February 28, 2020
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Senate Bill 2000

Senate Bill sb2000er

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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



  1                                 

  2         An act relating to the Florida KidCare program;

  3         amending s. 409.811, F.S.; defining the term

  4         "Florida KidCare program"; deleting a

  5         definition to conform; amending s. 409.8132,

  6         F.S.; limiting when an applicant may apply for

  7         Medikids program enrollment; deleting a special

  8         enrollment period provision; amending s.

  9         409.8134, F.S.; eliminating the Agency for

10         Health Care Administration's ability to request

11         an increase in the Florida KidCare program

12         enrollment ceiling; providing for open

13         enrollment periods; providing a timeframe for

14         statewide announcement of open enrollment

15         periods; providing for the enrollment of

16         certain children on an emergency basis;

17         providing limitations; providing a

18         disenrollment process under certain

19         circumstances; providing additional data for

20         certain agencies to collect and analyze;

21         amending s. 409.814, F.S.; revising Florida

22         KidCare program eligibility criteria; limiting

23         coverage; providing an exception for certain

24         children otherwise eligible or covered under a

25         family member's employer health coverage;

26         restricting enrollment of children whose

27         coverage was voluntarily canceled; providing an

28         age limitation for certain components;

29         requiring certain transfers to be managed

30         within authorized levels of funding; requiring

31         certain reserves to be established and


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         reviewed; requiring each applicant to provide

 2         certain documentation; requiring the program to

 3         withhold benefits from certain enrollees;

 4         providing additional fraudulent activities;

 5         amending s. 409.815, F.S.; revising coverage

 6         requirements for dental services; amending s.

 7         624.91, F.S.; removing the requirement for the

 8         Florida Healthy Kids Corporation to work with

 9         the Florida Partnership for School Readiness;

10         limiting eligibility for state-funded

11         assistance in paying Florida Healthy Kids

12         premiums; providing for future repeal of

13         certain provisions; providing additional

14         criteria for the corporation to determine

15         eligibility; eliminating authority to establish

16         an open enrollment period; revising the

17         corporation's purchasing criteria; removing a

18         restriction; eliminating authority to contract

19         with certain entities; eliminating authority to

20         establish a maximum number of participants;

21         eliminating authority to establish eligibility

22         criteria or premium and cost-sharing

23         requirements; providing that contracted

24         insurers are the payors of last resort;

25         requiring contracted insurers to coordinate

26         benefits with certain payors; deleting obsolete

27         provisions; requiring the Auditor General to

28         provide recommendations to prevent enrollment

29         of ineligible children in the Florida KidCare

30         program and report such recommendations to the

31         Governor and Legislature; requiring the Florida


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         Healthy Kids Corporation to use certain funds

 2         to contract for an actuarial study; requiring

 3         the Auditor General to perform audits to ensure

 4         the eligibility of children enrolled in the

 5         Florida Healthy Kids program; authorizing the

 6         Auditor General to require and receive any

 7         books, accounts, records, or other

 8         documentation relating to the Florida Healthy

 9         Kids Corporation; requiring the Office of

10         Program Policy Analysis and Government

11         Accountability to perform a study to determine

12         the appropriate family premium for the Florida

13         KidCare program and report its findings to the

14         Legislature; amending s. 409.818, F.S.;

15         deleting a cross-reference; repealing s.

16         409.819, F.S., relating to a program

17         identifying low-income, uninsured children for

18         certain purposes; providing appropriations;

19         providing effective dates.

20  

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

22  

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

24  409.811, Florida Statutes, are renumbered as subsections (15)

25  through (23), respectively, present subsection (23) of that

26  section is amended, and a new subsection (14) is added to that

27  section, to read:

28         409.811  Definitions relating to Florida KidCare

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

30  

31  


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         (14)  "Florida KidCare program," "KidCare program," or

 2  "program" means the health benefits program administered

 3  through ss. 409.810-409.820.

