HB 1173

1	A bill to be entitled
2	An act relating to medical assistance; amending s.
3	409.811, F.S.; revising, providing, and deleting
4	definitions; amending s. 409.812, F.S.; expanding
5	application of the Florida Kidcare program to include all
6	uninsured, low-income children; amending s. 409.813, F.S.;
7	specifying funding sources for health benefits coverage
8	for certain children; specifying certain program
9	components to be marketed as the Florida Kidcare program;
10	amending s. 409.8132, F.S.; conforming a cross-reference;
11	removing certain restrictions on enrollment in Medipass
12	under the Medikids program component; revising provisions
13	relating to penalties for nonpayment of premiums and
14	waiting periods for reinstatement of coverage; amending s.
15	409.8134, F.S.; revising provisions relating to enrollment
16	in the Florida Kidcare program; amending s. 409.814, F.S.;
17	requiring certain screening prior to enrollment in Florida
18	Kidcare Plus; removing a restriction on participation in
19	the Florida Healthy Kids program; revising Florida Kidcare
20	program eligibility criteria; revising limitations on
21	coverage; restricting enrollment of children whose
22	coverage was voluntarily canceled; providing exceptions;
23	deleting provisions that place a limit on enrollment in
24	Medikids and the Florida Healthy Kids program; revising an
25	age limitation for Title XXI-funded Florida Kidcare
26	coverage; requiring notice to health plans and providers
27	when a child is no longer eligible for certain coverage;
28	requiring electronic verification of applicants' income;
29	providing circumstances under which written documentation
30	is required; extending the period of time during which an
31	enrollee in the Florida Kidcare program may contest a
32	determination of ineligibility; amending s. 409.815, F.S.;
33	revising requirements for qualification for benchmark
34	benefits; permitting the Agency for Health Care
35	Administration to increase certain premium assistance
36	payments for Florida Kidcare Plus benefits under certain
37	circumstances; amending s. 409.816, F.S.; revising
38	limitations on premiums and cost sharing; conforming a
39	cross-reference; amending s. 409.8177, F.S.; revising
40	information to be included in a report to the Governor and
41	Legislature; amending s. 409.818, F.S.; increasing the age
42	for eligibility for coverage under the Florida Kidcare
43	program under certain circumstances; revising duties of
44	the Department of Children and Family Services, the
45	Department of Health, the Florida Healthy Kids
46	Corporation, and the agency; requiring the Department of
47	Health to publicize the Florida Kidcare program; removing
48	a provision requiring establishment of a toll-free
49	telephone line; providing for adoption of rules; removing
50	a requirement that the Office of Insurance Regulation
51	certify that certain health benefits coverage plans that
52	seek to provide services under the Florida Kidcare program
53	meet, exceed, or are actuarially equivalent to the
54	benchmark benefit plan and will be offered at an approved
55	rate; authorizing the corporation to determine eligibility
56	of certain applicants for the Florida Kidcare program;
57	amending s. 409.820, F.S.; requiring the agency, the
58	Department of Health, and the corporation to develop
59	standards for quality assurance and program access for
60	Florida Kidcare program components; amending s. 409.821,
61	F.S., relating to the Florida Kidcare program public
62	records exemption; providing for disclosure of certain
63	confidential and exempt information relating to an
64	enrollee's application or coverage to an enrollee's parent
65	or legal guardian; amending s. 409.904, F.S.; authorizing
66	Medicaid reimbursement for medical assistance provided to
67	pregnant women and certain children under specified
68	circumstances; requiring the agency to submit a state plan
69	amendment to implement the federal Family Opportunity Act;
70	amending s. 624.91, F.S.; deleting requirements relating
71	to limitations on eligibility for certain state-funded
72	assistance for payment of Florida Healthy Kids premiums;
73	revising the duties of the corporation; revising
74	provisions relating to who is eligible for optional
75	medical and related services payments; providing an
76	effective date.
77
78	Be It Enacted by the Legislature of the State of Florida:
79
80	Section 1.  Subsections (6), (11), and (25) of section
81	409.811, Florida Statutes, are amended, present subsection (12)
82	is renumbered as subsection (11) and amended, and new
83	subsections (12) and (27) are added to that section, to read:
84	409.811  Definitions relating to Florida Kidcare Act.--As
85	used in ss. 409.810-409.820, the term:
86	(6)  "Child with special health care needs" has the same
87	meaning as in s. 391.021(2) means a child whose serious or
88	chronic physical or developmental condition requires extensive
89	preventive and maintenance care beyond that required by
90	typically healthy children. Health care utilization by such a
91	child exceeds the statistically expected usage of the normal
92	child adjusted for chronological age, and such a child often
93	needs complex care requiring multiple providers, rehabilitation
94	services, and specialized equipment in a number of different
95	settings.
96	(11)  "Family" means the group or the individuals whose
97	income is considered in determining eligibility for the Florida
98	Kidcare program. The family includes a child with a custodial
99	parent or caretaker relative who resides in the same house or
100	living unit or, in the case of a child whose disability of
101	nonage has been removed under chapter 743, the child. The family
102	may also include other individuals whose income and resources
103	are considered in whole or in part in determining eligibility of
104	the child.
105	(11)(12)  "Family income" means cash received at periodic
106	intervals from any source, such as wages, benefits,
107	contributions, or rental property. Family income is calculated
108	using the budget methodologies authorized under Title XIX of the
109	Social Security Act. Income also may include any money that
110	would have been counted as income under the Aid to Families with
111	Dependent Children (AFDC) state plan in effect prior to August
112	22, 1996.
113	(12)  "Florida Kidcare Plus" means health benefits coverage
114	for children with special health care needs delivered through
115	the Children's Medical Services Network.
116	(25)  "Rural county" means a county having a population
117	density of less than 100 persons per square mile, or a county
118	defined by the most recent United States Census as rural, in
119	which there is no prepaid health plan participating in the
120	Medicaid program as of July 1, 1998.
121	(27)  "Maximum income threshold" means a percentage of the
122	current federal poverty level used to determine eligibility for
123	certain program components, as approved by federal waiver or an
124	amendment to the state plan.
125	Section 2.  Section 409.812, Florida Statutes, is amended
126	to read:
127	409.812  Program created; purpose.--The Florida Kidcare
128	program is created to provide a defined set of health benefits
129	to previously uninsured, low-income children through the
130	establishment of a variety of affordable health benefits
131	coverage options from which families may select coverage and
132	through which families may contribute financially to the health
133	care of their children.
134	Section 3.  Section 409.813, Florida Statutes, is amended
135	to read:
136	409.813  Health benefits coverage; program components;
137	entitlement and nonentitlement.--
138	(1)  The Florida Kidcare program includes health benefits
139	coverage provided to children as follows:
140	(a)  For children with family incomes at or below the
141	applicable Medicaid eligibility level, health benefits coverage
142	is funded through Title XIX of the Social Security Act.
143	(b)  For children with family incomes above the applicable
144	Medicaid eligibility level up to the maximum income threshold,
145	health benefits coverage is funded through Title XXI of the
146	Social Security Act.
147	(c)  For children with family incomes above the maximum
148	income threshold, health benefits coverage is funded through
149	family premiums.
150	(d)  For children with special health care needs with
151	family incomes above the maximum income threshold, the family
152	shall be afforded the opportunity to buy into the Medicaid
153	program, pursuant to s. 409.904.
