Senate Bill sb0822c1

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    Florida Senate - 2005                            CS for SB 822

    By the Committee on Ways and Means; and Senator Crist





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  1                      A bill to be entitled

  2         An act relating to the state group insurance

  3         program; amending s. 110.123, F.S.; revising

  4         the terms "state group insurance program" and

  5         "surviving spouse" and defining the term

  6         "TRICARE supplemental insurance plan";

  7         including the TRICARE supplemental insurance

  8         plan within the state group insurance program;

  9         requiring the Department of Management Services

10         to purchase health care for employees under the

11         TRICARE supplemental insurance plan;

12         authorizing a surviving spouse to elect to

13         continue coverage under the TRICARE

14         supplemental insurance plan; providing that an

15         enrollee in the TRICARE supplemental insurance

16         plan may change to any other state health plan

17         during open enrollment; providing an effective

18         date.

19  

20  Be It Enacted by the Legislature of the State of Florida:

21  

22         Section 1.  Subsections (2) and (3) of section 110.123,

23  Florida Statutes, are amended to read:

24         110.123  State group insurance program.--

25         (2)  DEFINITIONS.--As used in this section, the term:

26         (a)  "Department" means the Department of Management

27  Services.

28         (b)  "Enrollee" means all state officers and employees,

29  retired state officers and employees, surviving spouses of

30  deceased state officers and employees, and terminated

31  employees or individuals with continuation coverage who are

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    Florida Senate - 2005                            CS for SB 822
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 1  enrolled in an insurance plan offered by the state group

 2  insurance program. "Enrollee" includes all state university

 3  officers and employees, retired state university officers and

 4  employees, surviving spouses of deceased state university

 5  officers and employees, and terminated state university

 6  employees or individuals with continuation coverage who are

 7  enrolled in an insurance plan offered by the state group

 8  insurance program.

 9         (c)  "Full-time state employees" includes all full-time

10  employees of all branches or agencies of state government

11  holding salaried positions and paid by state warrant or from

12  agency funds, and employees paid from regular salary

13  appropriations for 8 months' employment, including university

14  personnel on academic contracts, but in no case shall "state

15  employee" or "salaried position" include persons paid from

16  other-personal-services (OPS) funds. "Full-time employees"

17  includes all full-time employees of the state universities.

18         (d)  "Health maintenance organization" or "HMO" means

19  an entity certified under part I of chapter 641.

20         (e)  "Health plan member" means any person

21  participating in a state group health insurance plan, a

22  TRICARE supplemental insurance plan, or in a health

23  maintenance organization plan under the state group insurance

24  program, including enrollees and covered dependents thereof.

25         (f)  "Part-time state employee" means any employee of

26  any branch or agency of state government paid by state warrant

27  from salary appropriations or from agency funds, and who is

28  employed for less than the normal full-time workweek

29  established by the department or, if on academic contract or

30  seasonal or other type of employment which is less than

31  year-round, is employed for less than 8 months during any

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 1  12-month period, but in no case shall "part-time" employee

 2  include a person paid from other-personal-services (OPS)

 3  funds. "Part-time state employee" includes any part-time

 4  employee of the state universities.

 5         (g)  "Retired state officer or employee" or "retiree"

 6  means any state or state university officer or employee who

 7  retires under a state retirement system or a state optional

 8  annuity or retirement program or is placed on disability

 9  retirement, and who was insured under the state group

10  insurance program at the time of retirement, and who begins

11  receiving retirement benefits immediately after retirement

12  from state or state university office or employment. In

13  addition to these requirements, any state officer or state

14  employee who retires under the Public Employee Optional

15  Retirement Program established under part II of chapter 121

16  shall be considered a "retired state officer or employee" or

17  "retiree" as used in this section if he or she:

18         1.  Meets the age and service requirements to qualify

19  for normal retirement as set forth in s. 121.021(29); or

20         2.  Has attained the age specified by s. 72(t)(2)(A)(i)

21  of the Internal Revenue Code and has 6 years of creditable

22  service.

23         (h)  "State agency" or "agency" means any branch,

24  department, or agency of state government. "State agency" or

25  "agency" includes any state university for purposes of this

26  section only.

