Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. SPB 7096
       
       
       
       
       
       
                                Barcode 280090                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: FAV            .                                
                  04/01/2011           .                                
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       The Committee on Budget (Alexander) recommended the following:
       
    1         Senate Amendment to Amendment (405496) 
    2  
    3         Delete lines 38 - 215
    4  and insert:
    5         (2) For the 2012 plan year and for each plan year
    6  thereafter, the department shall establish a single health
    7  insurance risk pool for each of the following groups
    8  participating in the state group insurance plans:
    9         (a) Active employees;
   10         (b) Retirees not eligible for Medicare; and
   11         (c) Retirees eligible for Medicare.
   12  
   13  Contribution determinations made pursuant to s. 110.123(5)(a)
   14  shall consider relative plan values; however, such
   15  determinations may encourage enrollment in consumer-directed
   16  plans.
   17         Section 4. Subsections (1), (2), and (3) of section
   18  110.12315, Florida Statutes, are amended to read:
   19         110.12315 Prescription drug program.—The state employees’
   20  prescription drug program is established. This program shall be
   21  administered by the Department of Management Services, according
   22  to the terms and conditions of the plan as established by the
   23  relevant provisions of the annual General Appropriations Act and
   24  implementing legislation, subject to the following conditions:
   25         (1) The Department of Management Services shall allow
   26  prescriptions written by health care providers under the plan to
   27  be filled by any licensed pharmacy pursuant to contractual
   28  claims-processing provisions. Nothing in This section does not
   29  prohibit may be construed as prohibiting a mail order
   30  prescription drug program distinct from the service provided by
   31  retail pharmacies.
   32         (2) In providing for reimbursement of pharmacies for
   33  prescription medicines dispensed to members of the state group
   34  health insurance plan and their dependents under the state
   35  employees’ prescription drug program:
   36         (a) Retail pharmacies participating in the program must be
   37  reimbursed at a uniform rate and subject to uniform conditions,
   38  according to applicable network agreements and the terms and
   39  conditions of the plan.
   40         (b) There shall be a 30-day supply limit for prescription
   41  card purchases and 90-day supply limit for mail order or mail
   42  order prescription drug purchases. The Department of Management
   43  Services may implement a 90-day supply limit program at select
   44  retail pharmacies if the department finds that it is in the best
   45  financial interest of the program.
   46         (c) The current pharmacy dispensing fee shall be negotiated
   47  in accordance with best industry practices remains in effect.
   48         (3) The Department of Management Services shall establish
   49  the reimbursement schedule for prescription pharmaceuticals
   50  dispensed under the program. Reimbursement rates for a
   51  prescription pharmaceutical must be based on the cost of the
   52  generic equivalent drug if a generic equivalent exists, unless
   53  the physician prescribing the pharmaceutical clearly states on
   54  the prescription that the brand name drug is medically necessary
   55  or that the drug product is included on the formulary of drug
   56  products that may not be interchanged as provided in chapter
   57  465, in which case reimbursement must be based on the cost of
   58  the brand name drug as specified in the reimbursement schedule
   59  adopted by the Department of Management Services.
   60  Notwithstanding the any other provision of this subsection, the
   61  department may require that a generic or formulary brand
   62  prescription be filled before dispensing an alternative within
   63  any therapeutic class.
   64         Section 5. Subsection (1) of section 112.0801, Florida
   65  Statutes, is amended to read:
   66         112.0801 Group insurance; participation by retired
   67  employees.—
   68         (1) Any state agency, county, municipality, special
   69  district, community college, or district school board which
   70  provides life, health, accident, hospitalization, or annuity
   71  insurance, or all of any kinds of such insurance, for its
   72  officers and employees and their dependents upon a group
   73  insurance plan or self-insurance plan shall allow all former
   74  personnel who have retired prior to October 1, 1987, as well as
   75  those who retire on or after such date, and their eligible
   76  dependents, the option of continuing to participate in such
   77  group insurance plan or self-insurance plan. Retirees and their
   78  eligible dependents shall be offered the same health and
   79  hospitalization insurance coverage as is offered to active
   80  employees at a premium cost of no more than the premium cost
   81  applicable to active employees. For the retired employees and
   82  their eligible dependents, the cost of any such continued
   83  participation in any type of plan or any of the cost thereof may
   84  be paid by the employer or by the retired employees. To
