Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS/HB 7169, 1st Eng.
       
       
       
       
       
       
                                Barcode 252560                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AD/2R         .                                
             04/29/2013 02:35 PM       .                                
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       Senator Negron moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 409.811, Florida Statutes, is amended to
    6  read:
    7         409.811 Definitions relating to Florida Kidcare Act.—As
    8  used in ss. 409.810-409.821, the term:
    9         (1) “Actuarially equivalent” means that:
   10         (a) The aggregate value of the benefits included in health
   11  benefits coverage is equal to the value of the benefits in the
   12  benchmark benefit plan; and
   13         (b) The benefits included in health benefits coverage are
   14  substantially similar to the benefits included in the benchmark
   15  benefit plan, except that preventive health services must be the
   16  same as in the benchmark benefit plan.
   17         (2) “Agency” means the Agency for Health Care
   18  Administration.
   19         (3) “Applicant” means a parent or guardian of a child or a
   20  child whose disability of nonage has been removed under chapter
   21  743, who applies for determination of eligibility for health
   22  benefits coverage under ss. 409.810-409.821.
   23         (4) “Child benchmark benefit plan” means the form and level
   24  of health benefits coverage established in s. 409.815.
   25         (5) “Child” means any person younger than under 19 years of
   26  age.
   27         (6) “Child with special health care needs” means a child
   28  whose serious or chronic physical or developmental condition
   29  requires extensive preventive and maintenance care beyond that
   30  required by typically healthy children. Health care utilization
   31  by such a child exceeds the statistically expected usage of the
   32  normal child adjusted for chronological age, and such a child
   33  often needs complex care requiring multiple providers,
   34  rehabilitation services, and specialized equipment in a number
   35  of different settings.
   36         (7) “Children’s Medical Services Network” or “network”
   37  means a statewide managed care service system as defined in s.
   38  391.021(1).
   39         (8) “CHIP” means the Children’s Health Insurance Program as
   40  authorized under Title XXI of the Social Security Act, and its
   41  regulations, ss. 409.810-409.820, and as administered in this
   42  state by the agency, the department, and the Florida Healthy
   43  Kids Corporation, as appropriate to their respective
   44  responsibilities.
   45         (9) “Combined eligibility notice” means an eligibility
   46  notice that informs an applicant, an enrollee, or multiple
   47  family members of a household, when feasible, of eligibility for
   48  each of the insurance affordability programs and enrollment into
   49  a program or exchange plan. A combined eligibility form must be
   50  issued by the last agency or department to make an eligibility,
   51  renewal or denial determination. The form must meet all of the
   52  federal and state law and regulatory requirements no later than
   53  January 1, 2014.
   54         (8) “Community rate” means a method used to develop
   55  premiums for a health insurance plan that spreads financial risk
   56  across a large population and allows adjustments only for age,
   57  gender, family composition, and geographic area.
   58         (10)(9) “Department” means the Department of Health.
   59         (11)(10) “Enrollee” means a child who has been determined
   60  eligible for and is receiving coverage under ss. 409.810
   61  409.821.
   62         (11) “Family” means the group or the individuals whose
   63  income is considered in determining eligibility for the Florida
   64  Kidcare program. The family includes a child with a parent or
   65  caretaker relative who resides in the same house or living unit
   66  or, in the case of a child whose disability of nonage has been
   67  removed under chapter 743, the child. The family may also
   68  include other individuals whose income and resources are
   69  considered in whole or in part in determining eligibility of the
   70  child.
   71         (12) “Family income” means cash received at periodic
   72  intervals from any source, such as wages, benefits,
   73  contributions, or rental property. Income also may include any
   74  money that would have been counted as income under the Aid to
   75  Families with Dependent Children (AFDC) state plan in effect
   76  prior to August 22, 1996.
   77         (12)(13) “Florida Kidcare program,” “Kidcare program,” or
   78  “program” means the health benefits program administered through
   79  ss. 409.810-409.821.
   80         (13)(14) “Guarantee issue” means that health benefits
   81  coverage must be offered to an individual regardless of the
   82  individual’s health status, preexisting condition, or claims
   83  history.
   84         (14)(15) “Health benefits coverage” means protection that
   85  provides payment of benefits for covered health care services or
   86  that otherwise provides, either directly or through arrangements
   87  with other persons, covered health care services on a prepaid
   88  per capita basis or on a prepaid aggregate fixed-sum basis.
   89         (15)(16) “Health insurance plan” means health benefits
   90  coverage under the following:
   91         (a) A health plan offered by any certified health
   92  maintenance organization or authorized health insurer, except a
   93  plan that is limited to the following: a limited benefit,
   94  specified disease, or specified accident; hospital indemnity;
   95  accident only; limited benefit convalescent care; Medicare
   96  supplement; credit disability; dental; vision; long-term care;
   97  disability income; coverage issued as a supplement to another
   98  health plan; workers’ compensation liability or other insurance;
   99  or motor vehicle medical payment only; or
  100         (b) An employee welfare benefit plan that includes health
  101  benefits established under the Employee Retirement Income
  102  Security Act of 1974, as amended.
  103         (16) “Household income” means the group or the individual
  104  whose income is considered in determining eligibility for the
  105  Florida Kidcare program. The term “household” has the same
  106  meaning as provided in s. 36B(d)(2) of the Internal Revenue Code
  107  of 1986.
  108         (17) “Medicaid” means the medical assistance program
  109  authorized by Title XIX of the Social Security Act, and
  110  regulations thereunder, and ss. 409.901-409.920, as administered
  111  in this state by the agency.
  112         (18) “Medically necessary” means the use of any medical
  113  treatment, service, equipment, or supply necessary to palliate
  114  the effects of a terminal condition, or to prevent, diagnose,
  115  correct, cure, alleviate, or preclude deterioration of a
  116  condition that threatens life, causes pain or suffering, or
  117  results in illness or infirmity and which is:
  118         (a) Consistent with the symptom, diagnosis, and treatment
  119  of the enrollee’s condition;
  120         (b) Provided in accordance with generally accepted
  121  standards of medical practice;
  122         (c) Not primarily intended for the convenience of the
  123  enrollee, the enrollee’s family, or the health care provider;
  124         (d) The most appropriate level of supply or service for the
  125  diagnosis and treatment of the enrollee’s condition; and
  126         (e) Approved by the appropriate medical body or health care
  127  specialty involved as effective, appropriate, and essential for
  128  the care and treatment of the enrollee’s condition.
  129         (19) “Medikids” means a component of the Florida Kidcare
  130  program of medical assistance authorized by Title XXI of the
  131  Social Security Act, and regulations thereunder, and s.
  132  409.8132, as administered in the state by the agency.
  133         (20) “Modified adjusted gross income” means the
  134  individual’s or household’s annual adjusted gross income as
  135  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986
  136  which is used to determine eligibility under the Florida Kidcare
  137  program.
  138         (21) “Patient Protection and Affordable Care Act” or “Act”
  139  means the federal law enacted as Pub. L. No. 111-148, as further
  140  amended by the federal Health Care and Education Reconciliation
  141  Act of 2010, Pub. L. No. 111-152, and any amendments,
  142  regulations, or guidance issued under those acts.
  143         (22)(20) “Preexisting condition exclusion” means, with
  144  respect to coverage, a limitation or exclusion of benefits
  145  relating to a condition based on the fact that the condition was
  146  present before the date of enrollment for such coverage, whether
  147  or not any medical advice, diagnosis, care, or treatment was
  148  recommended or received before such date.
  149         (23)(21) “Premium” means the entire cost of a health
  150  insurance plan, including the administration fee or the risk
  151  assumption charge.
  152         (24)(22) “Premium assistance payment” means the monthly
  153  consideration paid by the agency per enrollee in the Florida
  154  Kidcare program towards health insurance premiums.
  155         (25)(23) “Qualified alien” means an alien as defined in 8
  156  U.S.C. s. 1641 (b) and (c) s. 431 of the Personal Responsibility
  157  and Work Opportunity Reconciliation Act of 1996, as amended,
  158  Pub. L. No. 104-193.
  159         (26)(24) “Resident” means a United States citizen, or
  160  qualified alien, who is domiciled in this state.
  161         (27)(25) “Rural county” means a county having a population
  162  density of less than 100 persons per square mile, or a county
  163  defined by the most recent United States Census as rural, in
  164  which there is no prepaid health plan participating in the
  165  Medicaid program as of July 1, 1998.
  166         (26) “Substantially similar” means that, with respect to
  167  additional services as defined in s. 2103(c)(2) of Title XXI of
  168  the Social Security Act, these services must have an actuarial
  169  value equal to at least 75 percent of the actuarial value of the
  170  coverage for that service in the benchmark benefit plan and,
  171  with respect to the basic services as defined in s. 2103(c)(1)
  172  of Title XXI of the Social Security Act, these services must be
  173  the same as the services in the benchmark benefit plan.
  174         Section 2. Section 409.813, Florida Statutes, is amended to
  175  read:
  176         409.813 Health benefits coverage; program components;
  177  entitlement and nonentitlement.—
  178         (1) The Florida Kidcare program includes health benefits
  179  coverage provided to children through the following program
  180  components, which shall be marketed as the Florida Kidcare
  181  program:
  182         (a) Medicaid;
  183         (b) Medikids as created in s. 409.8132;
  184         (c) The Florida Healthy Kids Corporation as created in s.
  185  624.91; and
  186         (d) Employer-sponsored group health insurance plans
  187  approved under ss. 409.810-409.821; and
  188         (d)(e) The Children’s Medical Services network established
  189  in chapter 391.
  190         (2) Except for Title XIX-funded Florida Kidcare program
  191  coverage under the Medicaid program, coverage under the Florida
  192  Kidcare program is not an entitlement. No cause of action shall
  193  arise against the state, the department, the Department of
  194  Children and Families Family Services, or the agency, or the
  195  Florida Healthy Kids Corporation for failure to make health
  196  services available to any person under ss. 409.810-409.821.
