CS/HB 1125

1	A bill to be entitled
2	An act relating to health and human services; amending s.
3	408.036, F.S.; providing an exemption from review by the
4	agency and the requirement to file an application for a
5	certificate of need with the agency for certain Level III
6	neonatal intensive care units under certain circumstances;
7	amending s. 408.909, F.S.; removing a limitation on
8	eligibility for enrollment in an approved health flex
9	plan; amending s. 766.202, F.S.; revising the definition
10	of the term "health care provider" to include orthotists,
11	orthotic fitters, orthotic fitter assistants, pedorthists,
12	and prosthetists; amending s. 408.910, F.S.; providing and
13	revising definitions; revising eligibility requirements
14	for participation in the Florida Health Choices Program;
15	providing that statutory rural hospitals are eligible as
16	employers rather than participants under the program;
17	permitting specified eligible vendors to sell health
18	maintenance contracts or products and services; requiring
19	certain risk-bearing products offered by insurers to be
20	approved by the Office of Insurance Regulation; providing
21	requirements for product certification; providing duties
22	of the Florida Health Choices, Inc., including maintenance
23	of a toll-free telephone hotline to respond to requests
24	for assistance; providing for enrollment periods;
25	providing for certain risk pooling data used by the
26	corporation to be reported annually; amending s. 409.821,
27	F.S.; authorizing personal identifying information of a
28	Florida Kidcare program applicant to be disclosed to the
29	Florida Health Choices, Inc., to administer the program;
30	amending s. 409.912, F.S.; requiring the Agency for Health
31	Care Administration to establish a demonstration project
32	in Miami-Dade County of a long-term-care facility and a
33	psychiatric facility to improve access to health care by
34	medically underserved persons; providing an effective
35	date.
36
37	Be It Enacted by the Legislature of the State of Florida:
38
39	Section 1.  Paragraph (l) of subsection (3) of section
40	408.036, Florida Statutes, is amended to read:
41	408.036  Projects subject to review; exemptions.-
42	(3)  EXEMPTIONS.-Upon request, the following projects are
43	subject to exemption from the provisions of subsection (1):
44	(l)  For the establishment of:
45	1.  A Level II neonatal intensive care unit with at least
46	10 beds, upon documentation to the agency that the applicant
47	hospital had a minimum of 1,500 births during the previous 12
48	months; or
49	2.  A Level III neonatal intensive care unit with at least
50	15 beds, upon documentation to the agency that the applicant
51	hospital has a Level II neonatal intensive care unit of at least
52	10 beds and had a minimum of 3,500 births during the previous 12
53	months; or,
54	3.  A Level III neonatal intensive care unit with at least
55	5 beds, upon documentation to the agency that the applicant
56	hospital is a verified trauma center pursuant to s.
57	395.4001(14), and has a Level II neonatal intensive care unit,
58
59	if the applicant demonstrates that it meets the requirements for
60	quality of care, nurse staffing, physician staffing, physical
61	plant, equipment, emergency transportation, and data reporting
62	found in agency certificate-of-need rules for Level II and Level
63	III neonatal intensive care units and if the applicant commits
64	to the provision of services to Medicaid and charity patients at
65	a level equal to or greater than the district average. Such a
66	commitment is subject to s. 408.040.