27         (i)  "State group health insurance plan or plans" or

28  "state plan or plans" mean the state self-insured health

29  insurance plan or plans offered to state officers and

30  employees, retired state officers and employees, and surviving

31  

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 1  spouses of deceased state officers and employees pursuant to

 2  this section.

 3         (j)  "State-contracted HMO" means any health

 4  maintenance organization under contract with the department to

 5  participate in the state group insurance program.

 6         (k)  "State group insurance program" or "programs"

 7  means the package of insurance plans offered to state officers

 8  and employees, retired state officers and employees, and

 9  surviving spouses of deceased state officers and employees

10  pursuant to this section, including the state group health

11  insurance plan or plans, health maintenance organization

12  plans, TRICARE supplemental insurance plans, and other plans

13  required or authorized by law.

14         (l)  "State officer" means any constitutional state

15  officer, any elected state officer paid by state warrant, or

16  any appointed state officer who is commissioned by the

17  Governor and who is paid by state warrant.

18         (m)  "Surviving spouse" means the widow or widower of a

19  deceased state officer, full-time state employee, part-time

20  state employee, or retiree if such widow or widower was

21  covered as a dependent under the state group health insurance

22  plan, a TRICARE supplemental insurance plan, or a health

23  maintenance organization plan established pursuant to this

24  section at the time of the death of the deceased officer,

25  employee, or retiree. "Surviving spouse" also means any widow

26  or widower who is receiving or eligible to receive a monthly

27  state warrant from a state retirement system as the

28  beneficiary of a state officer, full-time state employee, or

29  retiree who died prior to July 1, 1979.  For the purposes of

30  this section, any such widow or widower shall cease to be a

31  surviving spouse upon his or her remarriage.

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 1         (n)  "TRICARE supplemental insurance plan" means the

 2  Department of Defense Health Insurance Program for eligible

 3  members of the uniformed services authorized by Title 10

 4  U.S.C. s. 1097.

 5         (3)  STATE GROUP INSURANCE PROGRAM.--

 6         (a)  The Division of State Group Insurance is created

 7  within the Department of Management Services.

 8         (b)  It is the intent of the Legislature to offer a

 9  comprehensive package of health insurance and retirement

10  benefits and a personnel system for state employees which are

11  provided in a cost-efficient and prudent manner, and to allow

12  state employees the option to choose benefit plans which best

13  suit their individual needs. Therefore, the state group

14  insurance program is established which may include the state

15  group health insurance plan or plans, health maintenance

16  organization plans, group life insurance plans, TRICARE

17  supplemental insurance plans, group accidental death and

18  dismemberment plans, and group disability insurance plans.

19  Furthermore, the department is additionally authorized to

20  establish and provide as part of the state group insurance

21  program any other group insurance plans or coverage choices

22  that are consistent with the provisions of this section.

23         (c)  Notwithstanding any provision in this section to

24  the contrary, it is the intent of the Legislature that the

25  department shall be responsible for all aspects of the

26  purchase of health care for state employees under the state

27  group health insurance plan or plans, TRICARE supplemental

28  insurance plans, and the health maintenance organization

29  plans. Responsibilities shall include, but not be limited to,

30  the development of requests for proposals or invitations to

31  negotiate for state employee health services, the

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 1  determination of health care benefits to be provided, and the

 2  negotiation of contracts for health care and health care

 3  administrative services.  Prior to the negotiation of

 4  contracts for health care services, the Legislature intends

 5  that the department shall develop, with respect to state

 6  collective bargaining issues, the health benefits and terms to

 7  be included in the state group health insurance program. The

 8  department shall adopt rules necessary to perform its

 9  responsibilities pursuant to this section.  It is the intent

10  of the Legislature that the department shall be responsible

11  for the contract management and day-to-day management of the

12  state employee health insurance program, including, but not

13  limited to, employee enrollment, premium collection, payment

14  to health care providers, and other administrative functions

15  related to the program.

