CS/HB 1125

A bill to be entitled
2An act relating to health and human services; amending s.
3408.036, F.S.; providing an exemption from review by the
4agency and the requirement to file an application for a
5certificate of need with the agency for certain Level III
6neonatal intensive care units under certain circumstances;
7amending s. 408.909, F.S.; removing a limitation on
8eligibility for enrollment in an approved health flex
9plan; amending s. 766.202, F.S.; revising the definition
10of the term "health care provider" to include orthotists,
11orthotic fitters, orthotic fitter assistants, pedorthists,
12and prosthetists; amending s. 408.910, F.S.; providing and
13revising definitions; revising eligibility requirements
14for participation in the Florida Health Choices Program;
15providing that statutory rural hospitals are eligible as
16employers rather than participants under the program;
17permitting specified eligible vendors to sell health
18maintenance contracts or products and services; requiring
19certain risk-bearing products offered by insurers to be
20approved by the Office of Insurance Regulation; providing
21requirements for product certification; providing duties
22of the Florida Health Choices, Inc., including maintenance
23of a toll-free telephone hotline to respond to requests
24for assistance; providing for enrollment periods;
25providing for certain risk pooling data used by the
26corporation to be reported annually; amending s. 409.821,
27F.S.; authorizing personal identifying information of a
28Florida Kidcare program applicant to be disclosed to the
29Florida Health Choices, Inc., to administer the program;
30amending s. 409.912, F.S.; requiring the Agency for Health
31Care Administration to establish a demonstration project
32in Miami-Dade County of a long-term-care facility and a
33psychiatric facility to improve access to health care by
34medically underserved persons; providing an effective
37Be It Enacted by the Legislature of the State of Florida:
39     Section 1.  Paragraph (l) of subsection (3) of section
40408.036, Florida Statutes, is amended to read:
41     408.036  Projects subject to review; exemptions.-
42     (3)  EXEMPTIONS.-Upon request, the following projects are
43subject 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
4610 beds, upon documentation to the agency that the applicant
47hospital had a minimum of 1,500 births during the previous 12
48months; or
49     2.  A Level III neonatal intensive care unit with at least
5015 beds, upon documentation to the agency that the applicant
51hospital has a Level II neonatal intensive care unit of at least
5210 beds and had a minimum of 3,500 births during the previous 12
53months; or,
54     3.  A Level III neonatal intensive care unit with at least
555 beds, upon documentation to the agency that the applicant
56hospital is a verified trauma center pursuant to s.
57395.4001(14), and has a Level II neonatal intensive care unit,
59if the applicant demonstrates that it meets the requirements for
60quality of care, nurse staffing, physician staffing, physical
61plant, equipment, emergency transportation, and data reporting
62found in agency certificate-of-need rules for Level II and Level
63III neonatal intensive care units and if the applicant commits
64to the provision of services to Medicaid and charity patients at
65a level equal to or greater than the district average. Such a
66commitment is subject to s. 408.040.
67     Section 2.  Paragraph (a) of subsection (5) of section
68408.909, Florida Statutes, is amended to read:
69     408.909  Health flex plans.-
70     (5)  ELIGIBILITY.-Eligibility to enroll in an approved
71health 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
74of the federal poverty level;
75     2.3.  Are not covered by a private insurance policy and are
76not eligible for coverage through a public health insurance
77program, such as Medicare or Medicaid, or another public health
78care program, such as Kidcare, and have not been covered at any
79time during the past 6 months, except that:
80     a.  A person who was covered under an individual health
81maintenance contract issued by a health maintenance organization
82licensed under part I of chapter 641 which was also an approved
83health flex plan on October 1, 2008, may apply for coverage in
84the same health maintenance organization's health flex plan
85without a lapse in coverage if all other eligibility
86requirements are met; or
87     b.  A person who was covered under Medicaid or Kidcare and
88lost eligibility for the Medicaid or Kidcare subsidy due to
89income restrictions within 90 days prior to applying for health
90care coverage through an approved health flex plan may apply for
91coverage in a health flex plan without a lapse in coverage if
92all other eligibility requirements are met; and
93     3.4.  Have applied for health care coverage as an
94individual through an approved health flex plan and have agreed
95to make any payments required for participation, including
96periodic payments or payments due at the time health care
97services are provided; or
98     Section 3.  Subsection (4) of section 766.202, Florida
99Statutes, is amended to read:
100     766.202  Definitions; ss. 766.201-766.212.-As used in ss.
