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Senate Bill 2000

Senate Bill sb2000

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2004                                  SB 2000

    By Senators Dockery, Peaden, Atwater, Fasano, Argenziano,
    Jones, Pruitt and Bennett




    15-1728C-04

  1                      A bill to be entitled

  2         An act relating to children's health care;

  3         amending s. 409.811, F.S.; clarifying

  4         definitions for purposes of the Florida Kidcare

  5         program; amending s. 409.8132, F.S.; revising

  6         provisions governing the Medikids program

  7         component; deleting obsolete and duplicative

  8         provisions; deleting requirements for a special

  9         enrollment period; amending s. 409.8134, F.S.;

10         requiring that the Florida Kidcare program

11         provide for open enrollment periods; providing

12         enrollment criteria; providing for the

13         enrollment of certain children on an emergency

14         basis; requiring the program to initiate

15         certain disenrollment procedures under

16         specified circumstances; exempting certain

17         children from disenrollment; revising

18         requirements for state agencies in analyzing

19         data regarding the Kidcare program; amending s.

20         409.814, F.S.; revising requirements for

21         enrollment in the Florida Kidcare program;

22         requiring proof of income and lack of insurance

23         coverage for the child; deleting obsolete and

24         duplicative provisions; providing requirements

25         if a child is transferred to another program

26         component; requiring the withholding of

27         benefits upon determination of ineligibility;

28         providing penalties for unlawfully obtaining

29         benefits or assisting in unlawfully obtaining

30         benefits; amending s. 409.815, F.S.; revising

31         coverage requirements for dental services;

                                  1

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 1         amending s. 409.816, F.S.; correcting a

 2         cross-reference; amending s. 409.818, F.S.;

 3         requiring the Agency for Health Care

 4         Administration to contract for the provision of

 5         comprehensive insurance coverage for enrollees;

 6         requiring a competitive selection process;

 7         repealing s. 409.818(2)(b) and 409.819, F.S.,

 8         relating to an outreach program operated by the

 9         Department of Health; amending s. 624.91, F.S.;

10         revising legislative intent with respect to

11         expanding health care coverage for children;

12         conforming provisions of the Florida Healthy

13         Kids Corporation Act to changes made in the

14         Florida Kidcare program; deleting obsolete

15         provisions; requiring the Florida Healthy Kids

16         Corporation to contract for an analysis of and

17         recommendations for managing ineligible

18         enrollment in the Kidcare program; providing

19         appropriations; providing effective dates.

20  

21  Be It Enacted by the Legislature of the State of Florida:

22  

23         Section 1.  Subsections (14) through (23) of section

24  409.811, Florida Statutes, are amended to read:

25         409.811  Definitions relating to Florida Kidcare

26  Act.--As used in ss. 409.810-409.820, the term:

27         (14)  "Florida Kidcare program," "Kidcare program," or

28  "program" means the health benefits program administered

29  through ss. 409.810-409.820.

30         (15)(14)  "Guarantee issue" means that health benefits

31  coverage must be offered to an individual regardless of the

                                  2

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    Florida Senate - 2004                                  SB 2000
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 1  individual's health status, preexisting condition, or claims

 2  history.

 3         (16)(15)  "Health benefits coverage" means protection

 4  that provides payment of benefits for covered health care

 5  services or that otherwise provides, either directly or

 6  through arrangements with other persons, covered health care

 7  services on a prepaid per capita basis or on a prepaid

 8  aggregate fixed-sum basis.

 9         (17)(16)  "Health insurance plan" means health benefits

10  coverage under the following:

11         (a)  A health plan offered by any certified health

12  maintenance organization or authorized health insurer, except

13  a plan that is limited to the following: a limited benefit,

14  specified disease, or specified accident; hospital indemnity;

15  accident only; limited benefit convalescent care; Medicare

16  supplement; credit disability; dental; vision; long-term care;

17  disability income; coverage issued as a supplement to another

18  health plan; workers' compensation liability or other

19  insurance; or motor vehicle medical payment only; or

20         (b)  An employee welfare benefit plan that includes

21  health benefits established under the Employee Retirement

22  Income Security Act of 1974, as amended.

23         (18)(17)  "Medicaid" means the medical assistance

24  program authorized by Title XIX of the Social Security Act,

25  and regulations thereunder, and ss. 409.901-409.920, as

26  administered in this state by the agency.

