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Consent Agenda

FLORIDA HEALTHY KIDS CORPORATION BOARD OF DIRECTORS MEETING January 11, 2018

CONSENT AGENDA

These items are considered routine and are enacted by one motion. There will be no separate discussion of these items unless removal of the item from the Consent Agenda is requested by a Board Member for full Board discussion. If such a request is made, the item will be pulled from the Consent Agenda and placed on the Regular Agenda. Board Members will receive the Consent Agenda in advance of each board meeting. Supporting documents for each items listed on the Consent Agenda are behind each referenced tab number.

Consent Item (1) Tab 1 Approve Minutes of the Board of Directors Meeting – October 26, 2017

Summary: The Board of Directors of the Florida Healthy Kids Corporation met on October 26, 2017 in Orlando, Florida and via conference call. The agenda included reports from the Chair, the Chief Executive Officer, the Purchasing and Contracting Committee, the Quality Improvement and Data Analysis Committee, the Finance and Audit Committee, and Operations and Enrollment update, a Community Outreach and Marketing update, and a Corporate Counsel Report.

Consent Item (2) Tab 2 Approve Minutes of the Executive Committee Meeting – December 11, 2017

Summary: The Executive Committee met on December 11, 2017 in Tallahassee, Florida and via conference call. The agenda included the waiver of October 2017 family premiums due to Hurricane Irma.

Consent Item (3) Tab 3 Approve Minutes of the Community Outreach and Marketing Committee Meeting – December 12, 2017

Summary: The Community Outreach and Marketing Committee met on December 12, 2017 in Tallahassee, Florida via conference call. The Committee’s agenda included updates on the Outreach Initiatives, Enhanced Media Campaign, and Marketing and Public Relations.

Consent Item (4) Tab 4 Approve Minutes of the Quality Improvement and Data Analysis Committee Meeting – December 29, 2017

Summary: The Quality Improvement and Data Analysis Committee met on December 29, 2017 in Tallahassee, Florida and via conference call. The Committee’s agenda included a report on the Medicaid and CHIP Managed Care Final Rule, an update on the Performance Improvement Projects, and a Business Intelligence Update.

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Tab 1

Board of Directors Meeting Minutes

October 26, 2017

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FLORIDA HEALTHY KIDS CORPORATION Board of Directors Meeting

October 26, 2017 – 9:00 a.m. Orlando, Florida

Board Members Present: Wendy Link, Chair Dr. Jose Armas (conference call) Philip Boyce, Baptist Health System Dr. Jeffrey Brosco, University of Miami Dr. Peter Claussen Tami Cullens, Ad Hoc Board Member Jeri Culley, Department of Children and Families (conference call) Dr. Steve Freedman, Ad Hoc Board Member Beth Kidder, Agency for Health Care Administration (conference call) Commissioner Chip LaMarca, Broward County Board of County Commissioners Henry Martell, Ad Hoc Board Member Dr. Mansooreh Salari, Children’s Medical Services (conference call) Dr. Tommy Schechtman, Pediatric Partners Justin Senior, Agency for Health Care Administration (conference call) Penny Taylor, Department of Education Paul Whitfield, Ad Hoc Board Member (conference call)

Board Members Absent: Dr. George Hutter, M.D. David Leidel, Ad Hoc Board Member

Other Persons in Attendance: Linda Beavers, Aetna Jim Benjack, Institute for Child Health Policy Tracy Bishop, Florida Healthy Kids Corporation (conference call) Joe Davis, Florida Healthy Kids Corporation Shaun Davis, Florida Healthy Kids Corporation (conference call) Alina Delgado (conference call) Jeff Dykes, Florida Healthy Kids Corporation Scott Ehero, AHS Colleen Englert Suzetta Furlong, Florida Healthy Kids Corporation Maggie Garrett, Argus Brittany Gray, DentaQuest Jena Grignon, Florida Healthy Kids Corporation (conference call) Allison Harrell, Thomas Howell Ferguson P.A. Bill Hinsdale, WellCare Mary Ellen Klas, Miami Herald (conference call) Catherine Leary, WellCare Amy Mercado, FL House District 48 Steven Malono, Florida Healthy Kids Corporation Rebecca Matthews, Florida Healthy Kids Corporation Tiffany Nelsen, Florida Healthy Kids Corporation Austin Noll, Florida Healthy Kids Corporation (conference call) Gina Padilla, Maximus

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Christine Sexton, Politico (conference call) Neiko Shea, Sunshine Health Chris Struk, Florida Office of Insurance Regulation (conference call) Sarah Szarek, Institute for Child Health Policy

Other Conference Call Participants Senate Health Policy Committee Senator Branynon’s Office Senate Minority Office House Democratic Office

MINUTES

I. Welcome and Introductions

Chair Wendy Link called the meeting of the Florida Healthy Kids Corporation (FHKC) Board of Directors to order at 9:15 a.m. Ms. Link reminded the Board of their fiduciary duty to act in the best interests of the FHKC and the children and families it serves. Ms. Link introduced and welcomed Surgeon General Celeste Philip’s designee, Dr. Jeffrey Brosco, to the Board. Dr. Brosco serves as the Deputy Secretary of Children’s Medical Services at the Department of Health, and is a professor of clinical pediatrics at the University of Miami Miller School of Medicine. Ms. Link also announced Dr. Hutter’s retirement from the Board after seven years of service as both a board member and the Chair of the Quality Improvement and Data Analysis Committee. Ms. Link then announced that Dr. Amra Resic has been appointed by CFO Patronis to represent the Family Academy of Family Physicians. She will attend her first meeting in January.

Ms. Tiffany Nelsen called the roll and confirmed a quorum was present.

II. Executive Reports

A. Chair’s Report

1. Election of OfficersDr. Claussen and Mr. Boyce were willing to continue serving as Vice Chair and Secretary/Treasurer, respectively. No other nominations were brought forward.

ACTION: A motion and a second were received for Dr. Peter Claussen to serve as Vice Chair. The motion was approved without objection.

ACTION: A motion and a second were received for Mr. Philip Boyce to serve as Secretary/Treasurer. The motion was approved without objection.

2. Code of Ethics

Ms. Link advised that in the coming weeks, Mr. Steve Malono will be circulating the Code of Ethics, including a Conflict of Interest Form, to the Board.

