((LATE FILED FOR: 4/30/2008 8:30:00 AM))Amendment
Bill No. CS/CS/CS/SB 2654
Amendment No. 020597
CHAMBER ACTION
Senate House
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1Representative Coley offered the following:
2
3     Amendment to Amendment (940817) (with title amendment)
4     Remove lines 36-770 and insert:
5     Section 4.  Subsections (6), (7), (8), (9), (10), (11),
6(12), (13), (14), (15), (16), (17), (18), (19), (20), (21),
7(22), (23), (24), (25), and (26) of section 409.811, Florida
8Statutes, are renumbered as subsections (7), (8), (9), (10),
9(11), (12), (13), (14), (15), (16), (17), (18), (19), (20),
10(21), (22), (23), (24), (25), (26), and (27), respectively, and
11a subsection (6) is added to that section, to read:
12     409.811  Definitions relating to Florida Kidcare Act.--As
13used in ss. 409.810-409.820, the term:
14     (6)  "Autism spectrum disorder" means any of the following
15disorders as defined with most recent edition of the Diagnostic
16and Statistical Manual of Mental Disorders of the American
17Psychiatric Association:
18     1.  Autistic disorder;
19     2.  Asperger syndrome; or
20     3.  Pervasive developmental disorder not otherwise
21specified.
22     Section 5.  Subsection (7) of section 409.8132, Florida
23Statutes, is amended to read:
24     409.8132  Medikids program component.--
25     (7)  ENROLLMENT.--Enrollment in the Medikids program
26component may occur at any time throughout the year. A child may
27not receive services under the Medikids program until the child
28is enrolled in a managed care plan or MediPass. Once determined
29eligible, an applicant may receive choice counseling and select
30a managed care plan or MediPass. The agency may initiate
31mandatory assignment for a Medikids applicant who has not chosen
32a managed care plan or MediPass provider after the applicant's
33voluntary choice period ends; however, the agency shall ensure
34that family members are assigned to the same managed care plan
35or the same MediPass provider to the greatest extent possible,
36including situations in which some family members are enrolled
37in Medicaid and other family members are enrolled in a Title
38XXI-funded component of the Florida Kidcare program. An
39applicant may select MediPass under the Medikids program
40component only in counties that have fewer than two managed care
41plans available to serve Medicaid recipients and only if the
42federal Health Care Financing Administration determines that
43MediPass constitutes "health insurance coverage" as defined in
44Title XXI of the Social Security Act.
45     Section 6.  Subsection (2) of section 409.8134, Florida
46Statutes, is amended, and subsection (5) is added to that
47section, to read:
48     409.8134  Program expenditure ceiling.--
49     (2)  Open enrollment periods shall consist of:
50     (a)  Enrollment for premium assistance.--The Florida
51Kidcare program may conduct enrollment at any time throughout
52the year for the purpose of enrolling children eligible for all
53program components listed in s. 409.813 except Medicaid. The
54four Florida Kidcare administrators shall work together to
55ensure that the year-round enrollment period is announced
56statewide. Eligible children for premium assistance shall be
57enrolled on a first-come, first-served basis using the date the
58enrollment application is received. Enrollment shall immediately
59cease when the expenditure ceiling is reached. Year-round
60enrollment for premium assistance shall only be held if the
61Social Services Estimating Conference determines that sufficient
62federal and state funds will be available to finance the
63increased enrollment through federal fiscal year 2007. Any
64individual who is not enrolled must reapply by submitting a new
65application. The application for the Florida Kidcare program
66shall be valid for a period of 120 days after the date it was
67received. At the end of the 120-day period, if the applicant has
68not been enrolled in the program, the application shall be
69invalid and the applicant shall be notified of the action. The
70applicant may reactivate resubmit the application after
71notification of the action taken by the program. Except for the
72Medicaid program, whenever the Social Services Estimating
73Conference determines that there are presently, or will be by
74the end of the current fiscal year, insufficient funds to
75finance the current or projected enrollment in the Florida
76Kidcare program, all additional enrollment must cease and
77additional enrollment may not resume until sufficient funds are
78available to finance such enrollment.
79     (b)  Open enrollment without premium assistance, effective
80July 1, 2009.--
81     1.  Effective July 1, 2009, an open enrollment period for
82the Florida Healthy Kids program for those enrollees not
83eligible for premium assistance may be held once each fiscal
84year and may not exceed 30 consecutive calendar days in length.
