Florida Senate - 2009                       CS for CS for SB 918
       
       
       
       By the Committees on Health and Human Services Appropriations;
       and Health Regulation; and Senators Rich, Lynn, Bennett,
       Aronberg, Sobel, Gaetz, Smith, and Lawson
       
       
       603-05641-09                                           2009918c2
    1                        A bill to be entitled                      
    2         An act relating to the Florida Kidcare program;
    3         amending s. 409.810, F.S.; correcting a cross
    4         reference; amending s. 409.811, F.S.; conforming
    5         cross-references; amending s. 409.812, F.S.;
    6         clarifying the application of the Florida Kidcare
    7         program to include all eligible uninsured, low-income
    8         children; amending s. 409.813, F.S.; specifying
    9         funding sources for health benefits coverage for
   10         certain children; specifying program components to be
   11         marketed as the Florida Kidcare program; conforming
   12         cross-references; amending s. 409.8132, F.S.; revising
   13         provisions relating to penalties for nonpayment of
   14         premiums and waiting periods for reinstatement of
   15         coverage; amending s. 409.8134, F.S.; revising
   16         provisions relating to enrollment in the Florida
   17         Kidcare program; amending s. 409.814, F.S.; removing a
   18         restriction on participation in the Florida Healthy
   19         Kids program; authorizing certain enrollees to opt out
   20         of the Children’s Medical Services network; revising
   21         coverage limitations; revising restrictions on
   22         enrollment of children whose coverage was voluntarily
   23         canceled; providing exceptions; deleting provisions
   24         that place a limit on enrollment in Medikids and the
   25         Florida Healthy Kids full-pay program; requiring
   26         notice to health plans and providers when a child is
   27         no longer eligible for certain coverage; requiring
   28         electronic verification of applicants’ income;
   29         providing circumstances under which written
   30         documentation is required; revising the timeframe for
   31         an enrollee to resolve disputes regarding the
   32         withholding of benefits; amending s. 409.815, F.S.;
   33         authorizing the Agency for Health Care Administration
   34         to increase premium assistance payments for benefits
   35         provided through Florida Kidcare Plus instead of the
   36         Children’s Medical Services; conforming cross
   37         references; amending ss. 409.816 and 409.817, F.S.;
   38         conforming cross-references; amending s. 409.8177,
   39         F.S.; revising information to be included in the
   40         annual program evaluation to the Governor and
   41         Legislature; amending s. 409.818, F.S.; clarifying
   42         that the Department of Health is the chair of Florida
   43         Kidcare coordinating council; conforming cross
   44         references; amending s. 624.91, F.S.; revising the
   45         duties of the Florida Healthy Kids Corporation;
   46         revising the date in which the corporation must
   47         provide a study to the Legislature and the Governor;
   48         correcting a cross-reference; expanding the membership
   49         of the board of directors of the Florida Healthy Kids
   50         Corporation; providing an effective date.
   51  
   52  Be It Enacted by the Legislature of the State of Florida:
   53  
   54         Section 1. Section 409.810, Florida Statutes, is amended to
   55  read:
   56         409.810 Short title.—Sections 409.810-409.821 409.810
   57  409.820 may be cited as the “Florida Kidcare Act.”
   58         Section 2. Subsections (3), (10), and (13) of section
   59  409.811, Florida Statutes, are amended to read
   60         409.811 Definitions relating to Florida Kidcare Act.—As
   61  used in ss. 409.810-409.821 ss. 409.810-409.820, the term:
   62         (3) “Applicant” means a parent or guardian of a child or a
   63  child whose disability of nonage has been removed under chapter
   64  743, who applies for determination of eligibility for health
   65  benefits coverage under ss. 409.810-409.821 ss. 409.810-409.820.
   66         (10) “Enrollee” means a child who has been determined
   67  eligible for and is receiving coverage under ss. 409.810-409.821
   68  ss. 409.810-409.820.
   69         (14)(13) “Florida Kidcare program,” “Kidcare program,” or
   70  “program” means the health benefits program administered through
   71  ss. 409.810-409.821 ss. 409.810-409.820.
