Florida Senate - 2008 SB 2472
By Senator Rich
34-03475B-08 20082472__
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A bill to be entitled
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An act relating to the Florida Kidcare program; amending
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s. 409.810, F.S.; correcting a cross-reference; amending
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s. 409.811, F.S.; providing definitions; conforming cross-
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references; amending s. 409.812, F.S.; expanding
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application of the Florida Kidcare program to include all
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uninsured, low-income children; amending s. 409.813, F.S.;
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specifying funding sources for health benefits coverage
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for certain children; specifying program components to be
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marketed as the Florida Kidcare program; conforming cross-
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references; amending s. 409.8132, F.S.; conforming a
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cross-reference; revising provisions relating to penalties
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for nonpayment of premiums and waiting periods for
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reinstatement of coverage; amending s. 409.8134, F.S.;
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revising provisions relating to enrollment in the Florida
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Kidcare program; amending s. 409.814, F.S.; removing a
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restriction on participation in the Florida Healthy Kids
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program; authorizing certain enrollees to opt out of the
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Children's Medical Services network; providing for
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continuation of Florida Kidcare program eligibility under
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certain circumstances; revising coverage limitations;
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restricting enrollment of children whose coverage was
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voluntarily canceled; providing exceptions; deleting
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provisions that place a limit on enrollment in Medikids
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and the Florida Healthy Kids program; revising age and
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income limitations for Title XXI-funded Florida Kidcare
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coverage; requiring notice to health plans and providers
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when a child is no longer eligible for certain coverage;
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requiring electronic verification of applicants' income;
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providing circumstances under which written documentation
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is required; revising the timeframe for an enrollee to
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resolve disputes regarding the withholding of benefits;
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amending s. 409.815, F.S.; providing an exception to a
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limitation on health benefits coverage for certain
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maternity services; permitting the Agency for Health Care
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Administration to increase certain premium assistance
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payments for Florida Kidcare Plus benefits under certain
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circumstances; conforming cross-references; amending s.
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409.816, F.S.; providing limitations on premiums and cost-
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sharing payments by enrollees covered under Title XIX of
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the Social Security Act; conforming a cross-reference;
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amending s. 409.817, F.S.; conforming a cross-reference;
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amending s. 409.8177, F.S.; revising information to be
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included in the annual program evaluation report to the
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Governor and Legislature; amending s. 409.818, F.S.;
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revising an age limitation for Florida Kidcare coverage;
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requiring the Department of Health to chair a Florida
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Kidcare coordinating council and adopt certain rules in
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conjunction therewith; removing a provision requiring
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establishment of a toll-free telephone line; conforming
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cross-references; amending s. 409.821, F.S., relating to
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the Florida Kidcare program public records exemption;
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providing for disclosure of certain confidential and
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exempt information relating to an enrollee's application
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or coverage to an enrollee's parent or legal guardian;
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amending s. 409.904, F.S.; revising provisions relating to
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eligibility of certain children for the Medicaid program;
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amending s. 624.91, F.S.; revising the duties of the
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Florida Healthy Kids Corporation; deleting provisions
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relating to publicizing the Florida Kidcare Corporation;
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correcting a cross-reference; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 409.810, Florida Statutes, is amended to
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read:
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409.820 may be cited as the "Florida Kidcare Act."
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Section 2. Section 409.811, Florida Statutes, is amended to
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read:
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409.811 Definitions relating to Florida Kidcare Act.--As
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(1) "Actuarially equivalent" means that:
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(a) The aggregate value of the benefits included in health
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benefits coverage is equal to the value of the benefits in the
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benchmark benefit plan; and
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(b) The benefits included in health benefits coverage are
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substantially similar to the benefits included in the benchmark
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benefit plan, except that preventive health services must be the
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same as in the benchmark benefit plan.
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(2) "Agency" means the Agency for Health Care
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Administration.
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(3) "Applicant" means a parent or guardian of a child or a
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child whose disability of nonage has been removed under chapter
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743, who applies for determination of eligibility for health
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(4) "Benchmark benefit plan" means the form and level of
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health benefits coverage established in s. 409.815.
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(5) "Child" means any person under 19 years of age.
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(6) "Child with special health care needs" means a child
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whose serious or chronic physical or developmental condition
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requires extensive preventive and maintenance care beyond that
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required by typically healthy children. Health care utilization
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by such a child exceeds the statistically expected usage of the
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normal child adjusted for chronological age, and such a child
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often needs complex care requiring multiple providers,
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rehabilitation services, and specialized equipment in a number of
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different settings.
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(7) "Children's Medical Services network" or "network"
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means a statewide managed care service system as defined in s.
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391.021(1).
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(8) "Community rate" means a method used to develop
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premiums for a health insurance plan that spreads financial risk
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across a large population and allows adjustments only for age,
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gender, family composition, and geographic area.
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(9) "Department" means the Department of Health.
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(10) "Enrollee" means a child who has been determined
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(11) "Family" means the group or the individuals whose
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income is considered in determining eligibility for the Florida
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Kidcare program. The family includes a child with a custodial
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parent or caretaker relative who resides in the same house or
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living unit or, in the case of a child whose disability of nonage
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has been removed under chapter 743, the child. The family may
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also include other individuals whose income and resources are
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considered in whole or in part in determining eligibility of the
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child.
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(12) "Family income" means cash received at periodic
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intervals from any source, such as wages, benefits,
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contributions, or rental property. Income also may include any
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money that would have been counted as income under the Aid to
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Families with Dependent Children (AFDC) state plan in effect
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prior to August 22, 1996.
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(13) "Florida Kidcare Plus" means health benefits coverage
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for children with special health care needs delivered through the
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Children's Medical Services network.
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(14)(13) "Florida Kidcare program," "Kidcare program," or
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"program" means the health benefits program administered through
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(15)(14) "Guarantee issue" means that health benefits
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coverage must be offered to an individual regardless of the
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individual's health status, preexisting condition, or claims
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history.
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(16)(15) "Health benefits coverage" means protection that
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provides payment of benefits for covered health care services or
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that otherwise provides, either directly or through arrangements
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with other persons, covered health care services on a prepaid per
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capita basis or on a prepaid aggregate fixed-sum basis.
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(17)(16) "Health insurance plan" means health benefits
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coverage under the following:
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(a) A health plan offered by any certified health
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maintenance organization or authorized health insurer, except a
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plan that is limited to the following: a limited benefit,
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specified disease, or specified accident; hospital indemnity;
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accident only; limited benefit convalescent care; Medicare
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supplement; credit disability; dental; vision; long-term care;
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disability income; coverage issued as a supplement to another
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health plan; workers' compensation liability or other insurance;
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or motor vehicle medical payment only; or
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(b) An employee welfare benefit plan that includes health
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benefits established under the Employee Retirement Income
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Security Act of 1974, as amended.