101766.201-766.212, the term:
102     (4)  "Health care provider" means any hospital, ambulatory
103surgical center, or mobile surgical facility as defined and
104licensed under chapter 395; a birth center licensed under
105chapter 383; any person licensed under chapter 458, chapter 459,
106chapter 460, chapter 461, chapter 462, chapter 463, part I of
107chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
108or chapter 486; a clinical lab licensed under chapter 483; a
109health maintenance organization certificated under part I of
110chapter 641; a blood bank; a plasma center; an industrial
111clinic; a renal dialysis facility; or a professional association
112partnership, corporation, joint venture, or other association
113for professional activity by health care providers.
114     Section 4.  Section 408.910, Florida Statutes, is amended
115to read:
116     408.910  Florida Health Choices Program.-
117     (1)  LEGISLATIVE INTENT.-The Legislature finds that a
118significant number of the residents of this state do not have
119adequate access to affordable, quality health care. The
120Legislature further finds that increasing access to affordable,
121quality health care can be best accomplished by establishing a
122competitive market for purchasing health insurance and health
123services. It is therefore the intent of the Legislature to
124create the Florida Health Choices Program to:
125     (a)  Expand opportunities for Floridians to purchase
126affordable health insurance and health services.
127     (b)  Preserve the benefits of employment-sponsored
128insurance while easing the administrative burden for employers
129who offer these benefits.
130     (c)  Enable individual choice in both the manner and amount
131of health care purchased.
132     (d)  Provide for the purchase of individual, portable
133health care coverage.
134     (e)  Disseminate information to consumers on the price and
135quality of health services.
136     (f)  Sponsor a competitive market that stimulates product
137innovation, quality improvement, and efficiency in the
138production and delivery of health services.
139     (2)  DEFINITIONS.-As used in this section, the term:
140     (a)  "Corporation" means the Florida Health Choices, Inc.,
141established under this section.
142     (b)  "Corporation's marketplace" means the single,
143centralized market established by the program that facilitates
144the purchase of products made available in the marketplace.
145     (c)(b)  "Health insurance agent" means an agent licensed
146under part IV of chapter 626.
147     (d)(c)  "Insurer" means an entity licensed under chapter
148624 which offers an individual health insurance policy or a
149group health insurance policy, a preferred provider organization
150as defined in s. 627.6471, or an exclusive provider organization
151as defined in s. 627.6472, or a health maintenance organization
152licensed under part I of chapter 641, or a prepaid limited
153health service organization or discount medical plan
154organization licensed under chapter 636.
155     (e)(d)  "Program" means the Florida Health Choices Program
156established by this section.
157     (3)  PROGRAM PURPOSE AND COMPONENTS.-The Florida Health
158Choices Program is created as a single, centralized market for
159the sale and purchase of various products that enable
160individuals to pay for health care. These products include, but
161are not limited to, health insurance plans, health maintenance
162organization plans, prepaid services, service contracts, and
163flexible spending accounts. The components of the program
165     (a)  Enrollment of employers.
166     (b)  Administrative services for participating employers,
168     1.  Assistance in seeking federal approval of cafeteria
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
173other eligible vendors.
174     5.  Assistance for participants in complying with reporting
176     (c)  Services to individual participants, including:
177     1.  Information about available products and participating
179     2.  Assistance with assessing the benefits and limits of
180each product, including information necessary to distinguish
181between policies offering creditable coverage and other products
182available through the program.
183     3.  Account information to assist individual participants
184with managing available resources.
185     4.  Services that promote healthy behaviors.
186     (d)  Recruitment of vendors, including insurers, health
187maintenance organizations, prepaid clinic service providers,
188provider service networks, and other providers.
189     (e)  Certification of vendors to ensure capability,
190reliability, and validity of offerings.
191     (f)  Collection of data, monitoring, assessment, and
192reporting of vendor performance.
193     (g)  Information services for individuals and employers.
194     (h)  Program evaluation.
195     (4)  ELIGIBILITY AND PARTICIPATION.-Participation in the
196program is voluntary and shall be available to employers,
197individuals, vendors, and health insurance agents as specified
198in this subsection.
