HB 1329

1	A bill to be entitled
2	An act relating to the Florida Kidcare program; amending
3	s. 409.810, F.S.; correcting a cross-reference; amending
4	s. 409.811, F.S.; providing definitions; conforming cross-
5	references; amending s. 409.812, F.S.; clarifying the
6	application of the Florida Kidcare program to include all
7	eligible uninsured, low-income children; amending s.
8	409.813, F.S.; specifying funding sources for health
9	benefits coverage for certain children; specifying program
10	components to be marketed as the Florida Kidcare program;
11	conforming cross-references; amending s. 409.8132, F.S.;
12	conforming a cross-reference; revising provisions relating
13	to penalties for nonpayment of premiums and waiting
14	periods for reinstatement of coverage; amending s.
15	409.8134, F.S.; revising provisions relating to enrollment
16	in the Florida Kidcare program; amending s. 409.814, F.S.;
17	removing a restriction on participation in the Florida
18	Healthy Kids program; authorizing certain enrollees to opt
19	out of the Children's Medical Services Network or Florida
20	Kidcare Plus; revising coverage limitations; revising
21	restrictions on enrollment of children whose coverage was
22	voluntarily canceled; providing exceptions; revising
23	limitations on age and income for coverage under the Title
24	XXI-funded Florida Kidcare program; requiring electronic
25	verification of applicants' income; providing
26	circumstances under which written documentation is
27	required; revising the timeframe for an enrollee to
28	resolve disputes regarding the withholding of benefits;
29	amending s. 409.815, F.S.; authorizing the Agency for
30	Health Care Administration to increase premium assistance
31	payments for benefits provided through Florida Kidcare
32	Plus rather than the Children's Medical Services Network;
33	conforming cross-references; amending ss. 409.816 and
34	409.817, F.S.; conforming cross-references; amending s.
35	409.8177, F.S.; revising information to be included in the
36	annual program evaluation submitted to the Governor and
37	Legislature; amending s. 409.818, F.S.; revising the
38	redetermination process for coverage under the Florida
39	Kidcare program; clarifying that the Department of Health
40	is the chair of a Florida Kidcare coordinating council;
41	conforming cross-references; amending s. 409.821, F.S.,
42	relating to an exemption from public records requirements
43	provided for the Florida Kidcare program; revising
44	requirements for disclosure of certain confidential and
45	exempt information relating to an enrollee's application;
46	amending s. 409.904, F.S.; revising provisions relating to
47	the determination of eligibility of certain children for
48	the Medicaid program; amending s. 624.91, F.S.; revising
49	the duties of the Florida Healthy Kids Corporation;
50	revising the date upon which the corporation must provide
51	a study to the Legislature and the Governor; correcting a
52	cross-reference; providing an effective date.
53
54	Be It Enacted by the Legislature of the State of Florida:
55
56	Section 1.  Section 409.810, Florida Statutes, is amended
57	to read:
58	409.810  Short title.--Sections 409.810-409.821 409.810-
59	409.820 may be cited as the "Florida Kidcare Act."
60	Section 2.  Section 409.811, Florida Statutes, is amended
61	to read:
62	409.811  Definitions relating to Florida Kidcare Act.--As
63	used in ss. 409.810-409.821 ss. 409.810-409.820, the term:
64	(1)  "Actuarially equivalent" means that:
65	(a)  The aggregate value of the benefits included in health
66	benefits coverage is equal to the value of the benefits in the
67	benchmark benefit plan; and
68	(b)  The benefits included in health benefits coverage are
69	substantially similar to the benefits included in the benchmark
70	benefit plan, except that preventive health services must be the
71	same as in the benchmark benefit plan.
72	(2)  "Agency" means the Agency for Health Care
73	Administration.
74	(3)  "Applicant" means a parent or guardian of a child or a
75	child whose disability of nonage has been removed under chapter
76	743, who applies for determination of eligibility for health
77	benefits coverage under ss. 409.810-409.821 ss. 409.810-409.820.
78	(4)  "Benchmark benefit plan" means the form and level of
79	health benefits coverage established in s. 409.815.
80	(5)  "Child" means any person under 19 years of age.
81	(6)  "Child with special health care needs" means a child
82	whose serious or chronic physical or developmental condition
83	requires extensive preventive and maintenance care beyond that
84	required by typically healthy children. Health care utilization
85	by such a child exceeds the statistically expected usage of the
86	normal child adjusted for chronological age, and such a child
87	often needs complex care requiring multiple providers,
88	rehabilitation services, and specialized equipment in a number
89	of different settings.
90	(7)  "Children's Medical Services Network" or "network"
91	means a statewide managed care service system as defined in s.
92	391.021(1).
93	(8)  "Community rate" means a method used to develop
94	premiums for a health insurance plan that spreads financial risk
95	across a large population and allows adjustments only for age,
96	gender, family composition, and geographic area.
97	(9)  "Department" means the Department of Health.
98	(10)  "Enrollee" means a child who has been determined
99	eligible for and is receiving coverage under ss. 409.810-409.821
100	ss. 409.810-409.820.
101	(11)  "Family" means the group or the individuals whose
102	income is considered in determining eligibility for the Florida
103	Kidcare program. The family includes a child with a parent or
104	caretaker relative who resides in the same house or living unit
105	or, in the case of a child whose disability of nonage has been
106	removed under chapter 743, the child. The family may also
107	include other individuals whose income and resources are
108	considered in whole or in part in determining eligibility of the
109	child.
110	(12)  "Family income" means cash received at periodic
111	intervals from any source, such as wages, benefits,
112	contributions, or rental property. Income also may include any
113	money that would have been counted as income under the Aid to
114	Families with Dependent Children (AFDC) state plan in effect
115	prior to August 22, 1996.
116	(13)  "Florida Kidcare Plus" means health benefits coverage
117	for children with special health care needs delivered through
118	the Children's Medical Services Network.
119	(14)(13)  "Florida Kidcare program," "Kidcare program," or
120	"program" means the health benefits program administered through
121	ss. 409.810-409.821 ss. 409.810-409.820.
122	(15)(14)  "Guarantee issue" means that health benefits
123	coverage must be offered to an individual regardless of the
124	individual's health status, preexisting condition, or claims
125	history.
126	(16)(15)  "Health benefits coverage" means protection that
127	provides payment of benefits for covered health care services or
128	that otherwise provides, either directly or through arrangements
129	with other persons, covered health care services on a prepaid
130	per capita basis or on a prepaid aggregate fixed-sum basis.