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(18) "Maximum income threshold" means a percentage of the
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current federal poverty level used to determine eligibility for
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certain program components, as approved by federal waiver or an
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amendment to the state plan.
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(19)(17) "Medicaid" means the medical assistance program
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authorized by Title XIX of the Social Security Act, and
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in this state by the agency.
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(20)(18) "Medically necessary" means the use of any medical
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treatment, service, equipment, or supply necessary to palliate
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the effects of a terminal condition, or to prevent, diagnose,
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correct, cure, alleviate, or preclude deterioration of a
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condition that threatens life, causes pain or suffering, or
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results in illness or infirmity and which is:
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(a) Consistent with the symptom, diagnosis, and treatment
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of the enrollee's condition;
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(b) Provided in accordance with generally accepted
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standards of medical practice;
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(c) Not primarily intended for the convenience of the
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enrollee, the enrollee's family, or the health care provider;
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(d) The most appropriate level of supply or service for the
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diagnosis and treatment of the enrollee's condition; and
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(e) Approved by the appropriate medical body or health care
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specialty involved as effective, appropriate, and essential for
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the care and treatment of the enrollee's condition.
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(21)(19) "Medikids" means a component of the Florida
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Kidcare program of medical assistance authorized by Title XXI of
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the Social Security Act, and regulations thereunder, and s.
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409.8132, as administered in the state by the agency.
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(22)(20) "Preexisting condition exclusion" means, with
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respect to coverage, a limitation or exclusion of benefits
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relating to a condition based on the fact that the condition was
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present before the date of enrollment for such coverage, whether
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or not any medical advice, diagnosis, care, or treatment was
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recommended or received before such date.
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(23)(21) "Premium" means the entire cost of a health
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insurance plan, including the administration fee or the risk
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assumption charge.
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(24)(22) "Premium assistance payment" means the monthly
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consideration paid by the agency per enrollee in the Florida
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Kidcare program towards health insurance premiums.
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(25)(23) "Qualified alien" means an alien as defined in s.
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431 of the Personal Responsibility and Work Opportunity
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Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
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(26)(24) "Resident" means a United States citizen, or
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qualified alien, who is domiciled in this state.
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(27)(25) "Rural county" means a county having a population
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density of less than 100 persons per square mile, or a county
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defined by the most recent United States Census as rural, in
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which there is no prepaid health plan participating in the
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Medicaid program as of July 1, 1998.
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(28)(26) "Substantially similar" means that, with respect
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to additional services as defined in s. 2103(c)(2) of Title XXI
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of the Social Security Act, these services must have an actuarial
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value equal to at least 75 percent of the actuarial value of the
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coverage for that service in the benchmark benefit plan and, with
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respect to the basic services as defined in s. 2103(c)(1) of
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Title XXI of the Social Security Act, these services must be the
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same as the services in the benchmark benefit plan.
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Section 3. Section 409.812, Florida Statutes, is amended to
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read:
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409.812 Program created; purpose.--The Florida Kidcare
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program is created to provide a defined set of health benefits to
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previously uninsured, low-income children through the
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establishment of a variety of affordable health benefits coverage
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options from which families may select coverage and through which
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families may contribute financially to the health care of their
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children.
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Section 4. Section 409.813, Florida Statutes, is amended to
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read:
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409.813 Health benefits coverage; program components;
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entitlement and nonentitlement.--
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(1) The Florida Kidcare program includes health benefits
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coverage provided to children as follows through:
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(a) For children with family incomes at or below the
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applicable Medicaid eligibility level, health benefits coverage
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is funded through Title XIX of the Social Security Act.
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(b) For children with family incomes above the applicable
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Medicaid eligibility level up to the maximum income threshold,
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health benefits coverage is funded through Title XXI of the
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Social Security Act.
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(c) For children with family incomes up to the maximum
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income threshold who do not qualify for health benefits coverage
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under Title XXI of the Social Security Act, health benefits
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coverage is funded through general revenue or local contributions
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if a specific appropriation is provided for this purpose.
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(d) For children with family incomes above the maximum
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income threshold, health benefits coverage is funded through
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family premiums.
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(2) The Florida Kidcare program includes health benefits
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coverage provided to children through the following program
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components, which shall be marketed as the Florida Kidcare
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program:
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(a)(1) Medicaid;
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(b)(2) Medikids as created in s. 409.8132;
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(c)(3) The Florida Healthy Kids Corporation as created in
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s. 624.91;
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(d)(4) Employer-sponsored group health insurance plans
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(e)(5) The Children's Medical Services network established
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in chapter 391.
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(3) Except for Title XIX-funded Florida Kidcare program
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coverage under the Medicaid program, coverage under the Florida
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Kidcare program is not an entitlement. No cause of action shall
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arise against the state, the department, the Department of
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Children and Family Services, or the agency for failure to make
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Section 5. Paragraph (b) of subsection (6) and subsection
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(8) of section 409.8132, Florida Statutes, are amended to read:
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409.8132 Medikids program component.--
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(6) ELIGIBILITY.--
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(b) The provisions of s. 409.814(3), (4), and (5), (6), and
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(7) shall be applicable to the Medikids program.
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(8) PENALTIES FOR VOLUNTARY CANCELLATION.--The agency shall
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establish enrollment criteria that must include penalties or
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waiting periods of 30 not fewer than 60 days for reinstatement of
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coverage upon voluntary cancellation for nonpayment of premiums.
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Section 6. Section 409.8134, Florida Statutes, is amended
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to read:
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409.8134 Program expenditure ceiling; enrollment.--
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(1) Except for the Medicaid program, a ceiling shall be
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placed on annual federal and state expenditures for the Florida
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Kidcare program as provided each year in the General
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Appropriations Act.
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(2) The Florida Kidcare program may conduct enrollment
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continuously at any time throughout the year for the purpose of
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enrolling children eligible for all program components listed in
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s. 409.813 except Medicaid. The four Florida Kidcare
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administrators shall work together to ensure that the year-round
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enrollment period is announced statewide. Eligible Children
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eligible for Title XXI-funded Florida Kidcare program coverage
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shall be enrolled on a first-come, first-served basis using the
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date the enrollment application is received. Enrollment shall
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immediately cease when the expenditure ceiling is reached. Year-
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round enrollment shall only be held if the Social Services
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Estimating Conference determines that sufficient federal and
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state funds will be available to finance the increased enrollment
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through federal fiscal year 2007. Any individual who is not
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enrolled must reapply by submitting a new application. The
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application for the Florida Kidcare program is shall be valid for
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a period of 120 days after the date it was received. At the end
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of the 120-day period, if the applicant has not been enrolled in
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the program, the application is shall be invalid and the
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applicant shall be notified of the action. The applicant may
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reactivate resubmit the application after notification of the
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action taken by the program. Except for the Medicaid program,
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whenever the Social Services Estimating Conference determines
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that there are presently, or will be by the end of the current
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fiscal year, insufficient funds to finance the current or
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projected enrollment in the Florida Kidcare program, all
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additional enrollment must cease and additional enrollment may
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not resume until sufficient funds are available to finance such
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enrollment.