   85  determine health and hospitalization plan costs, the employer
   86  shall commingle the claims experience of the retiree group with
   87  the claims experience of the active employees; and, for other
   88  types of coverage, the employer may commingle the claims
   89  experience of the retiree group with the claims experience of
   90  active employees. Retirees covered under Medicare may be
   91  experience-rated separately from the retirees not covered by
   92  Medicare and from active employees, provided that the total
   93  premium does not exceed that of the active group and coverage is
   94  basically the same as for the active group.
   95         Section 6. (1) For the period July 1, 2011, through
   96  December 31, 2012, the Department of Management Services shall
   97  administer the plans and benefits provided under the state group
   98  insurance program consistent with the following parameters:
   99         (a) The state group insurance program shall include a
  100  health insurance standard plan, a state group health insurance
  101  high-deductible plan, a state-contracted health maintenance
  102  organization standard plan, and a state-contracted health
  103  maintenance organization high-deductible plan. Beginning January
  104  1, 2012, the health insurance portion of the state group
  105  insurance program shall be self-insured for active employees and
  106  retirees not eligible for Medicare, and may be self-insured for
  107  retirees eligible for Medicare.
  108         (b) The benefits provided under each of the plans shall be
  109  those benefits as provided in the current State Employees’ PPO
  110  Plan Group Health Insurance Plan Booklet and Benefit Document,
  111  current health maintenance organization contracts, and other
  112  health insurance benefits that are approved by the Legislature.
  113         (c) The high-deductible plans shall continue to include an
  114  integrated health savings account. Such plans and accounts shall
  115  be administered in accordance with the requirements and
  116  limitations of federal provisions relating to the Medicare
  117  Prescription Drug, Improvement, and Modernization Act of 2003.
  118  The state shall make a monthly contribution to an employee’s
  119  health savings account to the extent authorized in s.
  120  110.123(12), Florida Statutes.
  121         (2)For the 2012 plan year and each plan year thereafter,
  122  the Department of Management Services shall develop a program of
  123  health insurance options and enrollee contribution requirements
  124  consistent with s. 110.123(5), Florida Statutes. Options shall
  125  encourage and promote enrollee health plan choices and positive
  126  behavior to promote the health and well-being of health plan
  127  members and to encourage appropriate plan utilization. The
  128  division shall determine the level of premiums necessary to
  129  fully fund the state group health insurance program for the next
  130  fiscal year. The Legislature shall provide in the General
  131  Appropriations Act a premium schedule.
  132         Section 7. The premiums charged under the state group
  133  insurance program for health insurance authorized in s. 110.123,
  134  Florida Statutes, shall be as follows:
  135         (1) STATE CONTRIBUTION.—
  136         (a) Effective July 1, 2011, for the coverage period
  137  beginning August 1, 2011, the state contribution toward the cost
  138  of any plan in the state group health insurance program which is
  139  paid by the executive, legislative, and judicial branches on
  140  behalf of participating employees, shall be, for individual
  141  coverage, the total actuarial cost for the lowest cost plan
  142  offered by the department for individual coverage and shall be,
  143  for family coverage, the total actuarial cost for the lowest
  144  cost plan offered by the department for family coverage, less
  145  the employee contribution in paragraphs (2)(a) and (b).
  146         (b) Effective July 1, 2011, for the coverage period
  147  beginning August 1, 2011, the state contribution toward the cost
  148  of any plan in the state group health insurance program which is
  149  paid by the executive, legislative, and judicial branches on
  150  behalf of each employee enrolled in the spouse program shall be
  151  one-half the total actuarial cost for the lowest cost plan
  152  offered by the department for family coverage, less the employee
  153  contribution in paragraphs (2)(a) and (b).
  154         (2) EMPLOYEE CONTRIBUTION.—
  155         (a) For employees not participating in the spouse program,
  156  effective July 1, 2011, for the coverage period beginning August
  157  1, 2011, the employee contribution toward the cost of a standard
  158  plan in the state group health insurance program shall be $50
  159  per month for individual coverage, and $200 per month for family
  160  coverage, plus the difference between the cost of the lowest
  161  cost plan and the cost of the plan selected.
  162         (b)For employees participating in the spouse program in
  163  accordance with section 60P-2.0036, Florida Administrative Code,
  164  effective July 1, 2011, for the coverage period beginning August
  165  1, 2011, the employee contribution toward the cost of a standard
  166  plan in the state group health insurance program shall be $100
  167  per month for family coverage, plus the difference between the
  168  cost of the lowest cost plan and the cost of the plan selected.