  197         Section 3. Subsections (6) and (7) of section 409.8132,
  198  Florida Statutes, are amended to read:
  199         409.8132 Medikids program component.—
  200         (6) ELIGIBILITY.—
  201         (a) A child who has attained the age of 1 year but who is
  202  under the age of 5 years is eligible to enroll in the Medikids
  203  program component of the Florida Kidcare program, if the child
  204  is a member of a family that has a family income which exceeds
  205  the Medicaid applicable income level as specified in s. 409.903,
  206  but which is equal to or below 200 percent of the current
  207  federal poverty level. In determining the eligibility of such a
  208  child, an assets test is not required. A child who is eligible
  209  for Medikids may elect to enroll in Florida Healthy Kids
  210  coverage or employer-sponsored group coverage. However, a child
  211  who is eligible for Medikids may participate in the Florida
  212  Healthy Kids program only if the child has a sibling
  213  participating in the Florida Healthy Kids program and the
  214  child’s county of residence permits such enrollment.
  215         (b) The provisions of s. 409.814 apply to the Medikids
  216  program.
  217         (7) ENROLLMENT.—Enrollment in the Medikids program
  218  component may occur at any time throughout the year. A child may
  219  not receive services under the Medikids program until the child
  220  is enrolled in a managed care plan or MediPass. Once determined
  221  eligible, an applicant may receive choice counseling and select
  222  a managed care plan or MediPass. The agency may initiate
  223  mandatory assignment for a Medikids applicant who has not chosen
  224  a managed care plan or MediPass provider after the applicant’s
  225  voluntary choice period ends. An applicant may select MediPass
  226  under the Medikids program component only in counties that have
  227  fewer than two managed care plans available to serve Medicaid
  228  recipients and only if the federal Health Care Financing
  229  Administration determines that MediPass constitutes “health
  230  insurance coverage” as defined in Title XXI of the Social
  231  Security Act.
  232         Section 4. Subsection (2) of section 409.8134, Florida
  233  Statutes, is amended to read:
  234         409.8134 Program expenditure ceiling; enrollment.—
  235         (2) The Florida Kidcare program may conduct enrollment
  236  continuously throughout the year.
  237         (a) Children eligible for coverage under the Title XXI
  238  funded Florida Kidcare program shall be enrolled on a first
  239  come, first-served basis using the date the enrollment
  240  application is received. Enrollment shall immediately cease when
  241  the expenditure ceiling is reached. Year-round enrollment shall
  242  only be held if the Social Services Estimating Conference
  243  determines that sufficient federal and state funds will be
  244  available to finance the increased enrollment.
  245         (b) The application for the Florida Kidcare program is
  246  valid for a period of 120 days after the date it was received.
  247  At the end of the 120-day period, if the applicant has not been
  248  enrolled in the program, the application is invalid and the
  249  applicant shall be notified of the action. The applicant may
  250  reactivate the application after notification of the action
  251  taken by the program.
  252         (c) Except for the Medicaid program, whenever the Social
  253  Services Estimating Conference determines that there are
  254  presently, or will be by the end of the current fiscal year,
  255  insufficient funds to finance the current or projected
  256  enrollment in the Florida Kidcare program, all additional
  257  enrollment must cease and additional enrollment may not resume
  258  until sufficient funds are available to finance such enrollment.
  259         Section 5. Section 409.814, Florida Statutes, is amended to
  260  read:
  261         409.814 Eligibility.—A child who has not reached 19 years
  262  of age whose household family income is equal to or below 200
  263  percent of the federal poverty level is eligible for the Florida
  264  Kidcare program as provided in this section. If an enrolled
  265  individual is determined to be ineligible for coverage, he or
  266  she must be immediately disenrolled from the respective Florida
  267  Kidcare program component and referred to another insurance
  268  affordability program, if appropriate, through a combined
  269  eligibility notice.
  270         (1) A child who is eligible for Medicaid coverage under s.
  271  409.903 or s. 409.904 must be offered the opportunity to enroll
  272  enrolled in Medicaid and is not eligible to receive health
  273  benefits under any other health benefits coverage authorized
  274  under the Florida Kidcare program. A child who is eligible for
  275  Medicaid and opts to enroll in CHIP may disenroll from CHIP at
  276  any time and transition to Medicaid. This transition must occur
  277  without any break in coverage.
  278         (2) A child who is not eligible for Medicaid, but who is
  279  eligible for the Florida Kidcare program, may obtain health
  280  benefits coverage under any of the other components listed in s.
  281  409.813 if such coverage is approved and available in the county
  282  in which the child resides.
  283         (3) A Title XXI-funded child who is eligible for the
  284  Florida Kidcare program who is a child with special health care
  285  needs, as determined through a medical or behavioral screening
  286  instrument, is eligible for health benefits coverage from and
  287  shall be assigned to and may opt out of the Children’s Medical
  288  Services Network.
  289         (4) The following children are not eligible to receive
  290  Title XXI-funded premium assistance for health benefits coverage
  291  under the Florida Kidcare program, except under Medicaid if the
  292  child would have been eligible for Medicaid under s. 409.903 or
  293  s. 409.904 as of June 1, 1997:
  294         (a) A child who is covered under a family member’s group
  295  health benefit plan or under other private or employer health
  296  insurance coverage, if the cost of the child’s participation is
  297  not greater than 5 percent of the household’s family’s income.
  298  If a child is otherwise eligible for a subsidy under the Florida
  299  Kidcare program and the cost of the child’s participation in the
  300  family member’s health insurance benefit plan is greater than 5
  301  percent of the household’s family’s income, the child may enroll
  302  in the appropriate subsidized Kidcare program.
  303         (b) A child who is seeking premium assistance for the
  304  Florida Kidcare program through employer-sponsored group
  305  coverage, if the child has been covered by the same employer’s
  306  group coverage during the 60 days before the family submitted an
  307  application for determination of eligibility under the program.
  308         (b)(c) A child who is an alien, but who does not meet the
  309  definition of qualified alien, in the United States.
  310         (c)(d) A child who is an inmate of a public institution or
  311  a patient in an institution for mental diseases.
  312         (d)(e) A child who is otherwise eligible for premium
  313  assistance for the Florida Kidcare program and has had his or
  314  her coverage in an employer-sponsored or private health benefit
  315  plan voluntarily canceled in the last 60 days, except those
  316  children whose coverage was voluntarily canceled for good cause,
  317  including, but not limited to, the following circumstances:
  318         1. The cost of participation in an employer-sponsored
  319  health benefit plan is greater than 5 percent of the household’s
  320  modified adjusted gross family’s income;
  321         2. The parent lost a job that provided an employer
  322  sponsored health benefit plan for children;
  323         3. The parent who had health benefits coverage for the
  324  child is deceased;
  325         4. The child has a medical condition that, without medical
  326  care, would cause serious disability, loss of function, or
  327  death;
  328         5. The employer of the parent canceled health benefits
  329  coverage for children;
  330         6. The child’s health benefits coverage ended because the
  331  child reached the maximum lifetime coverage amount;
  332         7. The child has exhausted coverage under a COBRA
  333  continuation provision;
  334         8. The health benefits coverage does not cover the child’s
  335  health care needs; or
  336         9. Domestic violence led to loss of coverage.
  337         (5) A child who is otherwise eligible for the Florida
  338  Kidcare program and who has a preexisting condition that
  339  prevents coverage under another insurance plan as described in
  340  paragraph (4)(a) which would have disqualified the child for the
  341  Florida Kidcare program if the child were able to enroll in the
  342  plan is eligible for Florida Kidcare coverage when enrollment is
  343  possible.
  344         (5)(6) A child whose household’s modified adjusted gross
  345  family income is above 200 percent of the federal poverty level
  346  or a child who is excluded under the provisions of subsection
  347  (4) may participate in the Florida Kidcare program as provided
  348  in s. 409.8132 or, if the child is ineligible for Medikids by
  349  reason of age, in the Florida Healthy Kids program, subject to
  350  the following:
  351         (a) The family is not eligible for premium assistance
  352  payments and must pay the full cost of the premium, including
  353  any administrative costs.
  354         (b) The board of directors of the Florida Healthy Kids
  355  Corporation may offer a reduced benefit package to these
  356  children in order to limit program costs for such families.
  357         (c) By August 15, 2013, the Florida Healthy Kids
  358  Corporation shall notify all current full-pay enrollees of the
  359  availability of the exchange and how to access other insurance
  360  affordability options. New applications for full-pay coverage
  361  may not be accepted after September 30, 2013.
  362         (6)(7) Once a child is enrolled in the Florida Kidcare
  363  program, the child is eligible for coverage for 12 months
  364  without a redetermination or reverification of eligibility, if
  365  the family continues to pay the applicable premium. Eligibility
  366  for program components funded through Title XXI of the Social
  367  Security Act terminates when a child attains the age of 19. A
  368  child who has not attained the age of 5 and who has been
  369  determined eligible for the Medicaid program is eligible for
  370  coverage for 12 months without a redetermination or
  371  reverification of eligibility.
  372         (7)(8) When determining or reviewing a child’s eligibility
  373  under the Florida Kidcare program, the applicant shall be
  374  provided with reasonable notice of changes in eligibility which
  375  may affect enrollment in one or more of the program components.
  376  If a transition from one program component to another is
  377  authorized, there shall be cooperation between the program
  378  components and the affected family which promotes continuity of
  379  health care coverage. Any authorized transfers must be managed
  380  within the program’s overall appropriated or authorized levels
  381  of funding. Each component of the program shall establish a
  382  reserve to ensure that transfers between components will be
  383  accomplished within current year appropriations. These reserves
  384  shall be reviewed by each convening of the Social Services
  385  Estimating Conference to determine the adequacy of such reserves
  386  to meet actual experience.
  387         (8)(9) In determining the eligibility of a child, an assets
  388  test is not required. Each applicant shall provide documentation
  389  during the application process and the redetermination process,
  390  including, but not limited to, the following:
  391         (a) Proof of household family income, which must be
  392  verified electronically to determine financial eligibility for
  393  the Florida Kidcare program. Written documentation, which may
  394  include wages and earnings statements or pay stubs, W-2 forms,
  395  or a copy of the applicant’s most recent federal income tax
  396  return, is required only if the electronic verification is not
  397  available or does not substantiate the applicant’s income. This
  398  paragraph expires December 31, 2013.
