Amendment
Bill No. CS/HB 1125

Amendment No. 144357

CHAMBER ACTION
Senate		House
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1	Representative Corcoran offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Section 408.910, Florida Statutes, is amended
6	to read:
7	408.910  Florida Health Choices Program.-
8	(1)  LEGISLATIVE INTENT.-The Legislature finds that a
9	significant number of the residents of this state do not have
10	adequate access to affordable, quality health care. The
11	Legislature further finds that increasing access to affordable,
12	quality health care can be best accomplished by establishing a
13	competitive market for purchasing health insurance and health
14	services. It is therefore the intent of the Legislature to
15	create the Florida Health Choices Program to:
16	(a)  Expand opportunities for Floridians to purchase
17	affordable health insurance and health services.
18	(b)  Preserve the benefits of employment-sponsored
19	insurance while easing the administrative burden for employers
20	who offer these benefits.
21	(c)  Enable individual choice in both the manner and amount
22	of health care purchased.
23	(d)  Provide for the purchase of individual, portable
24	health care coverage.
25	(e)  Disseminate information to consumers on the price and
26	quality of health services.
27	(f)  Sponsor a competitive market that stimulates product
28	innovation, quality improvement, and efficiency in the
29	production and delivery of health services.
30	(2)  DEFINITIONS.-As used in this section, the term:
31	(a)  "Corporation" means the Florida Health Choices, Inc.,
32	established under this section.
33	(b)  "Corporation's marketplace" means the single,
34	centralized market established by the program that facilitates
35	the purchase of products made available in the marketplace.
36	(c)(b)  "Health insurance agent" means an agent licensed
37	under part IV of chapter 626.
38	(d)(c)  "Insurer" means an entity licensed under chapter
39	624 which offers an individual health insurance policy or a
40	group health insurance policy, a preferred provider organization
41	as defined in s. 627.6471, or an exclusive provider organization
42	as defined in s. 627.6472, or a health maintenance organization
43	licensed under part I of chapter 641, or a prepaid limited
44	health service organization or discount medical plan
45	organization licensed under chapter 636.
46	(e)(d)  "Program" means the Florida Health Choices Program
47	established by this section.
48	(3)  PROGRAM PURPOSE AND COMPONENTS.-The Florida Health
49	Choices Program is created as a single, centralized market for
50	the sale and purchase of various products that enable
51	individuals to pay for health care. These products include, but
52	are not limited to, health insurance plans, health maintenance
53	organization plans, prepaid services, service contracts, and
54	flexible spending accounts. The components of the program
55	include:
56	(a)  Enrollment of employers.
57	(b)  Administrative services for participating employers,
58	including:
59	1.  Assistance in seeking federal approval of cafeteria
60	plans.
61	2.  Collection of premiums and other payments.
62	3.  Management of individual benefit accounts.
63	4.  Distribution of premiums to insurers and payments to
64	other eligible vendors.
65	5.  Assistance for participants in complying with reporting
66	requirements.
67	(c)  Services to individual participants, including:
68	1.  Information about available products and participating
69	vendors.
70	2.  Assistance with assessing the benefits and limits of
71	each product, including information necessary to distinguish
72	between policies offering creditable coverage and other products
73	available through the program.
74	3.  Account information to assist individual participants
75	with managing available resources.
76	4.  Services that promote healthy behaviors.
77	(d)  Recruitment of vendors, including insurers, health
78	maintenance organizations, prepaid clinic service providers,
79	provider service networks, and other providers.
80	(e)  Certification of vendors to ensure capability,
81	reliability, and validity of offerings.
82	(f)  Collection of data, monitoring, assessment, and
83	reporting of vendor performance.
84	(g)  Information services for individuals and employers.
85	(h)  Program evaluation.
86	(4)  ELIGIBILITY AND PARTICIPATION.-Participation in the
87	program is voluntary and shall be available to employers,
88	individuals, vendors, and health insurance agents as specified
89	in this subsection.
90	(a)  Employers eligible to enroll in the program include:
91	1.  Employers that meet criteria established by the
92	corporation and elect to make their employees eligible through
93	the program have 1 to 50 employees.