154	(2)  The Florida Kidcare program includes health benefits
155	coverage provided to children through the following program
156	components, which shall be marketed as the Florida Kidcare
157	program:
158	(a)(1)  Medicaid;
159	(b)(2)  Medikids as created in s. 409.8132;
160	(c)(3)  The Florida Healthy Kids Corporation as created in
161	s. 624.91;
162	(d)(4)  Employer-sponsored group health insurance plans
163	approved under ss. 409.810-409.820; and
164	(e)(5)  The Children's Medical Services network established
165	in chapter 391.
166	(3)  Except for Title XIX-funded Florida Kidcare coverage
167	under the Medicaid program, coverage under the Florida Kidcare
168	program is not an entitlement. No cause of action shall arise
169	against the state, the department, the Department of Children
170	and Family Services, or the agency for failure to make health
171	services available to any person under ss. 409.810-409.820.
172	Section 4.  Paragraph (b) of subsection (6) and subsections
173	(7) and (8) of section 409.8132, Florida Statutes, are amended
174	to read:
175	409.8132  Medikids program component.--
176	(6)  ELIGIBILITY.--
177	(b)  The provisions of s. 409.814(3), (4), and (5), and (7)
178	shall be applicable to the Medikids program.
179	(7)  ENROLLMENT.--Enrollment in the Medikids program
180	component may occur at any time throughout the year. A child may
181	not receive services under the Medikids program until the child
182	is enrolled in a managed care plan or MediPass. Once determined
183	eligible, an applicant may receive choice counseling and select
184	a managed care plan or MediPass. The agency may initiate
185	mandatory assignment for a Medikids applicant who has not chosen
186	a managed care plan or MediPass provider after the applicant's
187	voluntary choice period ends. An applicant may select MediPass
188	under the Medikids program component only in counties that have
189	fewer than two managed care plans available to serve Medicaid
190	recipients and only if the federal Health Care Financing
191	Administration determines that MediPass constitutes "health
192	insurance coverage" as defined in Title XXI of the Social
193	Security Act.
194	(8)  PENALTIES FOR VOLUNTARY CANCELLATION.--The agency
195	shall establish enrollment criteria that may must include
196	penalties or waiting periods of not more fewer than 30 60 days
197	for reinstatement of coverage upon voluntary cancellation for
198	nonpayment of premiums.
199	Section 5.  Section 409.8134, Florida Statutes, is amended
200	to read:
201	409.8134  Program expenditure ceiling; enrollment.--
202	(1)  Except for the Medicaid program, a ceiling shall be
203	placed on annual federal and state expenditures for the Florida
204	Kidcare program as provided each year in the General
205	Appropriations Act.
206	(2)  The Florida Kidcare program shall may conduct
207	enrollment continuously at any time throughout the year for the
208	purpose of enrolling children eligible for all program
209	components listed in s. 409.813 except Medicaid. The four
210	Florida Kidcare administrators shall work together to ensure
211	that the year-round enrollment period is announced statewide.
212	Eligible Children eligible for Title XXI-funded Florida Kidcare
213	coverage shall be enrolled on a first-come, first-served basis
214	using the date the enrollment application is received.
215	Enrollment shall immediately cease when the expenditure ceiling
216	is reached. Year-round enrollment shall only be held if the
217	Social Services Estimating Conference determines that sufficient
218	federal and state funds will be available to finance the
219	increased enrollment through federal fiscal year 2007. Any
220	individual who is not enrolled must reapply by submitting a new
221	application. The application for the Florida Kidcare program is
222	shall be valid for a period of 120 days after the date it was
223	received. At the end of the 120-day period, if the applicant has
224	not been enrolled in the program, the application is shall be
225	invalid and the applicant shall be notified of the action. The
226	applicant may reactivate resubmit the application after
227	notification of the action taken by the program. Except for the
228	Medicaid program, whenever the Social Services Estimating
229	Conference determines that there are presently, or will be by
230	the end of the current fiscal year, insufficient funds to
231	finance the current or projected enrollment in the Florida
232	Kidcare program, all additional enrollment must cease and
233	additional enrollment may not resume until sufficient funds are
234	available to finance such enrollment.
235	(3)  Upon determination by the Social Services Estimating
236	Conference that there are insufficient funds to finance the
237	current enrollment in the Florida Kidcare program within current
238	appropriations, the program shall initiate disenrollment
239	procedures to remove enrollees, except those children enrolled
240	in Florida Kidcare Plus the Children's Medical Services Network,
241	on a last-in, first-out basis until the expenditure and
242	appropriation levels are balanced.
243	(4)  The agencies that administer the Florida Kidcare
244	program components shall collect and analyze the data needed to
245	project program enrollment costs, including price level
246	adjustments, participation and attrition rates, current and
247	projected caseloads, the estimated number of children in the
248	state who are uninsured based on data from the most recent
249	United States Census, utilization, and current and projected
250	expenditures for the next 3 years. The agencies shall report
251	caseload and expenditure trends and estimated numbers of
252	uninsured children to the Social Services Estimating Conference
253	in accordance with chapter 216.
254	Section 6.  Section 409.814, Florida Statutes, is amended
255	to read:
256	409.814  Eligibility.--A child who has not reached 19 years
257	of age whose family income is equal to or below 200 percent of
258	the federal poverty level is eligible for the Florida Kidcare
259	program as provided in this section. For enrollment in Florida
260	Kidcare Plus the Children's Medical Services Network, a complete
261	application includes clinical eligibility the medical or
262	behavioral health screening. If, subsequently, an individual is
263	determined to be ineligible for coverage, he or she must
264	immediately be disenrolled from the respective Florida Kidcare
265	program component.
266	(1)  A child who is eligible for Medicaid coverage under s.
267	409.903 or s. 409.904 must be enrolled in Medicaid and is not
268	eligible to receive health benefits under any other health
269	benefits coverage authorized under the Florida Kidcare program.
270	(2)  A child who is not eligible for Medicaid, but who is
271	eligible for the Florida Kidcare program, may obtain health
272	benefits coverage under any of the other components listed in s.
273	409.813 if such coverage is approved and available in the county
274	in which the child resides. However, a child who is eligible for
275	Medikids may participate in the Florida Healthy Kids program
276	only if the child has a sibling participating in the Florida
277	Healthy Kids program and the child's county of residence permits
278	such enrollment.
279	(3)  A child who is eligible for the Florida Kidcare
280	program who is a child with special health care needs, as
281	determined through a clinical eligibility medical or behavioral
282	screening instrument, shall receive Florida Kidcare Plus is
283	eligible for health benefits coverage from and shall be referred
284	to the Children's Medical Services Network.
285	(4)  A child who becomes ineligible for Title XIX-funded
286	Florida Kidcare coverage due to exceeding income or age limits
287	shall have 60 days of continued eligibility following
288	redetermination before premium payments are required in order to
289	allow for a transition to Title XXI-funded Florida Kidcare
290	without a lapse in coverage.
291	(5)(4)  The following children are not eligible to receive
292	Title XXI-funded premium assistance for health benefits coverage
293	under the Florida Kidcare program, except under Medicaid if the
294	child would have been eligible for Medicaid under s. 409.903 or
295	s. 409.904 as of June 1, 1997:
296	(a)  A child who is eligible for coverage under a state
297	health benefit plan on the basis of a family member's employment
298	with a public agency in the state.
