations in which some family
589members are enrolled in a Medicaid managed care plan and other
590family members are enrolled in a Florida Healthy Kids plan. The
591Agency for Health Care Administration shall consult with the
592corporation to implement this subparagraph. The Florida Healthy
593Kids assignment process shall:
594     a.  Ensure that if the sibling of a Florida Healthy Kids
595enrollee is currently enrolled in a Medicaid provider service
596network in the same county as the Florida Healthy Kids enrollee
597and the county does not contain a Florida Healthy Kids health
598plan, the Florida Healthy Kids enrollee may be enrolled in the
599sibling's Medicaid provider service network for Florida Healthy
600Kids coverage.
601     b.  Ensure that if the sibling of a Florida Healthy Kids
602enrollee is currently enrolled in a Medicaid health maintenance
603organization in the same county as the Florida Healthy Kids
604enrollee and the county does not contain a Florida Healthy Kids
605health plan operated by or related to the Medicaid health
606maintenance organization, the Florida Healthy Kids enrollee may
607be enrolled in the sibling's Medicaid health maintenance
608organization for Florida Healthy Kids coverage.
609     Section 7.  This act shall take effect upon becoming a law.


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