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Senate Bill 2000

Senate Bill sb2000c1

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    Florida Senate - 2004                           CS for SB 2000

    By the Committee on Appropriations; and Senators Dockery,
    Peaden, Atwater, Fasano, Argenziano, Jones, Pruitt, Bennett,
    Lynn and Cowin



    309-2026-04

  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         providing requirements if a child is

23         transferred to another program component;

24         providing that an assets test is not required;

25         requiring certain information to accompany

26         applications; 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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    Florida Senate - 2004                           CS for SB 2000
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 1         amending s. 409.818, F.S.; requiring the Agency

 2         for Health Care Administration to contract for

 3         the provision of comprehensive insurance

 4         coverage for enrollees; requiring a competitive

 5         selection process; repealing s. 409.818(2)(b)

 6         and 409.819, F.S., relating to an outreach

 7         program operated by the Department of Health;

 8         amending s. 624.91, F.S.; revising legislative

 9         intent with respect to expanding health care

10         coverage for children; conforming provisions of

11         the Florida Healthy Kids Corporation Act to

12         changes made in the Florida Kidcare program;

13         deleting obsolete provisions; requiring the

14         Auditor General to conduct an analysis for the

15         purpose of making recommendations for managing

16         ineligible enrollment in the Kidcare program;

17         providing appropriations; providing effective

18         dates.

19  

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

21  

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

23  409.811, Florida Statutes, are amended to read:

24         409.811  Definitions relating to Florida Kidcare

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

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

27  "program" means the health benefits program administered

28  through ss. 409.810-409.820.

29         (15)(14)  "Guarantee issue" means that health benefits

30  coverage must be offered to an individual regardless of the

31  

                                  2

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    Florida Senate - 2004                           CS for 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  

                                  3

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    Florida Senate - 2004                           CS for 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                           CS for SB 2000
    309-2026-04




 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 (7) and (8) of section

 6  409.8132, Florida Statutes, are amended to read:

 7         409.8132  Medikids program component.--

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

 9  component may only occur during periodic open enrollment

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

11  applicant may apply for enrollment in the Medikids program

12  component and proceed through the eligibility determination

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

14  in Medikids shall not begin until the next open enrollment

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

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

17  plan or MediPass. In addition, once determined eligible, an

18  applicant may receive choice counseling and select a managed

19  care plan or MediPass. The agency may initiate mandatory

20  assignment for a Medikids applicant who has not chosen a

21  managed care plan or MediPass provider after the applicant's

22  voluntary choice period ends. An applicant may select MediPass

23  under the Medikids program component only in counties that

24  have fewer than two managed care plans available to serve

25  Medicaid recipients and only if the federal Health Care

26  Financing Administration determines that MediPass constitutes

27  "health insurance coverage" as defined in Title XXI of the

28  Social Security Act.

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

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

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

                                  5

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    Florida Senate - 2004                           CS for SB 2000
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 1  Medicaid eligibility and becomes eligible for Medikids, or for

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

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

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

 5         Section 3.  Section 409.8134, Florida Statutes, is

 6  amended to read:

 7         409.8134  Program enrollment and expenditure

 8  ceilings.--

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

10  be placed on annual federal and state expenditures and on

11  enrollment in the Florida Kidcare program as provided each

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

13  consultation with the Department of Health, may propose to

14  increase the enrollment ceiling in accordance with chapter

15  216.

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

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

18  purpose of enrolling children who are eligible for all program

19  components listed in s. 409.813, except Medicaid, on a

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

21  enrollment application is received as the criteria. The open

22  enrollment periods shall be September 1st through September

23  30th and January 1st through January 30th. Open enrollment

24  shall immediately cease when the enrollment ceiling is

25  reached. An open enrollment may be held only if, in the

26  opinion of the Governor, after consultation with the Social

27  Services Estimating Conference, there are sufficient funds

28  available because funding has been appropriated to finance

29  increased enrollment, attrition has increased, or an increase

30  in federal funds and state matching funds is authorized

31  through administrative actions taken pursuant to chapter 216.

