HB 1125

1	A bill to be entitled
2	An act relating to Florida Health Choices Program;
3	amending s. 408.910, F.S.; providing and revising
4	definitions; revising eligibility requirements for
5	participation in the Florida Health Choices Program;
6	providing that statutory rural hospitals are eligible as
7	employers rather than participants under the program;
8	permitting specified eligible vendors to sell health
9	maintenance contracts; requiring certain risk-bearing
10	products offered by insurers to be approved by the Office
11	of Insurance Regulation; providing requirements for
12	product certification; providing duties of the Florida
13	Health Choices, Inc., including maintenance of a toll-free
14	telephone hotline to respond to requests for assistance;
15	providing for enrollment periods; providing for certain
16	risk pooling data used by the corporation to be reported
17	annually; amending s. 409.821, F.S.; authorizing personal
18	identifying information of a Florida Kidcare program
19	applicant to be disclosed to the Florida Health Choices,
20	Inc., to administer the program; providing an effective
21	date.
22
23	Be It Enacted by the Legislature of the State of Florida:
24
25	Section 1.  Section 408.910, Florida Statutes, is amended
26	to read:
27	408.910  Florida Health Choices Program.-
28	(1)  LEGISLATIVE INTENT.-The Legislature finds that a
29	significant number of the residents of this state do not have
30	adequate access to affordable, quality health care. The
31	Legislature further finds that increasing access to affordable,
32	quality health care can be best accomplished by establishing a
33	competitive market for purchasing health insurance and health
34	services. It is therefore the intent of the Legislature to
35	create the Florida Health Choices Program to:
36	(a)  Expand opportunities for Floridians to purchase
37	affordable health insurance and health services.
38	(b)  Preserve the benefits of employment-sponsored
39	insurance while easing the administrative burden for employers
40	who offer these benefits.
41	(c)  Enable individual choice in both the manner and amount
42	of health care purchased.
43	(d)  Provide for the purchase of individual, portable
44	health care coverage.
45	(e)  Disseminate information to consumers on the price and
46	quality of health services.
47	(f)  Sponsor a competitive market that stimulates product
48	innovation, quality improvement, and efficiency in the
49	production and delivery of health services.
50	(2)  DEFINITIONS.-As used in this section, the term:
51	(a)  "Corporation" means the Florida Health Choices, Inc.,
52	established under this section.
53	(b)  "Corporation's marketplace" means the single,
54	centralized market established by the program that facilitates
55	the purchase of products made available in the marketplace.
56	(c)(b)  "Health insurance agent" means an agent licensed
57	under part IV of chapter 626.
58	(d)(c)  "Insurer" means an entity licensed under chapter
59	624 which offers an individual health insurance policy or a
60	group health insurance policy, a preferred provider organization
61	as defined in s. 627.6471, or an exclusive provider organization
62	as defined in s. 627.6472, or a health maintenance organization
63	licensed under part I of chapter 641.
64	(e)(d)  "Program" means the Florida Health Choices Program
65	established by this section.
66	(3)  PROGRAM PURPOSE AND COMPONENTS.-The Florida Health
67	Choices Program is created as a single, centralized market for
68	the sale and purchase of various products that enable
69	individuals to pay for health care. These products include, but
70	are not limited to, health insurance plans, health maintenance
71	organization plans, prepaid services, service contracts, and
72	flexible spending accounts. The components of the program
73	include:
74	(a)  Enrollment of employers.
75	(b)  Administrative services for participating employers,
76	including:
77	1.  Assistance in seeking federal approval of cafeteria
78	plans.
79	2.  Collection of premiums and other payments.
80	3.  Management of individual benefit accounts.
81	4.  Distribution of premiums to insurers and payments to
82	other eligible vendors.
83	5.  Assistance for participants in complying with reporting
84	requirements.
85	(c)  Services to individual participants, including:
86	1.  Information about available products and participating
87	vendors.
88	2.  Assistance with assessing the benefits and limits of
89	each product, including information necessary to distinguish
90	between policies offering creditable coverage and other products
91	available through the program.
92	3.  Account information to assist individual participants
93	with managing available resources.