299	(b)  A child who is currently eligible for or covered under
300	a family member's group health benefit plan or under other
301	employer health insurance coverage, excluding coverage provided
302	under the Florida Healthy Kids Corporation as established under
303	s. 624.91, provided that the cost of the child's participation
304	is not greater than 5 percent of the family's income. This
305	provision shall be applied during redetermination for children
306	who were enrolled prior to July 1, 2004. These enrollees shall
307	have 6 months of eligibility following redetermination to allow
308	for a transition to the other health benefit plan.
309	(c)  A child who is seeking premium assistance for the
310	Florida Kidcare program through employer-sponsored group
311	coverage, if the child has been covered by the same employer's
312	group coverage during the 60 days 6 months prior to the family's
313	submitting an application for determination of eligibility under
314	the program.
315	(d)  A child who is an alien, but who does not meet the
316	definition of qualified alien, in the United States.
317	(e)  A child who is an inmate of a public institution or a
318	patient in an institution for mental diseases.
319	(f)  A child who has had his or her coverage in an
320	employer-sponsored health benefit plan or a private health
321	benefit plan voluntarily canceled in the last 60 days 6 months,
322	except those children whose coverage was voluntarily canceled
323	for good cause, including, but not limited to:
324	1.  The cost of participation in an employer-sponsored
325	health benefit plan is greater than 5 percent of the family's
326	income;
327	2.  The parent lost a job that provided an employer-
328	sponsored health benefit plan for children;
329	3.  The parent with health benefits coverage for the child
330	is deceased;
331	4.  The child has a medical condition that, without medical
332	care, would cause serious disability, loss of function, or
333	death;
334	5.  The employer of the parent canceled health benefits
335	coverage for children;
336	6. The child's health benefits coverage ended because the
337	child reached the maximum lifetime coverage amount;
338	7.  The child has exhausted coverage under a COBRA
339	continuation provision;
340	8.  The health benefits coverage does not cover the child's
341	health care needs; or
342	9.  Domestic violence led to loss of coverage who were on
343	the waiting list prior to March 12, 2004.
344	(g)  A child who is otherwise eligible for Kidcare and who
345	has a preexisting condition that prevents coverage under another
346	insurance plan as described in paragraph (b) which would have
347	disqualified the child for Kidcare if the child were able to
348	enroll in the plan shall be eligible for Kidcare coverage when
349	enrollment is possible.
350	(6)  Subject to a specific appropriation for this purpose,
351	the following children are eligible to receive nonfederal
352	premium assistance for health benefits coverage under the
353	Florida Kidcare program if the child would otherwise qualify:
354	(a)  A child who is eligible for coverage under a state
355	health benefit plan on the basis of a family member's employment
356	with a public agency in the state.
357	(b)  A child who is an alien, but who does not meet the
358	definition of a qualified alien, in the United States.
359	(7)(5)  A child whose family income is above 200 percent of
360	the federal poverty level or a child who is excluded under the
361	provisions of subsection (5) (4) may participate in the Florida
362	Kidcare program, provided that Medikids program as provided in
363	s. 409.8132 or, if the child is ineligible for Medikids by
364	reason of age, in the Florida Healthy Kids program, subject to
365	the following provisions:
366	(a)  the family is not eligible for premium assistance
367	payments and must pay the full cost of the premium, including
368	any administrative costs.
369	(b)  The agency is authorized to place limits on enrollment
370	in Medikids by these children in order to avoid adverse
371	selection. The number of children participating in Medikids
372	whose family income exceeds 200 percent of the federal poverty
373	level must not exceed 10 percent of total enrollees in the
374	Medikids program.
375	(c)  The board of directors of the Florida Healthy Kids
376	Corporation is authorized to place limits on enrollment of these
377	children in order to avoid adverse selection. In addition, the
378	board is authorized to offer a reduced benefit package to these
379	children in order to limit program costs for such families. The
380	number of children participating in the Florida Healthy Kids
381	program whose family income exceeds 200 percent of the federal
382	poverty level must not exceed 10 percent of total enrollees in
383	the Florida Healthy Kids program.
384	(8)(6)  Once a child is enrolled in the Florida Kidcare
385	program, the child is eligible for coverage under the program
386	for 12 months without a redetermination or reverification of
387	eligibility, if the family continues to pay the applicable
388	premium. Eligibility for Florida Kidcare coverage program
389	components funded through Title XXI of the Social Security Act
390	shall terminate when a child attains the age of 19. Effective
391	January 1, 1999, A child who has not attained the age of 19 5
392	and who has been determined eligible for the Medicaid program is
393	eligible for coverage for 12 months without a redetermination or
394	reverification of eligibility.
395	(9)(7)  When determining or reviewing a child's eligibility
396	under the Florida Kidcare program, the applicant shall be
397	provided with reasonable notice of changes in eligibility which
398	may affect enrollment in one or more of the program components.
399	When a transition from one program component to another is
400	authorized, there shall be cooperation between the program
401	components, and the affected family, the child's health plan,
402	and providers that which promotes continuity of health care
403	coverage. When a child is no longer eligible for Florida Kidcare
404	coverage funded through Title XIX or Title XXI of the Social
405	Security Act, the child's health plan and other providers shall
406	be notified so that the health plans and providers may assist
407	the family in maintaining continuous coverage in the Florida
408	Kidcare program. Any authorized transfers must be managed within
409	the program's overall appropriated or authorized levels of
410	funding. Each component of the program shall establish a reserve
411	to ensure that transfers between components will be accomplished
412	within current year appropriations. These reserves shall be
413	reviewed by each convening of the Social Services Estimating
414	Conference to determine the adequacy of such reserves to meet
415	actual experience.
416	(10)(8)  In determining the eligibility of a child, an
417	assets test is not required. During the application process and
418	the redetermination process:
419	(a)  Each applicant's family income shall be verified
420	electronically to determine financial eligibility for the
421	Florida Kidcare program. Written documentation, which may
422	include wages and earning statements (pay stubs), W-2 forms, or
423	a copy of the applicant's most recent federal income tax return,
424	shall be required only if the electronic verification does not
425	substantiate the applicant's income. Each applicant shall
426	provide written documentation during the application process and
427	the redetermination process, including, but not limited to, the
428	following:
429	(a)  Proof of family income, which must include a copy of
430	the applicant's most recent federal income tax return. In the
431	absence of a federal income tax return, an applicant may submit
432	wages and earnings statements (pay stubs), W-2 forms, or other
433	appropriate documents.
434	(b)  Each applicant shall provide a statement from all
435	applicable family members that:
436	1.  Their employers do employer does not sponsor a health
437	benefit plans plan for employees; or
438	2.  The potential enrollee is not covered by an the
439	employer-sponsored health benefit plan because the potential
440	enrollee is not eligible for coverage, or, if the potential
441	enrollee is eligible but not covered, a statement of the cost to
442	enroll the potential enrollee in the employer-sponsored health
443	benefit plan.
444	(11)(9)  Subject to paragraph (5)(4)(b) and s. 624.91(4),
445	the Florida Kidcare program shall withhold benefits from an
446	enrollee if the program obtains evidence that the enrollee is no
447	longer eligible, submitted incorrect or fraudulent information
448	in order to establish eligibility, or failed to provide
449	verification of eligibility. The applicant or enrollee shall be
450	notified that because of such evidence program benefits will be
451	withheld unless the applicant or enrollee contacts a designated
452	representative of the program by a specified date, which must be
453	within 14 working 10 days after the date of notice, to discuss
454	and resolve the matter. The program shall make every effort to
455	resolve the matter within a timeframe that will not cause
456	benefits to be withheld from an eligible enrollee.