16         (d)1.  Notwithstanding the provisions of chapter 287

17  and the authority of the department, for the purpose of

18  protecting the health of, and providing medical services to,

19  state employees participating in the state group insurance

20  program, the department may contract to retain the services of

21  professional administrators for the state group insurance

22  program.  The agency shall follow good purchasing practices of

23  state procurement to the extent practicable under the

24  circumstances.

25         2.  Each vendor in a major procurement, and any other

26  vendor if the department deems it necessary to protect the

27  state's financial interests, shall, at the time of executing

28  any contract with the department, post an appropriate bond

29  with the department in an amount determined by the department

30  to be adequate to protect the state's interests but not higher

31  

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 1  than the full amount estimated to be paid annually to the

 2  vendor under the contract.

 3         3.  Each major contract entered into by the department

 4  pursuant to this section shall contain a provision for payment

 5  of liquidated damages to the department for material

 6  noncompliance by a vendor with a contract provision. The

 7  department may require a liquidated damages provision in any

 8  contract if the department deems it necessary to protect the

 9  state's financial interests.

10         4.  The provisions of s. 120.57(3) apply to the

11  department's contracting process, except:

12         a.  A formal written protest of any decision, intended

13  decision, or other action subject to protest shall be filed

14  within 72 hours after receipt of notice of the decision,

15  intended decision, or other action.

16         b.  As an alternative to any provision of s. 120.57(3),

17  the department may proceed with the bid selection or contract

18  award process if the director of the department sets forth, in

19  writing, particular facts and circumstances which demonstrate

20  the necessity of continuing the procurement process or the

21  contract award process in order to avoid a substantial

22  disruption to the provision of any scheduled insurance

23  services.

24         (e)  The Department of Management Services and the

25  Division of State Group Insurance may shall not prohibit or

26  limit any properly licensed insurer, health maintenance

27  organization, prepaid limited health services organization, or

28  insurance agent from competing for any insurance product or

29  plan purchased, provided, or endorsed by the department or the

30  division on the basis of the compensation arrangement used by

31  the insurer or organization for its agents.

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 1         (f)  Except as provided for in subparagraph (h)2., the

 2  state contribution toward the cost of any plan in the state

 3  group insurance program shall be uniform with respect to all

 4  state employees in a state collective bargaining unit

 5  participating in the same coverage tier in the same plan.

 6  Nothing contained within This section does not prohibit

 7  prohibits the development of separate benefit plans for

 8  officers and employees exempt from the career service or the

 9  development of separate benefit plans for each collective

10  bargaining unit.

11         (g)  Participation by individuals in the program is

12  shall be available to all state officers, full-time state

13  employees, and part-time state employees; and such

14  participation in the program or any plan is thereof shall be

15  voluntary. Participation in the program is shall also be

16  available to retired state officers and employees, as defined

17  in paragraph (2)(g), who elect at the time of retirement to

18  continue coverage under the program, but they may elect to

19  continue all or only part of the coverage they had at the time

20  of retirement. A surviving spouse may elect to continue

21  coverage only under a state group health insurance plan, a

22  TRICARE supplemental insurance plan, or a health maintenance

23  organization plan.

24         (h)1.  A person eligible to participate in the state

25  group insurance program may be authorized by rules adopted by

26  the department, in lieu of participating in the state group

27  health insurance plan, to exercise an option to elect

28  membership in a health maintenance organization plan which is

29  under contract with the state in accordance with criteria

30  established by this section and by said rules.  The offer of

31  optional membership in a health maintenance organization plan

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 1  permitted by this paragraph may be limited or conditioned by

 2  rule as may be necessary to meet the requirements of state and

 3  federal laws.

 4         2.  The department shall contract with health

 5  maintenance organizations seeking to participate in the state

 6  group insurance program through a request for proposal or

 7  other procurement process, as developed by the Department of

 8  Management Services and determined to be appropriate.

 9         a.  The department shall establish a schedule of

10  minimum benefits for health maintenance organization coverage,

11  and that schedule shall include: physician services; inpatient

12  and outpatient hospital services; emergency medical services,

13  including out-of-area emergency coverage; diagnostic

14  laboratory and diagnostic and therapeutic radiologic services;

15  mental health, alcohol, and chemical dependency treatment

16  services meeting the minimum requirements of state and federal

17  law; skilled nursing facilities and services; prescription

18  drugs; age-based and gender-based wellness benefits; and other

19  benefits as may be required by the department. Additional

20  services may be provided subject to the contract between the

21  department and the HMO.