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III. Consent Agenda

Mr. Malono was recognized to present the items on the Consent Agenda. He reviewed the items in the Consent Agenda, and explained that minor revisions were necessary to the Operational Efficiency and Integration Committee Meeting Minutes. He presented the items as a single item for Board approval.

ACTION: Approve the Consent Agenda as presented. The motion was approved without objection.

IV. Community Outreach and Marketing Update

Ms. Penny Taylor was recognized for this report. The Committee met on October 3, 2017. The focus of the committee has been to create sustainable initiatives at the “decision maker” level. Ms. Taylor also provided a short update on the Coordinate School Health Partnership’s Healthy District Awards. Currently, 45 of the 67 school districts have completed the voluntary self-assessment, which includes five KidCare-specific indicators. This is repeated every two years. Ms. Taylor explained that Mr. Joe Davis has made several presentations highlighting county specific-data, KidCare benefits, and programs to various districts throughout the state.

Ms. Taylor also provided an update on efforts made by Mr. Davis and committee members engage to the Florida Association of School Administrators (FASA) to collaboratively develop a school principal specific toolkit. FASA has agreed to help complete and promote this document by disseminating it to its over 6,000 members throughout the state.

Ms. Taylor recognized Mr. Joe Davis to give an update on the Enhanced Marketing Campaign and an overview of FHKC Outreach Grantees.

A. Enhanced Marketing Campaign Overview

Following the June 8, 2017 meeting, and with Board direction, FHKC implemented a statewide media campaign. Through an ITN process, FHKC awarded contracts to three seasoned partners:

• VancoreJones Communications – Direct Marketing Campaign• CBS Community Partnerships – Paid TV and Radio Ad Placement• Moore Communications Group – Earned Media and Branding

After launching on August 28, the campaign was paused due to Hurricane Irma. The television and radio ad components, as well as the digital and social media presence, were restarted on Monday, October 16. The direct marketing component of the campaign will resume in early January 2018. The components of this campaign are as follows:

VancoreJones provided a prospect list of approximately 120,000 Florida households with children potentially eligible for subsidized Florida KidCare. Throughout the campaign, a four-part series of oversized direct mail postcards will be distributed to these prospective customers. Most families will also receive several automated call messages and text messages. A series of video, banner and display ads will be advertised.

Mr. Davis played both a radio and TV commercial for the Board.

“I AM KidCare” English and Spanish television and radio ads will run for a total of 11 weeks in the 5 highest uninsured markets (Miami-Dade, Broward, Palm Beach, Orange & Hillsborough). The primary target audience of these ads are lower income families, specifically women with children, including Hispanic and African

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American households. During the initial campaign period (prior to the pause), the campaign had over 130,000 views and over 3,600 sessions to the web landing page.

B. Outreach Grantees and Initiatives

Mr. Davis provided an update on the following outreach grantees and initiatives: Florida Covering Kids and Families, We Are KidCare (WAK) Grantees, Boys and Girls Clubs VISTA Grants, Back-to-School Grantees, and Sponsorships. Mr. Davis concluded this presentation by playing CFO Patronis’ new KidCare commercial.

Ms. Link announced/welcomed Representative Amy Mercado, from Florida House of Representatives, District 48.

V. Purchasing and Contracting Committee Report

Ms. Kidder was recognized to present the report to the Board. The Committee met on September 26, 2017, and conducted its annual review of FHKC corporate documents, contract templates, and all in force contracts. The Committee received a report from Mr. Steve Malono on the status of the proposal to re-combine the subsidized and full pay populations, and the recommendation to not proceed with an early re-procurement, which the Committee supported.

The Committee also reviewed the corporate Bylaws, Plan of Operation, and Code of Ethics, including the updated conflicts list. There were no suggested revisions to the Bylaws. There were no suggested revisions to any of the corporate documents.

ACTION: The Purchasing and Contracting Committee recommended approval and re-adoption of the By-Laws, Plan of Operation and Code of Ethics. These were approved without objection.

The Committee reviewed the Purchasing and Contracting Committee Charter. There were no additional suggested revisions to the Committee Charter, and the charter was included in the previously approved Consent Agenda.

Ms. Kidder reminded the Board that part of the annual contract review includes a review of all of the contract templates used by the Corporation, as well as a review of the approved Contracting Guidelines. Because of extensive revisions to the contract templates over the past several years, staff had no recommendations for changes to those documents this year. Medical and dental plan contracts will need to be amended prior to July 1, 2018, to comply with the Federal CMS “Mega Rule.” The Committee will meet at a later date to review these revisions prior to bringing the matter before the full Board in the Spring of 2018.

The Committee reviewed all currently in force contracts. Committee members recommended some re-formatting and other technical changes to the manner in which the contract reports are presented, and those recommended changes are incorporated into the reports presented. The Committee will recommend adoption of each report, and any additional action items within such report, and staff will thereafter take the appropriate action.

Ms. Kidder presented the 2017 Insurer Contracts Annual Report to the Board.

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ACTION: The Purchasing and Contracting Committee recommends approval and adoption of the 2017 Insurer Contracts Annual Report. This was approved without objection.

Ms. Kidder presented the 2017 Vendor Contracts Annual Report to the Board.

ACTION: The Purchasing and Contracting Committee recommends approval and adoption of the 2017 Vendor Contracts Annual Report. This was approved without objection.

Ms. Kidder presented the 2017 Memoranda of Agreement Annual Report to the Board.

ACTION: The Purchasing and Contracting Committee recommends approval and adoption of the 2017 Memoranda of Agreement Annual Report. This was approved without objection.

Ms. Kidder presented the 2017 Marketing and Outreach Contracts Annual Report to the Board.

ACTION: The Purchasing and Contracting Committee recommends approval and adoption of the 2017 Marketing and Outreach Contracts Annual Report. This was approved without objection.

Ms. Kidder presented Amendment 11 to MED 140 and Revised Project Work Plan to the Board.

ACTION: The Purchasing and Contracting Committee recommends approval and adoption of Amendment 11 to the AHCA contract. This was approved without objection.

VI. Quality Improvement and Data Analysis Committee Report

Dr. Peter Claussen was recognized for this report. The Committee met on October 3, 2017, where an overview on the latest census data along with an update on the procurement process for the External Quality Review Organization contract was provided. Dr. Claussen recognized Ms. Suzetta Furlong to discuss the procurement and present staff’s award recommendation.

