Florida Senate - 2017             CONFERENCE COMMITTEE AMENDMENT
       Bill No. SB 2508
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Floor: AD/CR          .           Floor: AD            
             05/08/2017 02:58 PM       .      05/08/2017 07:49 PM       

       The Conference Committee on SB 2508 recommended the following:
    1         Senate Conference Committee Amendment (with title
    2  amendment)
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1. Section 110.12301, Florida Statutes, is amended
    7  to read:
    8         110.12301 Competitive procurement of postpayment claims
    9  review services and dependent eligibility verification
   10  services.—The Division of State Group Insurance is directed to
   11  competitively procure:
   12         (1) Postpayment claims review services for the state group
   13  health insurance plans established pursuant to s. 110.123.
   14  Compensation under the contract shall be paid from amounts
   15  identified as claim overpayments that are made by or on behalf
   16  of the health plans and that are recovered by the vendor. The
   17  vendor may retain that portion of the amount recovered as
   18  provided in the contract. The contract must require the vendor
   19  to maintain all necessary documentation supporting the amounts
   20  recovered, retained, and remitted to the division; and
   21         (2) A contingency-based contract for dependent eligibility
   22  verification services for the state group insurance program;
   23  however, compensation under the contract may not exceed
   24  historical claim costs for the prior 12 months for the dependent
   25  populations disenrolled as a result of the contractor’s vendor’s
   26  services.
   27         (a)1. By September 1, 2017, the division shall notify all
   28  subscribers regarding the eligibility rules for dependents.
   29  Through November 30, 2017, the division must may establish a 3
   30  month grace period and hold subscribers harmless for past claims
   31  of ineligible dependents if such dependents are removed from
   32  plan membership before December 1, 2017.
   33         2. Subparagraph 1. does not apply to any dependent
   34  identified as ineligible before July 1, 2017, for which the
   35  department has notified the state agency employing the
   36  associated subscriber The Department of Management Services
   37  shall submit budget amendments pursuant to chapter 216 in order
   38  to obtain budget authority necessary to expend funds from the
   39  State Employees’ Group Health Self-Insurance Trust Fund for
   40  payments to the vendor as provided in the contract.
   41         (b) The contractor providing dependent eligibility
   42  verification services may request the following information from
   43  subscribers:
   44         1. To prove a spouse’s eligibility:
   45         a. If married less than 12 months and the subscriber and
   46  his or her spouse have not filed a joint federal income tax
   47  return, a government-issued marriage certificate; or
   48         b. If married for 12 or more months, a transcript of the
   49  most recently filed federal income tax return.
   50         2. To prove a biological child’s or a newborn grandchild’s
   51  eligibility, a government-issued birth certificate.
   52         3. To prove an adopted child’s eligibility:
   53         a. An adoption certificate; or
   54         b. An adoption placement agreement and a petition for
   55  adoption.
   56         4. To prove a stepchild’s eligibility:
   57         a. A government-issued birth certificate for the stepchild;
   58  and
   59         b. The transcript of the subscriber’s most recently filed
   60  federal income tax return.
   61         5. Any other information necessary to verify the
   62  dependent’s eligibility for enrollment in the state group
   63  insurance program.
   64         (c) If a document requested from a subscriber is not
   65  confidential or exempt from public records requirements, the
   66  division and the contractor shall disclose to all subscribers
   67  that such information submitted to verify the eligibility of
   68  dependents may be subject to disclosure and inspection under
   69  chapter 119.
   70         (d) A government-issued marriage license or marriage
   71  certificate submitted for dependent eligibility verification
   72  must include the date of the marriage between the subscriber and
   73  the spouse.
   74         (e) A government-issued birth certificate submitted for
   75  dependent eligibility verification must list the parents’ names.
   76         (f) Foreign-born subscribers unable to obtain the necessary
   77  documentation within the specified time period of producing
   78  verification documentation may execute a signed affidavit
   79  attesting to eligibility requirements.
   80         (g) Documentation submitted to verify eligibility may be an
   81  original or a photocopy of an original document. Before
   82  submitting a document, the subscriber may redact any information
   83  on a document which is not necessary to verify the eligibility
   84  of the dependent.
   85         (h) All documentation obtained by the contractor to conduct
   86  the dependent eligibility verification services must be retained
   87  until June 30, 2019. The department or the contractor is not
   88  required to retain such documentation after June 30, 2019, and
   89  shall destroy such documentation as soon as practicable after
   90  such date.