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(3) Upon determination by the Social Services Estimating
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Conference that there are insufficient funds to finance the
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current enrollment in the Florida Kidcare program within current
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appropriations, the program shall initiate disenrollment
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procedures to remove enrollees, except those children enrolled in
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Florida Kidcare Plus the Children's Medical Services Network, on
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a last-in, first-out basis until the expenditure and
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appropriation levels are balanced.
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(4) The agencies that administer the Florida Kidcare
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program components shall collect and analyze the data needed to
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project program enrollment costs, including price level
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adjustments, participation and attrition rates, current and
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projected caseloads, utilization, and current and projected
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expenditures for the next 3 years. The agencies shall report
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caseload and expenditure trends to the Social Services Estimating
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Conference in accordance with chapter 216.
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Section 7. Section 409.814, Florida Statutes, is amended to
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read:
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409.814 Eligibility.--A child who has not reached 19 years
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of age whose family income is equal to or below 200 percent of
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the federal poverty level is eligible for the Florida Kidcare
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program as provided in this section. For enrollment in Florida
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Kidcare Plus the Children's Medical Services Network, a complete
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application includes the medical or behavioral health screening.
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If, subsequently, an individual is determined to be ineligible
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for coverage, he or she must immediately be disenrolled from the
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respective Florida Kidcare program component.
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(1) A child who is eligible for Medicaid coverage under s.
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eligible to receive health benefits under any other health
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benefits coverage authorized under the Florida Kidcare program.
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(2) A child who is not eligible for Medicaid, but who is
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eligible for the Florida Kidcare program, may obtain health
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benefits coverage under any of the other components listed in s.
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409.813 if such coverage is approved and available in the county
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in which the child resides. However, a child who is eligible for
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Medikids may participate in the Florida Healthy Kids program only
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if the child has a sibling participating in the Florida Healthy
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Kids program and the child's county of residence permits such
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enrollment.
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(3) A child who is eligible for the Florida Kidcare program
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who is a child with special health care needs, as determined
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through a medical or behavioral screening instrument, shall
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receive Florida Kidcare Plus is eligible for health benefits
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coverage and shall be assigned to and may opt out of from and
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shall be referred to the Children's Medical Services network.
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(4) A child who becomes ineligible for Title XIX-funded
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Florida Kidcare program coverage due to exceeding income or age
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limits shall have 60 days of continued eligibility following
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redetermination before premium payments are required in order to
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allow for a transition to the Title XXI-funded Florida Kidcare
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program without a lapse in coverage. The state shall use a Title
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XXI financing option for the 60 days of presumptive eligibility.
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Potential Florida Kidcare Plus, Medikids, and Florida Healthy
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Kids enrollees shall retain coverage with the Children's Medical
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Services network or their Medicaid or managed care providers
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during the transition period.
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(5)(4) The following children are not eligible to receive
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Title XXI-funded premium assistance for health benefits coverage
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under the Florida Kidcare program, except under Medicaid if the
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child would have been eligible for Medicaid under s. 409.903 or
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s. 409.904 as of June 1, 1997:
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(a) A child who is eligible for coverage under a state
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health benefit plan on the basis of a family member's employment
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with a public agency in the state.
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(b) A child who is currently eligible for or covered under
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a family member's group health benefit plan or under other
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private or employer health insurance coverage, excluding coverage
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provided under the Florida Healthy Kids Corporation as
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established under s. 624.91, provided that the cost of the
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child's participation is not greater than 5 percent of the
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family's income. If a child is otherwise eligible for a subsidy
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in the Florida Kidcare program and the cost of the child's
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participation in the family member's health insurance benefit
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plan is greater than 5 percent of the family's income, this
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section does not apply. This provision shall be applied during
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redetermination for children who were enrolled prior to July 1,
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2004. These enrollees shall have 6 months of eligibility
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following redetermination to allow for a transition to the other
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health benefit plan.
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(c) A child who is seeking premium assistance for the
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Florida Kidcare program through employer-sponsored group
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coverage, if the child has been covered by the same employer's
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group coverage during the 90 days 6 months prior to the family's
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submitting an application for determination of eligibility under
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the program.
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(d) A child who is an alien, but who does not meet the
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definition of qualified alien, in the United States.
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(e) A child who is an inmate of a public institution or a
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patient in an institution for mental diseases.
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(f) A child who is otherwise eligible for premium
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assistance for the Florida Kidcare program and has had his or her
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coverage in an employer-sponsored or private health benefit plan
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voluntarily canceled in the last 90 days 6 months, except those
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children whose coverage was voluntarily canceled for good cause,
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including, but not limited to, the following circumstances:
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1. The cost of participation in an employer-sponsored
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health benefit plan is greater than 5 percent of the family's
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income;
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2. The parent lost a job that provided an employer-
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sponsored health benefit plan for children;
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3. The parent with health benefits coverage for the child
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is deceased;
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4. The child has a medical condition that, without medical
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care, would cause serious disability, loss of function, or death;
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5. The employer of the parent canceled health benefits
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coverage for children;
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6. The child's health benefits coverage ended because the
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child reached the maximum lifetime coverage amount;
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7. The child has exhausted coverage under a COBRA
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continuation provision;
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8. The health benefits coverage does not cover the child's
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health care needs; or
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9. Domestic violence led to loss of coverage who were on
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the waiting list prior to March 12, 2004.
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(6)(g) A child who is otherwise eligible for the Florida
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Kidcare program and who has a preexisting condition that prevents
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coverage under another insurance plan as described in paragraph
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(5)(b) that which would have disqualified the child for the
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Florida Kidcare program if the child were able to enroll in the
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plan shall be eligible for Florida Kidcare coverage when
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enrollment is possible.
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(7)(5) A child whose family income is above 200 percent of
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the federal poverty level or a child who is excluded under the
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provisions of subsection (5) (4) may participate in the Florida
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Kidcare program. However, Medikids program as provided in s.
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409.8132 or, if the child is ineligible for Medikids by reason of
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age, in the Florida Healthy Kids program, subject to the
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following provisions:
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(a) the family is not eligible for premium assistance
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payments and must pay the full cost of the premium, including any
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administrative costs.