27         (19)(18)  "Medically necessary" means the use of any

28  medical treatment, service, equipment, or supply necessary to

29  palliate the effects of a terminal condition, or to prevent,

30  diagnose, correct, cure, alleviate, or preclude deterioration

31  

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    Florida Senate - 2004                                  SB 2000
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 1  of a condition that threatens life, causes pain or suffering,

 2  or results in illness or infirmity and which is:

 3         (a)  Consistent with the symptom, diagnosis, and

 4  treatment of the enrollee's condition;

 5         (b)  Provided in accordance with generally accepted

 6  standards of medical practice;

 7         (c)  Not primarily intended for the convenience of the

 8  enrollee, the enrollee's family, or the health care provider;

 9         (d)  The most appropriate level of supply or service

10  for the diagnosis and treatment of the enrollee's condition;

11  and

12         (e)  Approved by the appropriate medical body or health

13  care specialty involved as effective, appropriate, and

14  essential for the care and treatment of the enrollee's

15  condition.

16         (20)(19)  "Medikids" means a component of the Florida

17  Kidcare program of medical assistance authorized by Title XXI

18  of the Social Security Act, and regulations thereunder, and s.

19  409.8132, as administered in the state by the agency.

20         (21)(20)  "Preexisting condition exclusion" means, with

21  respect to coverage, a limitation or exclusion of benefits

22  relating to a condition based on the fact that the condition

23  was present before the date of enrollment for such coverage,

24  whether or not any medical advice, diagnosis, care, or

25  treatment was recommended or received before such date.

26         (22)(21)  "Premium" means the entire cost of a health

27  insurance plan, including the administration fee or the risk

28  assumption charge.

29         (23)(22)  "Premium assistance payment" means the

30  monthly consideration paid by the agency per enrollee in the

31  Florida Kidcare program towards health insurance premiums.

                                  4

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    Florida Senate - 2004                                  SB 2000
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 1         (23)  "Program" means the Florida Kidcare program, the

 2  medical assistance program authorized by Title XXI of the

 3  Social Security Act as part of the federal Balanced Budget Act

 4  of 1997.

 5         Section 2.  Subsections (4), (7), (8), and (9) of

 6  section 409.8132, Florida Statutes, are amended to read:

 7         409.8132  Medikids program component.--

 8         (4)  APPLICABILITY OF LAWS RELATING TO MEDICAID.--The

 9  provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,

10  409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127,

11  409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205

12  apply to the administration of the Medikids program component

13  of the Florida Kidcare program, except that s. 409.9122

14  applies to Medikids as modified by the provisions of

15  subsection (7).

16         (7)  ENROLLMENT.--Enrollment in the Medikids program

17  component may only occur during periodic open enrollment

18  periods as specified in s. 409.8134 by the agency. An

19  applicant may apply for enrollment in the Medikids program

20  component and proceed through the eligibility determination

21  process at any time throughout the year. However, enrollment

22  in Medikids shall not begin until the next open enrollment

23  period; and A child may not receive services under the

24  Medikids program until the child is enrolled in a managed care

25  plan or MediPass as provided in s. 409.9122, except that. In

26  addition, once determined eligible, an applicant may receive

27  choice counseling and select a managed care plan or MediPass.

28  The agency may initiate mandatory assignment for a Medikids

29  applicant who has not chosen a managed care plan or MediPass

30  provider after the applicant's voluntary choice period ends.

31  an applicant may select MediPass under the Medikids program

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    Florida Senate - 2004                                  SB 2000
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 1  component only in counties that have fewer than two managed

 2  care plans available to serve Medicaid recipients and only if

 3  the federal Health Care Financing Administration determines

 4  that MediPass constitutes "health insurance coverage" as

 5  defined in Title XXI of the Social Security Act.