94	4.  Services that promote healthy behaviors.
95	(d)  Recruitment of vendors, including insurers, health
96	maintenance organizations, prepaid clinic service providers,
97	provider service networks, and other providers.
98	(e)  Certification of vendors to ensure capability,
99	reliability, and validity of offerings.
100	(f)  Collection of data, monitoring, assessment, and
101	reporting of vendor performance.
102	(g)  Information services for individuals and employers.
103	(h)  Program evaluation.
104	(4)  ELIGIBILITY AND PARTICIPATION.-Participation in the
105	program is voluntary and shall be available to employers,
106	individuals, vendors, and health insurance agents as specified
107	in this subsection.
108	(a)  Employers eligible to enroll in the program include:
109	1.  Employers meeting criteria established by the
110	corporation and that elect to make employees of such employer
111	eligible for one or more of the health plans offered through the
112	program have 1 to 50 employees.
113	2.  Fiscally constrained counties described in s. 218.67.
114	3.  Municipalities having populations of fewer than 50,000
115	residents.
116	4.  School districts in fiscally constrained counties.
117	5.  Statutory rural hospitals.
118	(b)  Individuals eligible to participate in the program
119	include:
120	1.  Individual employees of enrolled employers.
121	2.  State employees not eligible for state employee health
122	benefits.
123	3.  State retirees.
124	4.  Medicaid reform participants who opt out select the
125	opt-out provision of reform.
126	5.  Statutory rural hospitals.
127	(c)  Employers who choose to participate in the program may
128	enroll by complying with the procedures established by the
129	corporation. The procedures must include, but are not limited
130	to:
131	1.  Submission of required information.
132	2.  Compliance with federal tax requirements for the
133	establishment of a cafeteria plan, pursuant to s. 125 of the
134	Internal Revenue Code, including designation of the employer's
135	plan as a premium payment plan, a salary reduction plan that has
136	flexible spending arrangements, or a salary reduction plan that
137	has a premium payment and flexible spending arrangements.
138	3.  Determination of the employer's contribution, if any,
139	per employee, provided that such contribution is equal for each
140	eligible employee.
141	4.  Establishment of payroll deduction procedures, subject
142	to the agreement of each individual employee who voluntarily
143	participates in the program.
144	5.  Designation of the corporation as the third-party
145	administrator for the employer's health benefit plan.
146	6.  Identification of eligible employees.
147	7.  Arrangement for periodic payments.
148	8.  Employer notification to employees of the intent to
149	transfer from an existing employee health plan to the program at
150	least 90 days before the transition.
151	(d)  Eligible vendors and the products and services that
152	the vendors are permitted to sell are as follows:
153	1.  Insurers licensed under chapter 624 may sell health
154	insurance policies, limited benefit policies, other risk-bearing
155	coverage, and other products or services.
156	2.  Health maintenance organizations licensed under part I
157	of chapter 641 may sell health maintenance contracts insurance
158	policies, limited benefit policies, other risk-bearing products,
159	and other products or services.
160	3.  Prepaid health clinic service providers licensed under
161	part II of chapter 641 may sell prepaid service contracts and
162	other arrangements for a specified amount and type of health
163	services or treatments.
164	4.  Health care providers, including hospitals and other
165	licensed health facilities, health care clinics, licensed health
166	professionals, pharmacies, and other licensed health care
167	providers, may sell service contracts and arrangements for a
168	specified amount and type of health services or treatments.
169	5.  Provider organizations, including service networks,
170	group practices, professional associations, and other
171	incorporated organizations of providers, may sell service
172	contracts and arrangements for a specified amount and type of
173	health services or treatments.
174	6.  Corporate entities providing specific health services
175	in accordance with applicable state law may sell service
176	contracts and arrangements for a specified amount and type of
177	health services or treatments.
178
179	A vendor described in subparagraphs 3.-6. may not sell products
180	that provide risk-bearing coverage unless that vendor is
181	authorized under a certificate of authority issued by the Office
182	of Insurance Regulation under the provisions of the Florida
183	Insurance Code. Otherwise eligible vendors may be excluded from
184	participating in the program for deceptive or predatory
185	practices, financial insolvency, or failure to comply with the
186	terms of the participation agreement or other standards set by
187	the corporation.
