CS/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. Any non-risk-bearing product must be
191	approved by the corporation.
192	(f)(e)  Eligible individuals may voluntarily continue
193	participation in the program regardless of subsequent changes in
194	job status or Medicaid eligibility. Individuals who join the
195	program may participate by complying with the procedures
196	established by the corporation. These procedures must include,
197	but are not limited to:
198	1.  Submission of required information.
199	2.  Authorization for payroll deduction.
200	3.  Compliance with federal tax requirements.
201	4.  Arrangements for payment in the event of job changes.
202	5.  Selection of products and services.
203	(g)(f)  Vendors who choose to participate in the program
204	may enroll by complying with the procedures established by the
205	corporation. These procedures may must include, but are not
206	limited to:
207	1.  Submission of required information, including a
208	complete description of the coverage, services, provider
209	network, payment restrictions, and other requirements of each
210	product offered through the program.
211	2.  Execution of an agreement to make all risk-bearing
212	products offered through the program guaranteed-issue policies,
213	subject to preexisting condition exclusions established by the
214	corporation.
215	3.  Execution of an agreement that prohibits refusal to
216	sell any offered non-risk-bearing product to a participant who
217	elects to buy it.
218	4.  Establishment of product prices based on age, gender,
219	and location of the individual participant, which may include
220	medical underwriting.
221	5.  Arrangements for receiving payment for enrolled
222	participants.
223	6.  Participation in ongoing reporting processes
224	established by the corporation.
225	7.  Compliance with grievance procedures established by the
226	corporation.
227	(h)(g)  Health insurance agents licensed under part IV of
228	chapter 626 are eligible to voluntarily participate as buyers'
229	representatives. A buyer's representative acts on behalf of an
230	individual purchasing health insurance and health services
231	through the program by providing information about products and
232	services available through the program and assisting the
233	individual with both the decision and the procedure of selecting
234	specific products. Serving as a buyer's representative does not
235	constitute a conflict of interest with continuing
236	responsibilities as a health insurance agent if the relationship
237	between each agent and any participating vendor is disclosed
238	before advising an individual participant about the products and
239	services available through the program. In order to participate,
240	a health insurance agent shall comply with the procedures
241	established by the corporation, including:
242	1.  Completion of training requirements.
243	2.  Execution of a participation agreement specifying the
244	terms and conditions of participation.
245	3.  Disclosure of any appointments to solicit insurance or
246	procure applications for vendors participating in the program.
247	4.  Arrangements to receive payment from the corporation
248	for services as a buyer's representative.
249	(5)  PRODUCTS.-
250	(a)  The products that may be made available for purchase
251	through the program include, but are not limited to:
252	1.  Health insurance policies.
253	2.  Health maintenance contracts.
254	3.2.  Limited benefit plans.
255	4.3.  Prepaid clinic services.
256	5.4.  Service contracts.
257	6.5.  Arrangements for purchase of specific amounts and
258	types of health services and treatments.
259	7.6.  Flexible spending accounts.
260	(b)  Health insurance policies, health maintenance
261	contracts, limited benefit plans, prepaid service contracts, and
262	other contracts for services must ensure the availability of
263	covered services and benefits to participating individuals for
264	at least 1 full enrollment year.
265	(c)  Products may be offered for multiyear periods provided
266	the price of the product is specified for the entire period or
267	for each separately priced segment of the policy or contract.
268	(d)  The corporation shall provide a disclosure form for
269	consumers to acknowledge their understanding of the nature of,
270	and any limitations to, the benefits provided by the products
271	and services being purchased by the consumer.
272	(e)  The corporation must determine that making the plan
273	available through the program is in the interest of eligible
274	individuals and eligible employers in the state.
275	(6)  PRICING.-Prices for the products sold through the
276	program must be transparent to participants and established by
277	the vendors based on age, gender, and location of participants.
