Florida Senate - 2013 SB 1844 By the Committee on Health Policy 588-03428-13 20131844__ 1 A bill to be entitled 2 An act relating to the Health Choice Plus Program; 3 amending s. 408.910, F.S.; conforming provisions to 4 changes made by the act; creating s. 408.9105, F.S.; 5 creating the Health Choice Plus Program; providing 6 legislative intent; providing definitions; providing 7 eligibility requirements; providing exceptions in 8 specific situations; providing for enrollment in the 9 program; providing for disenrollment in specific 10 situations; providing for reenrollment in specific 11 situations; providing requirements and procedures for 12 use of funds in a health benefits account; authorizing 13 the Florida Health Choices, Inc., to accept funds from 14 various sources to deposit into health benefits 15 accounts, subsidize the costs of coverage, and 16 administer and support the program; requiring the 17 corporation to manage the health benefits accounts and 18 provide the marketplace of options that an enrollee in 19 the program may use; providing for payment for 20 achieving health living performance goals; providing 21 that the Florida Insurance Code is not applicable to 22 the program; providing that coverage under the program 23 is not an entitlement; prohibiting a cause of action 24 against certain entities under certain circumstances; 25 requiring the corporation to submit to the Governor 26 and the Legislature information about the program in 27 its annual report and an evaluation of the 28 effectiveness of the program; providing for a program 29 review and repeal date; providing an effective date. 30 31 Be It Enacted by the Legislature of the State of Florida: 32 33 Section 1. Subsection (1) of section 408.910, Florida 34 Statutes, is amended to read: 35 408.910 Florida Health Choices Program.— 36 (1) LEGISLATIVE INTENT.—The Legislature finds that a 37 significant number of the residents of this state do not have 38 adequate access to affordable, quality health care. The 39 Legislature further finds that increasing access to affordable, 40 quality health care can be best accomplished by establishing
a41 competitive markets marketfor purchasing health insurance and 42 health services. It is therefore the intent of the Legislature 43 to create the Florida Health Choices Program and the Health 44 Choice Plus Program to: 45 (a) Expand opportunities for Floridians to purchase 46 affordable health insurance and health services. 47 (b) Preserve the benefits of employment-sponsored insurance 48 while easing the administrative burden for employers who offer 49 these benefits. 50 (c) Enable individual choice in both the manner and amount 51 of health care purchased. 52 (d) Provide for the purchase of individual, portable health 53 care coverage. 54 (e) Disseminate information to consumers on the price and 55 quality of health services. 56 (f) Sponsor acompetitive markets marketthat stimulate 57 stimulatesproduct innovation, quality improvement, and 58 efficiency in the production and delivery of health services. 59 Section 2. Section 408.9105, Florida Statutes, is created 60 to read: 61 408.9105 Health Choice Plus Program.— 62 (1) LEGISLATIVE INTENT.—The Legislature recognizes that 63 there are more than 600,000 uninsured residents in this state 64 who have incomes at or below 100 percent of the federal poverty 65 level. Many insurance options are not affordable, and the 66 Legislature intends to provide a benefit program to those 67 individuals who seek assistance with coverage and who assume 68 individual responsibility for their own health care needs. It is 69 therefore the intent of the Legislature to expand the services 70 provided by the Florida Health Choices Program and begin the 71 phase-in of the Health Choice Plus Program starting July 1, 72 2013. The Health Choice Plus Program must: 73 (a) Use the existing Florida Health Choices Corporation’s 74 infrastructure and governance to manage the program described in 75 this section. 76 (b) Offer goods and services to individuals who are between 77 19 to 64 years of age, inclusive. 78 (c) Establish guidelines for financial participation in the 79 program which allows for enrollees and others to contribute 80 toward a health benefits account. 81 1. An enrollee shall contribute at least $20 per month 82 toward the health benefits account. This amount may be adjusted 83 annually in the General Appropriations Act. 84 2. The level of benefit paid into an enrollee’s account 85 using state funds is to be determined by the corporation based 86 upon the availability of state, local, and federal funding. The 87 amount may not exceed $10 per individual per month. This amount 88 may be adjusted annually in the General Appropriations Act. 89 (d) Implement an employer-based contribution option. 90 (e) Develop and maintain an education and public outreach 91 campaign for the Health Choice Plus Program. 92 (f) Provide a secure website to facilitate the purchase of 93 goods and services and to provide public information about the 94 program. The website must also provide information about the 95 availability of insurance affordability programs targeted at 96 this population. 