| 1 | Representative Gardiner offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. This act may be cited as the "Window of |
| 6 | Opportunity Act." |
| 7 | Section 2. Subsection (18) is renumbered as subsection |
| 8 | (19) of section 391.026, Florida Statutes, and a new subsection |
| 9 | (18) is added to that section to read: |
| 10 | 391.026 Powers and duties of the department.--The |
| 11 | department shall have the following powers, duties, and |
| 12 | responsibilities: |
| 13 | (18) To provide services under contract to the Florida |
| 14 | Healthy Kids Corporation for Florida Healthy Kids benefit plans. |
| 15 | Children served under this contract are not enrollees of the |
| 16 | Children's Medical Services program component of the Florida |
| 17 | Kidcare program funded under Title XIX or Title XXI of the |
| 18 | Social Security Act. |
| 19 | Section 3. Subsections (13) through (40) of section |
| 20 | 393.063, Florida Statutes, are renumbered as subsections (14) |
| 21 | through (41), respectively, subsection (9)is amended, and a new |
| 22 | subsection (13) is added to that section, to read: |
| 23 | 393.063 Definitions.--For the purposes of this chapter, |
| 24 | the term: |
| 25 | (9) "Developmental disability" means a disorder or |
| 26 | syndrome that is attributable to retardation, cerebral palsy, |
| 27 | autism, spina bifida, Down syndrome, or Prader-Willi syndrome; |
| 28 | that manifests before the age of 18; and that constitutes a |
| 29 | substantial handicap that can reasonably be expected to continue |
| 30 | indefinitely. |
| 31 | (13) "Down syndrome" means a genetic disorder caused by |
| 32 | the presence of extra chromosomal material on chromosome 21. |
| 33 | Causes of the syndrome may include Trisomy 21, Mosaicism, |
| 34 | Robertsonian Translocation, and other duplications of a portion |
| 35 | of chromosome 21. |
| 36 | Section 4. Subsection (7) of section 409.8132, Florida |
| 37 | Statutes, is amended to read: |
| 38 | 409.8132 Medikids program component.-- |
| 39 | (7) ENROLLMENT.--Enrollment in the Medikids program |
| 40 | component may occur at any time throughout the year. A child may |
| 41 | not receive services under the Medikids program until the child |
| 42 | is enrolled in a managed care plan or MediPass. Once determined |
| 43 | eligible, an applicant may receive choice counseling and select |
| 44 | a managed care plan or MediPass. The agency may initiate |
| 45 | mandatory assignment for a Medikids applicant who has not chosen |
| 46 | a managed care plan or MediPass provider after the applicant's |
| 47 | voluntary choice period ends; however, the agency shall ensure |
| 48 | that family members are assigned to the same managed care plan |
| 49 | or the same MediPass provider to the greatest extent possible, |
| 50 | including situations in which some family members are enrolled |
| 51 | in Medicaid and other family members are enrolled in a Title |
| 52 | XXI-funded component of the Florida Kidcare program. An |
| 53 | applicant may select MediPass under the Medikids program |
| 54 | component only in counties that have fewer than two managed care |
| 55 | plans available to serve Medicaid recipients and only if the |
| 56 | federal Health Care Financing Administration determines that |
| 57 | MediPass constitutes "health insurance coverage" as defined in |
| 58 | Title XXI of the Social Security Act. |
| 59 | Section 5. Subsection (2) of section 409.8134, Florida |
| 60 | Statutes, is amended, and subsection (5) is added to that |
| 61 | section, to read: |
| 62 | 409.8134 Program expenditure ceiling.-- |
| 63 | (2) Open enrollment periods shall consist of: |
| 64 | (a) Enrollment for premium assistance.--The Florida |
| 65 | Kidcare program may conduct enrollment at any time throughout |
| 66 | the year for the purpose of enrolling children eligible for all |
| 67 | program components listed in s. 409.813 except Medicaid. The |
| 68 | four Florida Kidcare administrators shall work together to |
| 69 | ensure that the year-round enrollment period is announced |
| 70 | statewide. Eligible children for premium assistance shall be |
| 71 | enrolled on a first-come, first-served basis using the date the |
| 72 | enrollment application is received. Enrollment shall immediately |
| 73 | cease when the expenditure ceiling is reached. Year-round |
| 74 | enrollment for premium assistance shall only be held if the |
| 75 | Social Services Estimating Conference determines that sufficient |
| 76 | federal and state funds will be available to finance the |
| 77 | increased enrollment through federal fiscal year 2007. Any |
| 78 | individual who is not enrolled must reapply by submitting a new |
| 79 | application. The application for the Florida Kidcare program |
| 80 | shall be valid for a period of 120 days after the date it was |
| 81 | received. At the end of the 120-day period, if the applicant has |
| 82 | not been enrolled in the program, the application shall be |
| 83 | invalid and the applicant shall be notified of the action. The |
| 84 | applicant may reactivate resubmit the application after |
| 85 | notification of the action taken by the program. Except for the |
| 86 | Medicaid program, whenever the Social Services Estimating |
| 87 | Conference determines that there are presently, or will be by |
| 88 | the end of the current fiscal year, insufficient funds to |
| 89 | finance the current or projected enrollment in the Florida |
| 90 | Kidcare program, all additional enrollment must cease and |
| 91 | additional enrollment may not resume until sufficient funds are |
| 92 | available to finance such enrollment. |
| 93 | (b) Open enrollment without premium assistance, effective |
| 94 | July 1, 2009.-- |
| 95 | 1. Effective July 1, 2009, an open enrollment period for |
| 96 | the Florida Healthy Kids program for those enrollees not |
| 97 | eligible for premium assistance may be held once each fiscal |
| 98 | year and may not exceed 30 consecutive calendar days in length. |
| 99 | The timing and length of any open enrollment period shall be |
| 100 | determined by the Florida Healthy Kids Corporation. Applicants |
| 101 | shall be enrolled on a first come, first served basis, based |
| 102 | upon the date the application was received. During the 2009-2010 |
| 103 | fiscal year, the effective date for new enrollees without |
| 104 | premium assistance shall be October 1, 2009. However, for a |
| 105 | child who has had his or her coverage in an employer-sponsored |
| 106 | or private health benefit plan voluntarily canceled in the last |
| 107 | 90 days and who is otherwise eligible to participate without |
| 108 | premium assistance the effective date of coverage shall be the |
| 109 | end of the 90-day period or October 1, 2009, whichever is later. |
| 110 | 2. The following individuals are not subject to the open |
| 111 | enrollment period: |
| 112 | a. Enrollees in any Florida Kidcare program component that |
| 113 | are determined to be no longer eligible under that component due |
| 114 | to changes in income or age. These enrollees may transfer to the |
| 115 | Healthy Kids program if such transfer is initiated within 30 |
| 116 | days after the loss of such eligibility. |
| 117 | b. Applicants that have adopted a child in the state. |
| 118 | c. Applicants who have had employer-sponsored or private |