 6         (8)  SPECIAL ENROLLMENT PERIODS.--The agency shall

 7  establish a special enrollment period of 30 days' duration for

 8  any child who is enrolled in Medicaid if such child loses

 9  Medicaid eligibility and becomes eligible for Medikids, or for

10  any child who is enrolled in Medikids if such child moves to

11  another county that is not within the coverage area of the

12  child's Medikids managed care plan or MediPass provider.

13         (8)(9)  PENALTIES FOR VOLUNTARY CANCELLATION.--The

14  agency shall establish enrollment criteria that must include

15  penalties or waiting periods of not fewer than 60 days for

16  reinstatement of coverage upon voluntary cancellation for

17  nonpayment of premiums.

18         Section 3.  Section 409.8134, Florida Statutes, is

19  amended to read:

20         409.8134  Program enrollment and expenditure

21  ceilings.--

22         (1)  Except for the Medicaid program, a ceiling shall

23  be placed on annual federal and state expenditures and on

24  enrollment in the Florida Kidcare program as provided each

25  year in the General Appropriations Act. The agency, in

26  consultation with the Department of Health, may propose to

27  increase the enrollment ceiling in accordance with chapter

28  216.

29         (2)  The Florida Kidcare program may conduct a 30-day

30  open enrollment not more than twice per fiscal year for the

31  purpose of enrolling children who are eligible for all program

                                  6

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    Florida Senate - 2004                                  SB 2000
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 1  components listed in s. 409.813, except Medicaid, on a

 2  first-come, first-served basis, using the date the open

 3  enrollment application is received as the criteria. An open

 4  enrollment may be held only if the Social Services Estimating

 5  Conference determines that sufficient funds have been

 6  appropriated to finance increased enrollment or if an increase

 7  in federal funds and state matching funds is authorized

 8  through administrative actions taken pursuant to chapter 216.

 9  However, the Children's Medical Services Network may annually

10  enroll up to 120 additional children on an emergency basis

11  outside of the open enrollment periods and the cost of serving

12  these children must be managed within the Kidcare program's

13  appropriated or authorized levels of funding. Any child

14  included on the wait list after January 30, 2004, must reapply

15  by submitting a new application for the Kidcare program during

16  the open enrollment period. Except for the Medicaid program,

17  whenever the Social Services Estimating Conference determines

18  that there is presently, or will be by the end of the current

19  fiscal year, insufficient funds to finance the current or

20  projected enrollment in the Florida Kidcare program, all

21  additional enrollment must cease and additional enrollment may

22  not resume until sufficient funds are available to finance

23  such enrollment.

24         (3)  Upon a determination by the Social Services

25  Estimating Conference that there are insufficient funds to

26  finance the current enrollment in the Florida Kidcare program

27  within current appropriations, the program shall initiate

28  disenrollment procedures to remove enrollees, except for those

29  children enrolled in the Children's Medical Services network,

30  on a last-in, first-out basis, until the expenditure levels

31  and appropriation levels are balanced.

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    Florida Senate - 2004                                  SB 2000
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 1         (4)(3)  The agencies that administer the Florida

 2  Kidcare program components shall collect and analyze the data

 3  needed to project Florida Kidcare program enrollment costs,

 4  including price level adjustments outreach impacts,

 5  participation and attrition rates, current and projected

 6  caseloads, utilization, and current and projected expenditures

 7  for the next 3 years. The agencies shall report the caseload

 8  and expenditure trends to the Social Services Estimating

 9  Conference in accordance with chapter 216.

10         Section 4.  Effective July 1, 2004, section 409.814,

11  Florida Statutes, is amended to read:

12         409.814  Eligibility.--A child under 19 years of age

13  whose family income is equal to or below 200 percent of the

14  federal poverty level is eligible for the Florida Kidcare

15  program as provided in this section. In determining the

16  eligibility of such a child, an assets test is not required;