 4         (23)  "Program" means the Florida Kidcare program, the

 5  medical assistance program authorized by Title XXI of the

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

 7  of 1997.

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

 9  409.8132, Florida Statutes, are amended to read:

10         409.8132  Medikids program component.--

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

12  component may only occur during periodic open enrollment

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

14  applicant may apply for enrollment in the Medikids program

15  component and proceed through the eligibility determination

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

17  in Medikids shall not begin until the next open enrollment

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

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

20  plan or MediPass. In addition, Once determined eligible, an

21  applicant may receive choice counseling and select a managed

22  care plan or MediPass. The agency may initiate mandatory

23  assignment for a Medikids applicant who has not chosen a

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

25  voluntary choice period ends. An applicant may select MediPass

26  under the Medikids program component only in counties that

27  have fewer than two managed care plans available to serve

28  Medicaid recipients and only if the federal Health Care

29  Financing Administration determines that MediPass constitutes

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

31  Social Security Act.


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



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

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

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

 4  Medicaid eligibility and becomes eligible for Medikids, or for

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

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

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

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

 9  agency shall establish enrollment criteria that must include

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

11  reinstatement of coverage upon voluntary cancellation for

12  nonpayment of premiums.

13         Section 3.  Section 409.8134, Florida Statutes, is

14  amended to read:

15         409.8134  Program enrollment and expenditure

16  ceilings.--

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

18  be placed on annual federal and state expenditures and on

19  enrollment in the Florida KidCare Kidcare program as provided

20  each year in the General Appropriations Act. The agency, in

21  consultation with the Department of Health, may propose to

22  increase the enrollment ceiling in accordance with chapter

23  216.

24         (2)  Upon a unanimous recommendation by representatives

25  from each of the four Florida KidCare administrators, the

26  Florida KidCare program may conduct an open enrollment period

27  for the purpose of enrolling children eligible for all program

28  components listed in s. 409.813 except Medicaid. The four

29  Florida KidCare administrators shall work together to ensure

30  that the open enrollment period is announced statewide at

31  least 1 month before the open enrollment is to begin. Eligible


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  children shall be enrolled on a first-come, first-served basis

 2  using the date the open enrollment application is received.

 3  The potential open enrollment periods shall be January 1st

 4  through January 30th and September 1st through September 30th.

 5  Open enrollment shall immediately cease when the enrollment

 6  ceiling is reaches. An open enrollment shall only be held if

 7  the Social Services Estimating Conference determines that

 8  sufficient federal and state funds will be available to

 9  finance the increased enrollment through federal fiscal year

10  2007. Any individual who is not enrolled, including those

11  added to the waiting list after January 30, 2004, must reapply

12  by submitting a new application during the next open

13  enrollment period. However, the Children's Medical Services

14  Network may annually enroll up to 120 additional children

15  based on emergency disability criteria outside of the open

16  enrollment periods and the cost of serving these children must

17  be managed within the KidCare program's appropriated or

18  authorized levels of funding. Except for the Medicaid program,

19  whenever the Social Services Estimating Conference determines

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

21  fiscal year, insufficient funds to finance the current or

22  projected enrollment in the Florida Kidcare program, all

23  additional enrollment must cease and additional enrollment may

24  not resume until sufficient funds are available to finance

25  such enrollment.

26         (3)  Upon determination by the Social Services

27  Estimating Conference that there are insufficient funds to

28  finance the current enrollment in the Florida KidCare program

29  within current appropriations, the program shall initiate

30  disenrollment procedures to remove enrollees, except those

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


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  on a last-in, first-out basis until the expenditure and

 2  appropriation levels are balanced.