131	(17)(16)  "Health insurance plan" means health benefits
132	coverage under the following:
133	(a)  A health plan offered by any certified health
134	maintenance organization or authorized health insurer, except a
135	plan that is limited to the following: a limited benefit,
136	specified disease, or specified accident; hospital indemnity;
137	accident only; limited benefit convalescent care; Medicare
138	supplement; credit disability; dental; vision; long-term care;
139	disability income; coverage issued as a supplement to another
140	health plan; workers' compensation liability or other insurance;
141	or motor vehicle medical payment only; or
142	(b)  An employee welfare benefit plan that includes health
143	benefits established under the Employee Retirement Income
144	Security Act of 1974, as amended.
145	(18)(17)  "Medicaid" means the medical assistance program
146	authorized by Title XIX of the Social Security Act, and
147	regulations thereunder, and ss. 409.901-409.920, as administered
148	in this state by the agency.
149	(19)(18)  "Medically necessary" means the use of any
150	medical treatment, service, equipment, or supply necessary to
151	palliate the effects of a terminal condition, or to prevent,
152	diagnose, correct, cure, alleviate, or preclude deterioration of
153	a condition that threatens life, causes pain or suffering, or
154	results in illness or infirmity and which is:
155	(a)  Consistent with the symptom, diagnosis, and treatment
156	of the enrollee's condition;
157	(b)  Provided in accordance with generally accepted
158	standards of medical practice;
159	(c)  Not primarily intended for the convenience of the
160	enrollee, the enrollee's family, or the health care provider;
161	(d)  The most appropriate level of supply or service for
162	the diagnosis and treatment of the enrollee's condition; and
163	(e)  Approved by the appropriate medical body or health
164	care specialty involved as effective, appropriate, and essential
165	for the care and treatment of the enrollee's condition.
166	(20)(19)  "Medikids" means a component of the Florida
167	Kidcare program of medical assistance authorized by Title XXI of
168	the Social Security Act, and regulations thereunder, and s.
169	409.8132, as administered in the state by the agency.
170	(21)(20)  "Preexisting condition exclusion" means, with
171	respect to coverage, a limitation or exclusion of benefits
172	relating to a condition based on the fact that the condition was
173	present before the date of enrollment for such coverage, whether
174	or not any medical advice, diagnosis, care, or treatment was
175	recommended or received before such date.
176	(22)(21)  "Premium" means the entire cost of a health
177	insurance plan, including the administration fee or the risk
178	assumption charge.
179	(23)(22)  "Premium assistance payment" means the monthly
180	consideration paid by the agency per enrollee in the Florida
181	Kidcare program towards health insurance premiums.
182	(24)(23)  "Qualified alien" means an alien as defined in s.
183	431 of the Personal Responsibility and Work Opportunity
184	Reconciliation Act of 1996, as amended, Pub. L. No. 104-193.
185	(25)(24)  "Resident" means a United States citizen, or
186	qualified alien, who is domiciled in this state.
187	(26)(25)  "Rural county" means a county having a population
188	density of less than 100 persons per square mile, or a county
189	defined by the most recent United States Census as rural, in
190	which there is no prepaid health plan participating in the
191	Medicaid program as of July 1, 1998.
192	(27)(26)  "Substantially similar" means that, with respect
193	to additional services as defined in s. 2103(c)(2) of Title XXI
194	of the Social Security Act, these services must have an
195	actuarial value equal to at least 75 percent of the actuarial
196	value of the coverage for that service in the benchmark benefit
197	plan and, with respect to the basic services as defined in s.
198	2103(c)(1) of Title XXI of the Social Security Act, these
199	services must be the same as the services in the benchmark
200	benefit plan.
201	Section 3.  Section 409.812, Florida Statutes, is amended
202	to read:
203	409.812  Program created; purpose.--The Florida Kidcare
204	program is created to provide a defined set of health benefits
205	to previously uninsured, low-income children through the
206	establishment of a variety of affordable health benefits
207	coverage options from which families may select coverage and
208	through which families may contribute financially to the health
209	care of their children.
210	Section 4.  Section 409.813, Florida Statutes, is amended
211	to read:
212	409.813  Health benefits coverage; program components;
213	entitlement and nonentitlement.--
214	(1)  The Florida Kidcare program includes health benefits
215	coverage provided to children through the following program
216	components, which shall be marketed as the Florida Kidcare
217	program:
218	(a)(1)  Medicaid;
219	(b)(2)  Medikids as created in s. 409.8132;
220	(c)(3)  The Florida Healthy Kids Corporation as created in
221	s. 624.91;
222	(d)(4)  Employer-sponsored group health insurance plans
223	approved under ss. 409.810-409.821 ss. 409.810-409.820; and
224	(e)(5)  The Children's Medical Services network established
225	in chapter 391.
226	(2)  Except for Title XIX-funded Florida Kidcare program
227	coverage under the Medicaid program, coverage under the Florida
228	Kidcare program is not an entitlement. No cause of action shall
229	arise against the state, the department, the Department of
230	Children and Family Services, or the agency for failure to make
231	health services available to any person under ss. 409.810-
232	409.821 ss. 409.810-409.820.
233	Section 5.  Paragraph (b) of subsection (6) and subsection
234	(8) of section 409.8132, Florida Statutes, are amended to read:
235	409.8132  Medikids program component.--
236	(6)  ELIGIBILITY.--
237	(b)  The provisions of s. 409.814(3), (4), and (5), and (6)
238	shall be applicable to the Medikids program.
239	(8)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
240	shall establish enrollment criteria that must include penalties
241	or waiting periods of 30 not fewer than 60 days for
242	reinstatement of coverage upon voluntary cancellation for
243	nonpayment of premiums.
244	Section 6.  Section 409.8134, Florida Statutes, is amended
245	to read:
246	409.8134  Program expenditure ceiling; enrollment.--
247	(1)  Except for the Medicaid program, a ceiling shall be
248	placed on annual federal and state expenditures for the Florida
249	Kidcare program as provided each year in the General
250	Appropriations Act.
251	(2)  The Florida Kidcare program may conduct enrollment
252	continuously at any time throughout the year for the purpose of
253	enrolling children eligible for all program components listed in
254	s. 409.813 except Medicaid. The four Florida Kidcare
255	administrators shall work together to ensure that the year-round
256	enrollment period is announced statewide. Eligible Children
257	eligible for coverage under the Title XXI-funded components of
258	the Florida Kidcare program shall be enrolled on a first-come,
259	first-served basis using the date the enrollment application is
260	received. Enrollment shall immediately cease when the
261	expenditure ceiling is reached. Year-round enrollment shall only
262	be held if the Social Services Estimating Conference determines
263	that sufficient federal and state funds will be available to
264	finance the increased enrollment through federal fiscal year
265	2007. Any individual who is not enrolled must reapply by
266	submitting a new application. The application for the Florida
267	Kidcare program is shall be valid for a period of 120 days after
268	the date it was received. At the end of the 120-day period, if
269	the applicant has not been enrolled in the program, the
270	application is shall be invalid and the applicant shall be
271	notified of the action. The applicant may reactivate resubmit
272	the application after notification of the action taken by the
273	program. Except for the Medicaid program, whenever the Social
274	Services Estimating Conference determines that there are
275	presently, or will be by the end of the current fiscal year,
276	insufficient funds to finance the current or projected
277	enrollment in the Florida Kidcare program, all additional
278	enrollment must cease and additional enrollment may not resume
279	until sufficient funds are available to finance such enrollment.