A. External Quality Review Organization (EQRO) ITN

Ms. Furlong reported that the corporation’s current EQRO contract expires December 31, 2017. The ITN was initially launched on June 22, 2017, and distributed to eleven EQROs. Three vendors responded. A team of evaluators and negotiators comprised of Mr. Shaun Davis, Ms. Lindsay Lichti, Ms. Furlong, and Ms. Tori Bell (AHCA) scored each of the proposals. Based on initial results, negotiations continued with all three vendors.

Based on several positive observations from the negotiation team, including a commitment to improve the quality of healthcare for the people they serve, the negotiation team recommended the contract be awarded to Qsource. Ms. Furlong provided an overview of Qsource’s company background, and highlighted that the initial three-year term of the contract will cost less than $1.8 million, a savings of more than $197 thousand per year on average, compared to the current EQRO contract.

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ACTION: The motion to approve the EQRO contract be awarded to Qsource was approved without objection.

VII. Finance and Audit Committee Report (Action Items)

Mr. Philip Boyce was recognized for the report. The Finance & Audit Committee met on October 4, 2017 at 2:00 pm and a quorum was present. The committee accepted the committee charter with two proposed modifications, which were included in the consent agenda. The committee also reviewed and accepted the Corporation’s audited financial statements and draft audit report for the 2016-17 fiscal year, the unaudited 2017-18 year-to-date financial statements through August, and staff’s proposed amendments to the approved fiscal year 2017-18 budget. The committee concluded its agenda with an update on the internal audit function and CHIP Reauthorization from Ms. Matthews.

A. FYE June 30, 2017 Audited Financial Statements

Mr. Boyce recognized Mr. Dykes to present the Fiscal Year Ending June 30, 2017 Audited Financial Statements. The presentation included financial highlights for the year, the standard overview of financial activity, and three financial statements. Mr. Dykes explained that the Corporation closed the fiscal year with an increase in fund net position of a little over $1M. This was the result of an operating gain in the Full-Pay program of $1.3M and revenue of $1M from the assessment of liquidated damages against Maximus, for a total increase of $2.3M. Corporate funds were expended from the operating bank account totaling about $1.3M, bringing the net increase in fund net position to $1M.The government subsidized programs were revenue-neutral at year-end resulting in no impact to fund net position.

Total expenses including insurance premium payments, third-party administration and internal administrative expenses for personnel, corporate and site support all ended the year below budget. Expenses paid by corporate funds were right at budget. At year end, the Corporation’s financial position showed increased strength as supported by the increase in fund net position of $1M.

The Corporation ended the year with Total Assets of $34.7M, Total Current Liabilities of $14.0M, with a Total Fund Net Position of $20.7M, which amount includes the $1M in Board designated funds for the enhanced media campaign.

ACTION: The motion to approve the Fiscal Year Ending June 30, 2017 Audited Financial Statements was approved without objection.

B. FYE June 30, 2017 Draft Audit Report

Mr. Boyce recognized Mr. Dykes to present the Fiscal Year Ending June 30, 2017 Draft Audit and required auditor communications report. Mr. Dykes explained that the audit was conducted by Thomas Howell Ferguson. The firm audited the Corporation’s fiscal year 2016-17 financial statements in accordance with generally accepted auditing standards and government auditing standards issued by the Comptroller General. The auditors examined cost allocation methodologies and distributions across programs, considered how Corporate funds were used and reported, and conducted other procedures in accordance with generally accepted auditing standards. The auditor’s found that the financial statements present the financial position of the Corporation, as of June 30, 2017, fairly and in accordance with generally accepted accounting principles. The auditors also rendered an unmodified opinion relating to compliance with federal program requirements. There were no significant deficiencies or material weaknesses noted by the auditors involving the internal controls over financial reporting and its operation. There were no findings regarding noncompliance with the provisions of our agreement with the Agency for Health Care Administration.

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Mr. Dykes then recognized Ms. Allison Harrell, of Thomas, Howell, Ferguson, to summarize certain matters required by professional standards.

Ms. Harrell confirmed that no significant weaknesses, material deficiencies, or other issues arose during the audit. She confirmed that Thomas, Howell, Ferguson has communicated all required communications. Ms. Harrell further explained that on a sampling basis, the firm tested payments with contractors, payments with carriers, eligibility criteria, making sure active participants within the program are in the right program, etc. No new accounting pronouncements came up that needed to be applied.

ACTION: The motion to approve the Fiscal Year End Audit Report was approved without objection.

C. Year-to-Date Unaudited Financial Statements

Mr. Boyce recognized Mr. Dykes to present the Unaudited 2017-18 Year To Date Financial Statements through August. Mr. Dykes explained the Corporation closed the period thru August with a decrease in fund net position of ($46K). This was primarily attributed to the use of Corporate funds of $243K exceeding operating gains in the Full-Pay program of $197K. The government subsidized programs were revenue-neutral resulting in no impact to fund net position. The expense categories for insurance expenses, internal administration expenses for personnel, corporate and site support, as well as the use of Corporate funds, were all within budget. The Corporation’s assets of $56.2M and liabilities of $35.5M for this period are reported at $20.3M higher than normal due to the early receipt of government funds in August that were designated for September obligations. These funds were recorded as deferred revenue and will be recognized as earned revenue in the September financials. The total Fund Net Position was $20.7M at the end of August, which amount includes a remaining unspent balance of $926K for the Board designated enhanced media campaign.

ACTION: The motion to approve the 2017-18 Year-to-Date Unaudited Financial Statements Through August was approved without objection.

D. Proposed Amendments to FY 2017-2018 Budget

Mr. Boyce recognized Mr. Dykes to present the proposed amendments to the Fiscal Year 2017-2018 Budget. The fiscal year budget approved by the Board back in June was based on the outcome of the 2017 legislative session and resulting General Appropriations Act.

ACTION: The motion to approve the Proposed Amendments to FY 2017-2018 Budget was approved without objection.