   72         Section 3. Section 409.812, Florida Statutes, is amended to
   73  read:
   74         409.812 Program created; purpose.—The Florida Kidcare
   75  program is created to provide a defined set of health benefits
   76  to previously uninsured, low-income children through the
   77  establishment of a variety of affordable health benefits
   78  coverage options from which families may select coverage and
   79  through which families may contribute financially to the health
   80  care of their children.
   81         Section 4. Section 409.813, Florida Statutes, is amended to
   82  read:
   83         409.813 Health benefits coverage; program components;
   84  entitlement and nonentitlement.—
   85         (1) The Florida Kidcare program includes health benefits
   86  coverage provided to children through the following program
   87  components, which shall be marketed as the Florida Kidcare
   88  program:
   89         (a)(1) Medicaid;
   90         (b)(2) Medikids as created in s. 409.8132;
   91         (c)(3) The Florida Healthy Kids Corporation as created in
   92  s. 624.91;
   93         (d)(4) Employer-sponsored group health insurance plans
   94  approved under ss. 409.810-409.821 ss. 409.810-409.820; and
   95         (e)(5) The Children’s Medical Services network established
   96  in chapter 391.
   97         (2) Except for Title XIX-funded Florida Kidcare program
   98  coverage under the Medicaid program, coverage under the Florida
   99  Kidcare program is not an entitlement. No cause of action shall
  100  arise against the state, the department, the Department of
  101  Children and Family Services, or the agency for failure to make
  102  health services available to any person under ss. 409.810
  103  409.821 ss. 409.810-409.820.
  104         Section 5. Paragraph (b) of subsection (6) and subsection
  105  (8) of section 409.8132, Florida Statutes, are amended to read:
  106         409.8132 Medikids program component.—
  107         (6) ELIGIBILITY.—
  108         (b) The provisions of s. 409.814(3), (4), and (5), and (6)
  109  shall be applicable to the Medikids program.
  110         (8) PENALTIES FOR VOLUNTARY CANCELLATION.—The agency shall
  111  establish enrollment criteria that must include penalties or
  112  waiting periods of 30 not fewer than 60 days for reinstatement
  113  of coverage upon voluntary cancellation for nonpayment of
  114  premiums.
  115         Section 6. Subsection (2) of section 409.8134, Florida
  116  Statutes, is amended to read:
  117         409.8134 Program expenditure ceiling; enrollment.—
  118         (2) The Florida Kidcare program may conduct enrollment
  119  continuously at any time throughout the year for the purpose of
  120  enrolling children eligible for all program components listed in
  121  s. 409.813 except Medicaid. The four Florida Kidcare
  122  administrators shall work together to ensure that the year-round
  123  enrollment period is announced statewide. Eligible Children
  124  eligible for coverage under Title XXI-funded Florida Kidcare
  125  program shall be enrolled on a first-come, first-served basis
  126  using the date the enrollment application is received.
  127  Enrollment shall immediately cease when the expenditure ceiling
  128  is reached. Year-round enrollment shall only be held if the
  129  Social Services Estimating Conference determines that sufficient
  130  federal and state funds will be available to finance the
  131  increased enrollment through federal fiscal year 2007. Any
  132  individual who is not enrolled must reapply by submitting a new
  133  application. The application for the Florida Kidcare program is
  134  shall be valid for a period of 120 days after the date it was
  135  received. At the end of the 120-day period, if the applicant has
  136  not been enrolled in the program, the application is shall be
  137  invalid and the applicant shall be notified of the action. The
  138  applicant may reactivate resubmit the application after
  139  notification of the action taken by the program. Except for the
  140  Medicaid program, whenever the Social Services Estimating
  141  Conference determines that there are presently, or will be by
  142  the end of the current fiscal year, insufficient funds to
  143  finance the current or projected enrollment in the Florida
  144  Kidcare program, all additional enrollment must cease and
  145  additional enrollment may not resume until sufficient funds are
  146  available to finance such enrollment.
  147         Section 7. Section 409.814, Florida Statutes, is amended to
  148  read:
  149         409.814 Eligibility.—A child who has not reached 19 years
  150  of age whose family income is equal to or below 200 percent of
  151  the federal poverty level is eligible for the Florida Kidcare
  152  program as provided in this section. For enrollment in the
  153  Children’s Medical Services Network, a complete application
  154  includes the medical or behavioral health screening. If,
  155  subsequently, an individual is determined to be ineligible for
  156  coverage, he or she must immediately be disenrolled from the
  157  respective Florida Kidcare program component.