67	Section 2.  Paragraph (a) of subsection (5) of section
68	408.909, Florida Statutes, is amended to read:
69	408.909  Health flex plans.-
70	(5)  ELIGIBILITY.-Eligibility to enroll in an approved
71	health flex plan is limited to residents of this state who:
72	(a)1.  Are 64 years of age or younger;
73	2.  Have a family income equal to or less than 300 percent
74	of the federal poverty level;
75	2.3.  Are not covered by a private insurance policy and are
76	not eligible for coverage through a public health insurance
77	program, such as Medicare or Medicaid, or another public health
78	care program, such as Kidcare, and have not been covered at any
79	time during the past 6 months, except that:
80	a.  A person who was covered under an individual health
81	maintenance contract issued by a health maintenance organization
82	licensed under part I of chapter 641 which was also an approved
83	health flex plan on October 1, 2008, may apply for coverage in
84	the same health maintenance organization's health flex plan
85	without a lapse in coverage if all other eligibility
86	requirements are met; or
87	b.  A person who was covered under Medicaid or Kidcare and
88	lost eligibility for the Medicaid or Kidcare subsidy due to
89	income restrictions within 90 days prior to applying for health
90	care coverage through an approved health flex plan may apply for
91	coverage in a health flex plan without a lapse in coverage if
92	all other eligibility requirements are met; and
93	3.4.  Have applied for health care coverage as an
94	individual through an approved health flex plan and have agreed
95	to make any payments required for participation, including
96	periodic payments or payments due at the time health care
97	services are provided; or
98	Section 3.  Subsection (4) of section 766.202, Florida
99	Statutes, is amended to read:
100	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
101	766.201-766.212, the term:
102	(4)  "Health care provider" means any hospital, ambulatory
103	surgical center, or mobile surgical facility as defined and
104	licensed under chapter 395; a birth center licensed under
105	chapter 383; any person licensed under chapter 458, chapter 459,
106	chapter 460, chapter 461, chapter 462, chapter 463, part I of
107	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
108	or chapter 486; a clinical lab licensed under chapter 483; a
109	health maintenance organization certificated under part I of
110	chapter 641; a blood bank; a plasma center; an industrial
111	clinic; a renal dialysis facility; or a professional association
112	partnership, corporation, joint venture, or other association
113	for professional activity by health care providers.
114	Section 4.  Section 408.910, Florida Statutes, is amended
115	to read:
116	408.910  Florida Health Choices Program.-
117	(1)  LEGISLATIVE INTENT.-The Legislature finds that a
118	significant number of the residents of this state do not have
119	adequate access to affordable, quality health care. The
120	Legislature further finds that increasing access to affordable,
121	quality health care can be best accomplished by establishing a
122	competitive market for purchasing health insurance and health
123	services. It is therefore the intent of the Legislature to
124	create the Florida Health Choices Program to:
125	(a)  Expand opportunities for Floridians to purchase
126	affordable health insurance and health services.
127	(b)  Preserve the benefits of employment-sponsored
128	insurance while easing the administrative burden for employers
129	who offer these benefits.
130	(c)  Enable individual choice in both the manner and amount
131	of health care purchased.
132	(d)  Provide for the purchase of individual, portable
133	health care coverage.
134	(e)  Disseminate information to consumers on the price and
135	quality of health services.
136	(f)  Sponsor a competitive market that stimulates product
137	innovation, quality improvement, and efficiency in the
138	production and delivery of health services.
139	(2)  DEFINITIONS.-As used in this section, the term:
140	(a)  "Corporation" means the Florida Health Choices, Inc.,
141	established under this section.
142	(b)  "Corporation's marketplace" means the single,
143	centralized market established by the program that facilitates
144	the purchase of products made available in the marketplace.
145	(c)(b)  "Health insurance agent" means an agent licensed
146	under part IV of chapter 626.
147	(d)(c)  "Insurer" means an entity licensed under chapter
148	624 which offers an individual health insurance policy or a
149	group health insurance policy, a preferred provider organization
150	as defined in s. 627.6471, or an exclusive provider organization
151	as defined in s. 627.6472, or a health maintenance organization
152	licensed under part I of chapter 641, or a prepaid limited
153	health service organization or discount medical plan
154	organization licensed under chapter 636.
155	(e)(d)  "Program" means the Florida Health Choices Program
156	established by this section.
157	(3)  PROGRAM PURPOSE AND COMPONENTS.-The Florida Health
158	Choices Program is created as a single, centralized market for
159	the sale and purchase of various products that enable
160	individuals to pay for health care. These products include, but
161	are not limited to, health insurance plans, health maintenance
162	organization plans, prepaid services, service contracts, and
163	flexible spending accounts. The components of the program
164	include:
165	(a)  Enrollment of employers.
166	(b)  Administrative services for participating employers,
167	including:
168	1.  Assistance in seeking federal approval of cafeteria
169	plans.
170	2.  Collection of premiums and other payments.
171	3.  Management of individual benefit accounts.
172	4.  Distribution of premiums to insurers and payments to
173	other eligible vendors.