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(a)(b) The agency is authorized to place limits on
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enrollment in Medikids by these children in order to avoid
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adverse selection. The number of children participating in
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Medikids whose family income exceeds 250 200 percent of the
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federal poverty level must not exceed 25 10 percent of total
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enrollees in the Medikids program. Except for families who are
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enrolled in the program on July 1, 2008, or who are in transition
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from coverage in a subsidized Kidcare program, a family whose
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income exceeds 250 percent of the federal poverty level must have
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been uninsured for 6 consecutive months prior to enrollment in
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the program.
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(b)(c) The board of directors of the Florida Healthy Kids
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Corporation is authorized to place limits on enrollment of these
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children in order to avoid adverse selection. In addition, the
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board is authorized to offer a reduced benefit package to these
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children in order to limit program costs for such families. The
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number of children participating in the Florida Healthy Kids
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program whose family income exceeds 250 200 percent of the
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federal poverty level must not exceed 25 10 percent of total
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enrollees in the Florida Healthy Kids program. However, a family
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who is enrolled in the program on July 1, 2008, or who is in
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transition from coverage in a subsidized program, or a family
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whose income exceeds 250 percent of the federal poverty level
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must have been uninsured for 6 consecutive months before
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enrollment in the program.
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(8)(6) Once a child is enrolled in the Florida Kidcare
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program, the child is eligible for coverage under the program for
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12 months without a redetermination or reverification of
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eligibility, if the family continues to pay the applicable
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premium. Eligibility for Florida Kidcare coverage program
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components funded through Title XXI of the Social Security Act
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shall terminate when a child attains the age of 19. Effective
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January 1, 1999, A child who has not attained the age of 19 5 and
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who has been determined eligible for the Medicaid program is
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eligible for coverage for 12 months without a redetermination or
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reverification of eligibility.
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(9)(7) When determining or reviewing a child's eligibility
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under the Florida Kidcare program, the applicant shall be
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provided with reasonable notice of changes in eligibility which
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may affect enrollment in one or more of the program components.
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When a transition from one program component to another is
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authorized, there shall be cooperation between the program
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components, and the affected family, the child's health plan, and
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MediPass providers that which promotes continuity of health care
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coverage. When a child is no longer eligible for Florida Kidcare
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coverage funded through Title XIX or Title XXI of the Social
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Security Act, the child's health plan and other MediPass
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providers shall be notified so that the health plans and
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providers may assist the family in obtaining coverage through
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other available healthcare providers. Any authorized transfers
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must be managed within the program's overall appropriated or
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authorized levels of funding. Each component of the program shall
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establish a reserve to ensure that transfers between components
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will be accomplished within current year appropriations. These
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reserves shall be reviewed by each convening of the Social
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Services Estimating Conference to determine the adequacy of such
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reserves to meet actual experience.
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(10)(8) In determining the eligibility of a child, an
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assets test is not required. Each applicant shall provide written
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documentation During the application process and the
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redetermination process, including, but not limited to, the
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following:
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(a) Each applicant's Proof of family income shall be
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verified electronically to determine financial eligibility for
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the Florida Kidcare program. Written documentation, which may
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must include wages and earnings statements (pay stubs), W-2
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forms, or a copy of the applicant's most recent federal income
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tax return, shall be required only if the electronic verification
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is not available or does not substantiate the applicant's income.
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In the absence of a federal income tax return, an applicant may
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submit wages and earnings statements (pay stubs), W-2 forms, or
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other appropriate documents.
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(b) Each applicant shall provide a statement from all
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applicable, employed family members that:
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1. Their employers do employer does not sponsor a health
515
benefit plans plan for employees; or
516
2. The potential enrollee is not covered by an the
517
employer-sponsored health benefit plan because the potential
518
enrollee is not eligible for coverage, or, if the potential
519
enrollee is eligible but not covered, a statement of the cost to
520
enroll the potential enrollee in the employer-sponsored health
521
benefit plan. If the cost of the employer-sponsored health
522
benefit plan is greater than 5 percent of the family's income and
523
the potential enrollee is otherwise eligible for premium
524
assistance, he or she may be enrolled in the appropriate Florida
525
Kidcare program component.
526
(11)(9) Subject to paragraph (5)(b) (4)(b) and s.
527
624.91(4), the Florida Kidcare program shall withhold benefits
528
from an enrollee if the program obtains evidence that the
529
enrollee is no longer eligible, submitted incorrect or fraudulent
530
information in order to establish eligibility, or failed to
531
provide verification of eligibility. The applicant or enrollee
532
shall be notified that because of such evidence, program benefits
533
will be withheld unless the applicant or enrollee contacts a
534
designated representative of the program by a specified date,
535
which must be within 10 working days after the date of notice, to
536
discuss and resolve the matter. The program shall make every
537
effort to resolve the matter within a timeframe that will not
538
cause benefits to be withheld from an eligible enrollee.
539
(12)(10) The following individuals may be subject to
540
prosecution in accordance with s. 414.39:
541
(a) An applicant obtaining or attempting to obtain benefits
542
for a potential enrollee under the Florida Kidcare program when
543
the applicant knows or should have known the potential enrollee
544
does not qualify for the Florida Kidcare program.
545
(b) An individual who assists an applicant in obtaining or
546
attempting to obtain benefits for a potential enrollee under the
547
Florida Kidcare program when the individual knows or should have
548
known the potential enrollee does not qualify for the Florida
549
Kidcare program.
550
Section 8. Subsection (2) of section 409.815, Florida
551
Statutes, is amended to read:
552
409.815 Health benefits coverage; limitations.--
553
(2) BENCHMARK BENEFITS.--In order for health benefits
554
coverage to qualify for premium assistance payments for an
556
health benefits coverage, except for coverage under Medicaid and
557
Medikids, must include the following minimum benefits, as
558
medically necessary.
559
(a) Preventive health services.--Covered services include:
560
1. Well-child care, including services recommended in the
561
Guidelines for Health Supervision of Children and Youth as
562
developed by the American Academy of Pediatrics;
563
2. Immunizations and injections;
564
3. Health education counseling and clinical services;
565
4. Vision screening; and
566
5. Hearing screening.
567
(b) Inpatient hospital services.--All covered services
568
provided for the medical care and treatment of an enrollee who is
569
admitted as an inpatient to a hospital licensed under part I of
570
chapter 395, with the following exceptions:
571
1. All admissions must be authorized by the enrollee's
572
health benefits coverage provider.
573
2. The length of the patient stay shall be determined based
574
on the medical condition of the enrollee in relation to the
575
necessary and appropriate level of care.
576
3. Room and board may be limited to semiprivate
577
accommodations, unless a private room is considered medically
578
necessary or semiprivate accommodations are not available.
579
4. Admissions for rehabilitation and physical therapy are
580
limited to 15 days per contract year.