  158         (1) A child who is eligible for Medicaid coverage under s.
  159  409.903 or s. 409.904 must be enrolled in Medicaid and is not
  160  eligible to receive health benefits under any other health
  161  benefits coverage authorized under the Florida Kidcare program.
  162         (2) A child who is not eligible for Medicaid, but who is
  163  eligible for the Florida Kidcare program, may obtain health
  164  benefits coverage under any of the other components listed in s.
  165  409.813 if such coverage is approved and available in the county
  166  in which the child resides. However, a child who is eligible for
  167  Medikids may participate in the Florida Healthy Kids program
  168  only if the child has a sibling participating in the Florida
  169  Healthy Kids program and the child’s county of residence permits
  170  such enrollment.
  171         (3) A Title XXI-funded child who is eligible for the
  172  Florida Kidcare program who is a child with special health care
  173  needs, as determined through a medical or behavioral screening
  174  instrument, is eligible for health benefits coverage from and
  175  shall be assigned to and may opt out of referred to the
  176  Children’s Medical Services Network.
  177         (4) The following children are not eligible to receive
  178  Title XXI-funded premium assistance for health benefits coverage
  179  under the Florida Kidcare program, except under Medicaid if the
  180  child would have been eligible for Medicaid under s. 409.903 or
  181  s. 409.904 as of June 1, 1997:
  182         (a) A child who is eligible for coverage under a state
  183  health benefit plan on the basis of a family member’s employment
  184  with a public agency in the state.
  185         (b) A child who is currently eligible for or covered under
  186  a family member’s group health benefit plan or under other
  187  private or employer health insurance coverage, if excluding
  188  coverage provided under the Florida Healthy Kids Corporation as
  189  established under s. 624.91, provided that the cost of the
  190  child’s participation is not greater than 5 percent of the
  191  family’s income. If a child is otherwise eligible for a subsidy
  192  under the Florida Kidcare program and the cost of the child’s
  193  participation in the family member’s health insurance benefit
  194  plan is greater than 5 percent of the family’s income, the child
  195  may enroll in the appropriate subsidized Kidcare program. This
  196  provision shall be applied during redetermination for children
  197  who were enrolled prior to July 1, 2004. These enrollees shall
  198  have 6 months of eligibility following redetermination to allow
  199  for a transition to the other health benefit plan.
  200         (c) A child who is seeking premium assistance for the
  201  Florida Kidcare program through employer-sponsored group
  202  coverage, if the child has been covered by the same employer’s
  203  group coverage during the 60 days 6 months prior to the family’s
  204  submitting an application for determination of eligibility under
  205  the program.
  206         (d) A child who is an alien, but who does not meet the
  207  definition of qualified alien, in the United States.
  208         (e) A child who is an inmate of a public institution or a
  209  patient in an institution for mental diseases.
  210         (f) A child who is otherwise eligible for premium
  211  assistance for the Florida Kidcare program and has had his or
  212  her coverage in an employer-sponsored or private health benefit
  213  plan voluntarily canceled in the last 60 days 6 months, except
  214  those children whose coverage was voluntarily canceled for good
  215  cause, including, but not limited to, the following
  216  circumstances:
  217         1.The cost of participation in an employer-sponsored
  218  health benefit plan is greater than 5 percent of the family’s
  219  income;
  220         2.The parent lost a job that provided an employer
  221  sponsored health benefit plan for children;
  222         3.The parent who had health benefits coverage for the
  223  child is deceased;
  224         4.The child has a medical condition that, without medical
  225  care, would cause serious disability, loss of function, or
  226  death;
  227         5.The employer of the parent canceled health benefits
  228  coverage for children;
  229         6.The child’s health benefits coverage ended because the
  230  child reached the maximum lifetime coverage amount;
  231         7.The child has exhausted coverage under a COBRA
  232  continuation provision;
  233         8.The health benefits coverage does not cover the child’s
  234  health care needs; or
  235         9.Domestic violence led to loss of coverage who were on
  236  the waiting list prior to March 12, 2004.