174	5.  Assistance for participants in complying with reporting
175	requirements.
176	(c)  Services to individual participants, including:
177	1.  Information about available products and participating
178	vendors.
179	2.  Assistance with assessing the benefits and limits of
180	each product, including information necessary to distinguish
181	between policies offering creditable coverage and other products
182	available through the program.
183	3.  Account information to assist individual participants
184	with managing available resources.
185	4.  Services that promote healthy behaviors.
186	(d)  Recruitment of vendors, including insurers, health
187	maintenance organizations, prepaid clinic service providers,
188	provider service networks, and other providers.
189	(e)  Certification of vendors to ensure capability,
190	reliability, and validity of offerings.
191	(f)  Collection of data, monitoring, assessment, and
192	reporting of vendor performance.
193	(g)  Information services for individuals and employers.
194	(h)  Program evaluation.
195	(4)  ELIGIBILITY AND PARTICIPATION.-Participation in the
196	program is voluntary and shall be available to employers,
197	individuals, vendors, and health insurance agents as specified
198	in this subsection.
199	(a)  Employers eligible to enroll in the program include:
200	1.  Employers that meet criteria established by the
201	corporation and elect to make their employees eligible through
202	the program have 1 to 50 employees.
203	2.  Fiscally constrained counties described in s. 218.67.
204	3.  Municipalities having populations of fewer than 50,000
205	residents.
206	4.  School districts in fiscally constrained counties.
207	5.  Statutory rural hospitals.
208	(b)  Individuals eligible to participate in the program
209	include:
210	1.  Individual employees of enrolled employers.
211	2.  State employees not eligible for state employee health
212	benefits.
213	3.  State retirees.
214	4.  Medicaid reform participants who opt out select the
215	opt-out provision of reform.
216	5.  Statutory rural hospitals.
217	(c)  Employers who choose to participate in the program may
218	enroll by complying with the procedures established by the
219	corporation. The procedures must include, but are not limited
220	to:
221	1.  Submission of required information.
222	2.  Compliance with federal tax requirements for the
223	establishment of a cafeteria plan, pursuant to s. 125 of the
224	Internal Revenue Code, including designation of the employer's
225	plan as a premium payment plan, a salary reduction plan that has
226	flexible spending arrangements, or a salary reduction plan that
227	has a premium payment and flexible spending arrangements.
228	3.  Determination of the employer's contribution, if any,
229	per employee, provided that such contribution is equal for each
230	eligible employee.
231	4.  Establishment of payroll deduction procedures, subject
232	to the agreement of each individual employee who voluntarily
233	participates in the program.
234	5.  Designation of the corporation as the third-party
235	administrator for the employer's health benefit plan.
236	6.  Identification of eligible employees.
237	7.  Arrangement for periodic payments.
238	8.  Employer notification to employees of the intent to
239	transfer from an existing employee health plan to the program at
240	least 90 days before the transition.
241	(d)  All eligible vendors who choose to participate and the
242	products and services that the vendors are permitted to sell are
243	as follows:
244	1.  Insurers licensed under chapter 624 may sell health
245	insurance policies, limited benefit policies, other risk-bearing
246	coverage, and other products or services.
247	2.  Health maintenance organizations licensed under part I
248	of chapter 641 may sell health maintenance contracts insurance
249	policies, limited benefit policies, other risk-bearing products,
250	and other products or services.
251	3.  Prepaid limited health service organizations may sell
252	products and services as authorized under part I of chapter 636,
253	and discount medical plan organizations may sell products and
254	services as authorized under part II of chapter 636.
255	4.3.  Prepaid health clinic service providers licensed
256	under part II of chapter 641 may sell prepaid service contracts
257	and other arrangements for a specified amount and type of health
258	services or treatments.
259	5.4.  Health care providers, including hospitals and other
260	licensed health facilities, health care clinics, licensed health
261	professionals, pharmacies, and other licensed health care
262	providers, may sell service contracts and arrangements for a
263	specified amount and type of health services or treatments.
264	6.5.  Provider organizations, including service networks,
265	group practices, professional associations, and other
266	incorporated organizations of providers, may sell service
267	contracts and arrangements for a specified amount and type of
268	health services or treatments.