94	2.  Fiscally constrained counties described in s. 218.67.
95	3.  Municipalities having populations of fewer than 50,000
96	residents.
97	4.  School districts in fiscally constrained counties.
98	5.  Statutory rural hospitals.
99	(b)  Individuals eligible to participate in the program
100	include:
101	1.  Individual employees of enrolled employers.
102	2.  State employees not eligible for state employee health
103	benefits.
104	3.  State retirees.
105	4.  Medicaid reform participants who opt out select the
106	opt-out provision of reform.
107	5.  Statutory rural hospitals.
108	(c)  Employers who choose to participate in the program may
109	enroll by complying with the procedures established by the
110	corporation. The procedures must include, but are not limited
111	to:
112	1.  Submission of required information.
113	2.  Compliance with federal tax requirements for the
114	establishment of a cafeteria plan, pursuant to s. 125 of the
115	Internal Revenue Code, including designation of the employer's
116	plan as a premium payment plan, a salary reduction plan that has
117	flexible spending arrangements, or a salary reduction plan that
118	has a premium payment and flexible spending arrangements.
119	3.  Determination of the employer's contribution, if any,
120	per employee, provided that such contribution is equal for each
121	eligible employee.
122	4.  Establishment of payroll deduction procedures, subject
123	to the agreement of each individual employee who voluntarily
124	participates in the program.
125	5.  Designation of the corporation as the third-party
126	administrator for the employer's health benefit plan.
127	6.  Identification of eligible employees.
128	7.  Arrangement for periodic payments.
129	8.  Employer notification to employees of the intent to
130	transfer from an existing employee health plan to the program at
131	least 90 days before the transition.
132	(d)  All eligible vendors who choose to participate and the
133	products and services that the vendors are permitted to sell are
134	as follows:
135	1.  Insurers licensed under chapter 624 may sell health
136	insurance policies, limited benefit policies, other risk-bearing
137	coverage, and other products or services.
138	2.  Health maintenance organizations licensed under part I
139	of chapter 641 may sell health maintenance contracts insurance
140	policies, limited benefit policies, other risk-bearing products,
141	and other products or services.
142	3.  Prepaid limited health service organizations may sell
143	products and services as authorized under part I of chapter 636,
144	and discount medical plan organizations may sell products and
145	services as authorized under part II of chapter 636.
146	4.3.  Prepaid health clinic service providers licensed
147	under part II of chapter 641 may sell prepaid service contracts
148	and other arrangements for a specified amount and type of health
149	services or treatments.
150	5.4.  Health care providers, including hospitals and other
151	licensed health facilities, health care clinics, licensed health
152	professionals, pharmacies, and other licensed health care
153	providers, may sell service contracts and arrangements for a
154	specified amount and type of health services or treatments.
155	6.5.  Provider organizations, including service networks,
156	group practices, professional associations, and other
157	incorporated organizations of providers, may sell service
158	contracts and arrangements for a specified amount and type of
159	health services or treatments.
160	7.6.  Corporate entities providing specific health services
161	in accordance with applicable state law may sell service
162	contracts and arrangements for a specified amount and type of
163	health services or treatments.
164
165	A vendor described in subparagraphs 4.-7.3.-6. may not sell
166	products that provide risk-bearing coverage unless that vendor
167	is authorized under a certificate of authority issued by the
168	Office of Insurance Regulation and is authorized to provide
169	coverage in the relevant geographic area under the provisions of
170	the Florida Insurance Code. Otherwise eligible vendors may be
171	excluded from participating in the program for deceptive or
172	predatory practices, financial insolvency, or failure to comply
173	with the terms of the participation agreement or other standards
174	set by the corporation.
175	(e)  Eligible individuals may voluntarily continue
176	participation in the program regardless of subsequent changes in
177	job status or Medicaid eligibility. Individuals who join the
178	program may participate by complying with the procedures
179	established by the corporation. These procedures must include,
180	but are not limited to:
181	1.  Submission of required information.
182	2.  Authorization for payroll deduction.
183	3.  Compliance with federal tax requirements.
184	4.  Arrangements for payment in the event of job changes.
185	5.  Selection of products and services.