                                  6

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    Florida Senate - 2004                           CS for SB 2000
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 1  However, the Children's Medical Services Network may annually

 2  enroll up to 120 additional children based on disability

 3  criteria outside of the open enrollment periods and the cost

 4  of serving these children must be managed within the Kidcare

 5  program's appropriated or authorized levels of funding. Any

 6  child included on the wait list after January 30, 2004, must

 7  reapply by submitting a new application for the Kidcare

 8  program during the open enrollment period. Except for the

 9  Medicaid program, whenever the Social Services Estimating

10  Conference determines that there is presently, or will be by

11  the end of the current fiscal year, insufficient funds to

12  finance the current or projected enrollment in the Florida

13  Kidcare program, all additional enrollment must cease and

14  additional enrollment may not resume until sufficient funds

15  are available to finance such enrollment.

16         (3)  If, in the opinion of the Governor, after

17  consultation with the Social Services Estimating Conference,

18  there are insufficient funds available for Kidcare program

19  operations, the Governor shall develop a plan of action to

20  establish disenrollment procedures to remove enrollees, except

21  for those children enrolled in the Children's Medical Services

22  network, on a last-in, first-out basis, until the expenditure

23  levels and appropriation levels are balanced. In developing

24  the plan of action, the Governor shall, to the extent

25  possible, preserve legislative policy and intent.

26         (4)(3)  The agencies that administer the Florida

27  Kidcare program components shall collect and analyze the data

28  needed to project Florida Kidcare program enrollment costs,

29  including price level adjustments outreach impacts,

30  participation and attrition rates, current and projected

31  caseloads, utilization, and current and projected expenditures

                                  7

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    Florida Senate - 2004                           CS for SB 2000
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 1  for the next 3 years. The agencies shall report the caseload

 2  and expenditure trends to the Social Services Estimating

 3  Conference in accordance with chapter 216.

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

 5  Florida Statutes, is amended to read:

 6         409.814  Eligibility.--A child under 19 years of age

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

 8  federal poverty level is eligible for the Florida Kidcare

 9  program as provided in this section. In determining the

10  eligibility of such a child, an assets test is not required.

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

12  application, appears to be eligible for the Medicaid component

13  of the Florida Kidcare program is presumed eligible for

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

15  has been deemed presumptively eligible for Medicaid shall not

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

17  eligibility determination for Medicaid has been completed. The

18  Florida Healthy Kids Corporation may, subject to compliance

19  with applicable requirements of the Agency for Health Care

20  Administration and the Department of Children and Family

21  Services, be designated as an entity to conduct presumptive

22  eligibility determinations. An applicant under 19 years of age

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

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

25  Services network program component, who is screened as

26  ineligible for Medicaid and prior to the monthly verification

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

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

29  be enrolled in and begin receiving coverage from the

30  appropriate program component on the first day of the month

31  following the receipt of a completed application.  For

                                  8

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    Florida Senate - 2004                           CS for SB 2000
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 1  enrollment in the Children's Medical Services network, a

 2  complete application includes the medical or behavioral health

 3  screening. If, after verification, an individual is

 4  subsequently determined to be ineligible for coverage, he or

 5  she must immediately be disenrolled from the respective Title

 6  XXI-funded Kidcare program component.

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

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

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

10  health benefits coverage authorized under the Florida Kidcare

11  program ss. 409.810-409.820.

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

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

14  benefits coverage under any of the other components listed in

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

16  409.810-409.820 if such coverage is approved and available in

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

18  eligible for Medikids may participate in the Florida Healthy

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

20  the Florida Healthy Kids program and the child's county of

21  residence permits such enrollment.

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

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

24  determined through a medical or behavioral screening

25  instrument, is eligible for health benefits coverage from and

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

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

28  Title XXI premium assistance for health benefits coverage

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

30  under Medicaid if the child would have been eligible for

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

                                  9

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    Florida Senate - 2004                           CS for SB 2000
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 1         (a)  A child who is eligible for coverage under a state

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

 3  employment with a public agency in the state.

 4         (b)  A child who is currently eligible for or covered

 5  under a family member's group health benefit plan or under

 6  other employer health insurance coverage provided that the

 7  cost of the child's participation is not greater than 7.5

 8  percent of the family's gross income, excluding coverage

 9  provided under the Florida Healthy Kids Corporation as

10  established under s. 624.91. This provision will be applied

11  during redetermination for individuals who were enrolled prior

12  to July 1, 2004. These enrollees will have 6 months of

13  eligibility following redetermination to allow for a

14  transition to the other health benefit plan.

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

16  Florida Kidcare program through employer-sponsored group

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

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

19  submitting an application for determination of eligibility

20  under the Florida Kidcare program.

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

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

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

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

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

26  or a patient in an institution for mental diseases.

