HB 191

1	A bill to be entitled
2	An act relating to health and human services contracts;
3	establishing the Health and Human Services Contract
4	Resource Center to be administratively housed in the
5	Department of Management Services; providing the center's
6	duties; establishing a board of trustees composed of
7	certain agency heads; providing for an executive director
8	appointed by the Governor; providing for implementation by
9	a certain date; amending s. 287.057, F.S.; exempting
10	services provided by an eligible lead community-based
11	provider from being subject to the state competitive
12	bidding process; amending ss. 402.7305 and 427.0135, F.S.;
13	conforming cross-references; reenacting s. 287.058(5),
14	F.S., relating to contract documents for the procurement
15	of specified contractual services, to incorporate the
16	amendment made to s. 287.057, F.S., in a reference
17	thereto; reenacting s. 627.311(5)(c), F.S., relating to
18	joint underwriters and joint reinsurers, to incorporate
19	the amendment made to s. 287.057, F.S., in a reference
20	thereto; reenacting s. 627.351(6)(e), F.S., relating to
21	the Citizens Property Insurance Corporation, to
22	incorporate the amendment made to s. 287.057, F.S., in a
23	reference thereto; providing an effective date.
24
25	Be It Enacted by the Legislature of the State of Florida:
26
27	Section 1.  Health and Human Services Contract Resource
28	Center.-The Health and Human Services Contract Resource Center
29	is created and housed for administrative purposes only in the
30	Department of Management Services. The Legislature intends that
31	the center serve as a single, consolidated unit for the
32	administrative and fiscal contract management of health and
33	human services outsourced by the Department of Children and
34	Family Services, the Department of Elderly Affairs, the
35	Department of Health, the Agency for Persons with Disabilities,
36	the Department of Juvenile Justice, and the Agency for Health
37	Care Administration.
38	(1)  CENTER DUTIES.-The center shall:
39	(a)  Serve as the lead state agency for all administrative
40	and fiscal matters related to health and human services
41	contracts.
42	(b)  Provide administrative and fiscal monitoring
43	activities in coordination with the agency responsible for the
44	program components related to the services provided by the
45	health and human services contract.
46	(c)  Establish administrative and fiscal performance
47	standards for vendors providing health and human services. The
48	standards shall be used in contract monitoring and as part of
49	each agency's evaluation of competitive bids for health and
50	human services.
51	(d)  Develop uniform policies, contract administrative
52	requirements, and monitoring protocols related to the
53	administrative and fiscal requirements of vendors providing
54	health and human services.
55	(e)  Establish or arrange for the establishment of a
56	consolidated data warehouse and archive to maintain the
57	corporate, fiscal, and administrative records of health and
58	human services vendors. The center shall ensure that this data
59	is up to date and accessible to other agencies, participating
60	vendors, and the general public through web-based technology.
61	The records may include, but need not be limited to:
62	1.  Articles of incorporation.
63	2.  Bylaws.
64	3.  Governing board and committee meeting minutes.
65	4.  Financial audits.
66	5.  Organizational charts.
67	(f)  Manage the administrative and fiscal data in a manner
68	that allows contract information to be aggregated and assessed
69	to determine the amount, value, and achievement of
70	administrative standards by vendor, by agency, and by type of
71	service.
72	(g)  Establish a consolidated schedule for site visits to
73	monitor and evaluate the administrative and fiscal compliance of
74	vendors providing health and human services. The center shall
75	facilitate joint site visits with agency program staff whenever
76	possible.
77	(h)  Create an enterprise that allows nonstate agencies to
78	purchase center services. Eligible buyers include, but are not
79	limited to, local governments, nongovernmental organizations,
80	and vendors that have contracts for health and human services
81	with other local service agencies or organizations.
82	(2)  BOARD OF TRUSTEES.-
83	(a)  The center shall be governed by a board of trustees
84	consisting of the agency heads, or designees, of the Department
85	of Children and Family Services, the Department of Health, the
86	Department of Elderly Affairs, the Agency for Persons with
87	Disabilities, the Department of Juvenile Justice, and the Agency
88	for Health Care Administration. The chair of the board shall be
89	appointed by the Governor from the participating agency heads.
90	(b)  The board shall approve an annual work program and
91	business plan, review and approve center policies, and establish
92	a mechanism for receiving and evaluating feedback from health
93	and human services vendors.
