Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. SB 1844
       
       
       
       
       
       
                                Barcode 806166                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/17/2013           .                                
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       Appropriations Subcommittee on Health and Human Services (Bean)
       recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraphs (a), (b), (e), and (f) of subsection
    6  (4) and paragraph (b) of subsection (7) of section 408.910,
    7  Florida Statutes, are amended, and paragraph (c) is added to
    8  subsection (10) of that section, to read
    9         408.910 Florida Health Choices Program.—
   10         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
   11  program is voluntary and shall be available to employers,
   12  individuals, vendors, and health insurance agents as specified
   13  in this subsection.
   14         (a) Employers eligible to enroll in the program include
   15  those employers:
   16         1. Employers that meet criteria established by the
   17  corporation and elect to make their employees eligible through
   18  the program.
   19         2. Fiscally constrained counties described in s. 218.67.
   20         3. Municipalities having populations of fewer than 50,000
   21  residents.
   22         4. School districts in fiscally constrained counties.
   23         5. Statutory rural hospitals.
   24         (b) Individuals eligible to participate in the program
   25  include:
   26         1. Individual employees of enrolled employers.
   27         2. Other individuals that meet criteria established by the
   28  corporation State employees not eligible for state employee
   29  health benefits.
   30         3. State retirees.
   31         4. Medicaid participants who opt out.
   32         (e) Eligible individuals may participate in the program
   33  voluntarily continue participation in the program regardless of
   34  subsequent changes in job status or Medicaid eligibility.
   35  Individuals who join the program may participate by complying
   36  with the procedures established by the corporation. These
   37  procedures must include, but are not limited to:
   38         1. Submission of required information.
   39         2. Authorization for payroll deduction.
   40         3. Compliance with federal tax requirements.
   41         4. Arrangements for payment in the event of job changes.
   42         5. Selection of products and services.
   43         (f) Vendors who choose to participate in the program may
   44  enroll by complying with the procedures established by the
   45  corporation. These procedures may include, but are not limited
   46  to:
   47         1. Submission of required information, including a complete
   48  description of the coverage, services, provider network, payment
   49  restrictions, and other requirements of each product offered
   50  through the program.
   51         2. Execution of an agreement to comply with requirements
   52  established by the corporation.
   53         3. Execution of an agreement that prohibits refusal to sell
   54  any offered non-risk-bearing product or service to a participant
   55  who elects to buy it.
   56         4. Establishment of product prices based on applicable
   57  criteria age, gender, and location of the individual
   58  participant, which may include medical underwriting.
   59         5. Arrangements for receiving payment for enrolled
   60  participants.
   61         6. Participation in ongoing reporting processes established
   62  by the corporation.
   63         7. Compliance with grievance procedures established by the
   64  corporation.
   65         (7) THE MARKETPLACE PROCESS.—The program shall provide a
   66  single, centralized market for purchase of health insurance,
   67  health maintenance contracts, and other health products and
   68  services. Purchases may be made by participating individuals
   69  over the Internet or through the services of a participating
   70  health insurance agent. Information about each product and
   71  service available through the program shall be made available
   72  through printed material and an interactive Internet website. A
   73  participant needing personal assistance to select products and
   74  services shall be referred to a participating agent in his or
   75  her area.
   76         (b) Initial selection of products and services must be made
   77  by an individual participant within the applicable open
   78  enrollment period 60 days after the date the individual’s
   79  employer qualified for participation. An individual who fails to
   80  enroll in products and services by the end of this period is
   81  limited to participation in flexible spending account services
   82  until the next annual enrollment period.
   83         (10) EXEMPTIONS.—
   84         (c) Any standard forms, website design, or marketing
   85  communication developed by the corporation and used by the
   86  corporation, or any vendor that meets the requirements of s.
   87  408.910(4)(f) is not subject to the Florida Insurance Code, as
   88  established in s. 624.01.