199     (a)  Employers eligible to enroll in the program include:
200     1.  Employers that meet criteria established by the
201corporation and elect to make their employees eligible through
202the 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
206     4.  School districts in fiscally constrained counties.
207     5.  Statutory rural hospitals.
208     (b)  Individuals eligible to participate in the program
210     1.  Individual employees of enrolled employers.
211     2.  State employees not eligible for state employee health
213     3.  State retirees.
214     4.  Medicaid reform participants who opt out select the
215opt-out provision of reform.
216     5.  Statutory rural hospitals.
217     (c)  Employers who choose to participate in the program may
218enroll by complying with the procedures established by the
219corporation. The procedures must include, but are not limited
221     1.  Submission of required information.
222     2.  Compliance with federal tax requirements for the
223establishment of a cafeteria plan, pursuant to s. 125 of the
224Internal Revenue Code, including designation of the employer's
225plan as a premium payment plan, a salary reduction plan that has
226flexible spending arrangements, or a salary reduction plan that
227has a premium payment and flexible spending arrangements.
228     3.  Determination of the employer's contribution, if any,
229per employee, provided that such contribution is equal for each
230eligible employee.
231     4.  Establishment of payroll deduction procedures, subject
232to the agreement of each individual employee who voluntarily
233participates in the program.
234     5.  Designation of the corporation as the third-party
235administrator 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
239transfer from an existing employee health plan to the program at
240least 90 days before the transition.
241     (d)  All eligible vendors who choose to participate and the
242products and services that the vendors are permitted to sell are
243as follows:
244     1.  Insurers licensed under chapter 624 may sell health
245insurance policies, limited benefit policies, other risk-bearing
246coverage, and other products or services.
247     2.  Health maintenance organizations licensed under part I
248of chapter 641 may sell health maintenance contracts insurance
249policies, limited benefit policies, other risk-bearing products,
250and other products or services.
251     3.  Prepaid limited health service organizations may sell
252products and services as authorized under part I of chapter 636,
253and discount medical plan organizations may sell products and
254services as authorized under part II of chapter 636.
255     4.3.  Prepaid health clinic service providers licensed
256under part II of chapter 641 may sell prepaid service contracts
257and other arrangements for a specified amount and type of health
258services or treatments.
259     5.4.  Health care providers, including hospitals and other
260licensed health facilities, health care clinics, licensed health
261professionals, pharmacies, and other licensed health care
262providers, may sell service contracts and arrangements for a
263specified amount and type of health services or treatments.
264     6.5.  Provider organizations, including service networks,
265group practices, professional associations, and other
266incorporated organizations of providers, may sell service
267contracts and arrangements for a specified amount and type of
268health services or treatments.
269     7.6.  Corporate entities providing specific health services
270in accordance with applicable state law may sell service
271contracts and arrangements for a specified amount and type of
272health services or treatments.
274A vendor described in subparagraphs 3.-7. 3.-6. may not sell
275products that provide risk-bearing coverage unless that vendor
276is authorized under a certificate of authority issued by the
277Office of Insurance Regulation and is authorized to provide
278coverage in the relevant geographic area under the provisions of
279the Florida Insurance Code. Otherwise eligible vendors may be
280excluded from participating in the program for deceptive or
281predatory practices, financial insolvency, or failure to comply
282with the terms of the participation agreement or other standards
283set by the corporation.
284     (e)  Eligible individuals may voluntarily continue
285participation in the program regardless of subsequent changes in
286job status or Medicaid eligibility. Individuals who join the
287program may participate by complying with the procedures
288established by the corporation. These procedures must include,
289but 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
296enroll by complying with the procedures established by the
297corporation. These procedures may must include, but are not
298limited to:
299     1.  Submission of required information, including a
300complete description of the coverage, services, provider
301network, payment restrictions, and other requirements of each
302product offered through the program.
303     2.  Execution of an agreement to make all risk-bearing
304products offered through the program guaranteed-issue policies,
305subject to preexisting condition exclusions established comply
306with requirements established by the corporation.
307     3.  Execution of an agreement that prohibits refusal to
308sell any offered non-risk-bearing product to a participant who
309elects to buy it.
310     4.  Establishment of product prices based on age, gender,
311and location of the individual participant, which may include
312medical underwriting.
313     5.  Arrangements for receiving payment for enrolled
315     6.  Participation in ongoing reporting processes
316established by the corporation.