280	(3)  Upon determination by the Social Services Estimating
281	Conference that there are insufficient funds to finance the
282	current enrollment in the Florida Kidcare program within current
283	appropriations, the program shall initiate disenrollment
284	procedures to remove enrollees, except those children enrolled
285	in Florida Kidcare Plus the Children's Medical Services Network,
286	on a last-in, first-out basis until the expenditure and
287	appropriation levels are balanced.
288	(4)  The agencies that administer the Florida Kidcare
289	program components shall collect and analyze the data needed to
290	project program enrollment costs, including price level
291	adjustments, participation and attrition rates, current and
292	projected caseloads, utilization, and current and projected
293	expenditures for the next 3 years. The agencies shall report
294	caseload and expenditure trends to the Social Services
295	Estimating Conference in accordance with chapter 216.
296	Section 7.  Section 409.814, Florida Statutes, is amended
297	to read:
298	409.814  Eligibility.--A child who has not reached 19 years
299	of age whose family income is equal to or below 200 percent of
300	the federal poverty level is eligible for the Florida Kidcare
301	program as provided in this section. For enrollment in Florida
302	Kidcare Plus the Children's Medical Services Network, a complete
303	application includes the medical or behavioral health screening.
304	If, subsequently, an individual is determined to be ineligible
305	for coverage, he or she must immediately be disenrolled from the
306	respective Florida Kidcare program component.
307	(1)  A child who is eligible for Medicaid coverage under s.
308	409.903 or s. 409.904 must be enrolled in Medicaid and is not
309	eligible to receive health benefits under any other health
310	benefits coverage authorized under the Florida Kidcare program.
311	(2)  A child who is not eligible for Medicaid, but who is
312	eligible for the Florida Kidcare program, may obtain health
313	benefits coverage under any of the other components listed in s.
314	409.813 if such coverage is approved and available in the county
315	in which the child resides. However, a child who is eligible for
316	Medikids may participate in the Florida Healthy Kids program
317	only if the child has a sibling participating in the Florida
318	Healthy Kids program and the child's county of residence permits
319	such enrollment.
320	(3)  A child who is eligible for the Florida Kidcare
321	program who is a child with special health care needs, as
322	determined through a medical or behavioral screening instrument,
323	shall receive Florida Kidcare Plus is eligible for health
324	benefits coverage from and shall be assigned to and may opt out
325	of referred to the Children's Medical Services Network or
326	Florida Kidcare Plus.
327	(4)  The following children are not eligible to receive
328	Title XXI-funded premium assistance for health benefits coverage
329	under the Florida Kidcare program, except under Medicaid if the
330	child would have been eligible for Medicaid under s. 409.903 or
331	s. 409.904 as of June 1, 1997:
332	(a)  A child who is eligible for coverage under a state
333	health benefit plan on the basis of a family member's employment
334	with a public agency in the state.
335	(b)  A child who is currently eligible for or covered under
336	a family member's group health benefit plan or under other
337	private or employer health insurance coverage, if excluding
338	coverage provided under the Florida Healthy Kids Corporation as
339	established under s. 624.91, provided that the cost of the
340	child's participation is not greater than 5 percent of the
341	family's income. If a child is otherwise eligible for a subsidy
342	under the Florida Kidcare program and the cost of the child's
343	participation in the family member's health insurance benefit
344	plan is greater than 5 percent of the family's income, the child
345	may be enrolled in the appropriate subsidized Florida Kidcare
346	program component. This provision shall be applied during
347	redetermination for children who were enrolled prior to July 1,
348	2004. These enrollees shall have 6 months of eligibility
349	following redetermination to allow for a transition to the other
350	health benefit plan.
351	(c)  A child who is seeking premium assistance for the
352	Florida Kidcare program through employer-sponsored group
353	coverage, if the child has been covered by the same employer's
354	group coverage during the 60 days 6 months prior to the family's
355	submitting an application for determination of eligibility under
356	the program.
357	(d)  A child who is an alien, but who does not meet the
358	definition of qualified alien, in the United States.
359	(e)  A child who is an inmate of a public institution or a
360	patient in an institution for mental diseases.
361	(f)  A child who is otherwise eligible for premium
362	assistance for the Florida Kidcare program and has had his or
363	her coverage in an employer-sponsored or private health benefit
364	plan voluntarily canceled in the last 60 days 6 months, except
365	those children whose coverage was voluntarily canceled for good
366	cause, including, but not limited to, the following
367	circumstances:
368	1.  The cost of participation in an employer-sponsored
369	health benefit plan is greater than 5 percent of the family's
370	income;
371	2.  The parent lost a job that provided an employer-
372	sponsored health benefit plan for children;
373	3.  The parent who had health benefits coverage for the
374	child is deceased;
375	4.  The child has a medical condition that, without medical
376	care, would cause serious disability, loss of function, or
377	death;
378	5.  The employer of the parent canceled health benefits
379	coverage for children;
380	6.  The child's health benefits coverage ended because the
381	child reached the maximum lifetime coverage amount;
382	7.  The child has exhausted coverage under a COBRA
383	continuation provision;
384	8.  The health benefits coverage does not cover the child's
385	health care needs; or
386	9.  Domestic violence led to loss of coverage who were on
387	the waiting list prior to March 12, 2004.
388	(5)(g)  A child who is otherwise eligible for the Florida
389	Kidcare program and who has a preexisting condition that
390	prevents coverage under another insurance plan as described in
391	paragraph (4)(b) which would have disqualified the child for the
392	Florida Kidcare program if the child were able to enroll in the
393	plan shall be eligible for Florida Kidcare coverage when
394	enrollment is possible.
395	(6)(5)  A child whose family income is above 200 percent of
396	the federal poverty level or a child who is excluded under the
397	provisions of subsection (4) may participate in the Florida
398	Kidcare Medikids program as provided in s. 409.8132 or, if the
399	child is ineligible for Medikids by reason of age, in the
400	Florida Healthy Kids program, subject to the following
401	provisions:
402	(a)  The family is not eligible for premium assistance
403	payments and must pay the full cost of the premium, including
404	any administrative costs.
405	(b)  The board of directors of the Florida Healthy Kids
406	Corporation may offer a reduced benefit package to these
407	children in order to limit program costs for such families.