85The timing and length of any open enrollment period shall be
86determined by the Florida Healthy Kids Corporation. Applicants
87shall be enrolled on a first come, first served basis, based
88upon the date the application was received. During the 2009-2010
89fiscal year, the effective date for new enrollees without
90premium assistance shall be October 1, 2009. However, for a
91child who has had his or her coverage in an employer-sponsored
92or private health benefit plan voluntarily canceled in the last
9390 days and who is otherwise eligible to participate without
94premium assistance the effective date of coverage shall be the
95end of the 90-day period or October 1, 2009, whichever is later.
96     2.  The following individuals are not subject to the open
97enrollment period:
98     a.  Enrollees in any Florida Kidcare program component that
99are determined to be no longer eligible under that component due
100to changes in income or age. These enrollees may transfer to the
101Healthy Kids program if such transfer is initiated within 30
102days after the loss of such eligibility.
103     b.  Applicants that have adopted a child in the state.
104     c.  Applicants who have had employer-sponsored or private
105health insurance involuntarily canceled within 30 days prior to
106submission of the application.
107     3.  Any individual who is not enrolled under this
108subsection must reapply by submitting a new application during
109the next open enrollment period. The application for the Florida
110Kidcare program without premium assistance shall be valid for
111the period of the open enrollment.
112     (5)  Effective October 1, 2009, upon determination by the
113Social Service Estimating Conference, in consultation with the
114agency and the Florida Healthy Kids Corporation, that enrollment
115of children whose family income exceeds 200 percent of the
116federal poverty level is projected to raise overall premiums per
117enrollee by greater than 5_percent of current average premiums
118in the Florida Healthy Kids plans, the board of directors of the
119Florida Healthy Kids Corporation may, with the concurrence of
120the agency, take appropriate actions to reduce the projected
121cost below the projected_5 percent increase. Actions the board
122may take may include, but are not limited to:
123     (a)  Reducing habilitative and behavior analysis benefits
124to enrollees who are receiving these services.
125     (b)  Eliminating habilitative and or behavior analysis
126services as a benefit in Healthy Kids plans for enrollees and
127providing enrollees the opportunity to purchase these benefits
128separately.
129     (c)  Increasing copayments for habilitative and behavior
130analysis services provided to nonpremium assistance enrollees.
131     (d)  Reducing benefit packages to all nonpremium assistance
132enrollees.
133     Section 7.  Paragraphs (c) and (f) of subsection (4) and
134subsections (5), (7), and (8) of section 409.814, Florida
135Statutes, are amended to read:
136     409.814  Eligibility.--A child who has not reached 19 years
137of age whose family income is equal to or below 200 percent of
138the federal poverty level is eligible for the Florida Kidcare
139program as provided in this section. For enrollment in the
140Children's Medical Services Network, a complete application
141includes the medical or behavioral health screening. If,
142subsequently, an individual is determined to be ineligible for
143coverage, he or she must immediately be disenrolled from the
144respective Florida Kidcare program component.
145     (4)  The following children are not eligible to receive
146premium assistance for health benefits coverage under the
147Florida Kidcare program, except under Medicaid if the child
148would have been eligible for Medicaid under s. 409.903 or s.
149409.904 as of June 1, 1997:
150     (c)  A child who is seeking premium assistance for the
151Florida Kidcare program through employer-sponsored group
152coverage, if the child has been covered by the same employer's
153group coverage during the 90 days 6 months prior to the family's
154submitting an application for determination of eligibility under
155the program.
156     (f)  A child who has had his or her coverage in an
157employer-sponsored or private health benefit plan voluntarily
158canceled in the last 90 days 6 months, except those children who
159were on the waiting list prior to March 12, 2004, or whose
160coverage was voluntarily canceled for good cause, including, but
161not limited to, the following circumstances:
162     1.  The cost of participation in an employer-sponsored or
163private health benefit plan is greater than 5 percent of the
164family's income;
165     2.  The parent lost a job that provided an employer-
166sponsored health benefit plan for children;
167     3.  The parent with health benefits coverage for the child
168is deceased;
169     4.  The employer of the parent canceled health benefits
170coverage for children;
171     5.  The child's health benefits coverage ended because the
172child reached the maximum lifetime coverage amount;
173     6.  The child has exhausted coverage under a COBRA
174continuation provision; or
175     7.  A situation involving domestic violence led to the loss
176of coverage.
177     (5)  A child whose family income is above 200 percent of
178the federal poverty level or a child who is excluded under the
179provisions of subsection (4) may participate in the Medikids
180program as provided in s. 409.8132 or, if the child is
181ineligible for Medikids by reason of age, in the Florida Healthy
182Kids program as provided in s. 624.91, subject to the following
183provisions:
184     (a)  The family is not eligible for premium assistance
185payments and must pay the full cost of the premium, including
186any administrative costs.
