HB 1423

CS

CHAMBER ACTION

1	The Future of Florida's Families Committee recommends the
2	following:
3
4	Council/Committee Substitute
5	Remove the entire bill and insert:
6	A bill to be entitled
7	An act relating to children's health insurance; creating
8	s. 409.8195, F.S.; requiring the Department of Health to
9	develop a program to identify certain children for
10	referral to the Department of Children and Family Services
11	for certain eligibility and choices of health benefits
12	coverage under the Florida KidCare program; providing
13	program requirements and criteria; amending s. 409.908,
14	F.S.; requiring the Agency for Health Care Administration
15	to provide reimbursement for physician and dental services
16	at certain levels; requiring the agency to provide
17	reimbursement for dental services at certain rates;
18	amending s. 624.91, F.S.; authorizing the Florida Healthy
19	Kids Corporation to enter into contracts for certain
20	purposes; providing an effective date.
21
22	Be It Enacted by the Legislature of the State of Florida:
23
24	Section 1.  Section 409.8195, Florida Statutes, is created
25	to read:
26	409.8195  Identification of low-income, uninsured children;
27	determination of eligibility for the Florida KidCare program;
28	alternative health care information.--The Department of Health
29	shall develop a program, in conjunction with the Department of
30	Education, the Department of Children and Family Services, the
31	Agency for Health Care Administration, the Florida Healthy Kids
32	Corporation, local governments, employers, and other
33	stakeholders to identify low-income, uninsured children and, to
34	the extent possible and subject to appropriation, refer them to
35	the Department of Children and Family Services for eligibility
36	determination and provide parents with information about choices
37	of health benefits coverage under the Florida KidCare program.
38	These activities shall include, but not be limited to: training
39	community providers in effective methods of outreach; conducting
40	public information campaigns designed to publicize the Florida
41	KidCare program, the eligibility requirements of the program,
42	and the procedures for enrollment in the program; and
43	maintaining public awareness of the Florida KidCare program.
44	Special emphasis shall be placed on the identification of
45	minority children for referral to and participation in the
46	Florida KidCare program.
47	Section 2.  Paragraph (d) is added to subsection (12) of
48	section 409.908, Florida Statutes, to read:
49	409.908  Reimbursement of Medicaid providers.--Subject to
50	specific appropriations, the agency shall reimburse Medicaid
51	providers, in accordance with state and federal law, according
52	to methodologies set forth in the rules of the agency and in
53	policy manuals and handbooks incorporated by reference therein.
54	These methodologies may include fee schedules, reimbursement
55	methods based on cost reporting, negotiated fees, competitive
56	bidding pursuant to s. 287.057, and other mechanisms the agency
57	considers efficient and effective for purchasing services or
58	goods on behalf of recipients. If a provider is reimbursed based
59	on cost reporting and submits a cost report late and that cost
60	report would have been used to set a lower reimbursement rate
61	for a rate semester, then the provider's rate for that semester
62	shall be retroactively calculated using the new cost report, and
63	full payment at the recalculated rate shall be effected
64	retroactively. Medicare-granted extensions for filing cost
65	reports, if applicable, shall also apply to Medicaid cost
66	reports. Payment for Medicaid compensable services made on
67	behalf of Medicaid eligible persons is subject to the
68	availability of moneys and any limitations or directions
69	provided for in the General Appropriations Act or chapter 216.
70	Further, nothing in this section shall be construed to prevent
71	or limit the agency from adjusting fees, reimbursement rates,
72	lengths of stay, number of visits, or number of services, or
73	making any other adjustments necessary to comply with the
74	availability of moneys and any limitations or directions
75	provided for in the General Appropriations Act, provided the
76	adjustment is consistent with legislative intent.
77	(12)
78	(d)  Notwithstanding any other provision of this
79	subsection, the agency shall provide reimbursement for physician
80	and dental services provided to children under 21 years of age
81	at least at the level provided by federal law for physician
82	reimbursement under the Medicare program and provide
83	reimbursement for dental services at 50 percent of usual and
84	customary rates provided for dental services.
85	Section 3.  Paragraph (b) of subsection (5) of section
86	624.91, Florida Statutes, is amended to read:
87	624.91  The Florida Healthy Kids Corporation Act.--
88	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
89	(b)  The Florida Healthy Kids Corporation shall:
90	1.  Arrange for the collection of any family, local
91	contributions, or employer payment or premium, in an amount to
92	be determined by the board of directors, to provide for payment
93	of premiums for comprehensive insurance coverage and for the
94	actual or estimated administrative expenses.
95	2.  Arrange for the collection of any voluntary
96	contributions to provide for payment of premiums for children
97	who are not eligible for medical assistance under Title XXI of
98	the Social Security Act. Each fiscal year, the corporation shall