  399         (b) A statement from all applicable, employed household
  400  family members that:
  401         1. Their employers do not sponsor health benefit plans for
  402  employees;
  403         2. The potential enrollee is not covered by an employer
  404  sponsored health benefit plan; or
  405         3. The potential enrollee is covered by an employer
  406  sponsored health benefit plan and the cost of the employer
  407  sponsored health benefit plan is more than 5 percent of the
  408  household’s modified adjusted gross family’s income.
  409         (c) To enroll in the Children’s Medical Services Network, a
  410  completed application, including a clinical screening.
  411         (d) Effective January 1, 2014, eligibility shall be
  412  determined through electronic matching using the federally
  413  managed data services hub and other resources. Written
  414  documentation from the applicant may be accepted if the
  415  electronic verification does not substantiate the applicant’s
  416  income or if there has been a change in circumstances.
  417         (9)(10) Subject to paragraph (4)(a), the Florida Kidcare
  418  program shall withhold benefits from an enrollee if the program
  419  obtains evidence that the enrollee is no longer eligible,
  420  submitted incorrect or fraudulent information in order to
  421  establish eligibility, or failed to provide verification of
  422  eligibility. The applicant or enrollee shall be notified that
  423  because of such evidence program benefits will be withheld
  424  unless the applicant or enrollee contacts a designated
  425  representative of the program by a specified date, which must be
  426  within 10 working days after the date of notice, to discuss and
  427  resolve the matter. The program shall make every effort to
  428  resolve the matter within a timeframe that will not cause
  429  benefits to be withheld from an eligible enrollee.
  430         (10)(11) The following individuals may be subject to
  431  prosecution in accordance with s. 414.39:
  432         (a) An applicant obtaining or attempting to obtain benefits
  433  for a potential enrollee under the Florida Kidcare program when
  434  the applicant knows or should have known the potential enrollee
  435  does not qualify for the Florida Kidcare program.
  436         (b) An individual who assists an applicant in obtaining or
  437  attempting to obtain benefits for a potential enrollee under the
  438  Florida Kidcare program when the individual knows or should have
  439  known the potential enrollee does not qualify for the Florida
  440  Kidcare program.
  441         Section 6. Paragraphs (g), (k), (q), and (w) of subsection
  442  (2) of section 409.815, Florida Statutes, are amended to read:
  443         409.815 Health benefits coverage; limitations.—
  444         (2) BENCHMARK BENEFITS.—In order for health benefits
  445  coverage to qualify for premium assistance payments for an
  446  eligible child under ss. 409.810-409.821, the health benefits
  447  coverage, except for coverage under Medicaid and Medikids, must
  448  include the following minimum benefits, as medically necessary.
  449         (g) Behavioral health services.—
  450         1. Mental health benefits include:
  451         a. Inpatient services, limited to 30 inpatient days per
  452  contract year for psychiatric admissions, or residential
  453  services in facilities licensed under s. 394.875(6) or s.
  454  395.003 in lieu of inpatient psychiatric admissions; however, a
  455  minimum of 10 of the 30 days shall be available only for
  456  inpatient psychiatric services if authorized by a physician; and
  457         b. Outpatient services, including outpatient visits for
  458  psychological or psychiatric evaluation, diagnosis, and
  459  treatment by a licensed mental health professional, limited to
  460  40 outpatient visits each contract year.
  461         2. Substance abuse services include:
  462         a. Inpatient services, limited to 7 inpatient days per
  463  contract year for medical detoxification only and 30 days of
  464  residential services; and
  465         b. Outpatient services, including evaluation, diagnosis,
  466  and treatment by a licensed practitioner, limited to 40
  467  outpatient visits per contract year.
  468  
  469  Effective October 1, 2009, Covered services include inpatient
  470  and outpatient services for mental and nervous disorders as
  471  defined in the most recent edition of the Diagnostic and
  472  Statistical Manual of Mental Disorders published by the American
  473  Psychiatric Association. Such benefits include psychological or
  474  psychiatric evaluation, diagnosis, and treatment by a licensed
  475  mental health professional and inpatient, outpatient, and
  476  residential treatment of substance abuse disorders. Any benefit
  477  limitations, including duration of services, number of visits,
  478  or number of days for hospitalization or residential services,
  479  shall not be any less favorable than those for physical
  480  illnesses generally. The program may also implement appropriate
  481  financial incentives, peer review, utilization requirements, and
  482  other methods used for the management of benefits provided for
  483  other medical conditions in order to reduce service costs and
  484  utilization without compromising quality of care.
  485         (k) Hospice services.—Covered services include reasonable
  486  and necessary services for palliation or management of an
  487  enrollee’s terminal illness, with the following exceptions:
  488         1. Once a family elects to receive hospice care for an
  489  enrollee, other services that treat the terminal condition will
  490  not be covered; and
  491         2. Services required for conditions totally unrelated to
  492  the terminal condition are covered to the extent that the
  493  services are included in this section.
  494         (q) Dental services.—Effective October 1, 2009, Dental
  495  services shall be covered as required under federal law and may
  496  also include those dental benefits provided to children by the
  497  Florida Medicaid program under s. 409.906(6).
  498         (w) Reimbursement of federally qualified health centers and
  499  rural health clinics.—Effective October 1, 2009, Payments for
  500  services provided to enrollees by federally qualified health
  501  centers and rural health clinics under this section shall be
  502  reimbursed using the Medicaid Prospective Payment System as
  503  provided for under s. 2107(e)(1)(D) of the Social Security Act.
  504  If such services are paid for by health insurers or health care
  505  providers under contract with the Florida Healthy Kids
  506  Corporation, such entities are responsible for this payment. The
  507  agency may seek any available federal grants to assist with this
  508  transition.
  509         Section 7. Section 409.816, Florida Statutes, is amended to
  510  read:
  511         409.816 Limitations on premiums and cost-sharing.—The
  512  following limitations on premiums and cost-sharing are
  513  established for the program.
  514         (1) Enrollees who receive coverage under the Medicaid
  515  program may not be required to pay:
  516         (a) Enrollment fees, premiums, or similar charges; or
  517         (b) Copayments, deductibles, coinsurance, or similar
  518  charges.
  519         (2) Enrollees in households that have families with a
  520  modified adjusted gross family income equal to or below 150
  521  percent of the federal poverty level, who are not receiving
  522  coverage under the Medicaid program, may not be required to pay:
  523         (a) Enrollment fees, premiums, or similar charges that
  524  exceed the maximum monthly charge permitted under s. 1916(b)(1)
  525  of the Social Security Act; or
  526         (b) Copayments, deductibles, coinsurance, or similar
  527  charges that exceed a nominal amount, as determined consistent
  528  with regulations referred to in s. 1916(a)(3) of the Social
  529  Security Act. However, such charges may not be imposed for
  530  preventive services, including well-baby and well-child care,
  531  age-appropriate immunizations, and routine hearing and vision
  532  screenings.
  533         (3) Enrollees in households that have families with a
  534  modified adjusted gross family income above 150 percent of the
  535  federal poverty level who are not receiving coverage under the
  536  Medicaid program or who are not eligible under s. 409.814(5) s.
  537  409.814(6) may be required to pay enrollment fees, premiums,
  538  copayments, deductibles, coinsurance, or similar charges on a
  539  sliding scale related to income, except that the total annual
  540  aggregate cost-sharing with respect to all children in a
  541  household family may not exceed 5 percent of the household’s
  542  modified adjusted family’s income. However, copayments,
  543  deductibles, coinsurance, or similar charges may not be imposed
  544  for preventive services, including well-baby and well-child
  545  care, age-appropriate immunizations, and routine hearing and
  546  vision screenings.
  547         Section 8. Section 409.817, Florida Statutes, is repealed.
  548         Section 9. Section 409.8175, Florida Statutes, is repealed.
  549         Section 10. Paragraph (c) of subsection (1) of section
  550  409.8177, Florida Statutes, is amended to read:
  551         409.8177 Program evaluation.—
  552         (1) The agency, in consultation with the Department of
  553  Health, the Department of Children and Families Family Services,
  554  and the Florida Healthy Kids Corporation, shall contract for an
  555  evaluation of the Florida Kidcare program and shall by January 1
  556  of each year submit to the Governor, the President of the
  557  Senate, and the Speaker of the House of Representatives a report
  558  of the program. In addition to the items specified under s. 2108
  559  of Title XXI of the Social Security Act, the report shall
  560  include an assessment of crowd-out and access to health care, as
  561  well as the following:
  562         (c) The characteristics of the children and families
  563  assisted under the program, including ages of the children,
  564  household family income, and access to or coverage by other
  565  health insurance prior to the program and after disenrollment
  566  from the program.
  567         Section 11. Section 409.818, Florida Statutes, is amended
  568  to read:
  569         409.818 Administration.—In order to implement ss. 409.810
  570  409.821, the following agencies shall have the following duties:
  571         (1) The Department of Children and Families Family Services
  572  shall:
  573         (a) Maintain Develop a simplified eligibility determination
  574  and renewal process application mail-in form to be used for
  575  determining the eligibility of children for coverage under the
  576  Florida Kidcare program, in consultation with the agency, the
  577  Department of Health, and the Florida Healthy Kids Corporation.
  578  The simplified eligibility process application form must include
  579  an item that provides an opportunity for the applicant to
  580  indicate whether coverage is being sought for a child with
  581  special health care needs. Families applying for children’s
  582  Medicaid coverage must also be able to use the simplified
  583  application process form without having to pay a premium.
  584         (b) Establish and maintain the eligibility determination
  585  process under the program except as specified in subsection (3),
  586  which includes the following: (5).
  587         1. The department shall directly, or through the services
  588  of a contracted third-party administrator, establish and
  589  maintain a process for determining eligibility of children for
  590  coverage under the program. The eligibility determination
  591  process must be used solely for determining eligibility of
  592  applicants for health benefits coverage under the program. The
  593  eligibility determination process must include an initial
  594  determination of eligibility for any coverage offered under the
  595  program, as well as a redetermination or reverification of
  596  eligibility each subsequent 6 months. Effective January 1, 1999,
  597  A child who has not attained the age of 5 and who has been
  598  determined eligible for the Medicaid program is eligible for
  599  coverage for 12 months without a redetermination or
  600  reverification of eligibility. In conducting an eligibility
  601  determination, the department shall determine if the child has
  602  special health care needs.