187     (b)  Effective October 1, 2009, new applicants for
188nonpremium assistance in the Medikids program shall enroll in
189the Florida Healthy Kids program component of the Florida
190Kidcare program. The agency is authorized to place limits on
191enrollment in Medikids by these children in order to avoid
192adverse selection. The number of children participating in
193Medikids whose family income exceeds 200 percent of the federal
194poverty level must not exceed 10 percent of total enrollees in
195the Medikids program.
196     (c)  The board of directors of the Florida Healthy Kids
197Corporation is authorized to place limits on enrollment of these
198children in order to avoid adverse selection. In addition, the
199board is authorized to offer a reduced benefit package to these
200children in order to limit program costs for such families. The
201number of children participating in the Florida Healthy Kids
202program whose family income exceeds 200 percent of the federal
203poverty level must not exceed 10 percent of total enrollees in
204the Florida Healthy Kids program.
205     (7)  When determining or reviewing a child's eligibility
206under the Florida Kidcare program, the applicant shall be
207provided with reasonable notice of changes in eligibility which
208may affect enrollment in one or more of the program components.
209When a transition from one program component to another is
210authorized, there shall be cooperation between the program
211components, and the affected family, the child's health
212insurance plan, and the child's health care providers to promote
213which promotes continuity of health care coverage. If a child is
214determined ineligible for Medicaid or Medikids, the agency, in
215coordination with the department, shall notify that child's
216Medicaid managed care plan or MediPass provider of such
217determination before the child's eligibility is scheduled to be
218terminated so that the Medicaid managed care plan or MediPass
219provider can assist the child's family in applying for Florida
220Kidcare program coverage. Any authorized transfers must be
221managed within the program's overall appropriated or authorized
222levels of funding. Each component of the program shall establish
223a reserve to ensure that transfers between components will be
224accomplished within current year appropriations. These reserves
225shall be reviewed by each convening of the Social Services
226Estimating Conference to determine the adequacy of such reserves
227to meet actual experience.
228     (8)  In determining the eligibility of a child for the
229Florida Kidcare program, an assets test is not required. The
230information required under this section from each applicant
231shall be obtained electronically to the extent possible. If such
232information cannot be obtained electronically, the Each
233applicant shall provide written documentation during the
234application process and the redetermination process, including,
235but not limited to, the following:
236     (a)  Proof of family income, which must include a copy of
237the applicant's most recent federal income tax return. In the
238absence of a federal income tax return, an applicant may submit
239wages and earnings statements (pay stubs), W-2 forms, or other
240appropriate documents.
241     (b)  A statement from all family members that:
242     1.  Their employer does not sponsor a health benefit plan
243for employees; or
244     2.  The potential enrollee is not covered by the employer-
245sponsored health benefit plan because the potential enrollee is
246not eligible for coverage, or, if the potential enrollee is
247eligible but not covered, a statement of the cost to enroll the
248potential enrollee in the employer-sponsored health benefit
249plan.
250
251An individual who applies for coverage under the Florida Kidcare
252program and who pays the full cost of the premium is exempt from
253the requirements of this subsection.
254     Section 8.  Paragraphs (r) through (v) of subsection (2) of
255section 409.815, Florida Statutes, are redesignated as
256paragraphs (s) through (w), respectively, present paragraphs
257(o), (r), and (u) are amended, and a new paragraph (r) is added
258to that subsection, to read:
259     409.815  Health benefits coverage; limitations.--
260     (2)  BENCHMARK BENEFITS.--In order for health benefits
261coverage to qualify for premium assistance payments for an
262eligible child under ss. 409.810-409.820, the health benefits
263coverage, except for coverage under Medicaid and Medikids, must
264include the following minimum benefits, as medically necessary.
265     (o)  Therapy services.--Covered services include
266habilitative and rehabilitative services, including
267occupational, physical, respiratory, and speech therapies, with
268the following limitations:
269     1.  Rehabilitative services are limited to:
270     a.1.  Services must be for Short-term rehabilitation when
271where significant improvement in the enrollee's condition will
272result; and
273     b.2.  Services shall be limited to Not more than 24
274treatment sessions within a 60-day period per episode or injury,
275with the 60-day period beginning with the first treatment.
276     2.  Effective October 1, 2009, habilitative services shall
277be offered and are limited to:
278     a.  Habilitation when improvements in and maintenance of
279human behavior, skill acquisition, and communication will
280result; and
281     b.  Enrollees that are diagnosed with a developmental
282disability as defined in s. 393.063 or autism spectrum disorder.