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

 4  KidCare Kidcare program components shall collect and analyze

 5  the data needed to project Florida Kidcare program enrollment

 6  costs, including price level adjustments outreach impacts,

 7  participation and attrition rates, current and projected

 8  caseloads, utilization, and current and projected expenditures

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

10  and expenditure trends to the Social Services Estimating

11  Conference in accordance with chapter 216.

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

13  Florida Statutes, is amended to read:

14         409.814  Eligibility.--A child who has not reached 19

15  years of age whose family income is equal to or below 200

16  percent of the federal poverty level is eligible for the

17  Florida KidCare Kidcare program as provided in this section.

18  In determining the eligibility of such a child, an assets test

19  is not required. An applicant under 19 years of age who, based

20  on a complete application, appears to be eligible for the

21  Medicaid component of the Florida Kidcare program is presumed

22  eligible for coverage under Medicaid, subject to federal

23  rules. A child who has been deemed presumptively eligible for

24  Medicaid shall not be enrolled in a managed care plan until

25  the child's full eligibility determination for Medicaid has

26  been completed. The Florida Healthy Kids Corporation may,

27  subject to compliance with applicable requirements of the

28  Agency for Health Care Administration and the Department of

29  Children and Family Services, be designated as an entity to

30  conduct presumptive eligibility determinations. An applicant

31  under 19 years of age who, based on a complete application,


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  appears to be eligible for the Medikids, Florida Healthy Kids,

 2  or Children's Medical Services network program component, who

 3  is screened as ineligible for Medicaid and prior to the

 4  monthly verification of the applicant's enrollment in Medicaid

 5  or of eligibility for coverage under the state employee health

 6  benefit plan, may be enrolled in and begin receiving coverage

 7  from the appropriate program component on the first day of the

 8  month following the receipt of a completed application. For

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

10  complete application includes the medical or behavioral health

11  screening. If, subsequently after verification, an individual

12  is determined to be ineligible for coverage, he or she must

13  immediately be disenrolled from the respective Florida KidCare

14  Title XXI-funded Kidcare program component.

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

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

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

18  health benefits coverage authorized under the Florida KidCare

19  program ss. 409.810-409.820.

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

21  is eligible for the Florida KidCare Kidcare program, may

22  obtain health benefits coverage under any of the other

23  components listed in s. 409.813 types of health benefits

24  coverage authorized in ss. 409.810-409.820 if such coverage is

25  approved and available in the county in which the child

26  resides. However, a child who is eligible for Medikids may

27  participate in the Florida Healthy Kids program only if the

28  child has a sibling participating in the Florida Healthy Kids

29  program and the child's county of residence permits such

30  enrollment.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         (3)  A child who is eligible for the Florida KidCare

 2  Kidcare program who is a child with special health care needs,

 3  as determined through a medical or behavioral screening

 4  instrument, is eligible for health benefits coverage from and

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

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

 7  premium assistance for health benefits coverage under the

 8  Florida KidCare program ss. 409.810-409.820, except under

 9  Medicaid if the child would have been eligible for Medicaid

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

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

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

13  employment with a public agency in the state.

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

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

16  other employer health insurance coverage, excluding coverage

17  provided under the Florida Healthy Kids Corporation as

18  established under s. 624.91, provided that the cost of the

19  child's participation is not greater than 5 percent of the

20  family's income. This provision shall be applied during

21  redetermination for children who were enrolled prior to July

22  1, 2004. These enrollees shall have 6 months of eligibility

23  following redetermination to allow for a transition to the

24  other health benefit plan.

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

26  Florida KidCare program through employer-sponsored group

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

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

29  submitting an application for determination of eligibility

30  under the Florida Kidcare program.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



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

 2  definition of qualified alien, in the United States.

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

 4  or a patient in an institution for mental diseases.

 5         (f)  A child who has had his or her coverage in an

 6  employer-sponsored health benefit plan voluntarily canceled in

 7  the last 6 months, except those children who were on the

 8  waiting list prior to January 31, 2004.

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

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

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

12  Florida KidCare Kidcare program, excluding the Medicaid

13  program, but is subject to the following provisions:

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

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

16  any administrative costs.

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

18  enrollment in Medikids by these children in order to avoid

19  adverse selection. The number of children participating in

20  Medikids whose family income exceeds 200 percent of the

21  federal poverty level must not exceed 10 percent of total

22  enrollees in the Medikids program.