  237         (5)(g) A child who is otherwise eligible for the Florida
  238  Kidcare program and who has a preexisting condition that
  239  prevents coverage under another insurance plan as described in
  240  paragraph (4)(b) which would have disqualified the child for the
  241  Florida Kidcare program if the child were able to enroll in the
  242  plan shall be eligible for Florida Kidcare coverage when
  243  enrollment is possible.
  244         (6)(5) A child whose family income is above 200 percent of
  245  the federal poverty level or a child who is excluded under the
  246  provisions of subsection (4) may participate in the Florida
  247  Kidcare program Medikids program as provided in s. 409.8132 or,
  248  if the child is ineligible for Medikids by reason of age, in the
  249  Florida Healthy Kids program, subject to the following
  250  provisions:
  251         (a) The family is not eligible for premium assistance
  252  payments and must pay the full cost of the premium, including
  253  any administrative costs.
  254         (b) The board of directors of the Florida Healthy Kids
  255  Corporation may offer a reduced benefit package to these
  256  children in order to limit program costs for such families.
  257         (7)(6) Once a child is enrolled in the Florida Kidcare
  258  program, the child is eligible for coverage under the program
  259  for 12 months without a redetermination or reverification of
  260  eligibility, if the family continues to pay the applicable
  261  premium. Eligibility for program components funded through Title
  262  XXI of the Social Security Act shall terminate when a child
  263  attains the age of 19. Effective January 1, 1999, A child who
  264  has not attained the age of 5 and who has been determined
  265  eligible for the Medicaid program is eligible for coverage for
  266  12 months without a redetermination or reverification of
  267  eligibility.
  268         (8)(7) When determining or reviewing a child’s eligibility
  269  under the Florida Kidcare program, the applicant shall be
  270  provided with reasonable notice of changes in eligibility which
  271  may affect enrollment in one or more of the program components.
  272  When a transition from one program component to another is
  273  authorized, there shall be cooperation between the program
  274  components and the affected family which promotes continuity of
  275  health care coverage. Any authorized transfers must be managed
  276  within the program’s overall appropriated or authorized levels
  277  of funding. Each component of the program shall establish a
  278  reserve to ensure that transfers between components will be
  279  accomplished within current year appropriations. These reserves
  280  shall be reviewed by each convening of the Social Services
  281  Estimating Conference to determine the adequacy of such reserves
  282  to meet actual experience.
  283         (9)(8) In determining the eligibility of a child, an assets
  284  test is not required. Each applicant shall provide written
  285  documentation during the application process and the
  286  redetermination process, including, but not limited to, the
  287  following:
  288         (a) Each applicant’s proof of family income shall be
  289  verified electronically to determine financial eligibility for
  290  the Florida Kidcare program. Written documentation, which may
  291  must include wages and earnings statements or pay stubs, W-2
  292  forms, or a copy of the applicant’s most recent federal income
  293  tax return, shall be required only if the electronic
  294  verification is not available or does not substantiate the
  295  applicant’s income. In the absence of a federal income tax
  296  return, an applicant may submit wages and earnings statements
  297  (pay stubs), W-2 forms, or other appropriate documents.
  298         (b) Each applicant shall provide a statement from all
  299  applicable, employed family members that:
  300         1. Their employers do employer does not sponsor a health
  301  benefit plans plan for employees; or
  302         2. The potential enrollee is not covered by an the
  303  employer-sponsored health benefit plan; or because the potential
  304  enrollee is not eligible for coverage, or, if the potential
  305  enrollee is eligible but not covered, a statement of the cost to
  306  enroll the potential enrollee in the employer-sponsored health
  307  benefit plan.
  308         3.The potential enrollee is covered by an employer
  309  sponsored health benefit plan and the cost of the employer
  310  sponsored health benefit plan is more than 5 percent of the
  311  family’s income.
  312         (10)(9) Subject to paragraph (4)(b) and s. 624.91(4), the
  313  Florida Kidcare program shall withhold benefits from an enrollee
  314  if the program obtains evidence that the enrollee is no longer
  315  eligible, submitted incorrect or fraudulent information in order
  316  to establish eligibility, or failed to provide verification of
  317  eligibility. The applicant or enrollee shall be notified that
  318  because of such evidence program benefits will be withheld
  319  unless the applicant or enrollee contacts a designated
  320  representative of the program by a specified date, which must be
  321  within 10 working days after the date of notice, to discuss and
  322  resolve the matter. The program shall make every effort to
  323  resolve the matter within a timeframe that will not cause
  324  benefits to be withheld from an eligible enrollee.