283     (r)  Behavior analysis services.--Effective October 1,
2842009, behavior analysis and behavior assistant services shall be
285covered for enrollees that are diagnosed with a developmental
286disability as defined in s. 393.063 or autism spectrum disorder.
287For purposes of this paragraph:
288     1.  "Behavior analysis" means the design, implementation,
289and evaluation of instructional and environmental modifications
290to produce socially significant improvements in human behavior
291through skill acquisition and the reduction of problematic
292behavior. Applied behavior analysis shall be provided by an
293individual certified pursuant to s. 393.17 or an individual
294licensed under chapter 490 or chapter 491.
295     2.  "Behavior assistant services" means services provided
296by an individual with specific training to assist in carrying
297out plans designed by a behavior analyst.
298     (s)(r)  Lifetime maximum and limitations.--Health benefits
299coverage obtained under ss. 409.810-409.820 shall pay an
300enrollee's covered expenses at a lifetime maximum of $1 million
301per covered child. However, coverage for the combination of
302behavior analysis services and habilitative therapy services for
303recipients diagnosed with a developmental disability as defined
304in s. 393.063 or autism spectrum disorder shall be limited to
305$36,000 annually and may not exceed $108,000 in total lifetime
306benefits. Without prior authorization by the Florida Healthy
307Kids plan, not more than 12 percent of the annual maximum amount
308for combined habilitative therapy and behavior analysis services
309may be used on a monthly basis.
310     (v)(u)  Enhancements to minimum requirements.--
311     1.  This section sets the minimum benefits that must be
312included in any health benefits coverage, other than Medicaid or
313Medikids coverage, offered under ss. 409.810-409.820. Health
314benefits coverage may include additional benefits not included
315under this subsection, but may not include benefits excluded
316under paragraph (t) (s).
317     2.  Health benefits coverage may extend any limitations
318beyond the minimum benefits described in this section.
319
320Except for the Children's Medical Services Network, the agency
321may not increase the premium assistance payment for either
322additional benefits provided beyond the minimum benefits
323described in this section or the imposition of less restrictive
324service limitations.
325     Section 9.  Paragraph (b) of subsection (1) of section
326409.818, Florida Statutes, is amended to read:
327     409.818  Administration.--In order to implement ss.
328409.810-409.820, the following agencies shall have the following
329duties:
330     (1)  The Department of Children and Family Services shall:
331     (b)  Establish and maintain the eligibility determination
332process under the program except as specified in subsection (5).
333The department shall directly, or through the services of a
334contracted third-party administrator, establish and maintain a
335process for determining eligibility of children for coverage
336under the program. The eligibility determination process must be
337used solely for determining eligibility of applicants for health
338benefits coverage under the program. The eligibility
339determination process must include an initial determination of
340eligibility for any coverage offered under the program, as well
341as a redetermination or reverification of eligibility each
342subsequent 12 6 months. Effective January 1, 1999, a child who
343has not attained the age of 5 and who has been determined
344eligible for the Medicaid program is eligible for coverage for
34512 months without a redetermination or reverification of
346eligibility. In conducting an eligibility determination, the
347department shall determine if the child has special health care
348needs. The department, in consultation with the Agency for
349Health Care Administration and the Florida Healthy Kids
350Corporation, shall develop procedures for redetermining
351eligibility which enable a family to easily update any change in
352circumstances which could affect eligibility. The department may
353accept changes in a family's status as reported to the
354department by the Florida Healthy Kids Corporation without
355requiring a new application from the family. Redetermination of
356a child's eligibility for Medicaid may not be linked to a
357child's eligibility determination for other programs.
358     Section 10.  Subsection (26) is added to section 409.906,
359Florida Statutes, to read:
360     409.906  Optional Medicaid services.--Subject to specific
361appropriations, the agency may make payments for services which
362are optional to the state under Title XIX of the Social Security
363Act and are furnished by Medicaid providers to recipients who
364are determined to be eligible on the dates on which the services
365were provided. Any optional service that is provided shall be
366provided only when medically necessary and in accordance with
367state and federal law. Optional services rendered by providers
368in mobile units to Medicaid recipients may be restricted or
369prohibited by the agency. Nothing in this section shall be
370construed to prevent or limit the agency from adjusting fees,
371reimbursement rates, lengths of stay, number of visits, or
372number of services, or making any other adjustments necessary to
373comply with the availability of moneys and any limitations or
374directions provided for in the General Appropriations Act or
375chapter 216. If necessary to safeguard the state's systems of
376providing services to elderly and disabled persons and subject
377to the notice and review provisions of s. 216.177, the Governor
378may direct the Agency for Health Care Administration to amend
379the Medicaid state plan to delete the optional Medicaid service
380known as "Intermediate Care Facilities for the Developmentally
381Disabled." Optional services may include:
382     (26)  HOME AND COMMUNITY-BASED SERVICES FOR AUTISM SPECTRUM
383DISORDER AND OTHER DEVELOPMENTAL DISABILITIES.--The agency is
384authorized to seek federal approval through a Medicaid waiver or
385a state plan amendment for the provision of occupational
386therapy, speech therapy, physical therapy, behavior analysis,
387and behavior assistant services to individuals who are 5 years
388of age and under and have a diagnosed developmental disability
389as defined in s. 393.063 or autism spectrum disorder as defined
390in s. 409.811. Coverage for such services shall be limited to
391$36,000 annually and may not exceed $108,000 in total lifetime
392benefits. The agency shall submit an annual report beginning on
393January 1, 2009, to the President of the Senate, the Speaker of
394the House of Representatives, and the relevant committees of the
395Senate and the House of Representatives regarding progress on
396obtaining federal approval and recommendations for the
397implementation of these home and community-based services. The
398agency may not implement this subsection without prior
399legislative approval.