188	(e)  Any risk-bearing product available under subparagraph
189	(d)1. or subparagraph (d)2. must be approved by the Office of
190	Insurance Regulation.
191	(f)(e)  Eligible individuals may voluntarily continue
192	participation in the program regardless of subsequent changes in
193	job status or Medicaid eligibility. Individuals who join the
194	program may participate by complying with the procedures
195	established by the corporation. These procedures must include,
196	but are not limited to:
197	1.  Submission of required information.
198	2.  Authorization for payroll deduction.
199	3.  Compliance with federal tax requirements.
200	4.  Arrangements for payment in the event of job changes.
201	5.  Selection of products and services.
202	(g)(f)  Vendors who choose to participate in the program
203	may enroll by complying with the procedures established by the
204	corporation. These procedures may must include, but are not
205	limited to:
206	1.  Submission of required information, including a
207	complete description of the coverage, services, provider
208	network, payment restrictions, and other requirements of each
209	product offered through the program.
210	2.  Execution of an agreement to make all risk-bearing
211	products offered through the program guaranteed-issue policies,
212	subject to preexisting condition exclusions established by the
213	corporation.
214	3.  Execution of an agreement that prohibits refusal to
215	sell any offered non-risk-bearing product to a participant who
216	elects to buy it.
217	4.  Establishment of product prices based on age, gender,
218	and location of the individual participant, which may include
219	medical underwriting.
220	5.  Arrangements for receiving payment for enrolled
221	participants.
222	6.  Participation in ongoing reporting processes
223	established by the corporation.
224	7.  Compliance with grievance procedures established by the
225	corporation.
226	(h)(g)  Health insurance agents licensed under part IV of
227	chapter 626 are eligible to voluntarily participate as buyers'
228	representatives. A buyer's representative acts on behalf of an
229	individual purchasing health insurance and health services
230	through the program by providing information about products and
231	services available through the program and assisting the
232	individual with both the decision and the procedure of selecting
233	specific products. Serving as a buyer's representative does not
234	constitute a conflict of interest with continuing
235	responsibilities as a health insurance agent if the relationship
236	between each agent and any participating vendor is disclosed
237	before advising an individual participant about the products and
238	services available through the program. In order to participate,
239	a health insurance agent shall comply with the procedures
240	established by the corporation, including:
241	1.  Completion of training requirements.
242	2.  Execution of a participation agreement specifying the
243	terms and conditions of participation.
244	3.  Disclosure of any appointments to solicit insurance or
245	procure applications for vendors participating in the program.
246	4.  Arrangements to receive payment from the corporation
247	for services as a buyer's representative.
248	(5)  PRODUCTS.-
249	(a)  The products that may be made available for purchase
250	through the program include, but are not limited to:
251	1.  Health insurance policies.
252	2.  Health maintenance contracts.
253	3.2.  Limited benefit plans.
254	4.3.  Prepaid clinic services.
255	5.4.  Service contracts.
256	6.5.  Arrangements for purchase of specific amounts and
257	types of health services and treatments.
258	7.6.  Flexible spending accounts.
259	(b)  Health insurance policies, health maintenance
260	contracts, limited benefit plans, prepaid service contracts, and
261	other contracts for services must ensure the availability of
262	covered services and benefits to participating individuals for
263	at least 1 full enrollment year.
264	(c)  Products may be offered for multiyear periods provided
265	the price of the product is specified for the entire period or
266	for each separately priced segment of the policy or contract.
267	(d)  The corporation shall provide a disclosure form for
268	consumers to acknowledge their understanding of the nature of,
269	and any limitations to, the benefits provided by the products
270	and services being purchased by the consumer.
271	(e)  Any non-risk-bearing product other than those set
272	forth in paragraph (a) must be approved by the corporation.
273	(f)  The corporation must determine that making the plan
274	available through the program is in the interest of eligible
275	individuals and eligible employers in the state.
276	(6)  PRICING.-Prices for the products sold through the
277	program must be transparent to participants and established by
278	the vendors based on age, gender, and location of participants.