   91         Section 2. Upon the expiration and reversion of the
   92  amendments made to section 110.12315, Florida Statutes, pursuant
   93  to section 123 of chapter 2016-62, Laws of Florida, section
   94  110.12315, Florida Statutes, is amended to read:
   95         110.12315 Prescription drug program.—The state employees’
   96  prescription drug program is established. This program shall be
   97  administered by the Department of Management Services, according
   98  to the terms and conditions of the plan as established by the
   99  relevant provisions of the annual General Appropriations Act and
  100  implementing legislation, subject to the following conditions:
  101         (1) The department shall allow prescriptions written by
  102  health care providers under the plan to be filled by any
  103  licensed pharmacy and reimbursed pursuant to subsection (2)
  104  contractual claims-processing provisions. Nothing in This
  105  section may not be construed as prohibiting a mail order
  106  prescription drug program distinct from the service provided by
  107  retail pharmacies.
  108         (2) In providing for reimbursement of pharmacies for
  109  prescription drugs and supplies medicines dispensed to members
  110  of the state group health insurance plan and their dependents
  111  under the state employees’ prescription drug program:
  112         (a) Retail, mail order, and specialty pharmacies
  113  participating in the program must be reimbursed as established
  114  by contract and at a uniform rate and subject to uniform
  115  conditions, according to the terms and conditions of the plan.
  116         (b) There is shall be a 30-day supply limit for retail
  117  pharmacy fills, a 90-day supply limit for mail order fills, and
  118  a 90-day supply limit for maintenance drug fills by retail
  119  pharmacies prescription card purchases and 90-day supply limit
  120  for mail order or mail order prescription drug purchases. This
  121  paragraph may not be construed to prohibit fills at any amount
  122  less than the applicable supply limit.
  123         (c) The current pharmacy dispensing fee shall be negotiated
  124  by the department remains in effect.
  125         (d)(3) The department of Management Services shall
  126  establish the reimbursement schedule for prescription drugs and
  127  supplies pharmaceuticals dispensed under the program.
  128  Reimbursement rates for a prescription drug or supply
  129  pharmaceutical must be based on the cost of the generic
  130  equivalent drug or supply if a generic equivalent exists, unless
  131  the physician, advanced registered nurse practitioner, or
  132  physician assistant prescribing the drug or supply
  133  pharmaceutical clearly states on the prescription that the brand
  134  name drug or supply is medically necessary or that the drug or
  135  supply product is included on the formulary of drugs and
  136  supplies drug products that may not be interchanged as provided
  137  in chapter 465, in which case reimbursement must be based on the
  138  cost of the brand name drug or supply as specified in the
  139  reimbursement schedule adopted by the department of Management
  140  Services.
  141         (3) The department shall maintain the generic, preferred
  142  brand name, and the nonpreferred brand name lists of drugs and
  143  supplies to be used in the administration of the state
  144  employees’ prescription drug program.
  145         (4) The department shall maintain a list of maintenance
  146  drugs and supplies.
  147         (a) Preferred provider organization health plan members may
  148  have prescriptions for maintenance drugs and supplies filled up
  149  to three times as a supply for up to 30 days through a retail
  150  pharmacy; thereafter, prescriptions for the same maintenance
  151  drug or supply must be filled for up to 90 days either through
  152  the department’s contracted mail order pharmacy or through a
  153  retail pharmacy.
  154         (b) Health maintenance organization health plan members may
  155  have prescriptions for maintenance drugs and supplies filled for
  156  up to 90 days either through a mail order pharmacy or through a
  157  retail pharmacy.
  158         (5) Copayments made by health plan members for a supply for
  159  up to 90 days through a retail pharmacy shall be the same as
  160  copayments made for a similar supply through the department’s
  161  contracted mail order pharmacy.
  162         (6)(4) The department of Management Services shall conduct
  163  a prescription utilization review program. In order to
  164  participate in the state employees’ prescription drug program,
  165  retail pharmacies dispensing prescription drugs and supplies
  166  medicines to members of the state group health insurance plan or
  167  their covered dependents, or to subscribers or covered
  168  dependents of a health maintenance organization plan under the
  169  state group insurance program, shall make their records
  170  available for this review.
  171         (5) The Department of Management Services shall implement
  172  such additional cost-saving measures and adjustments as may be
  173  required to balance program funding within appropriations
  174  provided, including a trial or starter dose program and
  175  dispensing of long-term-maintenance medication in lieu of acute
  176  therapy medication.
