15 | 15 | | An act relating to Florida Kidcare program 2 |
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16 | 16 | | eligibility; amending s. 409.8132, F.S.; increasing 3 |
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17 | 17 | | the income eligibility threshold for coverage under 4 |
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18 | 18 | | the Medikids program component; amending s. 409.814, 5 |
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19 | 19 | | F.S.; increasing the income eligibility threshold for 6 |
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20 | 20 | | coverage under the Florida Kidcare program; requiring 7 |
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21 | 21 | | an applicant seeking coverage under the program to 8 |
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22 | 22 | | provide certain documentation if eligibility cannot be 9 |
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23 | 23 | | verified using reliable data sources; amending s. 10 |
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24 | 24 | | 409.816, F.S.; requiring that premiums for certain 11 |
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25 | 25 | | enrollees under the Florida Kidcare program be based 12 |
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26 | 26 | | on a tiered system of uniform premiums; amending s. 13 |
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27 | 27 | | 624.91, F.S.; conforming a provision to changes made 14 |
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28 | 28 | | by the act; providing effective dates. 15 |
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29 | 29 | | 16 |
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30 | 30 | | Be It Enacted by the Legislature of the State of Florida: 17 |
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31 | 31 | | 18 |
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32 | 32 | | Section 1. Effective January 1, 2024, paragraph (a) of 19 |
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33 | 33 | | subsection (6) of section 409.8132, Florida Statutes, is amended 20 |
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34 | 34 | | to read: 21 |
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35 | 35 | | 409.8132 Medikids program component.— 22 |
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36 | 36 | | (6) ELIGIBILITY.— 23 |
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37 | 37 | | (a) A child who has attained the age of 1 year but who is 24 |
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38 | 38 | | under the age of 5 years is eligible to enroll in the Medikids 25 |
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46 | 46 | | Page 2 of 11 |
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47 | 47 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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48 | 48 | | |
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49 | 49 | | |
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50 | 50 | | |
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51 | 51 | | program component of the Florida Kidcare program, if the child 26 |
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52 | 52 | | is a member of a family that has a family income which exceeds 27 |
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53 | 53 | | the Medicaid applicable income level as specified in s. 409.903, 28 |
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54 | 54 | | but which is equal to or below 300 200 percent of the current 29 |
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55 | 55 | | federal poverty level. In determining the eligibility of such a 30 |
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56 | 56 | | child, an assets test is not re quired. A child who is eligible 31 |
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57 | 57 | | for Medikids may elect to enroll in Florida Healthy Kids 32 |
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58 | 58 | | coverage or employer -sponsored group coverage. However, a child 33 |
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59 | 59 | | who is eligible for Medikids may participate in the Florida 34 |
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60 | 60 | | Healthy Kids program only if the child has a sibling 35 |
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61 | 61 | | participating in the Florida Healthy Kids program and the 36 |
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62 | 62 | | child's county of residence permits such enrollment. 37 |
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63 | 63 | | Section 2. Effective January 1, 2024, section 409.814, 38 |
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64 | 64 | | Florida Statutes, is amended to read: 39 |
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65 | 65 | | 409.814 Eligibility. —A child who has not reached 19 years 40 |
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66 | 66 | | of age whose family income is equal to or below 300 200 percent 41 |
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67 | 67 | | of the federal poverty level is eligible for the Florida Kidcare 42 |
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68 | 68 | | program as provided in this section. If an enrolled individual 43 |
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69 | 69 | | is determined to be ineligible for coverag e, he or she must be 44 |
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70 | 70 | | immediately disenrolled from the respective Florida Kidcare 45 |
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71 | 71 | | program component. 46 |
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72 | 72 | | (1) A child who is eligible for Medicaid coverage under s. 47 |
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73 | 73 | | 409.903 or s. 409.904 must be enrolled in Medicaid and is not 48 |
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74 | 74 | | eligible to receive health benefi ts under any other health 49 |
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75 | 75 | | benefits coverage authorized under the Florida Kidcare program. 50 |
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83 | 83 | | Page 3 of 11 |
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84 | 84 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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85 | 85 | | |
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86 | 86 | | |
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87 | 87 | | |
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88 | 88 | | (2) A child who is not eligible for Medicaid, but who is 51 |
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89 | 89 | | eligible for the Florida Kidcare program, may obtain health 52 |
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90 | 90 | | benefits coverage under any of the other compon ents listed in s. 53 |
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91 | 91 | | 409.813 if such coverage is approved and available in the county 54 |