457	(12)(10)  The following individuals may be subject to
458	prosecution in accordance with s. 414.39:
459	(a)  An applicant obtaining or attempting to obtain
460	benefits for a potential enrollee under the Florida Kidcare
461	program when the applicant knows or should have known the
462	potential enrollee does not qualify for the Florida Kidcare
463	program.
464	(b)  An individual who assists an applicant in obtaining or
465	attempting to obtain benefits for a potential enrollee under the
466	Florida Kidcare program when the individual knows or should have
467	known the potential enrollee does not qualify for the Florida
468	Kidcare program.
469	Section 7.  Section 409.815, Florida Statutes, is amended
470	to read:
471	409.815  Health benefits coverage; limitations.--
472	(1)  MEDICAID BENEFITS.--For purposes of the Florida
473	Kidcare program, benefits available under Medicaid and Medikids
474	include those goods and services provided under the medical
475	assistance program authorized by Title XIX of the Social
476	Security Act, and regulations thereunder, as administered in
477	this state by the agency. This includes those mandatory Medicaid
478	services authorized under s. 409.905 and optional Medicaid
479	services authorized under s. 409.906, rendered on behalf of
480	eligible individuals by qualified providers, in accordance with
481	federal requirements for Title XIX, subject to any limitations
482	or directions provided for in the General Appropriations Act or
483	chapter 216, and according to methodologies and limitations set
484	forth in agency rules and policy manuals and handbooks
485	incorporated by reference thereto.
486	(2)  BENCHMARK BENEFITS.--In order for health benefits
487	coverage to qualify for premium assistance payments for an
488	eligible child under ss. 409.810-409.820, the health benefits
489	coverage must be equivalent to the pediatric Medicaid benefit
490	package and be based upon a standard and appropriate assessment
491	of need for the services consistent with Early and Periodic
492	Screening, Diagnosis, and Treatment requirements as specified in
493	s. 409.905(2) and Title XIX of the Social Security Act, except
494	for coverage under Medicaid and Medikids, must include the
495	following minimum benefits, as medically necessary.
496	(a)  Preventive health services.--Covered services include:
497	1.  Well-child care, including services recommended in the
498	Guidelines for Health Supervision of Children and Youth as
499	developed by the American Academy of Pediatrics;
500	2.  Immunizations and injections;
501	3.  Health education counseling and clinical services;
502	4.  Vision screening; and
503	5.  Hearing screening.
504	(b)  Inpatient hospital services.--All covered services
505	provided for the medical care and treatment of an enrollee who
506	is admitted as an inpatient to a hospital licensed under part I
507	of chapter 395, with the following exceptions:
508	1.  All admissions must be authorized by the enrollee's
509	health benefits coverage provider.
510	2.  The length of the patient stay shall be determined
511	based on the medical condition of the enrollee in relation to
512	the necessary and appropriate level of care.
513	3.  Room and board may be limited to semiprivate
514	accommodations, unless a private room is considered medically
515	necessary or semiprivate accommodations are not available.
516	4.  Admissions for rehabilitation and physical therapy are
517	limited to 15 days per contract year.
518	(c)  Emergency services.--Covered services include visits
519	to an emergency room or other licensed facility if needed
520	immediately due to an injury or illness and delay means risk of
521	permanent damage to the enrollee's health. Health maintenance
522	organizations shall comply with the provisions of s. 641.513.
523	(d)  Maternity services.--Covered services include
524	maternity and newborn care, including prenatal and postnatal
525	care, with the following limitations:
526	1.  Coverage may be limited to the fee for vaginal
527	deliveries; and
528	2.  Initial inpatient care for newborn infants of enrolled
529	adolescents shall be covered, including normal newborn care,
530	nursery charges, and the initial pediatric or neonatal
531	examination, and the infant may be covered for up to 3 days
532	following birth.
533	(e)  Organ transplantation services.--Covered services
534	include pretransplant, transplant, and postdischarge services
535	and treatment of complications after transplantation for
536	transplants deemed necessary and appropriate within the
537	guidelines set by the Organ Transplant Advisory Council under s.
538	765.53 or the Bone Marrow Transplant Advisory Panel under s.
539	627.4236.
540	(f)  Outpatient services.--Covered services include
541	preventive, diagnostic, therapeutic, palliative care, and other
542	services provided to an enrollee in the outpatient portion of a
543	health facility licensed under chapter 395, except for the
544	following limitations:
545	1.  Services must be authorized by the enrollee's health
546	benefits coverage provider; and
547	2.  Treatment for temporomandibular joint disease (TMJ) is
548	specifically excluded.
549	(g)  Behavioral health services.--
550	1.  Mental health benefits include:
551	a.  Inpatient services, limited to not more than 30
552	inpatient days per contract year for psychiatric admissions, or
553	residential services in facilities licensed under s. 394.875(8)
554	or s. 395.003 in lieu of inpatient psychiatric admissions;
555	however, a minimum of 10 of the 30 days shall be available only
556	for inpatient psychiatric services when authorized by a
557	physician; and
558	b.  Outpatient services, including outpatient visits for
559	psychological or psychiatric evaluation, diagnosis, and
560	treatment by a licensed mental health professional, limited to a
561	maximum of 40 outpatient visits each contract year.
562	2.  Substance abuse services include:
563	a.  Inpatient services, limited to not more than 7
564	inpatient days per contract year for medical detoxification only
565	and 30 days of residential services; and
566	b.  Outpatient services, including evaluation, diagnosis,
567	and treatment by a licensed practitioner, limited to a maximum
568	of 40 outpatient visits per contract year.
569	(h)  Durable medical equipment.--Covered services include
570	equipment and devices that are medically indicated to assist in
571	the treatment of a medical condition and specifically prescribed
572	as medically necessary, with the following limitations:
573	1.  Low-vision and telescopic aides are not included.
574	2.  Corrective lenses and frames may be limited to one pair
575	every 2 years, unless the prescription or head size of the
576	enrollee changes.
577	3.  Hearing aids shall be covered only when medically
578	indicated to assist in the treatment of a medical condition.
579	4.  Covered prosthetic devices include artificial eyes and
580	limbs, braces, and other artificial aids.
581	(i)  Health practitioner services.--Covered services
582	include services and procedures rendered to an enrollee when
583	performed to diagnose and treat diseases, injuries, or other
584	conditions, including care rendered by health practitioners
585	acting within the scope of their practice, with the following
586	exceptions:
587	1.  Chiropractic services shall be provided in the same
588	manner as in the Florida Medicaid program.
589	2.  Podiatric services may be limited to one visit per day
590	totaling two visits per month for specific foot disorders.
591	(j)  Home health services.--Covered services include
592	prescribed home visits by both registered and licensed practical
593	nurses to provide skilled nursing services on a part-time
594	intermittent basis, subject to the following limitations:
595	1.  Coverage may be limited to include skilled nursing
596	services only;
597	2.  Meals, housekeeping, and personal comfort items may be
598	excluded; and
599	3.  Private duty nursing is limited to circumstances where
600	such care is medically necessary.