278	The corporation shall develop a methodology for evaluating the
279	actuarial soundness of products offered through the program. The
280	methodology shall be reviewed by the Office of Insurance
281	Regulation prior to use by the corporation. Before making the
282	product available to individual participants, the corporation
283	shall use the methodology to compare the expected health care
284	costs for the covered services and benefits to the vendor's
285	price for that coverage. The results shall be reported to
286	individuals participating in the program. Once established, the
287	price set by the vendor must remain in force for at least 1 year
288	and may only be redetermined by the vendor at the next annual
289	enrollment period. The corporation shall annually assess a
290	surcharge for each premium or price set by a participating
291	vendor. The surcharge may not be more than 2.5 percent of the
292	price and shall be used to generate funding for administrative
293	services provided by the corporation and payments to buyers'
294	representatives.
295	(7)  THE MARKETPLACE EXCHANGE PROCESS.-The program shall
296	provide a single, centralized market for purchase of health
297	insurance, health maintenance contracts, and other health
298	services. Purchases may be made by participating individuals
299	over the Internet or through the services of a participating
300	health insurance agent. Information about each product and
301	service available through the program shall be made available
302	through printed material and an interactive Internet website. A
303	participant needing personal assistance to select products and
304	services shall be referred to a participating agent in his or
305	her area.
306	(a)  Participation in the program may begin at any time
307	during a year after the employer completes enrollment and meets
308	the requirements specified by the corporation pursuant to
309	paragraph (4)(c).
310	(b)  Initial selection of products and services must be
311	made by an individual participant within 60 days after the date
312	the individual's employer qualified for participation. An
313	individual who fails to enroll in products and services by the
314	end of this period is limited to participation in flexible
315	spending account services until the next annual enrollment
316	period.
317	(c)  Initial enrollment periods for each product selected
318	by an individual participant must last at least 12 months,
319	unless the individual participant specifically agrees to a
320	different enrollment period.
321	(d)  If an individual has selected one or more products and
322	enrolled in those products for at least 12 months or any other
323	period specifically agreed to by the individual participant,
324	changes in selected products and services may only be made
325	during the annual enrollment period established by the
326	corporation.
327	(e)  The limits established in paragraphs (b)-(d) apply to
328	any risk-bearing product that promises future payment or
329	coverage for a variable amount of benefits or services. The
330	limits do not apply to initiation of flexible spending plans if
331	those plans are not associated with specific high-deductible
332	insurance policies or the use of spending accounts for any
333	products offering individual participants specific amounts and
334	types of health services and treatments at a contracted price.
335	(8)  CONSUMER INFORMATION.-The corporation shall:
336	(a)  Establish a secure website to facilitate the purchase
337	of products and services by participating individuals. The
338	website must provide information about each product or service
339	available through the program.
340	(b)  Inform individuals about other public health care
341	programs.
342	(a)  Prior to making a risk-bearing product available
343	through the program, the corporation shall provide information
344	regarding the product to the Office of Insurance Regulation. The
345	office shall review the product information and provide consumer
346	information and a recommendation on the risk-bearing product to
347	the corporation within 30 days after receiving the product
348	information.
349	1.  Upon receiving a recommendation that a risk-bearing
350	product should be made available in the marketplace, the
351	corporation may include the product on its website. If the
352	consumer information and recommendation is not received within
353	30 days, the corporation may make the risk-bearing product
354	available on the website without consumer information from the
355	office.
356	2.  Upon receiving a recommendation that a risk-bearing
357	product should not be made available in the marketplace, the
358	risk-bearing product may be included as an eligible product in
359	the marketplace and on its website only if a majority of the
360	board of directors vote to include the product.
361	(b)  If a risk-bearing product is made available on the
362	website, the corporation shall make the consumer information and
363	office recommendation available on the website and in print
364	format. The corporation shall make late-submitted and ongoing
365	updates to consumer information available on the website and in
366	print format.
367	(9)  RISK POOLING.-The program shall utilize methods for
368	pooling the risk of individual participants and preventing
369	selection bias. These methods shall include, but are not limited
370	to, a postenrollment risk adjustment of the premium payments to
371	the vendors. The corporation shall establish a methodology for
372	assessing the risk of enrolled individual participants based on
373	data reported annually by the vendors about their enrollees.