   89         Section 2. Section 408.9105, Florida Statutes, is created
   90  to read:
   91         408.9105Health Choice Plus Program.—
   92         (1) LEGISLATIVE INTENT.—The Legislature recognizes that
   93  there are more than 600,000 uninsured residents in this state
   94  who have incomes at or below 100 percent of the federal poverty
   95  level. Many insurance options are not affordable, and the
   96  Legislature intends to provide a benefit program to those
   97  individuals who seek assistance with coverage and who assume
   98  individual responsibility for their own health care needs. It is
   99  therefore the intent of the Legislature to expand the services
  100  provided by the Florida Health Choices Program and begin the
  101  phase-in of the Health Choice Plus Program starting July 1,
  102  2013. The Health Choice Plus Program shall:
  103         (a) Use the existing infrastructure and governance of
  104  Florida Health Choices, Inc., to manage the program described in
  105  this section.
  106         (b) Offer goods and services to individuals who are between
  107  19 to 64 years of age, inclusive.
  108         (c) Establish guidelines for financial participation in the
  109  program which allow for enrollees and others to contribute
  110  toward a health benefits account.
  111         1. An enrollee shall contribute at least $20 per month
  112  toward the health benefits account. This contribution amount may
  113  be adjusted annually in the General Appropriations Act.
  114         2. The level of benefit paid into an enrollee’s account
  115  using state funds is determined by the corporation based upon
  116  the availability of state, local, and federal funds. The amount
  117  may not exceed $10 per individual per month. This amount may be
  118  adjusted annually in the General Appropriations Act.
  119         (d) Implement an employer-based contribution option.
  120         (e) Develop and maintain an education and public outreach
  121  campaign for the Health Choice Plus Program.
  122         (f) Provide a secure website to facilitate the purchase of
  123  goods and services and to provide public information about the
  124  program. The website must also provide information about the
  125  availability of insurance affordability programs targeted at
  126  this population.
  127         (g) Establish an incentive program that rewards enrollees
  128  for achievements in reaching healthy living goals.
  129         (2) DEFINITIONS.—As used in this section, the term:
  130         (a) “CHIP” means Children’s Health Insurance Program as
  131  authorized under Title XXI of the Social Security Act.
  132         (b) “Corporation” means Florida Health Choices, Inc., as
  133  established under s. 408.910.
  134         (c) “Corporation’s marketplace” means the single,
  135  centralized market established by the corporation which
  136  facilitates the purchase of products made available in the
  137  marketplace.
  138         (d) “Enrollee” means an individual who participates in or
  139  receives benefits under the Health Choice Plus Program.
  140         (e) “Goods and services” means the individual products
  141  offered for sale to an enrollee on the corporation’s marketplace
  142  or other health care-related items that may be purchased by an
  143  enrollee in the private market. An enrollee may purchase these
  144  products using funds accumulated in his or her health benefits
  145  account.
  146         (f) “Health benefits account” means the account established
  147  for an enrollee at the corporation into which funds may be
  148  deposited by the state, the enrollee, other individuals, or
  149  organizations for the purchase of health care goods and services
  150  on the enrollee’s behalf.
  151         (g) “Lawful permanent resident” means a non-United States
  152  citizen who resides in the United States under legally
  153  recognized and lawfully recorded permanent residence as an
  154  immigrant. This individual may also be known as a permanent
  155  resident alien.
  156         (h) “Parent” or “caretaker relative” means an individual
  157  who is a relative that has primary custody or legal guardianship
  158  of a dependent child and provides the primary care and
  159  supervision of that dependent child in the same household. A
  160  caretaker relative must be related to the dependent child by
  161  blood, marriage, or adoption within the fifth degree of kinship.
  162         (i) “Patient Protection and Affordable Care Act” or “PPACA”
  163  means the federal law enacted as Pub. L. No. 111-148, as further
  164  amended by the federal Health Care and Education Reconciliation
  165  Act of 2010, Pub. L. No. 111-152, and any amendments.
  166         (j) “Program” means the Health Choice Plus Program
  167  established under this section.