400     Section 11.  Section 456.0291, Florida Statutes, is created
401to read:
402     456.0291  Requirement for instruction on developmental
403disabilities.--
404     (1)(a)  The appropriate board shall require each person
405licensed or certified under part I of chapter 464, chapter 490,
406or chapter 491 to complete a 2-hour continuing education course,
407approved by the board, on developmental disabilities, as defined
408in s. 393.063, with the addition of autism spectrum disorder, as
409defined in s. 409.811, as part of every third biennial
410relicensure or recertification. The course shall consist of
411information on the diagnosis and treatment of developmental
412disabilities and information on counseling and education of a
413parent whose child is diagnosed with a developmental disability,
414with an emphasis on autism spectrum disorder, as defined in s.
415409.811.
416     (b)  The Board of Medicine and the Board of Osteopathic
417Medicine shall require each physician with a primary care
418specialty of pediatrics to complete a 2-hour continuing
419education course, approved by the appropriate board, on
420developmental disabilities, as defined in s. 393.063, with the
421addition of autism spectrum disorder, as defined in s. 409.811,
422as part of every third biennial relicensure. The course shall
423consist of information on the diagnosis and treatment of
424developmental disabilities and information on counseling and
425education of a parent whose child is diagnosed with a
426developmental disability, with an emphasis on autism spectrum
427disorder, as defined in s. 409.811.
428     (c)  Each such licensee or certificateholder shall submit
429confirmation of having completed the course, on a form provided
430by the board, when submitting fees for every third biennial
431renewal.
432     (d)  The board may approve additional equivalent courses
433that may be used to satisfy the requirements of paragraph (a).
434Each licensing board that requires a licensee to complete an
435educational course pursuant to this subsection may include the
436hours required for completion of the course in the total hours
437of continuing education required by law for such profession
438unless the continuing education requirements for such profession
439consist of fewer than 30 hours biennially.
440     (e)  Any person holding two or more licenses subject to the
441provisions of this subsection shall be permitted to show proof
442of having taken one board-approved course on developmental
443disabilities for purposes of relicensure or recertification for
444additional licenses.
445     (f)  Failure to comply with the requirements of this
446subsection shall constitute grounds for disciplinary action
447under each respective practice act and under s. 456.072(1)(k).
448In addition to discipline by the board, the licensee shall be
449required to complete such course.
450     (2)  Each board may adopt rules pursuant to ss. 120.536(1)
451and 120.54 to carry out the provisions of this section.
452     (3)  The department shall implement a plan to promote
453awareness of developmental disabilities, with a focus on autism
454spectrum disorder, as defined in s. 409.811, to physicians
455licensed under chapter 458 or chapter 459 and parents. The
456department shall develop the plan in consultation with
457organizations representing allopathic and osteopathic
458physicians, the Board of Medicine, the Board of Osteopathic
459Medicine, and nationally recognized organizations that promote
460awareness of developmental disabilities. The department's plan
461shall include the distribution of educational materials for
462parents, including a developmental assessment tool.
463     Section 12.  Paragraph (b) of subsection (2) and paragraph
464(b) of subsection (5) of section 624.91, Florida Statutes, are
465amended to read:
466     624.91  The Florida Healthy Kids Corporation Act.--
467     (2)  LEGISLATIVE INTENT.--
468     (b)  It is the intent of the Legislature that the Florida
469Healthy Kids Corporation serve as one of several providers of
470services to children eligible for medical assistance under Title
471XXI of the Social Security Act. Although the corporation may
472serve other children, the Legislature intends the primary
473recipients of services provided through the corporation be
474school-age children with a family income below 200 percent of
475the federal poverty level, who do not qualify for Medicaid. It
476is also the intent of the Legislature that state and local
477government Florida Healthy Kids funds be used to continue
478coverage, subject to specific appropriations in the General
479Appropriations Act, to children not eligible for federal
480matching funds under Title XXI.
