HB 1423

1	A bill to be entitled
2	An act relating to children's health insurance; creating
3	s. 409.8195, F.S.; requiring the Department of Health to
4	develop a program to identify certain children for
5	referral to the Department of Children and Family Services
6	for certain eligibility and choices of health benefits
7	coverage under the Florida KidCare program; providing
8	program requirements and criteria; amending s. 409.908,
9	F.S.; requiring the Agency for Health Care Administration
10	to provide reimbursement for physician and dental services
11	at certain levels; amending s. 624.91, F.S.; authorizing
12	the Florida Healthy Kids Corporation to enter into
13	contracts for certain purposes; providing an effective
14	date.
15
16	Be It Enacted by the Legislature of the State of Florida:
17
18	Section 1.  Section 409.8195, Florida Statutes, is created
19	to read:
20	409.8195  Identification of low-income, uninsured children;
21	determination of eligibility for the Florida KidCare program;
22	alternative health care information.--The Department of Health
23	shall develop a program, in conjunction with the Department of
24	Education, the Department of Children and Family Services, the
25	Agency for Health Care Administration, the Florida Healthy Kids
26	Corporation, local governments, employers, and other
27	stakeholders to identify low-income, uninsured children and, to
28	the extent possible and subject to appropriation, refer them to
29	the Department of Children and Family Services for eligibility
30	determination and provide parents with information about choices
31	of health benefits coverage under the Florida KidCare program.
32	These activities shall include, but not be limited to: training
33	community providers in effective methods of outreach; conducting
34	public information campaigns designed to publicize the Florida
35	KidCare program, the eligibility requirements of the program,
36	and the procedures for enrollment in the program; and
37	maintaining public awareness of the Florida KidCare program.
38	Special emphasis shall be placed on the identification of
39	minority children for referral to and participation in the
40	Florida KidCare program.
41	Section 2.  Paragraph (d) is added to subsection (12) of
42	section 409.908, Florida Statutes, to read:
43	409.908  Reimbursement of Medicaid providers.--Subject to
44	specific appropriations, the agency shall reimburse Medicaid
45	providers, in accordance with state and federal law, according
46	to methodologies set forth in the rules of the agency and in
47	policy manuals and handbooks incorporated by reference therein.
48	These methodologies may include fee schedules, reimbursement
49	methods based on cost reporting, negotiated fees, competitive
50	bidding pursuant to s. 287.057, and other mechanisms the agency
51	considers efficient and effective for purchasing services or
52	goods on behalf of recipients. If a provider is reimbursed based
53	on cost reporting and submits a cost report late and that cost
54	report would have been used to set a lower reimbursement rate
55	for a rate semester, then the provider's rate for that semester
56	shall be retroactively calculated using the new cost report, and
57	full payment at the recalculated rate shall be effected
58	retroactively. Medicare-granted extensions for filing cost
59	reports, if applicable, shall also apply to Medicaid cost
60	reports. Payment for Medicaid compensable services made on
61	behalf of Medicaid eligible persons is subject to the
62	availability of moneys and any limitations or directions
63	provided for in the General Appropriations Act or chapter 216.
64	Further, nothing in this section shall be construed to prevent
65	or limit the agency from adjusting fees, reimbursement rates,
66	lengths of stay, number of visits, or number of services, or
67	making any other adjustments necessary to comply with the
68	availability of moneys and any limitations or directions
69	provided for in the General Appropriations Act, provided the
70	adjustment is consistent with legislative intent.
71	(12)
72	(d)  Notwithstanding any other provision of this
73	subsection, the agency shall provide reimbursement for physician
74	and dental services provided to children under 21 years of age
75	at least at the level provided by federal law for physician
76	reimbursement under the Medicare program.
77	Section 3.  Paragraph (b) of subsection (5) of section
78	624.91, Florida Statutes, is amended to read:
79	624.91  The Florida Healthy Kids Corporation Act.--
80	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
81	(b)  The Florida Healthy Kids Corporation shall:
82	1.  Arrange for the collection of any family, local
83	contributions, or employer payment or premium, in an amount to
84	be determined by the board of directors, to provide for payment
85	of premiums for comprehensive insurance coverage and for the
86	actual or estimated administrative expenses.