  325         (11)(10) The following individuals may be subject to
  326  prosecution in accordance with s. 414.39:
  327         (a) An applicant obtaining or attempting to obtain benefits
  328  for a potential enrollee under the Florida Kidcare program when
  329  the applicant knows or should have known the potential enrollee
  330  does not qualify for the Florida Kidcare program.
  331         (b) An individual who assists an applicant in obtaining or
  332  attempting to obtain benefits for a potential enrollee under the
  333  Florida Kidcare program when the individual knows or should have
  334  known the potential enrollee does not qualify for the Florida
  335  Kidcare program.
  336         Section 8. Paragraphs (u) and (v) of subsection (2) of
  337  section 409.815, Florida Statutes, are amended to read:
  338         409.815 Health benefits coverage; limitations.—
  339         (2) BENCHMARK BENEFITS.—In order for health benefits
  340  coverage to qualify for premium assistance payments for an
  341  eligible child under ss. 409.810-409.821 ss. 409.810-409.820,
  342  the health benefits coverage, except for coverage under Medicaid
  343  and Medikids, must include the following minimum benefits, as
  344  medically necessary.
  345         (u) Enhancements to minimum requirements.—
  346         1. This section sets the minimum benefits that must be
  347  included in any health benefits coverage, other than Medicaid or
  348  Medikids coverage, offered under ss. 409.810-409.821 ss.
  349  409.810-409.820. Health benefits coverage may include additional
  350  benefits not included under this subsection, but may not include
  351  benefits excluded under paragraph (s).
  352         2. Health benefits coverage may extend any limitations
  353  beyond the minimum benefits described in this section.
  354  
  355  Except for the Children’s Medical Services Network, the agency
  356  may not increase the premium assistance payment for either
  357  additional benefits provided beyond the minimum benefits
  358  described in this section or the imposition of less restrictive
  359  service limitations.
  360         (v) Applicability of other state laws.—Health insurers,
  361  health maintenance organizations, and their agents are subject
  362  to the provisions of the Florida Insurance Code, except for any
  363  such provisions waived in this section.
  364         1. Except as expressly provided in this section, a law
  365  requiring coverage for a specific health care service or
  366  benefit, or a law requiring reimbursement, utilization, or
  367  consideration of a specific category of licensed health care
  368  practitioner, does not apply to a health insurance plan policy
  369  or contract offered or delivered under ss. 409.810-409.821 ss.
  370  409.810-409.820 unless that law is made expressly applicable to
  371  such policies or contracts.
  372         2. Notwithstanding chapter 641, a health maintenance
  373  organization may issue contracts providing benefits equal to,
  374  exceeding, or actuarially equivalent to the benchmark benefit
  375  plan authorized by this section and may pay providers located in
  376  a rural county negotiated fees or Medicaid reimbursement rates
  377  for services provided to enrollees who are residents of the
  378  rural county.
  379         Section 9. Subsection (3) of section 409.816, Florida
  380  Statutes, is amended to read:
  381         409.816 Limitations on premiums and cost-sharing.—The
  382  following limitations on premiums and cost-sharing are
  383  established for the program.
  384         (3) Enrollees in families with a family income above 150
  385  percent of the federal poverty level, who are not receiving
  386  coverage under the Medicaid program or who are not eligible
  387  under s. 409.814(7) s. 409.814(5), may be required to pay
  388  enrollment fees, premiums, copayments, deductibles, coinsurance,
  389  or similar charges on a sliding scale related to income, except
  390  that the total annual aggregate cost-sharing with respect to all
  391  children in a family may not exceed 5 percent of the family’s
  392  income. However, copayments, deductibles, coinsurance, or
  393  similar charges may not be imposed for preventive services,
  394  including well-baby and well-child care, age-appropriate
  395  immunizations, and routine hearing and vision screenings.