186	(f)  Vendors who choose to participate in the program may
187	enroll by complying with the procedures established by the
188	corporation. These procedures may must include, but are not
189	limited to:
190	1.  Submission of required information, including a
191	complete description of the coverage, services, provider
192	network, payment restrictions, and other requirements of each
193	product offered through the program.
194	2.  Execution of an agreement to make all risk-bearing
195	products offered through the program guaranteed-issue policies,
196	subject to preexisting condition exclusions established comply
197	with requirements established by the corporation.
198	3.  Execution of an agreement that prohibits refusal to
199	sell any offered non-risk-bearing product to a participant who
200	elects to buy it.
201	4.  Establishment of product prices based on age, gender,
202	and location of the individual participant, which may include
203	medical underwriting.
204	5.  Arrangements for receiving payment for enrolled
205	participants.
206	6.  Participation in ongoing reporting processes
207	established by the corporation.
208	7.  Compliance with grievance procedures established by the
209	corporation.
210	(g)  Health insurance agents licensed under part IV of
211	chapter 626 are eligible to voluntarily participate as buyers'
212	representatives. A buyer's representative acts on behalf of an
213	individual purchasing health insurance and health services
214	through the program by providing information about products and
215	services available through the program and assisting the
216	individual with both the decision and the procedure of selecting
217	specific products. Serving as a buyer's representative does not
218	constitute a conflict of interest with continuing
219	responsibilities as a health insurance agent if the relationship
220	between each agent and any participating vendor is disclosed
221	before advising an individual participant about the products and
222	services available through the program. In order to participate,
223	a health insurance agent shall comply with the procedures
224	established by the corporation, including:
225	1.  Completion of training requirements.
226	2.  Execution of a participation agreement specifying the
227	terms and conditions of participation.
228	3.  Disclosure of any appointments to solicit insurance or
229	procure applications for vendors participating in the program.
230	4.  Arrangements to receive payment from the corporation
231	for services as a buyer's representative.
232	(5)  PRODUCTS.-
233	(a)  The products that may be made available for purchase
234	through the program include, but are not limited to:
235	1.  Health insurance policies.
236	2.  Health maintenance contracts.
237	3.2.  Limited benefit plans.
238	4.3.  Prepaid clinic services.
239	5.4.  Service contracts.
240	6.5.  Arrangements for purchase of specific amounts and
241	types of health services and treatments.
242	7.6.  Flexible spending accounts.
243	(b)  Health insurance policies, health maintenance
244	contracts, limited benefit plans, prepaid service contracts, and
245	other contracts for services must ensure the availability of
246	covered services and benefits to participating individuals for
247	at least 1 full enrollment year.
248	(c)  Products may be offered for multiyear periods provided
249	the price of the product is specified for the entire period or
250	for each separately priced segment of the policy or contract.
251	(d)  The corporation shall provide a disclosure form for
252	consumers to acknowledge their understanding of the nature of,
253	and any limitations to, the benefits provided by the products
254	and services being purchased by the consumer.
255	(e)  The corporation must determine that making the plan
256	available through the program is in the interest of eligible
257	individuals and eligible employers in the state.
258	(6)  PRICING.-Prices for the products and services sold
259	through the program must be transparent to participants and
260	established by the vendors. based on age, gender, and location
261	of participants. The corporation shall develop a methodology for
262	evaluating the actuarial soundness of products offered through
263	the program. The methodology shall be reviewed by the Office of
264	Insurance Regulation prior to use by the corporation. Before
265	making the product available to individual participants, the
266	corporation shall use the methodology to compare the expected
267	health care costs for the covered services and benefits to the
268	vendor's price for that coverage. The results shall be reported
269	to individuals participating in the program. Once established,
270	the price set by the vendor must remain in force for at least 1
271	year and may only be redetermined by the vendor at the next
272	annual enrollment period. The corporation shall annually assess
273	a surcharge for each premium or price set by a participating
274	vendor. The surcharge may not be more than 2.5 percent of the
275	price and shall be used to generate funding for administrative
276	services provided by the corporation and payments to buyers'
277	representatives.