581
(c) Emergency services.--Covered services include visits to
582
an emergency room or other licensed facility if needed
583
immediately due to an injury or illness and delay means risk of
584
permanent damage to the enrollee's health. Health maintenance
585
organizations shall comply with the provisions of s. 641.513.
586
(d) Maternity services.--Covered services include maternity
587
and newborn care, including prenatal and postnatal care, with the
588
following limitations:
589
1. Coverage may be limited to the fee for vaginal
590
deliveries unless another method of delivery is determined to be
591
medically necessary or better for the health of the mother or the
592
child; and
593
2. Initial inpatient care for newborn infants of enrolled
594
adolescents shall be covered, including normal newborn care,
595
nursery charges, and the initial pediatric or neonatal
596
examination, and the infant may be covered for up to 3 days
597
following birth.
598
(e) Organ transplantation services.--Covered services
599
include pretransplant, transplant, and postdischarge services and
600
treatment of complications after transplantation for transplants
601
deemed necessary and appropriate within the guidelines set by the
602
Organ Transplant Advisory Council under s. 765.53 or the Bone
603
Marrow Transplant Advisory Panel under s. 627.4236.
604
(f) Outpatient services.--Covered services include
605
preventive, diagnostic, therapeutic, palliative care, and other
606
services provided to an enrollee in the outpatient portion of a
607
health facility licensed under chapter 395, except for the
608
following limitations:
609
1. Services must be authorized by the enrollee's health
610
benefits coverage provider; and
611
2. Treatment for temporomandibular joint disease (TMJ) is
612
specifically excluded.
613
(g) Behavioral health services.--
614
1. Mental health benefits include:
615
a. Inpatient services, limited to not more than 30
616
inpatient days per contract year for psychiatric admissions, or
617
residential services in facilities licensed under s. 394.875(6)
618
or s. 395.003 in lieu of inpatient psychiatric admissions;
619
however, a minimum of 10 of the 30 days shall be available only
620
for inpatient psychiatric services when authorized by a
621
physician; and
622
b. Outpatient services, including outpatient visits for
623
psychological or psychiatric evaluation, diagnosis, and treatment
624
by a licensed mental health professional, limited to a maximum of
625
40 outpatient visits each contract year.
626
2. Substance abuse services include:
627
a. Inpatient services, limited to not more than 7 inpatient
628
days per contract year for medical detoxification only and 30
629
days of residential services; and
630
b. Outpatient services, including evaluation, diagnosis,
631
and treatment by a licensed practitioner, limited to a maximum of
632
40 outpatient visits per contract year.
633
(h) Durable medical equipment.--Covered services include
634
equipment and devices that are medically indicated to assist in
635
the treatment of a medical condition and specifically prescribed
636
as medically necessary, with the following limitations:
637
1. Low-vision and telescopic aides are not included.
638
2. Corrective lenses and frames may be limited to one pair
639
every 2 years, unless the prescription or head size of the
640
enrollee changes.
641
3. Hearing aids shall be covered only when medically
642
indicated to assist in the treatment of a medical condition.
643
4. Covered prosthetic devices include artificial eyes and
644
limbs, braces, and other artificial aids.
645
(i) Health practitioner services.--Covered services include
646
services and procedures rendered to an enrollee when performed to
647
diagnose and treat diseases, injuries, or other conditions,
648
including care rendered by health practitioners acting within the
649
scope of their practice, with the following exceptions:
650
1. Chiropractic services shall be provided in the same
651
manner as in the Florida Medicaid program.
652
2. Podiatric services may be limited to one visit per day
653
totaling two visits per month for specific foot disorders.
654
(j) Home health services.--Covered services include
655
prescribed home visits by both registered and licensed practical
656
nurses to provide skilled nursing services on a part-time
657
intermittent basis, subject to the following limitations:
658
1. Coverage may be limited to include skilled nursing
659
services only;
660
2. Meals, housekeeping, and personal comfort items may be
661
excluded; and
662
3. Private duty nursing is limited to circumstances where
663
such care is medically necessary.
664
(k) Hospice services.--Covered services include reasonable
665
and necessary services for palliation or management of an
666
enrollee's terminal illness, with the following exceptions:
667
1. Once a family elects to receive hospice care for an
668
enrollee, other services that treat the terminal condition will
669
not be covered; and
670
2. Services required for conditions totally unrelated to
671
the terminal condition are covered to the extent that the
672
services are included in this section.
673
(l) Laboratory and X-ray services.--Covered services
674
include diagnostic testing, including clinical radiologic,
675
laboratory, and other diagnostic tests.
676
(m) Nursing facility services.--Covered services include
677
regular nursing services, rehabilitation services, drugs and
678
biologicals, medical supplies, and the use of appliances and
679
equipment furnished by the facility, with the following
680
limitations:
681
1. All admissions must be authorized by the health benefits
682
coverage provider.
683
2. The length of the patient stay shall be determined based
684
on the medical condition of the enrollee in relation to the
685
necessary and appropriate level of care, but is limited to not
686
more than 100 days per contract year.
687
3. Room and board may be limited to semiprivate
688
accommodations, unless a private room is considered medically
689
necessary or semiprivate accommodations are not available.
690
4. Specialized treatment centers and independent kidney
691
disease treatment centers are excluded.
692
5. Private duty nurses, television, and custodial care are
693
excluded.
694
6. Admissions for rehabilitation and physical therapy are
695
limited to 15 days per contract year.
696
(n) Prescribed drugs.--
697
1. Coverage shall include drugs prescribed for the
698
treatment of illness or injury when prescribed by a licensed
699
health practitioner acting within the scope of his or her
700
practice.
701
2. Prescribed drugs may be limited to generics if available
702
and brand name products if a generic substitution is not
703
available, unless the prescribing licensed health practitioner
704
indicates that a brand name is medically necessary.
705
3. Prescribed drugs covered under this section shall
706
include all prescribed drugs covered under the Florida Medicaid
707
program.
708
(o) Therapy services.--Covered services include
709
rehabilitative services, including occupational, physical,
710
respiratory, and speech therapies, with the following
711
limitations:
712
1. Services must be for short-term rehabilitation where
713
significant improvement in the enrollee's condition will result;
714
and
715
2. Services shall be limited to not more than 24 treatment
716
sessions within a 60-day period per episode or injury, with the
717
60-day period beginning with the first treatment.
718
(p) Transportation services.--Covered services include
719
emergency transportation required in response to an emergency
720
situation.
721
(q) Dental services.--Dental services shall be covered and
722
may include those dental benefits provided to children by the
723
Florida Medicaid program under s. 409.906(6).
724
(r) Lifetime maximum.--Health benefits coverage obtained
726
covered expenses at a lifetime maximum of $1 million per covered
727
child.