269	7.6.  Corporate entities providing specific health services
270	in accordance with applicable state law may sell service
271	contracts and arrangements for a specified amount and type of
272	health services or treatments.
273
274	A vendor described in subparagraphs 3.-7. 3.-6. may not sell
275	products that provide risk-bearing coverage unless that vendor
276	is authorized under a certificate of authority issued by the
277	Office of Insurance Regulation and is authorized to provide
278	coverage in the relevant geographic area under the provisions of
279	the Florida Insurance Code. Otherwise eligible vendors may be
280	excluded from participating in the program for deceptive or
281	predatory practices, financial insolvency, or failure to comply
282	with the terms of the participation agreement or other standards
283	set by the corporation.
284	(e)  Eligible individuals may voluntarily continue
285	participation in the program regardless of subsequent changes in
286	job status or Medicaid eligibility. Individuals who join the
287	program may participate by complying with the procedures
288	established by the corporation. These procedures must include,
289	but are not limited to:
290	1.  Submission of required information.
291	2.  Authorization for payroll deduction.
292	3.  Compliance with federal tax requirements.
293	4.  Arrangements for payment in the event of job changes.
294	5.  Selection of products and services.
295	(f)  Vendors who choose to participate in the program may
296	enroll by complying with the procedures established by the
297	corporation. These procedures may must include, but are not
298	limited to:
299	1.  Submission of required information, including a
300	complete description of the coverage, services, provider
301	network, payment restrictions, and other requirements of each
302	product offered through the program.
303	2.  Execution of an agreement to make all risk-bearing
304	products offered through the program guaranteed-issue policies,
305	subject to preexisting condition exclusions established comply
306	with requirements established by the corporation.
307	3.  Execution of an agreement that prohibits refusal to
308	sell any offered non-risk-bearing product to a participant who
309	elects to buy it.
310	4.  Establishment of product prices based on age, gender,
311	and location of the individual participant, which may include
312	medical underwriting.
313	5.  Arrangements for receiving payment for enrolled
314	participants.
315	6.  Participation in ongoing reporting processes
316	established by the corporation.
317	7.  Compliance with grievance procedures established by the
318	corporation.
319	(g)  Health insurance agents licensed under part IV of
320	chapter 626 are eligible to voluntarily participate as buyers'
321	representatives. A buyer's representative acts on behalf of an
322	individual purchasing health insurance and health services
323	through the program by providing information about products and
324	services available through the program and assisting the
325	individual with both the decision and the procedure of selecting
326	specific products. Serving as a buyer's representative does not
327	constitute a conflict of interest with continuing
328	responsibilities as a health insurance agent if the relationship
329	between each agent and any participating vendor is disclosed
330	before advising an individual participant about the products and
331	services available through the program. In order to participate,
332	a health insurance agent shall comply with the procedures
333	established by the corporation, including:
334	1.  Completion of training requirements.
335	2.  Execution of a participation agreement specifying the
336	terms and conditions of participation.
337	3.  Disclosure of any appointments to solicit insurance or
338	procure applications for vendors participating in the program.
339	4.  Arrangements to receive payment from the corporation
340	for services as a buyer's representative.
341	(5)  PRODUCTS.-
342	(a)  The products that may be made available for purchase
343	through the program include, but are not limited to:
344	1.  Health insurance policies.
345	2.  Health maintenance contracts.
346	3.2.  Limited benefit plans.
347	4.3.  Prepaid clinic services.
348	5.4.  Service contracts.
349	6.5.  Arrangements for purchase of specific amounts and
350	types of health services and treatments.
351	7.6.  Flexible spending accounts.
352	(b)  Health insurance policies, health maintenance
353	contracts, limited benefit plans, prepaid service contracts, and
354	other contracts for services must ensure the availability of
355	covered services and benefits to participating individuals for
356	at least 1 full enrollment year.
357	(c)  Products may be offered for multiyear periods provided
358	the price of the product is specified for the entire period or
359	for each separately priced segment of the policy or contract.
360	(d)  The corporation shall provide a disclosure form for
361	consumers to acknowledge their understanding of the nature of,
362	and any limitations to, the benefits provided by the products
363	and services being purchased by the consumer.