87	2.  Arrange for the collection of any voluntary
88	contributions to provide for payment of premiums for children
89	who are not eligible for medical assistance under Title XXI of
90	the Social Security Act. Each fiscal year, the corporation shall
91	establish a local match policy for the enrollment of non-Title-
92	XXI-eligible children in the Healthy Kids program. By May 1 of
93	each year, the corporation shall provide written notification of
94	the amount to be remitted to the corporation for the following
95	fiscal year under that policy. Local match sources may include,
96	but are not limited to, funds provided by municipalities,
97	counties, school boards, hospitals, health care providers,
98	charitable organizations, special taxing districts, and private
99	organizations. The minimum local match cash contributions
100	required each fiscal year and local match credits shall be
101	determined by the General Appropriations Act. The corporation
102	shall calculate a county's local match rate based upon that
103	county's percentage of the state's total non-Title-XXI
104	expenditures as reported in the corporation's most recently
105	audited financial statement. In awarding the local match
106	credits, the corporation may consider factors including, but not
107	limited to, population density, per capita income, and existing
108	child-health-related expenditures and services.
109	3.  Subject to the provisions of s. 409.8134, accept
110	voluntary supplemental local match contributions that comply
111	with the requirements of Title XXI of the Social Security Act
112	for the purpose of providing additional coverage in contributing
113	counties under Title XXI.
114	4.  Establish the administrative and accounting procedures
115	for the operation of the corporation.
116	5.  Establish, with consultation from appropriate
117	professional organizations, standards for preventive health
118	services and providers and comprehensive insurance benefits
119	appropriate to children, provided that such standards for rural
120	areas shall not limit primary care providers to board-certified
121	pediatricians.
122	6.  Determine eligibility for children seeking to
123	participate in the Title XXI-funded components of the Florida
124	KidCare program consistent with the requirements specified in s.
125	409.814, as well as the non-Title-XXI-eligible children as
126	provided in subsection (3).
127	7.  Establish procedures under which providers of local
128	match to, applicants to and participants in the program may have
129	grievances reviewed by an impartial body and reported to the
130	board of directors of the corporation.
131	8.  Establish participation criteria and, if appropriate,
132	contract with an authorized insurer, health maintenance
133	organization, or third-party administrator to provide
134	administrative services to the corporation.
135	9.  Establish enrollment criteria which shall include
136	penalties or waiting periods of not fewer than 60 days for
137	reinstatement of coverage upon voluntary cancellation for
138	nonpayment of family premiums.
139	10.  Contract with authorized insurers or any provider of
140	health care services, meeting standards established by the
141	corporation, for the provision of comprehensive insurance
142	coverage to participants. Such standards shall include criteria
143	under which the corporation may contract with more than one
144	provider of health care services in program sites. Health plans
145	shall be selected through a competitive bid process. The Florida
146	Healthy Kids Corporation shall purchase goods and services in
147	the most cost-effective manner consistent with the delivery of
148	quality medical care. The maximum administrative cost for a
149	Florida Healthy Kids Corporation contract shall be 15 percent.
150	For health care contracts, the minimum medical loss ratio for a
151	Florida Healthy Kids Corporation contract shall be 85 percent.
152	For dental contracts, the remaining compensation to be paid to
153	the authorized insurer or provider under a Florida Healthy Kids
154	Corporation contract shall be no less than an amount which is 85
155	percent of premium; to the extent any contract provision does
156	not provide for this minimum compensation, this section shall
157	prevail. The health plan selection criteria and scoring system,
158	and the scoring results, shall be available upon request for
159	inspection after the bids have been awarded.
160	11.  Establish disenrollment criteria in the event local
161	matching funds are insufficient to cover enrollments.
162	12.  Develop and implement a plan to publicize the Florida
163	Healthy Kids Corporation, the eligibility requirements of the
164	program, and the procedures for enrollment in the program and to
165	maintain public awareness of the corporation and the program.
166	13.  Secure staff necessary to properly administer the
167	corporation. Staff costs shall be funded from state and local
168	matching funds and such other private or public funds as become
169	available. The board of directors shall determine the number of
170	staff members necessary to administer the corporation.
171	14.  Provide a report annually to the Governor, Chief
172	Financial Officer, Commissioner of Education, Senate President,
173	Speaker of the House of Representatives, and Minority Leaders of
174	the Senate and the House of Representatives.
175	15.  Establish benefit packages which conform to the
176	provisions of the Florida KidCare program, as created in ss.
177	409.810-409.820.
178	16.  As appropriate, enter into contracts with local school
179	boards or other agencies to provide onsite information,
180	enrollment, and other services necessary to the operation of the
181	corporation.
182	Section 4.  This act shall take effect July 1, 2006.

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