| 119 | health insurance involuntarily canceled within 30 days prior to |
| 120 | submission of the application. |
| 121 | 3. Any individual who is not enrolled under this |
| 122 | subsection must reapply by submitting a new application during |
| 123 | the next open enrollment period. The application for the Florida |
| 124 | Kidcare program without premium assistance shall be valid for |
| 125 | the period of the open enrollment. |
| 126 | (5) Effective October 1, 2009, upon determination by the |
| 127 | Social Service Estimating Conference, in consultation with the |
| 128 | agency and the Florida Healthy Kids Corporation, that enrollment |
| 129 | of children whose family income exceeds 200 percent of the |
| 130 | federal poverty level is projected to raise overall premiums per |
| 131 | enrollee by greater than 5_percent of current average premiums |
| 132 | in the Florida Healthy Kids plans, the board of directors of the |
| 133 | Florida Healthy Kids Corporation may, with the concurrence of |
| 134 | the agency, take appropriate actions to reduce the projected |
| 135 | cost below the projected_5 percent increase. Actions the board |
| 136 | may take may include, but are not limited to: |
| 137 | (a) Reducing habilitative and behavior analysis benefits |
| 138 | to enrollees who are receiving these services. |
| 139 | (b) Eliminating habilitative and or behavior analysis |
| 140 | services as a benefit in Healthy Kids plans for enrollees and |
| 141 | providing enrollees the opportunity to purchase these benefits |
| 142 | separately. |
| 143 | (c) Increasing copayments for habilitative and behavior |
| 144 | analysis services provided to nonpremium assistance enrollees. |
| 145 | (d) Reducing benefit packages to all nonpremium assistance |
| 146 | enrollees. |
| 147 | Section 6. Paragraphs (c) and (f) of subsection (4) and |
| 148 | subsections (5), (7), and (8) of section 409.814, Florida |
| 149 | Statutes, are amended to read: |
| 150 | 409.814 Eligibility.--A child who has not reached 19 years |
| 151 | of age whose family income is equal to or below 200 percent of |
| 152 | the federal poverty level is eligible for the Florida Kidcare |
| 153 | program as provided in this section. For enrollment in the |
| 154 | Children's Medical Services Network, a complete application |
| 155 | includes the medical or behavioral health screening. If, |
| 156 | subsequently, an individual is determined to be ineligible for |
| 157 | coverage, he or she must immediately be disenrolled from the |
| 158 | respective Florida Kidcare program component. |
| 159 | (4) The following children are not eligible to receive |
| 160 | premium assistance for health benefits coverage under the |
| 161 | Florida Kidcare program, except under Medicaid if the child |
| 162 | would have been eligible for Medicaid under s. 409.903 or s. |
| 163 | 409.904 as of June 1, 1997: |
| 164 | (c) A child who is seeking premium assistance for the |
| 165 | Florida Kidcare program through employer-sponsored group |
| 166 | coverage, if the child has been covered by the same employer's |
| 167 | group coverage during the 90 days 6 months prior to the family's |
| 168 | submitting an application for determination of eligibility under |
| 169 | the program. |
| 170 | (f) A child who has had his or her coverage in an |
| 171 | employer-sponsored or private health benefit plan voluntarily |
| 172 | canceled in the last 90 days 6 months, except those children who |
| 173 | were on the waiting list prior to March 12, 2004, or whose |
| 174 | coverage was voluntarily canceled for good cause, including, but |
| 175 | not limited to, the following circumstances: |
| 176 | 1. The cost of participation in an employer-sponsored or |
| 177 | private health benefit plan is greater than 5 percent of the |
| 178 | family's income; |
| 179 | 2. The parent lost a job that provided an employer- |
| 180 | sponsored health benefit plan for children; |
| 181 | 3. The parent with health benefits coverage for the child |
| 182 | is deceased; |
| 183 | 4. The employer of the parent canceled health benefits |
| 184 | coverage for children; |
| 185 | 5. The child's health benefits coverage ended because the |
| 186 | child reached the maximum lifetime coverage amount; |
| 187 | 6. The child has exhausted coverage under a COBRA |
| 188 | continuation provision; or |
| 189 | 7. A situation involving domestic violence led to the loss |
| 190 | of coverage. |
| 191 | (5) A child whose family income is above 200 percent of |
| 192 | the federal poverty level or a child who is excluded under the |
| 193 | provisions of subsection (4) may participate in the Medikids |
| 194 | program as provided in s. 409.8132 or, if the child is |
| 195 | ineligible for Medikids by reason of age, in the Florida Healthy |
| 196 | Kids program as provided in s. 624.91, subject to the following |
| 197 | provisions: |
| 198 | (a) The family is not eligible for premium assistance |
| 199 | payments and must pay the full cost of the premium, including |
| 200 | any administrative costs. |
| 201 | (b) Effective October 1, 2009, new applicants for |
| 202 | nonpremium assistance in the Medikids program shall enroll in |
| 203 | the Florida Healthy Kids program component of the Florida |
| 204 | Kidcare program. The agency is authorized to place limits on |
| 205 | enrollment in Medikids by these children in order to avoid |
| 206 | adverse selection. The number of children participating in |
| 207 | Medikids whose family income exceeds 200 percent of the federal |
| 208 | poverty level must not exceed 10 percent of total enrollees in |
| 209 | the Medikids program. |
| 210 | (c) The board of directors of the Florida Healthy Kids |
| 211 | Corporation is authorized to place limits on enrollment of these |
| 212 | children in order to avoid adverse selection. In addition, the |
| 213 | board is authorized to offer a reduced benefit package to these |
| 214 | children in order to limit program costs for such families. The |
| 215 | number of children participating in the Florida Healthy Kids |
| 216 | program whose family income exceeds 200 percent of the federal |
| 217 | poverty level must not exceed 10 percent of total enrollees in |
| 218 | the Florida Healthy Kids program. |
| 219 | (7) When determining or reviewing a child's eligibility |
| 220 | under the Florida Kidcare program, the applicant shall be |
| 221 | provided with reasonable notice of changes in eligibility which |
| 222 | may affect enrollment in one or more of the program components. |
| 223 | When a transition from one program component to another is |
| 224 | authorized, there shall be cooperation between the program |
| 225 | components, and the affected family, the child's health |
| 226 | insurance plan, and the child's health care providers to promote |
| 227 | which promotes continuity of health care coverage. If a child is |
| 228 | determined ineligible for Medicaid or Medikids, the agency, in |
| 229 | coordination with the department, shall notify that child's |
| 230 | Medicaid managed care plan or MediPass provider of such |
| 231 | determination before the child's eligibility is scheduled to be |
| 232 | terminated so that the Medicaid managed care plan or MediPass |
| 233 | provider can assist the child's family in applying for Florida |