728
(s) Cost-sharing.--Cost-sharing provisions must comply with
729
s. 409.816.
730
(t) Exclusions.--
731
1. Experimental or investigational procedures that have not
732
been clinically proven by reliable evidence are excluded;
733
2. Services performed for cosmetic purposes only or for the
734
convenience of the enrollee are excluded; and
735
3. Abortion may be covered only if necessary to save the
736
life of the mother or if the pregnancy is the result of an act of
737
rape or incest.
738
(u) Enhancements to minimum requirements.--
739
1. This section sets the minimum benefits that must be
740
included in any health benefits coverage, other than Medicaid or
742
409.820. Health benefits coverage may include additional benefits
743
not included under this subsection, but may not include benefits
744
excluded under paragraph (s).
745
2. Health benefits coverage may extend any limitations
746
beyond the minimum benefits described in this section.
747
748
Except for Florida Kidcare Plus benefits the Children's Medical
749
Services Network, the agency may not increase the premium
750
assistance payment for either additional benefits provided beyond
751
the minimum benefits described in this section or the imposition
752
of less restrictive service limitations.
753
(v) Applicability of other state laws.--Health insurers,
754
health maintenance organizations, and their agents are subject to
755
the provisions of the Florida Insurance Code, except for any such
756
provisions waived in this section.
757
1. Except as expressly provided in this section, a law
758
requiring coverage for a specific health care service or benefit,
759
or a law requiring reimbursement, utilization, or consideration
760
of a specific category of licensed health care practitioner, does
761
not apply to a health insurance plan policy or contract offered
763
that law is made expressly applicable to such policies or
764
contracts.
765
2. Notwithstanding chapter 641, a health maintenance
766
organization may issue contracts providing benefits equal to,
767
exceeding, or actuarially equivalent to the benchmark benefit
768
plan authorized by this section and may pay providers located in
769
a rural county negotiated fees or Medicaid reimbursement rates
770
for services provided to enrollees who are residents of the rural
771
county.
772
Section 9. Subsections (1) and (3) of section 409.816,
773
Florida Statutes, are amended to read:
774
409.816 Limitations on premiums and cost-sharing.--The
775
following limitations on premiums and cost-sharing are
776
established for the program.
777
(1) Enrollees who receive coverage under Title XIX of the
778
Social Security Act the Medicaid program may not be required to
779
pay:
780
(a) Enrollment fees, premiums, or similar charges; or
781
(b) Copayments, deductibles, coinsurance, or similar
782
charges.
783
(3) Enrollees in families with a family income above 150
784
percent of the federal poverty level, who are not receiving
785
coverage under the Medicaid program or who are not eligible under
786
s. 409.814(7)(5), may be required to pay enrollment fees,
787
premiums, copayments, deductibles, coinsurance, or similar
788
charges on a sliding scale related to income, except that the
789
total annual aggregate cost-sharing with respect to all children
790
in a family may not exceed 5 percent of the family's income.
791
However, copayments, deductibles, coinsurance, or similar charges
792
may not be imposed for preventive services, including well-baby
793
and well-child care, age-appropriate immunizations, and routine
794
hearing and vision screenings.
795
Section 10. Section 409.817, Florida Statutes, is amended
796
to read:
797
409.817 Approval of health benefits coverage; financial
798
assistance.--In order for health insurance coverage to qualify
799
for premium assistance payments for an eligible child under ss.
801
must:
802
(1) Be certified by the Office of Insurance Regulation of
803
the Financial Services Commission under s. 409.818 as meeting,
804
exceeding, or being actuarially equivalent to the benchmark
805
benefit plan;
806
(2) Be guarantee issued;
807
(3) Be community rated;
808
(4) Not impose any preexisting condition exclusion for
809
covered benefits; however, group health insurance plans may
810
permit the imposition of a preexisting condition exclusion, but
811
only insofar as it is permitted under s. 627.6561;
812
(5) Comply with the applicable limitations on premiums and
813
cost-sharing in s. 409.816;
814
(6) Comply with the quality assurance and access standards
815
developed under s. 409.820; and
816
(7) Establish periodic open enrollment periods, which may
817
not occur more frequently than quarterly.
818
Section 11. Paragraph (i) of subsection (1) of section
819
409.8177, Florida Statutes, is amended to read:
820
409.8177 Program evaluation.--
821
(1) The agency, in consultation with the Department of
822
Health, the Department of Children and Family Services, and the
823
Florida Healthy Kids Corporation, shall contract for an
824
evaluation of the Florida Kidcare program and shall by January 1
825
of each year submit to the Governor, the President of the Senate,
826
and the Speaker of the House of Representatives a report of the
827
program. In addition to the items specified under s. 2108 of
828
Title XXI of the Social Security Act, the report shall include an
829
assessment of crowd-out and access to health care, as well as the
830
following:
831
(i) An assessment of the effectiveness of the Florida
832
Kidcare program Medikids, Children's Medical Services network,
833
and other public and private programs in the state in increasing
834
the availability of affordable quality health insurance and
835
health care for children.
836
Section 12. Section 409.818, Florida Statutes, is amended
837
to read:
840
following duties:
841
(1) The Department of Children and Family Services shall:
842
(a) Develop a simplified eligibility application mail-in
843
form to be used for determining the eligibility of children for
844
coverage under the Florida Kidcare program, in consultation with
845
the agency, the Department of Health, and the Florida Healthy
846
Kids Corporation. The simplified eligibility application form
847
must include an item that provides an opportunity for the
848
applicant to indicate whether coverage is being sought for a
849
child with special health care needs. Families applying for
850
children's Medicaid coverage must also be able to use the
851
simplified application form without having to pay a premium.
852
(b) Establish and maintain the eligibility determination
853
process under the program except as specified in subsection (5).
854
The department shall directly, or through the services of a
855
contracted third-party administrator, establish and maintain a
856
process for determining eligibility of children for coverage
857
under the program. The eligibility determination process must be
858
used solely for determining eligibility of applicants for health
859
benefits coverage under the program and. The eligibility
860
determination process must include an initial determination of
861
eligibility for any coverage offered under the program, as well
862
as a redetermination or reverification of eligibility each
863
subsequent 6 months. Effective July 1, 2008 January 1, 1999, a
864
child who has not attained the age of 19 5 and who has been
865
determined eligible for the Medicaid program is eligible for
866
coverage for 12 months without a redetermination or
867
reverification of eligibility. In conducting an eligibility
868
determination, the department shall determine if the child has
869
special health care needs. The department, in consultation with
870
the Agency for Health Care Administration and the Florida Healthy
871
Kids Corporation, shall develop procedures for redetermining
872
eligibility which enable a family to easily update any change in
873
circumstances which could affect eligibility. The department may
874
accept changes in a family's status as reported to the department
875
by the Florida Healthy Kids Corporation without requiring a new
876
application from the family. Redetermination of a child's
877
eligibility for Medicaid may not be linked to a child's
878
eligibility determination for other programs.