278	(7)  THE MARKETPLACE EXCHANGE PROCESS.-The program shall
279	provide a single, centralized market for purchase of health
280	insurance, health maintenance contracts, and other health
281	products and services. Purchases may be made by participating
282	individuals over the Internet or through the services of a
283	participating health insurance agent. Information about each
284	product and service available through the program shall be made
285	available through printed material and an interactive Internet
286	website. A participant needing personal assistance to select
287	products and services shall be referred to a participating agent
288	in his or her area.
289	(a)  Participation in the program may begin at any time
290	during a year after the employer completes enrollment and meets
291	the requirements specified by the corporation pursuant to
292	paragraph (4)(c).
293	(b)  Initial selection of products and services must be
294	made by an individual participant within 60 days after the date
295	the individual's employer qualified for participation. An
296	individual who fails to enroll in products and services by the
297	end of this period is limited to participation in flexible
298	spending account services until the next annual enrollment
299	period.
300	(c)  Initial enrollment periods for each product selected
301	by an individual participant must last at least 12 months,
302	unless the individual participant specifically agrees to a
303	different enrollment period.
304	(d)  If an individual has selected one or more products and
305	enrolled in those products for at least 12 months or any other
306	period specifically agreed to by the individual participant,
307	changes in selected products and services may only be made
308	during the annual enrollment period established by the
309	corporation.
310	(e)  The limits established in paragraphs (b)-(d) apply to
311	any risk-bearing product that promises future payment or
312	coverage for a variable amount of benefits or services. The
313	limits do not apply to initiation of flexible spending plans if
314	those plans are not associated with specific high-deductible
315	insurance policies or the use of spending accounts for any
316	products offering individual participants specific amounts and
317	types of health services and treatments at a contracted price.
318	(8)  CONSUMER INFORMATION.-The corporation shall:
319	(a)  Establish a secure website to facilitate the purchase
320	of products and services by participating individuals. The
321	website must provide information about each product or service
322	available through the program.
323	(b)  Inform individuals about other public health care
324	programs.
325	(a)  Prior to making a risk-bearing product available
326	through the program, the corporation shall provide information
327	regarding the product to the Office of Insurance Regulation. The
328	office shall review the product information and provide consumer
329	information and a recommendation on the risk-bearing product to
330	the corporation within 30 days after receiving the product
331	information.
332	1.  Upon receiving a recommendation that a risk-bearing
333	product should be made available in the marketplace, the
334	corporation may include the product on its website. If the
335	consumer information and recommendation is not received within
336	30 days, the corporation may make the risk-bearing product
337	available on the website without consumer information from the
338	office.
339	2.  Upon receiving a recommendation that a risk-bearing
340	product should not be made available in the marketplace, the
341	risk-bearing product may be included as an eligible product in
342	the marketplace and on its website only if a majority of the
343	board of directors vote to include the product.
344	(b)  If a risk-bearing product is made available on the
345	website, the corporation shall make the consumer information and
346	office recommendation available on the website and in print
347	format. The corporation shall make late-submitted and ongoing
348	updates to consumer information available on the website and in
349	print format.
350	(9)  RISK POOLING.-The program may use shall utilize
351	methods for pooling the risk of individual participants and
352	preventing selection bias. These methods may shall include, but
353	are not limited to, a postenrollment risk adjustment of the
354	premium payments to the vendors. The corporation may shall
355	establish a methodology for assessing the risk of enrolled
356	individual participants based on data reported annually by the
357	vendors about their enrollees. Distribution Monthly
358	distributions of payments to the vendors may shall be adjusted
359	based on the assessed relative risk profile of the enrollees in
360	each risk-bearing product for the most recent period for which
361	data is available.
362	(10)  EXEMPTIONS.-
363	(a)  Products, other than the products set forth in
364	subparagraph (4)(d)1.-4., Policies sold as part of the program
365	are not subject to the licensing requirements of the Florida
366	Insurance Code, as defined in s. 624.01 chapter 641, or the
367	mandated offerings or coverages established in part VI of
368	chapter 627 and chapter 641.
369	(b)  The corporation may act as an administrator as defined
370	in s. 626.88 but is not required to be certified pursuant to
371	part VII of chapter 626. However, a third party administrator
372	used by the corporation must be certified under part VII of
373	chapter 626.