408	(7)(6)  Once a child is enrolled in the Florida Kidcare
409	program, the child is eligible for coverage under the program
410	for 12 months without a redetermination or reverification of
411	eligibility, if the family continues to pay the applicable
412	premium. Eligibility for program components funded through Title
413	XXI of the Social Security Act shall terminate when a child
414	attains the age of 19. Effective January 1, 1999, A child who
415	has not attained the age of 19 5 and who has been determined
416	eligible for the Medicaid program is eligible for coverage for
417	12 months without a redetermination or reverification of
418	eligibility.
419	(8)(7)  When determining or reviewing a child's eligibility
420	under the Florida Kidcare program, the applicant shall be
421	provided with reasonable notice of changes in eligibility which
422	may affect enrollment in one or more of the program components.
423	When a transition from one program component to another is
424	authorized, there shall be cooperation between the program
425	components and the affected family which promotes continuity of
426	health care coverage. Any authorized transfers must be managed
427	within the program's overall appropriated or authorized levels
428	of funding. Each component of the program shall establish a
429	reserve to ensure that transfers between components will be
430	accomplished within current year appropriations. These reserves
431	shall be reviewed by each convening of the Social Services
432	Estimating Conference to determine the adequacy of such reserves
433	to meet actual experience.
434	(9)(8)  In determining the eligibility of a child, an
435	assets test is not required. Each applicant shall provide
436	written documentation during the application process and the
437	redetermination process, including, but not limited to, the
438	following:
439	(a)  Each applicant's proof of family income shall be
440	verified electronically to determine financial eligibility for
441	the Florida Kidcare program. Written documentation, which may
442	must include wages and earnings statements or pay stubs, W-2
443	forms, or a copy of the applicant's most recent federal income
444	tax return, shall be required only if the electronic
445	verification is not available or does not substantiate the
446	applicant's income. In the absence of a federal income tax
447	return, an applicant may submit wages and earnings statements
448	(pay stubs), W-2 forms, or other appropriate documents.
449	(b)  Each applicant shall provide a statement from all
450	applicable, employed family members that:
451	1.  Their employers do employer does not sponsor a health
452	benefit plans plan for employees; or
453	2.  The potential enrollee is not covered by an the
454	employer-sponsored health benefit plan because the potential
455	enrollee is not eligible for coverage, or, if the potential
456	enrollee is eligible but not covered, a statement of the cost to
457	enroll the potential enrollee in the employer-sponsored health
458	benefit plan. If the cost of the employer-sponsored health
459	benefit plan is greater than 5 percent of the family's income
460	and the potential enrollee is otherwise eligible for premium
461	assistance, he or she may be enrolled in the appropriate,
462	subsidized component of the Florida Kidcare program.
463	(10)(9)  Subject to paragraph (4)(b) and s. 624.91(4), the
464	Florida Kidcare program shall withhold benefits from an enrollee
465	if the program obtains evidence that the enrollee is no longer
466	eligible, submitted incorrect or fraudulent information in order
467	to establish eligibility, or failed to provide verification of
468	eligibility. The applicant or enrollee shall be notified that
469	because of such evidence program benefits will be withheld
470	unless the applicant or enrollee contacts a designated
471	representative of the program by a specified date, which must be
472	within 10 working days after the date of notice, to discuss and
473	resolve the matter. The program shall make every effort to
474	resolve the matter within a timeframe that will not cause
475	benefits to be withheld from an eligible enrollee.
476	(11)(10)  The following individuals may be subject to
477	prosecution in accordance with s. 414.39:
478	(a)  An applicant obtaining or attempting to obtain
479	benefits for a potential enrollee under the Florida Kidcare
480	program when the applicant knows or should have known the
481	potential enrollee does not qualify for the Florida Kidcare
482	program.
483	(b)  An individual who assists an applicant in obtaining or
484	attempting to obtain benefits for a potential enrollee under the
485	Florida Kidcare program when the individual knows or should have
486	known the potential enrollee does not qualify for the Florida
487	Kidcare program.
488	Section 8.  Subsection (2) of section 409.815, Florida
489	Statutes, is amended to read:
490	409.815  Health benefits coverage; limitations.--
491	(2)  BENCHMARK BENEFITS.--In order for health benefits
492	coverage to qualify for premium assistance payments for an
493	eligible child under ss. 409.810-409.821 ss. 409.810-409.820,
494	the health benefits coverage, except for coverage under Medicaid
495	and Medikids, must include the following minimum benefits, as
496	medically necessary.
497	(a)  Preventive health services.--Covered services include:
498	1.  Well-child care, including services recommended in the
499	Guidelines for Health Supervision of Children and Youth as
500	developed by the American Academy of Pediatrics;
501	2.  Immunizations and injections;
502	3.  Health education counseling and clinical services;
503	4.  Vision screening; and
504	5.  Hearing screening.
505	(b)  Inpatient hospital services.--All covered services
506	provided for the medical care and treatment of an enrollee who
507	is admitted as an inpatient to a hospital licensed under part I
508	of chapter 395, with the following exceptions:
509	1.  All admissions must be authorized by the enrollee's
510	health benefits coverage provider.
511	2.  The length of the patient stay shall be determined
512	based on the medical condition of the enrollee in relation to
513	the necessary and appropriate level of care.
514	3.  Room and board may be limited to semiprivate
515	accommodations, unless a private room is considered medically
516	necessary or semiprivate accommodations are not available.
517	4.  Admissions for rehabilitation and physical therapy are
518	limited to 15 days per contract year.
519	(c)  Emergency services.--Covered services include visits
520	to an emergency room or other licensed facility if needed
521	immediately due to an injury or illness and delay means risk of
522	permanent damage to the enrollee's health. Health maintenance
523	organizations shall comply with the provisions of s. 641.513.
524	(d)  Maternity services.--Covered services include
525	maternity and newborn care, including prenatal and postnatal
526	care, with the following limitations:
527	1.  Coverage may be limited to the fee for vaginal
528	deliveries; and
529	2.  Initial inpatient care for newborn infants of enrolled
530	adolescents shall be covered, including normal newborn care,
531	nursery charges, and the initial pediatric or neonatal
532	examination, and the infant may be covered for up to 3 days
533	following birth.
534	(e)  Organ transplantation services.--Covered services
535	include pretransplant, transplant, and postdischarge services
536	and treatment of complications after transplantation for
537	transplants deemed necessary and appropriate within the
538	guidelines set by the Organ Transplant Advisory Council under s.
539	765.53 or the Bone Marrow Transplant Advisory Panel under s.
540	627.4236.
541	(f)  Outpatient services.--Covered services include
542	preventive, diagnostic, therapeutic, palliative care, and other
543	services provided to an enrollee in the outpatient portion of a
544	health facility licensed under chapter 395, except for the
545	following limitations:
546	1.  Services must be authorized by the enrollee's health
547	benefits coverage provider; and
548	2.  Treatment for temporomandibular joint disease (TMJ) is
549	specifically excluded.