317     7.  Compliance with grievance procedures established by the
319     (g)  Health insurance agents licensed under part IV of
320chapter 626 are eligible to voluntarily participate as buyers'
321representatives. A buyer's representative acts on behalf of an
322individual purchasing health insurance and health services
323through the program by providing information about products and
324services available through the program and assisting the
325individual with both the decision and the procedure of selecting
326specific products. Serving as a buyer's representative does not
327constitute a conflict of interest with continuing
328responsibilities as a health insurance agent if the relationship
329between each agent and any participating vendor is disclosed
330before advising an individual participant about the products and
331services available through the program. In order to participate,
332a health insurance agent shall comply with the procedures
333established by the corporation, including:
334     1.  Completion of training requirements.
335     2.  Execution of a participation agreement specifying the
336terms and conditions of participation.
337     3.  Disclosure of any appointments to solicit insurance or
338procure applications for vendors participating in the program.
339     4.  Arrangements to receive payment from the corporation
340for services as a buyer's representative.
341     (5)  PRODUCTS.-
342     (a)  The products that may be made available for purchase
343through 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
350types of health services and treatments.
351     7.6.  Flexible spending accounts.
352     (b)  Health insurance policies, health maintenance
353contracts, limited benefit plans, prepaid service contracts, and
354other contracts for services must ensure the availability of
355covered services and benefits to participating individuals for
356at least 1 full enrollment year.
357     (c)  Products may be offered for multiyear periods provided
358the price of the product is specified for the entire period or
359for each separately priced segment of the policy or contract.
360     (d)  The corporation shall provide a disclosure form for
361consumers to acknowledge their understanding of the nature of,
362and any limitations to, the benefits provided by the products
363and services being purchased by the consumer.
364     (e)  The corporation must determine that making the plan
365available through the program is in the interest of eligible
366individuals and eligible employers in the state.
367     (6)  PRICING.-Prices for the products and services sold
368through the program must be transparent to participants and
369established by the vendors. based on age, gender, and location
370of participants. The corporation shall develop a methodology for
371evaluating the actuarial soundness of products offered through
372the program. The methodology shall be reviewed by the Office of
373Insurance Regulation prior to use by the corporation. Before
374making the product available to individual participants, the
375corporation shall use the methodology to compare the expected
376health care costs for the covered services and benefits to the
377vendor's price for that coverage. The results shall be reported
378to individuals participating in the program. Once established,
379the price set by the vendor must remain in force for at least 1
380year and may only be redetermined by the vendor at the next
381annual enrollment period. The corporation shall annually assess
382a surcharge for each premium or price set by a participating
383vendor. The surcharge may not be more than 2.5 percent of the
384price and shall be used to generate funding for administrative
385services provided by the corporation and payments to buyers'
387     (7)  THE MARKETPLACE EXCHANGE PROCESS.-The program shall
388provide a single, centralized market for purchase of health
389insurance, health maintenance contracts, and other health
390products and services. Purchases may be made by participating
391individuals over the Internet or through the services of a
392participating health insurance agent. Information about each
393product and service available through the program shall be made
394available through printed material and an interactive Internet
395website. A participant needing personal assistance to select
396products and services shall be referred to a participating agent
397in his or her area.
398     (a)  Participation in the program may begin at any time
399during a year after the employer completes enrollment and meets
400the requirements specified by the corporation pursuant to
401paragraph (4)(c).
402     (b)  Initial selection of products and services must be
403made by an individual participant within 60 days after the date
404the individual's employer qualified for participation. An
405individual who fails to enroll in products and services by the
406end of this period is limited to participation in flexible
407spending account services until the next annual enrollment
409     (c)  Initial enrollment periods for each product selected
410by an individual participant must last at least 12 months,
411unless the individual participant specifically agrees to a
412different enrollment period.
413     (d)  If an individual has selected one or more products and
414enrolled in those products for at least 12 months or any other
415period specifically agreed to by the individual participant,
416changes in selected products and services may only be made
417during the annual enrollment period established by the
419     (e)  The limits established in paragraphs (b)-(d) apply to
420any risk-bearing product that promises future payment or
421coverage for a variable amount of benefits or services. The
422limits do not apply to initiation of flexible spending plans if
423those plans are not associated with specific high-deductible
424insurance policies or the use of spending accounts for any
425products offering individual participants specific amounts and
426types 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
429of products and services by participating individuals. The
430website must provide information about each product or service
431available through the program.