| 234 | Kidcare program coverage. Any authorized transfers must be |
| 235 | managed within the program's overall appropriated or authorized |
| 236 | levels of funding. Each component of the program shall establish |
| 237 | a reserve to ensure that transfers between components will be |
| 238 | accomplished within current year appropriations. These reserves |
| 239 | shall be reviewed by each convening of the Social Services |
| 240 | Estimating Conference to determine the adequacy of such reserves |
| 241 | to meet actual experience. |
| 242 | (8) In determining the eligibility of a child for the |
| 243 | Florida Kidcare program, an assets test is not required. The |
| 244 | information required under this section from each applicant |
| 245 | shall be obtained electronically to the extent possible. If such |
| 246 | information cannot be obtained electronically, the Each |
| 247 | applicant shall provide written documentation during the |
| 248 | application process and the redetermination process, including, |
| 249 | but not limited to, the following: |
| 250 | (a) Proof of family income, which must include a copy of |
| 251 | the applicant's most recent federal income tax return. In the |
| 252 | absence of a federal income tax return, an applicant may submit |
| 253 | wages and earnings statements (pay stubs), W-2 forms, or other |
| 254 | appropriate documents. |
| 255 | (b) A statement from all family members that: |
| 256 | 1. Their employer does not sponsor a health benefit plan |
| 257 | for employees; or |
| 258 | 2. The potential enrollee is not covered by the employer- |
| 259 | sponsored health benefit plan because the potential enrollee is |
| 260 | not eligible for coverage, or, if the potential enrollee is |
| 261 | eligible but not covered, a statement of the cost to enroll the |
| 262 | potential enrollee in the employer-sponsored health benefit |
| 263 | plan. |
| 264 |
|
| 265 | An individual who applies for coverage under the Florida Kidcare |
| 266 | program and who pays the full cost of the premium is exempt from |
| 267 | the requirements of this subsection. |
| 268 | Section 7. Paragraphs (r) through (v) of subsection (2) of |
| 269 | section 409.815, Florida Statutes, are redesignated as |
| 270 | paragraphs (s) through (w), respectively, present paragraphs |
| 271 | (o), (r), and (u) are amended, and a new paragraph (r) is added |
| 272 | to that subsection, to read: |
| 273 | 409.815 Health benefits coverage; limitations.-- |
| 274 | (2) BENCHMARK BENEFITS.--In order for health benefits |
| 275 | coverage to qualify for premium assistance payments for an |
| 276 | eligible child under ss. 409.810-409.820, the health benefits |
| 277 | coverage, except for coverage under Medicaid and Medikids, must |
| 278 | include the following minimum benefits, as medically necessary. |
| 279 | (o) Therapy services.--Covered services include |
| 280 | habilitative and rehabilitative services, including |
| 281 | occupational, physical, respiratory, and speech therapies, with |
| 282 | the following limitations: |
| 283 | 1. Rehabilitative services are limited to: |
| 284 | a.1. Services must be for Short-term rehabilitation when |
| 285 | where significant improvement in the enrollee's condition will |
| 286 | result; and |
| 287 | b.2. Services shall be limited to Not more than 24 |
| 288 | treatment sessions within a 60-day period per episode or injury, |
| 289 | with the 60-day period beginning with the first treatment. |
| 290 | 2. Effective October 1, 2009, habilitative services shall |
| 291 | be offered and are limited to: |
| 292 | a. Habilitation when improvements in and maintenance of |
| 293 | human behavior, skill acquisition, and communication will |
| 294 | result; and |
| 295 | b. Enrollees that are diagnosed with a developmental |
| 296 | disability as defined in s. 393.063 or autism spectrum disorder. |
| 297 | (r) Behavior analysis services.--Effective October 1, |
| 298 | 2009, behavior analysis and behavior assistant services shall be |
| 299 | covered for enrollees that are diagnosed with a developmental |
| 300 | disability as defined in s. 393.063 or autism spectrum disorder. |
| 301 | For purposes of this paragraph: |
| 302 | 1. "Behavior analysis" means the design, implementation, |
| 303 | and evaluation of instructional and environmental modifications |
| 304 | to produce socially significant improvements in human behavior |
| 305 | through skill acquisition and the reduction of problematic |
| 306 | behavior. Behavior analysis shall be provided by an individual |
| 307 | certified pursuant to s. 393.17 or an individual licensed under |
| 308 | chapter 490 or chapter 491. |
| 309 | 2. "Behavior assistant services" means services provided |
| 310 | by an individual with specific training to assist in carrying |
| 311 | out plans designed by a behavior analyst. |
| 312 | (s)(r) Lifetime maximum and limitations.--Health benefits |
| 313 | coverage obtained under ss. 409.810-409.820 shall pay an |
| 314 | enrollee's covered expenses at a lifetime maximum of $1 million |
| 315 | per covered child. However, coverage for the combination of |
| 316 | behavior analysis services and habilitative therapy services for |
| 317 | recipients diagnosed with a developmental disability as defined |
| 318 | in s. 393.063 or autism spectrum disorder shall be limited to |
| 319 | $36,000 annually and may not exceed $108,000 in total lifetime |
| 320 | benefits. Without prior authorization by the Florida Healthy |
| 321 | Kids plan, not more than 12 percent of the annual maximum amount |
| 322 | for combined habilitative therapy and behavior analysis services |
| 323 | may be used on a monthly basis. |
| 324 | (v)(u) Enhancements to minimum requirements.-- |
| 325 | 1. This section sets the minimum benefits that must be |
| 326 | included in any health benefits coverage, other than Medicaid or |
| 327 | Medikids coverage, offered under ss. 409.810-409.820. Health |
| 328 | benefits coverage may include additional benefits not included |
| 329 | under this subsection, but may not include benefits excluded |
| 330 | under paragraph (t) (s). |
| 331 | 2. Health benefits coverage may extend any limitations |
| 332 | beyond the minimum benefits described in this section. |
| 333 |
|
| 334 | Except for the Children's Medical Services Network, the agency |
| 335 | may not increase the premium assistance payment for either |
| 336 | additional benefits provided beyond the minimum benefits |
| 337 | described in this section or the imposition of less restrictive |
| 338 | service limitations. |
| 339 | Section 8. Paragraph (b) of subsection (1) of section |
| 340 | 409.818, Florida Statutes, is amended to read: |
| 341 | 409.818 Administration.--In order to implement ss. |
| 342 | 409.810-409.820, the following agencies shall have the following |
| 343 | duties: |
| 344 | (1) The Department of Children and Family Services shall: |
| 345 | (b) Establish and maintain the eligibility determination |
| 346 | process under the program except as specified in subsection (5). |
| 347 | The department shall directly, or through the services of a |
| 348 | contracted third-party administrator, establish and maintain a |
| 349 | process for determining eligibility of children for coverage |
| 350 | under the program. The eligibility determination process must be |