550	(g)  Behavioral health services.--
551	1.  Mental health benefits include:
552	a.  Inpatient services, limited to not more than 30
553	inpatient days per contract year for psychiatric admissions, or
554	residential services in facilities licensed under s. 394.875(6)
555	or s. 395.003 in lieu of inpatient psychiatric admissions;
556	however, a minimum of 10 of the 30 days shall be available only
557	for inpatient psychiatric services when authorized by a
558	physician; and
559	b.  Outpatient services, including outpatient visits for
560	psychological or psychiatric evaluation, diagnosis, and
561	treatment by a licensed mental health professional, limited to a
562	maximum of 40 outpatient visits each contract year.
563	2.  Substance abuse services include:
564	a.  Inpatient services, limited to not more than 7
565	inpatient days per contract year for medical detoxification only
566	and 30 days of residential services; and
567	b.  Outpatient services, including evaluation, diagnosis,
568	and treatment by a licensed practitioner, limited to a maximum
569	of 40 outpatient visits per contract year.
570	(h)  Durable medical equipment.--Covered services include
571	equipment and devices that are medically indicated to assist in
572	the treatment of a medical condition and specifically prescribed
573	as medically necessary, with the following limitations:
574	1.  Low-vision and telescopic aides are not included.
575	2.  Corrective lenses and frames may be limited to one pair
576	every 2 years, unless the prescription or head size of the
577	enrollee changes.
578	3.  Hearing aids shall be covered only when medically
579	indicated to assist in the treatment of a medical condition.
580	4.  Covered prosthetic devices include artificial eyes and
581	limbs, braces, and other artificial aids.
582	(i)  Health practitioner services.--Covered services
583	include services and procedures rendered to an enrollee when
584	performed to diagnose and treat diseases, injuries, or other
585	conditions, including care rendered by health practitioners
586	acting within the scope of their practice, with the following
587	exceptions:
588	1.  Chiropractic services shall be provided in the same
589	manner as in the Florida Medicaid program.
590	2.  Podiatric services may be limited to one visit per day
591	totaling two visits per month for specific foot disorders.
592	(j)  Home health services.--Covered services include
593	prescribed home visits by both registered and licensed practical
594	nurses to provide skilled nursing services on a part-time
595	intermittent basis, subject to the following limitations:
596	1.  Coverage may be limited to include skilled nursing
597	services only;
598	2.  Meals, housekeeping, and personal comfort items may be
599	excluded; and
600	3.  Private duty nursing is limited to circumstances where
601	such care is medically necessary.
602	(k)  Hospice services.--Covered services include reasonable
603	and necessary services for palliation or management of an
604	enrollee's terminal illness, with the following exceptions:
605	1.  Once a family elects to receive hospice care for an
606	enrollee, other services that treat the terminal condition will
607	not be covered; and
608	2.  Services required for conditions totally unrelated to
609	the terminal condition are covered to the extent that the
610	services are included in this section.
611	(l)  Laboratory and X-ray services.--Covered services
612	include diagnostic testing, including clinical radiologic,
613	laboratory, and other diagnostic tests.
614	(m)  Nursing facility services.--Covered services include
615	regular nursing services, rehabilitation services, drugs and
616	biologicals, medical supplies, and the use of appliances and
617	equipment furnished by the facility, with the following
618	limitations:
619	1.  All admissions must be authorized by the health
620	benefits coverage provider.
621	2.  The length of the patient stay shall be determined
622	based on the medical condition of the enrollee in relation to
623	the necessary and appropriate level of care, but is limited to
624	not more than 100 days per contract year.
625	3.  Room and board may be limited to semiprivate
626	accommodations, unless a private room is considered medically
627	necessary or semiprivate accommodations are not available.
628	4.  Specialized treatment centers and independent kidney
629	disease treatment centers are excluded.
630	5.  Private duty nurses, television, and custodial care are
631	excluded.
632	6.  Admissions for rehabilitation and physical therapy are
633	limited to 15 days per contract year.
634	(n)  Prescribed drugs.--
635	1.  Coverage shall include drugs prescribed for the
636	treatment of illness or injury when prescribed by a licensed
637	health practitioner acting within the scope of his or her
638	practice.
639	2.  Prescribed drugs may be limited to generics if
640	available and brand name products if a generic substitution is
641	not available, unless the prescribing licensed health
642	practitioner indicates that a brand name is medically necessary.
643	3.  Prescribed drugs covered under this section shall
644	include all prescribed drugs covered under the Florida Medicaid
645	program.
646	(o)  Therapy services.--Covered services include
647	rehabilitative services, including occupational, physical,
648	respiratory, and speech therapies, with the following
649	limitations:
650	1.  Services must be for short-term rehabilitation where
651	significant improvement in the enrollee's condition will result;
652	and
653	2.  Services shall be limited to not more than 24 treatment
654	sessions within a 60-day period per episode or injury, with the
655	60-day period beginning with the first treatment.
656	(p)  Transportation services.--Covered services include
657	emergency transportation required in response to an emergency
658	situation.
659	(q)  Dental services.--Dental services shall be covered and
660	may include those dental benefits provided to children by the
661	Florida Medicaid program under s. 409.906(6).
662	(r)  Lifetime maximum.--Health benefits coverage obtained
663	under ss. 409.810-409.821 ss. 409.810-409.820 shall pay an
664	enrollee's covered expenses at a lifetime maximum of $1 million
665	per covered child.
666	(s)  Cost-sharing.--Cost-sharing provisions must comply
667	with s. 409.816.
668	(t)  Exclusions.--
669	1.  Experimental or investigational procedures that have
670	not been clinically proven by reliable evidence are excluded;
671	2.  Services performed for cosmetic purposes only or for
672	the convenience of the enrollee are excluded; and
673	3.  Abortion may be covered only if necessary to save the
674	life of the mother or if the pregnancy is the result of an act
675	of rape or incest.
676	(u)  Enhancements to minimum requirements.--
677	1.  This section sets the minimum benefits that must be
678	included in any health benefits coverage, other than Medicaid or
679	Medikids coverage, offered under ss. 409.810-409.821 ss.
680	409.810-409.820. Health benefits coverage may include additional
681	benefits not included under this subsection, but may not include
682	benefits excluded under paragraph (s).
683	2.  Health benefits coverage may extend any limitations
684	beyond the minimum benefits described in this section.
685
686	Except for benefits provided under Florida Kidcare Plus the
687	Children's Medical Services Network, the agency may not increase
688	the premium assistance payment for either additional benefits
689	provided beyond the minimum benefits described in this section
690	or the imposition of less restrictive service limitations.
691	(v)  Applicability of other state laws.--Health insurers,
692	health maintenance organizations, and their agents are subject
693	to the provisions of the Florida Insurance Code, except for any
694	such provisions waived in this section.
