Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. SB 1240
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/09/2016           .                                

       The Committee on Health Policy (Sobel) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (2) of section 391.021, Florida
    6  Statutes, is amended, present subsections (3) through (8) of
    7  that section are redesignated as subsections (4) through (9),
    8  respectively, and a new subsection (3) is added to that section,
    9  to read:
   10         391.021 Definitions.—When used in this act, the term:
   11         (2) “Children with special health care needs” means those
   12  children younger than 21 years of age who have chronic and
   13  serious physical, developmental, behavioral, or emotional
   14  conditions and who require health care and related services of a
   15  type or amount beyond that which is generally required by
   16  children.
   17         (3) “Clinical eligibility” means the process used to
   18  determine if a child has a special health care need.
   19         Section 2. Section 391.029, Florida Statutes, is amended to
   20  read:
   21         391.029 Program eligibility.—
   22         (1) Eligibility for the Children’s Medical Services program
   23  is based on the diagnosis of one or more chronic and serious
   24  medical conditions and the family’s need for specialized
   25  services.
   26         (1)(2) The following individuals are eligible to receive
   27  services through the Children’s Medical Services program:
   28         (a) A high-risk pregnant female who is enrolled in
   29  Medicaid.
   30         (b) Children with serious special health care needs from
   31  birth to 21 years of age who are enrolled in Medicaid.
   32         (c) Children with serious special health care needs from
   33  birth to 19 years of age who are enrolled in a program under
   34  Title XXI of the Social Security Act.
   35         (2)(3) Subject to the availability of funds, the following
   36  individuals may receive services through the program:
   37         (a) Children with serious special health care needs from
   38  birth to 21 years of age who do not qualify for Medicaid or
   39  Title XXI of the Social Security Act but who are unable to
   40  access, due to lack of providers or lack of financial resources,
   41  specialized services that are medically necessary or essential
   42  family support services. Families shall participate financially
   43  in the cost of care based on a sliding fee scale established by
   44  the department.
   45         (b) Children with special health care needs from birth to
   46  21 years of age, as provided in Title V of the Social Security
   47  Act.
   48         (c) An infant who receives an award of compensation under
   49  s. 766.31(1). The Florida Birth-Related Neurological Injury
   50  Compensation Association shall reimburse the Children’s Medical
   51  Services Network the state’s share of funding, which must
   52  thereafter be used to obtain matching federal funds under Title
   53  XXI of the Social Security Act.
   54         (3)(4) Any child who has been provided with surgical or
   55  medical care or treatment under this act prior to being adopted
   56  and has serious and chronic special health care needs shall
   57  continue to be eligible to be provided with such care or
   58  treatment after his or her adoption, regardless of the financial
   59  ability of the persons adopting the child.
   60         (4) The department shall determine a child’s clinical
   61  eligibility for the Children’s Medical Services program. A
   62  child’s clinical eligibility must be determined through the use
   63  of an assessment instrument or through the review of
   64  documentation provided by a health care practitioner to the
   65  department.
   66         (5) The department shall adopt rules to implement this
   67  section. Until such rules are adopted, the department shall
   68  continue to determine clinical eligibility in accordance with
   69  rule 64C-2.002, Florida Administrative Code.
   70         Section 3. Section 391.081, Florida Statutes, is amended to
   71  read:
   72         391.081 Grievance reporting and resolution requirements.
   73  The department shall adopt and implement a system to provide
   74  assistance to eligible individuals and health care providers to
   75  resolve complaints and grievances. To the greatest extent
   76  possible, the department shall use existing grievance reporting
   77  and resolution processes. The department shall ensure that the
   78  system developed for the Children’s Medical Services program
   79  does not duplicate existing grievance reporting and resolution
   80  processes. The department must notify a parent or guardian of a
   81  child who has been determined clinically ineligible for the
   82  Children’s Medical Services program of the parent’s or
   83  guardian’s option to request another clinical eligibility
   84  determination and of the right to appeal the determination on
   85  behalf of his or her child, in accordance with the requirements
   86  of chapter 120.
   87         Section 4. Subsection (3) of section 409.974, Florida
   88  Statutes, is amended to read:
   89         409.974 Eligible plans.—
   90         (3) SPECIALTY PLANS.—Participation by specialty plans shall
   91  be subject to the procurement requirements of this section. The
   92  aggregate number of enrollees in enrollment of all specialty
   93  plans in a region, not including enrollees in the Children’s
   94  Medical Services Network, may not exceed 10 percent of the total
   95  number of enrollees in of that region. Enrollment in the
   96  Children’s Medical Services Network is not subject to the
   97  enrollment limit requirement of this subsection.
   98         Section 5. This act shall take effect upon becoming a law.
  100  ================= T I T L E  A M E N D M E N T ================
  101  And the title is amended as follows:
  102         Delete everything before the enacting clause
  103  and insert:
  104                        A bill to be entitled                      
  105         An act relating to Children’s Medical Services
  106         eligibility and enrollment; amending s. 391.021, F.S.;
  107         revising the definition of the term “children with
  108         special health care needs”; defining the term
  109         “clinical eligibility”; amending s. 391.029, F.S.;
  110         revising eligibility requirements for the Children’s
  111         Medical Services program; requiring the Department of
  112         Health to determine clinical eligibility for the
  113         Children’s Medical Services program by the use of an
  114         assessment instrument or through the review of
  115         documentation provided by a health care practitioner;
  116         requiring the department to adopt rules; providing for
  117         the continued applicability of an existing rule until
  118         new rules are adopted; amending s. 391.081, F.S.;
  119         requiring the department to provide notice to a parent
  120         or guardian of a child who has been determined
  121         clinically ineligible for the Children’s Medical
  122         Services program of the parent’s or guardian’s option
  123         to request another clinical eligibility determination
  124         and appeal rights under ch. 120, F.S.; amending s.
  125         409.974, F.S.; providing an exemption from regional
  126         specialty plan enrollment limits for the Children’s
  127         Medical Services Network; providing an effective date.