  603         2. The department, in consultation with the Agency for
  604  Health Care Administration and the Florida Healthy Kids
  605  Corporation, shall develop procedures for redetermining
  606  eligibility which enable applicants and enrollees a family to
  607  easily update any change in circumstances which could affect
  608  eligibility.
  609         3. The department may accept changes in a family’s status
  610  as reported to the department by the Florida Healthy Kids
  611  Corporation or the exchange without requiring a new application
  612  from the family. Redetermination of a child’s eligibility for
  613  Medicaid may not be linked to a child’s eligibility
  614  determination for other programs.
  615         4. The department, in consultation with the agency and the
  616  Florida Healthy Kids Corporation, shall develop a combined
  617  eligibility notice to inform applicants and enrollees of their
  618  application or renewal status, as appropriate. The content must
  619  be coordinated to meet all federal and state requirements under
  620  the federal Patient Protection and Affordable Care Act.
  621         (c) Inform program applicants about eligibility
  622  determinations and provide information about eligibility of
  623  applicants to the Florida Kidcare program and to insurers and
  624  their agents, through a centralized coordinating office.
  625         (d) Adopt rules necessary for conducting program
  626  eligibility functions.
  627         (2) The Department of Health shall:
  628         (a) Design an eligibility intake process for the program,
  629  in coordination with the Department of Children and Family
  630  Services, the agency, and the Florida Healthy Kids Corporation.
  631  The eligibility intake process may include local intake points
  632  that are determined by the Department of Health in coordination
  633  with the Department of Children and Family Services.
  634         (b) Chair a state-level Florida Kidcare coordinating
  635  council to review and make recommendations concerning the
  636  implementation and operation of the program. The coordinating
  637  council shall include representatives from the department, the
  638  Department of Children and Family Services, the agency, the
  639  Florida Healthy Kids Corporation, the Office of Insurance
  640  Regulation of the Financial Services Commission, local
  641  government, health insurers, health maintenance organizations,
  642  health care providers, families participating in the program,
  643  and organizations representing low-income families.
  644         (c) In consultation with the Florida Healthy Kids
  645  Corporation and the Department of Children and Family Services,
  646  establish a toll-free telephone line to assist families with
  647  questions about the program.
  648         (d) Adopt rules necessary to implement outreach activities.
  649         (2)(3) The Agency for Health Care Administration, under the
  650  authority granted in s. 409.914(1), shall:
  651         (a) Calculate the premium assistance payment necessary to
  652  comply with the premium and cost-sharing limitations specified
  653  in s. 409.816 and the federal Patient Protection and Affordable
  654  Care Act. The premium assistance payment for each enrollee in a
  655  health insurance plan participating in the Florida Healthy Kids
  656  Corporation shall equal the premium approved by the Florida
  657  Healthy Kids Corporation and the Office of Insurance Regulation
  658  of the Financial Services Commission pursuant to ss. 627.410 and
  659  641.31, less any enrollee’s share of the premium established
  660  within the limitations specified in s. 409.816. The premium
  661  assistance payment for each enrollee in an employer-sponsored
  662  health insurance plan approved under ss. 409.810-409.821 shall
  663  equal the premium for the plan adjusted for any benchmark
  664  benefit plan actuarial equivalent benefit rider approved by the
  665  Office of Insurance Regulation pursuant to ss. 627.410 and
  666  641.31, less any enrollee’s share of the premium established
  667  within the limitations specified in s. 409.816. In calculating
  668  the premium assistance payment levels for children with family
  669  coverage, the agency shall set the premium assistance payment
  670  levels for each child proportionately to the total cost of
  671  family coverage.
  672         (b) Make premium assistance payments to health insurance
  673  plans on a periodic basis. The agency may use its Medicaid
  674  fiscal agent or a contracted third-party administrator in making
  675  these payments. The agency may require health insurance plans
  676  that participate in the Medikids program or employer-sponsored
  677  group health insurance to collect premium payments from an
  678  enrollee’s family. Participating health insurance plans shall
  679  report premium payments collected on behalf of enrollees in the
  680  program to the agency in accordance with a schedule established
  681  by the agency.
  682         (c) Monitor compliance with quality assurance and access
  683  standards developed under s. 409.820 and in accordance with s.
  684  2103(f) of the Social Security Act, 42 U.S.C. s. 1397cc(f).
  685         (d) Establish a mechanism for investigating and resolving
  686  complaints and grievances from program applicants, enrollees,
  687  and health benefits coverage providers, and maintain a record of
  688  complaints and confirmed problems. In the case of a child who is
  689  enrolled in a managed care health maintenance organization, the
  690  agency must use the provisions of s. 641.511 to address
  691  grievance reporting and resolution requirements.
  692         (e) Approve health benefits coverage for participation in
  693  the program, following certification by the Office of Insurance
  694  Regulation under subsection (4).
  695         (e)(f) Adopt rules necessary for calculating premium
  696  assistance payment levels, making premium assistance payments,
  697  monitoring access and quality assurance standards and,
  698  investigating and resolving complaints and grievances,
  699  administering the Medikids program, and approving health
  700  benefits coverage.
  701         (f) Contract with the Florida Healthy Kids Corporation for
  702  the administration of the Florida Kidcare program and the
  703  Healthy Florida program and to facilitate the release of any
  704  federal and state funds.
  705  
  706  The agency is designated the lead state agency for Title XXI of
  707  the Social Security Act for purposes of receipt of federal
  708  funds, for reporting purposes, and for ensuring compliance with
  709  federal and state regulations and rules.
  710         (4) The Office of Insurance Regulation shall certify that
  711  health benefits coverage plans that seek to provide services
  712  under the Florida Kidcare program, except those offered through
  713  the Florida Healthy Kids Corporation or the Children’s Medical
  714  Services Network, meet, exceed, or are actuarially equivalent to
  715  the benchmark benefit plan and that health insurance plans will
  716  be offered at an approved rate. In determining actuarial
  717  equivalence of benefits coverage, the Office of Insurance
  718  Regulation and health insurance plans must comply with the
  719  requirements of s. 2103 of Title XXI of the Social Security Act.
  720  The department shall adopt rules necessary for certifying health
  721  benefits coverage plans.
  722         (3)(5) The Florida Healthy Kids Corporation shall retain
  723  its functions as authorized in s. 624.91, including eligibility
  724  determination for participation in the Healthy Kids program.
  725         (4)(6) The agency, the Department of Health, the Department
  726  of Children and Families Family Services, and the Florida
  727  Healthy Kids Corporation, and the Office of Insurance
  728  Regulation, after consultation with and approval of the Speaker
  729  of the House of Representatives and the President of the Senate,
  730  may are authorized to make program modifications that are
  731  necessary to overcome any objections of the United States
  732  Department of Health and Human Services to obtain approval of
  733  the state’s child health insurance plan under Title XXI of the
  734  Social Security Act.
  735         Section 12. Section 409.820, Florida Statutes, is amended
  736  to read:
  737         409.820 Quality assurance and access standards.—Except for
  738  Medicaid, the Department of Health, in consultation with the
  739  agency and the Florida Healthy Kids Corporation, shall develop a
  740  minimum set of pediatric and adolescent quality assurance and
  741  access standards for all program components. The standards must
  742  include a process for granting exceptions to specific
  743  requirements for quality assurance and access. Compliance with
  744  the standards shall be a condition of program participation by
  745  health benefits coverage providers. These standards shall comply
  746  with the provisions of this chapter and chapter 641 and Title
  747  XXI of the Social Security Act.
  748         Section 13. Section 624.91, Florida Statutes, is amended to
  749  read:
  750         624.91 The Florida Healthy Kids Corporation Act.—
  751         (1) SHORT TITLE.—This section may be cited as the “William
  752  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
  753         (2) LEGISLATIVE INTENT.—
  754         (a) The Legislature finds that increased access to health
  755  care services could improve children’s health and reduce the
  756  incidence and costs of childhood illness and disabilities among
  757  children in this state. Many children do not have comprehensive,
  758  affordable health care services available. It is the intent of
  759  the Legislature that the Florida Healthy Kids Corporation
  760  provide comprehensive health insurance coverage to such
  761  children. The corporation is encouraged to cooperate with any
  762  existing health service programs funded by the public or the
  763  private sector.
  764         (b) It is the intent of the Legislature that the Florida
  765  Healthy Kids Corporation serve as one of several providers of
  766  services to children eligible for medical assistance under Title
  767  XXI of the Social Security Act. Although the corporation may
  768  serve other children, the Legislature intends the primary
  769  recipients of services provided through the corporation be
  770  school-age children with a family income below 200 percent of
  771  the federal poverty level, who do not qualify for Medicaid. It
  772  is also the intent of the Legislature that state and local
  773  government Florida Healthy Kids funds be used to continue
  774  coverage, subject to specific appropriations in the General
  775  Appropriations Act, to children not eligible for federal
  776  matching funds under Title XXI.
  777         (c) It is further the intent of the Legislature that the
  778  Florida Healthy Kids Corporation administer and manage services
  779  for Healthy Florida, a health care program for uninsured adults
  780  using a unique network of providers and contracts. Enrollees in
  781  Healthy Florida will receive comprehensive health care services
  782  from private, licensed health insurers who meet standards
  783  established by the corporation. It is further the intent of the
  784  Legislature that these enrollees participate in their own health
  785  care decisionmaking and contribute financially toward their
  786  medical costs. The Legislature intends to provide an alternative
  787  benefit package that includes a full range of services that meet
  788  the needs of residents of this state. As a new program, the
  789  Legislature shall also ensure that a comprehensive evaluation is
  790  conducted to measure the overall impact of the program and
  791  identify whether to renew the program after an initial 3-year
  792  term.
  793         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only the
  794  following individuals are eligible for state-funded assistance
  795  in paying premiums for Healthy Florida or Florida Healthy Kids
  796  premiums:
  797         (a) Residents of this state who are eligible for the
  798  Florida Kidcare program pursuant to s. 409.814 or the Healthy
  799  Florida program pursuant to s. 624.917.
  800         (b) Notwithstanding s. 409.814, legal aliens who are
  801  enrolled in the Florida Healthy Kids program as of January 31,
  802  2004, who do not qualify for Title XXI federal funds because
  803  they are not qualified aliens as defined in s. 409.811.