695	1.  Except as expressly provided in this section, a law
696	requiring coverage for a specific health care service or
697	benefit, or a law requiring reimbursement, utilization, or
698	consideration of a specific category of licensed health care
699	practitioner, does not apply to a health insurance plan policy
700	or contract offered or delivered under ss. 409.810-409.821 ss.
701	409.810-409.820 unless that law is made expressly applicable to
702	such policies or contracts.
703	2.  Notwithstanding chapter 641, a health maintenance
704	organization may issue contracts providing benefits equal to,
705	exceeding, or actuarially equivalent to the benchmark benefit
706	plan authorized by this section and may pay providers located in
707	a rural county negotiated fees or Medicaid reimbursement rates
708	for services provided to enrollees who are residents of the
709	rural county.
710	Section 9.  Subsection (3) of section 409.816, Florida
711	Statutes, is amended to read:
712	409.816  Limitations on premiums and cost-sharing.--The
713	following limitations on premiums and cost-sharing are
714	established for the program.
715	(3)  Enrollees in families with a family income above 150
716	percent of the federal poverty level, who are not receiving
717	coverage under the Medicaid program or who are not eligible
718	under s. 409.814(6) s. 409.814(5), may be required to pay
719	enrollment fees, premiums, copayments, deductibles, coinsurance,
720	or similar charges on a sliding scale related to income, except
721	that the total annual aggregate cost-sharing with respect to all
722	children in a family may not exceed 5 percent of the family's
723	income. However, copayments, deductibles, coinsurance, or
724	similar charges may not be imposed for preventive services,
725	including well-baby and well-child care, age-appropriate
726	immunizations, and routine hearing and vision screenings.
727	Section 10.  Section 409.817, Florida Statutes, is amended
728	to read:
729	409.817  Approval of health benefits coverage; financial
730	assistance.--In order for health insurance coverage to qualify
731	for premium assistance payments for an eligible child under ss.
732	409.810-409.821 ss. 409.810-409.820, the health benefits
733	coverage must:
734	(1)  Be certified by the Office of Insurance Regulation of
735	the Financial Services Commission under s. 409.818 as meeting,
736	exceeding, or being actuarially equivalent to the benchmark
737	benefit plan;
738	(2)  Be guarantee issued;
739	(3)  Be community rated;
740	(4)  Not impose any preexisting condition exclusion for
741	covered benefits; however, group health insurance plans may
742	permit the imposition of a preexisting condition exclusion, but
743	only insofar as it is permitted under s. 627.6561;
744	(5)  Comply with the applicable limitations on premiums and
745	cost-sharing in s. 409.816;
746	(6)  Comply with the quality assurance and access standards
747	developed under s. 409.820; and
748	(7)  Establish periodic open enrollment periods, which may
749	not occur more frequently than quarterly.
750	Section 11.  Paragraph (i) of subsection (1) of section
751	409.8177, Florida Statutes, is amended to read:
752	409.8177  Program evaluation.--
753	(1)  The agency, in consultation with the Department of
754	Health, the Department of Children and Family Services, and the
755	Florida Healthy Kids Corporation, shall contract for an
756	evaluation of the Florida Kidcare program and shall by January 1
757	of each year submit to the Governor, the President of the
758	Senate, and the Speaker of the House of Representatives a report
759	of the program. In addition to the items specified under s. 2108
760	of Title XXI of the Social Security Act, the report shall
761	include an assessment of crowd-out and access to health care, as
762	well as the following:
763	(i)  An assessment of the effectiveness of the Florida
764	Kidcare program, including Medicaid, the Florida Healthy Kids
765	program, Medikids, and the Children's Medical Services Network,
766	and other public and private programs in the state in increasing
767	the availability of affordable quality health insurance and
768	health care for children.
769	Section 12.  Section 409.818, Florida Statutes, is amended
770	to read:
771	409.818  Administration.--In order to implement ss.
772	409.810-409.821 ss. 409.810-409.820, the following agencies
773	shall have the following duties:
774	(1)  The Department of Children and Family Services shall:
775	(a)  Develop a simplified eligibility application mail-in
776	form to be used for determining the eligibility of children for
777	coverage under the Florida Kidcare program, in consultation with
778	the agency, the Department of Health, and the Florida Healthy
779	Kids Corporation. The simplified eligibility application form
780	must include an item that provides an opportunity for the
781	applicant to indicate whether coverage is being sought for a
782	child with special health care needs. Families applying for
783	children's Medicaid coverage must also be able to use the
784	simplified application form without having to pay a premium.
785	(b)  Establish and maintain the eligibility determination
786	process under the program except as specified in subsection (5).
787	The department shall directly, or through the services of a
788	contracted third-party administrator, establish and maintain a
789	process for determining eligibility of children for coverage
790	under the program. The eligibility determination process must be
791	used solely for determining eligibility of applicants for health
792	benefits coverage under the program. The eligibility
793	determination process must include an initial determination of
794	eligibility for any coverage offered under the program, as well
795	as a redetermination or reverification of eligibility each
796	subsequent 12 6 months. Effective January 1, 1999, A child who
797	has not attained the age of 19 5 and who has been determined
798	eligible for the Medicaid program is eligible for coverage for
799	12 months without a redetermination or reverification of
800	eligibility. In conducting an eligibility determination, the
801	department shall determine if the child has special health care
802	needs. The department, in consultation with the Agency for
803	Health Care Administration and the Florida Healthy Kids
804	Corporation, shall develop procedures for redetermining
805	eligibility which enable a family to easily update any change in
806	circumstances which could affect eligibility. The department may
807	accept changes in a family's status as reported to the
808	department by the Florida Healthy Kids Corporation without
809	requiring a new application from the family. Redetermination of
810	a child's eligibility for Medicaid may not be linked to a
811	child's eligibility determination for other programs.
812	(c)  Inform program applicants about eligibility
813	determinations and provide information about eligibility of
814	applicants to Medicaid, Medikids, the Children's Medical
815	Services Network, and the Florida Kidcare program Healthy Kids
816	Corporation, and to insurers and their agents, through a
817	centralized coordinating office.
818	(d)  Adopt rules necessary for conducting program
819	eligibility functions.
820	(2)  The Department of Health shall:
821	(a)  Design an eligibility intake process for the program,
822	in coordination with the Department of Children and Family
823	Services, the agency, and the Florida Healthy Kids Corporation.
824	The eligibility intake process may include local intake points
825	that are determined by the Department of Health in coordination
826	with the Department of Children and Family Services.
827	(b)  Chair a state-level Florida Kidcare coordinating
828	council to review and make recommendations concerning the
829	implementation and operation of the program. The coordinating
830	council shall include representatives from the department, the
831	Department of Children and Family Services, the agency, the
832	Florida Healthy Kids Corporation, the Office of Insurance
833	Regulation of the Financial Services Commission, local
834	government, health insurers, health maintenance organizations,
835	health care providers, families participating in the program,
836	and organizations representing low-income families.