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

24  Corporation is authorized to place limits on enrollment of

25  these children in order to avoid adverse selection. In

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

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

28  such families. The number of children participating in the

29  Florida Healthy Kids program whose family income exceeds 200

30  percent of the federal poverty level must not exceed 10

31  


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  percent of total enrollees in the Florida Healthy Kids

 2  program.

 3         (d)  Children described in this subsection are not

 4  counted in the annual enrollment ceiling for the Florida

 5  KidCare Kidcare program.

 6         (6)  Once a child is enrolled in the Florida KidCare

 7  Kidcare program, the child is eligible for coverage under the

 8  program for 6 months without a redetermination or

 9  reverification of eligibility, if the family continues to pay

10  the applicable premium. Eligibility for program components

11  funded through Title XXI of the Social Security Act shall

12  terminate when a child attains the age of 19. Effective

13  January 1, 1999, a child who has not attained the age of 5 and

14  who has been determined eligible for the Medicaid program is

15  eligible for coverage for 12 months without a redetermination

16  or reverification of eligibility.

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

18  eligibility under the Florida KidCare program, the applicant

19  shall be provided with reasonable notice of changes in

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

21  program components. When a transition from one program

22  component to another is authorized appropriate, there shall be

23  cooperation between the program components and the affected

24  family which promotes continuity of health care coverage. Any

25  authorized transfers must be managed within the program's

26  overall appropriated or authorized levels of funding. Each

27  component of the program shall establish a reserve to ensure

28  that transfers between components will be accomplished within

29  current year appropriations. These reserves shall be reviewed

30  by each convening of the Social Services Estimating Conference

31  


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  to determine the adequacy of such reserves to meet actual

 2  experience.

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

 4  assets test is not required. Each applicant shall provide

 5  written documentation during the application process and the

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

 7  following:

 8         (a)  Proof of family income.

 9         (b)  A statement from all family members that:

10         1.  Their employer does not sponsor a health benefit

11  plan for employees; or

12         2.  The potential enrollee is not covered by the

13  employer-sponsored health benefit plan because the potential

14  enrollee is not eligible for coverage, or, if the potential

15  enrollee is eligible but not covered, a statement of the cost

16  to enroll the potential enrollee in the employer-sponsored

17  health benefit plan.

18         (9)  Subject to paragraph (4)(b) and s. 624.91(3), the

19  Florida KidCare program shall withhold benefits from an

20  enrollee if the program obtains evidence that the enrollee is

21  no longer eligible, submitted incorrect or fraudulent

22  information in order to establish eligibility, or failed to

23  provide verification of eligibility. The applicant or enrollee

24  shall be notified that because of such evidence program

25  benefits will be withheld unless the applicant or enrollee

26  contacts a designated representative of the program by a

27  specified date, which must be within 10 days after the date of

28  notice, to discuss and resolve the matter. The program shall

29  make every effort to resolve the matter within a timeframe

30  that will not cause benefits to be withheld from an eligible

31  enrollee.


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         (10)  The following individuals may be subject to

 2  prosecution in accordance with s. 414.39:

 3         (a)  An applicant obtaining or attempting to obtain

 4  benefits for a potential enrollee under the Florida KidCare

 5  program when the applicant knows or should have known the

 6  potential enrollee does not qualify for the Florida KidCare

 7  program.

 8         (b)  An individual who assists an applicant in

 9  obtaining or attempting to obtain benefits for a potential

10  enrollee under the Florida KidCare program when the individual

11  knows or should have known the potential enrollee does not

12  qualify for the Florida KidCare program.

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

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

15  amended to read:

16         409.815  Health benefits coverage; limitations.--

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

18  coverage to qualify for premium assistance payments for an

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

20  coverage, except for coverage under Medicaid and Medikids,

21  must include the following minimum benefits, as medically

22  necessary.