E. Data Security Report

Following the budget amendment report, Ms. Link recognized Mr. Malono to provide the Data Security Report. Mr. Malono explained that on the afternoon of July 25, 2017, the corporation fell victim to a “Phishing” scam which allowed access by unknown persons to an employee’s Outlook mailbox and contacts. On the morning of July 26, several undeliverable email notices and phone calls from recipients, including partner organizations, were received. The desktop password was immediately changed, and the computer was taken offline. Network virus and malware scans were performed without detecting anything of note. Prior to the breach being detected, the unknown persons sent two emails to approximately 600 unique

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addresses. No PHI or other sensitive information was contained in these outgoing emails, and no access to FHKC servers or other databases was obtained. The Office 365 “cloud” password was changed after a period of 24 hours. During this 24 hour period, there was potential for unauthorized persons to access the employee’s emails and contacts as far back as March of 2015. Due to the corporation’s recent migration to Office 365 environment, the audit function was set to the default “off”, and there is no ability to see who, if anyone, may have accessed the emails and contacts during the 24 hours.

FHKC contracted with Inspired Technologies of North Florida to assist with evaluating and addressing the various impacts. Inspired Technologies determined that unauthorized persons could have had access to about 37,500 emails in various mailboxes, containing about 2000 unique Social Security numbers, or other personally identifiable information. 1,700 of these Social Security numbers are in our current database. AHCA was notified within 10 days of incident discovery. On September 7, 2017, formal notification was provided to the U.S. Department of Health & Human Services, as well as Fla. Dept. of Legal Affairs, and AHCA (with a more complete report). Per federal law, a Press Release was issued to major news outlets statewide. Notification was posted on the Healthy Kids website, known affected individual on-line accounts were flagged, and notification letters were also sent by U.S. Mail and email to those potentially impacted.

FHKC made LifeLock credit monitoring available for each affected individual, at no charge, for 1 year. The corporation is conducting enhanced HIPAA training for all staff, and has put additional security/authentication protocols in place. Inspired Technologies continues to conduct IT assessment and help implement resulting recommendations.

F. Internal Audit Function Ms. Matthews explained the corporation’s auditing firm, Mauldin and Jenkins, has provided their draft report on factors to consider when staff is reviewing for internal auditors. To date, there are 4 full-time internal auditor interviews scheduled for the week of November 7. Working with Mauldin and Jenkins, the corporation expanded the scope of the role of the internal auditor. Ms. Matthews further explained this person will be performing normal risk assessments and auditing throughout the year, and will also focus on ad hoc management guidance as needed. Ms. Matthews explained the goal is to have the position filled before the January 2018 meeting. The next step for Mauldin and Jenkins is to move forward with preparing the risk assessment with staff and develop a proposed audit plan for the year. The firm will continue to assist the new individual as they initiate themselves into the organization.

VIII. Chief Executive Officer’s Report

A. State and Federal Update

Ms. Matthews was recognized to provide an update on the status of the Full Pay Program. Ms. Matthews reminded the Board that FHKC staff have been working for the past year towards the goal of re-combining the full pay population with Title XXI for the purposes of premium development with the goal of reducing the current high full pay premiums and deductibles. While Ms. Matthews and staff have been encouraged by the support for this proposal both in the Florida legislature and Congress, and received written approval from HHS to recombine the two risk pools, the corporation will not proceed with these recombining efforts at this time. While re-procuring the health plan contracts one year early would have provided premium relief to Full Pay families more quickly, several crucial questions remain unanswered. These include the status of the CHIP program, Florida Legislative funding and approval, as well as concerns regarding sufficient timing, and the various complexities of any ITN response. There was also concern regarding conflicting with and overlapping AHCA’s ongoing MMA procurement timeline. With guidance from the Purchasing & Contracting

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Committee, and Ms. Kidder, the corporation will instead re-procure the health plan contracts according to the normal contractual cycle, with new contracts to be effective October 1, 2019.

Sunshine State Health, the current full pay plan, is under contract through September 30, 2018. Sunshine has agreed in principle to extend the current full pay “Stars” program for an additional year, through September 30, 2019.

B. Federal CHIP Reauthorization

Both the House and Senate have included 5 years of funding in their current proposed legislation. They both continue the current match rate for two years, but then the ACA required increase in the match rate is reduced by 50 percent. One year later, the match rate goes back to what it was before the ACA. The two bills, however, do not currently mirror each other.

Dr. Tommy Schechtman expressed concerns regarding the longevity of Florida’s funding and how best to urge governors and legislators to stress the importance of reauthorization.

Ms. Link advised that there are lobbyists in Washington D.C., advocating on behalf of the Board. Ms. Matthews further explained that Florida is funded through January 2018. Some states have run out of initial funding but those programs are currently still operating with federal assistance. To date, Colorado has provided an update to its members but no known state has issued any public notices. CHIP Reauthorization remains a bipartisan effort, but it remains to be seen how the pending House and Senate bills and federal government will pay for CHIP. Mr. Malono explained that FHKC, working with AHCA and DOH, has developed a flexible contingency plan with dates for notices and any necessary action. Per Ms. Link’s direction, the corporation will continue to provide updates and a special Board meeting will be called if necessary.

IX. Operations and Enrollment

A. Update

Ms. Matthews began the Operations and Enrollment Update with a report on the Autopayment and IncentiveProgram. Each year the Board is asked to reauthorize the Autopay Incentive Program, which encouragesfamilies to have their premiums automatically deducted by waiving the service fee for up to 12 months. InOctober 2017, the service fee was reduced from $1.50 to $1.20. In preparation for the request to reauthorizethe program and in response to questions received at the October 2016 Board Meeting, the corporation didmore research into the effect the program has on disenrollment rates. As Mr. Dykes explained, the annualcost of this program is $135,000 and includes the expected program growth and adjustment for the $.30 feedecrease. Additionally, after the first 12 months in the incentive program, families are more willing to pay theautopay fee and continue in the program. There is about 20% less disenrollment for nonpayment due tononpayment for those families in the autopay program.

ACTION: Motion to continue the autopay credit incentive program at $1.20 transaction fee for those who enroll in autopayment. The motion was approved without objection.

Ms. Matthews explained that the 2016 Census data released in September 2017 provided a wealth of information about the changes experienced by States and larger counties from 2015 to 2016. Data about

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smaller counties and data at the zip code level will be released through the end of the year, and will be reported at the January 2018 Board meeting.

Florida reduced the number of uninsured children by 26,000 or 9.2% from 283,000 in 2015 to 257,000 in 2016. Since 2013, Florida has reduced the number of uninsured children by 188,000 or 42%. KidCare overall saw a reduction of 25,000 children, of which 18,500 were children in Medicaid.