601	(k)  Hospice services.--Covered services include reasonable
602	and necessary services for palliation or management of an
603	enrollee's terminal illness, with the following exceptions:
604	1.  Once a family elects to receive hospice care for an
605	enrollee, other services that treat the terminal condition will
606	not be covered; and
607	2.  Services required for conditions totally unrelated to
608	the terminal condition are covered to the extent that the
609	services are included in this section.
610	(l)  Laboratory and X-ray services.--Covered services
611	include diagnostic testing, including clinical radiologic,
612	laboratory, and other diagnostic tests.
613	(m)  Nursing facility services.--Covered services include
614	regular nursing services, rehabilitation services, drugs and
615	biologicals, medical supplies, and the use of appliances and
616	equipment furnished by the facility, with the following
617	limitations:
618	1.  All admissions must be authorized by the health
619	benefits coverage provider.
620	2.  The length of the patient stay shall be determined
621	based on the medical condition of the enrollee in relation to
622	the necessary and appropriate level of care, but is limited to
623	not more than 100 days per contract year.
624	3.  Room and board may be limited to semiprivate
625	accommodations, unless a private room is considered medically
626	necessary or semiprivate accommodations are not available.
627	4.  Specialized treatment centers and independent kidney
628	disease treatment centers are excluded.
629	5.  Private duty nurses, television, and custodial care are
630	excluded.
631	6.  Admissions for rehabilitation and physical therapy are
632	limited to 15 days per contract year.
633	(n)  Prescribed drugs.--
634	1.  Coverage shall include drugs prescribed for the
635	treatment of illness or injury when prescribed by a licensed
636	health practitioner acting within the scope of his or her
637	practice.
638	2.  Prescribed drugs may be limited to generics if
639	available and brand name products if a generic substitution is
640	not available, unless the prescribing licensed health
641	practitioner indicates that a brand name is medically necessary.
642	3.  Prescribed drugs covered under this section shall
643	include all prescribed drugs covered under the Florida Medicaid
644	program.
645	(o)  Therapy services.--Covered services include
646	rehabilitative services, including occupational, physical,
647	respiratory, and speech therapies, with the following
648	limitations:
649	1.  Services must be for short-term rehabilitation where
650	significant improvement in the enrollee's condition will result;
651	and
652	2.  Services shall be limited to not more than 24 treatment
653	sessions within a 60-day period per episode or injury, with the
654	60-day period beginning with the first treatment.
655	(p)  Transportation services.--Covered services include
656	emergency transportation required in response to an emergency
657	situation.
658	(q)  Dental services.--Dental services shall be covered and
659	may include those dental benefits provided to children by the
660	Florida Medicaid program under s. 409.906(6).
661	(r)  Lifetime maximum.--Health benefits coverage obtained
662	under ss. 409.810-409.820 shall pay an enrollee's covered
663	expenses at a lifetime maximum of $1 million per covered child.
664	(a)(s)  Cost-sharing.--Cost-sharing provisions must comply
665	with s. 409.816.
666	(b)(t)  Exclusions.--
667	1.  Experimental or investigational procedures that have
668	not been clinically proven by reliable evidence are excluded;
669	2.  Services performed for cosmetic purposes only or for
670	the convenience of the enrollee are excluded; and
671	3.  Abortion may be covered only if necessary to save the
672	life of the mother or if the pregnancy is the result of an act
673	of rape or incest.
674	(c)(u)  Enhancements to minimum requirements.--
675	1.  This section sets the minimum benefits that must be
676	included in any health benefits coverage, other than Medicaid or
677	Medikids coverage, offered under ss. 409.810-409.820. Health
678	benefits coverage may include additional benefits not included
679	in the pediatric Medicaid benefit package under this subsection,
680	but may not include benefits excluded under paragraph (b) (s).
681	2.  Health benefits coverage may extend any limitations
682	beyond the minimum benefits described in this section.
683
684	Except for Florida Kidcare Plus benefits the Children's Medical
685	Services Network, the agency may not increase the premium
686	assistance payment for either additional benefits provided
687	beyond the minimum benefits described in this section or the
688	imposition of less restrictive service limitations.
689	(d)(v)  Applicability of other state laws.--Health
690	insurers, health maintenance organizations, and their agents are
691	subject to the provisions of the Florida Insurance Code, except
692	for any such provisions waived in this section.
693	1.  Except as expressly provided in this section, a law
694	requiring coverage for a specific health care service or
695	benefit, or a law requiring reimbursement, utilization, or
696	consideration of a specific category of licensed health care
697	practitioner, does not apply to a health insurance plan policy
698	or contract offered or delivered under ss. 409.810-409.820
699	unless that law is made expressly applicable to such policies or
700	contracts.
701	2.  Notwithstanding chapter 641, a health maintenance
702	organization may issue contracts providing benefits equal to,
703	exceeding, or actuarially equivalent to the benchmark benefit
704	plan authorized by this section and may pay providers located in
705	a rural county negotiated fees or Medicaid reimbursement rates
706	for services provided to enrollees who are residents of the
707	rural county.
708	Section 8.  Section 409.816, Florida Statutes, is amended
709	to read:
710	409.816  Limitations on premiums and cost-sharing.--The
711	following limitations on premiums and cost-sharing are
712	established for the program.
713	(1)  Enrollees who receive coverage under Title XIX of the
714	Social Security Act the Medicaid program may not be required to
715	pay:
716	(a)  Enrollment fees, premiums, or similar charges; or
717	(b)  Copayments, deductibles, coinsurance, or similar
718	charges.
719	(2)  Enrollees in families with a family income equal to or
720	below 150 percent of the federal poverty level, who are not
721	receiving coverage under the Medicaid program, may not be
722	required to pay:
723	(a)  Enrollment fees, premiums, or similar charges that
724	exceed the maximum monthly charge permitted under s. 1916(b)(1)
725	of the Social Security Act; or
726	(b)  Copayments, deductibles, coinsurance, or similar
727	charges that exceed a nominal amount, as determined consistent
728	with regulations referred to in s. 1916(a)(3) of the Social
729	Security Act. However, such charges may not be imposed for
730	preventive services, including well-baby and well-child care,
731	age-appropriate immunizations, and routine hearing and vision
732	screenings.
733	(3)  Enrollees in families with a family income above 150
734	percent of the federal poverty level, who are not receiving
735	coverage under the Medicaid program or who are not eligible
736	under s. 409.814(7)(5), may be required to pay enrollment fees,
737	premiums, copayments, deductibles, coinsurance, or similar
738	charges on a sliding scale related to income, except that the
739	total annual aggregate cost-sharing with respect to all children
740	in a family may not exceed 5 percent of the family's income.
741	However, copayments, deductibles, coinsurance, or similar
742	charges may not be imposed for preventive services, including
743	well-baby and well-child care, age-appropriate immunizations,
744	and routine hearing and vision screenings.
745	(4)  Enrollees in families with a family income up to the
746	maximum income threshold, who receive Florida Kidcare Plus
747	benefits, may not be required to pay:
748	(a)  Enrollment fees, premiums, or similar charges; or
749	(b)  Copayments, deductibles, coinsurance, or similar
750	charges.