279	The corporation shall develop a methodology for evaluating the
280	actuarial soundness of products offered through the program. The
281	methodology shall be reviewed by the Office of Insurance
282	Regulation prior to use by the corporation. Before making the
283	product available to individual participants, the corporation
284	shall use the methodology to compare the expected health care
285	costs for the covered services and benefits to the vendor's
286	price for that coverage. The results shall be reported to
287	individuals participating in the program. Once established, the
288	price set by the vendor must remain in force for at least 1 year
289	and may only be redetermined by the vendor at the next annual
290	enrollment period. The corporation shall annually assess a
291	surcharge for each premium or price set by a participating
292	vendor. The surcharge may not be more than 2.5 percent of the
293	price and shall be used to generate funding for administrative
294	services provided by the corporation and payments to buyers'
295	representatives.
296	(7)  THE MARKETPLACE EXCHANGE PROCESS.-The program shall
297	provide a single, centralized market for purchase of health
298	insurance, health maintenance contracts, and other health
299	services. Purchases may be made by participating individuals
300	over the Internet or through the services of a participating
301	health insurance agent. Information about each product and
302	service available through the program shall be made available
303	through printed material and an interactive Internet website. A
304	participant needing personal assistance to select products and
305	services shall be referred to a participating agent in his or
306	her area.
307	(a)  Participation in the program may begin at any time
308	during a year after the employer completes enrollment and meets
309	the requirements specified by the corporation pursuant to
310	paragraph (4)(c).
311	(b)  Initial selection of products and services must be
312	made by an individual participant within 60 days after the date
313	the individual's employer qualified for participation. An
314	individual who fails to enroll in products and services by the
315	end of this period is limited to participation in flexible
316	spending account services until the next annual enrollment
317	period.
318	(c)  Initial enrollment periods for each product selected
319	by an individual participant must last at least 12 months,
320	unless the individual participant specifically agrees to a
321	different enrollment period.
322	(d)  If an individual has selected one or more products and
323	enrolled in those products for at least 12 months or any other
324	period specifically agreed to by the individual participant,
325	changes in selected products and services may only be made
326	during the annual enrollment period established by the
327	corporation.
328	(e)  The limits established in paragraphs (b)-(d) apply to
329	any risk-bearing product that promises future payment or
330	coverage for a variable amount of benefits or services. The
331	limits do not apply to initiation of flexible spending plans if
332	those plans are not associated with specific high-deductible
333	insurance policies or the use of spending accounts for any
334	products offering individual participants specific amounts and
335	types of health services and treatments at a contracted price.
336	(8)  CONSUMER INFORMATION.-The corporation shall:
337	(a)  Establish a secure website to facilitate the purchase
338	of products and services by participating individuals. The
339	website must provide information about each product or service
340	available through the program.
341	(b)  Inform individuals about other public health care
342	programs.
343	(a)  Prior to making a risk-bearing product available
344	through the program, the corporation shall provide information
345	regarding the product to the Office of Insurance Regulation. The
346	office shall review the product information and provide consumer
347	information and a recommendation on the risk-bearing product to
348	the corporation within 30 days after receiving the product
349	information.
350	1.  Upon receiving a recommendation that a risk-bearing
351	product should be made available in the marketplace, the
352	corporation may include the product on its website. If the
353	consumer information and recommendation is not received within
354	30 days, the corporation may make the risk-bearing product
355	available on the website without consumer information from the
356	office.
357	2.  Upon receiving a recommendation that a risk-bearing
358	product should not be made available in the marketplace, the
359	risk-bearing product may be included as an eligible product in
360	the marketplace and on its website only if a majority of the
361	board of directors vote to include the product.
362	(b)  If a risk-bearing product is made available on the
363	website, the corporation shall make the consumer information and
364	office recommendation available on the website and in print
365	format. The corporation shall make late-submitted and ongoing
366	updates to consumer information available on the website and in
367	print format.