17  however, proof of family income must be provided, as well as a

18  statement from an employed family member's employer that the

19  applicant is not covered, and is not eligible for coverage,

20  under the family member's group health benefit plan or under

21  other employer-provided health insurance coverage. An

22  applicant under 19 years of age who, based on a complete

23  application, appears to be eligible for the Medicaid component

24  of the Florida Kidcare program is presumed eligible for

25  coverage under Medicaid, subject to federal rules. A child who

26  has been deemed presumptively eligible for Medicaid shall not

27  be enrolled in a managed care plan until the child's full

28  eligibility determination for Medicaid has been completed. The

29  Florida Healthy Kids Corporation may, subject to compliance

30  with applicable requirements of the Agency for Health Care

31  Administration and the Department of Children and Family

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    Florida Senate - 2004                                  SB 2000
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 1  Services, be designated as an entity to conduct presumptive

 2  eligibility determinations. An applicant under 19 years of age

 3  who, based on a complete application, appears to be eligible

 4  for the Medikids, Florida Healthy Kids, or Children's Medical

 5  Services network program component, who is screened as

 6  ineligible for Medicaid and prior to the monthly verification

 7  of the applicant's enrollment in Medicaid or of eligibility

 8  for coverage under the state employee health benefit plan, may

 9  be enrolled in and begin receiving coverage from the

10  appropriate program component on the first day of the month

11  following the receipt of a completed application.  For

12  enrollment in the Children's Medical Services network, a

13  complete application includes the medical or behavioral health

14  screening. If, after verification, an individual is

15  subsequently determined to be ineligible for coverage, he or

16  she must immediately be disenrolled from the respective Title

17  XXI-funded Kidcare program component.

18         (1)  A child who is eligible for Medicaid coverage

19  under s. 409.903 or s. 409.904 must be enrolled in Medicaid

20  and is not eligible to receive health benefits under any other

21  health benefits coverage authorized under the Florida Kidcare

22  program ss. 409.810-409.820.

23         (2)  A child who is not eligible for Medicaid, but who

24  is eligible for the Florida Kidcare program, may obtain health

25  benefits coverage under any of the other components listed in

26  s. 409.813 types of health benefits coverage authorized in ss.

27  409.810-409.820 if such coverage is approved and available in

28  the county in which the child resides. However, a child who is

29  eligible for Medikids may participate in the Florida Healthy

30  Kids program only if the child has a sibling participating in

31  

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    Florida Senate - 2004                                  SB 2000
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 1  the Florida Healthy Kids program and the child's county of

 2  residence permits such enrollment.

 3         (3)  A child who is eligible for the Florida Kidcare

 4  program who is a child with special health care needs, as

 5  determined through a medical or behavioral screening

 6  instrument, is eligible for health benefits coverage from and

 7  shall be referred to the Children's Medical Services network.

 8         (4)  The following children are not eligible to receive

 9  Title XXI premium assistance for health benefits coverage

10  under the Florida Kidcare program ss. 409.810-409.820, except

11  under Medicaid if the child would have been eligible for

12  Medicaid under s. 409.903 or s. 409.904 as of June 1, 1997:

13         (a)  A child who is eligible for coverage under a state

14  health benefit plan on the basis of a family member's

15  employment with a public agency in the state.

16         (b)  A child who is currently eligible for coverage or

17  covered under a family member's group health benefit plan or

18  under other employer health insurance coverage, excluding

19  coverage provided under the Florida Healthy Kids Corporation

20  as established under s. 624.91.

21         (c)  A child who is seeking premium assistance for the

22  Florida Kidcare program through employer-sponsored group

23  coverage, if the child has been covered by the same employer's

24  group coverage during the 6 months prior to the family's

25  submitting an application for determination of eligibility

26  under the Florida Kidcare program.

27         (d)  A child who is an alien, but who does not meet the

28  definition of qualified alien, in the United States. Such

29  child may apply for enrollment as a non-Title XXI child as

30  provided in s. 624.91(4)(b)2.

31  

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 1         (e)  A child who is an inmate of a public institution

 2  or a patient in an institution for mental diseases.