481     (5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
482     (b)  The Florida Healthy Kids Corporation shall:
483     1.  Arrange for the collection of any family, local
484contributions, or employer payment or premium, in an amount to
485be determined by the board of directors, to provide for payment
486of premiums for comprehensive insurance coverage and for the
487actual or estimated administrative expenses.
488     2.  Arrange for the collection of any voluntary
489contributions to provide for payment of premiums for children
490who are not eligible for medical assistance under Title XXI of
491the Social Security Act.
492     3.  Subject to the provisions of s. 409.8134, accept
493voluntary supplemental local match contributions that comply
494with the requirements of Title XXI of the Social Security Act
495for the purpose of providing additional coverage in contributing
496counties under Title XXI.
497     4.  Establish the administrative and accounting procedures
498for the operation of the corporation.
499     5.  Establish, with consultation from appropriate
500professional organizations, standards for preventive health
501services and providers and comprehensive insurance benefits
502appropriate to children, provided that such standards for rural
503areas shall not limit primary care providers to board-certified
504pediatricians.
505     6.  Determine eligibility for children seeking to
506participate in the Title XXI-funded components of the Florida
507Kidcare program consistent with the requirements specified in s.
508409.814, as well as the non-Title-XXI-eligible children as
509provided in subsection (3).
510     7.  Establish procedures under which providers of local
511match to, applicants to and participants in the program may have
512grievances reviewed by an impartial body and reported to the
513board of directors of the corporation.
514     8.  Establish participation criteria and, if appropriate,
515contract with an authorized insurer, health maintenance
516organization, or third-party administrator to provide
517administrative services to the corporation.
518     9.  Establish enrollment criteria which shall include
519penalties or waiting periods of not fewer than 60 days for
520reinstatement of coverage upon voluntary cancellation for
521nonpayment of family premiums.
522     10.  Contract with authorized insurers or any provider of
523health care services, meeting standards established by the
524corporation, for the provision of comprehensive insurance
525coverage to participants. Such standards shall include criteria
526under which the corporation may contract with more than one
527provider of health care services in program sites. Health plans
528shall be selected through a competitive bid process. The Florida
529Healthy Kids Corporation shall purchase goods and services in
530the most cost-effective manner consistent with the delivery of
531quality medical care. The maximum administrative cost for a
532Florida Healthy Kids Corporation contract shall be 15 percent.
533For health care contracts, the minimum medical loss ratio for a
534Florida Healthy Kids Corporation contract shall be 85 percent.
535For dental contracts, the remaining compensation to be paid to
536the authorized insurer or provider under a Florida Healthy Kids
537Corporation contract shall be no less than an amount which is 85
538percent of premium; to the extent any contract provision does
539not provide for this minimum compensation, this section shall
540prevail. The health plan selection criteria and scoring system,
541and the scoring results, shall be available upon request for
542inspection after the bids have been awarded.
543     11.  Establish disenrollment criteria in the event local
544matching funds are insufficient to cover enrollments.
545     12.  Develop and implement a plan to publicize the Florida
546Kidcare program Healthy Kids Corporation, the eligibility
547requirements of the program, and the procedures for enrollment
548in the program and to maintain public awareness of the
549corporation and the program. Health care and dental health plans
550participating in the program may develop and distribute
551marketing and other promotional materials and participate in
552activities, such as health fairs and public events, as approved
553by the corporation. Health care and dental health plans may also
554contact their current and former enrollees to encourage
555continued participation in the program and assist the enrollee
556in transferring from a Title XIX-funded plan to a Title XXI-
557funded plan.
558     13.  Establish an assignment process for Florida Healthy
559Kids program enrollees to ensure that family members are
560assigned to the same managed care plan to the greatest extent
561possible, including situations in which some family members are
562enrolled in a Medicaid managed care plan and other family
563members are enrolled in a Florida Healthy Kids plan. The Agency
564for Health Care Administration shall consult with the
565corporation to implement this subparagraph.
566     14.13.  Secure staff necessary to properly administer the
567corporation. Staff costs shall be funded from state and local
568matching funds and such other private or public funds as become
569available. The board of directors shall determine the number of
570staff members necessary to administer the corporation.