97 (g) Establish an incentive program that rewards enrollees 98 for achievements in reaching healthy living goals. 99 (2) DEFINITIONS.—For the Health Choice Plus Program, the 100 following terms are applicable: 101 (a) “CHIP” means Children’s Health Insurance Program as 102 authorized under Title XXI of the Social Security Act. 103 (b) “Corporation” means Florida Health Choices, Inc., as 104 established under s. 408.910. 105 (c) “Corporation’s marketplace” means the single, 106 centralized market established by the corporation which 107 facilitates the purchase of products made available in the 108 marketplace. 109 (d) “Enrollee” means an individual who participates in or 110 receives benefits under the Health Choice Plus Program. 111 (e) “Program” means the Health Choice Plus Program 112 established under this section. 113 (f) ”Vendor” means an entity that meets the requirements 114 under s. 408.910(4)(d) and is accepted by the corporation. 115 (g) “Health benefits account” means the account established 116 for an enrollee at the corporation into which funds may be 117 deposited by the state, the enrollee, other individuals, or 118 organizations for the purchase of health care goods and services 119 on the enrollee’s behalf. 120 (h) “Parent” or “caretaker relative” means an individual 121 who is a relative that has primary custody or legal guardianship 122 of a dependent child and provides the primary care and 123 supervision to that dependent child in the same household. A 124 caretaker relative must be related to the dependent child by 125 blood, marriage, or adoption within the fifth degree of kinship. 126 (i) ”Goods and services” means the individual products 127 offered for sale to an enrollee on the corporation’s marketplace 128 or other health care-related items that may be purchased by an 129 enrollee in the private market. An enrollee may purchase these 130 products using funds accumulated in his or her health benefits 131 account. 132 (j) “Lawful permanent resident” means a non-United States 133 citizen who resides in the United States under legally 134 recognized and lawfully recorded permanent residence as an 135 immigrant. This individual may also be known as a permanent 136 resident alien. 137 (k) “Patient Protection and Affordable Care Act” or “PPACA” 138 means the federal law enacted as Pub. L. No. 111-148, as further 139 amended by the federal Health Care and Education Reconciliation 140 Act of 2010, Pub. L. No. 111-152, and any amendments. 141 (3) ELIGIBILITY.— 142 (a) To be eligible for the Health Choice Plus Program, an 143 individual must be a resident of this state and meet all of the 144 following criteria: 145 1. Be between 19 and 64 years of age, inclusive. 146 2. Have a modified adjusted gross income that does not 147 exceed 100 percent of the federal poverty level based on the 148 individual’s most recent federal tax return, or if the 149 individual did not file a tax return, the individual’s most 150 recent monthly income. 151 3. Be a United States citizen or a lawful permanent 152 resident. 153 4. Not be eligible for Medicaid. 154 5. Not be eligible for employer-sponsored insurance 155 coverage. If the enrollee is eligible for employer-sponsored 156 coverage but the cost of that coverage for the enrollee’s share 157 for individual coverage would exceed 5 percent of the enrollee’s 158 total modified adjusted gross household income or the enrollee’s 159 share of family coverage would exceed 5 percent of enrollee’s 160 total modified adjusted gross household income, the enrollee is 161 not eligible for employer-sponsored coverage under this section. 162 6. Not be enrolled in other coverage that meets the 163 definition of essential benefits coverage under PPACA. 164 (b) In addition to the requirements in paragraph (a), an 165 enrollee must meet the following categorical requirements in 166 order to maintain enrollment in the program: 167 1. For an enrollee who is also a parent or a caretaker 168 relative, the enrollee must do all of the following: 169 a. Maintain enrollment in Medicaid or CHIP for any 170 dependent child in the household who is eligible for Medicaid or 171 CHIP and who must be enrolled in Medicaid or CHIP throughout the 172 enrollee’s participation in the Health Choice Plus program. 173 b. Complete a health assessment within the first 3 months 174 after enrollment at a county health department, federally 175 qualified health center, or other approved health care provider. 176 c. Schedule and keep at least one preventive visit with a 177 primary care provider within 6 months after enrollment and 178 repeat the preventive visit at least once every 18 months 179 thereafter. 