| 351 | used solely for determining eligibility of applicants for health |
| 352 | benefits coverage under the program. The eligibility |
| 353 | determination process must include an initial determination of |
| 354 | eligibility for any coverage offered under the program, as well |
| 355 | as a redetermination or reverification of eligibility each |
| 356 | subsequent 12 6 months. Effective January 1, 1999, a child who |
| 357 | has not attained the age of 5 and who has been determined |
| 358 | eligible for the Medicaid program is eligible for coverage for |
| 359 | 12 months without a redetermination or reverification of |
| 360 | eligibility. In conducting an eligibility determination, the |
| 361 | department shall determine if the child has special health care |
| 362 | needs. The department, in consultation with the Agency for |
| 363 | Health Care Administration and the Florida Healthy Kids |
| 364 | Corporation, shall develop procedures for redetermining |
| 365 | eligibility which enable a family to easily update any change in |
| 366 | circumstances which could affect eligibility. The department may |
| 367 | accept changes in a family's status as reported to the |
| 368 | department by the Florida Healthy Kids Corporation without |
| 369 | requiring a new application from the family. Redetermination of |
| 370 | a child's eligibility for Medicaid may not be linked to a |
| 371 | child's eligibility determination for other programs. |
| 372 | Section 9. Subsection (26) is added to section 409.906, |
| 373 | Florida Statutes, to read: |
| 374 | 409.906 Optional Medicaid services.--Subject to specific |
| 375 | appropriations, the agency may make payments for services which |
| 376 | are optional to the state under Title XIX of the Social Security |
| 377 | Act and are furnished by Medicaid providers to recipients who |
| 378 | are determined to be eligible on the dates on which the services |
| 379 | were provided. Any optional service that is provided shall be |
| 380 | provided only when medically necessary and in accordance with |
| 381 | state and federal law. Optional services rendered by providers |
| 382 | in mobile units to Medicaid recipients may be restricted or |
| 383 | prohibited by the agency. Nothing in this section shall be |
| 384 | construed to prevent or limit the agency from adjusting fees, |
| 385 | reimbursement rates, lengths of stay, number of visits, or |
| 386 | number of services, or making any other adjustments necessary to |
| 387 | comply with the availability of moneys and any limitations or |
| 388 | directions provided for in the General Appropriations Act or |
| 389 | chapter 216. If necessary to safeguard the state's systems of |
| 390 | providing services to elderly and disabled persons and subject |
| 391 | to the notice and review provisions of s. 216.177, the Governor |
| 392 | may direct the Agency for Health Care Administration to amend |
| 393 | the Medicaid state plan to delete the optional Medicaid service |
| 394 | known as "Intermediate Care Facilities for the Developmentally |
| 395 | Disabled." Optional services may include: |
| 396 | (26) HOME AND COMMUNITY-BASED SERVICES FOR AUTISM SPECTRUM |
| 397 | DISORDER AND OTHER DEVELOPMENTAL DISABILITIES.--The agency is |
| 398 | authorized to seek federal approval through a Medicaid waiver or |
| 399 | a state plan amendment for the provision of occupational |
| 400 | therapy, speech therapy, physical therapy, behavior analysis, |
| 401 | and behavior assistant services to individuals who are 5 years |
| 402 | of age and under and have a diagnosed developmental disability |
| 403 | as defined in s. 393.063 or autism spectrum disorder. Coverage |
| 404 | for such services shall be limited to $36,000 annually and may |
| 405 | not exceed $108,000 in total lifetime benefits. The agency shall |
| 406 | submit an annual report beginning on January 1, 2009, to the |
| 407 | President of the Senate, the Speaker of the House of |
| 408 | Representatives, and the relevant committees of the Senate and |
| 409 | the House of Representatives regarding progress on obtaining |
| 410 | federal approval and recommendations for the implementation of |
| 411 | these home and community-based services. The agency may not |
| 412 | implement this subsection without prior legislative approval. |
| 413 | Section 10. Section 456.0291, Florida Statutes, is created |
| 414 | to read: |
| 415 | 456.0291 Requirement for instruction on developmental |
| 416 | disabilities.-- |
| 417 | (1)(a) The appropriate board shall require each person |
| 418 | licensed or certified under part I of chapter 464, chapter 490, |
| 419 | or chapter 491 to complete a 2-hour continuing education course, |
| 420 | approved by the board, on developmental disabilities, as defined |
| 421 | in s. 393.063, with the addition of autism spectrum disorder, as |
| 422 | part of every third biennial relicensure or recertification. The |
| 423 | course shall consist of information on the diagnosis and |
| 424 | treatment of developmental disabilities and information on |
| 425 | counseling and education of a parent whose child is diagnosed |
| 426 | with a developmental disability, with an emphasis on autism |
| 427 | spectrum disorder. |
| 428 | (b) The Board of Medicine and the Board of Osteopathic |
| 429 | Medicine shall require each physician with a primary care |
| 430 | specialty of pediatrics to complete a 2-hour continuing |
| 431 | education course, approved by the appropriate board, on |
| 432 | developmental disabilities, as defined in s. 393.063, with the |
| 433 | addition of autism spectrum disorder, as part of every third |
| 434 | biennial relicensure. The course shall consist of information on |
| 435 | the diagnosis and treatment of developmental disabilities and |
| 436 | information on counseling and education of a parent whose child |
| 437 | is diagnosed with a developmental disability, with an emphasis |
| 438 | on autism spectrum disorder. |
| 439 | (c) Each such licensee or certificateholder shall submit |
| 440 | confirmation of having completed the course, on a form provided |
| 441 | by the board, when submitting fees for every third biennial |
| 442 | renewal. |
| 443 | (d) The board may approve additional equivalent courses |
| 444 | that may be used to satisfy the requirements of paragraph (a). |
| 445 | Each licensing board that requires a licensee to complete an |
| 446 | educational course pursuant to this subsection may include the |
| 447 | hours required for completion of the course in the total hours |
| 448 | of continuing education required by law for such profession |
| 449 | unless the continuing education requirements for such profession |
| 450 | consist of fewer than 30 hours biennially. |
| 451 | (e) Any person holding two or more licenses subject to the |
| 452 | provisions of this subsection shall be permitted to show proof |
| 453 | of having taken one board-approved course on developmental |
| 454 | disabilities for purposes of relicensure or recertification for |
| 455 | additional licenses. |
| 456 | (f) Failure to comply with the requirements of this |
| 457 | subsection shall constitute grounds for disciplinary action |
| 458 | under each respective practice act and under s. 456.072(1)(k). |
| 459 | In addition to discipline by the board, the licensee shall be |
| 460 | required to complete such course. |