  804         (4) NONENTITLEMENT.—Nothing in this section shall be
  805  construed as providing an individual with an entitlement to
  806  health care services. No cause of action shall arise against the
  807  state, the Florida Healthy Kids Corporation, or a unit of local
  808  government for failure to make health services available under
  809  this section.
  810         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
  811         (a) There is created the Florida Healthy Kids Corporation,
  812  a not-for-profit corporation.
  813         (b) The Florida Healthy Kids Corporation shall:
  814         1. Arrange for the collection of any family, individual, or
  815  local contributions, or employer payment or premium, in an
  816  amount to be determined by the board of directors, to provide
  817  for payment of premiums for comprehensive insurance coverage and
  818  for the actual or estimated administrative expenses.
  819         2. Arrange for the collection of any voluntary
  820  contributions to provide for payment of premiums for enrollees
  821  in the Florida Kidcare program or Healthy Florida premiums for
  822  children who are not eligible for medical assistance under Title
  823  XIX or Title XXI of the Social Security Act.
  824         3. Subject to the provisions of s. 409.8134, accept
  825  voluntary supplemental local match contributions that comply
  826  with the requirements of Title XXI of the Social Security Act
  827  for the purpose of providing additional Florida Kidcare coverage
  828  in contributing counties under Title XXI.
  829         4. Establish the administrative and accounting procedures
  830  for the operation of the corporation.
  831         5. Establish, with consultation from appropriate
  832  professional organizations, standards for preventive health
  833  services and providers and comprehensive insurance benefits
  834  appropriate to children, provided that such standards for rural
  835  areas shall not limit primary care providers to board-certified
  836  pediatricians.
  837         6. Determine eligibility for children seeking to
  838  participate in the Title XXI-funded components of the Florida
  839  Kidcare program consistent with the requirements specified in s.
  840  409.814, as well as the non-Title-XXI-eligible children as
  841  provided in subsection (3).
  842         7. Establish procedures under which providers of local
  843  match to, applicants to and participants in the program may have
  844  grievances reviewed by an impartial body and reported to the
  845  board of directors of the corporation.
  846         8. Establish participation criteria and, if appropriate,
  847  contract with an authorized insurer, health maintenance
  848  organization, or third-party administrator to provide
  849  administrative services to the corporation.
  850         9. Establish enrollment criteria that include penalties or
  851  waiting periods of 30 days for reinstatement of coverage upon
  852  voluntary cancellation for nonpayment of family and individual
  853  premiums under the programs.
  854         10. Contract with authorized insurers or any provider of
  855  health care services, meeting standards established by the
  856  corporation, for the provision of comprehensive insurance
  857  coverage to participants. Such standards shall include criteria
  858  under which the corporation may contract with more than one
  859  provider of health care services in program sites.
  860         a. Health plans shall be selected through a competitive bid
  861  process.
  862         b. The Florida Healthy Kids Corporation shall purchase
  863  goods and services in the most cost-effective manner consistent
  864  with the delivery of quality medical care. The maximum
  865  administrative cost for a Florida Healthy Kids Corporation
  866  contract shall be 15 percent. For all health care contracts, the
  867  minimum medical loss ratio is for a Florida Healthy Kids
  868  Corporation contract shall be 85 percent. The calculations must
  869  use uniform financial data collected from all plans in a format
  870  established by the corporation and shall be computed for each
  871  insurer on a statewide basis. Funds shall be classified in a
  872  manner consistent with 45 C.F.R. part 158 For dental contracts,
  873  the remaining compensation to be paid to the authorized insurer
  874  or provider under a Florida Healthy Kids Corporation contract
  875  shall be no less than an amount which is 85 percent of premium;
  876  to the extent any contract provision does not provide for this
  877  minimum compensation, this section shall prevail.
  878         c. The health plan selection criteria and scoring system,
  879  and the scoring results, shall be available upon request for
  880  inspection after the bids have been awarded.
  881         11. Establish disenrollment criteria in the event local
  882  matching funds are insufficient to cover enrollments.
  883         12. Develop and implement a plan to publicize the Florida
  884  Kidcare program and Healthy Florida, the eligibility
  885  requirements of the programs program, and the procedures for
  886  enrollment in the program and to maintain public awareness of
  887  the corporation and the programs program.
  888         13. Secure staff necessary to properly administer the
  889  corporation. Staff costs shall be funded from state and local
  890  matching funds and such other private or public funds as become
  891  available. The board of directors shall determine the number of
  892  staff members necessary to administer the corporation.
  893         14. In consultation with the partner agencies, annually
  894  provide a report on the Florida Kidcare program annually to the
  895  Governor, the Chief Financial Officer, the Commissioner of
  896  Education, the President of the Senate, the Speaker of the House
  897  of Representatives, and the Minority Leaders of the Senate and
  898  the House of Representatives.
  899         15. Provide information on a quarterly basis to the
  900  Legislature and the Governor which compares the costs and
  901  utilization of the full-pay enrolled population and the Title
  902  XXI-subsidized enrolled population in the Florida Kidcare
  903  program. The information, at a minimum, must include:
  904         a. The monthly enrollment and expenditure for full-pay
  905  enrollees in the Medikids and Florida Healthy Kids programs
  906  compared to the Title XXI-subsidized enrolled population; and
  907         b. The costs and utilization by service of the full-pay
  908  enrollees in the Medikids and Florida Healthy Kids programs and
  909  the Title XXI-subsidized enrolled population. This subparagraph
  910  is repealed effective December 31, 2013.
  911  
  912  By February 1, 2010, the Florida Healthy Kids Corporation shall
  913  provide a study to the Legislature and the Governor on premium
  914  impacts to the subsidized portion of the program from the
  915  inclusion of the full-pay program, which shall include
  916  recommendations on how to eliminate or mitigate possible impacts
  917  to the subsidized premiums.
  918         16. By August 15, 2013, the corporation shall notify all
  919  current full-pay enrollees of the availability of the exchange,
  920  as defined in the federal Patient Protection and Affordable Care
  921  Act, and how to access other insurance affordability options.
  922  New applications for full-pay coverage may not be accepted after
  923  September 30, 2013.
  924         17.16. Establish benefit packages that conform to the
  925  provisions of the Florida Kidcare program, as created in ss.
  926  409.810-409.821.
  927         (c) Coverage under the corporation’s program is secondary
  928  to any other available private coverage held by, or applicable
  929  to, the participant child or family member. Insurers under
  930  contract with the corporation are the payors of last resort and
  931  must coordinate benefits with any other third-party payor that
  932  may be liable for the participant’s medical care.
  933         (d) The Florida Healthy Kids Corporation shall be a private
  934  corporation not for profit, registered, incorporated, and
  935  organized pursuant to chapter 617, and shall have all powers
  936  necessary to carry out the purposes of this act, including, but
  937  not limited to, the power to receive and accept grants, loans,
  938  or advances of funds from any public or private agency and to
  939  receive and accept from any source contributions of money,
  940  property, labor, or any other thing of value, to be held, used,
  941  and applied for the purposes of this act. The corporation and
  942  any committees it forms shall act in compliance with part III of
  943  chapter 112, and chapters 119 and 286.
  944         (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.—
  945         (a) The Florida Healthy Kids Corporation shall operate
  946  subject to the supervision and approval of a board of directors
  947  chaired by an appointee designated by the Governor Chief
  948  Financial Officer or her or his designee, and composed of 15 12
  949  other members. The Senate shall confirm the designated chair and
  950  other board appointees selected for 3-year terms of office as
  951  follows:
  952         1. The Secretary of Health Care Administration, or his or
  953  her designee, as an ex officio member.
  954         2. The State Surgeon General, or his or her designee, as an
  955  ex officio member One member appointed by the Commissioner of
  956  Education from the Office of School Health Programs of the
  957  Florida Department of Education.
  958         3. The Secretary of Children and Families, or his or her
  959  designee, as an ex officio member One member appointed by the
  960  Chief Financial Officer from among three members nominated by
  961  the Florida Pediatric Society.
  962         4. Four members One member, appointed by the Governor, who
  963  represents the Children’s Medical Services Program.
  964         5. Two members One member appointed by the President of the
  965  Senate Chief Financial Officer from among three members
  966  nominated by the Florida Hospital Association.
  967         6. Two members One member, appointed by the Senate Minority
  968  Leader Governor, who is an expert on child health policy.
  969         7. Two members One member, appointed by the Speaker of the
  970  House of Representatives Chief Financial Officer, from among
  971  three members nominated by the Florida Academy of Family
  972  Physicians.
  973         8. Two members One member, appointed by the House Minority
  974  Leader Governor, who represents the state Medicaid program.
  975         9. One member, appointed by the Chief Financial Officer,
  976  from among three members nominated by the Florida Association of
  977  Counties.
  978         10. The State Health Officer or her or his designee.
  979         11. The Secretary of Children and Family Services, or his
  980  or her designee.
  981         12. One member, appointed by the Governor, from among three
  982  members nominated by the Florida Dental Association.
  983         (b) A member of the board of directors may be removed by
  984  the official who appointed that member. The board shall appoint
  985  an executive director, who is responsible for other staff
  986  authorized by the board.
  987         (c) Board members are entitled to receive, from funds of
  988  the corporation, reimbursement for per diem and travel expenses
  989  as provided by s. 112.061.
  990         (d) There shall be no liability on the part of, and no
  991  cause of action shall arise against, any member of the board of
  992  directors, or its employees or agents, for any action they take
  993  in the performance of their powers and duties under this act.
  994         (e) Board members who are serving on or before the date of
  995  enactment of this act or similar legislation may remain until
  996  July 1, 2013.
  997         (f) An executive steering committee is created to provide
  998  management direction and support and to make recommendations to
  999  the board on the programs. The steering committee is composed of
 1000  the Secretary of Health Care Administration, the Secretary of
 1001  Children and Families, and the State Surgeon General. Committee
 1002  members may not delegate their membership or attendance.