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

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

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

30  Florida Kidcare program, excluding the Medicaid program, but

31  is subject to the following provisions:

                                  10

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    Florida Senate - 2004                           CS for SB 2000
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 1         (a)  The family is not eligible for premium assistance

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

 3  any administrative costs.

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

 5  enrollment in Medikids by these children in order to avoid

 6  adverse selection.  The number of children participating in

 7  Medikids whose family income exceeds 200 percent of the

 8  federal poverty level must not exceed 10 percent of total

 9  enrollees in the Medikids program.

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

11  Corporation is authorized to place limits on enrollment of

12  these children in order to avoid adverse selection. In

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

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

15  such families. The number of children participating in the

16  Florida Healthy Kids program whose family income exceeds 200

17  percent of the federal poverty level must not exceed 10

18  percent of total enrollees in the Florida Healthy Kids

19  program.

20         (d)  Children described in this subsection are not

21  counted in the annual enrollment ceiling for the Florida

22  Kidcare program.

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

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

25  for 6 months without a redetermination or reverification of

26  eligibility, if the family continues to pay the applicable

27  premium. Eligibility for program components funded through

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

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

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

31  determined eligible for the Medicaid program is eligible for

                                  11

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    Florida Senate - 2004                           CS for SB 2000
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 1  coverage for 12 months without a redetermination or

 2  reverification of eligibility.

 3         (7)  When determining or reviewing a child's

 4  eligibility under the Florida Kidcare program, the applicant

 5  shall be provided with reasonable notice of changes in

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

 7  program components.  When a transition from one program

 8  component to another is authorized appropriate, there shall be

 9  cooperation between the program components and the affected

10  family which promotes continuity of health care coverage. Any

11  authorized transfers must be managed within the Florida

12  Kidcare program's overall appropriated or authorized levels of

13  funding. Each component of Kidcare shall establish a reserve

14  to assure that transfers between components will be

15  accomplished within current-year appropriations. These

16  reserves shall be reviewed by each convening of the Social

17  Services Estimating Conference to determine their adequacy to

18  meet actual experience.

19         (8)  In determining the eligibility of a child, an

20  assets test is not required. The applicant shall provide

21  written documentation during the application process and the

22  redetermination process, including, but not limited to, the

23  following:

24         (a)  Proof of family income;

25         (b)  A statement that:

26         1.  No employer of a family member sponsors a health

27  plan for employees; or

28         2.a.  The potential enrollee is not covered by a family

29  member's employer's sponsored health benefit plan; or

30  

31  

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    Florida Senate - 2004                           CS for SB 2000
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 1         b.  The potential enrollee is not eligible for coverage

 2  by a family member's employer's sponsored health benefit plan;

 3  and

 4         (c)  A statement indicating the incremental cost to

 5  enroll the potential enrollee in a family member's employer's

 6  sponsored health plan.

 7         (9)  The Florida Kidcare program shall withhold

 8  benefits from an enrollee if, after redetermination of

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

10  that the enrollee is no longer eligible, submitted incorrect

11  or fraudulent information in order to establish eligibility,

12  or fails to provide required information that verifies

13  eligibility.

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

15  because of such evidence, program benefits will be withheld

16  unless the applicant or enrollee contacts a designated

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

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

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

20  resolve the matter within a timeframe that will not cause

21  benefits to be withheld from an eligible enrollee.

22         (b)  An applicant or individual who assists the

23  applicant to obtain or attempt to obtain benefits under the

24  Florida Kidcare program which the applicant or individual

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

26  to prosecution in accordance with s. 414.39.

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

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

29  amended to read:

30         409.815  Health benefits coverage; limitations.--

31  

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    Florida Senate - 2004                           CS for SB 2000
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 1         (2)  BENCHMARK BENEFITS.--In order for health benefits

 2  coverage to qualify for premium assistance payments for an

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

 4  coverage, except for coverage under Medicaid and Medikids,

 5  must include the following minimum benefits, as medically

 6  necessary.

 7         (q)  Dental services.--Dental services shall be covered

 8  and may services include those dental benefits services

 9  provided to children by the Florida Medicaid program under s.

10  409.906(6) s. 409.906(5), up to a maximum benefit of $750 per

11  enrollee per year.

12         Section 6.  Paragraph (h) is added to subsection (3) of

13  section 409.818, Florida Statutes, to read:

14         409.818  Administration.--In order to implement ss.