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92 | 92 | | in which the child resides. 55 |
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93 | 93 | | (3) A Title XXI-funded child who is eligible for the 56 |
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94 | 94 | | Florida Kidcare program who is a child with special health care 57 |
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95 | 95 | | needs, as determined throu gh a medical or behavioral screening 58 |
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96 | 96 | | instrument, is eligible for health benefits coverage from and 59 |
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97 | 97 | | shall be assigned to and may opt out of the Children's Medical 60 |
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98 | 98 | | Services Network. 61 |
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99 | 99 | | (4) A Title XXI-funded child who reaches 19 years of age 62 |
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100 | 100 | | is eligible for continued Title XXI-funded coverage for the 63 |
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101 | 101 | | duration of a pregnancy and the postpartum period consisting of 64 |
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102 | 102 | | the 12-month period beginning on the last day of a pregnancy, if 65 |
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103 | 103 | | such pregnancy or postpartum period begins prior to the child 66 |
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104 | 104 | | reaching 19 years of a ge, and if the child is ineligible for 67 |
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105 | 105 | | Medicaid. 68 |
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106 | 106 | | (5) The following children are not eligible to receive 69 |
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107 | 107 | | Title XXI-funded premium assistance for health benefits coverage 70 |
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108 | 108 | | under the Florida Kidcare program, except under Medicaid if the 71 |
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109 | 109 | | child would have been eligible for Medicaid under s. 409.903 or 72 |
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110 | 110 | | s. 409.904 as of June 1, 1997: 73 |
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111 | 111 | | (a) A child who is covered under a family member's group 74 |
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112 | 112 | | health benefit plan or under other private or employer health 75 |
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120 | 120 | | Page 4 of 11 |
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121 | 121 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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122 | 122 | | |
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123 | 123 | | |
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124 | 124 | | |
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125 | 125 | | insurance coverage, if the cost of the child's participation is 76 |
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126 | 126 | | not greater than 5 percent of the family's income. If a child is 77 |
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127 | 127 | | otherwise eligible for a subsidy under the Florida Kidcare 78 |
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128 | 128 | | program and the cost of the child's participation in the family 79 |
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129 | 129 | | member's health insurance benefit plan is greater than 5 percent 80 |
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130 | 130 | | of the family's income, the child may enroll in the appropriate 81 |
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131 | 131 | | subsidized Kidcare program. 82 |
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132 | 132 | | (b) A child who is seeking premium assistance for the 83 |
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133 | 133 | | Florida Kidcare program through employer -sponsored group 84 |
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134 | 134 | | coverage, if the child has been covered by the same employer's 85 |
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135 | 135 | | group coverage during the 60 days before the family submitted an 86 |
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136 | 136 | | application for determination of eligibility under the program. 87 |
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137 | 137 | | (c) A child who is an alien but who does not meet the 88 |
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138 | 138 | | definition of a lawfully residing child. This paragraph does not 89 |
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139 | 139 | | extend eligibility for the Florida Kidcare program to an 90 |
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140 | 140 | | undocumented immigrant. 91 |
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141 | 141 | | (d) A child who is an inmate of a public institution or a 92 |
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142 | 142 | | patient in an institution for mental diseases. 93 |
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143 | 143 | | (e) A child who is otherwise eligible for premium 94 |
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144 | 144 | | assistance for the Florida Kidcare program and has had his or 95 |
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145 | 145 | | her coverage in an employer -sponsored or private health benefit 96 |
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146 | 146 | | plan voluntarily canceled in the last 60 days, except those 97 |
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147 | 147 | | children whose coverage was voluntarily canceled for good cause, 98 |
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148 | 148 | | including, but not limited to, the following circumstances: 99 |
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149 | 149 | | 1. The cost of participation in an employer -sponsored 100 |
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157 | 157 | | Page 5 of 11 |
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158 | 158 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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159 | 159 | | |
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160 | 160 | | |
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161 | 161 | | |
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162 | 162 | | health benefit plan is greater than 5 percent of the family's 101 |
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163 | 163 | | income; 102 |
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164 | 164 | | 2. The parent lost a job that provided an employer -103 |
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165 | 165 | | sponsored health benefit plan for children; 104 |
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166 | 166 | | 3. The parent who had health benefits coverage for the 105 |
