| 1 | Representative Coley offered the following: |
| 2 |
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| 3 | Amendment to Amendment (171333) (with title amendment) |
| 4 | Remove lines 19-742 and insert: |
| 5 | Section 3. Subsections (13) through (40) of section |
| 6 | 393.063, Florida Statutes, are renumbered as subsections (14) |
| 7 | through (41), respectively, subsections (3) and (9) are amended, |
| 8 | and a new subsection (13) is added to that section, to read: |
| 9 | 393.063 Definitions.--For the purposes of this chapter, |
| 10 | the term: |
| 11 | (3)(a) "Autism" means a pervasive, neurologically based |
| 12 | developmental disability of extended duration which causes |
| 13 | severe learning, communication, and behavior disorders with age |
| 14 | of onset during infancy or childhood. Individuals with autism |
| 15 | exhibit impairment in reciprocal social interaction, impairment |
| 16 | in verbal and nonverbal communication and imaginative ability, |
| 17 | and a markedly restricted repertoire of activities and |
| 18 | interests. |
| 19 | (b) "Autism spectrum disorder" means any of the following |
| 20 | disorders as defined with most recent edition of the Diagnostic |
| 21 | and Statistical Manual of Mental Disorders of the American |
| 22 | Psychiatric Association: |
| 23 | 1. Autistic disorder; |
| 24 | 2. Asperger syndrome; or |
| 25 | 3. Pervasive developmental disorder not otherwise |
| 26 | specified. |
| 27 | (9) "Developmental disability" means a disorder or |
| 28 | syndrome that is attributable to retardation, cerebral palsy, |
| 29 | autism, spina bifida, Down syndrome, or Prader-Willi syndrome; |
| 30 | that manifests before the age of 18; and that constitutes a |
| 31 | substantial handicap that can reasonably be expected to continue |
| 32 | indefinitely. |
| 33 | (13) "Down syndrome" means a genetic disorder caused by |
| 34 | the presence of extra chromosomal material on chromosome 21. |
| 35 | Causes of the syndrome may include Trisomy 21, Mosaicism, |
| 36 | Robertsonian Translocation, and other duplications of a portion |
| 37 | of chromosome 21. |
| 38 | Section 4. Subsection (7) of section 409.8132, Florida |
| 39 | Statutes, is amended to read: |
| 40 | 409.8132 Medikids program component.-- |
| 41 | (7) ENROLLMENT.--Enrollment in the Medikids program |
| 42 | component may occur at any time throughout the year. A child may |
| 43 | not receive services under the Medikids program until the child |
| 44 | is enrolled in a managed care plan or MediPass. Once determined |
| 45 | eligible, an applicant may receive choice counseling and select |
| 46 | a managed care plan or MediPass. The agency may initiate |
| 47 | mandatory assignment for a Medikids applicant who has not chosen |
| 48 | a managed care plan or MediPass provider after the applicant's |
| 49 | voluntary choice period ends; however, the agency shall ensure |
| 50 | that family members are assigned to the same managed care plan |
| 51 | or the same MediPass provider to the greatest extent possible, |
| 52 | including situations in which some family members are enrolled |
| 53 | in Medicaid and other family members are enrolled in a Title |
| 54 | XXI-funded component of the Florida Kidcare program. An |
| 55 | applicant may select MediPass under the Medikids program |
| 56 | component only in counties that have fewer than two managed care |
| 57 | plans available to serve Medicaid recipients and only if the |
| 58 | federal Health Care Financing Administration determines that |
| 59 | MediPass constitutes "health insurance coverage" as defined in |
| 60 | Title XXI of the Social Security Act. |
| 61 | Section 5. Subsection (2) of section 409.8134, Florida |
| 62 | Statutes, is amended, and subsection (5) is added to that |
| 63 | section, to read: |
| 64 | 409.8134 Program expenditure ceiling.-- |
| 65 | (2) Open enrollment periods shall consist of: |
| 66 | (a) Enrollment for premium assistance.--The Florida |
| 67 | Kidcare program may conduct enrollment at any time throughout |
| 68 | the year for the purpose of enrolling children eligible for all |
| 69 | program components listed in s. 409.813 except Medicaid. The |
| 70 | four Florida Kidcare administrators shall work together to |
| 71 | ensure that the year-round enrollment period is announced |
| 72 | statewide. Eligible children for premium assistance shall be |
| 73 | enrolled on a first-come, first-served basis using the date the |
| 74 | enrollment application is received. Enrollment shall immediately |
| 75 | cease when the expenditure ceiling is reached. Year-round |
| 76 | enrollment for premium assistance shall only be held if the |
| 77 | Social Services Estimating Conference determines that sufficient |
| 78 | federal and state funds will be available to finance the |
| 79 | increased enrollment through federal fiscal year 2007. Any |
| 80 | individual who is not enrolled must reapply by submitting a new |
| 81 | application. The application for the Florida Kidcare program |
| 82 | shall be valid for a period of 120 days after the date it was |
| 83 | received. At the end of the 120-day period, if the applicant has |
| 84 | not been enrolled in the program, the application shall be |
| 85 | invalid and the applicant shall be notified of the action. The |
| 86 | applicant may reactivate resubmit the application after |
| 87 | notification of the action taken by the program. Except for the |
| 88 | Medicaid program, whenever the Social Services Estimating |
| 89 | Conference determines that there are presently, or will be by |
| 90 | the end of the current fiscal year, insufficient funds to |
| 91 | finance the current or projected enrollment in the Florida |
| 92 | Kidcare program, all additional enrollment must cease and |
| 93 | additional enrollment may not resume until sufficient funds are |
| 94 | available to finance such enrollment. |
| 95 | (b) Open enrollment without premium assistance, effective |
| 96 | July 1, 2009.-- |
| 97 | 1. Effective July 1, 2009, an open enrollment period for |