180 d. Provide proof of employment for at least 20 hours a week 181 or of efforts made to seek employment. In lieu of employment, 182 the enrollee may provide proof of volunteering for at least 10 183 hours a month at a school or at a nonprofit organization or 184 enrollment as a full-time student at an accredited educational 185 institution. Exceptions to this requirement may be made on a 186 case-by-case basis for medical conditions for the enrollee or if 187 the enrollee is the primary caretaker for a family member who 188 has a chronic and severe medical condition that requires a 189 minimum of 40 hours a week of care. 190 2. For an enrollee who is also a childless adult, the 191 enrollee must do all of the following: 192 a. Provide proof of employment for at least 20 hours a week 193 or of efforts made to seek employment. In lieu of employment, 194 the enrollee may provide proof of volunteering for at least 20 195 hours a month at a school or at a nonprofit organization or 196 enrollment as a full-time student at an accredited educational 197 institution. Exceptions to this requirement may be made on a 198 case-by-case basis for medical conditions for the enrollee or if 199 the enrollee is the primary caretaker for a family member who 200 has a chronic and severe medical condition that requires a 201 minimum of 40 hours a week of care. 202 b. Complete a health assessment within the first 3 months 203 after enrollment at a county health department, federally 204 qualified health center, or other approved health care provider; 205 c. Schedule and keep at least one preventive visit with a 206 primary care provider within the first 6 months after enrollment 207 and repeat the preventive visit at least once every 18 months 208 thereafter. 209 210 If the enrollee fails to meet the requirements specified in this 211 subsection, the enrollee is disenrolled from the program at the 212 end of the month in which the enrollee has not met the 213 requirements. The enrollee may receive one 30-day extension to 214 comply before cancellation of coverage. If an enrollee’s 215 coverage is canceled, the enrollee may not reapply for coverage 216 until the next open enrollment period or 90 days after 217 cancellation of coverage occurs, whichever occurs later. The 218 individual’s reenrollment is subject to available funding. 219 (4) ENROLLMENT.— 220 (a) Enrollment in the Health Choice Plus Program may occur 221 through the portal of the Florida Health Choices Program, a 222 referral process from the Department of Children and Families, 223 the Florida Healthy Kids Corporation, or the exchange as defined 224 by the federal Patient Protection and Affordable Care Act. 225 (b) Subject to available funding, the corporation shall 226 establish at least one open enrollment period each year. When 227 the program is full based on available funding, enrollment must 228 cease. 229 (c) Eligibility is determined by using electronic means to 230 the fullest extent practicable before requesting any written 231 documentation from an applicant. 232 (5) HEALTH BENEFITS ACCOUNT.— 233 (a) A health benefits account is established for each 234 enrollee upon confirmation of eligibility in the program. The 235 corporation shall determine the deposit amount and frequency of 236 deposits based on the availability of funds, the number of 237 enrollees, and other factors. 238 (b) An enrollee shall make a financial contribution toward 239 his or her own health benefits account in order to maintain 240 enrollment in accordance with paragraph (1)(c). 241 1. The corporation shall establish disenrollment criteria 242 for failure to pay the required minimum contribution. 243 2. The disenrollment criteria must include waiting periods 244 of not more than 1 month before reinstatement to the program if 245 the enrollee is still eligible and has paid all required 246 financial obligations. 247 3. The enrollee’s employer may contribute toward an 248 employee’s health benefits account under the program, including 249 making the enrollee’s required contribution, in whole or in 250 part, to the enrollee’s health benefits account at any time. 251 (c) Subject to appropriations available for this specific 252 purpose, the corporation shall establish a procedure for the 253 deposit of supplemental or bonus funds into an enrollee’s health 254 benefits account if certain healthy living performance goals are 255 achieved. These goals must be established no later than July 1 256 in each fiscal year and distributed to all enrollees, published 257 on the corporation’s website, and distributed to new enrollees 258 within 30 calendar days after enrollment. For calendar year 259 2014, the goals must be established no later than October 1, 260 2013. 261 1. An enrollee may use funds deposited in a health benefits 262 account to offset other health care costs or to purchase other 263 products and services offered by the marketplace, subject to 264 guidelines established by the corporation and in accordance with 265 federal law. 266 2. Bonus funds may accumulate in the enrollee’s health 267 benefits account for the duration of the program and must 268 automatically expire and return to the corporation upon the 269 termination of the program. 