368	(9)  RISK POOLING.-The program shall utilize methods for
369	pooling the risk of individual participants and preventing
370	selection bias. These methods shall include, but are not limited
371	to, a postenrollment risk adjustment of the premium payments to
372	the vendors. The corporation shall establish a methodology for
373	assessing the risk of enrolled individual participants based on
374	data reported annually by the vendors about their enrollees.
375	Monthly distributions of payments to the vendors shall be
376	adjusted based on the assessed relative risk profile of the
377	enrollees in each risk-bearing product for the most recent
378	period for which data is available.
379	(10)  EXEMPTIONS.-
380	(a)  Products, other than the risk-bearing products set
381	forth in subparagraph (4)(d)1. or subparagraph (4)(d)2.,
382	Policies sold as part of the program are not subject to the
383	licensing requirements of the Florida Insurance Code, as defined
384	in s. 624.01 chapter 641, or the mandated offerings or coverages
385	established in part VI of chapter 627 and chapter 641.
386	(b)  The corporation may act as an administrator as defined
387	in s. 626.88 but is not required to be certified pursuant to
388	part VII of chapter 626. However, a third party administrator
389	used by the corporation must be certified under part VII of
390	chapter 626.
391	(11)  CORPORATION.-There is created the Florida Health
392	Choices, Inc., which shall be registered, incorporated,
393	organized, and operated in compliance with part III of chapter
394	112 and chapters 119, 286, and 617. The purpose of the
395	corporation is to administer the program created in this section
396	and to conduct such other business as may further the
397	administration of the program.
398	(a)  The corporation shall be governed by a 15-member board
399	of directors consisting of:
400	1.  Three ex officio, nonvoting members to include:
401	a.  The Secretary of Health Care Administration or a
402	designee with expertise in health care services.
403	b.  The Secretary of Management Services or a designee with
404	expertise in state employee benefits.
405	c.  The commissioner of the Office of Insurance Regulation
406	or a designee with expertise in insurance regulation.
407	2.  Four members appointed by and serving at the pleasure
408	of the Governor.
409	3.  Four members appointed by and serving at the pleasure
410	of the President of the Senate.
411	4.  Four members appointed by and serving at the pleasure
412	of the Speaker of the House of Representatives.
413	5.  Board members may not include insurers, health
414	insurance agents or brokers, health care providers, health
415	maintenance organizations, prepaid service providers, or any
416	other entity, affiliate or subsidiary of eligible vendors.
417	(b)  Members shall be appointed for terms of up to 3 years.
418	Any member is eligible for reappointment. A vacancy on the board
419	shall be filled for the unexpired portion of the term in the
420	same manner as the original appointment.
421	(c)  The board shall select a chief executive officer for
422	the corporation who shall be responsible for the selection of
423	such other staff as may be authorized by the corporation's
424	operating budget as adopted by the board.
425	(d)  Board members are entitled to receive, from funds of
426	the corporation, reimbursement for per diem and travel expenses
427	as provided by s. 112.061. No other compensation is authorized.
428	(e)  There is no liability on the part of, and no cause of
429	action shall arise against, any member of the board or its
430	employees or agents for any action taken by them in the
431	performance of their powers and duties under this section.
432	(f)  The board shall develop and adopt bylaws and other
433	corporate procedures as necessary for the operation of the
434	corporation and carrying out the purposes of this section. The
435	bylaws shall:
436	1.  Specify procedures for selection of officers and
437	qualifications for reappointment, provided that no board member
438	shall serve more than 9 consecutive years.
439	2.  Require an annual membership meeting that provides an
440	opportunity for input and interaction with individual
441	participants in the program.
442	3.  Specify policies and procedures regarding conflicts of
443	interest, including the provisions of part III of chapter 112,
444	which prohibit a member from participating in any decision that
445	would inure to the benefit of the member or the organization
446	that employs the member. The policies and procedures shall also
447	require public disclosure of the interest that prevents the
448	member from participating in a decision on a particular matter.
449	(g)  The corporation may exercise all powers granted to it
450	under chapter 617 necessary to carry out the purposes of this
451	section, including, but not limited to, the power to receive and
452	accept grants, loans, or advances of funds from any public or
453	private agency and to receive and accept from any source
454	contributions of money, property, labor, or any other thing of
455	value to be held, used, and applied for the purposes of this
456	section.