94	(3)  EXECUTIVE DIRECTOR.-The Governor shall appoint an
95	executive director of the center. The executive director must
96	have a graduate degree from an accredited institution and at
97	least 7 years of executive-level experience.
98	(4)  IMPLEMENTATION.-The activities of the center shall be
99	phased in beginning with children's services contracts of the
100	Department of Children and Family Services and the Department of
101	Health. Other agency contracts shall be incorporated into the
102	center's management protocols in accordance with a schedule
103	developed by the board of trustees and approved by the
104	Legislative Budget Commission. However, the phasing in of all
105	agency contracts must be completed by June 30, 2011.
106	Section 2.  Paragraph (f) of subsection (3) of section
107	287.057, Florida Statutes, is amended to read:
108	287.057  Procurement of commodities or contractual
109	services.-
110	(3)  When the purchase price of commodities or contractual
111	services exceeds the threshold amount provided in s. 287.017 for
112	CATEGORY TWO, no purchase of commodities or contractual services
113	may be made without receiving competitive sealed bids,
114	competitive sealed proposals, or competitive sealed replies
115	unless:
116	(f)  The purchase is for any of the following contractual
117	services and commodities are not subject to the competitive-
118	solicitation requirements of this section:
119	1.  Artistic services. For the purposes of this subsection,
120	the term "artistic services" does not include advertising or
121	typesetting. As used in this subparagraph, the term
122	"advertising" means the making of a representation in any form
123	in connection with a trade, business, craft, or profession in
124	order to promote the supply of commodities or services by the
125	person promoting the commodities or contractual services.
126	2.  Academic program reviews if the fee for such services
127	does not exceed $50,000.
128	3.  Lectures by individuals.
129	4.  Legal services, including attorney, paralegal, expert
130	witness, appraisal, or mediator services.
131	5.a.  Health services involving examination, diagnosis,
132	treatment, prevention, medical consultation, or administration.
133	b.  Beginning January 1, 2011, health services, include
134	including, but are not limited to, substance abuse and mental
135	health services, involving examination, diagnosis, treatment,
136	prevention, or medical consultation, if when such services are
137	offered to eligible individuals participating in a specific
138	program that qualifies multiple providers and uses a standard
139	payment methodology. Reimbursement for the of administrative
140	costs of for providers of services purchased in this manner are
141	shall also be exempt. For purposes of this subparagraph sub-
142	subparagraph, the term "providers" means health professionals,
143	health facilities, or organizations that deliver or arrange for
144	the delivery of health services.
145	6.  Services provided to persons with mental or physical
146	disabilities by not-for-profit corporations which have obtained
147	exemptions under the provisions of s. 501(c)(3) of the United
148	States Internal Revenue Code or when such services are governed
149	by the provisions of Office of Management and Budget Circular A-
150	122. However, in acquiring such services, the agency shall
151	consider the ability of the vendor, past performance,
152	willingness to meet time requirements, and price.
153	7.  Medicaid services delivered to an eligible Medicaid
154	recipient unless the agency is directed otherwise by in law.
155	8.  Family placement services.
156	9.  Services provided by an eligible lead community-based
157	provider as described in s. 409.1671(1)(e) currently under
158	contract with the Department of Children and Family Services and
159	in compliance with the department's performance, fiscal, and
160	administrative standards.
161	10.9.  Prevention services related to mental health,
162	including drug abuse prevention programs, child abuse prevention
163	programs, and shelters for runaways, operated by not-for-profit
164	corporations. However, in acquiring such services, the agency
165	must shall consider the ability of the vendor, past performance,
166	willingness to meet time requirements, and price.
167	11.10.  Training and education services provided to injured
168	employees pursuant to s. 440.491(6).
169	12.11.  Contracts entered into pursuant to s. 337.11.
170	13.12.  Services or commodities provided by governmental
171	agencies.