751	Section 9.  Paragraph (i) of subsection (1) of section
752	409.8177, Florida Statutes, is amended to read:
753	409.8177  Program evaluation.--
754	(1)  The agency, in consultation with the Department of
755	Health, the Department of Children and Family Services, and the
756	Florida Healthy Kids Corporation, shall contract for an
757	evaluation of the Florida Kidcare program and shall by January 1
758	of each year submit to the Governor, the President of the
759	Senate, and the Speaker of the House of Representatives a report
760	of the program. In addition to the items specified under s. 2108
761	of Title XXI of the Social Security Act, the report shall
762	include an assessment of crowd-out and access to health care, as
763	well as the following:
764	(i)  An assessment of the effectiveness of the Florida
765	Kidcare program Medikids, Children's Medical Services network,
766	and other public and private programs in the state in increasing
767	the availability of affordable quality health insurance and
768	health care for children.
769	Section 10.  Section 409.818, Florida Statutes, is amended
770	to read:
771	409.818  Administration.--In order to implement ss.
772	409.810-409.820, the following agencies shall have the following
773	duties:
774	(1)  The Department of Children and Family Services shall:
775	(a)  Develop a simplified eligibility application mail-in
776	form to be used for determining the eligibility of children for
777	coverage under the Florida Kidcare program, in consultation with
778	the agency, the Department of Health, and the Florida Healthy
779	Kids Corporation. The simplified eligibility application form
780	must include an item that provides an opportunity for the
781	applicant to indicate whether coverage is being sought for a
782	child with special health care needs. Families applying for
783	children's Medicaid coverage must also be able to use the
784	simplified application form without having to pay a premium.
785	(b)  Establish and maintain the eligibility determination
786	process under the program except as specified in subsection (4)
787	(5). The department shall directly, or through the services of a
788	contracted third-party administrator, establish and maintain a
789	process for determining eligibility of children for coverage
790	under the program. The eligibility determination process must be
791	used solely for determining eligibility of applicants for health
792	benefits coverage under the program. The eligibility
793	determination process must include an initial determination of
794	eligibility for any coverage offered under the program, as well
795	as a redetermination or reverification of eligibility each
796	subsequent 6 months. Effective July 1, 2007 January 1, 1999, a
797	child who has not attained the age of 19 5 and who has been
798	determined eligible for the Medicaid program is eligible for
799	coverage for 12 months without a redetermination or
800	reverification of eligibility. In conducting an eligibility
801	determination, the department shall determine if the child has
802	special health care needs. The department, in consultation with
803	the Agency for Health Care Administration and the Florida
804	Healthy Kids Corporation, shall develop procedures for
805	redetermining eligibility which enable a family to easily update
806	any change in circumstances which could affect eligibility. The
807	department may accept changes in a family's status as reported
808	to the department by the Florida Healthy Kids Corporation
809	without requiring a new application from the family.
810	Redetermination of a child's eligibility for Medicaid may not be
811	linked to a child's eligibility determination for other
812	programs.
813	(c)  Inform program applicants about eligibility
814	determinations and provide information about eligibility of
815	applicants to the Florida Kidcare program Medicaid, Medikids,
816	the Children's Medical Services Network, and the Florida Healthy
817	Kids Corporation, and to insurers and their agents, through a
818	centralized coordinating office.
819	(d)  Adopt rules necessary for conducting program
820	eligibility functions.
821	(2)  The Department of Health shall:
822	(a)  Design an eligibility intake process for the program,
823	in coordination with the Department of Children and Family
824	Services, the agency, and the Florida Healthy Kids Corporation.
825	The eligibility intake process may include local intake points
826	that are determined by the Department of Health in coordination
827	with the Department of Children and Family Services.
828	(b)  Chair a state-level coordinating council to review and
829	make recommendations concerning the implementation and operation
830	of the program. The coordinating council shall include
831	representatives from the department, the Department of Children
832	and Family Services, the agency, the Florida Healthy Kids
833	Corporation, the Office of Insurance Regulation of the Financial
834	Services Commission, local government, health insurers, health
835	maintenance organizations, health care providers, families
836	participating in the program, and organizations representing
837	low-income families.
838	(c)  In consultation with the Florida Healthy Kids
839	Corporation and the Department of Children and Family Services,
840	establish a toll-free telephone line to assist families with
841	questions about the program.
842	(c)(d)  Adopt rules necessary to implement the Florida
843	Kidcare program outreach activities.
844	(d)  In consultation with the Kidcare Coordinating Council,
845	develop and implement a plan to publicize the Florida Kidcare
846	program, the eligibility requirements of the program, and the
847	procedures for enrollment in the program and to maintain public
848	awareness of and outreach for the Florida Kidcare program.
849	(3)  The Agency for Health Care Administration, under the
850	authority granted in s. 409.914(1), shall:
851	(a)  Calculate the premium assistance payment necessary to
852	comply with the premium and cost-sharing limitations specified
853	in s. 409.816. The premium assistance payment for each enrollee
854	in a health insurance plan participating in the Florida Healthy
855	Kids Corporation shall equal the premium approved by the Florida
856	Healthy Kids Corporation and the Office of Insurance Regulation
857	of the Financial Services Commission pursuant to ss. 627.410 and
858	641.31, less any enrollee's share of the premium established
859	within the limitations specified in s. 409.816. The premium
860	assistance payment for each enrollee in an employer-sponsored
861	health insurance plan approved under ss. 409.810-409.820 shall
862	equal the premium for the plan adjusted for any benchmark
863	benefit plan actuarial equivalent benefit rider approved by the
864	Office of Insurance Regulation pursuant to ss. 627.410 and
865	641.31, less any enrollee's share of the premium established
866	within the limitations specified in s. 409.816. In calculating
867	the premium assistance payment levels for children with family
868	coverage, the agency shall set the premium assistance payment
869	levels for each child proportionately to the total cost of
870	family coverage.
871	(b)  Make premium assistance payments to health insurance
872	plans on a periodic basis. The agency may use its Medicaid
873	fiscal agent or a contracted third-party administrator in making
874	these payments. The agency may require health insurance plans
875	that participate in the Medikids program or employer-sponsored
876	group health insurance to collect premium payments from an
877	enrollee's family. Participating health insurance plans shall
878	report premium payments collected on behalf of enrollees in the
879	program to the agency in accordance with a schedule established
880	by the agency.
881	(c)  Monitor compliance with quality assurance and access
882	standards developed under s. 409.820.
883	(d)  Establish a mechanism for investigating and resolving
884	complaints and grievances from program applicants, enrollees,
885	and health benefits coverage providers, and maintain a record of
886	complaints and confirmed problems. In the case of a child who is
887	enrolled in a health maintenance organization, the agency must
888	use the provisions of s. 641.511 to address grievance reporting
889	and resolution requirements.
890	(e)  Approve health benefits coverage for participation in
891	the program, following certification by the Office of Insurance
892	Regulation under subsection (4).
893	(f)  Adopt all rules necessary to comply with or administer
894	ss. 409.810-409.820 and all rules necessary to comply with
895	federal requirements, including, at a minimum, rules specifying
896	policies, procedures, and criteria for the following activities:
897	1.  for Calculating premium assistance payment levels;,
898	2.  Making premium assistance payments;,
899	3.  Monitoring access and quality assurance standards;,
900	4.  Investigating and resolving complaints and grievances;,
901	5.  Administering the Medikids program;, and
902	6.  Approving health benefits coverage; and
903	7.  Determining application and enrollment requirements,
904	including documentation requirements, eligibility determinations
905	and redeterminations, enrollee premium payment requirements,
906	cancellation of coverage, reinstatement of coverage,
907	disenrollment procedures, applicant and enrollee notification
908	requirements, application and enrollment time processing
909	standards, and call center standards.