364	(e)  The corporation must determine that making the plan
365	available through the program is in the interest of eligible
366	individuals and eligible employers in the state.
367	(6)  PRICING.-Prices for the products and services sold
368	through the program must be transparent to participants and
369	established by the vendors. based on age, gender, and location
370	of participants. The corporation shall develop a methodology for
371	evaluating the actuarial soundness of products offered through
372	the program. The methodology shall be reviewed by the Office of
373	Insurance Regulation prior to use by the corporation. Before
374	making the product available to individual participants, the
375	corporation shall use the methodology to compare the expected
376	health care costs for the covered services and benefits to the
377	vendor's price for that coverage. The results shall be reported
378	to individuals participating in the program. Once established,
379	the price set by the vendor must remain in force for at least 1
380	year and may only be redetermined by the vendor at the next
381	annual enrollment period. The corporation shall annually assess
382	a surcharge for each premium or price set by a participating
383	vendor. The surcharge may not be more than 2.5 percent of the
384	price and shall be used to generate funding for administrative
385	services provided by the corporation and payments to buyers'
386	representatives.
387	(7)  THE MARKETPLACE EXCHANGE PROCESS.-The program shall
388	provide a single, centralized market for purchase of health
389	insurance, health maintenance contracts, and other health
390	products and services. Purchases may be made by participating
391	individuals over the Internet or through the services of a
392	participating health insurance agent. Information about each
393	product and service available through the program shall be made
394	available through printed material and an interactive Internet
395	website. A participant needing personal assistance to select
396	products and services shall be referred to a participating agent
397	in his or her area.
398	(a)  Participation in the program may begin at any time
399	during a year after the employer completes enrollment and meets
400	the requirements specified by the corporation pursuant to
401	paragraph (4)(c).
402	(b)  Initial selection of products and services must be
403	made by an individual participant within 60 days after the date
404	the individual's employer qualified for participation. An
405	individual who fails to enroll in products and services by the
406	end of this period is limited to participation in flexible
407	spending account services until the next annual enrollment
408	period.
409	(c)  Initial enrollment periods for each product selected
410	by an individual participant must last at least 12 months,
411	unless the individual participant specifically agrees to a
412	different enrollment period.
413	(d)  If an individual has selected one or more products and
414	enrolled in those products for at least 12 months or any other
415	period specifically agreed to by the individual participant,
416	changes in selected products and services may only be made
417	during the annual enrollment period established by the
418	corporation.
419	(e)  The limits established in paragraphs (b)-(d) apply to
420	any risk-bearing product that promises future payment or
421	coverage for a variable amount of benefits or services. The
422	limits do not apply to initiation of flexible spending plans if
423	those plans are not associated with specific high-deductible
424	insurance policies or the use of spending accounts for any
425	products offering individual participants specific amounts and
426	types of health services and treatments at a contracted price.
427	(8)  CONSUMER INFORMATION.-The corporation shall:
428	(a)  Establish a secure website to facilitate the purchase
429	of products and services by participating individuals. The
430	website must provide information about each product or service
431	available through the program.
432	(b)  Inform individuals about other public health care
433	programs.
434	(a)  Prior to making a risk-bearing product available
435	through the program, the corporation shall provide information
436	regarding the product to the Office of Insurance Regulation. The
437	office shall review the product information and provide consumer
438	information and a recommendation on the risk-bearing product to
439	the corporation within 30 days after receiving the product
440	information.
441	1.  Upon receiving a recommendation that a risk-bearing
442	product should be made available in the marketplace, the
443	corporation may include the product on its website. If the
444	consumer information and recommendation is not received within
445	30 days, the corporation may make the risk-bearing product
446	available on the website without consumer information from the
447	office.
448	2.  Upon receiving a recommendation that a risk-bearing
449	product should not be made available in the marketplace, the
450	risk-bearing product may be included as an eligible product in
451	the marketplace and on its website only if a majority of the
452	board of directors vote to include the product.
453	(b)  If a risk-bearing product is made available on the
454	website, the corporation shall make the consumer information and
455	office recommendation available on the website and in print
456	format. The corporation shall make late-submitted and ongoing
457	updates to consumer information available on the website and in
458	print format.