22         b.  The department may establish uniform deductibles,

23  copayments, coverage tiers, or coinsurance schedules for all

24  participating HMO plans.

25         c.  The department may require detailed information

26  from each health maintenance organization participating in the

27  procurement process, including information pertaining to

28  organizational status, experience in providing prepaid health

29  benefits, accessibility of services, financial stability of

30  the plan, quality of management services, accreditation

31  status, quality of medical services, network access and

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 1  adequacy, performance measurement, ability to meet the

 2  department's reporting requirements, and the actuarial basis

 3  of the proposed rates and other data determined by the

 4  director to be necessary for the evaluation and selection of

 5  health maintenance organization plans and negotiation of

 6  appropriate rates for these plans.  Upon receipt of proposals

 7  by health maintenance organization plans and the evaluation of

 8  those proposals, the department may enter into negotiations

 9  with all of the plans or a subset of the plans, as the

10  department determines appropriate. Nothing shall preclude the

11  department from negotiating regional or statewide contracts

12  with health maintenance organization plans when this is

13  cost-effective and when the department determines that the

14  plan offers high value to enrollees.

15         d.  The department may limit the number of HMOs that it

16  contracts with in each service area based on the nature of the

17  bids the department receives, the number of state employees in

18  the service area, or any unique geographical characteristics

19  of the service area. The department shall establish by rule

20  service areas throughout the state.

21         e.  All persons participating in the state group

22  insurance program may be required to contribute towards a

23  total state group health premium that may vary depending upon

24  the plan and coverage tier selected by the enrollee and the

25  level of state contribution authorized by the Legislature.

26         3.  The department is authorized to negotiate and to

27  contract with specialty psychiatric hospitals for mental

28  health benefits, on a regional basis, for alcohol, drug abuse,

29  and mental and nervous disorders. The department may

30  establish, subject to the approval of the Legislature pursuant

31  to subsection (5), any such regional plan upon completion of

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 1  an actuarial study to determine any impact on plan benefits

 2  and premiums.

 3         4.  In addition to contracting pursuant to subparagraph

 4  2., the department may enter into contract with any HMO to

 5  participate in the state group insurance program which:

 6         a.  Serves greater than 5,000 recipients on a prepaid

 7  basis under the Medicaid program;

 8         b.  Does not currently meet the 25-percent

 9  non-Medicare/non-Medicaid enrollment composition requirement

10  established by the Department of Health excluding participants

11  enrolled in the state group insurance program;

12         c.  Meets the minimum benefit package and copayments

13  and deductibles contained in sub-subparagraphs 2.a. and b.;

14         d.  Is willing to participate in the state group

15  insurance program at a cost of premiums that is not greater

16  than 95 percent of the cost of HMO premiums accepted by the

17  department in each service area; and

18         e.  Meets the minimum surplus requirements of s.

19  641.225.

20  

21  The department is authorized to contract with HMOs that meet

22  the requirements of sub-subparagraphs a.-d. prior to the open

23  enrollment period for state employees.  The department is not

24  required to renew the contract with the HMOs as set forth in

25  this paragraph more than twice. Thereafter, the HMOs shall be

26  eligible to participate in the state group insurance program

27  only through the request for proposal or invitation to

28  negotiate process described in subparagraph 2.

29         5.  All enrollees in a state group health insurance

30  plan, a TRICARE supplemental insurance plan, or any health

31  maintenance organization plan shall have the option of

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 1  changing to any other health plan that which is offered by the

 2  state within any open enrollment period designated by the

 3  department. Open enrollment shall be held at least once each

 4  calendar year.