 1003         (7) LICENSING NOT REQUIRED; FISCAL OPERATION.—
 1004         (a) The corporation shall not be deemed an insurer. The
 1005  officers, directors, and employees of the corporation shall not
 1006  be deemed to be agents of an insurer. Neither the corporation
 1007  nor any officer, director, or employee of the corporation is
 1008  subject to the licensing requirements of the insurance code or
 1009  the rules of the Department of Financial Services or Office of
 1010  Insurance Regulation. However, any marketing representative
 1011  utilized and compensated by the corporation must be appointed as
 1012  a representative of the insurers or health services providers
 1013  with which the corporation contracts.
 1014         (b) The board has complete fiscal control over the
 1015  corporation and is responsible for all corporate operations.
 1016         (c) The Department of Financial Services shall supervise
 1017  any liquidation or dissolution of the corporation and shall
 1018  have, with respect to such liquidation or dissolution, all power
 1019  granted to it pursuant to the insurance code.
 1020         Section 14. Section 624.915, Florida Statutes, is repealed.
 1021         Section 15. Section 624.917, Florida Statutes, is created
 1022  to read:
 1023         624.917 Healthy Florida program.—
 1024         (1) PROGRAM CREATION.—There is created Healthy Florida, a
 1025  health care program for lower income, uninsured adults who meet
 1026  the eligibility guidelines established under s. 624.91. The
 1027  Florida Healthy Kids Corporation shall administer the program
 1028  under its existing corporate governance and structure.
 1029         (2) DEFINITIONS.—As used in this section, the term:
 1030         (a) “Actuarially equivalent” means:
 1031         1. The aggregate value of the benefits included in health
 1032  benefits coverage is equal to the value of the benefits in the
 1033  child benchmark benefit plan as defined in s. 409.811; and
 1034         2. The benefits included in health benefits coverage are
 1035  substantially similar to the benefits included in the child
 1036  benchmark benefit plan, except that preventive health services
 1037  do not include dental services.
 1038         (b) “Agency” means the Agency for Health Care
 1039  Administration.
 1040         (c) “Applicant” means the individual who applies for
 1041  determination of eligibility for health benefits coverage under
 1042  this section.
 1043         (d) “Child” means any person younger than 19 years of age.
 1044         (e) “Child benchmark benefit plan” means the form and level
 1045  of health benefits coverage established in s. 409.815.
 1046         (f) “Corporation” means the Florida Healthy Kids
 1047  Corporation.
 1048         (g) “Enrollee” means an individual who has been determined
 1049  eligible for and is receiving coverage under this section.
 1050         (h) “Florida Kidcare program” or “Kidcare program” means
 1051  the health benefits program administered through ss. 409.810
 1052  409.821.
 1053         (i) “Health benefits coverage” means protection that
 1054  provides payment of benefits for covered health care services or
 1055  that otherwise provides, either directly or through arrangements
 1056  with other persons, covered health care services on a prepaid
 1057  per capita basis or on a prepaid aggregate fixed-sum basis.
 1058         (j) “Healthy Florida” means the program created by this
 1059  section which is administered by the Florida Healthy Kids
 1060  Corporation.
 1061         (k) “Healthy Kids” means the Florida Kidcare program
 1062  component created under s. 624.91 for children who are 5 through
 1063  18 years of age.
 1064         (l) “Household income” means the group or the individual
 1065  whose income is considered in determining eligibility for the
 1066  Healthy Florida program. The term “household” has the same
 1067  meaning as provided in s. 36B(d)(2) of the Internal Revenue Code
 1068  of 1986.
 1069         (m) “Medicaid” means the medical assistance program
 1070  authorized by Title XIX of the Social Security Act, and
 1071  regulations thereunder, and ss. 409.901-409.920, as administered
 1072  in this state by the agency.
 1073         (n) “Medically necessary” means the use of any medical
 1074  treatment, service, equipment, or supply necessary to palliate
 1075  the effects of a terminal condition, or to prevent, diagnose,
 1076  correct, cure, alleviate, or preclude deterioration of a
 1077  condition that threatens life, causes pain or suffering, or
 1078  results in illness or infirmity and which is:
 1079         1. Consistent with the symptom, diagnosis, and treatment of
 1080  the enrollee’s condition;
 1081         2. Provided in accordance with generally accepted standards
 1082  of medical practice;
 1083         3. Not primarily intended for the convenience of the
 1084  enrollee, the enrollee’s family, or the health care provider;
 1085         4. The most appropriate level of supply or service for the
 1086  diagnosis and treatment of the enrollee’s condition; and
 1087         5. Approved by the appropriate medical body or health care
 1088  specialty involved as effective, appropriate, and essential for
 1089  the care and treatment of the enrollee’s condition.
 1090         (o) “Modified adjusted gross income” means the individual
 1091  or household’s annual adjusted gross income as defined in s.
 1092  36B(d)(2) of the Internal Revenue Code of 1986 which is used to
 1093  determine eligibility under the Florida Kidcare program.
 1094         (p) “Patient Protection and Affordable Care Act” or “Act”
 1095  means the federal law enacted as Pub. L. No. 111-148, as further
 1096  amended by the federal Health Care and Education Reconciliation
 1097  Act of 2010, Pub. L. No. 111-152, and any amendments,
 1098  regulations, or guidance thereunder, issued under those acts.
 1099         (q) “Premium” means the entire cost of a health insurance
 1100  plan, including the administration fee or the risk assumption
 1101  charge.
 1102         (r) “Premium assistance payment” means the monthly
 1103  consideration paid by the agency per enrollee in the Florida
 1104  Kidcare program towards health insurance premiums.
 1105         (s) “Qualified alien” means an alien as defined in 8 U.S.C.
 1106  s. 1641(b) and (c).
 1107         (t) “Resident” means a United States citizen or qualified
 1108  alien who is domiciled in this state.
 1109         (3) ELIGIBILITY.—To be eligible and remain eligible for the
 1110  Healthy Florida program, an individual must be a resident of
 1111  this state and meet the following additional criteria:
 1112         (a) Be identified as newly eligible, as defined in s.
 1113  1902(a)(10)(A)(i)(VIII) of the Social Security Act or s. 2001 of
 1114  the federal Patient Protection and Affordable Care Act, and as
 1115  may be further defined by federal regulation.
 1116         (b) Maintain eligibility with the corporation and meet all
 1117  renewal requirements as established by the corporation.
 1118         (c) Renew eligibility on at least an annual basis.
 1119         (4) ENROLLMENT.—The corporation may begin the enrollment of
 1120  applicants in the Healthy Florida program on October 1, 2013.
 1121  Enrollment may occur directly, through the services of a third
 1122  party administrator, referrals from the Department of Children
 1123  and Families, and the exchange as defined by the federal Patient
 1124  Protection and Affordable Care Act. As an enrollee disenrolls,
 1125  the corporation must also provide the enrollee with information
 1126  about other insurance affordability programs and electronically
 1127  refer the enrollee to the exchange or other programs, as
 1128  appropriate. The earliest coverage effective date under the
 1129  program shall be January 1, 2014.
 1130         (5) DELIVERY OF SERVICES.—The corporation shall contract
 1131  with authorized insurers licensed under chapter 627; managed
 1132  care organizations authorized under chapter 641; and provider
 1133  service networks authorized under ss. 409.912(4)(d) and
 1134  409.962(13) which are prepaid plans. These insurers, managed
 1135  care organizations, and provider service networks must meet
 1136  standards established by the corporation to provide
 1137  comprehensive health care services to enrollees who qualify for
 1138  services under this section. The corporation may contract for
 1139  such services on a statewide or regional basis. To encourage
 1140  continuity of care among enrollees who may transition across
 1141  multiple insurance affordability programs, the corporation is
 1142  encouraged to contract with those insurers and managed care
 1143  organizations that participate in more than one such program.
 1144         (a) The corporation shall establish access and network
 1145  standards for such contracts and ensure that contracted
 1146  providers have sufficient providers to meet enrollee needs.
 1147  Quality standards must be developed by the corporation, specific
 1148  to the adult population, which take into consideration
 1149  recommendations from the National Committee on Quality
 1150  Assurance, stakeholders, and other existing performance
 1151  indicators from both public and commercial populations. The
 1152  corporation and its contracted health plans shall develop
 1153  policies that minimize the disruption of enrollee medical homes
 1154  when enrollees transition between insurance affordability plans.
 1155         (b) The corporation shall provide an enrollee a choice of
 1156  plans. The corporation may select a plan if no selection has
 1157  been received before the coverage start date. Once enrolled, an
 1158  enrollee has an initial 90-day free-look period before a lock-in
 1159  period of not more than 12 months is applied. Exceptions to the
 1160  lock-in period must be offered to an enrollee for reasons based
 1161  upon good cause or qualifying events.
 1162         (c) The corporation may consider contracts that provide
 1163  family plans that would allow members from multiple state and
 1164  federally funded programs to remain together under the same
 1165  plan.
 1166         (d) All contracts must meet the medical loss ratio
 1167  requirements under s. 624.91.
 1168         (6) BENEFITS.—The corporation shall establish a benefits
 1169  package that is actuarially equivalent to the benchmark benefit
 1170  plan offered under s. 409.815(2), excluding dental, and meets
 1171  the alternative benefits package requirements under s. 1937 of
 1172  the Social Security Act. Benefits must be offered as an
 1173  integrated, single package.
 1174         (a) In addition to benchmark benefits, health reimbursement
 1175  accounts or a comparable health savings account for each
 1176  enrollee must be established through the corporation or the
 1177  contracts managed by the corporation. Enrollees must be rewarded
 1178  for healthy behaviors, wellness program adherence, and other
 1179  activities established by the corporation which demonstrate
 1180  compliance with preventive care or disease management
 1181  guidelines. Funds deposited into these accounts may be used to
 1182  pay cost-sharing obligations or to purchase over-the-counter
 1183  health-related items to the extent allowed under federal law or
 1184  regulation.
 1185         (b) Enhanced services may be offered if the cost of such
 1186  additional services provides savings to the overall plan.
 1187         (c) The corporation shall establish a process for the
 1188  payment of wrap-around services not covered by the benchmark
 1189  benefit plan through a separate subcapitation process to its
 1190  contracted providers if it is determined that such services are
 1191  required by federal law. Such services would be covered when
 1192  deemed medically necessary on an individual basis. The
 1193  subcapitation pool is subject to a separate reconciliation
 1194  process under the medical loss ratio provisions in s. 624.91.