| 461 | (2) Each board may adopt rules pursuant to ss. 120.536(1) |
| 462 | and 120.54 to carry out the provisions of this section. |
| 463 | (3) The department shall implement a plan to promote |
| 464 | awareness of developmental disabilities, with a focus on autism |
| 465 | spectrum disorder, to physicians licensed under chapter 458 or |
| 466 | chapter 459 and parents. The department shall develop the plan |
| 467 | in consultation with organizations representing allopathic and |
| 468 | osteopathic physicians, the Board of Medicine, the Board of |
| 469 | Osteopathic Medicine, and nationally recognized organizations |
| 470 | that promote awareness of developmental disabilities. The |
| 471 | department's plan shall include the distribution of educational |
| 472 | materials for parents, including a developmental assessment |
| 473 | tool. |
| 474 | Section 11. Paragraph (b) of subsection (2) and paragraph |
| 475 | (b) of subsection (5) of section 624.91, Florida Statutes, are |
| 476 | amended to read: |
| 477 | 624.91 The Florida Healthy Kids Corporation Act.-- |
| 478 | (2) LEGISLATIVE INTENT.-- |
| 479 | (b) It is the intent of the Legislature that the Florida |
| 480 | Healthy Kids Corporation serve as one of several providers of |
| 481 | services to children eligible for medical assistance under Title |
| 482 | XXI of the Social Security Act. Although the corporation may |
| 483 | serve other children, the Legislature intends the primary |
| 484 | recipients of services provided through the corporation be |
| 485 | school-age children with a family income below 200 percent of |
| 486 | the federal poverty level, who do not qualify for Medicaid. It |
| 487 | is also the intent of the Legislature that state and local |
| 488 | government Florida Healthy Kids funds be used to continue |
| 489 | coverage, subject to specific appropriations in the General |
| 490 | Appropriations Act, to children not eligible for federal |
| 491 | matching funds under Title XXI. |
| 492 | (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.-- |
| 493 | (b) The Florida Healthy Kids Corporation shall: |
| 494 | 1. Arrange for the collection of any family, local |
| 495 | contributions, or employer payment or premium, in an amount to |
| 496 | be determined by the board of directors, to provide for payment |
| 497 | of premiums for comprehensive insurance coverage and for the |
| 498 | actual or estimated administrative expenses. |
| 499 | 2. Arrange for the collection of any voluntary |
| 500 | contributions to provide for payment of premiums for children |
| 501 | who are not eligible for medical assistance under Title XXI of |
| 502 | the Social Security Act. |
| 503 | 3. Subject to the provisions of s. 409.8134, accept |
| 504 | voluntary supplemental local match contributions that comply |
| 505 | with the requirements of Title XXI of the Social Security Act |
| 506 | for the purpose of providing additional coverage in contributing |
| 507 | counties under Title XXI. |
| 508 | 4. Establish the administrative and accounting procedures |
| 509 | for the operation of the corporation. |
| 510 | 5. Establish, with consultation from appropriate |
| 511 | professional organizations, standards for preventive health |
| 512 | services and providers and comprehensive insurance benefits |
| 513 | appropriate to children, provided that such standards for rural |
| 514 | areas shall not limit primary care providers to board-certified |
| 515 | pediatricians. |
| 516 | 6. Determine eligibility for children seeking to |
| 517 | participate in the Title XXI-funded components of the Florida |
| 518 | Kidcare program consistent with the requirements specified in s. |
| 519 | 409.814, as well as the non-Title-XXI-eligible children as |
| 520 | provided in subsection (3). |
| 521 | 7. Establish procedures under which providers of local |
| 522 | match to, applicants to and participants in the program may have |
| 523 | grievances reviewed by an impartial body and reported to the |
| 524 | board of directors of the corporation. |
| 525 | 8. Establish participation criteria and, if appropriate, |
| 526 | contract with an authorized insurer, health maintenance |
| 527 | organization, or third-party administrator to provide |
| 528 | administrative services to the corporation. |
| 529 | 9. Establish enrollment criteria which shall include |
| 530 | penalties or waiting periods of not fewer than 60 days for |
| 531 | reinstatement of coverage upon voluntary cancellation for |
| 532 | nonpayment of family premiums. |
| 533 | 10. Contract with authorized insurers or any provider of |
| 534 | health care services, meeting standards established by the |
| 535 | corporation, for the provision of comprehensive insurance |
| 536 | coverage to participants. Such standards shall include criteria |
| 537 | under which the corporation may contract with more than one |
| 538 | provider of health care services in program sites. Health plans |
| 539 | shall be selected through a competitive bid process. The Florida |
| 540 | Healthy Kids Corporation shall purchase goods and services in |
| 541 | the most cost-effective manner consistent with the delivery of |
| 542 | quality medical care. The maximum administrative cost for a |
| 543 | Florida Healthy Kids Corporation contract shall be 15 percent. |
| 544 | For health care contracts, the minimum medical loss ratio for a |
| 545 | Florida Healthy Kids Corporation contract shall be 85 percent. |
| 546 | For dental contracts, the remaining compensation to be paid to |
| 547 | the authorized insurer or provider under a Florida Healthy Kids |
| 548 | Corporation contract shall be no less than an amount which is 85 |
| 549 | percent of premium; to the extent any contract provision does |
| 550 | not provide for this minimum compensation, this section shall |
| 551 | prevail. The health plan selection criteria and scoring system, |
| 552 | and the scoring results, shall be available upon request for |
| 553 | inspection after the bids have been awarded. |
| 554 | 11. Establish disenrollment criteria in the event local |
| 555 | matching funds are insufficient to cover enrollments. |
| 556 | 12. Develop and implement a plan to publicize the Florida |
| 557 | Kidcare program Healthy Kids Corporation, the eligibility |
| 558 | requirements of the program, and the procedures for enrollment |
| 559 | in the program and to maintain public awareness of the |
| 560 | corporation and the program. Health care and dental health plans |
| 561 | participating in the program may develop and distribute |
| 562 | marketing and other promotional materials and participate in |
| 563 | activities, such as health fairs and public events, as approved |
| 564 | by the corporation. Health care and dental health plans may also |
| 565 | contact their current and former enrollees to encourage |
| 566 | continued participation in the program and assist the enrollee |
| 567 | in transferring from a Title XIX-funded plan to a Title XXI- |
| 568 | funded plan. |
| 569 | 13. Establish an assignment process for Florida Healthy |
| 570 | Kids program enrollees to ensure that family members are |
| 571 | assigned to the same managed care plan to the greatest extent |
| 572 | possible, including situations in which some family members are |
| 573 | enrolled in a Medicaid managed care plan and other family |