457	(h)  The corporation may establish technical advisory
458	panels consisting of interested parties, including consumers,
459	health care providers, individuals with expertise in insurance
460	regulation, and insurers.
461	(i)  The corporation shall:
462	1.  Determine eligibility of employers, vendors,
463	individuals, and agents in accordance with subsection (4).
464	2.  Establish procedures necessary for the operation of the
465	program, including, but not limited to, procedures for
466	application, enrollment, risk assessment, risk adjustment, plan
467	administration, performance monitoring, and consumer education.
468	3.  Arrange for collection of contributions from
469	participating employers and individuals.
470	4.  Arrange for payment of premiums and other appropriate
471	disbursements based on the selections of products and services
472	by the individual participants.
473	5.  Establish criteria for disenrollment of participating
474	individuals based on failure to pay the individual's share of
475	any contribution required to maintain enrollment in selected
476	products.
477	6.  Establish criteria for exclusion of vendors pursuant to
478	paragraph (4)(d).
479	7.  Develop and implement a plan for promoting public
480	awareness of and participation in the program.
481	8.  Secure staff and consultant services necessary to the
482	operation of the program.
483	9.  Establish policies and procedures regarding
484	participation in the program for individuals, vendors, health
485	insurance agents, and employers.
486	10.  Provide for the operation of a toll-free hotline to
487	respond to requests for assistance.
488	11.  Provide for initial, open, and special enrollment
489	periods.
490	10.  Develop a plan, in coordination with the Department of
491	Revenue, to establish tax credits or refunds for employers that
492	participate in the program. The corporation shall submit the
493	plan to the Governor, the President of the Senate, and the
494	Speaker of the House of Representatives by January 1, 2009.
495	(12)  REPORT.-Beginning in the 2009-2010 fiscal year,
496	submit by February 1 an annual report to the Governor, the
497	President of the Senate, and the Speaker of the House of
498	Representatives documenting the corporation's activities in
499	compliance with the duties delineated in this section.
500	(13)  PROGRAM INTEGRITY.-To ensure program integrity and to
501	safeguard the financial transactions made under the auspices of
502	the program, the corporation is authorized to establish
503	qualifying criteria and certification procedures for vendors,
504	require performance bonds or other guarantees of ability to
505	complete contractual obligations, monitor the performance of
506	vendors, and enforce the agreements of the program through
507	financial penalty or disqualification from the program.
508	Section 2.  Section 409.821, Florida Statutes, is amended
509	to read:
510	409.821  Florida Kidcare program public records exemption.-
511	(1)  Personal identifying information of a Florida Kidcare
512	program applicant or enrollee, as defined in s. 409.811, held by
513	the Agency for Health Care Administration, the Department of
514	Children and Family Services, the Department of Health, or the
515	Florida Healthy Kids Corporation is confidential and exempt from
516	s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
517	(2)(a)  Upon request, such information shall be disclosed
518	to:
519	1.  Another governmental entity in the performance of its
520	official duties and responsibilities;
521	2.  The Department of Revenue for purposes of administering
522	the state Title IV-D program; or
523	3.  The Florida Health Choices, Inc., for the purpose of
524	administering the program authorized pursuant to s. 408.910; or
525	4.3.  Any person who has the written consent of the program
526	applicant.
527	(b)  This section does not prohibit an enrollee's legal
528	guardian from obtaining confirmation of coverage, dates of
529	coverage, the name of the enrollee's health plan, and the amount
530	of premium being paid.
531	(3)  This exemption applies to any information identifying
532	a Florida Kidcare program applicant or enrollee held by the
533	Agency for Health Care Administration, the Department of
534	Children and Family Services, the Department of Health, or the
535	Florida Healthy Kids Corporation before, on, or after the
536	effective date of this exemption.
537	(4)  A knowing and willful violation of this section is a
538	misdemeanor of the second degree, punishable as provided in s.
539	775.082 or s. 775.083.
540	Section 3.  This act shall take effect July 1, 2011.

CODING: Words stricken are deletions; words underlined are additions.