172	Section 3.  Paragraph (a) of subsection (2) of section
173	402.7305, Florida Statutes, is amended to read:
174	402.7305  Department of Children and Family Services;
175	procurement of contractual services; contract management.-
176	(2)  PROCUREMENT OF COMMODITIES AND CONTRACTUAL SERVICES.-
177	(a)  Notwithstanding s. 287.057(3)(f)13.12., whenever the
178	department intends to contract with a public postsecondary
179	institution to provide a service, the department must allow all
180	public postsecondary institutions in this state that are
181	accredited by the Southern Association of Colleges and Schools
182	to bid on the contract. Thereafter, notwithstanding any other
183	provision to the contrary, if a public postsecondary institution
184	intends to subcontract for any service awarded in the contract,
185	the subcontracted service must be procured by competitive
186	procedures.
187	Section 4.  Subsection (3) of section 427.0135, Florida
188	Statutes, is amended to read:
189	427.0135  Purchasing agencies; duties and
190	responsibilities.-Each purchasing agency, in carrying out the
191	policies and procedures of the commission, shall:
192	(3)  Not procure transportation disadvantaged services
193	without initially negotiating with the commission, as provided
194	in s. 287.057(3)(f)13.12., or unless otherwise authorized by
195	statute. If the purchasing agency, after consultation with the
196	commission, determines that it cannot reach mutually acceptable
197	contract terms with the commission, the purchasing agency may
198	contract for the same transportation services provided in a more
199	cost-effective manner and of comparable or higher quality and
200	standards. The Medicaid agency shall implement this subsection
201	in a manner consistent with s. 409.908(18) and as otherwise
202	limited or directed by the General Appropriations Act.
203	Section 5.  For the purpose of incorporating the amendment
204	made by this act to section 287.057, Florida Statutes, in a
205	reference thereto, subsection (5) of section 287.058, Florida
206	Statutes, is reenacted to read:
207	287.058  Contract document.-
208	(5)  Unless otherwise provided in the General
209	Appropriations Act or the substantive bill implementing the
210	General Appropriations Act, the Chief Financial Officer may
211	waive the requirements of this section for services which are
212	included in s. 287.057(3)(f).
213	Section 6.  For the purpose of incorporating the amendment
214	made by this act to section 287.057, Florida Statutes, in a
215	reference thereto, paragraph (c) of subsection (5) of section
216	627.311, Florida Statutes, is reenacted to read:
217	627.311  Joint underwriters and joint reinsurers; public
218	records and public meetings exemptions.-
219	(5)
220	(c)  The operation of the plan shall be governed by a plan
221	of operation that is prepared at the direction of the board of
222	governors and approved by order of the office. The plan is
223	subject to continuous review by the office. The office may, by
224	order, withdraw approval of all or part of a plan if the office
225	determines that conditions have changed since approval was
226	granted and that the purposes of the plan require changes in the
227	plan. The plan of operation shall:
228	1.  Authorize the board to engage in the activities
229	necessary to implement this subsection, including, but not
230	limited to, borrowing money.
231	2.  Develop criteria for eligibility for coverage by the
232	plan, including, but not limited to, documented rejection by at
233	least two insurers which reasonably assures that insureds
234	covered under the plan are unable to acquire coverage in the
235	voluntary market.
236	3.  Require notice from the agent to the insured at the
237	time of the application for coverage that the application is for
238	coverage with the plan and that coverage may be available
239	through an insurer, group self-insurers' fund, commercial self-
240	insurance fund, or assessable mutual insurer through another
241	agent at a lower cost.
242	4.  Establish programs to encourage insurers to provide
243	coverage to applicants of the plan in the voluntary market and
244	to insureds of the plan, including, but not limited to:
245	a.  Establishing procedures for an insurer to use in
246	notifying the plan of the insurer's desire to provide coverage
247	to applicants to the plan or existing insureds of the plan and
248	in describing the types of risks in which the insurer is
249	interested. The description of the desired risks must be on a
250	form developed by the plan.
251	b.  Developing forms and procedures that provide an insurer
252	with the information necessary to determine whether the insurer
253	wants to write particular applicants to the plan or insureds of
254	the plan.
255	c.  Developing procedures for notice to the plan and the
256	applicant to the plan or insured of the plan that an insurer
257	will insure the applicant or the insured of the plan, and notice
258	of the cost of the coverage offered; and developing procedures
259	for the selection of an insuring entity by the applicant or
260	insured of the plan.
261	d.  Provide for a market-assistance plan to assist in the
262	placement of employers. All applications for coverage in the
263	plan received 45 days before the effective date for coverage
264	shall be processed through the market-assistance plan. A market-
265	assistance plan specifically designed to serve the needs of
266	small, good policyholders as defined by the board must be
267	reviewed and updated periodically.