 3         (5)  A child whose family income is above 200 percent

 4  of the federal poverty level or a child who is excluded under

 5  the provisions of subsection (4) may participate in the

 6  Florida Kidcare program, excluding the Medicaid program, but

 7  is subject to the following provisions:

 8         (a)  The family is not eligible for premium assistance

 9  payments and must pay the full cost of the premium, including

10  any administrative costs.

11         (b)  The agency is authorized to place limits on

12  enrollment in Medikids by these children in order to avoid

13  adverse selection.  The number of children participating in

14  Medikids whose family income exceeds 200 percent of the

15  federal poverty level must not exceed 10 percent of total

16  enrollees in the Medikids program.

17         (c)  The board of directors of the Florida Healthy Kids

18  Corporation is authorized to place limits on enrollment of

19  these children in order to avoid adverse selection. In

20  addition, the board is authorized to offer a reduced benefit

21  package to these children in order to limit program costs for

22  such families. The number of children participating in the

23  Florida Healthy Kids program whose family income exceeds 200

24  percent of the federal poverty level must not exceed 10

25  percent of total enrollees in the Florida Healthy Kids

26  program.

27         (d)  Children described in this subsection are not

28  counted in the annual enrollment ceiling for the Florida

29  Kidcare program.

30         (5)(6)  Once a child is enrolled in the Florida Kidcare

31  program, the child is eligible for coverage under the program

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 1  for 6 months without a redetermination or reverification of

 2  eligibility, if the family continues to pay the applicable

 3  premium. Eligibility for program components funded through

 4  Title XXI of the Social Security Act shall terminate when a

 5  child reaches 19 years of age. Effective January 1, 1999, a

 6  child who has not attained the age of 5 and who has been

 7  determined eligible for the Medicaid program is eligible for

 8  coverage for 12 months without a redetermination or

 9  reverification of eligibility.

10         (6)(7)  When determining or reviewing a child's

11  eligibility under the Florida Kidcare program, the applicant

12  shall be provided with reasonable notice of changes in

13  eligibility which may affect enrollment in one or more of the

14  program components.  When a transition from one program

15  component to another is authorized appropriate, there shall be

16  cooperation between the program components and the affected

17  family which promotes continuity of health care coverage. Any

18  authorized transfers must be managed within the Florida

19  Kidcare program's overall appropriated or authorized levels of

20  funding.

21         (7)  The Florida Kidcare program shall withhold

22  benefits from an enrollee if, after redetermination of

23  eligibility or at any other time, the program obtains evidence

24  that the enrollee is no longer eligible, submitted incorrect

25  or fraudulent information in order to establish eligibility,

26  or fails to provide required information that verifies

27  eligibility.

28         (a)  The applicant or enrollee shall be notified that,

29  because of such evidence, program benefits will be withheld

30  unless the applicant or enrollee contacts a designated

31  representative of the program by a specified date, which must

                                  12

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 1  be within 10 days after the date of notice, to discuss and

 2  resolve the matter. The program shall make every effort to

 3  resolve the matter within a timeframe that will not cause

 4  benefits to be withheld from an eligible enrollee.

 5         (b)  An applicant or individual who assists the

 6  applicant to obtain or attempt to obtain benefits under the

 7  Florida Kidcare program which the applicant or individual

 8  knows that the applicant does not qualify for shall be subject

 9  to prosecution in accordance with s. 414.39.

10         Section 5.  Effective July 1, 2004, paragraph (q) of

11  subsection (2) of section 409.815, Florida Statutes, is

12  amended to read:

13         409.815  Health benefits coverage; limitations.--

14         (2)  BENCHMARK BENEFITS.--In order for health benefits

15  coverage to qualify for premium assistance payments for an

16  eligible child under ss. 409.810-409.820, the health benefits

17  coverage, except for coverage under Medicaid and Medikids,

18  must include the following minimum benefits, as medically

19  necessary.

20         (q)  Dental services.--Covered services may include

21  those dental services provided to children by the Florida

22  Medicaid program under s. 409.906(5), up to a maximum benefit

23  of $750 per enrollee per year.

