Florida Senate - 2016                             CS for SB 1240
       By the Committee on Health Policy; and Senator Sobel
       588-03253-16                                          20161240c1
    1                        A bill to be entitled                      
    2         An act relating to Children’s Medical Services
    3         eligibility and enrollment; amending s. 391.021, F.S.;
    4         revising the definition of the term “children with
    5         special health care needs”; defining the term
    6         “clinical eligibility”; amending s. 391.029, F.S.;
    7         revising eligibility requirements for the Children’s
    8         Medical Services program; requiring the Department of
    9         Health to determine clinical eligibility for the
   10         Children’s Medical Services program by the use of an
   11         assessment instrument or through the review of
   12         documentation provided by a health care practitioner;
   13         requiring the department to adopt rules; providing for
   14         the continued applicability of an existing rule until
   15         new rules are adopted; amending s. 391.081, F.S.;
   16         requiring the department to provide notice to a parent
   17         or guardian of a child who has been determined
   18         clinically ineligible for the Children’s Medical
   19         Services program of the parent’s or guardian’s option
   20         to request another clinical eligibility determination
   21         and appeal rights under ch. 120, F.S.; amending s.
   22         409.974, F.S.; providing an exemption from regional
   23         specialty plan enrollment limits for the Children’s
   24         Medical Services Network; providing an effective date.
   26  Be It Enacted by the Legislature of the State of Florida:
   28         Section 1. Subsection (2) of section 391.021, Florida
   29  Statutes, is amended, present subsections (3) through (8) of
   30  that section are redesignated as subsections (4) through (9),
   31  respectively, and a new subsection (3) is added to that section,
   32  to read:
   33         391.021 Definitions.—When used in this act, the term:
   34         (2) “Children with special health care needs” means those
   35  children younger than 21 years of age who have chronic and
   36  serious physical, developmental, behavioral, or emotional
   37  conditions and who require health care and related services of a
   38  type or amount beyond that which is generally required by
   39  children.
   40         (3) “Clinical eligibility” means the process used to
   41  determine if a child has a special health care need.
   42         Section 2. Section 391.029, Florida Statutes, is amended to
   43  read:
   44         391.029 Program eligibility.—
   45         (1) Eligibility for the Children’s Medical Services program
   46  is based on the diagnosis of one or more chronic and serious
   47  medical conditions and the family’s need for specialized
   48  services.
   49         (1)(2) The following individuals are eligible to receive
   50  services through the Children’s Medical Services program:
   51         (a) A high-risk pregnant female who is enrolled in
   52  Medicaid.
   53         (b) Children with serious special health care needs from
   54  birth to 21 years of age who are enrolled in Medicaid.
   55         (c) Children with serious special health care needs from
   56  birth to 19 years of age who are enrolled in a program under
   57  Title XXI of the Social Security Act.
   58         (2)(3) Subject to the availability of funds, the following
   59  individuals may receive services through the program:
   60         (a) Children with serious special health care needs from
   61  birth to 21 years of age who do not qualify for Medicaid or
   62  Title XXI of the Social Security Act but who are unable to
   63  access, due to lack of providers or lack of financial resources,
   64  specialized services that are medically necessary or essential
   65  family support services. Families shall participate financially
   66  in the cost of care based on a sliding fee scale established by
   67  the department.
   68         (b) Children with special health care needs from birth to
   69  21 years of age, as provided in Title V of the Social Security
   70  Act.
   71         (c) An infant who receives an award of compensation under
   72  s. 766.31(1). The Florida Birth-Related Neurological Injury
   73  Compensation Association shall reimburse the Children’s Medical
   74  Services Network the state’s share of funding, which must
   75  thereafter be used to obtain matching federal funds under Title
   76  XXI of the Social Security Act.
   77         (3)(4) Any child who has been provided with surgical or
   78  medical care or treatment under this act prior to being adopted
   79  and has serious and chronic special health care needs shall
   80  continue to be eligible to be provided with such care or
   81  treatment after his or her adoption, regardless of the financial
   82  ability of the persons adopting the child.
   83         (4) The department shall determine a child’s clinical
   84  eligibility for the Children’s Medical Services program. A
   85  child’s clinical eligibility must be determined through the use
   86  of an assessment instrument or through the review of
   87  documentation provided by a health care practitioner to the
   88  department.
   89         (5) The department shall adopt rules to implement this
   90  section. Until such rules are adopted, the department shall
   91  continue to determine clinical eligibility in accordance with
   92  rule 64C-2.002, Florida Administrative Code.
   93         Section 3. Section 391.081, Florida Statutes, is amended to
   94  read:
   95         391.081 Grievance reporting and resolution requirements.
   96  The department shall adopt and implement a system to provide
   97  assistance to eligible individuals and health care providers to
   98  resolve complaints and grievances. To the greatest extent
   99  possible, the department shall use existing grievance reporting
  100  and resolution processes. The department shall ensure that the
  101  system developed for the Children’s Medical Services program
  102  does not duplicate existing grievance reporting and resolution
  103  processes. The department must notify a parent or guardian of a
  104  child who has been determined clinically ineligible for the
  105  Children’s Medical Services program of the parent’s or
  106  guardian’s option to request another clinical eligibility
  107  determination and of the right to appeal the determination on
  108  behalf of his or her child, in accordance with the requirements
  109  of chapter 120.
  110         Section 4. Subsection (3) of section 409.974, Florida
  111  Statutes, is amended to read:
  112         409.974 Eligible plans.—
  113         (3) SPECIALTY PLANS.—Participation by specialty plans shall
  114  be subject to the procurement requirements of this section. The
  115  aggregate number of enrollees in enrollment of all specialty
  116  plans in a region, not including enrollees in the Children’s
  117  Medical Services Network, may not exceed 10 percent of the total
  118  number of enrollees in of that region. Enrollment in the
  119  Children’s Medical Services Network is not subject to the
  120  enrollment limit requirement of this subsection.
  121         Section 5. This act shall take effect upon becoming a law.