June 01, 2020
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Amendment CaShTmL-190726.HTM
                                                  SENATE AMENDMENT
    Bill No. CS for SB 2000
    Amendment No. ___   Barcode 190726
                            CHAMBER ACTION
              Senate                               House
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       03/03/2004 11:38 AM         .                    
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11  Senators Peaden and Dockery moved the following amendment:
12  
13         Senate Amendment (with title amendment) 
14         On page 2, line 22, through
15            page 15, line 4, delete those lines
16  
17  and insert:  
18         Section 1.  Subsections (14) through (22) of section
19  409.811, Florida Statutes, are renumbered as subsections (15)
20  through (23), respectively, present subsection (23) of that
21  section is amended, and a new subsection (14) is added to that
22  section, to read:
23         409.811  Definitions relating to Florida KidCare
24  Kidcare Act.--As used in ss. 409.810-409.820, the term:
25         (14)  "Florida KidCare program," "KidCare program," or
26  "program" means the health benefits program administered
27  through ss. 409.810-409.820.
28         (23)  "Program" means the Florida Kidcare program, the
29  medical assistance program authorized by Title XXI of the
30  Social Security Act as part of the federal Balanced Budget Act
31  of 1997.
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    7:59 AM   03/03/04                              s2000c1c-02j14

SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 Section 2. Subsections (7), (8), and (9) of section 2 409.8132, Florida Statutes, are amended to read: 3 409.8132 Medikids program component.-- 4 (7) ENROLLMENT.--Enrollment in the Medikids program component 5 may only occur during periodic open enrollment periods as 6 specified in s. 409.8134 by the agency. An applicant may apply 7 for enrollment in the Medikids program component and proceed 8 through the eligibility determination process at any time 9 throughout the year. However, enrollment in Medikids shall not 10 begin until the next open enrollment period; and A child may 11 not receive services under the Medikids program until the 12 child is enrolled in a managed care plan or MediPass. In 13 addition, Once determined eligible, an applicant may receive 14 choice counseling and select a managed care plan or MediPass. 15 The agency may initiate mandatory assignment for a Medikids 16 applicant who has not chosen a managed care plan or MediPass 17 provider after the applicant's voluntary choice period ends. 18 An applicant may select MediPass under the Medikids program 19 component only in counties that have fewer than two managed 20 care plans available to serve Medicaid recipients and only if 21 the federal Health Care Financing Administration determines 22 that MediPass constitutes "health insurance coverage" as 23 defined in Title XXI of the Social Security Act. 24 (8) SPECIAL ENROLLMENT PERIODS.--The agency shall 25 establish a special enrollment period of 30 days' duration for 26 any child who is enrolled in Medicaid if such child loses 27 Medicaid eligibility and becomes eligible for Medikids, or for 28 any child who is enrolled in Medikids if such child moves to 29 another county that is not within the coverage area of the 30 child's Medikids managed care plan or MediPass provider. 31 (8)(9) PENALTIES FOR VOLUNTARY CANCELLATION.--The 2 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 agency shall establish enrollment criteria that must include 2 penalties or waiting periods of not fewer than 60 days for 3 reinstatement of coverage upon voluntary cancellation for 4 nonpayment of premiums. 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 Kidcare program as provided 12 each 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) Upon a unanimous recommendation by representatives 17 from each of the four Florida KidCare administrators, the 18 Florida KidCare program may conduct an open enrollment period 19 for the purpose of enrolling children eligible for all program 20 components listed in s. 409.813 except Medicaid. The four 21 Florida KidCare administrators shall work together to ensure 22 that the open enrollment period is announced statewide at 23 least 1 month before the open enrollment is to begin. Eligible 24 children shall be enrolled on a first-come, first-served basis 25 using the date the open enrollment application is received. 