24         Section 6.  Effective July 1, 2004, subsection (3) of

25  section 409.816, Florida Statutes, is amended to read:

26         409.816  Limitations on premiums and cost-sharing.--The

27  following limitations on premiums and cost-sharing are

28  established for the program.

29         (3)  Enrollees in families with a family income above

30  150 percent of the federal poverty level, who are not

31  receiving coverage under the Medicaid program or who are not

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 1  eligible under s. 409.814(5), may be required to pay

 2  enrollment fees, premiums, copayments, deductibles,

 3  coinsurance, or similar charges on a sliding scale related to

 4  income, except that the total annual aggregate cost-sharing

 5  with respect to all children in a family may not exceed 5

 6  percent of the family's income. However, copayments,

 7  deductibles, coinsurance, or similar charges may not be

 8  imposed for preventive services, including well-baby and

 9  well-child care, age-appropriate immunizations, and routine

10  hearing and vision screenings.

11         Section 7.  Paragraph (h) is added to subsection (3) of

12  section 409.818, Florida Statutes, to read:

13         409.818  Administration.--In order to implement ss.

14  409.810-409.820, the following agencies shall have the

15  following duties:

16         (3)  The Agency for Health Care Administration, under

17  the authority granted in s. 409.914(1), shall:

18         (h)  Contract, either directly or through the services

19  of a third-party, with authorized insurers or any provider of

20  health care services meeting standards established by the

21  agency, for the provision of comprehensive insurance coverage

22  for enrollees. Such standards shall include criteria under

23  which the agency or third-party may contract with more than

24  one provider of health care services in program sites. Health

25  plans shall be selected through a competitive procurement

26  process.

27  

28  The agency is designated the lead state agency for Title XXI

29  of the Social Security Act for purposes of receipt of federal

30  funds, for reporting purposes, and for ensuring compliance

31  with federal and state regulations and rules.

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 1         Section 8.  Paragraph (b) of subsection (2) of section

 2  409.818 and section 409.819, Florida Statutes, are repealed.

 3         Section 9.  Subsections (2) and (4) of section 624.91,

 4  Florida Statutes, are amended to read:

 5         624.91  The Florida Healthy Kids Corporation Act.--

 6         (2)  LEGISLATIVE INTENT.--

 7         (a)  The Legislature finds that increased access to

 8  health care services could improve children's health and

 9  reduce the incidence and costs of childhood illness and

10  disabilities among children in this state. Many children do

11  not have comprehensive, affordable health care services

12  available.  It is the intent of the Legislature that the

13  Florida Healthy Kids Corporation provide comprehensive health

14  insurance coverage to such children. The corporation is

15  encouraged to cooperate with any existing health service

16  programs funded by the public or the private sector and to

17  work cooperatively with the Florida Partnership for School

18  Readiness.

19         (b)  It is the intent of the Legislature that the

20  Florida Healthy Kids Corporation serve as one of several

21  providers of services to children eligible for medical

22  assistance under Title XXI of the Social Security Act.

23  Although the corporation may serve other children, The

24  Legislature further intends that the primary recipients of

25  services provided through the corporation be school-age

26  children with a family income below 200 percent of the federal

27  poverty level, who do not qualify for Medicaid.  It is also

28  the intent of the Legislature that state and local government

29  Florida Healthy Kids funds be used to continue and expand

30  coverage, subject to specific appropriations in the General

31  Appropriations Act, to children who are legal aliens but do

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 1  not meet the definition of a qualified alien for the purpose

 2  of eligibility not eligible for federal matching funds under

 3  Title XXI. The Florida Healthy Kids Corporation may provide

 4  coverage to children whose family pays the full cost of the

 5  premiums, including any administrative costs.