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167 | 167 | | child is deceased; 106 |
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168 | 168 | | 4. The child has a medical condition that, without medical 107 |
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169 | 169 | | care, would cause serious disability, loss of function, or 108 |
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170 | 170 | | death; 109 |
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171 | 171 | | 5. The employer of the parent cancel ed health benefits 110 |
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172 | 172 | | coverage for children; 111 |
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173 | 173 | | 6. The child's health benefits coverage ended because the 112 |
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174 | 174 | | child reached the maximum lifetime coverage amount; 113 |
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175 | 175 | | 7. The child has exhausted coverage under a COBRA 114 |
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176 | 176 | | continuation provision; 115 |
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177 | 177 | | 8. The health benefits c overage does not cover the child's 116 |
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178 | 178 | | health care needs; or 117 |
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179 | 179 | | 9. Domestic violence led to loss of coverage. 118 |
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180 | 180 | | (6) A child who is otherwise eligible for the Florida 119 |
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181 | 181 | | Kidcare program and who has a preexisting condition that 120 |
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182 | 182 | | prevents coverage under another insura nce plan as described in 121 |
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183 | 183 | | paragraph (5)(a) which would have disqualified the child for the 122 |
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184 | 184 | | Florida Kidcare program if the child were able to enroll in the 123 |
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185 | 185 | | plan is eligible for Florida Kidcare coverage when enrollment is 124 |
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186 | 186 | | possible. 125 |
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194 | 194 | | Page 6 of 11 |
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195 | 195 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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196 | 196 | | |
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197 | 197 | | |
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198 | 198 | | |
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199 | 199 | | (7) A child whose family income is above 300 200 percent 126 |
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200 | 200 | | of the federal poverty level or a child who is excluded under 127 |
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201 | 201 | | the provisions of subsection (5) may participate in the Florida 128 |
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202 | 202 | | Kidcare program as provided in s. 409.8132 or, if the child is 129 |
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203 | 203 | | ineligible for Medikids by reason o f age, in the Florida Healthy 130 |
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204 | 204 | | Kids program, subject to the following: 131 |
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205 | 205 | | (a) The family is not eligible for premium assistance 132 |
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206 | 206 | | payments and must pay the full cost of the premium, including 133 |
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207 | 207 | | any administrative costs. 134 |
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208 | 208 | | (b) The board of directors of the Florid a Healthy Kids 135 |
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209 | 209 | | Corporation may offer a reduced benefit package to these 136 |
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210 | 210 | | children in order to limit program costs for such families. 137 |
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211 | 211 | | (8) Once a child is enrolled in the Florida Kidcare 138 |
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212 | 212 | | program, the child is eligible for coverage for 12 months 139 |
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213 | 213 | | without a redetermination or reverification of eligibility, if 140 |
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214 | 214 | | the family continues to pay the applicable premium. Eligibility 141 |
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215 | 215 | | for program components funded through Title XXI of the Social 142 |
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216 | 216 | | Security Act terminates when a child attains the age of 19. A 143 |
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217 | 217 | | child who has not attained the age of 5 and who has been 144 |
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218 | 218 | | determined eligible for the Medicaid program is eligible for 145 |
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219 | 219 | | coverage for 12 months without a redetermination or 146 |
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220 | 220 | | reverification of eligibility. 147 |
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221 | 221 | | (9) When determining or reviewing a child's eligibility 148 |
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222 | 222 | | under the Florida Kidcare program, the applicant shall be 149 |
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223 | 223 | | provided with reasonable notice of changes in eligibility which 150 |
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231 | 231 | | Page 7 of 11 |
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232 | 232 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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233 | 233 | | |
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234 | 234 | | |
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235 | 235 | | |
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236 | 236 | | may affect enrollment in one or more of the program components. 151 |
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237 | 237 | | If a transition from one program component to another is 152 |
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238 | 238 | | authorized, there shall be cooperation between the program 153 |
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239 | 239 | | components and the affected family which promotes continuity of 154 |
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240 | 240 | | health care coverage. Any authorized transfers must be managed 155 |
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241 | 241 | | within the program's overall appropriated or authorized levels 156 |