26 The potential open enrollment periods shall be January 1st 27 through January 30th and September 1st through September 30th. 28 Open enrollment shall immediately cease when the enrollment 29 ceiling is reaches. An open enrollment shall only be held if 30 the Social Services Estimating Conference determines that 31 sufficient federal and state funds will be available to 3 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 finance the increased enrollment through federal fiscal year 2 2007. Any individual who is not enrolled, including those 3 added to the waiting list after January 30, 2004, must reapply 4 by submitting a new application during the next open 5 enrollment period. However, the Children's Medical Services 6 Network may annually enroll up to 120 additional children 7 based on emergency disability criteria outside of the open 8 enrollment periods and the cost of serving these children must 9 be managed within the KidCare program's appropriated or 10 authorized levels of funding. Except for the Medicaid program, 11 whenever the Social Services Estimating Conference determines 12 that there is presently, or will be by the end of the current 13 fiscal year, insufficient funds to finance the current or 14 projected enrollment in the Florida Kidcare program, all 15 additional enrollment must cease and additional enrollment may 16 not resume until sufficient funds are available to finance 17 such enrollment. 18 (3) Upon determination by the Social Services 19 Estimating Conference that there are insufficient funds to 20 finance the current enrollment in the Florida KidCare program 21 within current appropriations, the program shall initiate 22 disenrollment procedures to remove enrollees, except those 23 children enrolled in the Children's Medical Services network, 24 on a last-in, first-out basis until the expenditure and 25 appropriation levels are balanced. 26 (4)(3) The agencies that administer the Florida 27 KidCare Kidcare program components shall collect and analyze 28 the data needed to project Florida Kidcare program enrollment 29 costs, including price level adjustments outreach impacts, 30 participation and attrition rates, current and projected 31 caseloads, utilization, and current and projected expenditures 4 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 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 who has not reached 19 7 years of age whose family income is equal to or below 200 8 percent of the federal poverty level is eligible for the 9 Florida KidCare Kidcare program as provided in this section. 10 In determining the eligibility of such a child, an assets test 11 is not required. An applicant under 19 years of age who, based 12 on a complete application, appears to be eligible for the 13 Medicaid component of the Florida Kidcare program is presumed 14 eligible for coverage under Medicaid, subject to federal 15 rules. A child who has been deemed presumptively eligible for 16 Medicaid shall not be enrolled in a managed care plan until 17 the child's full eligibility determination for Medicaid has 18 been completed. The Florida Healthy Kids Corporation may, 19 subject to compliance with applicable requirements of the 20 Agency for Health Care Administration and the Department of 21 Children and Family Services, be designated as an entity to 22 conduct presumptive eligibility determinations. An applicant 23 under 19 years of age who, based on a complete application, 24 appears to be eligible for the Medikids, Florida Healthy Kids, 25 or Children's Medical Services network program component, who 26 is screened as ineligible for Medicaid and prior to the 27 monthly verification of the applicant's enrollment in Medicaid 28 or of eligibility for coverage under the state employee health 29 benefit plan, may be enrolled in and begin receiving coverage 30 from the appropriate program component on the first day of the 31 month following the receipt of a completed application. For 5 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 enrollment in the Children's Medical Services network, a 2 complete application includes the medical or behavioral health 3 screening. If, subsequently after verification, an individual 4 is determined to be ineligible for coverage, he or she must 5 immediately be disenrolled from the respective Florida KidCare 6 Title 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 Kidcare program, may 14 obtain health benefits coverage under any of the other 15 components listed in s. 409.813 types of health benefits 16 coverage authorized in ss. 409.810-409.820 if such coverage is 17 approved and available in the county in which the child 18 resides. However, a child who is eligible for Medikids may 19 participate in the Florida Healthy Kids program only if the 20 child has a sibling participating in the Florida Healthy Kids 21 program and the child's county of residence permits such 22 enrollment. 23 (3) A child who is eligible for the Florida KidCare 24 Kidcare program who is a child with special health care needs, 25 as determined through a medical or behavioral screening 26 instrument, is eligible for health benefits coverage from and 27 shall be referred to the Children's Medical Services network. 