15  409.810-409.820, the following agencies shall have the

16  following duties:

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

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

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

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

21  health care services meeting standards established by the

22  agency, for the provision of comprehensive insurance coverage

23  for enrollees. Such standards shall include criteria under

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

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

26  plans shall be selected through a competitive procurement

27  process.

28  

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

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

31  

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 1  funds, for reporting purposes, and for ensuring compliance

 2  with federal and state regulations and rules.

 3         Section 7.  Paragraph (b) of subsection (2) of section

 4  409.818 and section 409.819, Florida Statutes, are repealed.

 5         Section 8.  Subsections (2) and (4) of section 624.91,

 6  Florida Statutes, are amended to read:

 7         624.91  The Florida Healthy Kids Corporation Act.--

 8         (2)  LEGISLATIVE INTENT.--

 9         (a)  The Legislature finds that increased access to

10  health care services could improve children's health and

11  reduce the incidence and costs of childhood illness and

12  disabilities among children in this state. Many children do

13  not have comprehensive, affordable health care services

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

15  Florida Healthy Kids Corporation provide comprehensive health

16  insurance coverage to such children. The corporation is

17  encouraged to cooperate with any existing health service

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

19  work cooperatively with the Florida Partnership for School

20  Readiness.

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

22  Florida Healthy Kids Corporation serve as one of several

23  providers of services to children eligible for medical

24  assistance under Title XXI of the Social Security Act.

25  Although the corporation may serve other children, The

26  Legislature further intends that the primary recipients of

27  services provided through the corporation be school-age

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

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

30  the intent of the Legislature that state and local government

31  Florida Healthy Kids funds be used to continue and expand

                                  15

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 1  coverage, subject to specific appropriations in the General

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

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

 4  of eligibility not eligible for federal matching funds under

 5  Title XXI. The Florida Healthy Kids Corporation may provide

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

 7  premiums, including any administrative costs.

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

 9         (a)  There is created the Florida Healthy Kids

10  Corporation, a not-for-profit corporation.

11         (b)  The Florida Healthy Kids Corporation shall:

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

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

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

15  payment of premiums for comprehensive insurance coverage and

16  for the actual or estimated administrative expenses;

17         2.  Arrange for the collection of any voluntary

18  contributions to provide for payment of premiums for children

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

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

21  shall establish a local match policy for the enrollment of

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

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

24  notification of the amount to be remitted to the corporation

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

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

27  municipalities, counties, school boards, hospitals, health

28  care providers, charitable organizations, special taxing

29  districts, and private organizations. The minimum local match

30  cash contributions required each fiscal year and local match

31  credits shall be determined by the General Appropriations Act.

                                  16

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

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

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

 4  most recently audited financial statement. In awarding the

 5  local match credits, the corporation may consider factors

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

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

 8  services;

 9         3.  Subject to s. 409.8134, accept voluntary

10  supplemental local match contributions that comply with the

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

12  purpose of providing additional coverage in contributing

13  counties under Title XXI;

14         4.  Establish the administrative and accounting

15  procedures for the operation of the corporation;

16         5.  Establish, with consultation from appropriate

17  professional organizations, standards for preventive health

18  services and providers and comprehensive insurance benefits

19  appropriate to children; provided that such standards for

20  rural areas shall not limit primary care providers to

21  board-certified pediatricians;

22         6.  Determine Establish eligibility for criteria which

23  children seeking must meet in order to participate in the

24  components of the Florida Kidcare program, except for

25  Medicaid, funded under Title XXI, consistent with the

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

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

28         7.  Establish procedures under which providers of local

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

30  have grievances reviewed by an impartial body and reported to

31  the board of directors of the corporation;

                                  17

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    Florida Senate - 2004                           CS for SB 2000
    309-2026-04




 1         8.  Establish participation criteria and, if

 2  appropriate, contract with an authorized insurer, health

 3  maintenance organization, or third-party insurance

 4  administrator to provide administrative services to the

 5  corporation;

 6         9.  Establish enrollment criteria which shall include

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

 8  reinstatement of coverage upon voluntary cancellation for

 9  nonpayment of family premiums;

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

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

12  enrolled in Medicaid or Medikids if such child loses Medicaid

13  or Medikids eligibility and becomes eligible for the Florida

14  Healthy Kids program;

15         10.11.  Contract with authorized insurers or any

16  provider of health care services, meeting standards

17  established by the corporation, for the provision of

18  comprehensive insurance coverage to participants.  Such

19  standards shall include criteria under which the corporation

20  may contract with more than one provider of health care

21  services in program sites. Health plans shall be selected

22  through a competitive bid process. The corporation shall

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

24  consistent with the delivery of quality medical care. The

25  maximum administrative cost for a Florida Healthy Kids

26  Corporation contract shall be 15 percent. The minimum medical

27  loss ratio for a Florida Healthy Kids Corporation contract

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

29  based primarily on quality criteria established by the board.