| 98 | the Florida Healthy Kids program for those enrollees not |
| 99 | eligible for premium assistance may be held once each fiscal |
| 100 | year and may not exceed 30 consecutive calendar days in length. |
| 101 | The timing and length of any open enrollment period shall be |
| 102 | determined by the Florida Healthy Kids Corporation. Applicants |
| 103 | shall be enrolled on a first come, first served basis, based |
| 104 | upon the date the application was received. During the 2009-2010 |
| 105 | fiscal year, the effective date for new enrollees without |
| 106 | premium assistance shall be October 1, 2009. However, for a |
| 107 | child who has had his or her coverage in an employer-sponsored |
| 108 | or private health benefit plan voluntarily canceled in the last |
| 109 | 90 days and who is otherwise eligible to participate without |
| 110 | premium assistance the effective date of coverage shall be the |
| 111 | end of the 90-day period or October 1, 2009, whichever is later. |
| 112 | 2. The following individuals are not subject to the open |
| 113 | enrollment period: |
| 114 | a. Enrollees in any Florida Kidcare program component that |
| 115 | are determined to be no longer eligible under that component due |
| 116 | to changes in income or age. These enrollees may transfer to the |
| 117 | Healthy Kids program if such transfer is initiated within 30 |
| 118 | days after the loss of such eligibility. |
| 119 | b. Applicants that have adopted a child in the state. |
| 120 | c. Applicants who have had employer-sponsored or private |
| 121 | health insurance involuntarily canceled within 30 days prior to |
| 122 | submission of the application. |
| 123 | 3. Any individual who is not enrolled under this |
| 124 | subsection must reapply by submitting a new application during |
| 125 | the next open enrollment period. The application for the Florida |
| 126 | Kidcare program without premium assistance shall be valid for |
| 127 | the period of the open enrollment. |
| 128 | (5) Effective October 1, 2009, upon determination by the |
| 129 | Social Service Estimating Conference, in consultation with the |
| 130 | agency and the Florida Healthy Kids Corporation, that enrollment |
| 131 | of children whose family income exceeds 200 percent of the |
| 132 | federal poverty level is projected to raise overall premiums per |
| 133 | enrollee by greater than 5_percent of current average premiums |
| 134 | in the Florida Healthy Kids plans, the board of directors of the |
| 135 | Florida Healthy Kids Corporation may, with the concurrence of |
| 136 | the agency, take appropriate actions to reduce the projected |
| 137 | cost below the projected_5 percent increase. Actions the board |
| 138 | may take may include, but are not limited to: |
| 139 | (a) Reducing habilitative and behavior analysis benefits |
| 140 | to enrollees who are receiving these services. |
| 141 | (b) Eliminating habilitative and or behavior analysis |
| 142 | services as a benefit in Healthy Kids plans for enrollees and |
| 143 | providing enrollees the opportunity to purchase these benefits |
| 144 | separately. |
| 145 | (c) Increasing copayments for habilitative and behavior |
| 146 | analysis services provided to nonpremium assistance enrollees. |
| 147 | (d) Reducing benefit packages to all nonpremium assistance |
| 148 | enrollees. |
| 149 | Section 6. Paragraphs (c) and (f) of subsection (4) and |
| 150 | subsections (5), (7), and (8) of section 409.814, Florida |
| 151 | Statutes, are amended to read: |
| 152 | 409.814 Eligibility.--A child who has not reached 19 years |
| 153 | of age whose family income is equal to or below 200 percent of |
| 154 | the federal poverty level is eligible for the Florida Kidcare |
| 155 | program as provided in this section. For enrollment in the |
| 156 | Children's Medical Services Network, a complete application |
| 157 | includes the medical or behavioral health screening. If, |
| 158 | subsequently, an individual is determined to be ineligible for |
| 159 | coverage, he or she must immediately be disenrolled from the |
| 160 | respective Florida Kidcare program component. |
| 161 | (4) The following children are not eligible to receive |
| 162 | premium assistance for health benefits coverage under the |
| 163 | Florida Kidcare program, except under Medicaid if the child |
| 164 | would have been eligible for Medicaid under s. 409.903 or s. |
| 165 | 409.904 as of June 1, 1997: |
| 166 | (c) A child who is seeking premium assistance for the |
| 167 | Florida Kidcare program through employer-sponsored group |
| 168 | coverage, if the child has been covered by the same employer's |
| 169 | group coverage during the 90 days 6 months prior to the family's |
| 170 | submitting an application for determination of eligibility under |
| 171 | the program. |
| 172 | (f) A child who has had his or her coverage in an |
| 173 | employer-sponsored or private health benefit plan voluntarily |
| 174 | canceled in the last 90 days 6 months, except those children who |
| 175 | were on the waiting list prior to March 12, 2004, or whose |
| 176 | coverage was voluntarily canceled for good cause, including, but |
| 177 | not limited to, the following circumstances: |
| 178 | 1. The cost of participation in an employer-sponsored or |
| 179 | private health benefit plan is greater than 5 percent of the |
| 180 | family's income; |
| 181 | 2. The parent lost a job that provided an employer- |
| 182 | sponsored health benefit plan for children; |
| 183 | 3. The parent with health benefits coverage for the child |
| 184 | is deceased; |
| 185 | 4. The employer of the parent canceled health benefits |
| 186 | coverage for children; |
| 187 | 5. The child's health benefits coverage ended because the |
| 188 | child reached the maximum lifetime coverage amount; |
| 189 | 6. The child has exhausted coverage under a COBRA |
| 190 | continuation provision; or |
| 191 | 7. A situation involving domestic violence led to the loss |