 6         (4)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--

 7         (a)  There is created the Florida Healthy Kids

 8  Corporation, a not-for-profit corporation.

 9         (b)  The Florida Healthy Kids Corporation shall:

10         1.  Arrange for the collection of any family, local

11  contributions, or employer payment or premium, in an amount to

12  be determined by the board of directors, to provide for

13  payment of premiums for comprehensive insurance coverage and

14  for the actual or estimated administrative expenses;

15         2.  Arrange for the collection of any voluntary

16  contributions to provide for payment of premiums for children

17  who are not eligible for medical assistance under Title XXI of

18  the Social Security Act. Each fiscal year, the corporation

19  shall establish a local match policy for the enrollment of

20  non-Title-XXI-eligible children in the Healthy Kids program.

21  By May 1 of each year, the corporation shall provide written

22  notification of the amount to be remitted to the corporation

23  for the following fiscal year under that policy. Local match

24  sources may include, but are not limited to, funds provided by

25  municipalities, counties, school boards, hospitals, health

26  care providers, charitable organizations, special taxing

27  districts, and private organizations. The minimum local match

28  cash contributions required each fiscal year and local match

29  credits shall be determined by the General Appropriations Act.

30  The corporation shall calculate a county's local match rate

31  based upon that county's percentage of the state's total

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 1  non-Title-XXI expenditures as reported in the corporation's

 2  most recently audited financial statement. In awarding the

 3  local match credits, the corporation may consider factors

 4  including, but not limited to, population density, per capita

 5  income, and existing child-health-related expenditures and

 6  services;

 7         3.  Subject to s. 409.8134, accept voluntary

 8  supplemental local match contributions that comply with the

 9  requirements of Title XXI of the Social Security Act for the

10  purpose of providing additional coverage in contributing

11  counties under Title XXI;

12         4.  Establish the administrative and accounting

13  procedures for the operation of the corporation;

14         5.  Establish, with consultation from appropriate

15  professional organizations, standards for preventive health

16  services and providers and comprehensive insurance benefits

17  appropriate to children; provided that such standards for

18  rural areas shall not limit primary care providers to

19  board-certified pediatricians;

20         6.  Determine Establish eligibility for criteria which

21  children seeking must meet in order to participate in the

22  components of the Florida Kidcare program, except for

23  Medicaid, funded under Title XXI, consistent with the

24  requirements specified in s. 409.814, as well as non-Title

25  XXI-eligible children as provided in subparagraph 2.;

26         7.  Establish procedures under which providers of local

27  match to, applicants to and participants in the program may

28  have grievances reviewed by an impartial body and reported to

29  the board of directors of the corporation;

30         8.  Establish participation criteria and, if

31  appropriate, contract with an authorized insurer, health

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 1  maintenance organization, or third-party insurance

 2  administrator to provide administrative services to the

 3  corporation;

 4         9.  Establish enrollment criteria which shall include

 5  penalties or waiting periods of not fewer than 60 days for

 6  reinstatement of coverage upon voluntary cancellation for

 7  nonpayment of family premiums;

 8         10.  If a space is available, establish a special open

 9  enrollment period of 30 days' duration for any child who is

10  enrolled in Medicaid or Medikids if such child loses Medicaid

11  or Medikids eligibility and becomes eligible for the Florida

12  Healthy Kids program;

13         10.11.  Contract with authorized insurers or any

14  provider of health care services, meeting standards

15  established by the corporation, for the provision of

16  comprehensive insurance coverage to participants.  Such

17  standards shall include criteria under which the corporation

18  may contract with more than one provider of health care

19  services in program sites. Health plans shall be selected

20  through a competitive bid process. The corporation shall

21  purchase goods and services in the most cost-effective manner

22  consistent with the delivery of quality medical care. The

23  maximum administrative cost for a Florida Healthy Kids

24  Corporation contract shall be 15 percent. The minimum medical

25  loss ratio for a Florida Healthy Kids Corporation contract

26  shall be 85 percent. The selection of health plans shall be

27  based primarily on quality criteria established by the board.