571     15.14.  Provide a report annually to the Governor, Chief
572Financial Officer, Commissioner of Education, Senate President,
573Speaker of the House of Representatives, and Minority Leaders of
574the Senate and the House of Representatives.
575     16.  Provide a report by October 31, 2008, to the Governor,
576the Senate, and the House of Representatives, which includes an
577actuarial analysis of the projected impact on premiums from the
578addition of habilitative and behavior analysis services in
579accordance with s. 409.815.
580     17.  Provide information on a quarterly basis to the
581Governor, the Senate, and the House of Representatives that
582assesses the cost and utilization of services for the Florida
583Healthy Kids health benefits plans provided through the Florida
584Healthy Kids Corporation. The information must be specific to
585each eligibility component of the plan and, at a minimum,
586include:
587     a.  The monthly enrollment and expenditures for enrollees.
588     b.  The cost and utilization of specific services.
589     c.  An analysis of the impact on premiums prior to and
590following implementation of the Window of Opportunity Act.
591     d.  An analysis of trends regarding transfer of enrollees
592from the Florida Healthy Kids plans to the Children's Medical
593Services Network plan.
594     e.  Any recommendations resulting from the analysis
595conducted under this subparagraph.
596     18.15.  Establish benefit packages which conform to the
597provisions of the Florida Kidcare program, as created in ss.
598409.810-409.820.
599     Section 13.  Section 624.916, Florida Statutes, is created
600to read:
601     624.916  Developmental disabilities compact.--
602     (1)  The Office of Insurance Regulation shall convene a
603workgroup by August 31, 2008, for the purpose of negotiating a
604compact that includes a binding agreement among the participants
605relating to insurance and access to services for persons with
606developmental disabilities as defined in s. 393.063, with the
607addition of autism spectrum disorder, as defined in s. 409.811.
608The workgroup shall consist of the following:
609     (a)  Representatives of all health insurers licensed under
610this chapter.
611     (b)  Representatives of all health maintenance
612organizations licensed under part I of chapter 641.
613     (c)  Representatives of employers with self-insured health
614benefit plans.
615     (d)  Two designees of the Governor, one of whom must be a
616consumer advocate.
617     (e)  A designee of the President of the Senate.
618     (f)  A designee of the Speaker of the House of
619Representatives.
620     (2)  The Office of Insurance Regulation shall convene a
621consumer advisory workgroup for the purpose of providing a forum
622for comment on the compact negotiated in subsection (1). The
623office shall convene the workgroup prior to finalization of the
624compact.
625     (3)  The agreement shall include the following components:
626     (a)  A requirement that each signatory to the agreement
627increase coverage for behavior analysis and behavior assistant
628services as defined in s. 409.815(2)(r) and speech therapy,
629physical therapy, and occupational therapy when medically
630necessary due to the presence of a developmental disability as
631defined in s. 393.063 or autism spectrum disorder, as defined in
632s. 409.811.
633     (b)  Procedures for clear and specific notice to
634policyholders identifying the amount, scope, and conditions
635under which coverage is provided for behavior analysis and
636behavior assistant services as defined in s. 409.815(2)(r) and
637speech therapy, physical therapy, and occupational therapy when
638medically necessary due to the presence of a developmental
639disability as defined in s. 393.063 or autism spectrum disorder,
640as defined in s. 409.811.
641     (c)  Penalties for documented cases of denial of claims for
642medically necessary services due to the presence of a
643developmental disability as defined in s. 393.063 or autism
644spectrum disorder, as defined in s. 409.811.
645     (d)  Proposals for new product lines that may be offered in
646conjunction with traditional health insurance and provide a more
647appropriate means of spreading risk, financing costs, and
648accessing favorable prices.
649     (4)  Upon completion of the negotiations for the compact,
650the office shall report the results to the Governor, the
651President of the Senate, and the Speaker of the House of
652Representatives.
653     (5)  Beginning February 15, 2009, and continuing annually
654thereafter, the Office of Insurance Regulation shall provide a
655report to the Governor, the President of the Senate, and the
656Speaker of the House of Representatives regarding the
657implementation of the agreement negotiated under this section.
658The report shall include:
659     (a)  The signatories to the agreement.
660     (b)  An analysis of the coverage provided under the
661agreement in comparison to the coverage required under ss.
662627.6686 and 641.31098.
663     (c)  An analysis of the compliance with the agreement by
664the signatories, including documented cases of claims denied in
665violation of the agreement.
666     (6)  The Office of Insurance Regulation shall continue to
667monitor participation, compliance, and effectiveness of the
668agreement and report its findings at least annually.