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

31  

                                  18

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    Florida Senate - 2004                           CS for SB 2000
    309-2026-04




 1  scoring results, shall be available upon request for

 2  inspection after the bids have been awarded;

 3         11.12.  Establish disenrollment criteria in the event

 4  local matching funds are insufficient to cover enrollments;

 5         12.13.  Develop and implement a plan to publicize the

 6  Florida Healthy Kids Corporation, the eligibility requirements

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

 8  program and to maintain public awareness of the corporation

 9  and the program;

10         13.14.  Secure staff necessary to properly administer

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

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

13  become available. The board of directors shall determine the

14  number of staff members necessary to administer the

15  corporation;

16         15.  As appropriate, enter into contracts with local

17  school boards or other agencies to provide onsite information,

18  enrollment, and other services necessary to the operation of

19  the corporation;

20         14.16.  Provide a report annually to the Governor,

21  Chief Financial Officer, Commissioner of Education, Senate

22  President, Speaker of the House of Representatives, and

23  Minority Leaders of the Senate and the House of

24  Representatives;

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

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

27  program; and

28         15.18.  Establish eligibility criteria, premium and

29  cost-sharing requirements, and benefit packages that which

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

31  created in ss. 409.810-409.820; and.

                                  19

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    Florida Senate - 2004                           CS for SB 2000
    309-2026-04




 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 9.  The Auditor General shall perform an

23  analysis of children enrolled in the Florida Kidcare program

24  who are ineligible pursuant to the requirements of section

25  409.814(4), Florida Statutes, for the purpose of making

26  recommendations to implement mechanisms to prevent such

27  enrollment. The results of the analysis and recommendations

28  shall be reported to the Governor and the Legislature by

29  December 31, 2004.

30         Section 10.  The sum of $6,566,073 from the General

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

                                  20

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    Florida Senate - 2004                           CS for SB 2000
    309-2026-04




 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 11.  Except as otherwise expressly provided in

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

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

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27  

28  

29  

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31  

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    Florida Senate - 2004                           CS for SB 2000
    309-2026-04




 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         Senate Bill 2000

 3                                 

 4  Restores current law related to Medikids that allows certain
    exceptions to mandatory managed care requirements.
 5  
    Specifies the dates of the open enrollment periods to be
 6  September 1 - 30 and January 1 - 30; specifies that open
    enrollment is to cease when the enrollment ceiling is reached;
 7  and requires the Governor to determine whether an open
    enrollment is to be held after consultation with the Social
 8  Services Estimating Conference.

 9  Provides that the Children's Medical Services Network may
    annually enroll up to 120 additional children based on
10  disability criteria rather than on an emergency basis.

11  Requires the Governor to develop a plan of action to establish
    disenrollment procedures after consultation with the Social
12  Services Estimating Conference regarding the amount of funds
    available.
13  
    Adds a provision that provides an affordability exception to
14  allow children to be enrolled in KidCare if the cost of adding
    children to an employer sponsored insurance plan exceeds 7.5
15  percent of the family's gross income; provides an additional 6
    months of eligibility following redetermination to allow for a
16  transition period for children enrolled prior to July 1, 2004.

17  Restores current law related to children excluded from the
    Title XXI program whose family income is above 200% of the
18  federal poverty level and the 10% enrollment limitations for
    the full pay option.
19  
    Provides for reserves to be established to assure transfers
20  between KidCare program components and allows for reviews by
    the Social Services Estimating Conference.
21  
    Provides eligibility requirements to exclude an asset test;
22  requires proof of income; and requires statements from an
    applicant regarding coverage under an employer's sponsored
23  health insurance plan as well as cost of coverage.

24  Provides that dental services shall be covered and specifies
    that dental services may include benefits provided under the
25  Medicaid program.

26  Specifies that the Auditor General shall perform an analysis
    of children enrolled in the KidCare program rather than
27  requiring the Florida Health Kids Corporation to contract for
    this analysis.
28  

29  

30  

31  

                                  22

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