| 192 | of coverage. |
| 193 | (5) A child whose family income is above 200 percent of |
| 194 | the federal poverty level or a child who is excluded under the |
| 195 | provisions of subsection (4) may participate in the Medikids |
| 196 | program as provided in s. 409.8132 or, if the child is |
| 197 | ineligible for Medikids by reason of age, in the Florida Healthy |
| 198 | Kids program as provided in s. 624.91, subject to the following |
| 199 | provisions: |
| 200 | (a) The family is not eligible for premium assistance |
| 201 | payments and must pay the full cost of the premium, including |
| 202 | any administrative costs. |
| 203 | (b) Effective October 1, 2009, new applicants for |
| 204 | nonpremium assistance in the Medikids program shall enroll in |
| 205 | the Florida Healthy Kids program component of the Florida |
| 206 | Kidcare program. The agency is authorized to place limits on |
| 207 | enrollment in Medikids by these children in order to avoid |
| 208 | adverse selection. The number of children participating in |
| 209 | Medikids whose family income exceeds 200 percent of the federal |
| 210 | poverty level must not exceed 10 percent of total enrollees in |
| 211 | the Medikids program. |
| 212 | (c) The board of directors of the Florida Healthy Kids |
| 213 | Corporation is authorized to place limits on enrollment of these |
| 214 | children in order to avoid adverse selection. In addition, the |
| 215 | board is authorized to offer a reduced benefit package to these |
| 216 | children in order to limit program costs for such families. The |
| 217 | number of children participating in the Florida Healthy Kids |
| 218 | program whose family income exceeds 200 percent of the federal |
| 219 | poverty level must not exceed 10 percent of total enrollees in |
| 220 | the Florida Healthy Kids program. |
| 221 | (7) When determining or reviewing a child's eligibility |
| 222 | under the Florida Kidcare program, the applicant shall be |
| 223 | provided with reasonable notice of changes in eligibility which |
| 224 | may affect enrollment in one or more of the program components. |
| 225 | When a transition from one program component to another is |
| 226 | authorized, there shall be cooperation between the program |
| 227 | components, and the affected family, the child's health |
| 228 | insurance plan, and the child's health care providers to promote |
| 229 | which promotes continuity of health care coverage. If a child is |
| 230 | determined ineligible for Medicaid or Medikids, the agency, in |
| 231 | coordination with the department, shall notify that child's |
| 232 | Medicaid managed care plan or MediPass provider of such |
| 233 | determination before the child's eligibility is scheduled to be |
| 234 | terminated so that the Medicaid managed care plan or MediPass |
| 235 | provider can assist the child's family in applying for Florida |
| 236 | Kidcare program coverage. Any authorized transfers must be |
| 237 | managed within the program's overall appropriated or authorized |
| 238 | levels of funding. Each component of the program shall establish |
| 239 | a reserve to ensure that transfers between components will be |
| 240 | accomplished within current year appropriations. These reserves |
| 241 | shall be reviewed by each convening of the Social Services |
| 242 | Estimating Conference to determine the adequacy of such reserves |
| 243 | to meet actual experience. |
| 244 | (8) In determining the eligibility of a child for the |
| 245 | Florida Kidcare program, an assets test is not required. The |
| 246 | information required under this section from each applicant |
| 247 | shall be obtained electronically to the extent possible. If such |
| 248 | information cannot be obtained electronically, the Each |
| 249 | applicant shall provide written documentation during the |
| 250 | application process and the redetermination process, including, |
| 251 | but not limited to, the following: |
| 252 | (a) Proof of family income, which must include a copy of |
| 253 | the applicant's most recent federal income tax return. In the |
| 254 | absence of a federal income tax return, an applicant may submit |
| 255 | wages and earnings statements (pay stubs), W-2 forms, or other |
| 256 | appropriate documents. |
| 257 | (b) A statement from all family members that: |
| 258 | 1. Their employer does not sponsor a health benefit plan |
| 259 | for employees; or |
| 260 | 2. The potential enrollee is not covered by the employer- |
| 261 | sponsored health benefit plan because the potential enrollee is |
| 262 | not eligible for coverage, or, if the potential enrollee is |
| 263 | eligible but not covered, a statement of the cost to enroll the |
| 264 | potential enrollee in the employer-sponsored health benefit |
| 265 | plan. |
| 266 |
|
| 267 | An individual who applies for coverage under the Florida Kidcare |
| 268 | program and who pays the full cost of the premium is exempt from |
| 269 | the requirements of this subsection. |
| 270 | Section 7. Paragraphs (r) through (v) of subsection (2) of |
| 271 | section 409.815, Florida Statutes, are redesignated as |
| 272 | paragraphs (s) through (w), respectively, present paragraphs |
| 273 | (o), (r), and (u) are amended, and a new paragraph (r) is added |
| 274 | to that subsection, to read: |
| 275 | 409.815 Health benefits coverage; limitations.-- |
| 276 | (2) BENCHMARK BENEFITS.--In order for health benefits |
| 277 | coverage to qualify for premium assistance payments for an |
| 278 | eligible child under ss. 409.810-409.820, the health benefits |
| 279 | coverage, except for coverage under Medicaid and Medikids, must |
| 280 | include the following minimum benefits, as medically necessary. |
| 281 | (o) Therapy services.--Covered services include |
| 282 | habilitative and rehabilitative services, including |
| 283 | occupational, physical, respiratory, and speech therapies, with |
| 284 | the following limitations: |
| 285 | 1. Rehabilitative services are limited to: |