669     Section 14.  Section 627.6686, Florida Statutes, is created
670to read:
671     627.6686  Coverage for individuals with developmental
672disabilities required; exception.--
673     (1)  As used in this section, the term:
674     (a)  "Developmental disability" has the same meaning as
675provided in s. 393.063, with the addition of autism spectrum
676disorder, as defined in s. 409.811.
677     (b)  "Eligible individual" means an individual under 18
678years of age or an individual 18 years of age or older who is in
679high school who has been diagnosed as having a developmental
680disability at 8 years of age or younger.
681     (c)  "Health insurance plan" means a group health insurance
682policy or group health benefit plan offered by an insurer which
683includes the state group insurance program provided under s.
684110.123. The term does not include any health insurance plan
685offered in the individual market, any health insurance plan that
686is individually underwritten, or any health insurance plan
687provided to a small employer.
688     (d)  "Insurer" means an insurer providing health insurance
689coverage, which is licensed to engage in the business of
690insurance in this state and is subject to insurance regulation.
691     (2)  A health insurance plan issued or renewed on or after
692July 1, 2009, shall provide coverage to an eligible individual
693for:
694     (a)  Well-baby and well-child screening for diagnosing the
695presence of a developmental disability.
696     (b)  Treatment of a developmental disability through speech
697therapy, occupational therapy, physical therapy, and behavior
698analysis services. Behavior analysis services shall be provided
699by an individual certified pursuant to s. 393.17 or an
700individual licensed under chapter 490 or chapter 491.
701     (3)  The coverage required pursuant to subsection (2) is
702subject to the following requirements:
703     (a)  Coverage shall be limited to treatment that is
704prescribed by the insured's treating physician in accordance
705with a treatment plan.
706     (b)  Coverage for the services described in subsection (2)
707shall be limited to $36,000 annually and may not exceed $108,000
708in total lifetime benefits.
709     (c)  Coverage may not be denied on the basis that provided
710services are habilitative in nature.
711     (d)  Coverage may be subject to other general exclusions
712and limitations of the insurer's policy or plan, including, but
713not limited to, coordination of benefits, participating provider
714requirements, restrictions on services provided by family or
715household members, and utilization review of health care
716services, including the review of medical necessity, case
717management, and other managed care provisions.
718     (4)  The coverage required pursuant to subsection (2) may
719not be subject to dollar limits, deductibles, or coinsurance
720provisions that are less favorable to an insured than the dollar
721limits, deductibles, or coinsurance provisions that apply to
722physical illnesses that are generally covered under the health
723insurance plan, except as otherwise provided in subsection (3).
724     (5)  An insurer may not deny or refuse to issue coverage
725for medically necessary services, refuse to contract with, or
726refuse to renew or reissue or otherwise terminate or restrict
727coverage for an individual because the individual is diagnosed
728as having a developmental disability.
729     (6)  The treatment plan required pursuant to subsection (3)
730shall include all elements necessary for the health insurance
731plan to appropriately pay claims. These elements include, but
732are not limited to, a diagnosis, the proposed treatment by type,
733the frequency and duration of treatment, the anticipated
734outcomes stated as goals, the frequency with which the treatment
735plan will be updated, and the signature of the treating
736physician.
737     (7)  Beginning January 1, 2011, the maximum benefit under
738paragraph (3)(b) shall be adjusted annually on January 1 of each
739calendar year to reflect any change from the previous year in
740the medical component of the then current Consumer Price Index
741for all urban consumers, published by the Bureau of Labor
742Statistics of the United States Department of Labor.
743     (8)  This section may not be construed as limiting benefits
744and coverage otherwise available to an insured under a health
745insurance plan.
746     (9)  The Office of Insurance Regulation may not enforce
747this section against an insurer that is a signatory no later
748than July 1, 2009, to the developmental disabilities compact
749established under s. 624.916. The Office of Insurance Regulation
750shall enforce this section against an insurer that is a
751signatory to the compact established under s. 624.916 if the
752insurer has not complied with the terms of the compact for all
753health insurance plans by July 1, 2010.
754     Section 15.  Section 641.31098, Florida Statutes, is
755created to read:
756     641.31098  Coverage for individuals with developmental
757disabilities.--
758     (1)  As used in this section, the term:
759     (a)  "Developmental disability" has the same meaning as
760provided in s. 393.063, with the addition of autism spectrum
761disorder, as defined in s. 409.811.
762
763
764
765
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766
T I T L E  A M E N D M E N T
767     Remove lines 1509-1510 and insert:
768
769definition of the term "Down syndrome"; amending s.
770409.811, F.S.; providing a definition of the term "autism
771spectrum disorder"; amending s. 409.8132, F.S.; revising
772provisions relating to enrollment


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