  396         Section 10. Section 409.817, Florida Statutes, is amended
  397  to read:
  398         409.817 Approval of health benefits coverage; financial
  399  assistance.—In order for health insurance coverage to qualify
  400  for premium assistance payments for an eligible child under ss.
  401  409.810-409.821 ss. 409.810-409.820, the health benefits
  402  coverage must:
  403         (1) Be certified by the Office of Insurance Regulation of
  404  the Financial Services Commission under s. 409.818 as meeting,
  405  exceeding, or being actuarially equivalent to the benchmark
  406  benefit plan;
  407         (2) Be guarantee issued;
  408         (3) Be community rated;
  409         (4) Not impose any preexisting condition exclusion for
  410  covered benefits; however, group health insurance plans may
  411  permit the imposition of a preexisting condition exclusion, but
  412  only insofar as it is permitted under s. 627.6561;
  413         (5) Comply with the applicable limitations on premiums and
  414  cost-sharing in s. 409.816;
  415         (6) Comply with the quality assurance and access standards
  416  developed under s. 409.820; and
  417         (7) Establish periodic open enrollment periods, which may
  418  not occur more frequently than quarterly.
  419         Section 11. Paragraph (i) of subsection (1) of section
  420  409.8177, Florida Statutes, is amended to read:
  421         409.8177 Program evaluation.—
  422         (1) The agency, in consultation with the Department of
  423  Health, the Department of Children and Family Services, and the
  424  Florida Healthy Kids Corporation, shall contract for an
  425  evaluation of the Florida Kidcare program and shall by January 1
  426  of each year submit to the Governor, the President of the
  427  Senate, and the Speaker of the House of Representatives a report
  428  of the program. In addition to the items specified under s. 2108
  429  of Title XXI of the Social Security Act, the report shall
  430  include an assessment of crowd-out and access to health care, as
  431  well as the following:
  432         (i) An assessment of the effectiveness of the Florida
  433  Kidcare program, including Medicaid, the Florida Healthy Kids
  434  program, Medikids, and the Children’s Medical Services network,
  435  and other public and private programs in the state in increasing
  436  the availability of affordable quality health insurance and
  437  health care for children.
  438         Section 12. Paragraph (c) of subsection (1), paragraph (b)
  439  of subsection (2), and paragraph (a) subsection (3), of section
  440  409.818, Florida Statutes, are amended to read:
  441         409.818 Administration.—In order to implement ss. 409.810
  442  409.821 ss. 409.810-409.820, the following agencies shall have
  443  the following duties:
  444         (1) The Department of Children and Family Services shall:
  445         (c) Inform program applicants about eligibility
  446  determinations and provide information about eligibility of
  447  applicants to Medicaid, Medikids, the Children’s Medical
  448  Services Network, and the Florida Kidcare program Healthy Kids
  449  Corporation, and to insurers and their agents, through a
  450  centralized coordinating office.
  451         (2) The Department of Health shall:
  452         (b) Chair a state-level Florida Kidcare coordinating
  453  council to review and make recommendations concerning the
  454  implementation and operation of the program. The coordinating
  455  council shall include representatives from the department, the
  456  Department of Children and Family Services, the agency, the
  457  Florida Healthy Kids Corporation, the Office of Insurance
  458  Regulation of the Financial Services Commission, local
  459  government, health insurers, health maintenance organizations,
  460  health care providers, families participating in the program,
  461  and organizations representing low-income families.
  462         (3) The Agency for Health Care Administration, under the
  463  authority granted in s. 409.914(1), shall:
  464         (a) Calculate the premium assistance payment necessary to
  465  comply with the premium and cost-sharing limitations specified
  466  in s. 409.816. The premium assistance payment for each enrollee
  467  in a health insurance plan participating in the Florida Healthy
  468  Kids Corporation shall equal the premium approved by the Florida
  469  Healthy Kids Corporation and the Office of Insurance Regulation
  470  of the Financial Services Commission pursuant to ss. 627.410 and
  471  641.31, less any enrollee’s share of the premium established
  472  within the limitations specified in s. 409.816. The premium
  473  assistance payment for each enrollee in an employer-sponsored
  474  health insurance plan approved under ss. 409.810-409.821 ss.