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

24  and may services include those dental benefits services

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

26  409.906(6) s. 409.906(5) up to a maximum benefit of $750 per

27  enrollee per year.

28         Section 6.  Subsections (3) through (7) of section

29  624.91, Florida Statutes, are renumbered as subsections (4)

30  through (8), respectively, present subsections (2) and (4) of

31  


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  that section are amended, and a new subsection (3) is added to

 2  that section, to read:

 3         624.91  The Florida Healthy Kids Corporation Act.--

 4         (2)  LEGISLATIVE INTENT.--

 5         (a)  The Legislature finds that increased access to

 6  health care services could improve children's health and

 7  reduce the incidence and costs of childhood illness and

 8  disabilities among children in this state. Many children do

 9  not have comprehensive, affordable health care services

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

11  Florida Healthy Kids Corporation provide comprehensive health

12  insurance coverage to such children. The corporation is

13  encouraged to cooperate with any existing health service

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

15  work cooperatively with the Florida Partnership for School

16  Readiness.

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

18  Florida Healthy Kids Corporation serve as one of several

19  providers of services to children eligible for medical

20  assistance under Title XXI of the Social Security Act.

21  Although the corporation may serve other children, the

22  Legislature intends the primary recipients of services

23  provided through the corporation be school-age children with a

24  family income below 200 percent of the federal poverty level,

25  who do not qualify for Medicaid. It is also the intent of the

26  Legislature that state and local government Florida Healthy

27  Kids funds be used to continue and expand coverage, subject to

28  specific appropriations in the General Appropriations Act, to

29  children not eligible for federal matching funds under Title

30  XXI.

31  


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         (3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the

 2  following individuals are eligible for state-funded assistance

 3  in paying Florida Healthy Kids premiums:

 4         (a)  Residents of this state who are eligible for the

 5  Florida KidCare program pursuant to s. 409.814.

 6         (b)  Notwithstanding s. 409.814, legal aliens who are

 7  enrolled in the Florida Healthy Kids program as of January 31,

 8  2004, who do not qualify for Title XXI federal funds because

 9  they are not qualified aliens as defined in s. 409.811.

10         (c)  Notwithstanding s. 409.814, individuals who have

11  attained the age of 19 as of March 31, 2004, who were

12  receiving Florida Healthy Kids benefits prior to the enactment

13  of the Florida KidCare program. This paragraph shall be

14  repealed March 31, 2005.

15         (d)  Notwithstanding s. 409.814, state employee

16  dependents who were enrolled in the Florida Healthy Kids

17  program as of January 31, 2004. Such individuals shall remain

18  eligible until January 1, 2005.

19         (5)(4)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--

20         (a)  There is created the Florida Healthy Kids

21  Corporation, a not-for-profit corporation.

22         (b)  The Florida Healthy Kids Corporation shall:

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

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

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

26  payment of premiums for comprehensive insurance coverage and

27  for the actual or estimated administrative expenses.;

28         2.  Arrange for the collection of any voluntary

29  contributions to provide for payment of premiums for children

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

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


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  shall establish a local match policy for the enrollment of

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

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

 4  notification of the amount to be remitted to the corporation

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

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

 7  municipalities, counties, school boards, hospitals, health

 8  care providers, charitable organizations, special taxing

 9  districts, and private organizations. The minimum local match

10  cash contributions required each fiscal year and local match

11  credits shall be determined by the General Appropriations Act.