Additionally, Florida experienced a reduction in the uninsured rate of 0.7% from 2015 to 2016 and a reduction of 4.9% since 2013. Florida has seen larger reductions than the nation over the same time period, reducing the uninsured rate by nearly half. The national reduction from 2013 to 2016 was only 2.6%. As expected, Florida has a similar number of uninsured children to other large states like Texas, California and New York.

The Five Highest Uninsured Counties (Broward, Hillsborough, Miami-Dade, Orange and Palm Beach) as a whole represent 45% of the uninsured children statewide in 2016. They also represent close to half of the statewide reduction in the number of uninsured children. While all of the Five Counties have seen large reductions in number of uninsured children since 2013, Orange County has made the most progress with a 53% reduction. Orange County has made this progress while having one of the largest increases in their child population since 2013.

Most of the Five Counties have uninsured rates close to the statewide average. Orange County was also a leader in this measure with a reduction in the uninsured rate from 2015 to 2016 of 1.6% and has cut the rate in half since 2013.

The corporation has seen strong growth throughout this calendar year, with CHIP and Full Pay enrollment increasing by almost 8,500 or 5%. We continue to see strong growth in the Healthy Kids Full Pay program, which has increased by 2,250 or 22% since January 2017. In addition, CMS has increased enrollment by almost 1,900 or 21%.

Subsidy enrollment decreased from September to October, with a net decrease of about 4,000 children. Some of this reduction may be related to Hurricane Irma, which made landfall on September 11. We have made numerous efforts throughout the month to contact families and encourage them to take advantage of the extended premium payment deadline for October coverage.

X. Impacts of Hurricanes Irma and Maria

Ms. Link began this report by reminding the Board that on September 11, 2017, Hurricane Irma made landfall, and Floridians have felt its impact in many ways. The corporation and agency partners (ACHA and DOH) have collaborated throughout the entire process. At the beginning of October - 97% of the children in Healthy Kids, MediKids and Children’s Medical Services had their October premium paid prior to the beginning of the month – leaving 3% that did not make a payment. Typically, the Corporation experiences 2% cancellation per month for non-payment.

At the close of business October 25, more than 54,000 (54,691) outreach attempts in English, Spanish or Creole have been made directed to enrollee who did not make a payment for October. These included 5,675 mailed letters, 10,367 emails, 14,355 text messages, 19,889 auto-dialed calls, and 4,405 personal calls from Maximus to families. As a result of these repeated outreach attempts, 1,978 families indicated they wanted to enroll in October coverage, 1,625 paid their October premium and were retro enrolled. 1,545 inbound calls to the call center were generated as a result of outreach efforts. 447 callers said they did not want the coverage, and 234 said they cannot afford it.

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Ms. Link then recognized Ms. Matthews to provide further information regarding the corporation’s response. Prior to Irma making landfall, Governor Scott declared a state of emergency in all 67 Florida counties. Subsequent to landfall, the Federal Emergency Management Administration (“FEMA”) declared that the residents of 48 specific counties would be eligible for “individual” assistance from FEMA. The corporation and partners immediately began exploring necessary actions from a State Plan perspective. On September 13, 2017, Florida’s Office of Insurance Regulation issued an Emergency Order requiring all insurance companies, including HMOs, to suspend cancellations and non-renewals, and extend payment grace periods, for periods of as much as 90 days. FHKC immediately began conferring with AHCA and the DOH with respect to available options, including an extension of payment grace periods or premium waiver/deferment, and the financial effects of any such action. Meetings and/or conference calls among the partners occurred frequently, often daily.

On September 27, 2017, AHCA confirmed to FHKC in writing that the September 13, 2017 OIR Emergency Order was not applicable to the KidCare program, and that the KidCare partners were free to fashion a “KidCare specific” response to Irma. From shortly after landfall, FHKC has been closely monitoring new application levels. New application levels throughout the remainder of September were consistent with prior months. Because about 95% of applications are received online, and originate from middle and southern regions of Florida, it appeared normal application/communication methods were likely not significantly affected by Irma.

On October 1, the KidCare partners determined, after approval from Florida’s Governor and CFO, to extend the premium payment grace period for October coverage an extra 30 days through October 31, 2017. The extended grace period was limited to families living in the 48 counties eligible for FEMA individual assistance. Families who paid the premium on or before October 31 would have coverage reinstated to October 1.

On October 2, AHCA, on behalf of all KidCare partners, announced the details of the grace period extension in a Press Release. FHKC immediately instituted an outreach program to all KidCare families who had not paid their October premium (9,000~) to make them aware of the extended grace period. This included letters, emails, a weekly auto-dialer telephone campaign, a text message campaign, as well as notifications and FAQs on the website, and an alert on all individual affected web accounts. Special attention was paid to CMS enrollees. Emails were also sent to many partner and advocacy groups, as well as to all health and dental plans.

6,338 were eligible for subsidized coverage, and 2,666 were eligible for Full Pay coverage. The net decrease for CHIP, including subsidy and Full Pay, is 4,051. This encompasses the 48 counties that fell within the emergency declaration. (For entire state, the number is 4,151).

Ms. Furlong explained that staff has been tracking all outreach attempts, including those individuals who could not be contacted. Ms. Link emphasized the fact that many families have had the ability to reach us through the call center, electronically, etc. Ms. Link also raised questions regarding the fairness of paying those outstanding premiums when most families were able to pay on time, and potential impacts on the federal match rate should the premiums be waived.

Secretary Justin Senior stated that a waiver of premium must be requested from the federal government. The state plan would need to be updated to allow the waiver of premiums, and to extend the 30-day period for payments. He then suggested potentially waiving the premium only for the subsidized population. Identifying those members who did not want to continue coverage would be administratively and financially challenging. Secretary Senior then explained AHCA has been researching the “Chip In” program, which allows non-provider entities to pay premium on behalf of CHIP families.

Ms. Matthews advised the Board that, to date, the outreach campaign has been approximately 70% successful. Out of 44,611 attempts to contact families through emails, texts, and autodialed calls, 32,244 successfully resulted in contacting families. Unsuccessful attempts included those with undeliverable email addresses. When an undeliverable message was received, alternative means of contact were used to continue outreach efforts.