837	(c)  In consultation with the Florida Healthy Kids
838	Corporation and the Department of Children and Family Services,
839	establish a toll-free telephone line to assist families with
840	questions about the program.
841	(d)  Adopt rules necessary to implement outreach
842	activities.
843	(3)  The Agency for Health Care Administration, under the
844	authority granted in s. 409.914(1), shall:
845	(a)  Calculate the premium assistance payment necessary to
846	comply with the premium and cost-sharing limitations specified
847	in s. 409.816. The premium assistance payment for each enrollee
848	in a health insurance plan participating in the Florida Healthy
849	Kids Corporation shall equal the premium approved by the Florida
850	Healthy Kids Corporation and the Office of Insurance Regulation
851	of the Financial Services Commission pursuant to ss. 627.410 and
852	641.31, less any enrollee's share of the premium established
853	within the limitations specified in s. 409.816. The premium
854	assistance payment for each enrollee in an employer-sponsored
855	health insurance plan approved under ss. 409.810-409.821 ss.
856	409.810-409.820 shall equal the premium for the plan adjusted
857	for any benchmark benefit plan actuarial equivalent benefit
858	rider approved by the Office of Insurance Regulation pursuant to
859	ss. 627.410 and 641.31, less any enrollee's share of the premium
860	established within the limitations specified in s. 409.816. In
861	calculating the premium assistance payment levels for children
862	with family coverage, the agency shall set the premium
863	assistance payment levels for each child proportionately to the
864	total cost of family coverage.
865	(b)  Make premium assistance payments to health insurance
866	plans on a periodic basis. The agency may use its Medicaid
867	fiscal agent or a contracted third-party administrator in making
868	these payments. The agency may require health insurance plans
869	that participate in the Medikids program or employer-sponsored
870	group health insurance to collect premium payments from an
871	enrollee's family. Participating health insurance plans shall
872	report premium payments collected on behalf of enrollees in the
873	program to the agency in accordance with a schedule established
874	by the agency.
875	(c)  Monitor compliance with quality assurance and access
876	standards developed under s. 409.820.
877	(d)  Establish a mechanism for investigating and resolving
878	complaints and grievances from program applicants, enrollees,
879	and health benefits coverage providers, and maintain a record of
880	complaints and confirmed problems. In the case of a child who is
881	enrolled in a health maintenance organization, the agency must
882	use the provisions of s. 641.511 to address grievance reporting
883	and resolution requirements.
884	(e)  Approve health benefits coverage for participation in
885	the program, following certification by the Office of Insurance
886	Regulation under subsection (4).
887	(f)  Adopt rules necessary for calculating premium
888	assistance payment levels, making premium assistance payments,
889	monitoring access and quality assurance standards, investigating
890	and resolving complaints and grievances, administering the
891	Medikids program, and approving health benefits coverage.
892
893	The agency is designated the lead state agency for Title XXI of
894	the Social Security Act for purposes of receipt of federal
895	funds, for reporting purposes, and for ensuring compliance with
896	federal and state regulations and rules.
897	(4)  The Office of Insurance Regulation shall certify that
898	health benefits coverage plans that seek to provide services
899	under the Florida Kidcare program, except those offered through
900	the Florida Healthy Kids Corporation or the Children's Medical
901	Services Network, meet, exceed, or are actuarially equivalent to
902	the benchmark benefit plan and that health insurance plans will
903	be offered at an approved rate. In determining actuarial
904	equivalence of benefits coverage, the Office of Insurance
905	Regulation and health insurance plans must comply with the
906	requirements of s. 2103 of Title XXI of the Social Security Act.
907	The department shall adopt rules necessary for certifying health
908	benefits coverage plans.
909	(5)  The Florida Healthy Kids Corporation shall retain its
910	functions as authorized in s. 624.91, including eligibility
911	determination for participation in the Healthy Kids program.
912	(6)  The agency, the Department of Health, the Department
913	of Children and Family Services, the Florida Healthy Kids
914	Corporation, and the Office of Insurance Regulation, after
915	consultation with and approval of the Speaker of the House of
916	Representatives and the President of the Senate, are authorized
917	to make program modifications that are necessary to overcome any
918	objections of the United States Department of Health and Human
919	Services to obtain approval of the state's child health
920	insurance plan under Title XXI of the Social Security Act.
921	Section 13.  Section 409.821, Florida Statutes, is amended
922	to read:
923	409.821  Florida Kidcare program public records
924	exemption.--
925	(1)  Notwithstanding any other law to the contrary, any
926	Personal identifying information identifying of a Florida
927	Kidcare program applicant or enrollee, as defined in s. 409.811,
928	held by the Agency for Health Care Administration, the
929	Department of Children and Family Services, the Department of
930	Health, or the Florida Healthy Kids Corporation is confidential
931	and exempt from s. 119.07(1) and s. 24(a), Art. I of the State
932	Constitution.
933	(2)(a)  Upon request, Such information shall be disclosed
934	to:
935	1.  another governmental entity only if disclosure is
936	necessary for the entity to perform in the performance of its
937	official duties and responsibilities under the Florida Kidcare
938	program and shall be disclosed to;
939	2.  the Department of Revenue for purposes of administering
940	the state Title IV-D program. The receiving governmental entity
941	must maintain the confidential and exempt status of such
942	information. Furthermore, such information may not be released
943	to; or
944	3.  any other person without who has the written consent of
945	the program applicant.
946	(b)  This section does not prohibit an enrollee's legal
947	guardian from obtaining confirmation of coverage, dates of
948	coverage, the name of the enrollee's health plan, and the amount
949	of premium being paid.
950	(3)  This exemption applies to any information identifying
951	a Florida Kidcare program applicant or enrollee held by the
952	Agency for Health Care Administration, the Department of
953	Children and Family Services, the Department of Health, or the
954	Florida Healthy Kids Corporation before, on, or after the
955	effective date of this exemption.
956	(4)  A knowing and willful violation of this section is a
957	misdemeanor of the second degree, punishable as provided in s.
958	775.082 or s. 775.083. This section does not prohibit an
959	enrollee's parent or legal guardian from obtaining any record
960	relating to the enrollee's application or coverage under the
961	Florida Kidcare program, including, but not limited to,
962	confirmation of coverage, the dates of coverage, the name of the
963	enrollee's health plan, and the amount of premium.
964	Section 14.  Subsection (6) of section 409.904, Florida
965	Statutes, is amended to read:
966	409.904  Optional payments for eligible persons.--The
967	agency may make payments for medical assistance and related
968	services on behalf of the following persons who are determined
969	to be eligible subject to the income, assets, and categorical
970	eligibility tests set forth in federal and state law. Payment on
971	behalf of these Medicaid eligible persons is subject to the
972	availability of moneys and any limitations established by the
973	General Appropriations Act or chapter 216.
974	(6)  A child who has not attained the age of 19 who has
975	been determined eligible for the Medicaid program is deemed to
976	be eligible for a total of 12 6 months, regardless of changes in
977	circumstances other than attainment of the maximum age.