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

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

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

15  most recently audited financial statement. In awarding the

16  local match credits, the corporation may consider factors

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

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

19  services.;

20         3.  Subject to the provisions of s. 409.8134, accept

21  voluntary supplemental local match contributions that comply

22  with the requirements of Title XXI of the Social Security Act

23  for the purpose of providing additional coverage in

24  contributing counties under Title XXI.;

25         4.  Establish the administrative and accounting

26  procedures for the operation of the corporation.;

27         5.  Establish, with consultation from appropriate

28  professional organizations, standards for preventive health

29  services and providers and comprehensive insurance benefits

30  appropriate to children,; provided that such standards for

31  


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  rural areas shall not limit primary care providers to

 2  board-certified pediatricians.;

 3         6.  Determine Establish eligibility for criteria which

 4  children seeking must meet in order to participate in the

 5  Title XXI-funded components of the Florida KidCare program

 6  consistent with the requirements specified in s. 409.814, as

 7  well as the non-Title-XXI-eligible children as provided in

 8  subsection (3).;

 9         7.  Establish procedures under which providers of local

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

11  have grievances reviewed by an impartial body and reported to

12  the board of directors of the corporation.;

13         8.  Establish participation criteria and, if

14  appropriate, contract with an authorized insurer, health

15  maintenance organization, or third-party insurance

16  administrator to provide administrative services to the

17  corporation.;

18         9.  Establish enrollment criteria which shall include

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

20  reinstatement of coverage upon voluntary cancellation for

21  nonpayment of family premiums.;

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

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

24  enrolled in Medicaid or Medikids if such child loses Medicaid

25  or Medikids eligibility and becomes eligible for the Florida

26  Healthy Kids program;

27         10.11.  Contract with authorized insurers or any

28  provider of health care services, meeting standards

29  established by the corporation, for the provision of

30  comprehensive insurance coverage to participants. Such

31  standards shall include criteria under which the corporation


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1  may contract with more than one provider of health care

 2  services in program sites. Health plans shall be selected

 3  through a competitive bid process. The Florida Healthy Kids

 4  Corporation shall purchase goods and services in the most

 5  cost-effective manner consistent with the delivery of quality

 6  medical care. The maximum administrative cost for a Florida

 7  Healthy Kids Corporation contract shall be 15 percent. The

 8  minimum medical loss ratio for a Florida Healthy Kids

 9  Corporation contract shall be 85 percent. The selection of

10  health plans shall be based primarily on quality criteria

11  established by the board. The health plan selection criteria

12  and scoring system, and the scoring results, shall be

13  available upon request for inspection after the bids have been

14  awarded.;

15         11.12.  Establish disenrollment criteria in the event

16  local matching funds are insufficient to cover enrollments.;

17         12.13.  Develop and implement a plan to publicize the

18  Florida Healthy Kids Corporation, the eligibility requirements

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

20  program and to maintain public awareness of the corporation

21  and the program.;

22         13.14.  Secure staff necessary to properly administer

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

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

25  become available. The board of directors shall determine the

26  number of staff members necessary to administer the

27  corporation.;

28         15.  As appropriate, enter into contracts with local

29  school boards or other agencies to provide onsite information,

30  enrollment, and other services necessary to the operation of

31  the corporation;


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    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         14.16.  Provide a report annually to the Governor,

 2  Chief Financial Officer, Commissioner of Education, Senate

 3  President, Speaker of the House of Representatives, and

 4  Minority Leaders of the Senate and the House of

 5  Representatives.;

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

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

 8  program; and

 9         15.18.  Establish eligibility criteria, premium and

10  cost-sharing requirements, and benefit packages which conform

11  to the provisions of the Florida KidCare Kidcare program, as

12  created in ss. 409.810-409.820.

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

14  secondary to any other available private coverage held by, or

15  applicable to, the participant child or family member.

16  Insurers under contract with the corporation are the payors of

17  last resort and must coordinate benefits with any other

18  third-party payor that may be liable for the participant's

19  medical care The corporation may establish procedures for

20  coordinating benefits under this program with benefits under

21  other public and private coverage.

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

23  private corporation not for profit, organized pursuant to

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

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

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

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

28  accept from any source contributions of money, property,

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

30  applied for the purposes of this act.