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242 | 242 | | of funding. Each component of the program shall establish a 157 |
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243 | 243 | | reserve to ensure that transfers between components will be 158 |
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244 | 244 | | accomplished within current year appropriations. These reserves 159 |
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245 | 245 | | shall be reviewed by each convening of the Social Services 160 |
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246 | 246 | | Estimating Conference to determine the adequacy of such reserves 161 |
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247 | 247 | | to meet actual experience. 162 |
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248 | 248 | | (10) In determining the eligibility of a child, an assets 163 |
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249 | 249 | | test is not required. If eligibility for the Florida Kidcare 164 |
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250 | 250 | | program cannot be verified using reliable data sources in 165 |
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251 | 251 | | accordance with federal requirem ents, each applicant shall 166 |
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252 | 252 | | provide documentation during the application process and the 167 |
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253 | 253 | | redetermination process, including, but not limited to, the 168 |
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254 | 254 | | following: 169 |
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255 | 255 | | (a) Proof of family income, which must be verified 170 |
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256 | 256 | | electronically to determine financial eligib ility for the 171 |
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257 | 257 | | Florida Kidcare program. Written documentation, which may 172 |
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258 | 258 | | include wages and earnings statements or pay stubs, W -2 forms, 173 |
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259 | 259 | | or a copy of the applicant's most recent federal income tax 174 |
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260 | 260 | | return, is required only if the electronic verification is no t 175 |
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268 | 268 | | Page 8 of 11 |
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269 | 269 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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270 | 270 | | |
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271 | 271 | | |
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272 | 272 | | |
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273 | 273 | | available or does not substantiate the applicant's income. 176 |
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274 | 274 | | (b) A statement from all applicable, employed family 177 |
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275 | 275 | | members that: 178 |
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276 | 276 | | 1. Their employers do not sponsor health benefit plans for 179 |
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277 | 277 | | employees; 180 |
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278 | 278 | | 2. The potential enrollee is not covered by an emplo yer-181 |
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279 | 279 | | sponsored health benefit plan; or 182 |
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280 | 280 | | 3. The potential enrollee is covered by an employer -183 |
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281 | 281 | | sponsored health benefit plan and the cost of the employer -184 |
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282 | 282 | | sponsored health benefit plan is more than 5 percent of the 185 |
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283 | 283 | | family's income. 186 |
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284 | 284 | | (c) To enroll in the Child ren's Medical Services Network, 187 |
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285 | 285 | | a completed application, including a clinical screening. 188 |
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286 | 286 | | (11) Subject to paragraph (5)(a), the Florida Kidcare 189 |
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287 | 287 | | program shall withhold benefits from an enrollee if the program 190 |
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288 | 288 | | obtains evidence that the enrollee is no longer eligible, 191 |
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289 | 289 | | submitted incorrect or fraudulent information in order to 192 |
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290 | 290 | | establish eligibility, or failed to provide verification of 193 |
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291 | 291 | | eligibility. The applicant or enrollee shall be notified that 194 |
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292 | 292 | | because of such evidence program benefits will be withheld 195 |
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293 | 293 | | unless the applicant or enrollee contacts a designated 196 |
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294 | 294 | | representative of the program by a specified date, which must be 197 |
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295 | 295 | | within 10 working days after the date of notice, to discuss and 198 |
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296 | 296 | | resolve the matter. The program shall make every effort to 199 |
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297 | 297 | | resolve the matter within a timeframe that will not cause 200 |
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305 | 305 | | Page 9 of 11 |
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306 | 306 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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307 | 307 | | |
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308 | 308 | | |
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309 | 309 | | |
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310 | 310 | | benefits to be withheld from an eligible enrollee. 201 |
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311 | 311 | | (12) The following individuals may be subject to 202 |
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312 | 312 | | prosecution in accordance with s. 414.39: 203 |
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313 | 313 | | (a) An applicant obtaining or attempting to obtain 204 |
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314 | 314 | | benefits for a poten tial enrollee under the Florida Kidcare 205 |
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315 | 315 | | program when the applicant knows or should have known the 206 |
