July 08, 2020
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Bill No. 1073
Amendment No. 143501
Senate House

1Representative Sobel offered the following:
3     Amendment (with title amendment)
4     Remove lines 574-603 and insert:
5     Section 11.  Section 409.818, Florida Statutes, is amended
6to read:
7     409.818  Administration.--In order to implement ss.
8409.810-409.820, the following agencies shall have the following
10     (1)  The Department of Children and Family Services shall:
11     (a)  Develop a simplified eligibility application mail-in
12form to be used for determining the eligibility of children for
13coverage under the Florida KidCare Kidcare program, in
14consultation with the agency, the Department of Health, and the
15Florida Healthy Kids Corporation. The simplified eligibility
16application form must include an item that provides an
17opportunity for the applicant to indicate whether coverage is
18being sought for a child with special health care needs.
19Families applying for children's Medicaid coverage must also be
20able to use the simplified application form without having to
21pay a premium.
22     (b)  Establish and maintain the Medicaid eligibility
23determination process under the program except as specified in
24subsection (5). The department shall directly, or through the
25services of a contracted third-party administrator, establish
26and maintain a process for determining Medicaid eligibility of
27children for coverage under the program. The eligibility
28determination process must be used solely for determining
29eligibility of applicants for health benefits coverage under the
30program. The eligibility determination process must include an
31initial determination of eligibility for any coverage offered
32under the program, as well as a redetermination or
33reverification of eligibility each subsequent 6 months.
34Effective January 1, 1999, a child who has not attained the age
35of 5 and who has been determined eligible for the Medicaid
36program is eligible for coverage for 12 months without a
37redetermination or reverification of eligibility. In conducting
38an eligibility determination, the department shall determine if
39the child has special health care needs. The department, in
40consultation with the Agency for Health Care Administration and
41the Florida Healthy Kids Corporation, shall develop procedures
42for redetermining Medicaid eligibility which enable a family to
43easily update any change in circumstances which could affect
44eligibility. The department may accept changes in a family's
45status as reported to the department by the Agency for Health
46Care Administration or its contracted third-party administrator
47Florida Healthy Kids Corporation without requiring a new
48application from the family. Redetermination of a child's
49eligibility for Medicaid may not be linked to a child's
50eligibility determination for other programs.
51     (c)  Inform program applicants about eligibility
52determinations and provide information about eligibility of
53applicants to Medicaid, Medikids, the Children's Medical
54Services network, and the Florida Healthy Kids Corporation, and
55to insurers and their agents, through a centralized coordinating
57     (d)  Adopt rules necessary for conducting Medicaid program
58eligibility functions.
59     (2)  The Department of Health shall:
60     (a)  Design an eligibility intake process for the program,
61in coordination with the Department of Children and Family
62Services, the agency, and the Florida Healthy Kids Corporation.
63The eligibility intake process may include local intake points
64that are determined by the Department of Health in coordination
65with the Department of Children and Family Services.
66     (b)  Design and implement program outreach activities under
67s. 409.819.
68     (b)(c)  Chair a state-level coordinating council to review
69and make recommendations concerning the implementation and
70operation of the program. The coordinating council shall include
71representatives from the department, the Department of Children
72and Family Services, the agency, the Florida Healthy Kids
73Corporation, the Office of Insurance Regulation of the Financial
74Services Commission, local government, health insurers, health
75maintenance organizations, health care providers, families
76participating in the program, and organizations representing
77low-income families.
78     (c)(d)  In consultation with the Florida Healthy Kids
79Corporation and the Department of Children and Family Services,
80establish establishing a toll-free telephone line to assist
81families with questions about the program.
82     (d)(e)  Adopt rules necessary to implement outreach
84     (3)  The Agency for Health Care Administration, under the
85authority granted in s. 409.914(1), shall:
86     (a)  Calculate the premium assistance payment necessary to
87comply with the premium and cost-sharing limitations specified
88in s. 409.816. The premium assistance payment for each enrollee
89in a health insurance plan participating in the Florida Healthy
90Kids Corporation shall equal the premium approved by the Florida
91Healthy Kids Corporation and the Office of Insurance Regulation
92of the Financial Services Commission pursuant to ss. 627.410 and
93641.31, less any enrollee's share of the premium established
94within the limitations specified in s. 409.816. The premium
95assistance payment for each enrollee in an employer-sponsored
96health insurance plan approved under ss. 409.810-409.820 shall
97equal the premium for the plan adjusted for any benchmark
98benefit plan actuarial equivalent benefit rider approved by the
99Office of Insurance Regulation pursuant to ss. 627.410 and
100641.31, less any enrollee's share of the premium established
101within the limitations specified in s. 409.816. In calculating
102the premium assistance payment levels for children with family
103coverage, the agency shall set the premium assistance payment
104levels for each child proportionately to the total cost of
105family coverage.