| 286 | a.1. Services must be for Short-term rehabilitation when |
| 287 | where significant improvement in the enrollee's condition will |
| 288 | result; and |
| 289 | b.2. Services shall be limited to Not more than 24 |
| 290 | treatment sessions within a 60-day period per episode or injury, |
| 291 | with the 60-day period beginning with the first treatment. |
| 292 | 2. Effective October 1, 2009, habilitative services shall |
| 293 | be offered and are limited to: |
| 294 | a. Habilitation when improvements in and maintenance of |
| 295 | human behavior, skill acquisition, and communication will |
| 296 | result; and |
| 297 | b. Enrollees that are diagnosed with a developmental |
| 298 | disability as defined in s. 393.063(3)(a) or autism spectrum |
| 299 | disorder as defined in s. 393.063(3)(b). |
| 300 | (r) Behavior analysis services.--Effective October 1, |
| 301 | 2009, behavior analysis and behavior assistant services shall be |
| 302 | covered for enrollees that are diagnosed with a developmental |
| 303 | disability as defined in s. 393.063(3)(a) or autism spectrum |
| 304 | disorder as defined in s. 393.063(3)(b). For purposes of this |
| 305 | paragraph: |
| 306 | 1. "Behavior analysis" means the design, implementation, |
| 307 | and evaluation of instructional and environmental modifications |
| 308 | to produce socially significant improvements in human behavior |
| 309 | through skill acquisition and the reduction of problematic |
| 310 | behavior. Behavior analysis shall be provided by an individual |
| 311 | certified pursuant to s. 393.17 or an individual licensed under |
| 312 | chapter 490 or chapter 491. |
| 313 | 2. "Behavior assistant services" means services provided |
| 314 | by an individual with specific training to assist in carrying |
| 315 | out plans designed by a behavior analyst. |
| 316 | (s)(r) Lifetime maximum and limitations.--Health benefits |
| 317 | coverage obtained under ss. 409.810-409.820 shall pay an |
| 318 | enrollee's covered expenses at a lifetime maximum of $1 million |
| 319 | per covered child. However, coverage for the combination of |
| 320 | behavior analysis services and habilitative therapy services for |
| 321 | recipients diagnosed with a developmental disability as defined |
| 322 | in s. 393.063(3)(a) or autism spectrum disorder as defined in s. |
| 323 | 393.063(3)(b) shall be limited to $36,000 annually and may not |
| 324 | exceed $108,000 in total lifetime benefits. Without prior |
| 325 | authorization by the Florida Healthy Kids plan, not more than 12 |
| 326 | percent of the annual maximum amount for combined habilitative |
| 327 | therapy and behavior analysis services may be used on a monthly |
| 328 | basis. |
| 329 | (v)(u) Enhancements to minimum requirements.-- |
| 330 | 1. This section sets the minimum benefits that must be |
| 331 | included in any health benefits coverage, other than Medicaid or |
| 332 | Medikids coverage, offered under ss. 409.810-409.820. Health |
| 333 | benefits coverage may include additional benefits not included |
| 334 | under this subsection, but may not include benefits excluded |
| 335 | under paragraph (t) (s). |
| 336 | 2. Health benefits coverage may extend any limitations |
| 337 | beyond the minimum benefits described in this section. |
| 338 |
|
| 339 | Except for the Children's Medical Services Network, the agency |
| 340 | may not increase the premium assistance payment for either |
| 341 | additional benefits provided beyond the minimum benefits |
| 342 | described in this section or the imposition of less restrictive |
| 343 | service limitations. |
| 344 | Section 8. Paragraph (b) of subsection (1) of section |
| 345 | 409.818, Florida Statutes, is amended to read: |
| 346 | 409.818 Administration.--In order to implement ss. |
| 347 | 409.810-409.820, the following agencies shall have the following |
| 348 | duties: |
| 349 | (1) The Department of Children and Family Services shall: |
| 350 | (b) Establish and maintain the eligibility determination |
| 351 | process under the program except as specified in subsection (5). |
| 352 | The department shall directly, or through the services of a |
| 353 | contracted third-party administrator, establish and maintain a |
| 354 | process for determining eligibility of children for coverage |
| 355 | under the program. The eligibility determination process must be |
| 356 | used solely for determining eligibility of applicants for health |
| 357 | benefits coverage under the program. The eligibility |
| 358 | determination process must include an initial determination of |
| 359 | eligibility for any coverage offered under the program, as well |
| 360 | as a redetermination or reverification of eligibility each |
| 361 | subsequent 12 6 months. Effective January 1, 1999, a child who |
| 362 | has not attained the age of 5 and who has been determined |
| 363 | eligible for the Medicaid program is eligible for coverage for |
| 364 | 12 months without a redetermination or reverification of |
| 365 | eligibility. In conducting an eligibility determination, the |
| 366 | department shall determine if the child has special health care |
| 367 | needs. The department, in consultation with the Agency for |
| 368 | Health Care Administration and the Florida Healthy Kids |
| 369 | Corporation, shall develop procedures for redetermining |
| 370 | eligibility which enable a family to easily update any change in |
| 371 | circumstances which could affect eligibility. The department may |
| 372 | accept changes in a family's status as reported to the |
| 373 | department by the Florida Healthy Kids Corporation without |
| 374 | requiring a new application from the family. Redetermination of |
| 375 | a child's eligibility for Medicaid may not be linked to a |
| 376 | child's eligibility determination for other programs. |
| 377 | Section 9. Subsection (26) is added to section 409.906, |
| 378 | Florida Statutes, to read: |
| 379 | 409.906 Optional Medicaid services.--Subject to specific |