432     (b)  Inform individuals about other public health care
434     (a)  Prior to making a risk-bearing product available
435through the program, the corporation shall provide information
436regarding the product to the Office of Insurance Regulation. The
437office shall review the product information and provide consumer
438information and a recommendation on the risk-bearing product to
439the corporation within 30 days after receiving the product
441     1.  Upon receiving a recommendation that a risk-bearing
442product should be made available in the marketplace, the
443corporation may include the product on its website. If the
444consumer information and recommendation is not received within
44530 days, the corporation may make the risk-bearing product
446available on the website without consumer information from the
448     2.  Upon receiving a recommendation that a risk-bearing
449product should not be made available in the marketplace, the
450risk-bearing product may be included as an eligible product in
451the marketplace and on its website only if a majority of the
452board of directors vote to include the product.
453     (b)  If a risk-bearing product is made available on the
454website, the corporation shall make the consumer information and
455office recommendation available on the website and in print
456format. The corporation shall make late-submitted and ongoing
457updates to consumer information available on the website and in
458print format.
459     (9)  RISK POOLING.-The program may use shall utilize
460methods for pooling the risk of individual participants and
461preventing selection bias. These methods may shall include, but
462are not limited to, a postenrollment risk adjustment of the
463premium payments to the vendors. The corporation may shall
464establish a methodology for assessing the risk of enrolled
465individual participants based on data reported annually by the
466vendors about their enrollees. Distribution Monthly
467distributions of payments to the vendors may shall be adjusted
468based on the assessed relative risk profile of the enrollees in
469each risk-bearing product for the most recent period for which
470data is available.
471     (10)  EXEMPTIONS.-
472     (a)  Products, other than the products set forth in
473subparagraph (4)(d)1.-4., Policies sold as part of the program
474are not subject to the licensing requirements of the Florida
475Insurance Code, as defined in s. 624.01 chapter 641, or the
476mandated offerings or coverages established in part VI of
477chapter 627 and chapter 641.
478     (b)  The corporation may act as an administrator as defined
479in s. 626.88 but is not required to be certified pursuant to
480part VII of chapter 626. However, a third party administrator
481used by the corporation must be certified under part VII of
482chapter 626.
483     (11)  CORPORATION.-There is created the Florida Health
484Choices, Inc., which shall be registered, incorporated,
485organized, and operated in compliance with part III of chapter
486112 and chapters 119, 286, and 617. The purpose of the
487corporation is to administer the program created in this section
488and to conduct such other business as may further the
489administration of the program.
490     (a)  The corporation shall be governed by a 15-member board
491of directors consisting of:
492     1.  Three ex officio, nonvoting members to include:
493     a.  The Secretary of Health Care Administration or a
494designee with expertise in health care services.
495     b.  The Secretary of Management Services or a designee with
496expertise in state employee benefits.
497     c.  The commissioner of the Office of Insurance Regulation
498or a designee with expertise in insurance regulation.
499     2.  Four members appointed by and serving at the pleasure
500of the Governor.
501     3.  Four members appointed by and serving at the pleasure
502of the President of the Senate.
503     4.  Four members appointed by and serving at the pleasure
504of the Speaker of the House of Representatives.
505     5.  Board members may not include insurers, health
506insurance agents or brokers, health care providers, health
507maintenance organizations, prepaid service providers, or any
508other entity, affiliate or subsidiary of eligible vendors.
509     (b)  Members shall be appointed for terms of up to 3 years.
510Any member is eligible for reappointment. A vacancy on the board
511shall be filled for the unexpired portion of the term in the
512same manner as the original appointment.
513     (c)  The board shall select a chief executive officer for
514the corporation who shall be responsible for the selection of
515such other staff as may be authorized by the corporation's
516operating budget as adopted by the board.
517     (d)  Board members are entitled to receive, from funds of
518the corporation, reimbursement for per diem and travel expenses
519as provided by s. 112.061. No other compensation is authorized.
520     (e)  There is no liability on the part of, and no cause of
521action shall arise against, any member of the board or its
522employees or agents for any action taken by them in the
523performance of their powers and duties under this section.