374	Monthly distributions of payments to the vendors shall be
375	adjusted based on the assessed relative risk profile of the
376	enrollees in each risk-bearing product for the most recent
377	period for which data is available.
378	(10)  EXEMPTIONS.-
379	(a)  Products, other than the risk-bearing products set
380	forth in subparagraph (4)(d)1. or subparagraph (4)(d)2.,
381	Policies sold as part of the program are not subject to the
382	licensing requirements of the Florida Insurance Code, as defined
383	in s. 624.01 chapter 641, or the mandated offerings or coverages
384	established in part VI of chapter 627 and chapter 641.
385	(b)  The corporation may act as an administrator as defined
386	in s. 626.88 but is not required to be certified pursuant to
387	part VII of chapter 626. However, a third party administrator
388	used by the corporation must be certified under part VII of
389	chapter 626.
390	(11)  CORPORATION.-There is created the Florida Health
391	Choices, Inc., which shall be registered, incorporated,
392	organized, and operated in compliance with part III of chapter
393	112 and chapters 119, 286, and 617. The purpose of the
394	corporation is to administer the program created in this section
395	and to conduct such other business as may further the
396	administration of the program.
397	(a)  The corporation shall be governed by a 15-member board
398	of directors consisting of:
399	1.  Three ex officio, nonvoting members to include:
400	a.  The Secretary of Health Care Administration or a
401	designee with expertise in health care services.
402	b.  The Secretary of Management Services or a designee with
403	expertise in state employee benefits.
404	c.  The commissioner of the Office of Insurance Regulation
405	or a designee with expertise in insurance regulation.
406	2.  Four members appointed by and serving at the pleasure
407	of the Governor.
408	3.  Four members appointed by and serving at the pleasure
409	of the President of the Senate.
410	4.  Four members appointed by and serving at the pleasure
411	of the Speaker of the House of Representatives.
412	5.  Board members may not include insurers, health
413	insurance agents or brokers, health care providers, health
414	maintenance organizations, prepaid service providers, or any
415	other entity, affiliate or subsidiary of eligible vendors.
416	(b)  Members shall be appointed for terms of up to 3 years.
417	Any member is eligible for reappointment. A vacancy on the board
418	shall be filled for the unexpired portion of the term in the
419	same manner as the original appointment.
420	(c)  The board shall select a chief executive officer for
421	the corporation who shall be responsible for the selection of
422	such other staff as may be authorized by the corporation's
423	operating budget as adopted by the board.
424	(d)  Board members are entitled to receive, from funds of
425	the corporation, reimbursement for per diem and travel expenses
426	as provided by s. 112.061. No other compensation is authorized.
427	(e)  There is no liability on the part of, and no cause of
428	action shall arise against, any member of the board or its
429	employees or agents for any action taken by them in the
430	performance of their powers and duties under this section.
431	(f)  The board shall develop and adopt bylaws and other
432	corporate procedures as necessary for the operation of the
433	corporation and carrying out the purposes of this section. The
434	bylaws shall:
435	1.  Specify procedures for selection of officers and
436	qualifications for reappointment, provided that no board member
437	shall serve more than 9 consecutive years.
438	2.  Require an annual membership meeting that provides an
439	opportunity for input and interaction with individual
440	participants in the program.
441	3.  Specify policies and procedures regarding conflicts of
442	interest, including the provisions of part III of chapter 112,
443	which prohibit a member from participating in any decision that
444	would inure to the benefit of the member or the organization
445	that employs the member. The policies and procedures shall also
446	require public disclosure of the interest that prevents the
447	member from participating in a decision on a particular matter.
448	(g)  The corporation may exercise all powers granted to it
449	under chapter 617 necessary to carry out the purposes of this
450	section, including, but not limited to, the power to receive and
451	accept grants, loans, or advances of funds from any public or
452	private agency and to receive and accept from any source
453	contributions of money, property, labor, or any other thing of
454	value to be held, used, and applied for the purposes of this
455	section.