99	establish a local match policy for the enrollment of non-Title-
100	XXI-eligible children in the Healthy Kids program. By May 1 of
101	each year, the corporation shall provide written notification of
102	the amount to be remitted to the corporation for the following
103	fiscal year under that policy. Local match sources may include,
104	but are not limited to, funds provided by municipalities,
105	counties, school boards, hospitals, health care providers,
106	charitable organizations, special taxing districts, and private
107	organizations. The minimum local match cash contributions
108	required each fiscal year and local match credits shall be
109	determined by the General Appropriations Act. The corporation
110	shall calculate a county's local match rate based upon that
111	county's percentage of the state's total non-Title-XXI
112	expenditures as reported in the corporation's most recently
113	audited financial statement. In awarding the local match
114	credits, the corporation may consider factors including, but not
115	limited to, population density, per capita income, and existing
116	child-health-related expenditures and services.
117	3.  Subject to the provisions of s. 409.8134, accept
118	voluntary supplemental local match contributions that comply
119	with the requirements of Title XXI of the Social Security Act
120	for the purpose of providing additional coverage in contributing
121	counties under Title XXI.
122	4.  Establish the administrative and accounting procedures
123	for the operation of the corporation.
124	5.  Establish, with consultation from appropriate
125	professional organizations, standards for preventive health
126	services and providers and comprehensive insurance benefits
127	appropriate to children, provided that such standards for rural
128	areas shall not limit primary care providers to board-certified
129	pediatricians.
130	6.  Determine eligibility for children seeking to
131	participate in the Title XXI-funded components of the Florida
132	KidCare program consistent with the requirements specified in s.
133	409.814, as well as the non-Title-XXI-eligible children as
134	provided in subsection (3).
135	7.  Establish procedures under which providers of local
136	match to, applicants to and participants in the program may have
137	grievances reviewed by an impartial body and reported to the
138	board of directors of the corporation.
139	8.  Establish participation criteria and, if appropriate,
140	contract with an authorized insurer, health maintenance
141	organization, or third-party administrator to provide
142	administrative services to the corporation.
143	9.  Establish enrollment criteria which shall include
144	penalties or waiting periods of not fewer than 60 days for
145	reinstatement of coverage upon voluntary cancellation for
146	nonpayment of family premiums.
147	10.  Contract with authorized insurers or any provider of
148	health care services, meeting standards established by the
149	corporation, for the provision of comprehensive insurance
150	coverage to participants. Such standards shall include criteria
151	under which the corporation may contract with more than one
152	provider of health care services in program sites. Health plans
153	shall be selected through a competitive bid process. The Florida
154	Healthy Kids Corporation shall purchase goods and services in
155	the most cost-effective manner consistent with the delivery of
156	quality medical care. The maximum administrative cost for a
157	Florida Healthy Kids Corporation contract shall be 15 percent.
158	For health care contracts, the minimum medical loss ratio for a
159	Florida Healthy Kids Corporation contract shall be 85 percent.
160	For dental contracts, the remaining compensation to be paid to
161	the authorized insurer or provider under a Florida Healthy Kids
162	Corporation contract shall be no less than an amount which is 85
163	percent of premium; to the extent any contract provision does
164	not provide for this minimum compensation, this section shall
165	prevail. The health plan selection criteria and scoring system,
166	and the scoring results, shall be available upon request for
167	inspection after the bids have been awarded.
168	11.  Establish disenrollment criteria in the event local
169	matching funds are insufficient to cover enrollments.
170	12.  Develop and implement a plan to publicize the Florida
171	Healthy Kids Corporation, the eligibility requirements of the
172	program, and the procedures for enrollment in the program and to
173	maintain public awareness of the corporation and the program.
174	13.  Secure staff necessary to properly administer the
175	corporation. Staff costs shall be funded from state and local
176	matching funds and such other private or public funds as become
177	available. The board of directors shall determine the number of
178	staff members necessary to administer the corporation.
179	14.  Provide a report annually to the Governor, Chief
180	Financial Officer, Commissioner of Education, Senate President,
181	Speaker of the House of Representatives, and Minority Leaders of
182	the Senate and the House of Representatives.
183	15.  Establish benefit packages which conform to the
184	provisions of the Florida KidCare program, as created in ss.
185	409.810-409.820.
186	16.  As appropriate, enter into contracts with local school
187	boards or other agencies to provide onsite information,
188	enrollment, and other services necessary to the operation of the
189	corporation.
190	Section 4.  This act shall take effect July 1, 2006.

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