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316 | 316 | | potential enrollee does not qualify for the Florida Kidcare 207 |
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317 | 317 | | program. 208 |
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318 | 318 | | (b) An individual who assists an applicant in obtaining or 209 |
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319 | 319 | | attempting to obtain benefit s for a potential enrollee under the 210 |
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320 | 320 | | Florida Kidcare program when the individual knows or should have 211 |
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321 | 321 | | known the potential enrollee does not qualify for the Florida 212 |
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322 | 322 | | Kidcare program. 213 |
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323 | 323 | | Section 3. Effective January 1, 2024, subsection (3) of 214 |
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324 | 324 | | section 409.816, Florida Statutes, is amended to read: 215 |
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325 | 325 | | 409.816 Limitations on premiums and cost sharing. —The 216 |
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326 | 326 | | following limitations on premiums and cost sharing are 217 |
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327 | 327 | | established for the program. 218 |
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328 | 328 | | (3) Enrollees in families with a family income above 150 219 |
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329 | 329 | | percent of the federal poverty level who are not receiving 220 |
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330 | 330 | | coverage under the Medicaid program or who are not eligible 221 |
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331 | 331 | | under s. 409.814(7) may be required to pay enrollment fees, 222 |
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332 | 332 | | premiums, copayments, deductibles, coinsurance, or similar 223 |
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333 | 333 | | charges on a sliding scale r elated to income, except that the 224 |
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334 | 334 | | total annual aggregate cost sharing with respect to all children 225 |
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342 | 342 | | Page 10 of 11 |
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343 | 343 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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344 | 344 | | |
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345 | 345 | | |
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346 | 346 | | |
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347 | 347 | | in a family may not exceed 5 percent of the family's income. 226 |
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348 | 348 | | However, copayments, deductibles, coinsurance, or similar 227 |
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349 | 349 | | charges may not be imposed for prevent ive services, including 228 |
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350 | 350 | | well-baby and well-child care, age-appropriate immunizations, 229 |
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351 | 351 | | and routine hearing and vision screenings. Premiums for 230 |
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352 | 352 | | enrollees paying enrollment fees, premiums, copayments, 231 |
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353 | 353 | | deductibles, coinsurance, or similar charges as provided i n this 232 |
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354 | 354 | | subsection shall be based on at least three but no more than six 233 |
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355 | 355 | | tiers of uniform premiums that increase with each tier as a 234 |
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356 | 356 | | percentage of the applicable threshold amount of the federal 235 |
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357 | 357 | | poverty level, by tier. 236 |
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358 | 358 | | Section 4. Effective January 1, 202 4, paragraph (b) of 237 |
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359 | 359 | | subsection (2) of section 624.91, Florida Statutes, is amended 238 |
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360 | 360 | | to read: 239 |
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361 | 361 | | 624.91 The Florida Healthy Kids Corporation Act. — 240 |
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362 | 362 | | (2) LEGISLATIVE INTENT. — 241 |
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363 | 363 | | (b) It is the intent of the Legislature that the Florida 242 |
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364 | 364 | | Healthy Kids Corporation s erve as one of several providers of 243 |
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365 | 365 | | services to children eligible for medical assistance under Title 244 |
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366 | 366 | | XXI of the Social Security Act. Although the corporation may 245 |
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367 | 367 | | serve other children, the Legislature intends the primary 246 |
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368 | 368 | | recipients of services provided thro ugh the corporation be 247 |
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369 | 369 | | school-age children with a family income equal to or below 300 248 |
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370 | 370 | | 200 percent of the federal poverty level, who do not qualify for 249 |
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371 | 371 | | Medicaid. It is also the intent of the Legislature that state 250 |
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379 | 379 | | Page 11 of 11 |
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380 | 380 | | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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381 | 381 | | |
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382 | 382 | | |
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383 | 383 | | |
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384 | 384 | | and local government Florida Healthy Kids f unds be used to 251 |
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385 | 385 | | continue coverage, subject to specific appropriations in the 252 |
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386 | 386 | | General Appropriations Act, to children not eligible for federal 253 |
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387 | 387 | | matching funds under Title XXI. 254 |
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388 | 388 | | Section 5. Except as otherwise expressly provided in this 255 |
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389 | 389 | | act, this act shall take effect upon becoming a law. 256 |
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