374	(11)  CORPORATION.-There is created the Florida Health
375	Choices, Inc., which shall be registered, incorporated,
376	organized, and operated in compliance with part III of chapter
377	112 and chapters 119, 286, and 617. The purpose of the
378	corporation is to administer the program created in this section
379	and to conduct such other business as may further the
380	administration of the program.
381	(a)  The corporation shall be governed by a 15-member board
382	of directors consisting of:
383	1.  Three ex officio, nonvoting members to include:
384	a.  The Secretary of Health Care Administration or a
385	designee with expertise in health care services.
386	b.  The Secretary of Management Services or a designee with
387	expertise in state employee benefits.
388	c.  The commissioner of the Office of Insurance Regulation
389	or a designee with expertise in insurance regulation.
390	2.  Four members appointed by and serving at the pleasure
391	of the Governor.
392	3.  Four members appointed by and serving at the pleasure
393	of the President of the Senate.
394	4.  Four members appointed by and serving at the pleasure
395	of the Speaker of the House of Representatives.
396	5.  Board members may not include insurers, health
397	insurance agents or brokers, health care providers, health
398	maintenance organizations, prepaid service providers, or any
399	other entity, affiliate or subsidiary of eligible vendors.
400	(b)  Members shall be appointed for terms of up to 3 years.
401	Any member is eligible for reappointment. A vacancy on the board
402	shall be filled for the unexpired portion of the term in the
403	same manner as the original appointment.
404	(c)  The board shall select a chief executive officer for
405	the corporation who shall be responsible for the selection of
406	such other staff as may be authorized by the corporation's
407	operating budget as adopted by the board.
408	(d)  Board members are entitled to receive, from funds of
409	the corporation, reimbursement for per diem and travel expenses
410	as provided by s. 112.061. No other compensation is authorized.
411	(e)  There is no liability on the part of, and no cause of
412	action shall arise against, any member of the board or its
413	employees or agents for any action taken by them in the
414	performance of their powers and duties under this section.
415	(f)  The board shall develop and adopt bylaws and other
416	corporate procedures as necessary for the operation of the
417	corporation and carrying out the purposes of this section. The
418	bylaws shall:
419	1.  Specify procedures for selection of officers and
420	qualifications for reappointment, provided that no board member
421	shall serve more than 9 consecutive years.
422	2.  Require an annual membership meeting that provides an
423	opportunity for input and interaction with individual
424	participants in the program.
425	3.  Specify policies and procedures regarding conflicts of
426	interest, including the provisions of part III of chapter 112,
427	which prohibit a member from participating in any decision that
428	would inure to the benefit of the member or the organization
429	that employs the member. The policies and procedures shall also
430	require public disclosure of the interest that prevents the
431	member from participating in a decision on a particular matter.
432	(g)  The corporation may exercise all powers granted to it
433	under chapter 617 necessary to carry out the purposes of this
434	section, including, but not limited to, the power to receive and
435	accept grants, loans, or advances of funds from any public or
436	private agency and to receive and accept from any source
437	contributions of money, property, labor, or any other thing of
438	value to be held, used, and applied for the purposes of this
439	section.
440	(h)  The corporation may establish technical advisory
441	panels consisting of interested parties, including consumers,
442	health care providers, individuals with expertise in insurance
443	regulation, and insurers.
444	(i)  The corporation shall:
445	1.  Determine eligibility of employers, vendors,
446	individuals, and agents in accordance with subsection (4).
447	2.  Establish procedures necessary for the operation of the
448	program, including, but not limited to, procedures for
449	application, enrollment, risk assessment, risk adjustment, plan
450	administration, performance monitoring, and consumer education.
451	3.  Arrange for collection of contributions from
452	participating employers and individuals.
453	4.  Arrange for payment of premiums and other appropriate
454	disbursements based on the selections of products and services
455	by the individual participants.
456	5.  Establish criteria for disenrollment of participating
457	individuals based on failure to pay the individual's share of
458	any contribution required to maintain enrollment in selected
459	products.
460	6.  Establish criteria for exclusion of vendors pursuant to
461	paragraph (4)(d).
462	7.  Develop and implement a plan for promoting public
463	awareness of and participation in the program.