268	5.  Provide for policy and claims services to the insureds
269	of the plan of the nature and quality provided for insureds in
270	the voluntary market.
271	6.  Provide for the review of applications for coverage
272	with the plan for reasonableness and accuracy, using any
273	available historic information regarding the insured.
274	7.  Provide for procedures for auditing insureds of the
275	plan which are based on reasonable business judgment and are
276	designed to maximize the likelihood that the plan will collect
277	the appropriate premiums.
278	8.  Authorize the plan to terminate the coverage of and
279	refuse future coverage for any insured that submits a fraudulent
280	application to the plan or provides fraudulent or grossly
281	erroneous records to the plan or to any service provider of the
282	plan in conjunction with the activities of the plan.
283	9.  Establish service standards for agents who submit
284	business to the plan.
285	10.  Establish criteria and procedures to prohibit any
286	agent who does not adhere to the established service standards
287	from placing business with the plan or receiving, directly or
288	indirectly, any commissions for business placed with the plan.
289	11.  Provide for the establishment of reasonable safety
290	programs for all insureds in the plan. All insureds of the plan
291	must participate in the safety program.
292	12.  Authorize the plan to terminate the coverage of and
293	refuse future coverage to any insured who fails to pay premiums
294	or surcharges when due; who, at the time of application, is
295	delinquent in payments of workers' compensation or employer's
296	liability insurance premiums or surcharges owed to an insurer,
297	group self-insurers' fund, commercial self-insurance fund, or
298	assessable mutual insurer licensed to write such coverage in
299	this state; or who refuses to substantially comply with any
300	safety programs recommended by the plan.
301	13.  Authorize the board of governors to provide the goods
302	and services required by the plan through staff employed by the
303	plan, through reasonably compensated service providers who
304	contract with the plan to provide services as specified by the
305	board of governors, or through a combination of employees and
306	service providers.
307	a.  Purchases that equal or exceed $2,500 but are less than
308	or equal to $25,000, shall be made by receipt of written quotes,
309	telephone quotes, or informal bids, whenever practical. The
310	procurement of goods or services valued over $25,000 is subject
311	to competitive solicitation, except in situations in which the
312	goods or services are provided by a sole source or are deemed an
313	emergency purchase, or the services are exempted from
314	competitive-solicitation requirements under s. 287.057(3)(f).
315	Justification for the sole-sourcing or emergency procurement
316	must be documented. Contracts for goods or services valued at or
317	over $100,000 are subject to board approval.
318	b.  The board shall determine whether it is more cost-
319	effective and in the best interests of the plan to use legal
320	services provided by in-house attorneys employed by the plan
321	rather than contracting with outside counsel. In making such
322	determination, the board shall document its findings and shall
323	consider the expertise needed; whether time commitments exceed
324	in-house staff resources; whether local representation is
325	needed; the travel, lodging, and other costs associated with in-
326	house representation; and such other factors that the board
327	determines are relevant.
328	14.  Provide for service standards for service providers,
329	methods of determining adherence to those service standards,
330	incentives and disincentives for service, and procedures for
331	terminating contracts for service providers that fail to adhere
332	to service standards.
333	15.  Provide procedures for selecting service providers and
334	standards for qualification as a service provider that
335	reasonably assure that any service provider selected will
336	continue to operate as an ongoing concern and is capable of
337	providing the specified services in the manner required.
338	16.  Provide for reasonable accounting and data-reporting
339	practices.
340	17.  Provide for annual review of costs associated with the
341	administration and servicing of the policies issued by the plan
342	to determine alternatives by which costs can be reduced.
343	18.  Authorize the acquisition of such excess insurance or
344	reinsurance as is consistent with the purposes of the plan.
345	19.  Provide for an annual report to the office on a date
346	specified by the office and containing such information as the
347	office reasonably requires.
348	20.  Establish multiple rating plans for various
349	classifications of risk which reflect risk of loss, hazard
350	grade, actual losses, size of premium, and compliance with loss
351	control. At least one of such plans must be a preferred-rating
352	plan to accommodate small-premium policyholders with good
353	experience as defined in sub-subparagraph 22.a.