456	(h)  The corporation may establish technical advisory
457	panels consisting of interested parties, including consumers,
458	health care providers, individuals with expertise in insurance
459	regulation, and insurers.
460	(i)  The corporation shall:
461	1.  Determine eligibility of employers, vendors,
462	individuals, and agents in accordance with subsection (4).
463	2.  Establish procedures necessary for the operation of the
464	program, including, but not limited to, procedures for
465	application, enrollment, risk assessment, risk adjustment, plan
466	administration, performance monitoring, and consumer education.
467	3.  Arrange for collection of contributions from
468	participating employers and individuals.
469	4.  Arrange for payment of premiums and other appropriate
470	disbursements based on the selections of products and services
471	by the individual participants.
472	5.  Establish criteria for disenrollment of participating
473	individuals based on failure to pay the individual's share of
474	any contribution required to maintain enrollment in selected
475	products.
476	6.  Establish criteria for exclusion of vendors pursuant to
477	paragraph (4)(d).
478	7.  Develop and implement a plan for promoting public
479	awareness of and participation in the program.
480	8.  Secure staff and consultant services necessary to the
481	operation of the program.
482	9.  Establish policies and procedures regarding
483	participation in the program for individuals, vendors, health
484	insurance agents, and employers.
485	10.  Provide for the operation of a toll-free hotline to
486	respond to requests for assistance.
487	11.  Provide for initial, open, and special enrollment
488	periods.
489	10.  Develop a plan, in coordination with the Department of
490	Revenue, to establish tax credits or refunds for employers that
491	participate in the program. The corporation shall submit the
492	plan to the Governor, the President of the Senate, and the
493	Speaker of the House of Representatives by January 1, 2009.
494	(12)  REPORT.-Beginning in the 2009-2010 fiscal year,
495	submit by February 1 an annual report to the Governor, the
496	President of the Senate, and the Speaker of the House of
497	Representatives documenting the corporation's activities in
498	compliance with the duties delineated in this section.
499	(13)  PROGRAM INTEGRITY.-To ensure program integrity and to
500	safeguard the financial transactions made under the auspices of
501	the program, the corporation is authorized to establish
502	qualifying criteria and certification procedures for vendors,
503	require performance bonds or other guarantees of ability to
504	complete contractual obligations, monitor the performance of
505	vendors, and enforce the agreements of the program through
506	financial penalty or disqualification from the program.
507	Section 2.  Section 409.821, Florida Statutes, is amended
508	to read:
509	409.821  Florida Kidcare program public records exemption.-
510	(1)  Personal identifying information of a Florida Kidcare
511	program applicant or enrollee, as defined in s. 409.811, held by
512	the Agency for Health Care Administration, the Department of
513	Children and Family Services, the Department of Health, or the
514	Florida Healthy Kids Corporation is confidential and exempt from
515	s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
516	(2)(a)  Upon request, such information shall be disclosed
517	to:
518	1.  Another governmental entity in the performance of its
519	official duties and responsibilities;
520	2.  The Department of Revenue for purposes of administering
521	the state Title IV-D program; or
522	3.  The Florida Health Choices, Inc., for the purpose of
523	administering the program authorized pursuant to s. 408.910; or
524	4.3.  Any person who has the written consent of the program
525	applicant.
526	(b)  This section does not prohibit an enrollee's legal
527	guardian from obtaining confirmation of coverage, dates of
528	coverage, the name of the enrollee's health plan, and the amount
529	of premium being paid.
530	(3)  This exemption applies to any information identifying
531	a Florida Kidcare program applicant or enrollee held by the
532	Agency for Health Care Administration, the Department of
533	Children and Family Services, the Department of Health, or the
534	Florida Healthy Kids Corporation before, on, or after the
535	effective date of this exemption.
536	(4)  A knowing and willful violation of this section is a
537	misdemeanor of the second degree, punishable as provided in s.
538	775.082 or s. 775.083.
539	Section 3.  This act shall take effect July 1, 2011.

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