464	8.  Secure staff and consultant services necessary to the
465	operation of the program.
466	9.  Establish policies and procedures regarding
467	participation in the program for individuals, vendors, health
468	insurance agents, and employers.
469	10.  Provide for the operation of a toll-free hotline to
470	respond to requests for assistance.
471	11.  Provide for initial, open, and special enrollment
472	periods.
473	12.  Evaluate options for employer participation which may
474	conform with common insurance practices.
475	10.  Develop a plan, in coordination with the Department of
476	Revenue, to establish tax credits or refunds for employers that
477	participate in the program. The corporation shall submit the
478	plan to the Governor, the President of the Senate, and the
479	Speaker of the House of Representatives by January 1, 2009.
480	(12)  REPORT.-Beginning in the 2009-2010 fiscal year,
481	submit by February 1 an annual report to the Governor, the
482	President of the Senate, and the Speaker of the House of
483	Representatives documenting the corporation's activities in
484	compliance with the duties delineated in this section.
485	(13)  PROGRAM INTEGRITY.-To ensure program integrity and to
486	safeguard the financial transactions made under the auspices of
487	the program, the corporation is authorized to establish
488	qualifying criteria and certification procedures for vendors,
489	require performance bonds or other guarantees of ability to
490	complete contractual obligations, monitor the performance of
491	vendors, and enforce the agreements of the program through
492	financial penalty or disqualification from the program.
493	Section 2.  Section 409.821, Florida Statutes, is amended
494	to read:
495	409.821  Florida Kidcare program public records exemption.-
496	(1)  Personal identifying information of a Florida Kidcare
497	program applicant or enrollee, as defined in s. 409.811, held by
498	the Agency for Health Care Administration, the Department of
499	Children and Family Services, the Department of Health, or the
500	Florida Healthy Kids Corporation is confidential and exempt from
501	s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
502	(2)(a)  Upon request, such information shall be disclosed
503	to:
504	1.  Another governmental entity in the performance of its
505	official duties and responsibilities;
506	2.  The Department of Revenue for purposes of administering
507	the state Title IV-D program; or
508	3.  The Florida Health Choices, Inc., for the purpose of
509	administering the program authorized pursuant to s. 408.910; or
510	4.3.  Any person who has the written consent of the program
511	applicant.
512	(b)  This section does not prohibit an enrollee's legal
513	guardian from obtaining confirmation of coverage, dates of
514	coverage, the name of the enrollee's health plan, and the amount
515	of premium being paid.
516	(3)  This exemption applies to any information identifying
517	a Florida Kidcare program applicant or enrollee held by the
518	Agency for Health Care Administration, the Department of
519	Children and Family Services, the Department of Health, or the
520	Florida Healthy Kids Corporation before, on, or after the
521	effective date of this exemption.
522	(4)  A knowing and willful violation of this section is a
523	misdemeanor of the second degree, punishable as provided in s.
524	775.082 or s. 775.083.
525	Section 3.  Subsection (41) of section 409.912, Florida
526	Statutes, is amended to read:
527	409.912  Cost-effective purchasing of health care.-The
528	agency shall purchase goods and services for Medicaid recipients
529	in the most cost-effective manner consistent with the delivery
530	of quality medical care. To ensure that medical services are
531	effectively utilized, the agency may, in any case, require a
532	confirmation or second physician's opinion of the correct
533	diagnosis for purposes of authorizing future services under the
534	Medicaid program. This section does not restrict access to
535	emergency services or poststabilization care services as defined
536	in 42 C.F.R. part 438.114. Such confirmation or second opinion
537	shall be rendered in a manner approved by the agency. The agency
538	shall maximize the use of prepaid per capita and prepaid
539	aggregate fixed-sum basis services when appropriate and other
540	alternative service delivery and reimbursement methodologies,
541	including competitive bidding pursuant to s. 287.057, designed
542	to facilitate the cost-effective purchase of a case-managed
543	continuum of care. The agency shall also require providers to
544	minimize the exposure of recipients to the need for acute
545	inpatient, custodial, and other institutional care and the
546	inappropriate or unnecessary use of high-cost services. The
547	agency shall contract with a vendor to monitor and evaluate the
548	clinical practice patterns of providers in order to identify
549	trends that are outside the normal practice patterns of a
550	provider's professional peers or the national guidelines of a
551	provider's professional association. The vendor must be able to
552	provide information and counseling to a provider whose practice
553	patterns are outside the norms, in consultation with the agency,
554	to improve patient care and reduce inappropriate utilization.