 1195         (d) A prior authorization process and other utilization
 1196  controls may be established by the plan for any benefit if
 1197  approved by the corporation.
 1198         (7) COST SHARING.—The corporation may collect premiums and
 1199  copayments from enrollees in accordance with federal law.
 1200  Amounts to be collected for the Healthy Florida program must be
 1201  established annually in the General Appropriations Act.
 1202         (a) Payment of a monthly premium may be required before the
 1203  establishment of an enrollee’s coverage start date and to retain
 1204  monthly coverage.
 1205         (b) An enrollee who has a family income above the federal
 1206  poverty level may be required to make nominal copayments, in
 1207  accordance with federal rule, as a condition of receiving a
 1208  health care service.
 1209         (c) A provider is responsible for the collection of point
 1210  of-service cost-sharing obligations. The enrollee’s cost-sharing
 1211  contribution is considered part of the provider’s total
 1212  reimbursement. Failure to collect an enrollee’s cost sharing
 1213  reduces the provider’s share of the reimbursement.
 1214         (8) PROGRAM MANAGEMENT.—The corporation is responsible for
 1215  the oversight of the Healthy Florida program. The agency shall
 1216  seek a state plan amendment or other appropriate federal
 1217  approval to implement the Healthy Florida program. The agency
 1218  shall consult with the corporation in the amendment’s
 1219  development and submit by June 14, 2013, the state plan
 1220  amendment to the federal Department of Health and Human
 1221  Services. The agency shall contract with the corporation for the
 1222  administration of the Healthy Florida program and for the timely
 1223  release of federal and state funds. The agency retains its
 1224  authorities as provided in ss. 409.902 and 409.963.
 1225         (a) The corporation shall establish a process by which
 1226  grievances can be resolved and Healthy Florida recipients can be
 1227  informed of their rights under the Medicaid Fair Hearing
 1228  Process, as appropriate, or any alternative resolution process
 1229  adopted by the corporation.
 1230         (b) The corporation shall establish a program integrity
 1231  process to ensure compliance with program guidelines. At a
 1232  minimum, the corporation shall withhold benefits from an
 1233  applicant or enrollee if the corporation obtains evidence that
 1234  the applicant or enrollee is no longer eligible, submitted
 1235  incorrect or fraudulent information in order to establish
 1236  eligibility, or failed to provide verification of eligibility.
 1237  The corporation shall notify the applicant or enrollee that,
 1238  because of such evidence, program benefits must be withheld
 1239  unless the applicant or enrollee contacts a designated
 1240  representative of the corporation by a specified date, which
 1241  must be within 10 working days after the date of notice, to
 1242  discuss and resolve the matter. The corporation shall make every
 1243  effort to resolve the matter within a timeframe that will not
 1244  cause benefits to be withheld from an eligible enrollee. The
 1245  following individuals may be subject to specific prosecution in
 1246  accordance with s. 414.39:
 1247         1. An applicant who obtains or attempts to obtain benefits
 1248  for a potential enrollee under the Healthy Florida program when
 1249  the applicant knows or should have known that the potential
 1250  enrollee does not qualify for the Healthy Florida program.
 1251         2. An individual who assists an applicant in obtaining or
 1252  attempting to obtain benefits for a potential enrollee under the
 1253  Healthy Florida program when the individual knows or should have
 1254  known that the potential enrollee does not qualify for the
 1255  Healthy Florida program.
 1256         (9) APPLICABILITY OF LAWS RELATING TO MEDICAID.—The
 1257  provisions of ss. 409.902, 409.9128, and 409.920 apply to the
 1258  administration of the Healthy Florida program.
 1259         (10) PROGRAM EVALUATION.—The corporation shall collect both
 1260  eligibility and enrollment data from program applicants and
 1261  enrollees as well as encounter and utilization data from all
 1262  contracted entities during the program term. The corporation
 1263  shall submit monthly enrollment reports to the President of the
 1264  Senate, the Speaker of the House of Representative, and the
 1265  Minority Leaders of the Senate and the House of Representatives.
 1266  The corporation shall submit an interim independent evaluation
 1267  of the Healthy Florida program to the presiding officers no
 1268  later than July 1, 2015, with annual evaluations due July 1 each
 1269  year thereafter. The evaluations must address, at a minimum,
 1270  application and enrollment trends and issues, utilization and
 1271  cost data, and customer satisfaction.
 1272         (11) PROGRAM EXPIRATION.—The Healthy Florida program shall
 1273  expire at the end of the state fiscal year in which any of these
 1274  conditions occur, whichever occurs first:
 1275         (a) The federal match contribution falls below 90 percent.
 1276         (b) The federal match contribution falls below the
 1277  increased FMAP for medical assistance for newly eligible
 1278  mandatory individuals as specified in the federal Patient
 1279  Protection and Affordable Care Act, Pub. L. No. 111-148, as
 1280  amended by the federal Health Care and Education Reconciliation
 1281  Act of 2010, Pub. L. No. 111-152.
 1282         (c) The federal match for the Healthy Florida program and
 1283  the Medicaid program are blended under federal law or regulation
 1284  in such a way that causes the overall federal contribution to
 1285  diminish when compared to separate, nonblended federal
 1286  contributions.
 1287         Section 16. The Florida Healthy Kids Corporation may make
 1288  changes to comply with the objections of the federal Department
 1289  of Health and Human Services to gain approval of the Healthy
 1290  Florida program in compliance with the federal Patient
 1291  Protection and Affordable Care Act, upon giving notice to the
 1292  Senate and the House of Representatives of the proposed changes.
 1293  If there is a conflict between a provision in this section and
 1294  the federal Patient Protection and Affordable Care Act, Pub. L.
 1295  No. 111-148, as amended by the federal Health Care and Education
 1296  Reconciliation Act of 2010, Pub. L. No. 111-152, the provision
 1297  must be interpreted and applied so as to comply with the
 1298  requirement of the federal law.
 1299         Section 17. Section 627.6474, Florida Statutes, is amended
 1300  to read:
 1301         627.6474 Provider contracts.—
 1302         (1) A health insurer may shall not require a contracted
 1303  health care practitioner as defined in s. 456.001(4) to accept
 1304  the terms of other health care practitioner contracts with the
 1305  insurer or any other insurer, or health maintenance
 1306  organization, under common management and control with the
 1307  insurer, including Medicare and Medicaid practitioner contracts
 1308  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
 1309  s. 641.315, except for a practitioner in a group practice as
 1310  defined in s. 456.053 who must accept the terms of a contract
 1311  negotiated for the practitioner by the group, as a condition of
 1312  continuation or renewal of the contract. Any contract provision
 1313  that violates this section is void. A violation of this
 1314  subsection section is not subject to the criminal penalty
 1315  specified in s. 624.15.
 1316         (2)(a) A contract between a health insurer and a dentist
 1317  licensed under chapter 466 for the provision of services to an
 1318  insured may not contain any provision that requires the dentist
 1319  to provide services to the insured under such contract at a fee
 1320  set by the health insurer unless such services are covered
 1321  services under the applicable contract.
 1322         (b) Covered services are those services that are listed as
 1323  a benefit that the insured is entitled to receive under the
 1324  contract. An insurer may not provide merely de minimis
 1325  reimbursement or coverage in order to avoid the requirements of
 1326  this section. Fees for covered services shall be set in good
 1327  faith and must not be nominal.
 1328         (c) A health insurer may not require as a condition of the
 1329  contract that the dentist participate in a discount medical plan
 1330  under part II of chapter 636.
 1331         Section 18. Subsection (13) is added to section 636.035,
 1332  Florida Statutes, to read:
 1333         636.035 Provider arrangements.—
 1334         (13)(a) A contract between a prepaid limited health service
 1335  organization and a dentist licensed under chapter 466 for the
 1336  provision of services to a subscriber of the prepaid limited
 1337  health service organization may not contain any provision that
 1338  requires the dentist to provide services to the subscriber of
 1339  the prepaid limited health service organization at a fee set by
 1340  the prepaid limited health service organization unless such
 1341  services are covered services under the applicable contract.
 1342         (b) Covered services are those services that are listed as
 1343  a benefit that the subscriber is entitled to receive under the
 1344  contract. A prepaid limited health service organization may not
 1345  provide merely de minimis reimbursement or coverage in order to
 1346  avoid the requirements of this section. Fees for covered
 1347  services shall be set in good faith and must not be nominal.
 1348         (c) A prepaid limited health service organization may not
 1349  require as a condition of the contract that the dentist
 1350  participate in a discount medical plan under part II of this
 1351  chapter.
 1352         Section 19. Subsection (11) is added to section 641.315,
 1353  Florida Statutes, to read:
 1354         641.315 Provider contracts.—
 1355         (11)(a) A contract between a health maintenance
 1356  organization and a dentist licensed under chapter 466 for the
 1357  provision of services to a subscriber of the health maintenance
 1358  organization may not contain any provision that requires the
 1359  dentist to provide services to the subscriber of the health
 1360  maintenance organization at a fee set by the health maintenance
 1361  organization unless such services are covered services under the
 1362  applicable contract.
 1363         (b) Covered services are those services that are listed as
 1364  a benefit that the subscriber is entitled to receive under the
 1365  contract. A health maintenance organization may not provide
 1366  merely de minimis reimbursement or coverage in order to avoid
 1367  the requirements of this section. Fees for covered services
 1368  shall be set in good faith and must not be nominal.
 1369         (c) A health maintenance organization may not require as a
 1370  condition of the contract that the dentist participate in a
 1371  discount medical plan under part II of chapter 636.
 1372         Section 20. Paragraph (a) of subsection (3) of section
 1373  766.1115, Florida Statutes, is amended, and paragraph (h) is
 1374  added to subsection (4) of that section, to read:
 1375         766.1115 Health care providers; creation of agency
 1376  relationship with governmental contractors.—
 1377         (3) DEFINITIONS.—As used in this section, the term:
 1378         (a) “Contract” means an agreement executed in compliance
 1379  with this section between a health care provider and a
 1380  governmental contractor which allows. This contract shall allow
 1381  the health care provider to deliver health care services to low
 1382  income recipients as an agent of the governmental contractor.