| 380 | appropriations, the agency may make payments for services which |
| 381 | are optional to the state under Title XIX of the Social Security |
| 382 | Act and are furnished by Medicaid providers to recipients who |
| 383 | are determined to be eligible on the dates on which the services |
| 384 | were provided. Any optional service that is provided shall be |
| 385 | provided only when medically necessary and in accordance with |
| 386 | state and federal law. Optional services rendered by providers |
| 387 | in mobile units to Medicaid recipients may be restricted or |
| 388 | prohibited by the agency. Nothing in this section shall be |
| 389 | construed to prevent or limit the agency from adjusting fees, |
| 390 | reimbursement rates, lengths of stay, number of visits, or |
| 391 | number of services, or making any other adjustments necessary to |
| 392 | comply with the availability of moneys and any limitations or |
| 393 | directions provided for in the General Appropriations Act or |
| 394 | chapter 216. If necessary to safeguard the state's systems of |
| 395 | providing services to elderly and disabled persons and subject |
| 396 | to the notice and review provisions of s. 216.177, the Governor |
| 397 | may direct the Agency for Health Care Administration to amend |
| 398 | the Medicaid state plan to delete the optional Medicaid service |
| 399 | known as "Intermediate Care Facilities for the Developmentally |
| 400 | Disabled." Optional services may include: |
| 401 | (26) HOME AND COMMUNITY-BASED SERVICES FOR AUTISM SPECTRUM |
| 402 | DISORDER AND OTHER DEVELOPMENTAL DISABILITIES.--The agency is |
| 403 | authorized to seek federal approval through a Medicaid waiver or |
| 404 | a state plan amendment for the provision of occupational |
| 405 | therapy, speech therapy, physical therapy, behavior analysis, |
| 406 | and behavior assistant services to individuals who are 5 years |
| 407 | of age and under and have a diagnosed developmental disability |
| 408 | as defined in s. 393.063(3)(a) or autism spectrum disorder as |
| 409 | defined in s. 393.063(3)(b). Coverage for such services shall be |
| 410 | limited to $36,000 annually and may not exceed $108,000 in total |
| 411 | lifetime benefits. The agency shall submit an annual report |
| 412 | beginning on January 1, 2009, to the President of the Senate, |
| 413 | the Speaker of the House of Representatives, and the relevant |
| 414 | committees of the Senate and the House of Representatives |
| 415 | regarding progress on obtaining federal approval and |
| 416 | recommendations for the implementation of these home and |
| 417 | community-based services. The agency may not implement this |
| 418 | subsection without prior legislative approval. |
| 419 | Section 10. Section 456.0291, Florida Statutes, is created |
| 420 | to read: |
| 421 | 456.0291 Requirement for instruction on developmental |
| 422 | disabilities.-- |
| 423 | (1)(a) The appropriate board shall require each person |
| 424 | licensed or certified under part I of chapter 464, chapter 490, |
| 425 | or chapter 491 to complete a 2-hour continuing education course, |
| 426 | approved by the board, on developmental disabilities as defined |
| 427 | in s. 393.063(3)(a) or autism spectrum disorder as defined in s. |
| 428 | 393.063(3)(b), as part of every third biennial relicensure or |
| 429 | recertification. The course shall consist of information on the |
| 430 | diagnosis and treatment of developmental disabilities and |
| 431 | information on counseling and education of a parent whose child |
| 432 | is diagnosed with a developmental disability as defined in s. |
| 433 | 393.063(3)(a), with an emphasis on autism spectrum disorder as |
| 434 | defined in s. 393.063(3)(b). |
| 435 | (b) The Board of Medicine and the Board of Osteopathic |
| 436 | Medicine shall require each physician with a primary care |
| 437 | specialty of pediatrics to complete a 2-hour continuing |
| 438 | education course, approved by the appropriate board, on |
| 439 | developmental disabilities as defined in s. 393.063(3)(a) and |
| 440 | autism spectrum disorder as defined in s. 393.063(3)(b), as part |
| 441 | of every third biennial relicensure. The course shall consist of |
| 442 | information on the diagnosis and treatment of developmental |
| 443 | disabilities and information on counseling and education of a |
| 444 | parent whose child is diagnosed with a developmental disability |
| 445 | as defined in s. 393.063(3)(a), with an emphasis on autism |
| 446 | spectrum disorder as defined in s. 393.063(3)(b). |
| 447 | (c) Each such licensee or certificateholder shall submit |
| 448 | confirmation of having completed the course, on a form provided |
| 449 | by the board, when submitting fees for every third biennial |
| 450 | renewal. |
| 451 | (d) The board may approve additional equivalent courses |
| 452 | that may be used to satisfy the requirements of paragraph (a). |
| 453 | Each licensing board that requires a licensee to complete an |
| 454 | educational course pursuant to this subsection may include the |
| 455 | hours required for completion of the course in the total hours |
| 456 | of continuing education required by law for such profession |
| 457 | unless the continuing education requirements for such profession |
| 458 | consist of fewer than 30 hours biennially. |
| 459 | (e) Any person holding two or more licenses subject to the |
| 460 | provisions of this subsection shall be permitted to show proof |
| 461 | of having taken one board-approved course on developmental |
| 462 | disabilities for purposes of relicensure or recertification for |
| 463 | additional licenses. |
| 464 | (f) Failure to comply with the requirements of this |
| 465 | subsection shall constitute grounds for disciplinary action |
| 466 | under each respective practice act and under s. 456.072(1)(k). |
| 467 | In addition to discipline by the board, the licensee shall be |
| 468 | required to complete such course. |
| 469 | (2) Each board may adopt rules pursuant to ss. 120.536(1) |