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Ms. Furlong explained that these have been identified as “no touch” families. MMS researched these accounts and continued outreach attempts. Fewer than 100 could not be reached at all. Additionally, 5,000 letters were mailed to all identified families during this time. Ms. Furlong further explained that 1,545 of those identified have indicated they want their payment to apply to October and not November. While Dr. Schechtman and Secretary Senior expressed concerns regarding potentially failing to actively contact some members, Ms. Link reminded the Board that this reenrollment is a two-way street, and that there is a degree of individual responsibility.

Dr. Schechtman, representing American chapter of pediatrics, reminded the Board of a letter from pediatricians in impacted areas requesting that the state waive premiums for two months. If the premiums were waived for the two months, the anticipated financial impact would be approximately $6.5M, of which the state would be responsible for $225,000-$250,000 in the 48 impacted counties.

Ms. Link recommended identifying which of the 234 who indicated they could not afford October coverage are in the subsidized population and provide them with information about the Chip In program, as well as continue to work with providers to identify those who lost coverage and provide retroactive coverage. Ms. Kidder explained that if premiums were waived, the state would still receive the federal match. She recommended amending the state plan, which can be done retroactively, to provide more options going forward.

ACTION: Approve extending the meeting until 2:15 p.m. This motion was approved without objection.

Mr. Dykes explained that, as of the Board Meeting, the outstanding family contribution related to the unpaid October coverage totaled about $60,000, with total insurance cost for benefits, administration, etc., of approximately $850,000. Mr. Dykes further explained that $53,000 of the outstanding family contribution is from Healthy Kids families, while the remaining $7,000 are from other groups. The total cost is just under $700,000. Ms. Link advised that AHCA would be responsible for the outstanding total cost if no reimbursement mechanism were available. Ms. Link recommended staff, Ms. Kidder, and Secretary Senior continue efforts to develop a clear picture of the effects of Hurricane Irma, and the discussion would continue in either a full Board of Directors or Executive Committee conference call.

In the interest of time, the Operational Efficiency and Integration Committee Report was postponed to the January 2018 meeting.

XI. Corporate Counsel’s Report

Mr. Malono provided a brief update on the trade secret litigation from last dental procurement. He explained this is still currently pending with the First District Court of Appeal.

With no other business to report, the meeting adjourned at 2:15 p.m.

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Tab 2

Executive Committee Meeting Minutes

December 11, 2017

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FLORIDA HEALTHY KIDS CORPORATION Executive Committee Meeting December 11, 2017 – 10:00 a.m.

Tallahassee, Florida

Committee Members Present: Wendy Link, Chair (conference call) Dr. Peter Claussen, Vice Chair (conference call) Philip Boyce, Secretary/Treasurer (conference call)

Board Members Present: Dr. Jeffrey Brosco, University of Miami (conference call) Steve Freedman, PhD, Ad Hoc Board Member (conference call) Beth Kidder, Agency for Health Care Administration (conference call) Dr. Mansooreh Salari, Children’s Medical Services (conference call) Penny Taylor, Department of Education (conference call)

Other Attendees: Tracy Bishop, Florida Healthy Kids Corporation Joe Davis, Florida Healthy Kids Corporation Jeff Dykes, Florida Healthy Kids Corporation Suzetta Furlong, Florida Healthy Kids Corporation Steve Malono, Florida Healthy Kids Corporation Rebecca Matthews, Florida Healthy Kids Corporation Tiffany Nelsen, Florida Healthy Kids Corporation Austin Noll, Florida Healthy Kids Corporation

MINUTES

I. Welcome and Introductions

The meeting of the Executive Committee was called to order by Ms. Wendy Link, Chair, at 10:03 a.m. A quorum was present.

II. Hurricane Irma: Waiver of October, 2017 Family Premiums

Ms. Link recognized Ms. Rebecca Matthews to provide background information on the status of October enrollment and related family premium issues surrounding Hurricane Irma. This issue was discussed at length during the October 26, 2017 Board of Directors meeting. FHKC staff was charged to determine if previously enrolled families did not pay their October premiums because they could not afford to pay. FHKC staff was also to consult with the Agency for Health Care Administration (AHCA) staff to see if the “CHIP-IN” program might be used to pay the outstanding family premiums.

AHCA determined the best approach was to utilize the “CHIP-IN” program to pay all outstanding October premiums for the CHIP subsidized population, but only for those who were enrolled for the month of September and lived in the 48 counties FEMA identified as eligible for individual assistance. Children no longer eligible for the program, to the extent they could be identified, were to be excluded. AHCA also concluded that FHKC is eligible to legally participate in the “CHIP-IN” program. AHCA will reimburse FHKC for the funds supplied by FHKC to the “CHIP-IN” program to cover the family contribution for the subsidized Healthy Kids and MediKids enrollees, as well as CMS Managed Care Plan enrollees. FHKC will deposit an estimated $55,000 into the “CHIP-IN” program for payment of the October family premium for these approximately 4,550 previously enrolled children who did not pay for October coverage.

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A State Plan Amendment authorizing this payment, retroactive to September 1, has been prepared by AHCA, approved by FHKC, and will be filed with the HHS Centers for Medicare and Medicaid Services.

ACTION: Accept the proposal by the Agency for Health Care Administration (AHCA) allowing the Florida Healthy Kids Corporation to deposit adequate funds into the “CHIP-IN” program for payment on behalf of applicable families for the October family contribution, subject to AHCA fully reimbursing FHKC within 60 days. The motion was approved without objection.

III. Other Business

Ms. Matthews reported Florida KidCare has seen an increase in enrollment during the months of November and December. Usually during this time of year there is a dip in enrollment. During the 2017 calendar year, CHIP has enrolled 10,000 new enrollees.

The meeting was adjourned at 10:10 a.m.