270 (d) The marketplace is encouraged to use existing community 271 programs and partnerships to deliver services and to include 272 traditional safety net providers for the delivery of services to 273 enrollees, including, but not limited to, rural health clinics, 274 federally qualified health centers, county health departments, 275 emergency room diversion programs, and community mental health 276 centers. A health care entity that receives state funding must 277 participate in the Health Choice Plus Program and offer services 278 or products through the marketplace or to enrollees, as 279 appropriate. An enrollee may be required to make nominal 280 copayments to providers for any nonpreventive services. The 281 corporation may establish the amount of the copayments when 282 applicable. 283 (e) Except for supplemental funds described under paragraph 284 (c), funds deposited in a health benefits account belong to the 285 enrollee when deposited and are available for health-care 286 related expenditures, including, but not limited to, physician’s 287 fees, hospital costs, prescriptions, insurance premium payments, 288 copayments, and coinsurance. The corporation shall establish a 289 process or contract with another entity for the management of 290 the funds. The process must ensure the timely distribution and 291 the appropriate expenditure of the state’s contributions. 292 (f) The corporation shall establish a refund process for an 293 enrollee who requests the closure of a health benefits account 294 and the return of any unspent individual contributions. The 295 enrollee may be refunded only those funds that the enrollee or 296 employer has contributed to his or her health benefits account. 297 All other state funds in the enrollee’s health benefits account 298 revert to the corporation. 299 (6) FUNDING.— 300 (a) The corporation may accept funds from an employer to 301 deposit in an enrollee’s health benefits account to supplement 302 funds if such a deposit is not in conflict with other provisions 303 of this section. 304 (b) The corporation may accept state and federal funds to 305 further subsidize the costs of coverage and to administer the 306 program. 307 (c) The corporation shall seek other grants and donations 308 to support the program. 309 (d) An assessment on vendors that participate in the 310 marketplace may be used to fund the administration of the 311 program. 312 (7) SERVICES.—The corporation shall manage the health 313 benefits accounts and provide a marketplace of options from 314 which an enrollee may also use his or her health benefits 315 account to purchase individual services and products, including, 316 but not limited to, discount medical plans, limited benefit 317 plans, health flex plans, individual health insurance plans, 318 bundled services, or other prepaid health care coverage. 319 (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.— 320 (a) To the extent that funds are made available for this 321 purpose, an enrollee is rewarded for achieving a healthy 322 lifestyle and using preventive health care services 323 appropriately. 324 (b) The program shall post on its website, by July 1 of 325 each fiscal year, a list of optional healthy living performance 326 goals and the proposed incentives for achievement of each goal. 327 The corporation shall establish a procedure for the 328 documentation of such goals, timeframes for achievement of the 329 optional goals, and the payment of supplemental amounts into an 330 enrollee’s health benefits account, subject to available 331 funding. 332 (c) Bonus payments for achieving a healthy living 333 performance goal shall be paid into an enrollee’s health 334 benefits account at the end of the quarter in which the goal is 335 achieved. The amount of the payment is based upon the schedule 336 posted by the program on July 1 of that fiscal year. 337 (9) APPLICABILITY OF INSURANCE CODE.—Coverage offered under 338 this program is not insurance. Any standard forms, website 339 design, or marketing communication developed by the corporation 340 and used by the corporation or any vendor that meets the 341 requirements of s. 408.910(4)(f) is not subject to the Florida 342 Insurance Code. 343 (10) LIABILITY.—Coverage under the Health Choice Plus 344 Program is not an entitlement, and a cause of action does not 345 arise against the state, a local governmental entity, any other 346 political subdivision of the state, or the corporation or its 347 board of directors for failure to make coverage under this 348 section available to an eligible person or for discontinuation 349 of any coverage. 350 (11) PROGRAM EVALUATION.—The corporation shall include 351 information about the Health Choice Plus Program in its annual 352 report under s. 408.910. The corporation shall complete and 353 submit by January 1, 2016, a separate independent evaluation of 354 the effectiveness of the Health Choice Plus Program to the 355 Governor, the President of the Senate, and the Speaker of the 356 House of Representatives. 357 (12) PROGRAM REVIEW.—The Health Choice Plus Program is 358 subject to repeal on July 1, 2016, unless reviewed and saved 359 from repeal through reenactment by the Legislature. 360 Section 3. This act shall take effect July 1, 2013.