| 470 | and 120.54 to carry out the provisions of this section. |
| 471 | (3) The department shall implement a plan to promote |
| 472 | awareness of developmental disabilities as defined in s. |
| 473 | 393.063(3)(a), with an emphasis on autism spectrum disorder as |
| 474 | defined in s. 393.063(3)(b), to physicians licensed under |
| 475 | chapter 458 or chapter 459 and parents. The department shall |
| 476 | develop the plan in consultation with organizations representing |
| 477 | allopathic and osteopathic physicians, the Board of Medicine, |
| 478 | the Board of Osteopathic Medicine, and nationally recognized |
| 479 | organizations that promote awareness of developmental |
| 480 | disabilities. The department's plan shall include the |
| 481 | distribution of educational materials for parents, including a |
| 482 | developmental assessment tool. |
| 483 | Section 11. Paragraph (b) of subsection (2) and paragraph |
| 484 | (b) of subsection (5) of section 624.91, Florida Statutes, are |
| 485 | amended to read: |
| 486 | 624.91 The Florida Healthy Kids Corporation Act.-- |
| 487 | (2) LEGISLATIVE INTENT.-- |
| 488 | (b) It is the intent of the Legislature that the Florida |
| 489 | Healthy Kids Corporation serve as one of several providers of |
| 490 | services to children eligible for medical assistance under Title |
| 491 | XXI of the Social Security Act. Although the corporation may |
| 492 | serve other children, the Legislature intends the primary |
| 493 | recipients of services provided through the corporation be |
| 494 | school-age children with a family income below 200 percent of |
| 495 | the federal poverty level, who do not qualify for Medicaid. It |
| 496 | is also the intent of the Legislature that state and local |
| 497 | government Florida Healthy Kids funds be used to continue |
| 498 | coverage, subject to specific appropriations in the General |
| 499 | Appropriations Act, to children not eligible for federal |
| 500 | matching funds under Title XXI. |
| 501 | (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.-- |
| 502 | (b) The Florida Healthy Kids Corporation shall: |
| 503 | 1. Arrange for the collection of any family, local |
| 504 | contributions, or employer payment or premium, in an amount to |
| 505 | be determined by the board of directors, to provide for payment |
| 506 | of premiums for comprehensive insurance coverage and for the |
| 507 | actual or estimated administrative expenses. |
| 508 | 2. Arrange for the collection of any voluntary |
| 509 | contributions to provide for payment of premiums for children |
| 510 | who are not eligible for medical assistance under Title XXI of |
| 511 | the Social Security Act. |
| 512 | 3. Subject to the provisions of s. 409.8134, accept |
| 513 | voluntary supplemental local match contributions that comply |
| 514 | with the requirements of Title XXI of the Social Security Act |
| 515 | for the purpose of providing additional coverage in contributing |
| 516 | counties under Title XXI. |
| 517 | 4. Establish the administrative and accounting procedures |
| 518 | for the operation of the corporation. |
| 519 | 5. Establish, with consultation from appropriate |
| 520 | professional organizations, standards for preventive health |
| 521 | services and providers and comprehensive insurance benefits |
| 522 | appropriate to children, provided that such standards for rural |
| 523 | areas shall not limit primary care providers to board-certified |
| 524 | pediatricians. |
| 525 | 6. Determine eligibility for children seeking to |
| 526 | participate in the Title XXI-funded components of the Florida |
| 527 | Kidcare program consistent with the requirements specified in s. |
| 528 | 409.814, as well as the non-Title-XXI-eligible children as |
| 529 | provided in subsection (3). |
| 530 | 7. Establish procedures under which providers of local |
| 531 | match to, applicants to and participants in the program may have |
| 532 | grievances reviewed by an impartial body and reported to the |
| 533 | board of directors of the corporation. |
| 534 | 8. Establish participation criteria and, if appropriate, |
| 535 | contract with an authorized insurer, health maintenance |
| 536 | organization, or third-party administrator to provide |
| 537 | administrative services to the corporation. |
| 538 | 9. Establish enrollment criteria which shall include |
| 539 | penalties or waiting periods of not fewer than 60 days for |
| 540 | reinstatement of coverage upon voluntary cancellation for |
| 541 | nonpayment of family premiums. |
| 542 | 10. Contract with authorized insurers or any provider of |
| 543 | health care services, meeting standards established by the |
| 544 | corporation, for the provision of comprehensive insurance |
| 545 | coverage to participants. Such standards shall include criteria |
| 546 | under which the corporation may contract with more than one |
| 547 | provider of health care services in program sites. Health plans |
| 548 | shall be selected through a competitive bid process. The Florida |
| 549 | Healthy Kids Corporation shall purchase goods and services in |
| 550 | the most cost-effective manner consistent with the delivery of |
| 551 | quality medical care. The maximum administrative cost for a |
| 552 | Florida Healthy Kids Corporation contract shall be 15 percent. |
| 553 | For health care contracts, the minimum medical loss ratio for a |
| 554 | Florida Healthy Kids Corporation contract shall be 85 percent. |
| 555 | For dental contracts, the remaining compensation to be paid to |
| 556 | the authorized insurer or provider under a Florida Healthy Kids |
| 557 | Corporation contract shall be no less than an amount which is 85 |
| 558 | percent of premium; to the extent any contract provision does |
| 559 | not provide for this minimum compensation, this section shall |
| 560 | prevail. The health plan selection criteria and scoring system, |
| 561 | and the scoring results, shall be available upon request for |
| 562 | inspection after the bids have been awarded. |