354	21.  Establish agent commission schedules.
355	22.  For employers otherwise eligible for coverage under
356	the plan, establish three tiers of employers meeting the
357	criteria and subject to the rate limitations specified in this
358	subparagraph.
359	a.  Tier One.-
360	(I)  Criteria; rated employers.-An employer that has an
361	experience modification rating shall be included in Tier One if
362	the employer meets all of the following:
363	(A)  The experience modification is below 1.00.
364	(B)  The employer had no lost-time claims subsequent to the
365	applicable experience modification rating period.
366	(C)  The total of the employer's medical-only claims
367	subsequent to the applicable experience modification rating
368	period did not exceed 20 percent of premium.
369	(II)  Criteria; non-rated employers.-An employer that does
370	not have an experience modification rating shall be included in
371	Tier One if the employer meets all of the following:
372	(A)  The employer had no lost-time claims for the 3-year
373	period immediately preceding the inception date or renewal date
374	of the employer's coverage under the plan.
375	(B)  The total of the employer's medical-only claims for
376	the 3-year period immediately preceding the inception date or
377	renewal date of the employer's coverage under the plan did not
378	exceed 20 percent of premium.
379	(C)  The employer has secured workers' compensation
380	coverage for the entire 3-year period immediately preceding the
381	inception date or renewal date of the employer's coverage under
382	the plan.
383	(D)  The employer is able to provide the plan with a loss
384	history generated by the employer's prior workers' compensation
385	insurer, except if the employer is not able to produce a loss
386	history due to the insolvency of an insurer, the receiver shall
387	provide to the plan, upon the request of the employer or the
388	employer's agent, a copy of the employer's loss history from the
389	records of the insolvent insurer if the loss history is
390	contained in records of the insurer which are in the possession
391	of the receiver. If the receiver is unable to produce the loss
392	history, the employer may, in lieu of the loss history, submit
393	an affidavit from the employer and the employer's insurance
394	agent setting forth the loss history.
395	(E)  The employer is not a new business.
396	(III)  Premiums.-The premiums for Tier One insureds shall
397	be set at a premium level 25 percent above the comparable
398	voluntary market premiums until the plan has sufficient
399	experience as determined by the board to establish an
400	actuarially sound rate for Tier One, at which point the board
401	shall, subject to paragraph (e), adjust the rates, if necessary,
402	to produce actuarially sound rates, provided such rate
403	adjustment shall not take effect prior to January 1, 2007.
404	b.  Tier Two.-
405	(I)  Criteria; rated employers.-An employer that has an
406	experience modification rating shall be included in Tier Two if
407	the employer meets all of the following:
408	(A)  The experience modification is equal to or greater
409	than 1.00 but not greater than 1.10.
410	(B)  The employer had no lost-time claims subsequent to the
411	applicable experience modification rating period.
412	(C)  The total of the employer's medical-only claims
413	subsequent to the applicable experience modification rating
414	period did not exceed 20 percent of premium.
415	(II)  Criteria; non-rated employers.-An employer that does
416	not have any experience modification rating shall be included in
417	Tier Two if the employer is a new business. An employer shall be
418	included in Tier Two if the employer has less than 3 years of
419	loss experience in the 3-year period immediately preceding the
420	inception date or renewal date of the employer's coverage under
421	the plan and the employer meets all of the following:
422	(A)  The employer had no lost-time claims for the 3-year
423	period immediately preceding the inception date or renewal date
424	of the employer's coverage under the plan.
425	(B)  The total of the employer's medical-only claims for
426	the 3-year period immediately preceding the inception date or
427	renewal date of the employer's coverage under the plan did not
428	exceed 20 percent of premium.
429	(C)  The employer is able to provide the plan with a loss
430	history generated by the workers' compensation insurer that
431	provided coverage for the portion or portions of such period
432	during which the employer had secured workers' compensation
433	coverage, except if the employer is not able to produce a loss
434	history due to the insolvency of an insurer, the receiver shall
435	provide to the plan, upon the request of the employer or the
436	employer's agent, a copy of the employer's loss history from the
437	records of the insolvent insurer if the loss history is
438	contained in records of the insurer which are in the possession
439	of the receiver. If the receiver is unable to produce the loss
440	history, the employer may, in lieu of the loss history, submit
441	an affidavit from the employer and the employer's insurance
442	agent setting forth the loss history.