  177         (7)(6) Participating pharmacies must use a point-of-sale
  178  device or an online computer system to verify a participant’s
  179  eligibility for coverage. The state is not liable for
  180  reimbursement of a participating pharmacy for dispensing
  181  prescription drugs and supplies to any person whose current
  182  eligibility for coverage has not been verified by the state’s
  183  contracted administrator or by the department of Management
  184  Services.
  185         (7) Under the state employees’ prescription drug program
  186  copayments must be made as follows:
  187         (8)(a) Effective July 1, 2017 January 1, 2006, for the
  188  State Group Health Insurance Standard Plan, copayments must be
  189  made as follows:
  190         1. For a supply for up to 30 days from a retail pharmacy:
  191         a. For generic drug with card.....................$7 $10.
  192         b.2. For preferred brand name drug with card.....$30 $25.
  193         c.3. For nonpreferred brand name drug with card..$50 $40.
  194         2. For a supply for up to 90 days from a mail order
  195  pharmacy or a retail pharmacy:
  196         a.4. For generic mail order drug.................$14 $20.
  197         b.5. For preferred brand name mail order drug....$60 $50.
  198         c.6. For nonpreferred brand name mail order drug$100 $80.
  199         (b) Effective July 1, 2017 January 1, 2006, for the State
  200  Group Health Insurance High Deductible Plan, coinsurance must be
  201  paid as follows:
  202         1. For a supply for up to 30 days from a retail pharmacy:
  203         a.Retail coinsurance For generic drug with card.....30%.
  204         b.2.Retail coinsurance For preferred brand name drug with
  205  card........................................................30%.
  206         c.3.Retail coinsurance For nonpreferred brand name drug
  207  with card...................................................50%.
  208         2. For a supply for up to 90 days from a mail order
  209  pharmacy or a retail pharmacy:
  210         a.4. Mail order coinsurance For generic drug.........30%.
  211         b.5. Mail order coinsurance For preferred brand name
  212  drug........................................................30%.
  213         c.6. Mail order coinsurance For nonpreferred brand name
  214  drug........................................................50%.
  215         (c) The Department of Management Services shall create a
  216  preferred brand name drug list to be used in the administration
  217  of the state employees’ prescription drug program.
  218         Section 3. This act shall take effect July 1, 2017.
  220  ================= T I T L E  A M E N D M E N T ================
  221  And the title is amended as follows:
  222         Delete everything before the enacting clause
  223  and insert:
  224                        A bill to be entitled                      
  225         An act relating to the Division of State Group
  226         Insurance; amending s. 110.12301, F.S.; removing a
  227         requirement that a contract for dependent eligibility
  228         verification services for the state group insurance
  229         program be a contingency-based contract; requiring the
  230         division to notify subscribers of dependent
  231         eligibility rules by a certain date; requiring the
  232         division to hold a subscriber harmless for past claims
  233         of ineligible dependents for a specified timeframe;
  234         providing for applicability; removing a requirement
  235         that the Department of Management Services submit
  236         budget amendments pursuant to ch. 216, F.S., regarding
  237         vendor payments for dependent eligibility verification
  238         services; authorizing the contractor providing
  239         dependent eligibility verification services to request
  240         certain information from subscribers; requiring the
  241         division and the contractor to disclose to subscribers
  242         that dependent eligibility verification information
  243         may be subject to disclosure and inspection under
  244         public records requirements under certain
  245         circumstances; specifying requirements for marriage
  246         licenses or certificates or birth certificates
  247         submitted for dependent eligibility verification;
  248         authorizing foreign-born subscribers to submit an
  249         affidavit in lieu of documentation under certain
  250         circumstances; specifying that original or photocopied
  251         documentation may be submitted; authorizing a
  252         subscriber to redact unnecessary information before
  253         submitting documentation; requiring the contractor to
  254         retain documentation obtained for dependent
  255         eligibility verification services for a specified
  256         timeframe; requiring the department and the contractor
  257         to destroy such documentation after a specified date;
  258         amending s. 110.12315, F.S.; providing that retail,
  259         mail order, and specialty pharmacies participating in
  260         the state employees’ prescription drug program shall
  261         be reimbursed as established by contract; revising
  262         supply limitations under the program; requiring that
  263         the pharmacy dispensing fee be negotiated by the
  264         department; revising provisions governing the
  265         reimbursement schedule for prescription drugs and
  266         supplies dispensed under the program; requiring the
  267         department to maintain certain lists; establishing
  268         supply limitations for maintenance drugs and supplies;
  269         specifying pricing of certain copayments by health
  270         plan members; deleting a provision requiring the
  271         department to implement additional cost-saving
  272         measures and adjustments; revising copayment and
  273         coinsurance amounts for the State Group Health
  274         Insurance Standard Plan and the State Group Health
  275         Insurance High Deductible Plan; providing an effective
  276         date.