910
911	The agency is designated the lead state agency for Title XXI of
912	the Social Security Act for purposes of receipt of federal
913	funds, for reporting purposes, and for ensuring compliance with
914	federal and state regulations and rules.
915	(4)  The Office of Insurance Regulation shall certify that
916	health benefits coverage plans that seek to provide services
917	under the Florida Kidcare program, except those offered through
918	the Florida Healthy Kids Corporation or the Children's Medical
919	Services Network, meet, exceed, or are actuarially equivalent to
920	the benchmark benefit plan and that health insurance plans will
921	be offered at an approved rate. In determining actuarial
922	equivalence of benefits coverage, the Office of Insurance
923	Regulation and health insurance plans must comply with the
924	requirements of s. 2103 of Title XXI of the Social Security Act.
925	The department shall adopt rules necessary for certifying health
926	benefits coverage plans.
927	(4)(5)  The Florida Healthy Kids Corporation shall retain
928	its functions as authorized in s. 624.91, including eligibility
929	determination for participation in the non-Title XIX-funded
930	Florida Kidcare program in accordance with administrative rules
931	and policies established by the agency Healthy Kids program.
932	(5)(6)  The agency, the Department of Health, the
933	Department of Children and Family Services, the Florida Healthy
934	Kids Corporation, and the Office of Insurance Regulation, after
935	consultation with and approval of the Speaker of the House of
936	Representatives and the President of the Senate, are authorized
937	to make program modifications that are necessary to overcome any
938	objections of the United States Department of Health and Human
939	Services to obtain approval of the state's child health
940	insurance plan under Title XXI of the Social Security Act.
941	Section 11.  Section 409.820, Florida Statutes, is amended
942	to read:
943	409.820  Quality assurance and access standards.--Except
944	for Medicaid, The Department of Health, in consultation with the
945	agency and the Florida Healthy Kids Corporation, shall develop a
946	minimum set of quality assurance and access standards for all
947	Florida Kidcare program components. The standards must include a
948	process for granting exceptions to specific requirements for
949	quality assurance and access. Compliance with the standards
950	shall be a condition of program participation by health benefits
951	coverage providers. These standards shall comply with the
952	provisions of this chapter and chapter 641 and Title XXI of the
953	Social Security Act.
954	Section 12.  Section 409.821, Florida Statutes, is amended
955	to read:
956	409.821  Florida Kidcare program public records
957	exemption.--Notwithstanding any other law to the contrary, any
958	information identifying a Florida Kidcare program applicant or
959	enrollee, as defined in s. 409.811, held by the Agency for
960	Health Care Administration, the Department of Children and
961	Family Services, the Department of Health, or the Florida
962	Healthy Kids Corporation is confidential and exempt from s.
963	119.07(1) and s. 24(a), Art. I of the State Constitution. Such
964	information may be disclosed to another governmental entity only
965	if disclosure is necessary for the entity to perform its duties
966	and responsibilities under the Florida Kidcare program and shall
967	be disclosed to the Department of Revenue for purposes of
968	administering the state Title IV-D program. The receiving
969	governmental entity must maintain the confidential and exempt
970	status of such information. Furthermore, such information may
971	not be released to any person without the written consent of the
972	program applicant. This exemption applies to any information
973	identifying a Florida Kidcare program applicant or enrollee held
974	by the Agency for Health Care Administration, the Department of
975	Children and Family Services, the Department of Health, or the
976	Florida Healthy Kids Corporation before, on, or after the
977	effective date of this exemption. A violation of this section is
978	a misdemeanor of the second degree, punishable as provided in s.
979	775.082 or s. 775.083. This section does not prohibit an
980	enrollee's parent or legal guardian from obtaining any record
981	relating to the enrollee's Florida Kidcare application or
982	coverage, including, but not limited to, confirmation of
983	coverage, the dates of coverage, the name of the enrollee's
984	health plan, and the amount of premium.
985	Section 13.  Section 409.904, Florida Statutes, is amended
986	to read:
987	409.904  Optional payments for eligible persons.--The
988	agency may make payments for medical assistance and related
989	services on behalf of the following persons who are determined
990	to be eligible subject to the income, assets, and categorical
991	eligibility tests set forth in federal and state law. Payment on
992	behalf of these Medicaid eligible persons is subject to the
993	availability of moneys and any limitations established by the
994	General Appropriations Act or chapter 216.
995	(1)(a)  From July 1, 2005, through December 31, 2005, a
996	person who is age 65 or older or is determined to be disabled,
997	whose income is at or below 88 percent of federal poverty level,
998	and whose assets do not exceed established limitations.
999	(b)  Effective January 1, 2006, and subject to federal
1000	waiver approval, a person who is age 65 or older or is
1001	determined to be disabled, whose income is at or below 88
1002	percent of the federal poverty level, whose assets do not exceed
1003	established limitations, and who is not eligible for Medicare
1004	or, if eligible for Medicare, is also eligible for and receiving
1005	Medicaid-covered institutional care services, hospice services,
1006	or home and community-based services. The agency shall seek
1007	federal authorization through a waiver to provide this coverage.
1008	(2)  A family, a pregnant woman, a child under age 21, a
1009	person age 65 or over, or a blind or disabled person, who would
1010	be eligible under any group listed in s. 409.903(1), (2), or
1011	(3), except that the income or assets of such family or person
1012	exceed established limitations. For a family or person in one of
1013	these coverage groups, medical expenses are deductible from
1014	income in accordance with federal requirements in order to make
1015	a determination of eligibility. A family or person eligible
1016	under the coverage known as the "medically needy," is eligible
1017	to receive the same services as other Medicaid recipients, with
1018	the exception of services in skilled nursing facilities and
1019	intermediate care facilities for the developmentally disabled.
1020	(3)  A person who is in need of the services of a licensed
1021	nursing facility, a licensed intermediate care facility for the
1022	developmentally disabled, or a state mental hospital, whose
1023	income does not exceed 300 percent of the SSI income standard,
1024	and who meets the assets standards established under federal and
1025	state law. In determining the person's responsibility for the
1026	cost of care, the following amounts must be deducted from the
1027	person's income:
1028	(a)  The monthly personal allowance for residents as set
1029	based on appropriations.
1030	(b)  The reasonable costs of medically necessary services
1031	and supplies that are not reimbursable by the Medicaid program.
1032	(c)  The cost of premiums, copayments, coinsurance, and
1033	deductibles for supplemental health insurance.
1034	(4)  A low-income person who meets all other requirements
1035	for Medicaid eligibility except citizenship and who is in need
1036	of emergency medical services. The eligibility of such a
1037	recipient is limited to the period of the emergency, in
1038	accordance with federal regulations.
1039	(5)  Subject to specific federal authorization, a woman
1040	living in a family that has an income that is at or below 200
1041	185 percent of the most current federal poverty level is
1042	eligible for family planning services as specified in s.
1043	409.905(3) for a period of up to 24 months following a loss of
1044	Medicaid benefits.
1045	(6)  A child who has not attained the age of 19 who has
1046	been determined eligible for the Medicaid program is deemed to
1047	be eligible for a total of 12 6 months, regardless of changes in
1048	circumstances other than attainment of the maximum age.