443	(III)  Premiums.-The premiums for Tier Two insureds shall
444	be set at a rate level 50 percent above the comparable voluntary
445	market premiums until the plan has sufficient experience as
446	determined by the board to establish an actuarially sound rate
447	for Tier Two, at which point the board shall, subject to
448	paragraph (e), adjust the rates, if necessary, to produce
449	actuarially sound rates, provided such rate adjustment shall not
450	take effect prior to January 1, 2007.
451	c.  Tier Three.-
452	(I)  Eligibility.-An employer shall be included in Tier
453	Three if the employer does not meet the criteria for Tier One or
454	Tier Two.
455	(II)  Rates.-The board shall establish, subject to
456	paragraph (e), and the plan shall charge, actuarially sound
457	rates for Tier Three insureds.
458	23.  For Tier One or Tier Two employers which employ no
459	nonexempt employees or which report payroll which is less than
460	the minimum wage hourly rate for one full-time employee for 1
461	year at 40 hours per week, the plan shall establish actuarially
462	sound premiums, provided, however, that the premiums may not
463	exceed $2,500. These premiums shall be in addition to the fee
464	specified in subparagraph 26. When the plan establishes
465	actuarially sound rates for all employers in Tier One and Tier
466	Two, the premiums for employers referred to in this paragraph
467	are no longer subject to the $2,500 cap.
468	24.  Provide for a depopulation program to reduce the
469	number of insureds in the plan. If an employer insured through
470	the plan is offered coverage from a voluntary market carrier:
471	a.  During the first 30 days of coverage under the plan;
472	b.  Before a policy is issued under the plan;
473	c.  By issuance of a policy upon expiration or cancellation
474	of the policy under the plan; or
475	d.  By assumption of the plan's obligation with respect to
476	an in-force policy,
477
478	that employer is no longer eligible for coverage through the
479	plan. The premium for risks assumed by the voluntary market
480	carrier must be no greater than the premium the insured would
481	have paid under the plan, and shall be adjusted upon renewal to
482	reflect changes in the plan rates and the tier for which the
483	insured would qualify as of the time of renewal. The insured may
484	be charged such premiums only for the first 3 years of coverage
485	in the voluntary market. A premium under this subparagraph is
486	deemed approved and is not an excess premium for purposes of s.
487	627.171.
488	25.  Require that policies issued and applications must
489	include a notice that the policy could be replaced by a policy
490	issued from a voluntary market carrier and that, if an offer of
491	coverage is obtained from a voluntary market carrier, the
492	policyholder is no longer eligible for coverage through the
493	plan. The notice must also specify that acceptance of coverage
494	under the plan creates a conclusive presumption that the
495	applicant or policyholder is aware of this potential.
496	26.  Require that each application for coverage and each
497	renewal premium be accompanied by a nonrefundable fee of $475 to
498	cover costs of administration and fraud prevention. The board
499	may, with the prior approval of the office, increase the amount
500	of the fee pursuant to a rate filing to reflect increased costs
501	of administration and fraud prevention. The fee is not subject
502	to commission and is fully earned upon commencement of coverage.
503	Section 7.  For the purpose of incorporating the amendment
504	made by this act to section 287.057, Florida Statutes, in a
505	reference thereto, paragraph (e) of subsection (6) of section
506	627.351, Florida Statutes, is reenacted to read:
507	627.351  Insurance risk apportionment plans.-
508	(6)  CITIZENS PROPERTY INSURANCE CORPORATION.-
509	(e)  Purchases that equal or exceed $2,500, but are less
510	than $25,000, shall be made by receipt of written quotes,
511	written record of telephone quotes, or informal bids, whenever
512	practical. The procurement of goods or services valued at or
513	over $25,000 shall be subject to competitive solicitation,
514	except in situations where the goods or services are provided by
515	a sole source or are deemed an emergency purchase; the services
516	are exempted from competitive solicitation requirements under s.
517	287.057(3)(f); or the procurement of services is subject to s.
518	627.3513. Justification for the sole-sourcing or emergency
519	procurement must be documented. Contracts for goods or services
520	valued at or over $100,000 are subject to approval by the board.
521	Section 8.  This act shall take effect July 1, 2011.

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