106     (b)  Annually calculate the program enrollment ceiling
107based on estimated per child premium assistance payments and the
108estimated appropriation available for the program.
109     (c)  Make premium assistance payments to health insurance
110plans on a periodic basis. The agency may use its Medicaid
111fiscal agent or a contracted third-party administrator in making
112these payments. The agency may require health insurance plans
113that participate in the Medikids program or employer-sponsored
114group health insurance to collect premium payments from an
115enrollee's family. Participating health insurance plans shall
116report premium payments collected on behalf of enrollees in the
117program to the agency in accordance with a schedule established
118by the agency.
119     (d)  Monitor compliance with quality assurance and access
120standards developed under s. 409.820.
121     (e)  Establish a mechanism for investigating and resolving
122complaints and grievances from program applicants, enrollees,
123and health benefits coverage providers, and maintain a record of
124complaints and confirmed problems. In the case of a child who is
125enrolled in a health maintenance organization, the agency must
126use the provisions of s. 641.511 to address grievance reporting
127and resolution requirements.
128     (f)  Approve health benefits coverage for participation in
129the program, following certification by the Office of Insurance
130Regulation under subsection (4).
131     (g)  Adopt rules necessary for calculating premium
132assistance payment levels, calculating the program enrollment
133ceiling, making premium assistance payments, monitoring access
134and quality assurance standards, investigating and resolving
135complaints and grievances, administering the Medikids program,
136and approving health benefits coverage.
137     (h)  Establish and maintain the eligibility determination
138process under the Title XXI-funded program. The agency shall
139directly, or through the services of a contracted third-party
140administrator, establish and maintain a process for determining
141eligibility of children for coverage under the program. The
142eligibility determination process must be used solely for
143determining eligibility of applicants for health benefits
144coverage under the program. The eligibility determination
145process must include an initial determination of eligibility for
146any coverage offered under the program, as well as a
147redetermination or reverification of eligibility each subsequent
1486 months. In conducting an eligibility determination, the
149Department of Health shall determine if the child has special
150health care needs. The agency, in consultation with the
151Department of Health and the Florida Healthy Kids Corporation,
152shall develop procedures for redetermining eligibility that
153enable a family to easily update any change in circumstances
154that could affect eligibility.
155     (i)  Adopt rules pursuant to ss. 409.810-409.820,
156including, at a minimum, rules specifying policies, procedures,
157and criteria for the following Florida KidCare activities:
158     1.  Application requirements, including documentation
160     2.  Eligibility determination.
161     3.  Eligibility redetermination.
162     4.  Premium payment requirements.
163     5.  Cancellation of coverage.
164     6.  Reinstatement of coverage.
165     7.  Open enrollment.
166     8.  Disenrollment procedures.
167     9.  Applicant and enrollee notification requirements.
168     10.  Application and enrollment time processing standards.
170The agency is designated the lead state agency for Title XXI of
171the Social Security Act for purposes of receipt of federal
172funds, for reporting purposes, and for ensuring compliance with
173federal and state regulations and rules.
174     (4)  The Office of Insurance Regulation shall certify that
175health benefits coverage plans that seek to provide services
176under the Florida KidCare Kidcare program, except those offered
177through the Florida Healthy Kids Corporation or the Children's
178Medical Services network, meet, exceed, or are actuarially
179equivalent to the benchmark benefit plan and that health
180insurance plans will be offered at an approved rate. In
181determining actuarial equivalence of benefits coverage, the
182Office of Insurance Regulation and health insurance plans must
183comply with the requirements of s. 2103 of Title XXI of the
184Social Security Act. The department shall adopt rules necessary
185for certifying health benefits coverage plans.
186     (5)  The Florida Healthy Kids Corporation shall retain its
187functions as authorized in s. 624.91, including eligibility
188determination for participation in the non-Title-XXI-funded
189portions of the Healthy Kids program.
190     (6)  The agency, the Department of Health, the Department
191of Children and Family Services, the Florida Healthy Kids
192Corporation, and the Office of Insurance Regulation, after
193consultation with and approval of the Speaker of the House of
194Representatives and the President of the Senate, are authorized
195to make program modifications that are necessary to overcome any
196objections of the United States Department of Health and Human
197Services to obtain approval of the state's child health
198insurance plan under Title XXI of the Social Security Act.
200================ T I T L E  A M E N D M E N T =============
201     Remove lines 63 and 64 and insert:
202Legislature; amending s. 409.818, F.S.; requiring the agency to
203establish and maintain a process for determining the eligibility
204of children for coverage under the Florida KidCare program;
205providing requirements of the eligibility determination process
206for certain programs; providing rulemaking authority to the
207agency to govern the Florida KidCare program; repealing s.
208409.819, F.S., relating to a

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