 5         6.  When a contract between a treating provider and the

 6  state-contracted health maintenance organization is terminated

 7  for any reason other than for cause, each party shall allow

 8  any enrollee for whom treatment was active to continue

 9  coverage and care when medically necessary, through completion

10  of treatment of a condition for which the enrollee was

11  receiving care at the time of the termination, until the

12  enrollee selects another treating provider, or until the next

13  open enrollment period offered, whichever is longer, but no

14  longer than 6 months after termination of the contract. Each

15  party to the terminated contract shall allow an enrollee who

16  has initiated a course of prenatal care, regardless of the

17  trimester in which care was initiated, to continue care and

18  coverage until completion of postpartum care. This does not

19  prevent a provider from refusing to continue to provide care

20  to an enrollee who is abusive, noncompliant, or in arrears in

21  payments for services provided. For care continued under this

22  subparagraph, the program and the provider shall continue to

23  be bound by the terms of the terminated contract. Changes made

24  within 30 days before termination of a contract are effective

25  only if agreed to by both parties.

26         7.  Any HMO participating in the state group insurance

27  program shall submit health care utilization and cost data to

28  the department, in such form and in such manner as the

29  department shall require, as a condition of participating in

30  the program.  The department shall enter into negotiations

31  with its contracting HMOs to determine the nature and scope of

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 1  the data submission and the final requirements, format,

 2  penalties associated with noncompliance, and timetables for

 3  submission.  These determinations shall be adopted by rule.

 4         8.  The department may establish and direct, with

 5  respect to collective bargaining issues, a comprehensive

 6  package of insurance benefits that may include supplemental

 7  health and life coverage, dental care, long-term care, vision

 8  care, and other benefits it determines necessary to enable

 9  state employees to select from among benefit options that best

10  suit their individual and family needs.

11         a.  Based upon a desired benefit package, the

12  department shall issue a request for proposal or invitation to

13  negotiate for health insurance providers interested in

14  participating in the state group insurance program, and the

15  department shall issue a request for proposal or invitation to

16  negotiate for insurance providers interested in participating

17  in the non-health-related components of the state group

18  insurance program. Upon receipt of all proposals, the

19  department may enter into contract negotiations with insurance

20  providers submitting bids or negotiate a specially designed

21  benefit package. Insurance providers offering or providing

22  supplemental coverage as of May 30, 1991, which qualify for

23  pretax benefit treatment pursuant to s. 125 of the Internal

24  Revenue Code of 1986, with 5,500 or more state employees

25  currently enrolled may be included by the department in the

26  supplemental insurance benefit plan established by the

27  department without participating in a request for proposal,

28  submitting bids, negotiating contracts, or negotiating a

29  specially designed benefit package. These contracts shall

30  provide state employees with the most cost-effective and

31  comprehensive coverage available; however, no state or agency

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 1  funds shall be contributed toward the cost of any part of the

 2  premium of such supplemental benefit plans. With respect to

 3  dental coverage, the division shall include in any

 4  solicitation or contract for any state group dental program

 5  made after July 1, 2001, a comprehensive indemnity dental plan

 6  option which offers enrollees a completely unrestricted choice

 7  of dentists. If a dental plan is endorsed, or in some manner

 8  recognized as the preferred product, such plan shall include a

 9  comprehensive indemnity dental plan option which provides

10  enrollees with a completely unrestricted choice of dentists.

11         b.  Pursuant to the applicable provisions of s.

12  110.161, and s. 125 of the Internal Revenue Code of 1986, the

13  department shall enroll in the pretax benefit program those

14  state employees who voluntarily elect coverage in any of the

15  supplemental insurance benefit plans as provided by

16  sub-subparagraph a.

17         c.  Nothing herein contained shall be construed to

18  prohibit insurance providers from continuing to provide or

19  offer supplemental benefit coverage to state employees as

20  provided under existing agency plans.

21         (i)  The benefits of the insurance authorized by this

22  section shall not be in lieu of any benefits payable under

23  chapter 440, the Workers' Compensation Law. The insurance

24  authorized by this law shall not be deemed to constitute

25  insurance to secure workers' compensation benefits as required

26  by chapter 440.

27         Section 2.  This act shall take effect upon becoming a

28  law.

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 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         Senate Bill 822

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 4  The committee substitute provides a reference to the United
    States Code that authorizes the TRICARE program in federal
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