| 574 | members are enrolled in a Florida Healthy Kids plan. The Agency |
| 575 | for Health Care Administration shall consult with the |
| 576 | corporation to implement this subparagraph. |
| 577 | 14.13. Secure staff necessary to properly administer the |
| 578 | corporation. Staff costs shall be funded from state and local |
| 579 | matching funds and such other private or public funds as become |
| 580 | available. The board of directors shall determine the number of |
| 581 | staff members necessary to administer the corporation. |
| 582 | 15.14. Provide a report annually to the Governor, Chief |
| 583 | Financial Officer, Commissioner of Education, Senate President, |
| 584 | Speaker of the House of Representatives, and Minority Leaders of |
| 585 | the Senate and the House of Representatives. |
| 586 | 16. Provide a report by October 31, 2008, to the Governor, |
| 587 | the Senate, and the House of Representatives, which includes an |
| 588 | actuarial analysis of the projected impact on premiums from the |
| 589 | addition of habilitative and behavior analysis services in |
| 590 | accordance with s. 409.815. |
| 591 | 17. Provide information on a quarterly basis to the |
| 592 | Governor, the Senate, and the House of Representatives that |
| 593 | assesses the cost and utilization of services for the Florida |
| 594 | Healthy Kids health benefits plans provided through the Florida |
| 595 | Healthy Kids Corporation. The information must be specific to |
| 596 | each eligibility component of the plan and, at a minimum, |
| 597 | include: |
| 598 | a. The monthly enrollment and expenditures for enrollees. |
| 599 | b. The cost and utilization of specific services. |
| 600 | c. An analysis of the impact on premiums prior to and |
| 601 | following implementation of the Window of Opportunity Act. |
| 602 | d. An analysis of trends regarding transfer of enrollees |
| 603 | from the Florida Healthy Kids plans to the Children's Medical |
| 604 | Services Network plan. |
| 605 | e. Any recommendations resulting from the analysis |
| 606 | conducted under this subparagraph. |
| 607 | 18.15. Establish benefit packages which conform to the |
| 608 | provisions of the Florida Kidcare program, as created in ss. |
| 609 | 409.810-409.820. |
| 610 | Section 12. Section 624.916, Florida Statutes, is created |
| 611 | to read: |
| 612 | 624.916 Developmental disabilities compact.-- |
| 613 | (1) The Office of Insurance Regulation shall convene a |
| 614 | workgroup by August 31, 2008, for the purpose of negotiating a |
| 615 | compact that includes a binding agreement among the participants |
| 616 | relating to insurance and access to services for persons with |
| 617 | developmental disabilities as defined in s. 393.063, with the |
| 618 | addition of autism spectrum disorder. The workgroup shall |
| 619 | consist of the following: |
| 620 | (a) Representatives of all health insurers licensed under |
| 621 | this chapter. |
| 622 | (b) Representatives of all health maintenance |
| 623 | organizations licensed under part I of chapter 641. |
| 624 | (c) Representatives of employers with self-insured health |
| 625 | benefit plans. |
| 626 | (d) Two designees of the Governor, one of whom must be a |
| 627 | consumer advocate. |
| 628 | (e) A designee of the President of the Senate. |
| 629 | (f) A designee of the Speaker of the House of |
| 630 | Representatives. |
| 631 | (2) The Office of Insurance Regulation shall convene a |
| 632 | consumer advisory workgroup for the purpose of providing a forum |
| 633 | for comment on the compact negotiated in subsection (1). The |
| 634 | office shall convene the workgroup prior to finalization of the |
| 635 | compact. |
| 636 | (3) The agreement shall include the following components: |
| 637 | (a) Procedures for clear and specific notice to |
| 638 | policyholders identifying the amount, scope, and conditions |
| 639 | under which coverage is provided for speech therapy, physical |
| 640 | therapy, occupational therapy, and behavioral interventions when |
| 641 | necessary due to the presence of a developmental disability. |
| 642 | (b) Penalties for documented cases of denial of claims for |
| 643 | medically necessary services due to the presence of a |
| 644 | developmental disability. |
| 645 | (c) Proposals for new product lines that may be offered in |
| 646 | conjunction with traditional health insurance and provide a more |
| 647 | appropriate means of spreading risk, financing costs, and |
| 648 | accessing favorable prices. |
| 649 | (4) Upon completion of the negotiations for the compact, |
| 650 | the office shall report the results to the Governor, the |
| 651 | President of the Senate, and the Speaker of the House of |
| 652 | Representatives. The office shall continue to monitor |
| 653 | participation, compliance, and effectiveness of the agreement |
| 654 | and report its findings at least annually. |
| 655 | Section 13. Section 627.6686, Florida Statutes, is created |
| 656 | to read: |
| 657 | 627.6686 Coverage for individuals with developmental |
| 658 | disabilities required; exception.-- |
| 659 | (1) As used in this section, the term: |
| 660 | (a) "Developmental disability" has the same meaning as |
| 661 | provided in s. 393.063, with the addition of autism spectrum |
| 662 | disorder. |
| 663 | (b) "Eligible individual" means an individual under 18 |
| 664 | years of age or an individual 18 years of age or older who is in |
| 665 | high school who has been diagnosed as having a developmental |
| 666 | disability at 8 years of age or younger. |
| 667 | (c) "Health insurance plan" means a group health insurance |
| 668 | policy or group health benefit plan offered by an insurer which |
| 669 | includes the state group insurance program provided under s. |
| 670 | 110.123. The term does not include any health insurance plan |
| 671 | offered in the individual market, any health insurance plan that |
| 672 | is individually underwritten, or any health insurance plan |
| 673 | provided to a small employer. |
| 674 | (d) "Insurer" means an insurer providing health insurance |
| 675 | coverage, which is licensed to engage in the business of |
| 676 | insurance in this state and is subject to insurance regulation. |
| 677 | (2) A health insurance plan issued or renewed on or after |
| 678 | July 1, 2009, shall provide coverage to an eligible individual |
| 679 | for: |
| 680 | (a) Well-baby and well-child screening for diagnosing the |
| 681 | presence of a developmental disability. |
| 682 | (b) Treatment of a developmental disability through speech |
| 683 | therapy, occupational therapy, physical therapy, and behavior |
| 684 | analysis services. Behavior analysis services shall be provided |
| 685 | by an individual certified pursuant to s. 393.17 or an |
| 686 | individual licensed under chapter 490 or chapter 491. |
| 687 | (3) The coverage required pursuant to subsection (2) is |
| 688 | subject to the following requirements: |
| 689 | (a) Coverage shall be limited to treatment that is |
| 690 | prescribed by the insured's treating physician in accordance |
| 691 | with a treatment plan. |
| 692 | (b) Coverage for the services described in subsection (2) |
| 693 | shall be limited to $36,000 annually and may not exceed $108,000 |
| 694 | in total lifetime benefits. |
| 695 | (c) Coverage may not be denied on the basis that provided |