1049	Effective January 1, 1999, a child who has not attained the age
1050	of 5 and who has been determined eligible for the Medicaid
1051	program is deemed to be eligible for a total of 12 months
1052	regardless of changes in circumstances other than attainment of
1053	the maximum age.
1054	(7)  A pregnant woman for the duration of her pregnancy and
1055	for the postpartum period as defined by federal law and rule, or
1056	a child under 1 year of age, who lives in a family that has an
1057	income above 185 percent of the most recently published federal
1058	poverty level, but which is at or below 200 percent of such
1059	poverty level. In determining the eligibility of such pregnant
1060	woman or child, an assets test is not required. A pregnant woman
1061	or child who is eligible for Medicaid under this subsection must
1062	be offered the opportunity, subject to federal rules, to be made
1063	presumptively eligible. A pregnant woman or child who has been
1064	deemed presumptively eligible for Medicaid shall not be enrolled
1065	in a managed care plan until full eligibility for Medicaid has
1066	been determined.
1067	(8)  A child who has attained the age of 6 but has not
1068	attained the age of 19 who lives in a family that has an income
1069	above 100 percent of the most recently published federal poverty
1070	level, but which is at or below 133 percent of such poverty
1071	level. In determining the eligibility of such child, an assets
1072	test is not required. A child who is eligible for Medicaid under
1073	this subsection must be offered the opportunity, subject to
1074	federal rules, to be made presumptively eligible.
1075	(9)(8)  A Medicaid-eligible individual for the individual's
1076	health insurance premiums, if the agency determines that such
1077	payments are cost-effective.
1078	(10)(9)  Eligible women with incomes at or below 200
1079	percent of the federal poverty level and under age 65, for
1080	cancer treatment pursuant to the federal Breast and Cervical
1081	Cancer Prevention and Treatment Act of 2000, screened through
1082	the Mary Brogan Breast and Cervical Cancer Early Detection
1083	Program established under s. 381.93.
1084
1085	The agency shall submit a state plan amendment to the Federal
1086	Government to implement the provisions of the Family Opportunity
1087	Act, pursuant the Deficit Reduction Act of 2005.
1088	Section 14.  Subsections (4) through (8) of section 624.91,
1089	Florida Statutes, are renumbered as subsections (3) through (7),
1090	respectively, and present subsection (3) and paragraph (b) of
1091	present subsection (5) of that section are amended to read:
1092	624.91  The Florida Healthy Kids Corporation Act.--
1093	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.--Only the
1094	following individuals are eligible for state-funded assistance
1095	in paying Florida Healthy Kids premiums:
1096	(a)  Residents of this state who are eligible for the
1097	Florida Kidcare program pursuant to s. 409.814.
1098	(b)  Notwithstanding s. 409.814, legal aliens who are
1099	enrolled in the Florida Healthy Kids program as of January 31,
1100	2004, who do not qualify for Title XXI federal funds because
1101	they are not qualified aliens as defined in s. 409.811.
1102	(4)(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1103	(b)  The Florida Healthy Kids Corporation shall:
1104	1.  Arrange for the collection of any family, local
1105	contributions, or employer payment or premium, in an amount to
1106	be determined by the board of directors, to provide for payment
1107	of premiums for comprehensive insurance coverage and for the
1108	actual or estimated administrative expenses.
1109	2.  Arrange for the collection of any voluntary
1110	contributions to provide for payment of Florida Kidcare premiums
1111	for children who are not eligible for medical assistance under
1112	Title XIX or Title XXI of the Social Security Act.
1113	3.  Subject to the provisions of s. 409.8134, accept
1114	voluntary supplemental local match contributions that comply
1115	with the requirements of Title XXI of the Social Security Act
1116	for the purpose of providing additional Florida Kidcare coverage
1117	in contributing counties under Title XXI.
1118	4.  Establish the administrative and accounting procedures
1119	for the operation of the corporation.
1120	5.  Establish, with consultation from appropriate
1121	professional organizations, standards for preventive health
1122	services and providers and comprehensive insurance benefits
1123	appropriate to children, provided that such standards for rural
1124	areas shall not limit primary care providers to board-certified
1125	pediatricians.
1126	6.  In accordance with administrative rules and policies
1127	established by the Agency for Health Care Administration,
1128	determine eligibility for children seeking to participate in the
1129	Title XXI-funded components of the Florida Kidcare program
1130	consistent with the requirements specified in s. 409.814, as
1131	well as the non-Title-XXI-eligible children as provided in
1132	subsection (3).
1133	7.  Establish procedures under which providers of local
1134	match to, applicants to and participants in the program may have
1135	grievances reviewed by an impartial body and reported to the
1136	board of directors of the corporation.
1137	8.  Establish participation criteria and, if appropriate,
1138	contract with an authorized insurer, health maintenance
1139	organization, or third-party administrator to provide
1140	administrative services to the corporation.
1141	9.  Establish enrollment criteria which shall include
1142	penalties or waiting periods of not more fewer than 30 60 days
1143	for reinstatement of coverage upon voluntary cancellation for
1144	nonpayment of family premiums.
1145	10.  Contract with authorized insurers or any provider of
1146	health care services, meeting standards established by the
1147	corporation, for the provision of comprehensive insurance
1148	coverage to participants. Such standards shall include criteria
1149	under which the corporation may contract with more than one
1150	provider of health care services in program sites. Health plans
1151	shall be selected through a competitive bid process. The Florida
1152	Healthy Kids Corporation shall purchase goods and services in
1153	the most cost-effective manner consistent with the delivery of
1154	quality medical care. The maximum administrative cost for a
1155	Florida Healthy Kids Corporation contract shall be 15 percent.
1156	For health care contracts, the minimum medical loss ratio for a
1157	Florida Healthy Kids Corporation contract shall be 85 percent.
1158	For dental contracts, the remaining compensation to be paid to
1159	the authorized insurer or provider under a Florida Healthy Kids
1160	Corporation contract shall be no less than an amount which is 85
1161	percent of premium; to the extent any contract provision does
1162	not provide for this minimum compensation, this section shall
1163	prevail. The health plan selection criteria and scoring system,
1164	and the scoring results, shall be available upon request for
1165	inspection after the bids have been awarded.
1166	11.  Establish disenrollment criteria in the event local
1167	matching funds are insufficient to cover enrollments.
1168	12.  In accordance with administrative rules and policies
1169	established by the Agency for Health Care Administration,
1170	maintain a toll-free telephone line to assist families with
1171	questions about the program. Develop and implement a plan to
1172	publicize the Florida Healthy Kids Corporation, the eligibility
1173	requirements of the program, and the procedures for enrollment
1174	in the program and to maintain public awareness of the
1175	corporation and the program.
1176	13.  Secure staff necessary to properly administer the
1177	corporation. Staff costs shall be funded from state and local
1178	matching funds and such other private or public funds as become
1179	available. The board of directors shall determine the number of
1180	staff members necessary to administer the corporation.
1181	14.  Provide a report annually to the Governor, Chief
1182	Financial Officer, Commissioner of Education, Senate President,
1183	Speaker of the House of Representatives, and Minority Leaders of
1184	the Senate and the House of Representatives.
1185	15.  Establish benefit packages which conform to the
1186	provisions of the Florida Kidcare program, as created in ss.
1187	409.810-409.820.
1188	Section 15.  This act shall take effect July 1, 2007.

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