879
(c) Inform program applicants about eligibility
880
determinations and provide information about eligibility of
881
applicants to Medicaid, Medikids, the Children's Medical Services
882
Network, and the Florida Kidcare program Healthy Kids
883
Corporation, and to insurers and their agents, through a
884
centralized coordinating office.
885
(d) Adopt rules necessary for conducting program
886
eligibility functions.
887
(2) The Department of Health shall:
888
(a) Design an eligibility intake process for the program,
889
in coordination with the Department of Children and Family
890
Services, the agency, and the Florida Healthy Kids Corporation.
891
The eligibility intake process may include local intake points
892
that are determined by the Department of Health in coordination
893
with the Department of Children and Family Services.
894
(b) Chair a state-level Florida Kidcare coordinating
895
council to review and make recommendations concerning the
896
implementation and operation of the program. The coordinating
897
council shall include representatives from the department, the
898
Department of Children and Family Services, the agency, the
899
Florida Healthy Kids Corporation, the Office of Insurance
900
Regulation of the Financial Services Commission, local
901
government, health insurers, health maintenance organizations,
902
health care providers, families participating in the program, and
903
organizations representing low-income families.
904
(c) In consultation with the Florida Healthy Kids
905
Corporation and the Department of Children and Family Services,
906
establish a toll-free telephone line to assist families with
907
questions about the program.
908
(c)(d) In consultation with the Florida Kidcare
909
coordinating council, adopt rules and policies necessary to
910
implement Florida Kidcare program outreach activities.
911
(3) The Agency for Health Care Administration, under the
912
authority granted in s. 409.914(1), shall:
913
(a) Calculate the premium assistance payment necessary to
914
comply with the premium and cost-sharing limitations specified in
915
s. 409.816. The premium assistance payment for each enrollee in a
916
health insurance plan participating in the Florida Healthy Kids
917
Corporation shall equal the premium approved by the Florida
918
Healthy Kids Corporation and the Office of Insurance Regulation
919
of the Financial Services Commission pursuant to ss. 627.410 and
920
641.31, less any enrollee's share of the premium established
921
within the limitations specified in s. 409.816. The premium
922
assistance payment for each enrollee in an employer-sponsored
924
409.820 shall equal the premium for the plan adjusted for any
925
benchmark benefit plan actuarial equivalent benefit rider
926
approved by the Office of Insurance Regulation pursuant to ss.
928
established within the limitations specified in s. 409.816. In
929
calculating the premium assistance payment levels for children
930
with family coverage, the agency shall set the premium assistance
931
payment levels for each child proportionately to the total cost
932
of family coverage.
933
(b) Make premium assistance payments to health insurance
934
plans on a periodic basis. The agency may use its Medicaid fiscal
935
agent or a contracted third-party administrator in making these
936
payments. The agency may require health insurance plans that
937
participate in the Medikids program or employer-sponsored group
938
health insurance to collect premium payments from an enrollee's
939
family. Participating health insurance plans shall report premium
940
payments collected on behalf of enrollees in the program to the
941
agency in accordance with a schedule established by the agency.
942
(c) Monitor compliance with quality assurance and access
943
standards developed under s. 409.820.
944
(d) Establish a mechanism for investigating and resolving
945
complaints and grievances from program applicants, enrollees, and
946
health benefits coverage providers, and maintain a record of
947
complaints and confirmed problems. In the case of a child who is
948
enrolled in a health maintenance organization, the agency must
949
use the provisions of s. 641.511 to address grievance reporting
950
and resolution requirements.
951
(e) Approve health benefits coverage for participation in
952
the program, following certification by the Office of Insurance
953
Regulation under subsection (4).
954
(f) Adopt rules necessary for calculating premium
955
assistance payment levels, making premium assistance payments,
956
monitoring access and quality assurance standards, investigating
957
and resolving complaints and grievances, administering the
958
Medikids program, and approving health benefits coverage.
959
960
The agency is designated the lead state agency for Title XXI of
961
the Social Security Act for purposes of receipt of federal funds,
962
for reporting purposes, and for ensuring compliance with federal
963
and state regulations and rules.
964
(4) The Office of Insurance Regulation shall certify that
965
health benefits coverage plans that seek to provide services
966
under the Florida Kidcare program, except those offered through
967
the Florida Healthy Kids Corporation or the Children's Medical
968
Services network, meet, exceed, or are actuarially equivalent to
969
the benchmark benefit plan and that health insurance plans will
970
be offered at an approved rate. In determining actuarial
971
equivalence of benefits coverage, the Office of Insurance
972
Regulation and health insurance plans must comply with the
973
requirements of s. 2103 of Title XXI of the Social Security Act.
974
The department shall adopt rules necessary for certifying health
975
benefits coverage plans.
976
(5) The Florida Healthy Kids Corporation shall retain its
977
functions as authorized in s. 624.91, including eligibility
978
determination for participation in the Healthy Kids program.
979
(6) The agency, the Department of Health, the Department of
980
Children and Family Services, the Florida Healthy Kids
981
Corporation, and the Office of Insurance Regulation, after
982
consultation with and approval of the Speaker of the House of
983
Representatives and the President of the Senate, are authorized
984
to make program modifications that are necessary to overcome any
985
objections of the United States Department of Health and Human
986
Services to obtain approval of the state's child health insurance
987
plan under Title XXI of the Social Security Act.
988
Section 13. Section 409.821, Florida Statutes, is amended
989
to read:
990
409.821 Florida Kidcare program public records
991
exemption.--Notwithstanding any other law to the contrary, any
992
information identifying a Florida Kidcare program applicant or
993
enrollee, as defined in s. 409.811, held by the Agency for Health
994
Care Administration, the Department of Children and Family
995
Services, the Department of Health, or the Florida Healthy Kids
996
Corporation is confidential and exempt from s. 119.07(1) and s.
997
24(a), Art. I of the State Constitution. Such information may be
998
disclosed to another governmental entity only if disclosure is
999
necessary for the entity to perform its duties and
1000
responsibilities under the Florida Kidcare program and shall be
1001
disclosed to the Department of Revenue for purposes of
1002
administering the state Title IV-D program. The receiving
1003
governmental entity must maintain the confidential and exempt
1004
status of such information. Furthermore, such information may not
1005
be released to any person without the written consent of the
1006
program applicant. This exemption applies to any information
1007
identifying a Florida Kidcare program applicant or enrollee held
1008
by the Agency for Health Care Administration, the Department of
1009
Children and Family Services, the Department of Health, or the
1010
Florida Healthy Kids Corporation before, on, or after the
1011
effective date of this exemption. A violation of this section is
1012
a misdemeanor of the second degree, punishable as provided in s.