28  The health plan selection criteria and scoring system, and the

29  scoring results, shall be available upon request for

30  inspection after the bids have been awarded;

31  

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 1         11.12.  Establish disenrollment criteria in the event

 2  local matching funds are insufficient to cover enrollments;

 3         12.13.  Develop and implement a plan to publicize the

 4  Florida Healthy Kids Corporation, the eligibility requirements

 5  of the program, and the procedures for enrollment in the

 6  program and to maintain public awareness of the corporation

 7  and the program;

 8         13.14.  Secure staff necessary to properly administer

 9  the corporation. Staff costs shall be funded from state and

10  local matching funds and such other private or public funds as

11  become available. The board of directors shall determine the

12  number of staff members necessary to administer the

13  corporation;

14         15.  As appropriate, enter into contracts with local

15  school boards or other agencies to provide onsite information,

16  enrollment, and other services necessary to the operation of

17  the corporation;

18         14.16.  Provide a report annually to the Governor,

19  Chief Financial Officer, Commissioner of Education, Senate

20  President, Speaker of the House of Representatives, and

21  Minority Leaders of the Senate and the House of

22  Representatives;

23         17.  Each fiscal year, establish a maximum number of

24  participants, on a statewide basis, who may enroll in the

25  program; and

26         15.18.  Establish eligibility criteria, premium and

27  cost-sharing requirements, and benefit packages that which

28  conform to the provisions of the Florida Kidcare program, as

29  created in ss. 409.810-409.820; and.

30  

31  

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 1         16.  Establish criteria, premium and cost-sharing

 2  requirements, and benefit packages for non-Title XII-eligible

 3  children.

 4         (c)  Coverage under the corporation's program is

 5  secondary to any other available private coverage held by or

 6  applicable to the participant child or family member. Insurers

 7  under contract with the corporation are the payors of last

 8  resort and must coordinate benefits with any other third-party

 9  payor who may be liable for the participant's medical care.

10  The corporation may establish procedures for coordinating

11  benefits under this program with benefits under other public

12  and private coverage.

13         (d)  The Florida Healthy Kids Corporation shall be a

14  private corporation not for profit, organized pursuant to

15  chapter 617, and shall have all powers necessary to carry out

16  the purposes of this act, including, but not limited to, the

17  power to receive and accept grants, loans, or advances of

18  funds from any public or private agency and to receive and

19  accept from any source contributions of money, property,

20  labor, or any other thing of value, to be held, used, and

21  applied for the purposes of this act.

22         Section 10.  The Florida Healthy Kids Corporation shall

23  enter into a contract for an analysis of children enrolled in

24  the Florida Kidcare program who are ineligible pursuant to the

25  requirements of section 409.814(4), Florida Statutes, for the

26  purpose of making recommendations to implement mechanisms to

27  prevent such enrollment. The results of the analysis and

28  recommendations shall be reported to the Governor and the

29  Legislature by December 31, 2004.

30         Section 11.  The sum of $6,566,073 from the General

31  Revenue Fund, the sum of $454,687 from the Grants and

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    Florida Senate - 2004                                  SB 2000
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 1  Donations Trust Fund, and the sum of $16,272,440 from the

 2  Medical Care Trust Fund are appropriated to the Agency for

 3  Health Care Administration, and the sum of $1,984,113 from the

 4  Donations Trust Fund is appropriated to the Department of

 5  Health, for the 2003-2004 fiscal year for the purpose of

 6  serving children who submitted an application to the Florida

 7  Kidcare program as of January 30, 2004, and who are determined

 8  to be eligible for program components funded under Title XXI

 9  of the Social Security Act.

10         Section 12.  Except as otherwise expressly provided in

11  this act, this act shall take effect upon becoming a law.

12  

13            *****************************************

14                          SENATE SUMMARY

15    Revises various provisions of the Florida Kidcare
      program. Requires the program to conduct two 30-day
16    enrollment periods each fiscal year. Provides for
      emergency enrollment of up to 120 children under certain
17    circumstances. Provides procedures for disenrollment on a
      last-in, first-out basis. Revises coverage for dental
18    services. Requires the Florida Healthy Kids Corporation
      to enter into a contract for an analysis of and
19    recommendations for managing enrollment in the Florida
      Kidcare program. (See bill for details.)
20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

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