28 (4) The following children are not eligible to receive 29 premium assistance for health benefits coverage under the 30 Florida KidCare program ss. 409.810-409.820, except under 31 Medicaid if the child would have been eligible for Medicaid 6 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 under s. 409.903 or s. 409.904 as of June 1, 1997: 2 (a) A child who is eligible for coverage under a state 3 health benefit plan on the basis of a family member's 4 employment with a public agency in the state. 5 (b) A child who is currently eligible for or covered 6 under a family member's group health benefit plan or under 7 other employer health insurance coverage, excluding coverage 8 provided under the Florida Healthy Kids Corporation as 9 established under s. 624.91, provided that the cost of the 10 child's participation is not greater than 5 percent of the 11 family's income. This provision shall be applied during 12 redetermination for children who were enrolled prior to July 13 1, 2004. These enrollees shall have 6 months of eligibility 14 following redetermination to allow for a transition to the 15 other health benefit plan. 16 (c) A child who is seeking premium assistance for the 17 Florida KidCare program through employer-sponsored group 18 coverage, if the child has been covered by the same employer's 19 group coverage during the 6 months prior to the family's 20 submitting an application for determination of eligibility 21 under the Florida Kidcare program. 22 (d) A child who is an alien, but who does not meet the 23 definition of qualified alien, in the United States. 24 (e) A child who is an inmate of a public institution 25 or a patient in an institution for mental diseases. 26 (f) A child who has had his or her coverage in an 27 employer-sponsored health benefit plan voluntarily canceled in 28 the last 6 months, except those children who were on the 29 waiting list prior to January 31, 2004. 30 (5) A child whose family income is above 200 percent 31 of the federal poverty level or a child who is excluded under 7 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 the provisions of subsection (4) may participate in the 2 Florida KidCare Kidcare program, excluding the Medicaid 3 program, but is subject to the following provisions: 4 (a) The family is not eligible for premium assistance 5 payments and must pay the full cost of the premium, including 6 any administrative costs. 7 (b) The agency is authorized to place limits on 8 enrollment in Medikids by these children in order to avoid 9 adverse selection. The number of children participating in 10 Medikids whose family income exceeds 200 percent of the 11 federal poverty level must not exceed 10 percent of total 12 enrollees in the Medikids program. 13 (c) The board of directors of the Florida Healthy Kids 14 Corporation is authorized to place limits on enrollment of 15 these children in order to avoid adverse selection. In 16 addition, the board is authorized to offer a reduced benefit 17 package to these children in order to limit program costs for 18 such families. The number of children participating in the 19 Florida Healthy Kids program whose family income exceeds 200 20 percent of the federal poverty level must not exceed 10 21 percent of total enrollees in the Florida Healthy Kids 22 program. 23 (d) Children described in this subsection are not 24 counted in the annual enrollment ceiling for the Florida 25 KidCare Kidcare program. 26 (6) Once a child is enrolled in the Florida KidCare 27 Kidcare program, the child is eligible for coverage under the 28 program for 6 months without a redetermination or 29 reverification of eligibility, if the family continues to pay 30 the applicable premium. Eligibility for program components 31 funded through Title XXI of the Social Security Act shall 8 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 terminate when a child attains the age of 19. Effective 2 January 1, 1999, a child who has not attained the age of 5 and 3 who has been determined eligible for the Medicaid program is 4 eligible for coverage for 12 months without a redetermination 5 or reverification of eligibility. 6 (7) When determining or reviewing a child's 7 eligibility under the Florida KidCare program, the applicant 8 shall be provided with reasonable notice of changes in 9 eligibility which may affect enrollment in one or more of the 10 program components. When a transition from one program 11 component to another is authorized appropriate, there shall be 12 cooperation between the program components and the affected 13 family which promotes continuity of health care coverage. Any 14 authorized transfers must be managed within the program's 15 overall appropriated or authorized levels of funding. Each 16 component of the program shall establish a reserve to ensure 17 that transfers between components will be accomplished within 18 current year appropriations. These reserves shall be reviewed 19 by each convening of the Social Services Estimating Conference 20 to determine the adequacy of such reserves to meet actual 21 experience. 