459	(9)  RISK POOLING.-The program may use shall utilize
460	methods for pooling the risk of individual participants and
461	preventing selection bias. These methods may shall include, but
462	are not limited to, a postenrollment risk adjustment of the
463	premium payments to the vendors. The corporation may shall
464	establish a methodology for assessing the risk of enrolled
465	individual participants based on data reported annually by the
466	vendors about their enrollees. Distribution Monthly
467	distributions of payments to the vendors may shall be adjusted
468	based on the assessed relative risk profile of the enrollees in
469	each risk-bearing product for the most recent period for which
470	data is available.
471	(10)  EXEMPTIONS.-
472	(a)  Products, other than the products set forth in
473	subparagraph (4)(d)1.-4., Policies sold as part of the program
474	are not subject to the licensing requirements of the Florida
475	Insurance Code, as defined in s. 624.01 chapter 641, or the
476	mandated offerings or coverages established in part VI of
477	chapter 627 and chapter 641.
478	(b)  The corporation may act as an administrator as defined
479	in s. 626.88 but is not required to be certified pursuant to
480	part VII of chapter 626. However, a third party administrator
481	used by the corporation must be certified under part VII of
482	chapter 626.
483	(11)  CORPORATION.-There is created the Florida Health
484	Choices, Inc., which shall be registered, incorporated,
485	organized, and operated in compliance with part III of chapter
486	112 and chapters 119, 286, and 617. The purpose of the
487	corporation is to administer the program created in this section
488	and to conduct such other business as may further the
489	administration of the program.
490	(a)  The corporation shall be governed by a 15-member board
491	of directors consisting of:
492	1.  Three ex officio, nonvoting members to include:
493	a.  The Secretary of Health Care Administration or a
494	designee with expertise in health care services.
495	b.  The Secretary of Management Services or a designee with
496	expertise in state employee benefits.
497	c.  The commissioner of the Office of Insurance Regulation
498	or a designee with expertise in insurance regulation.
499	2.  Four members appointed by and serving at the pleasure
500	of the Governor.
501	3.  Four members appointed by and serving at the pleasure
502	of the President of the Senate.
503	4.  Four members appointed by and serving at the pleasure
504	of the Speaker of the House of Representatives.
505	5.  Board members may not include insurers, health
506	insurance agents or brokers, health care providers, health
507	maintenance organizations, prepaid service providers, or any
508	other entity, affiliate or subsidiary of eligible vendors.
509	(b)  Members shall be appointed for terms of up to 3 years.
510	Any member is eligible for reappointment. A vacancy on the board
511	shall be filled for the unexpired portion of the term in the
512	same manner as the original appointment.
513	(c)  The board shall select a chief executive officer for
514	the corporation who shall be responsible for the selection of
515	such other staff as may be authorized by the corporation's
516	operating budget as adopted by the board.
517	(d)  Board members are entitled to receive, from funds of
518	the corporation, reimbursement for per diem and travel expenses
519	as provided by s. 112.061. No other compensation is authorized.
520	(e)  There is no liability on the part of, and no cause of
521	action shall arise against, any member of the board or its
522	employees or agents for any action taken by them in the
523	performance of their powers and duties under this section.
524	(f)  The board shall develop and adopt bylaws and other
525	corporate procedures as necessary for the operation of the
526	corporation and carrying out the purposes of this section. The
527	bylaws shall:
528	1.  Specify procedures for selection of officers and
529	qualifications for reappointment, provided that no board member
530	shall serve more than 9 consecutive years.
531	2.  Require an annual membership meeting that provides an
532	opportunity for input and interaction with individual
533	participants in the program.
534	3.  Specify policies and procedures regarding conflicts of
535	interest, including the provisions of part III of chapter 112,
536	which prohibit a member from participating in any decision that
537	would inure to the benefit of the member or the organization
538	that employs the member. The policies and procedures shall also
539	require public disclosure of the interest that prevents the
540	member from participating in a decision on a particular matter.
