No. CS/CS/HB 1291
Filed under Healthcare.
Florida Birth-Related Neurological Injury Compensation Association; Requires agency to recover full amount of medical assistance from neurological injury compensation association; 766.302, F.S.; provides & revising definitions; removes limitation on time subject to plan compensation; provides & revising definitions; removes limitation on time subject to plan compensation; revises terminology; revises provisions relating to filing claims; conforms cross-reference; revises items that are eligible for award providing compensation; requires compensation to be provided for certain actual expenses; requires compensation for costs of major medical health coverage; requires plan to reimburse certain payments made for services provided; exempts expenses for professional custodial care in certain circumstances; requires that, upon entry of final order for compensation, parents or legal guardians obtain private health insurance or submit application for Medicaid program; requires directors to maintain plan of operation; requires certain assessments to be paid into Florida Birth-Related Neurological Injury Compensation Association at certain times for certain purposes; requires plan of operation to include provision for fraud; removes obsolete provisions; revises provisions relating to actuarial valuation of plan; requires association to submit quarterly estimates; requires association to state whether plan is actuarially sound; authorizes transfer of funds to association from Insurance Regulatory Trust Fund if plan is not actuarially sound; requires association to require each entity to issue casualty insurance and pay annual assessment; provides requirements for annual assessments; requires increase in assessments after certain findings.
Plain English Summary
AI-GENERATEDOnce a child is awarded compensation for a birth-related neurological injury, a family member must maintain private health insurance or apply for Medicaid, and the compensation plan must now pay the premiums, out-of-pocket costs, and any Medicaid claims for that participant's care.
The plan now covers dental care, facility care, legal costs for guardianship, and a bigger psychotherapy benefit that continues after a participant's death. A 10-hour daily cap on paid family caregiving is gone, and pay is now tied to Medicaid's home-health-aide rate.
Hospitals and physicians face assessment increases of up to 100 percent each if the plan runs short, in a set order, before casualty insurers can be assessed at all, a change from the routine annual assessment insurers previously paid.
The plan's shield against lawsuits may now cover anyone merely involved in a delivery, not just those directly involved. The board also cannot add costly new benefits in any year the plan's expenses outrun its assessment income.
AIOnce an administrative law judge enters a final order awarding compensation, a family member must obtain private health insurance or apply for Medicaid within days of that order, with a January 2027 deadline for people already receiving benefits.
AIThe compensation plan must pay for a participant's health insurance, including premiums and out-of-pocket costs, and must reimburse Medicaid's fee-for-service and capitation payments for that participant's care, crediting the money to Medicaid's trust fund.
AIThe state's Medicaid agency gains a new party to bill when recovering medical assistance payments: the compensation association itself, for costs it owes a participant under the plan's award statute.
AIFamily members giving hands-on care to an injured child were capped at 10 paid hours a day, with professional care barred during those hours. Both limits are struck, and the hourly pay rate switches from minimum wage to Medicaid's home-health-aide rate.
AIWhen the plan isn't on track to stay actuarially sound, the state must first raise hospital and participating-physician assessments, then other physicians' assessments, each by up to 100 percent, before casualty insurers can be assessed at all.
AIThe plan's exclusivity of remedy bars ordinary lawsuits over a birth-related neurological injury. That protection used to cover only parties directly involved in the delivery; removing that word lets it reach anyone merely described as involved.
AIThe $10,000 annual psychotherapy benefit for family members now also allows a psychiatrist as the provider, reaches other relatives beyond immediate family, and adds a new $20,000 benefit payable after the participant dies.
AIIf the plan's operating expenses exceed its assessment revenue plus investment income for the prior fiscal year, as shown in its audited financial statements, the board may not create new benefits or make existing ones more generous.