| 696 | services are habilitative in nature. |
| 697 | (d) Coverage may be subject to other general exclusions |
| 698 | and limitations of the insurer's policy or plan, including, but |
| 699 | not limited to, coordination of benefits, participating provider |
| 700 | requirements, restrictions on services provided by family or |
| 701 | household members, and utilization review of health care |
| 702 | services, including the review of medical necessity, case |
| 703 | management, and other managed care provisions. |
| 704 | (4) The coverage required pursuant to subsection (2) may |
| 705 | not be subject to dollar limits, deductibles, or coinsurance |
| 706 | provisions that are less favorable to an insured than the dollar |
| 707 | limits, deductibles, or coinsurance provisions that apply to |
| 708 | physical illnesses that are generally covered under the health |
| 709 | insurance plan, except as otherwise provided in subsection (3). |
| 710 | (5) An insurer may not deny or refuse to issue coverage |
| 711 | for medically necessary services, refuse to contract with, or |
| 712 | refuse to renew or reissue or otherwise terminate or restrict |
| 713 | coverage for an individual because the individual is diagnosed |
| 714 | as having a developmental disability. |
| 715 | (6) The treatment plan required pursuant to subsection (3) |
| 716 | shall include all elements necessary for the health insurance |
| 717 | plan to appropriately pay claims. These elements include, but |
| 718 | are not limited to, a diagnosis, the proposed treatment by type, |
| 719 | the frequency and duration of treatment, the anticipated |
| 720 | outcomes stated as goals, the frequency with which the treatment |
| 721 | plan will be updated, and the signature of the treating |
| 722 | physician. |
| 723 | (7) Beginning January 1, 2011, the maximum benefit under |
| 724 | paragraph (3)(b) shall be adjusted annually on January 1 of each |
| 725 | calendar year to reflect any change from the previous year in |
| 726 | the medical component of the then current Consumer Price Index |
| 727 | for all urban consumers, published by the Bureau of Labor |
| 728 | Statistics of the United States Department of Labor. |
| 729 | (8) This section may not be construed as limiting benefits |
| 730 | and coverage otherwise available to an insured under a health |
| 731 | insurance plan. |
| 732 | (9) The Office of Insurance Regulation may not enforce |
| 733 | this section against an insurer that is a signatory to the |
| 734 | developmental disabilities compact established under s. 624.916. |
| 735 | Section 14. Section 641.31098, Florida Statutes, is |
| 736 | created to read: |
| 737 | 641.31098 Coverage for individuals with developmental |
| 738 | disabilities.-- |
| 739 | (1) As used in this section, the term: |
| 740 | (a) "Developmental disability" has the same meaning as |
| 741 | provided in s. 393.063, with the addition of autism spectrum |
| 742 | disorder. |
| 743 | (b) "Eligible individual" means an individual under 18 |
| 744 | years of age or an individual 18 years of age or older who is in |
| 745 | high school who has been diagnosed as having a developmental |
| 746 | disability at 8 years of age or younger. |
| 747 | (c) "Health maintenance contract" means a group health |
| 748 | maintenance contract offered by a health maintenance |
| 749 | organization. This term does not include a health maintenance |
| 750 | contract offered in the individual market, a health maintenance |
| 751 | contract that is individually underwritten, or a health |
| 752 | maintenance contract provided to a small employer. |
| 753 | (2) A health maintenance contract issued or renewed on or |
| 754 | after July 1, 2009, shall provide coverage to an eligible |
| 755 | individual for: |
| 756 | (a) Well-baby and well-child screening for diagnosing the |
| 757 | presence of a developmental disability. |
| 758 | (b) Treatment of a developmental disability through speech |
| 759 | therapy, occupational therapy, physical therapy, and behavior |
| 760 | analysis services. Behavior analysis services shall be provided |
| 761 | by an individual certified pursuant to s. 393.17 or an |
| 762 | individual licensed under chapter 490 or chapter 491. |
| 763 | (3) The coverage required pursuant to subsection (2) is |
| 764 | subject to the following requirements: |
| 765 | (a) Coverage shall be limited to treatment that is |
| 766 | prescribed by the subscriber's treating physician in accordance |
| 767 | with a treatment plan. |
| 768 | (b) Coverage for the services described in subsection (2) |
| 769 | shall be limited to $36,000 annually and may not exceed $108,000 |
| 770 | in total benefits. |
| 771 | (c) Coverage may not be denied on the basis that provided |
| 772 | services are habilitative in nature. |
| 773 | (d) Coverage may be subject to general exclusions and |
| 774 | limitations of the subscriber's contract, including, but not |
| 775 | limited to, coordination of benefits, participating provider |
| 776 | requirements, and utilization review of health care services, |
| 777 | including the review of medical necessity, case management, and |
| 778 | other managed care provisions. |
| 779 | (4) The coverage required pursuant to subsection (2) may |
| 780 | not be subject to dollar limits, deductibles, or coinsurance |
| 781 | provisions that are less favorable to a subscriber than the |
| 782 | dollar limits, deductibles, or coinsurance provisions that apply |
| 783 | to physical illnesses that are generally covered under the |
| 784 | subscriber's contract, except as otherwise provided in |
| 785 | subsection (3). |
| 786 | (5) A health maintenance organization may not deny or |
| 787 | refuse to issue coverage for medically necessary services, |
| 788 | refuse to contract with, or refuse to renew or reissue or |
| 789 | otherwise terminate or restrict coverage for an individual |
| 790 | solely because the individual is diagnosed as having a |
| 791 | developmental disability. |
| 792 | (6) The treatment plan required pursuant to subsection (3) |
| 793 | shall include, but is not limited to, a diagnosis, the proposed |
| 794 | treatment by type, the frequency and duration of treatment, the |
| 795 | anticipated outcomes stated as goals, the frequency with which |
| 796 | the treatment plan will be updated, and the signature of the |
| 797 | treating physician. |
| 798 | (7) Beginning January 1, 2011, the maximum benefit under |
| 799 | paragraph (3)(b) shall be adjusted annually on January 1 of each |
| 800 | calendar year to reflect any change from the previous year in |
| 801 | the medical component of the then current Consumer Price Index |
| 802 | for all urban consumers, published by the Bureau of Labor |
| 803 | Statistics of the United States Department of Labor. |
| 804 | (8) The Office of Insurance Regulation may not enforce |
| 805 | this section against a health maintenance organization that is a |
| 806 | signatory to the developmental disabilities compact established |
| 807 | under s. 624.916. |
| 808 | Section 15. This act shall take effect July 1, 2008. |
| 809 |
|
| 810 |
|
| 811 |
|
| 812 | ----------------------------------------------------- |
| 813 | T I T L E A M E N D M E N T |
| 814 | Remove the entire title and insert: |
| 815 | A bill to be entitled |