 1383  The contract must be for volunteer, uncompensated services. For
 1384  services to qualify as volunteer, uncompensated services under
 1385  this section, the health care provider must receive no
 1386  compensation from the governmental contractor for any services
 1387  provided under the contract and must not bill or accept
 1388  compensation from the recipient, or a any public or private
 1389  third-party payor, for the specific services provided to the
 1390  low-income recipients covered by the contract.
 1391         (4) CONTRACT REQUIREMENTS.—A health care provider that
 1392  executes a contract with a governmental contractor to deliver
 1393  health care services on or after April 17, 1992, as an agent of
 1394  the governmental contractor is an agent for purposes of s.
 1395  768.28(9), while acting within the scope of duties under the
 1396  contract, if the contract complies with the requirements of this
 1397  section and regardless of whether the individual treated is
 1398  later found to be ineligible. A health care provider under
 1399  contract with the state may not be named as a defendant in any
 1400  action arising out of medical care or treatment provided on or
 1401  after April 17, 1992, under contracts entered into under this
 1402  section. The contract must provide that:
 1403         (h) As an agent of the governmental contractor for purposes
 1404  of s. 768.28(9), while acting within the scope of duties under
 1405  the contract, a health care provider licensed under chapter 466
 1406  may allow a patient or a parent or guardian of the patient to
 1407  voluntarily contribute a fee to cover costs of dental laboratory
 1408  work related to the services provided to the patient. This
 1409  contribution may not exceed the actual cost of the dental
 1410  laboratory charges and is deemed in compliance with this
 1411  section.
 1412  
 1413  A governmental contractor that is also a health care provider is
 1414  not required to enter into a contract under this section with
 1415  respect to the health care services delivered by its employees.
 1416         Section 21. The amendments to ss. 627.6474, 636.035, and
 1417  641.315, Florida Statutes, apply to contracts entered into or
 1418  renewed on or after July 1, 2013.
 1419         Section 22. (1) The sum of $1,258,054,808 from the Medical
 1420  Care Trust Fund is appropriated to the Agency for Health Care
 1421  Administration beginning in the 2013-2014 fiscal year to provide
 1422  coverage for individuals who enroll in the Healthy Florida
 1423  program.
 1424         (2) The sum of $254,151 from the General Revenue Fund and
 1425  $18,235,833 from the Medical Care Trust Fund is appropriated to
 1426  the Agency for Health Care Administration beginning in the 2013
 1427  2014 fiscal year to comply with federal regulations to
 1428  compensate insurers and managed care organizations that contract
 1429  with the Healthy Florida program for the imposition of the
 1430  annual fee on health insurance providers under section 9010 of
 1431  the federal Patient Protection and Affordable Care Act, Pub. L.
 1432  No. 111-148, as amended by the federal Health Care and Education
 1433  Reconciliation Act of 2010, Pub. L. No. 111-152.
 1434         (3) The sum of $10,676,377 from the General Revenue Fund
 1435  and $10,676,377 from the Medical Care Trust Fund is appropriated
 1436  beginning in the 2013-2014 fiscal year to the Agency for Health
 1437  Care Administration to contract with the Florida Healthy Kids
 1438  Corporation under s. 409.818(2)(f), Florida Statutes, to fund
 1439  administrative costs necessary for implementing and operating
 1440  the Healthy Florida program.
 1441         (4) The Agency for Health Care Administration may submit
 1442  budget amendments to the Legislative Budget Commission pursuant
 1443  to chapter 216, Florida Statutes, to fund the Healthy Florida
 1444  program for the coverage of children who transfer from the
 1445  Florida Kidcare Program to the Healthy Florida program, or to
 1446  provide additional spending authority from the Medical Care
 1447  Trust Fund under subsection (1) for the coverage of individuals
 1448  who enroll in the Healthy Florida program, during the 2013-2014
 1449  fiscal year.
 1450         Section 23. This act shall take effect upon becoming a law.
 1451  
 1452  ================= T I T L E  A M E N D M E N T ================
 1453         And the title is amended as follows:
 1454         Delete everything before the enacting clause
 1455  and insert:
 1456                        A bill to be entitled                      
 1457         An act relating to health care; amending s. 409.811,
 1458         F.S.; revising and providing definitions; amending s.
 1459         409.813, F.S.; revising the components of the Florida
 1460         Kidcare program; prohibiting a cause of action from
 1461         arising against the Florida Healthy Kids Corporation
 1462         for failure to make health services available;
 1463         amending s. 409.8132, F.S.; revising the eligibility
 1464         of the Medikids program component; revising the
 1465         enrollment requirements of the Medikids program
 1466         component; amending s. 409.8134, F.S.; conforming
 1467         provisions to changes made by the act; amending s.
 1468         409.814, F.S.; revising eligibility requirements for
 1469         the Florida Kidcare program; amending s. 409.815,
 1470         F.S.; revising the minimum health benefits coverage
 1471         under the Florida Kidcare Act; deleting obsolete
 1472         provisions; amending ss. 409.816 and 409.8177, F.S.;
 1473         conforming provisions to changes made by the act;
 1474         repealing s. 409.817, F.S., relating to the approval
 1475         of health benefits coverage and financial assistance;
 1476         repealing s. 409.8175, F.S., relating to delivery of
 1477         services in rural counties; amending s. 409.818, F.S.;
 1478         revising the duties of the Department of Children and
 1479         Families and the Agency for Health Care Administration
 1480         with regard to the Florida Kidcare Act; deleting the
 1481         duties of the Department of Health and the Office of
 1482         Insurance Regulation with regard to the Florida
 1483         Kidcare Act; amending s. 409.820, F.S.; requiring the
 1484         Department of Health, in consultation with the agency
 1485         and the Florida Healthy Kids Corporation, to develop a
 1486         minimum set of pediatric and adolescent quality
 1487         assurance and access standards for all program
 1488         components; amending s. 624.91, F.S.; revising the
 1489         legislative intent of the Florida Healthy Kids
 1490         Corporation Act to include the Healthy Florida
 1491         program; revising participation guidelines for
 1492         nonsubsidized enrollees in the Healthy Florida
 1493         program; revising the medical loss ratio requirements
 1494         for the contracts for the Florida Healthy Kids
 1495         Corporation; modifying the membership of the Florida
 1496         Healthy Kids Corporation’s board of directors;
 1497         creating an executive steering committee; requiring
 1498         additional corporate compliance requirements for the
 1499         Florida Healthy Kids Corporation; repealing s.
 1500         624.915, F.S., relating to the operating fund of the
 1501         Florida Healthy Kids Corporation; creating s. 624.917,
 1502         F.S.; creating the Healthy Florida program; providing
 1503         definitions; providing eligibility and enrollment
 1504         requirements; authorizing the Florida Healthy Kids
 1505         Corporation to contract with certain insurers, managed
 1506         care organizations, and provider service networks;
 1507         encouraging the corporation to contract with insurers
 1508         and managed care organizations that participate in
 1509         more than one insurance affordability program under
 1510         certain circumstances; requiring the corporation to
 1511         establish a benefits package and a process for payment
 1512         of services; authorizing the corporation to collect
 1513         premiums and copayments; requiring the corporation to
 1514         oversee the Healthy Florida program and to establish a
 1515         grievance process and integrity process; providing
 1516         applicability of certain state laws for administration
 1517         of the Healthy Florida program; requiring the
 1518         corporation to collect certain data and to submit
 1519         enrollment reports and interim independent evaluations
 1520         to the Legislature; providing for expiration of the
 1521         program; providing an implementation and
 1522         interpretation clause; amending s. 627.6474, F.S.;
 1523         prohibiting a contract between a health insurer and a
 1524         dentist from requiring the dentist to provide services
 1525         at a fee set by the insurer under certain
 1526         circumstances; providing that covered services are
 1527         those services listed as a benefit that the insured is
 1528         entitled to receive under a contract; prohibiting an
 1529         insurer from providing merely de minimis reimbursement
 1530         or coverage; requiring that fees for covered services
 1531         be set in good faith and not be nominal; prohibiting a
 1532         health insurer from requiring as a condition of a
 1533         contract that a dentist participate in a discount
 1534         medical plan; amending s. 636.035, F.S.; prohibiting a
 1535         contract between a prepaid limited health service
 1536         organization and a dentist from requiring the dentist
 1537         to provide services at a fee set by the organization
 1538         under certain circumstances; providing that covered
 1539         services are those services listed as a benefit that a
 1540         subscriber of a prepaid limited health service
 1541         organization is entitled to receive under a contract;
 1542         prohibiting a prepaid limited health service
 1543         organization from providing merely de minimis
 1544         reimbursement or coverage; requiring that fees for
 1545         covered services be set in good faith and not be
 1546         nominal; prohibiting the prepaid limited health
 1547         service organization from requiring as a condition of
 1548         a contract that a dentist participate in a discount
 1549         medical plan; amending s. 641.315, F.S.; prohibiting a
 1550         contract between a health maintenance organization and
 1551         a dentist from requiring the dentist to provide
 1552         services at a fee set by the organization under
 1553         certain circumstances; providing that covered services
 1554         are those services listed as a benefit that a
 1555         subscriber of a health maintenance organization is
 1556         entitled to receive under a contract; prohibiting a
 1557         health maintenance organization from providing merely
 1558         de minimis reimbursement or coverage; requiring that
 1559         fees for covered services be set in good faith and not
 1560         be nominal; prohibiting the health maintenance
 1561         organization from requiring as a condition of a
 1562         contract that a dentist participate in a discount
 1563         medical plan; amending s. 766.1115, F.S.; revising a
 1564         definition; requiring a contract with a governmental
 1565         contractor for health care services to include a
 1566         provision for a health care provider licensed under
 1567         ch. 466, F.S., as an agent of the governmental
 1568         contractor, to allow a patient or a parent or guardian
 1569         of the patient to voluntarily contribute a fee to
 1570         cover costs of dental laboratory work related to the
 1571         services provided to the patient without forfeiting
 1572         sovereign immunity; prohibiting the contribution from
 1573         exceeding the actual amount of the dental laboratory
 1574         charges; providing that the contribution complies with
 1575         the requirements of s. 766.1115, F.S.; providing for
 1576         applicability; providing appropriations; providing an
 1577         effective date.