| 563 | 11. Establish disenrollment criteria in the event local |
| 564 | matching funds are insufficient to cover enrollments. |
| 565 | 12. Develop and implement a plan to publicize the Florida |
| 566 | Kidcare program Healthy Kids Corporation, the eligibility |
| 567 | requirements of the program, and the procedures for enrollment |
| 568 | in the program and to maintain public awareness of the |
| 569 | corporation and the program. Health care and dental health plans |
| 570 | participating in the program may develop and distribute |
| 571 | marketing and other promotional materials and participate in |
| 572 | activities, such as health fairs and public events, as approved |
| 573 | by the corporation. Health care and dental health plans may also |
| 574 | contact their current and former enrollees to encourage |
| 575 | continued participation in the program and assist the enrollee |
| 576 | in transferring from a Title XIX-funded plan to a Title XXI- |
| 577 | funded plan. |
| 578 | 13. Establish an assignment process for Florida Healthy |
| 579 | Kids program enrollees to ensure that family members are |
| 580 | assigned to the same managed care plan to the greatest extent |
| 581 | possible, including situations in which some family members are |
| 582 | enrolled in a Medicaid managed care plan and other family |
| 583 | members are enrolled in a Florida Healthy Kids plan. The Agency |
| 584 | for Health Care Administration shall consult with the |
| 585 | corporation to implement this subparagraph. |
| 586 | 14.13. Secure staff necessary to properly administer the |
| 587 | corporation. Staff costs shall be funded from state and local |
| 588 | matching funds and such other private or public funds as become |
| 589 | available. The board of directors shall determine the number of |
| 590 | staff members necessary to administer the corporation. |
| 591 | 15.14. Provide a report annually to the Governor, Chief |
| 592 | Financial Officer, Commissioner of Education, Senate President, |
| 593 | Speaker of the House of Representatives, and Minority Leaders of |
| 594 | the Senate and the House of Representatives. |
| 595 | 16. Provide a report by October 31, 2008, to the Governor, |
| 596 | the Senate, and the House of Representatives, which includes an |
| 597 | actuarial analysis of the projected impact on premiums from the |
| 598 | addition of habilitative and behavior analysis services in |
| 599 | accordance with s. 409.815. |
| 600 | 17. Provide information on a quarterly basis to the |
| 601 | Governor, the Senate, and the House of Representatives that |
| 602 | assesses the cost and utilization of services for the Florida |
| 603 | Healthy Kids health benefits plans provided through the Florida |
| 604 | Healthy Kids Corporation. The information must be specific to |
| 605 | each eligibility component of the plan and, at a minimum, |
| 606 | include: |
| 607 | a. The monthly enrollment and expenditures for enrollees. |
| 608 | b. The cost and utilization of specific services. |
| 609 | c. An analysis of the impact on premiums prior to and |
| 610 | following implementation of the Window of Opportunity Act. |
| 611 | d. An analysis of trends regarding transfer of enrollees |
| 612 | from the Florida Healthy Kids plans to the Children's Medical |
| 613 | Services Network plan. |
| 614 | e. Any recommendations resulting from the analysis |
| 615 | conducted under this subparagraph. |
| 616 | 18.15. Establish benefit packages which conform to the |
| 617 | provisions of the Florida Kidcare program, as created in ss. |
| 618 | 409.810-409.820. |
| 619 | Section 12. Section 624.916, Florida Statutes, is created |
| 620 | to read: |
| 621 | 624.916 Developmental disabilities compact.-- |
| 622 | (1) The Office of Insurance Regulation shall convene a |
| 623 | workgroup by August 31, 2008, for the purpose of negotiating a |
| 624 | compact that includes a binding agreement among the participants |
| 625 | relating to insurance and access to services for persons with |
| 626 | developmental disabilities as defined in s. 393.063 and autism |
| 627 | spectrum disorder as defined in s. 393.063(3)(b). The workgroup |
| 628 | shall consist of the following: |
| 629 | (a) Representatives of all health insurers licensed under |
| 630 | this chapter. |
| 631 | (b) Representatives of all health maintenance |
| 632 | organizations licensed under part I of chapter 641. |
| 633 | (c) Representatives of employers with self-insured health |
| 634 | benefit plans. |
| 635 | (d) Two designees of the Governor, one of whom must be a |
| 636 | consumer advocate. |
| 637 | (e) A designee of the President of the Senate. |
| 638 | (f) A designee of the Speaker of the House of |
| 639 | Representatives. |
| 640 | (2) The Office of Insurance Regulation shall convene a |
| 641 | consumer advisory workgroup for the purpose of providing a forum |
| 642 | for comment on the compact negotiated in subsection (1). The |
| 643 | office shall convene the workgroup prior to finalization of the |
| 644 | compact. |
| 645 | (3) The agreement shall include the following components: |
| 646 | (a) Procedures for clear and specific notice to |
| 647 | policyholders identifying the amount, scope, and conditions |
| 648 | under which coverage is provided for speech therapy, physical |
| 649 | therapy, occupational therapy, and behavioral interventions when |
| 650 | necessary due to the presence of a developmental disability. |
| 651 | (b) Penalties for documented cases of denial of claims for |
| 652 | medically necessary services due to the presence of a |
| 653 | developmental disability. |
| 654 | (c) Proposals for new product lines that may be offered in |
| 655 | conjunction with traditional health insurance and provide a more |
| 656 | appropriate means of spreading risk, financing costs, and |
| 657 | accessing favorable prices. |
| 658 | (4) Upon completion of the negotiations for the compact, |
| 659 | the office shall report the results to the Governor, the |