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Tab 3

Community Outreach and Marketing Committee

Meeting Minutes

December 12, 2017

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FLORIDA HEALTHY KIDS CORPORATION Community Outreach and Marketing Committee

December 12, 2017 – 10:00 a.m. Tallahassee, Florida

Committee Members Present: Penny Taylor, Chair Robin Ingram, Committee Member (conference call) Kriss Vallese, Committee Member Melanie Hall, Advisory Member (conference call) Jordan Jacobs, Advisory Member Jodi Ray, Advisory Member (conference call)

Committee Members Absent: Commissioner Chip LaMarca, Committee Member Angela Wiggins, Committee Member

Other Members in Attendance: Tracy Bishop, Florida Healthy Kids Corporation Ashley Carr, Florida Healthy Kids Corporation Joe Davis, Florida Healthy Kids Corporation Jena Grignon, Florida Healthy Kids Corporation Rebecca Matthews, Florida Healthy Kids Corporation Steven Malono, Florida Healthy Kids Corporation Tiffany Nelsen, Florida Healthy Kids Corporation Austin Noll, Florida Healthy Kids Corporation Santiago Sanchez, Agency for Health Care Administration Kaylyn Stevenson, Florida Healthy Kids Corporation

MINUTES

I. Welcome and Introductions

Ms. Penny Taylor called the meeting to order at 10:00 am. Introductions were made via phone and in person. A quorum was present.

II. Outreach Initiatives

Ms. Taylor recognized Mr. Joe Davis to provide an overview of the outreach initiatives. Mr. Davis introduced to the committee the Corporation’s efforts in establishing a partnership with state colleges for a health and dental outreach campaign. Mr. Davis explained that a scope of work has been drafted for a campaign that would increase awareness and drive individuals involved with the colleges as students, faculty, staff, and their associated family members to the Florida KidCare application process. Mr. Davis announced that the Corporation was drafting an Invitation to Negotiate that could be available to one of the following: one or more of the 28 state colleges, the Association of Florida Colleges, or the Florida Department of Education, Division of Florida Colleges.

Mr. Davis then announced that the Corporation had been awarded a $110,000 grant from the Health Foundation of South Florida to pilot a program incentivizing schools and community-based organizations in Miami-Dade and Broward counties to increase KidCare enrollment. The one-year project has a targeted start date of January 2018, and would allow FHKC to hire a Miami-based consultant to oversee the project. Ms. Taylor also reminded the committee of the Healthy District Symposium on January 17, and asked FHKC staff to assist in generating press related to the event.

Lastly, Mr. Davis provided an update on FHKC’s engagement of faith-based leaders at various events, including the Governor’s Faith-Based and Community-Based Council-led Florida Faith Symposium. FHKC continues to receive

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commitments from leaders of mega-churches of all faiths around the state, though with a concentration on the highest uninsured markets, to promote KidCare in their places of worship, as well as to serve as champions for the program.

III. Enhanced Media Campaign

Ms. Taylor recognized Ms. Ashley Carr to provide an overview of the enhanced media campaign. Ms. Carr explained that following the five-week campaign pause due to Hurricane Irma, the campaign’s television and radio ads began again on October 16, running for four weeks before the Thanksgiving holiday. The ads will pause again during the holiday season, before a final campaign push between January 8-19, 2018.

The direct marketing component of the EMC is also scheduled restart on or around January 8. This will feature digital ads on Facebook and family-friendly websites, a series of three oversized targeted mailers, and automated calls and text messages to targeted prospective families in our highest uninsured counties. A small subsection of families may also receive live outbound calls to encourage and ease the application process.

FHKC and the three vendors continue to monitor and track the campaign’s performance. However, due to the natural lag of application to enrollment, final campaign performance data will be compiled to be shared with the Committee and the Board during the spring. Ms. Rebecca Matthews added that data appears promising, citing that Florida KidCare applications and enrollment are steadily continuing to increase.

IV. Marketing and Public Relations

Ms. Taylor recognized Ms. Carr and Ms. Jordan Jacobs to provide an update on marketing and public relations items. Ms. Carr informed the committee that FHKC staff have engaged in conversations with the Motor Vehicle Network (MVN) to include Florida KidCare messaging within the rotation of digital advertisements at local DMV locations. The Network agreed to pilot a test campaign in Volusia, Broward and Miami-Dade counties, and the Corporation is currently developing creative content for MVN approval. The no-cost advertisements will be placed in other DMV locations upon successful launch of the pilot.

Ms. Carr then introduced the expanded Dental Health Month campaign for February 2018. With the goals of increasing enrollees’ use of dental benefits, encouraging new enrollments, and raising awareness of good dental health, FHKC will launch a multi-faceted marketing campaign that will leverage FHKC Board Member Dr. Peter Claussen. FHKC will create a 30 second video advertisement featuring Dr. Claussen, and will author an op-ed to encourage parents to secure dental health coverage for their children. Additionally, the campaign will feature a three-part email campaign to highlight the benefits of childhood dental care, account pop-up notifications and continued partnership with Colgate and community liaisons. Committee members expressed excitement for the dental awareness campaign, and offered additional suggestions to capitalize on National Dental Health Month.

V. Other Business

Ms. Taylor recognized Ms. Matthews to provide a brief update on the state of federal funding for the Children’s Health Insurance Program (CHIP). Ms. Matthews explained that Congress is expected to either renew funding or pass a Continuing Resolution before the Christmas holiday. Ms. Matthews and FHKC staff remain optimistic that Congress will renew funding soon.

Ms. Taylor then recognized Mr. Austin Noll to provide an update on Florida KidCare enrollment. Mr. Noll told the committee that Florida CHIP enrollment has surpassed 200,000 children, and continues to slowly grow approximately 1% every month. Despite changes to the full-pay programs, enrollment continues to grow as well. Mr. Noll expressed that FHKC staff continue to find ways to promote application conversion and enrollment retention to complement the efforts of the Community Outreach and Marketing departments.

Ms. Kriss Vallese moved to adjourn the meeting, and Ms. Melanie Hall seconded the motion. The meeting was adjourned at 11:03 a.m.

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Tab 4

Quality Improvement and Data Analysis Committee

Meeting Minutes

December 29, 2017

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FLORIDA HEALTHY KIDS CORPORATION Quality Improvement and Data Analysis Committee

December 29, 2017 – 10:00 a.m. Tallahassee, Florida

Committee Members Present: Peter Claussen, D.D.S, Board Member, Committee Vice-Chair (conference call) Dr. Jeffrey Brosco, Board Member (conference call) Beth Kidder, Board Member Mansooreh Salari, M.D., Board Member (conference call)

Committee Members Absent: Jose Armas, M.D., Board Member Philip Boyce, Board Member Dr. Dennis Cookro, M.D., Committee Member Tommy Schechtman, M.D., Board Member Rachel LaCroix, Ph.D., Advisory Member Mary Pat Moore, Advisory Member

Other Persons In Attendance: Tracy Bishop, Florida Healthy Kids Corporation John Couzins, QSource (conference call) Joe Davis, Florida Healthy Kids Corporation Shaun Davis, Florida Healthy Kids Corporation Dawn FitzGerald, QSource (conference call) Suzetta Furlong, Florida Healthy Kids Corporation Lois Heffernan, QSource (conference call) Lindsay Lichti, Florida Healthy Kids Corporation Steve Malono, Florida Healthy Kids Corporation Rebecca Matthews, Florida Healthy Kids Corporation Austin Noll, Florida Healthy Kids Corporation

MINUTES

I. Welcome and Introductions

The Vice Chair, Dr. Peter Claussen, called the Quality Improvement and Data Analysis Committee meeting to order at 10:00 a.m. A quorum was present.