22 (8) In determining the eligibility of a child, an 23 assets test is not required. Each applicant shall provide 24 written documentation during the application process and the 25 redetermination process, including, but not limited to, the 26 following: 27 (a) Proof of family income. 28 (b) A statement from all family members that: 29 1. Their employer does not sponsor a health benefit 30 plan for employees; or 31 2. The potential enrollee is not covered by the 9 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 employer-sponsored health benefit plan because the potential 2 enrollee is not eligible for coverage, or, if the potential 3 enrollee is eligible but not covered, a statement of the cost 4 to enroll the potential enrollee in the employer-sponsored 5 health benefit plan. 6 (9) Subject to paragraph (4)(b) and s. 624.91(3), the 7 Florida KidCare program shall withhold benefits from an 8 enrollee if the program obtains evidence that the enrollee is 9 no longer eligible, submitted incorrect or fraudulent 10 information in order to establish eligibility, or failed to 11 provide verification of eligibility. The applicant or enrollee 12 shall be notified that because of such evidence program 13 benefits will be withheld unless the applicant or enrollee 14 contacts a designated representative of the program by a 15 specified date, which must be within 10 days after the date of 16 notice, to discuss and resolve the matter. The program shall 17 make every effort to resolve the matter within a timeframe 18 that will not cause benefits to be withheld from an eligible 19 enrollee. 20 (10) The following individuals may be subject to 21 prosecution in accordance with s. 414.39: 22 (a) An applicant obtaining or attempting to obtain 23 benefits for a potential enrollee under the Florida KidCare 24 program when the applicant knows or should have known the 25 potential enrollee does not qualify for the Florida KidCare 26 program. 27 (b) An individual who assists an applicant in 28 obtaining or attempting to obtain benefits for a potential 29 enrollee under the Florida KidCare program when the individual 30 knows or should have known the potential enrollee does not 31 qualify for the Florida KidCare program. 10 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 Section 5. Effective July 1, 2004, paragraph (q) of 2 subsection (2) of section 409.815, Florida Statutes, is 3 amended to read: 4 409.815 Health benefits coverage; limitations.-- 5 (2) BENCHMARK BENEFITS.--In order for health benefits 6 coverage to qualify for premium assistance payments for an 7 eligible child under ss. 409.810-409.820, the health benefits 8 coverage, except for coverage under Medicaid and Medikids, 9 must include the following minimum benefits, as medically 10 necessary. 11 (q) Dental services.--Dental services shall be covered 12 and may services include those dental benefits services 13 provided to children by the Florida Medicaid program under s. 14 409.906(6) s. 409.906(5) up to a maximum benefit of $750 per 15 enrollee per year. 16 17 (Redesignate subsequent sections.) 18 19 20 ================ T I T L E A M E N D M E N T =============== 21 And the title is amended as follows: 22 On page 1, line 1, through 23 page 2, line 7, delete those lines 24 25 and insert: 26 An act relating to the Florida KidCare program; 27 amending s. 409.811, F.S.; defining the term 28 "Florida KidCare program"; deleting a 29 definition to conform; amending s. 409.8132, 30 F.S.; limiting when an applicant may apply for 31 Medikids program enrollment; deleting a special 11 7:59 AM 03/03/04 s2000c1c-02j14
SENATE AMENDMENT Bill No. CS for SB 2000 Amendment No. ___ Barcode 190726 1 enrollment period provision; amending s. 2 409.8134, F.S.; eliminating the Agency for 3 Health Care Administration's ability to request 4 an increase in the Florida KidCare program 5 enrollment ceiling; providing for open 6 enrollment periods; providing a timeframe for 7 statewide announcement of open enrollment 8 periods; providing for the enrollment of 9 certain children on an emergency basis; 10 providing limitations; providing a 11 disenrollment process under certain 12 circumstances; providing additional data for 13 certain agencies to collect and analyze; 14 amending s. 409.814, F.S.; revising Florida 15 KidCare program eligibility criteria; limiting 16 coverage; providing an exception for certain 17 children otherwise eligible or covered under a 18 family member's employer health coverage; 19 restricting enrollment of children whose 20 coverage was voluntarily canceled; providing an 21 age limitation for certain components; 22 requiring certain transfers to be managed 23 within authorized levels of funding; requiring 24 certain reserves to be established and 25 reviewed; requiring each applicant to provide 26 certain documentation; requiring the program to 27 withhold benefits from certain enrollees; 28 providing additional fraudulent activities; 29 amending s. 409.815, F.S.; revising coverage 30 requirements for dental services; 31 12 7:59 AM 03/03/04 s2000c1c-02j14
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