541	(g)  The corporation may exercise all powers granted to it
542	under chapter 617 necessary to carry out the purposes of this
543	section, including, but not limited to, the power to receive and
544	accept grants, loans, or advances of funds from any public or
545	private agency and to receive and accept from any source
546	contributions of money, property, labor, or any other thing of
547	value to be held, used, and applied for the purposes of this
548	section.
549	(h)  The corporation may establish technical advisory
550	panels consisting of interested parties, including consumers,
551	health care providers, individuals with expertise in insurance
552	regulation, and insurers.
553	(i)  The corporation shall:
554	1.  Determine eligibility of employers, vendors,
555	individuals, and agents in accordance with subsection (4).
556	2.  Establish procedures necessary for the operation of the
557	program, including, but not limited to, procedures for
558	application, enrollment, risk assessment, risk adjustment, plan
559	administration, performance monitoring, and consumer education.
560	3.  Arrange for collection of contributions from
561	participating employers and individuals.
562	4.  Arrange for payment of premiums and other appropriate
563	disbursements based on the selections of products and services
564	by the individual participants.
565	5.  Establish criteria for disenrollment of participating
566	individuals based on failure to pay the individual's share of
567	any contribution required to maintain enrollment in selected
568	products.
569	6.  Establish criteria for exclusion of vendors pursuant to
570	paragraph (4)(d).
571	7.  Develop and implement a plan for promoting public
572	awareness of and participation in the program.
573	8.  Secure staff and consultant services necessary to the
574	operation of the program.
575	9.  Establish policies and procedures regarding
576	participation in the program for individuals, vendors, health
577	insurance agents, and employers.
578	10.  Provide for the operation of a toll-free hotline to
579	respond to requests for assistance.
580	11.  Provide for initial, open, and special enrollment
581	periods.
582	12.  Evaluate options for employer participation which may
583	conform with common insurance practices.
584	10.  Develop a plan, in coordination with the Department of
585	Revenue, to establish tax credits or refunds for employers that
586	participate in the program. The corporation shall submit the
587	plan to the Governor, the President of the Senate, and the
588	Speaker of the House of Representatives by January 1, 2009.
589	(12)  REPORT.-Beginning in the 2009-2010 fiscal year,
590	submit by February 1 an annual report to the Governor, the
591	President of the Senate, and the Speaker of the House of
592	Representatives documenting the corporation's activities in
593	compliance with the duties delineated in this section.
594	(13)  PROGRAM INTEGRITY.-To ensure program integrity and to
595	safeguard the financial transactions made under the auspices of
596	the program, the corporation is authorized to establish
597	qualifying criteria and certification procedures for vendors,
598	require performance bonds or other guarantees of ability to
599	complete contractual obligations, monitor the performance of
600	vendors, and enforce the agreements of the program through
601	financial penalty or disqualification from the program.
602	Section 5.  Section 409.821, Florida Statutes, is amended
603	to read:
604	409.821  Florida Kidcare program public records exemption.-
605	(1)  Personal identifying information of a Florida Kidcare
606	program applicant or enrollee, as defined in s. 409.811, held by
607	the Agency for Health Care Administration, the Department of
608	Children and Family Services, the Department of Health, or the
609	Florida Healthy Kids Corporation is confidential and exempt from
610	s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
611	(2)(a)  Upon request, such information shall be disclosed
612	to:
613	1.  Another governmental entity in the performance of its
614	official duties and responsibilities;
615	2.  The Department of Revenue for purposes of administering
616	the state Title IV-D program; or
617	3.  The Florida Health Choices, Inc., for the purpose of
618	administering the program authorized pursuant to s. 408.910; or
619	4.3.  Any person who has the written consent of the program
620	applicant.
621	(b)  This section does not prohibit an enrollee's legal
622	guardian from obtaining confirmation of coverage, dates of
623	coverage, the name of the enrollee's health plan, and the amount
624	of premium being paid.
625	(3)  This exemption applies to any information identifying
626	a Florida Kidcare program applicant or enrollee held by the
627	Agency for Health Care Administration, the Department of
628	Children and Family Services, the Department of Health, or the
629	Florida Healthy Kids Corporation before, on, or after the
630	effective date of this exemption.
631	(4)  A knowing and willful violation of this section is a
632	misdemeanor of the second degree, punishable as provided in s.