524     (f)  The board shall develop and adopt bylaws and other
525corporate procedures as necessary for the operation of the
526corporation and carrying out the purposes of this section. The
527bylaws shall:
528     1.  Specify procedures for selection of officers and
529qualifications for reappointment, provided that no board member
530shall serve more than 9 consecutive years.
531     2.  Require an annual membership meeting that provides an
532opportunity for input and interaction with individual
533participants in the program.
534     3.  Specify policies and procedures regarding conflicts of
535interest, including the provisions of part III of chapter 112,
536which prohibit a member from participating in any decision that
537would inure to the benefit of the member or the organization
538that employs the member. The policies and procedures shall also
539require public disclosure of the interest that prevents the
540member from participating in a decision on a particular matter.
541     (g)  The corporation may exercise all powers granted to it
542under chapter 617 necessary to carry out the purposes of this
543section, including, but not limited to, the power to receive and
544accept grants, loans, or advances of funds from any public or
545private agency and to receive and accept from any source
546contributions of money, property, labor, or any other thing of
547value to be held, used, and applied for the purposes of this
549     (h)  The corporation may establish technical advisory
550panels consisting of interested parties, including consumers,
551health care providers, individuals with expertise in insurance
552regulation, and insurers.
553     (i)  The corporation shall:
554     1.  Determine eligibility of employers, vendors,
555individuals, and agents in accordance with subsection (4).
556     2.  Establish procedures necessary for the operation of the
557program, including, but not limited to, procedures for
558application, enrollment, risk assessment, risk adjustment, plan
559administration, performance monitoring, and consumer education.
560     3.  Arrange for collection of contributions from
561participating employers and individuals.
562     4.  Arrange for payment of premiums and other appropriate
563disbursements based on the selections of products and services
564by the individual participants.
565     5.  Establish criteria for disenrollment of participating
566individuals based on failure to pay the individual's share of
567any contribution required to maintain enrollment in selected
569     6.  Establish criteria for exclusion of vendors pursuant to
570paragraph (4)(d).
571     7.  Develop and implement a plan for promoting public
572awareness of and participation in the program.
573     8.  Secure staff and consultant services necessary to the
574operation of the program.
575     9.  Establish policies and procedures regarding
576participation in the program for individuals, vendors, health
577insurance agents, and employers.
578     10.  Provide for the operation of a toll-free hotline to
579respond to requests for assistance.
580     11.  Provide for initial, open, and special enrollment
582     12.  Evaluate options for employer participation which may
583conform with common insurance practices.
584     10.  Develop a plan, in coordination with the Department of
585Revenue, to establish tax credits or refunds for employers that
586participate in the program. The corporation shall submit the
587plan to the Governor, the President of the Senate, and the
588Speaker of the House of Representatives by January 1, 2009.
589     (12)  REPORT.-Beginning in the 2009-2010 fiscal year,
590submit by February 1 an annual report to the Governor, the
591President of the Senate, and the Speaker of the House of
592Representatives documenting the corporation's activities in
593compliance with the duties delineated in this section.
594     (13)  PROGRAM INTEGRITY.-To ensure program integrity and to
595safeguard the financial transactions made under the auspices of
596the program, the corporation is authorized to establish
597qualifying criteria and certification procedures for vendors,
598require performance bonds or other guarantees of ability to
599complete contractual obligations, monitor the performance of
600vendors, and enforce the agreements of the program through
601financial penalty or disqualification from the program.
602     Section 5.  Section 409.821, Florida Statutes, is amended
603to read:
604     409.821  Florida Kidcare program public records exemption.-
605     (1)  Personal identifying information of a Florida Kidcare
606program applicant or enrollee, as defined in s. 409.811, held by
607the Agency for Health Care Administration, the Department of
608Children and Family Services, the Department of Health, or the
609Florida Healthy Kids Corporation is confidential and exempt from
610s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
611     (2)(a)  Upon request, such information shall be disclosed
613     1.  Another governmental entity in the performance of its
614official duties and responsibilities;
615     2.  The Department of Revenue for purposes of administering
616the state Title IV-D program; or
617     3.  The Florida Health Choices, Inc., for the purpose of
618administering the program authorized pursuant to s. 408.910; or
619     4.3.  Any person who has the written consent of the program
621     (b)  This section does not prohibit an enrollee's legal
622guardian from obtaining confirmation of coverage, dates of
623coverage, the name of the enrollee's health plan, and the amount
624of premium being paid.