978	Effective January 1, 1999, a child who has not attained the age
979	of 5 and who has been determined eligible for the Medicaid
980	program is deemed to be eligible for a total of 12 months
981	regardless of changes in circumstances other than attainment of
982	the maximum age.
983	Section 15.  Subsection (5) of section 624.91, Florida
984	Statutes, is amended to read:
985	624.91  The Florida Healthy Kids Corporation Act.--
986	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
987	(a)  There is created the Florida Healthy Kids Corporation,
988	a not-for-profit corporation.
989	(b)  The Florida Healthy Kids Corporation shall:
990	1.  Arrange for the collection of any family, local
991	contributions, or employer payment or premium, in an amount to
992	be determined by the board of directors, to provide for payment
993	of premiums for comprehensive insurance coverage and for the
994	actual or estimated administrative expenses.
995	2.  Arrange for the collection of any voluntary
996	contributions to provide for payment of Florida Kidcare program
997	premiums for children who are not eligible for medical
998	assistance under Title XIX or Title XXI of the Social Security
999	Act.
1000	3.  Subject to the provisions of s. 409.8134, accept
1001	voluntary supplemental local match contributions that comply
1002	with the requirements of Title XXI of the Social Security Act
1003	for the purpose of providing additional Florida Kidcare coverage
1004	in contributing counties under Title XXI.
1005	4.  Establish the administrative and accounting procedures
1006	for the operation of the corporation.
1007	5.  Establish, with consultation from appropriate
1008	professional organizations, standards for preventive health
1009	services and providers and comprehensive insurance benefits
1010	appropriate to children, provided that such standards for rural
1011	areas shall not limit primary care providers to board-certified
1012	pediatricians.
1013	6.  Determine eligibility for children seeking to
1014	participate in the Title XXI-funded components of the Florida
1015	Kidcare program consistent with the requirements specified in s.
1016	409.814, as well as the non-Title-XXI-eligible children as
1017	provided in subsection (3).
1018	7.  Establish procedures under which providers of local
1019	match to, applicants to and participants in the program may have
1020	grievances reviewed by an impartial body and reported to the
1021	board of directors of the corporation.
1022	8.  Establish participation criteria and, if appropriate,
1023	contract with an authorized insurer, health maintenance
1024	organization, or third-party administrator to provide
1025	administrative services to the corporation.
1026	9.  Establish enrollment criteria that which shall include
1027	penalties or waiting periods of 30 not fewer than 60 days for
1028	reinstatement of coverage upon voluntary cancellation for
1029	nonpayment of family premiums.
1030	10.  Contract with authorized insurers or any provider of
1031	health care services, meeting standards established by the
1032	corporation, for the provision of comprehensive insurance
1033	coverage to participants. Such standards shall include criteria
1034	under which the corporation may contract with more than one
1035	provider of health care services in program sites. Health plans
1036	shall be selected through a competitive bid process. The Florida
1037	Healthy Kids Corporation shall purchase goods and services in
1038	the most cost-effective manner consistent with the delivery of
1039	quality medical care. The maximum administrative cost for a
1040	Florida Healthy Kids Corporation contract shall be 15 percent.
1041	For health care contracts, the minimum medical loss ratio for a
1042	Florida Healthy Kids Corporation contract shall be 85 percent.
1043	For dental contracts, the remaining compensation to be paid to
1044	the authorized insurer or provider under a Florida Healthy Kids
1045	Corporation contract shall be no less than an amount which is 85
1046	percent of premium; to the extent any contract provision does
1047	not provide for this minimum compensation, this section shall
1048	prevail. The health plan selection criteria and scoring system,
1049	and the scoring results, shall be available upon request for
1050	inspection after the bids have been awarded.
1051	11.  Establish disenrollment criteria in the event local
1052	matching funds are insufficient to cover enrollments.
1053	12.  Develop and implement a plan to publicize the Florida
1054	Kidcare program Healthy Kids Corporation, the eligibility
1055	requirements of the program, and the procedures for enrollment
1056	in the program and to maintain public awareness of the
1057	corporation and the program.
1058	13.  Secure staff necessary to properly administer the
1059	corporation. Staff costs shall be funded from state and local
1060	matching funds and such other private or public funds as become
1061	available. The board of directors shall determine the number of
1062	staff members necessary to administer the corporation.
1063	14.  In consultation with the partner agencies, provide a
1064	report on the Florida Kidcare program annually to the Governor,
1065	Chief Financial Officer, Commissioner of Education, Senate
1066	President of the Senate, Speaker of the House of
1067	Representatives, and Minority Leaders of the Senate and the
1068	House of Representatives.
1069	15.  Provide information on a quarterly basis to the
1070	Legislature and the Governor which compares the costs and
1071	utilization of the full-pay enrolled population and the Title
1072	XXI-subsidized enrolled population in the Florida Kidcare
1073	program. The information, at a minimum, must include:
1074	a.  The monthly enrollment and expenditure for full-pay
1075	enrollees in the Medikids and Florida Healthy Kids programs
1076	compared to the Title XXI-subsidized enrolled population; and
1077	b.  The costs and utilization by service of the full-pay
1078	enrollees in the Medikids and Florida Healthy Kids programs and
1079	the Title XXI-subsidized enrolled population.
1080
1081	By February 1, 2010 2009, the Florida Healthy Kids Corporation
1082	shall provide a study to the Legislature and the Governor on
1083	premium impacts to the subsidized portion of the program from
1084	the inclusion of the full-pay program, which shall include
1085	recommendations on how to eliminate or mitigate possible impacts
1086	to the subsidized premiums.
1087	16.  Establish benefit packages that which conform to the
1088	provisions of the Florida Kidcare program, as created in ss.
1089	409.810-409.821 ss. 409.810-409.820.
1090	(c)  Coverage under the corporation's program is secondary
1091	to any other available private coverage held by, or applicable
1092	to, the participant child or family member. Insurers under
1093	contract with the corporation are the payors of last resort and
1094	must coordinate benefits with any other third-party payor that
1095	may be liable for the participant's medical care.
1096	(d)  The Florida Healthy Kids Corporation shall be a
1097	private corporation not for profit, organized pursuant to
1098	chapter 617, and shall have all powers necessary to carry out
1099	the purposes of this act, including, but not limited to, the
1100	power to receive and accept grants, loans, or advances of funds
1101	from any public or private agency and to receive and accept from
1102	any source contributions of money, property, labor, or any other
1103	thing of value, to be held, used, and applied for the purposes
1104	of this act.
1105	Section 16.  This act shall take effect July 1, 2009.

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