  475  409.810-409.820 shall equal the premium for the plan adjusted
  476  for any benchmark benefit plan actuarial equivalent benefit
  477  rider approved by the Office of Insurance Regulation pursuant to
  478  ss. 627.410 and 641.31, less any enrollee’s share of the premium
  479  established within the limitations specified in s. 409.816. In
  480  calculating the premium assistance payment levels for children
  481  with family coverage, the agency shall set the premium
  482  assistance payment levels for each child proportionately to the
  483  total cost of family coverage.
  484  
  485  The agency is designated the lead state agency for Title XXI of
  486  the Social Security Act for purposes of receipt of federal
  487  funds, for reporting purposes, and for ensuring compliance with
  488  federal and state regulations and rules.
  489         Section 13. Subsection (6) and paragraph (a) of subsection
  490  (5), of section 624.91, Florida Statutes, are amended to read:
  491         624.91 The Florida Healthy Kids Corporation Act.—
  492         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
  493         (a) There is created the Florida Healthy Kids Corporation,
  494  a not-for-profit corporation.
  495         (b) The Florida Healthy Kids Corporation shall:
  496         1. Arrange for the collection of any family, local
  497  contributions, or employer payment or premium, in an amount to
  498  be determined by the board of directors, to provide for payment
  499  of premiums for comprehensive insurance coverage and for the
  500  actual or estimated administrative expenses.
  501         2. Arrange for the collection of any voluntary
  502  contributions to provide for payment of Florida Kidcare program
  503  premiums for children who are not eligible for medical
  504  assistance under Title XIX or Title XXI of the Social Security
  505  Act.
  506         3. Subject to the provisions of s. 409.8134, accept
  507  voluntary supplemental local match contributions that comply
  508  with the requirements of Title XXI of the Social Security Act
  509  for the purpose of providing additional Florida Kidcare coverage
  510  in contributing counties under Title XXI.
  511         4. Establish the administrative and accounting procedures
  512  for the operation of the corporation.
  513         5. Establish, with consultation from appropriate
  514  professional organizations, standards for preventive health
  515  services and providers and comprehensive insurance benefits
  516  appropriate to children, provided that such standards for rural
  517  areas shall not limit primary care providers to board-certified
  518  pediatricians.
  519         6. Determine eligibility for children seeking to
  520  participate in the Title XXI-funded components of the Florida
  521  Kidcare program consistent with the requirements specified in s.
  522  409.814, as well as the non-Title-XXI-eligible children as
  523  provided in subsection (3).
  524         7. Establish procedures under which providers of local
  525  match to, applicants to and participants in the program may have
  526  grievances reviewed by an impartial body and reported to the
  527  board of directors of the corporation.
  528         8. Establish participation criteria and, if appropriate,
  529  contract with an authorized insurer, health maintenance
  530  organization, or third-party administrator to provide
  531  administrative services to the corporation.
  532         9. Establish enrollment criteria that which shall include
  533  penalties or waiting periods of 30 not fewer than 60 days for
  534  reinstatement of coverage upon voluntary cancellation for
  535  nonpayment of family premiums.
  536         10. Contract with authorized insurers or any provider of
  537  health care services, meeting standards established by the
  538  corporation, for the provision of comprehensive insurance
  539  coverage to participants. Such standards shall include criteria
  540  under which the corporation may contract with more than one
  541  provider of health care services in program sites. Health plans
  542  shall be selected through a competitive bid process. The Florida
  543  Healthy Kids Corporation shall purchase goods and services in
  544  the most cost-effective manner consistent with the delivery of
  545  quality medical care. The maximum administrative cost for a
  546  Florida Healthy Kids Corporation contract shall be 15 percent.
  547  For health care contracts, the minimum medical loss ratio for a
  548  Florida Healthy Kids Corporation contract shall be 85 percent.
  549  For dental contracts, the remaining compensation to be paid to
  550  the authorized insurer or provider under a Florida Healthy Kids
  551  Corporation contract shall be no less than an amount which is 85
  552  percent of premium; to the extent any contract provision does
  553  not provide for this minimum compensation, this section shall
  554  prevail. The health plan selection criteria and scoring system,
  555  and the scoring results, shall be available upon request for
  556  inspection after the bids have been awarded.
  557         11. Establish disenrollment criteria in the event local
  558  matching funds are insufficient to cover enrollments.