555	The agency may mandate prior authorization, drug therapy
556	management, or disease management participation for certain
557	populations of Medicaid beneficiaries, certain drug classes, or
558	particular drugs to prevent fraud, abuse, overuse, and possible
559	dangerous drug interactions. The Pharmaceutical and Therapeutics
560	Committee shall make recommendations to the agency on drugs for
561	which prior authorization is required. The agency shall inform
562	the Pharmaceutical and Therapeutics Committee of its decisions
563	regarding drugs subject to prior authorization. The agency is
564	authorized to limit the entities it contracts with or enrolls as
565	Medicaid providers by developing a provider network through
566	provider credentialing. The agency may competitively bid single-
567	source-provider contracts if procurement of goods or services
568	results in demonstrated cost savings to the state without
569	limiting access to care. The agency may limit its network based
570	on the assessment of beneficiary access to care, provider
571	availability, provider quality standards, time and distance
572	standards for access to care, the cultural competence of the
573	provider network, demographic characteristics of Medicaid
574	beneficiaries, practice and provider-to-beneficiary standards,
575	appointment wait times, beneficiary use of services, provider
576	turnover, provider profiling, provider licensure history,
577	previous program integrity investigations and findings, peer
578	review, provider Medicaid policy and billing compliance records,
579	clinical and medical record audits, and other factors. Providers
580	shall not be entitled to enrollment in the Medicaid provider
581	network. The agency shall determine instances in which allowing
582	Medicaid beneficiaries to purchase durable medical equipment and
583	other goods is less expensive to the Medicaid program than long-
584	term rental of the equipment or goods. The agency may establish
585	rules to facilitate purchases in lieu of long-term rentals in
586	order to protect against fraud and abuse in the Medicaid program
587	as defined in s. 409.913. The agency may seek federal waivers
588	necessary to administer these policies.
589	(41)  The agency shall establish provide for the
590	development of a demonstration project by establishment in
591	Miami-Dade County of a long-term-care facility and a psychiatric
592	facility licensed pursuant to chapter 395 to improve access to
593	health care for a predominantly minority, medically underserved,
594	and medically complex population and to evaluate alternatives to
595	nursing home care and general acute care for such population.
596	Such project is to be located in a health care condominium and
597	collocated colocated with licensed facilities providing a
598	continuum of care. These projects are The establishment of this
599	project is not subject to the provisions of s. 408.036 or s.
600	408.039.
601	Section 4.  This act shall take effect July 1, 2011.
602
603
604	-----------------------------------------------------
605	T I T L E  A M E N D M E N T
606	Remove the entire title and insert:
607	A bill to be entitled
608	An act relating to health and human services; amending s.
609	408.910, F.S.; providing and revising definitions;
610	revising eligibility requirements for participation in the
611	Florida Health Choices Program; providing that statutory
612	rural hospitals are eligible as employers rather than
613	participants under the program; permitting specified
614	eligible vendors to sell health maintenance contracts or
615	products and services; requiring certain risk-bearing
616	products offered by insurers to be approved by the Office
617	of Insurance Regulation; providing requirements for
618	product certification; providing duties of the Florida
619	Health Choices, Inc., including maintenance of a toll-free
620	telephone hotline to respond to requests for assistance;
621	providing for enrollment periods; providing for certain
622	risk pooling data used by the corporation to be reported
623	annually; amending s. 409.821, F.S.; authorizing personal
624	identifying information of a Florida Kidcare program
625	applicant to be disclosed to the Florida Health Choices,
626	Inc., to administer the program; amending s. 409.912,
627	F.S.; requiring the Agency for Health Care Administration
628	to establish a demonstration project in Miami-Dade County
629	of a long-term-care facility and a psychiatric facility to
630	improve access to health care by medically underserved
631	persons; providing an effective date.

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