633	775.082 or s. 775.083.
634	Section 6.  Subsection (41) of section 409.912, Florida
635	Statutes, is amended to read:
636	409.912  Cost-effective purchasing of health care.-The
637	agency shall purchase goods and services for Medicaid recipients
638	in the most cost-effective manner consistent with the delivery
639	of quality medical care. To ensure that medical services are
640	effectively utilized, the agency may, in any case, require a
641	confirmation or second physician's opinion of the correct
642	diagnosis for purposes of authorizing future services under the
643	Medicaid program. This section does not restrict access to
644	emergency services or poststabilization care services as defined
645	in 42 C.F.R. part 438.114. Such confirmation or second opinion
646	shall be rendered in a manner approved by the agency. The agency
647	shall maximize the use of prepaid per capita and prepaid
648	aggregate fixed-sum basis services when appropriate and other
649	alternative service delivery and reimbursement methodologies,
650	including competitive bidding pursuant to s. 287.057, designed
651	to facilitate the cost-effective purchase of a case-managed
652	continuum of care. The agency shall also require providers to
653	minimize the exposure of recipients to the need for acute
654	inpatient, custodial, and other institutional care and the
655	inappropriate or unnecessary use of high-cost services. The
656	agency shall contract with a vendor to monitor and evaluate the
657	clinical practice patterns of providers in order to identify
658	trends that are outside the normal practice patterns of a
659	provider's professional peers or the national guidelines of a
660	provider's professional association. The vendor must be able to
661	provide information and counseling to a provider whose practice
662	patterns are outside the norms, in consultation with the agency,
663	to improve patient care and reduce inappropriate utilization.
664	The agency may mandate prior authorization, drug therapy
665	management, or disease management participation for certain
666	populations of Medicaid beneficiaries, certain drug classes, or
667	particular drugs to prevent fraud, abuse, overuse, and possible
668	dangerous drug interactions. The Pharmaceutical and Therapeutics
669	Committee shall make recommendations to the agency on drugs for
670	which prior authorization is required. The agency shall inform
671	the Pharmaceutical and Therapeutics Committee of its decisions
672	regarding drugs subject to prior authorization. The agency is
673	authorized to limit the entities it contracts with or enrolls as
674	Medicaid providers by developing a provider network through
675	provider credentialing. The agency may competitively bid single-
676	source-provider contracts if procurement of goods or services
677	results in demonstrated cost savings to the state without
678	limiting access to care. The agency may limit its network based
679	on the assessment of beneficiary access to care, provider
680	availability, provider quality standards, time and distance
681	standards for access to care, the cultural competence of the
682	provider network, demographic characteristics of Medicaid
683	beneficiaries, practice and provider-to-beneficiary standards,
684	appointment wait times, beneficiary use of services, provider
685	turnover, provider profiling, provider licensure history,
686	previous program integrity investigations and findings, peer
687	review, provider Medicaid policy and billing compliance records,
688	clinical and medical record audits, and other factors. Providers
689	shall not be entitled to enrollment in the Medicaid provider
690	network. The agency shall determine instances in which allowing
691	Medicaid beneficiaries to purchase durable medical equipment and
692	other goods is less expensive to the Medicaid program than long-
693	term rental of the equipment or goods. The agency may establish
694	rules to facilitate purchases in lieu of long-term rentals in
695	order to protect against fraud and abuse in the Medicaid program
696	as defined in s. 409.913. The agency may seek federal waivers
697	necessary to administer these policies.
698	(41)  The agency shall establish provide for the
699	development of a demonstration project by establishment in
700	Miami-Dade County of a long-term-care facility and a psychiatric
701	facility licensed pursuant to chapter 395 to improve access to
702	health care for a predominantly minority, medically underserved,
703	and medically complex population and to evaluate alternatives to
704	nursing home care and general acute care for such population.
705	Such project is to be located in a health care condominium and
706	collocated colocated with licensed facilities providing a
707	continuum of care. These projects are The establishment of this
708	project is not subject to the provisions of s. 408.036 or s.
709	408.039.
710	Section 7.  This act shall take effect July 1, 2011.

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