II. Performance Improvement Project

Dr. Claussen recognized Mr. Austin Noll to introduce the representatives from QSource, FHKC’s newly contracted External Quality Review Organization (EQRO), and present the annual Performance Improvement Projects (PIP).

The current PIP for the health plans is to improve the rate of well-child visits in the 5th and 6th years of life. The current PIP for dental plans is to improve the use of dental preventive services. Based on the contract with QSource, training, educational and technical support will be provided to the health and dental plans. QSource will incorporate Plan-Do-Study-Act (PDSA) elements into PIPs. Health and dental plans will also be required to report on their PIPs quarterly.

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FHKC staff recommended to the Committee that both the health and dental plans continue with their current PIP during 2018. FHKC staff will provide recommendations for 2019 PIP topics to the Committee prior to the October 2018 Board of Directors meeting.

ACTION: Approve the recommendation that the Health and Dental Plans will continue with their current Performance Improvement Projects throughout the 2018 year. The motion was approved without objection.

III. Medicaid and CHIP Managed Care Final Rule

Dr. Claussen recognized Ms. Lindsay Lichti to provide an update on the Medicaid and CHIP Managed Care Final Rule. The Medicaid and CHIP Managed Care Final Rule has made widespread changes to CHIP managed care plan requirements that will be effective July 1, 2018.

a. Network Adequacy Exceptions

The Committee has the responsibility to review requests from the health and dental plans seeking exemptions that may include waivers regarding board certification status, appointment or access standards. The health and dental plans need these exemptions because some rural areas don’t have providers practicing in the network area, providers may not pass the plan’s credentialing process, or some areas have providers that don’t accept the insurance.

Ms. Lichti presented to the Committee the revised Standard Operation Procedure 300-02: Provider Exemptions which highlights six key parts of the service area exemption process.

ACTION: Approve the recommended revisions to the Standard Operating Procedure 300-02: Provider Exemptions. The motion was approved without objection.

b. Indian Health Care Providers

A supplemental payment is required to be made to providers who are Indian Health Care Providers when a plan pays the provider less than the full amount the provider has the right to receive. Similar requirements already exist for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).

Indian Health Care Providers are not mentioned in current health plan contracts. The plans are required to pay FQHCs and RHCs the full amount that both FQHCs and RHCs are eligible to receive, including the amount that would otherwise be made through a supplement payment.

FHKC staff recommended that contractually the health plans will pay the full amount an Indian Health Care Providers is eligible to be paid, specifying that no supplemental payments for FHKC will be provided. Also, require the same attestations and reporting of the Indian Health Care Provider payments as are currently required for FQHCs and RHCs. These recommendations will mirror the FQHC and RHC requirements for Indian Health Care Providers.

ACTION: Approve the recommendations as presented. The motion was approved without objection.

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c. Disenrollment of Enrollees by Managed Care Organizations

The current health plan contract allows plans to request an eligibility review if they believe an enrollee is not eligible for healthy Kids coverage because the enrollee is eligible for other publicly funded coverage.

FHKC staff recommended to amend the contracts as follows:

3-9 Eligibility

INSURER shall accept those Enrollees which FHKC has determined meet the Program’s eligibility requirements. INSURER may not request disenrollment of an Enrollee for any reason other than as detailed in item B, requests for eligibility review, below.

[3-9] B. Requests for Eligibility Review

If INSURER has reasonable cause to believe that an Enrollee is not eligible for the Program because that Enrollee should in fact be placed in a different state or federal program for such services which eligibility would render that Enrollee ineligible for the Program, INSURER may request in writing that FHKC review the eligibility of that Enrollee. INSURER must provide the reason for the eligibility review request, including how the relevant considerations were discovered. INSURER must confirm no other considerations influenced INSURER’s decision to request the review, including an adverse change in the Enrollee’s health status, utilization of services, the Enrollee’s diminished mental capacity, or uncooperative or disruptive behavior resulting from the Enrollee’s special needs. FHKC shall ensure that all records and findings maintained by FHKC concerning a particular eligibility determination will be made available to INSURER with reasonable promptness to the extent permitted under sections 624.91 and 409.821, F.S. regarding confidentiality of information held by FHKC and the Florida KidCare program.

ACTION: Approve the recommendation to amend the contract as presented. The motion was approved without objection.

d. Continuation of Care/Transition of Care Policy

FHKC reviewed the Agency for Health Care Administration’s continuation of coverage policy and contract documents in order to make recommendations for health plan contracts to be aligned with the Medicaid and CHIP Managed Care Final Rule. The five areas of the Continuation of Care/Transition of Care Policy that will need to be amended include eligibility, timeframes, benefits, medical records, and claims payment. The Committee recommended to table further discussion and a vote on the amended revisions to the Continuation of Care/Transition of Care Policy until the next Committee meeting.

IV. Business Intelligence Update

Dr. Claussen recognized Mr. Noll for this update. The Data Analytics unit was formed a year ago with three primary goals: 1) Focus on best practices, 2) Assist with outreach efforts, and 3) Promote operational efficiency. The unit set out to accomplish these goals by centralizing data, automating manual processes, and creating media-rich content. The Data Analytics unit has accomplished key steps towards its goals.

A census dashboard has been developed where individuals can view the latest enrollment data by county along with uninsured data at the county and zip code level. Also, an applications dashboard was developed which allows users to view the total number of applications received by day and source. FHKC also uses an enrollment dashboard which show the trends in each program and the most recent month’s enrollment level.

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Mr. Noll also presented to the Committee the 2018 goals of the Data Analytics unit.

V. Other Business

With no other business, the meeting was adjourned at 10:42 a.m.

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