| 660 | President of the Senate, and the Speaker of the House of |
| 661 | Representatives. The office shall continue to monitor |
| 662 | participation, compliance, and effectiveness of the agreement |
| 663 | and report its findings at least annually. |
| 664 | Section 13. Section 627.6686, Florida Statutes, is created |
| 665 | to read: |
| 666 | 627.6686 Coverage for individuals with developmental |
| 667 | disabilities required; exception.-- |
| 668 | (1) As used in this section, the term: |
| 669 | (a) "Developmental disability" has the same meaning as |
| 670 | provided in s. 393.063(3)(a) and "autism spectrum disorder" as |
| 671 | defined in s. 393.063(3)(b). |
| 672 | (b) "Eligible individual" means an individual under 18 |
| 673 | years of age or an individual 18 years of age or older who is in |
| 674 | high school who has been diagnosed as having a developmental |
| 675 | disability at 8 years of age or younger. |
| 676 | (c) "Health insurance plan" means a group health insurance |
| 677 | policy or group health benefit plan offered by an insurer which |
| 678 | includes the state group insurance program provided under s. |
| 679 | 110.123. The term does not include any health insurance plan |
| 680 | offered in the individual market, any health insurance plan that |
| 681 | is individually underwritten, or any health insurance plan |
| 682 | provided to a small employer. |
| 683 | (d) "Insurer" means an insurer providing health insurance |
| 684 | coverage, which is licensed to engage in the business of |
| 685 | insurance in this state and is subject to insurance regulation. |
| 686 | (2) A health insurance plan issued or renewed on or after |
| 687 | July 1, 2009, shall provide coverage to an eligible individual |
| 688 | for: |
| 689 | (a) Well-baby and well-child screening for diagnosing the |
| 690 | presence of a developmental disability. |
| 691 | (b) Treatment of a developmental disability through speech |
| 692 | therapy, occupational therapy, physical therapy, and behavior |
| 693 | analysis services. Behavior analysis services shall be provided |
| 694 | by an individual certified pursuant to s. 393.17 or an |
| 695 | individual licensed under chapter 490 or chapter 491. |
| 696 | (3) The coverage required pursuant to subsection (2) is |
| 697 | subject to the following requirements: |
| 698 | (a) Coverage shall be limited to treatment that is |
| 699 | prescribed by the insured's treating physician in accordance |
| 700 | with a treatment plan. |
| 701 | (b) Coverage for the services described in subsection (2) |
| 702 | shall be limited to $36,000 annually and may not exceed $108,000 |
| 703 | in total lifetime benefits. |
| 704 | (c) Coverage may not be denied on the basis that provided |
| 705 | services are habilitative in nature. |
| 706 | (d) Coverage may be subject to other general exclusions |
| 707 | and limitations of the insurer's policy or plan, including, but |
| 708 | not limited to, coordination of benefits, participating provider |
| 709 | requirements, restrictions on services provided by family or |
| 710 | household members, and utilization review of health care |
| 711 | services, including the review of medical necessity, case |
| 712 | management, and other managed care provisions. |
| 713 | (4) The coverage required pursuant to subsection (2) may |
| 714 | not be subject to dollar limits, deductibles, or coinsurance |
| 715 | provisions that are less favorable to an insured than the dollar |
| 716 | limits, deductibles, or coinsurance provisions that apply to |
| 717 | physical illnesses that are generally covered under the health |
| 718 | insurance plan, except as otherwise provided in subsection (3). |
| 719 | (5) An insurer may not deny or refuse to issue coverage |
| 720 | for medically necessary services, refuse to contract with, or |
| 721 | refuse to renew or reissue or otherwise terminate or restrict |
| 722 | coverage for an individual because the individual is diagnosed |
| 723 | as having a developmental disability. |
| 724 | (6) The treatment plan required pursuant to subsection (3) |
| 725 | shall include all elements necessary for the health insurance |
| 726 | plan to appropriately pay claims. These elements include, but |
| 727 | are not limited to, a diagnosis, the proposed treatment by type, |
| 728 | the frequency and duration of treatment, the anticipated |
| 729 | outcomes stated as goals, the frequency with which the treatment |
| 730 | plan will be updated, and the signature of the treating |
| 731 | physician. |
| 732 | (7) Beginning January 1, 2011, the maximum benefit under |
| 733 | paragraph (3)(b) shall be adjusted annually on January 1 of each |
| 734 | calendar year to reflect any change from the previous year in |
| 735 | the medical component of the then current Consumer Price Index |
| 736 | for all urban consumers, published by the Bureau of Labor |
| 737 | Statistics of the United States Department of Labor. |
| 738 | (8) This section may not be construed as limiting benefits |
| 739 | and coverage otherwise available to an insured under a health |
| 740 | insurance plan. |
| 741 | (9) The Office of Insurance Regulation may not enforce |
| 742 | this section against an insurer that is a signatory to the |
| 743 | developmental disabilities compact established under s. 624.916. |
| 744 | Section 14. Section 641.31098, Florida Statutes, is |
| 745 | created to read: |
| 746 | 641.31098 Coverage for individuals with developmental |
| 747 | disabilities.-- |
| 748 | (1) As used in this section, the term: |
| 749 | (a) "Developmental disability" has the same meaning as |
| 750 | provided in s. 393.063 in s. 393.063(3)(a) and autism spectrum |
| 751 | disorder as defined in s. 393.063(3)(b). |
| 752 |
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| 753 | ====== T I T L E A M E N D M E N T ===== |
| 754 | Remove line 822 and insert: |
| 755 | Services; amending 393.063, F.S.; providing a definition of |
| 756 | "autism spectrum disorder"; revising the definition |