| 816 | An act relating to children with disabilities; creating |
| 817 | the "Window of Opportunity Act"; amending s. 391.026, |
| 818 | F.S.; requiring the Department of Health to provide |
| 819 | certain services under contract to the Florida Healthy |
| 820 | Kids Corporation; specifying that children served under |
| 821 | such contract are not enrollees of Children's Medical |
| 822 | Services; amending 393.063, F.S.; revising the definition |
| 823 | of the term "developmental disability"; providing a |
| 824 | definition of the term "Down syndrome"; amending s. |
| 825 | 409.8132, F.S.; revising provisions relating to enrollment |
| 826 | in the Medikids program component of Florida Kidcare; |
| 827 | providing for the Agency for Health Care Administration to |
| 828 | assign family members to the same managed care plan or |
| 829 | Medicaid provider, under certain circumstances; amending |
| 830 | s. 409.8134, F.S.; providing eligibility criteria for |
| 831 | enrollment for premium assistance; providing for |
| 832 | enrollment without premium assistance in the Florida |
| 833 | Kidcare program during open enrollment periods; providing |
| 834 | limitations on year-round enrollment for premium |
| 835 | assistance; specifying a time period for enrollees not |
| 836 | eligible for premium assistance to enroll in the Florida |
| 837 | Healthy Kids program; providing exceptions; providing for |
| 838 | certain enrollees to transfer to the Healthy Kids program |
| 839 | under certain circumstances; authorizing the board of |
| 840 | directors of the Florida Healthy Kids Corporation to take |
| 841 | certain actions to reduce projected costs of the program |
| 842 | under certain circumstances; amending s. 409.814, F.S.; |
| 843 | revising conditions for eligibility for premium assistance |
| 844 | for the Florida Kidcare Program; providing limitations on |
| 845 | enrollment in the Medikids program after January 1, 2009; |
| 846 | providing for enrollment of new applicants in the Florida |
| 847 | Healthy Kids program; revising duties of the board of |
| 848 | directors of the Florida Healthy Kids Corporation |
| 849 | regarding enrollment limitations; providing for |
| 850 | notification to certain managed care plans or MediPass |
| 851 | providers prior to termination of a child's eligibility |
| 852 | for Florida Kidcare; providing for certain information |
| 853 | relating to eligibility to be obtained electronically; |
| 854 | providing an exemption from certain requirements for |
| 855 | individuals who pay the full cost of the Florida Kidcare |
| 856 | premium; amending s. 409.815, F.S.; revising provisions |
| 857 | relating to health benefits coverage for specified |
| 858 | services to include habilitative and behavior analysis |
| 859 | services; providing definitions; limiting the lifetime |
| 860 | maximum of health benefits coverage for certain services; |
| 861 | amending s. 409.818, F.S.; revising timeframe for |
| 862 | redetermination or reverification of eligibility for |
| 863 | Florida Kidcare; amending s. 409.906, F.S.; authorizing |
| 864 | the Agency for Health Care Administration to seek federal |
| 865 | approval through a state plan amendment to provide home |
| 866 | and community-based services for autism spectrum disorder |
| 867 | and other development disabilities; specifying eligibility |
| 868 | criteria; specifying limitations on provision of benefits; |
| 869 | requiring reports to the Legislature; requiring |
| 870 | legislative approval for implementation of certain |
| 871 | provisions; creating s. 456.0291, F.S.; authorizing |
| 872 | certain licensing boards to require special continuing |
| 873 | education on developmental disabilities for certain |
| 874 | licensees and certificateholders; providing penalties; |
| 875 | providing rulemaking authority; requiring the Department |
| 876 | of Health to develop and implement a plan to promote |
| 877 | awareness of developmental disabilities, with a focus on |
| 878 | autism spectrum disorder; amending s. 624.91, F.S.; |
| 879 | revising legislative intent; requiring the Florida Healthy |
| 880 | Kids Corporation to provide information relating to costs |
| 881 | and utilization of full-pay and Title XXI subsidized |
| 882 | populations enrolled in Florida Healthy Kids health |
| 883 | benefits coverage plans; establishing an assignment |
| 884 | process; requiring the corporation to provide a report by |
| 885 | October 31, 2008, to the Governor and Legislature that |
| 886 | includes an analysis of the projected impact on premiums |
| 887 | resulting from the provision of additional services; |
| 888 | requiring the corporation to provide a quarterly |
| 889 | assessment of costs and utilization of services for |
| 890 | Florida Healthy Kids benefit plans to the Governor and |
| 891 | Legislature; creating s. 624.916, F.S.; directing the |
| 892 | Office of Insurance Regulation to establish a workgroup to |
| 893 | develop and execute a compact relating to coverage for |
| 894 | insured persons with development disabilities; providing |
| 895 | for membership of the workgroup; requiring the workgroup |
| 896 | to convene within a specified period of time; directing |
| 897 | the office to establish a consumer advisory workgroup and |
| 898 | providing purpose thereof; requiring the compact to |
| 899 | contain specified components; requiring a report to the |
| 900 | Legislature; creating s. 627.6686, F.S.; providing health |
| 901 | insurance coverage for individuals with developmental |
| 902 | disabilities; providing definitions; providing coverage |
| 903 | for certain screening to diagnose and treat developmental |
| 904 | disabilities; providing limitations on coverage; providing |
| 905 | for eligibility standards for benefits and coverage; |
| 906 | prohibiting insurers from denying coverage under certain |
| 907 | circumstances; specifying required elements of a treatment |
| 908 | plan; providing, beginning January 1, 2011, that the |
| 909 | maximum benefit shall be adjusted annually; clarifying |
| 910 | that the section may not be construed as limiting benefits |
| 911 | and coverage otherwise available to an insured under a |
| 912 | health insurance plan; prohibiting the Office of Insurance |
| 913 | Regulation from enforcing certain provisions against |
| 914 | insurers that are signatories to the developmental |
| 915 | disabilities compact; creating s. 641.31098, F.S.; |
| 916 | providing coverage under a health maintenance contract for |
| 917 | individuals with developmental disabilities; providing |
| 918 | definitions; providing coverage for certain screening to |
| 919 | diagnose and treat developmental disabilities; providing |
| 920 | limitations on coverage; providing for eligibility |
| 921 | standards for benefits and coverage; prohibiting health |
| 922 | maintenance organizations from denying coverage under |
| 923 | certain circumstances; specifying required elements of a |
| 924 | treatment plan; providing, beginning January 1, 2011, that |
| 925 | the maximum benefit shall be adjusted annually; |
| 926 | prohibiting the Office of Insurance Regulation from |
| 927 | enforcing certain provisions against health maintenance |
| 928 | organizations that are signatories to the developmental |
| 929 | disabilities compact; providing an effective date. |