625     (3)  This exemption applies to any information identifying
626a Florida Kidcare program applicant or enrollee held by the
627Agency for Health Care Administration, the Department of
628Children and Family Services, the Department of Health, or the
629Florida Healthy Kids Corporation before, on, or after the
630effective date of this exemption.
631     (4)  A knowing and willful violation of this section is a
632misdemeanor of the second degree, punishable as provided in s.
633775.082 or s. 775.083.
634     Section 6.  Subsection (41) of section 409.912, Florida
635Statutes, is amended to read:
636     409.912  Cost-effective purchasing of health care.-The
637agency shall purchase goods and services for Medicaid recipients
638in the most cost-effective manner consistent with the delivery
639of quality medical care. To ensure that medical services are
640effectively utilized, the agency may, in any case, require a
641confirmation or second physician's opinion of the correct
642diagnosis for purposes of authorizing future services under the
643Medicaid program. This section does not restrict access to
644emergency services or poststabilization care services as defined
645in 42 C.F.R. part 438.114. Such confirmation or second opinion
646shall be rendered in a manner approved by the agency. The agency
647shall maximize the use of prepaid per capita and prepaid
648aggregate fixed-sum basis services when appropriate and other
649alternative service delivery and reimbursement methodologies,
650including competitive bidding pursuant to s. 287.057, designed
651to facilitate the cost-effective purchase of a case-managed
652continuum of care. The agency shall also require providers to
653minimize the exposure of recipients to the need for acute
654inpatient, custodial, and other institutional care and the
655inappropriate or unnecessary use of high-cost services. The
656agency shall contract with a vendor to monitor and evaluate the
657clinical practice patterns of providers in order to identify
658trends that are outside the normal practice patterns of a
659provider's professional peers or the national guidelines of a
660provider's professional association. The vendor must be able to
661provide information and counseling to a provider whose practice
662patterns are outside the norms, in consultation with the agency,
663to improve patient care and reduce inappropriate utilization.
664The agency may mandate prior authorization, drug therapy
665management, or disease management participation for certain
666populations of Medicaid beneficiaries, certain drug classes, or
667particular drugs to prevent fraud, abuse, overuse, and possible
668dangerous drug interactions. The Pharmaceutical and Therapeutics
669Committee shall make recommendations to the agency on drugs for
670which prior authorization is required. The agency shall inform
671the Pharmaceutical and Therapeutics Committee of its decisions
672regarding drugs subject to prior authorization. The agency is
673authorized to limit the entities it contracts with or enrolls as
674Medicaid providers by developing a provider network through
675provider credentialing. The agency may competitively bid single-
676source-provider contracts if procurement of goods or services
677results in demonstrated cost savings to the state without
678limiting access to care. The agency may limit its network based
679on the assessment of beneficiary access to care, provider
680availability, provider quality standards, time and distance
681standards for access to care, the cultural competence of the
682provider network, demographic characteristics of Medicaid
683beneficiaries, practice and provider-to-beneficiary standards,
684appointment wait times, beneficiary use of services, provider
685turnover, provider profiling, provider licensure history,
686previous program integrity investigations and findings, peer
687review, provider Medicaid policy and billing compliance records,
688clinical and medical record audits, and other factors. Providers
689shall not be entitled to enrollment in the Medicaid provider
690network. The agency shall determine instances in which allowing
691Medicaid beneficiaries to purchase durable medical equipment and
692other goods is less expensive to the Medicaid program than long-
693term rental of the equipment or goods. The agency may establish
694rules to facilitate purchases in lieu of long-term rentals in
695order to protect against fraud and abuse in the Medicaid program
696as defined in s. 409.913. The agency may seek federal waivers
697necessary to administer these policies.
698     (41)  The agency shall establish provide for the
699development of a demonstration project by establishment in
700Miami-Dade County of a long-term-care facility and a psychiatric
701facility licensed pursuant to chapter 395 to improve access to
702health care for a predominantly minority, medically underserved,
703and medically complex population and to evaluate alternatives to
704nursing home care and general acute care for such population.
705Such project is to be located in a health care condominium and
706collocated colocated with licensed facilities providing a
707continuum of care. These projects are The establishment of this
708project is not subject to the provisions of s. 408.036 or s.
710     Section 7.  This act shall take effect July 1, 2011.

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