1014
enrollee's parent or legal guardian from obtaining any record
1015
relating to the enrollee's Florida Kidcare program application or
1016
coverage, including, but not limited to, confirmation of
1017
coverage, the dates of coverage, the name of the enrollee's
1018
health plan, and the amount of premium.
1019
Section 14. Subsection (6) of section 409.904, Florida
1020
Statutes, is amended to read:
1021
409.904 Optional payments for eligible persons.--The agency
1022
may make payments for medical assistance and related services on
1023
behalf of the following persons who are determined to be eligible
1024
subject to the income, assets, and categorical eligibility tests
1025
set forth in federal and state law. Payment on behalf of these
1026
Medicaid eligible persons is subject to the availability of
1027
moneys and any limitations established by the General
1028
Appropriations Act or chapter 216.
1029
(6) A child who has not attained the age of 19 who has been
1030
determined eligible for the Medicaid program is deemed to be
1031
eligible for a total of 12 6 months, regardless of changes in
1032
circumstances other than attainment of the maximum age. Effective
1033
January 1, 1999, a child who has not attained the age of 5 and
1034
who has been determined eligible for the Medicaid program is
1035
deemed to be eligible for a total of 12 months regardless of
1036
changes in circumstances other than attainment of the maximum
1037
age.
1038
Section 15. Subsection (5) of section 624.91, Florida
1039
Statutes, is amended to read:
1040
624.91 The Florida Healthy Kids Corporation Act.--
1041
(5) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1042
(a) There is created the Florida Healthy Kids Corporation,
1043
a not-for-profit corporation.
1044
(b) The Florida Healthy Kids Corporation shall:
1045
1. Arrange for the collection of any family, local
1046
contributions, or employer payment or premium, in an amount to be
1047
determined by the board of directors, to provide for payment of
1048
premiums for comprehensive insurance coverage and for the actual
1049
or estimated administrative expenses.
1050
2. Arrange for the collection of any voluntary
1051
contributions to provide for payment of Florida Kidcare program
1052
premiums for children who are not eligible for medical assistance
1053
under Title XIX or Title XXI of the Social Security Act.
1054
3. Subject to the provisions of s. 409.8134, accept
1055
voluntary supplemental local match contributions that comply with
1056
the requirements of Title XXI of the Social Security Act for the
1057
purpose of providing additional Florida Kidcare coverage in
1058
contributing counties under Title XXI.
1059
4. Establish the administrative and accounting procedures
1060
for the operation of the corporation.
1061
5. Establish, with consultation from appropriate
1062
professional organizations, standards for preventive health
1063
services and providers and comprehensive insurance benefits
1064
appropriate to children, provided that such standards for rural
1065
areas shall not limit primary care providers to board-certified
1066
pediatricians.
1067
6. Determine eligibility for children seeking to
1068
participate in the Title XXI-funded components of the Florida
1069
Kidcare program consistent with the requirements specified in s.
1070
409.814, as well as the non-Title-XXI-eligible children as
1071
provided in subsection (3).
1072
7. Establish procedures under which providers of local
1073
match to, applicants to and participants in the program may have
1074
grievances reviewed by an impartial body and reported to the
1075
board of directors of the corporation.
1076
8. Establish participation criteria and, if appropriate,
1077
contract with an authorized insurer, health maintenance
1078
organization, or third-party administrator to provide
1079
administrative services to the corporation.
1080
9. Establish enrollment criteria that which shall include
1081
penalties or waiting periods of 30 not fewer than 60 days for
1082
reinstatement of coverage upon voluntary cancellation for
1083
nonpayment of family premiums.
1084
10. Contract with authorized insurers or any provider of
1085
health care services, meeting standards established by the
1086
corporation, for the provision of comprehensive insurance
1087
coverage to participants. Such standards shall include criteria
1088
under which the corporation may contract with more than one
1089
provider of health care services in program sites. Health plans
1090
shall be selected through a competitive bid process. The Florida
1091
Healthy Kids Corporation shall purchase goods and services in the
1092
most cost-effective manner consistent with the delivery of
1093
quality medical care. The maximum administrative cost for a
1094
Florida Healthy Kids Corporation contract shall be 15 percent.
1095
For health care contracts, the minimum medical loss ratio for a
1096
Florida Healthy Kids Corporation contract shall be 85 percent.
1097
For dental contracts, the remaining compensation to be paid to
1098
the authorized insurer or provider under a Florida Healthy Kids
1099
Corporation contract shall be no less than an amount which is 85
1100
percent of premium; to the extent any contract provision does not
1101
provide for this minimum compensation, this section shall
1102
prevail. The health plan selection criteria and scoring system,
1103
and the scoring results, shall be available upon request for
1104
inspection after the bids have been awarded.
1105
11. Establish disenrollment criteria in the event local
1106
matching funds are insufficient to cover enrollments.
1107
12. Develop and implement a plan to publicize the Florida
1108
Healthy Kids Corporation, the eligibility requirements of the
1109
program, and the procedures for enrollment in the program and to
1110
maintain public awareness of the corporation and the program.
1111
12.13. Secure staff necessary to properly administer the
1112
corporation. Staff costs shall be funded from state and local
1113
matching funds and such other private or public funds as become
1114
available. The board of directors shall determine the number of
1115
staff members necessary to administer the corporation.
1116
13.14. In consultation with the Florida Kidcare
1117
coordinating council and all partner agencies, provide a report
1118
on the Florida Kidcare program annually to the Governor, Chief
1119
Financial Officer, Commissioner of Education, Senate President of
1120
the Senate, Speaker of the House of Representatives, and Minority
1121
Leaders of the Senate and the House of Representatives.
1122
14.15. Establish benefit packages that which conform to the
1123
provisions of the Florida Kidcare program, as created in ss.
1125
(c) Coverage under the corporation's program is secondary
1126
to any other available private coverage held by, or applicable
1127
to, the participant child or family member. Insurers under
1128
contract with the corporation are the payors of last resort and
1129
must coordinate benefits with any other third-party payor that
1130
may be liable for the participant's medical care.
1131
(d) The Florida Healthy Kids Corporation shall be a private
1132
corporation not for profit, organized pursuant to chapter 617,
1133
and shall have all powers necessary to carry out the purposes of
1134
this act, including, but not limited to, the power to receive and
1135
accept grants, loans, or advances of funds from any public or
1136
private agency and to receive and accept from any source
1137
contributions of money, property, labor, or any other thing of
1138
value, to be held, used, and applied for the purposes of this
1139
act.
1140
Section 16. This act shall take effect July 1, 2008.
CODING: Words stricken are deletions; words underlined are additions.