  559         12. Develop and implement a plan to publicize the Florida
  560  Kidcare program Healthy Kids Corporation, the eligibility
  561  requirements of the program, and the procedures for enrollment
  562  in the program and to maintain public awareness of the
  563  corporation and the program.
  564         13. Secure staff necessary to properly administer the
  565  corporation. Staff costs shall be funded from state and local
  566  matching funds and such other private or public funds as become
  567  available. The board of directors shall determine the number of
  568  staff members necessary to administer the corporation.
  569         14. In consultation with the partner agencies, provide a
  570  report on the Florida Kidcare program annually to the Governor,
  571  Chief Financial Officer, Commissioner of Education, Senate
  572  President of the Senate, the Speaker of the House of
  573  Representatives, and Minority Leaders of the Senate and the
  574  House of Representatives.
  575         15. Provide information on a quarterly basis to the
  576  Legislature and the Governor which compares the costs and
  577  utilization of the full-pay enrolled population and the Title
  578  XXI-subsidized enrolled population in the Florida Kidcare
  579  program. The information, at a minimum, must include:
  580         a. The monthly enrollment and expenditure for full-pay
  581  enrollees in the Medikids and Florida Healthy Kids programs
  582  compared to the Title XXI-subsidized enrolled population; and
  583         b. The costs and utilization by service of the full-pay
  584  enrollees in the Medikids and Florida Healthy Kids programs and
  585  the Title XXI-subsidized enrolled population.
  586  
  587  By February 1, 2010 2009, the Florida Healthy Kids Corporation
  588  shall provide a study to the Legislature and the Governor on
  589  premium impacts to the subsidized portion of the program from
  590  the inclusion of the full-pay program, which shall include
  591  recommendations on how to eliminate or mitigate possible impacts
  592  to the subsidized premiums.
  593         16. Establish benefit packages that which conform to the
  594  provisions of the Florida Kidcare program, as created in ss.
  595  409.810-409.821 ss. 409.810-409.820.
  596         (c) Coverage under the corporation’s program is secondary
  597  to any other available private coverage held by, or applicable
  598  to, the participant child or family member. Insurers under
  599  contract with the corporation are the payors of last resort and
  600  must coordinate benefits with any other third-party payor that
  601  may be liable for the participant’s medical care.
  602         (d) The Florida Healthy Kids Corporation shall be a private
  603  corporation not for profit, organized pursuant to chapter 617,
  604  and shall have all powers necessary to carry out the purposes of
  605  this act, including, but not limited to, the power to receive
  606  and accept grants, loans, or advances of funds from any public
  607  or private agency and to receive and accept from any source
  608  contributions of money, property, labor, or any other thing of
  609  value, to be held, used, and applied for the purposes of this
  610  act.
  611         (6) BOARD OF DIRECTORS.—
  612         (a) The Florida Healthy Kids Corporation shall operate
  613  subject to the supervision and approval of a board of directors
  614  chaired by the Chief Financial Officer or her or his designee,
  615  and composed of 11 10 other members selected for 3-year terms of
  616  office as follows:
  617         1. The Secretary of Health Care Administration, or his or
  618  her designee;
  619         2. One member appointed by the Commissioner of Education
  620  from the Office of School Health Programs of the Florida
  621  Department of Education;
  622         3. One member appointed by the Chief Financial Officer from
  623  among three members nominated by the Florida Pediatric Society;
  624         4. One member, appointed by the Governor, who represents
  625  the Children’s Medical Services Program;
  626         5. One member appointed by the Chief Financial Officer from
  627  among three members nominated by the Florida Hospital
  628  Association;
  629         6. One member, appointed by the Governor, who is an expert
  630  on child health policy;
  631         7. One member, appointed by the Chief Financial Officer,
  632  from among three members nominated by the Florida Academy of
  633  Family Physicians;
  634         8. One member, appointed by the Governor, who represents
  635  the state Medicaid program;
  636         9. One member, appointed by the Chief Financial Officer,
  637  from among three members nominated by the Florida Association of
  638  Counties; and
  639         10. The State Health Officer or her or his designee; and.
  640         11.The Secretary of Children and Family Services, or his
  641  or her designee.
  642         Section 14. This act shall take effect July 1, 2009.