31  


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 1         Section 7.  The Auditor General shall provide

 2  recommendations to implement mechanisms to prevent enrollment

 3  of children in the Florida KidCare program who are ineligible

 4  pursuant to the requirements of section 409.814(4), Florida

 5  Statutes. Such recommendations shall be reported to the

 6  Governor, the President of the Senate, and the Speaker of the

 7  House of Representatives by March 1, 2005.

 8         Section 8.  The Florida Healthy Kids Corporation shall

 9  use existing funds from their operating fund established by

10  section 624.915, Florida Statutes, to contract for an

11  actuarial study on the impact of full-pay enrollees on the

12  cost of services for each Florida KidCare program component.

13         Section 9.  The Auditor General shall perform periodic

14  audits through the 2005-2006 fiscal year to ensure that

15  children enrolled in the Florida Healthy Kids program are

16  eligible pursuant to sections 409.814 and 624.91, Florida

17  Statutes. The Auditor General shall have the authority to

18  require and receive from the Florida Healthy Kids Corporation

19  or from its independent auditor any books, accounts, records,

20  or other documentation relating to the corporation. Any

21  contract entered into by the corporation pursuant to section

22  624.91(4)(b)11. or section 624.91(4)(b)15., Florida Statutes,

23  shall specify that the records of the contractor relating to

24  the contract or its performance must be available for review

25  and audit by the Auditor General.

26         Section 10.  The Office of Program Policy Analysis and

27  Government Accountability shall perform a study to determine

28  the appropriate family premium for the Florida KidCare program

29  and submit a report to the President of the Senate and the

30  Speaker of the House of Representatives by January 1, 2005.

31  The report shall set out no fewer than three options and shall


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 1  make a recommendation as to the appropriate family premium for

 2  the Florida KidCare program. Each option shall include a

 3  detailed explanation of the analysis that led to the

 4  conclusion. A discussion of family premiums collected by Title

 5  XXI programs in other states shall be part of the report.

 6         Section 11.  Subsection (2) of section 409.818, Florida

 7  Statutes, is amended to read:

 8         409.818  Administration.--In order to implement ss.

 9  409.810-409.820, the following agencies shall have the

10  following duties:

11         (2)  The Department of Health shall:

12         (a)  Design an eligibility intake process for the

13  program, in coordination with the Department of Children and

14  Family Services, the agency, and the Florida Healthy Kids

15  Corporation. The eligibility intake process may include local

16  intake points that are determined by the Department of Health

17  in coordination with the Department of Children and Family

18  Services.

19         (b)  Design and implement program outreach activities

20  under s. 409.819.

21         (b)(c)  Chair a state-level coordinating council to

22  review and make recommendations concerning the implementation

23  and operation of the program. The coordinating council shall

24  include representatives from the department, the Department of

25  Children and Family Services, the agency, the Florida Healthy

26  Kids Corporation, the Office of Insurance Regulation of the

27  Financial Services Commission, local government, health

28  insurers, health maintenance organizations, health care

29  providers, families participating in the program, and

30  organizations representing low-income families.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 2000, 1st Engrossed



 1         (c)(d)  In consultation with the Florida Healthy Kids

 2  Corporation and the Department of Children and Family

 3  Services, establish establishing a toll-free telephone line to

 4  assist families with questions about the program.

 5         (d)(e)  Adopt rules necessary to implement outreach

 6  activities.

 7         Section 12.  Section 409.819, Florida Statutes, is

 8  repealed.

 9         Section 13.  The sums of $6,566,073 from the General

10  Revenue Fund, $454,687 from the Grants and Donations Trust

11  Fund, and $16,272,440 from the Medical Care Trust Fund are

12  appropriated to the Agency for Health Care Administration, and

13  the sum of $1,984,113 is appropriated from the Donations Trust

14  Fund to the Department of Health, for the 2003-2004 fiscal

15  year for the purpose of serving children on whose behalf

16  applications are submitted to the Florida KidCare program as

17  of January 30, 2004, and who are determined to be eligible for

18  program components funded under Title XXI of the Social

19  Security Act.

20         Section 14.  Except as otherwise provided in this act,

21  this act shall take effect upon becoming a law.

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  


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