  168         (k) “Vendor” means an entity that meets the requirements
  169  under s. 408.910(4)(d) and is accepted by the corporation.
  170         (3) ELIGIBILITY.—
  171         (a) To be eligible for the Health Choice Plus Program, an
  172  individual must be a resident of this state and meet all of the
  173  following criteria:
  174         1. Be between 19 and 64 years of age, inclusive.
  175         2. Have a modified adjusted gross income that does not
  176  exceed 100 percent of the federal poverty level based on the
  177  individual’s most recent federal tax return, or if the
  178  individual did not file a tax return, the individual’s most
  179  recent monthly income.
  180         3. Be a United States citizen or a lawful permanent
  181  resident.
  182         4. Be ineligible for Medicaid.
  183         5. Be ineligible for employer-sponsored insurance coverage.
  184  If the enrollee is eligible for employer-sponsored coverage but
  185  the cost of that coverage for the enrollee’s share for
  186  individual coverage would exceed 5 percent of the enrollee’s
  187  total modified adjusted gross household income or the enrollee’s
  188  share of family coverage would exceed 5 percent of enrollee’s
  189  total modified adjusted gross household income, the enrollee is
  190  not considered eligible for employer-sponsored coverage for
  191  purposes of this section.
  192         6. Not be enrolled in other coverage that meets the
  193  definition of essential benefits coverage under PPACA.
  194         (b) In addition to the requirements in paragraph (a), an
  195  enrollee must meet the following categorical requirements in
  196  order to maintain enrollment in the program:
  197         1. For an enrollee who is also a parent or a caretaker
  198  relative, the enrollee must do all of the following:
  199         a. Maintain enrollment in Medicaid or CHIP for any
  200  dependent child in the household who is eligible for Medicaid or
  201  CHIP and who must be enrolled in Medicaid or CHIP throughout the
  202  enrollee’s participation in the Health Choice Plus Program.
  203         b. Complete a health assessment within the first 3 months
  204  after enrollment at a county health department, federally
  205  qualified health center, or other approved health care provider.
  206         c. Schedule and keep at least one preventive visit with a
  207  primary care provider within 6 months after enrollment and
  208  repeat the preventive visit at least once every 18 months
  209  thereafter.
  210         d. Provide proof of employment for at least 20 hours a week
  211  or proof of efforts made to seek employment. In lieu of
  212  employment, the enrollee may provide proof of volunteering for
  213  at least 10 hours a month at a school or at a nonprofit
  214  organization or enrollment as a full-time student at an
  215  accredited educational institution. Exceptions to this
  216  requirement may be made on a case-by-case basis for medical
  217  conditions for an enrollee or if the enrollee is the primary
  218  caretaker for a family member who has a chronic and severe
  219  medical condition that requires a minimum of 40 hours a week of
  220  care.
  221         2. For an enrollee who is also a childless adult, the
  222  enrollee must do all of the following:
  223         a. Provide proof of employment for at least 20 hours a week
  224  or proof of efforts made to seek employment. In lieu of
  225  employment, the enrollee may provide proof of volunteering for
  226  at least 20 hours a month at a school or at a nonprofit
  227  organization or enrollment as a full-time student at an
  228  accredited educational institution. Exceptions to this
  229  requirement may be made on a case-by-case basis for medical
  230  conditions for the enrollee or if the enrollee is the primary
  231  caretaker for a family member who has a chronic and severe
  232  medical condition that requires a minimum of 40 hours a week of
  233  care.
  234         b. Complete a health assessment within the first 3 months
  235  after enrollment at a county health department, federally
  236  qualified health center, or other approved health care provider.
  237         c. Schedule and keep at least one preventive visit with a
  238  primary care provider within the first 6 months after enrollment
  239  and repeat the preventive visit at least once every 18 months
  240  thereafter.
  241  
  242  If the enrollee fails to meet the requirements specified in this
  243  subsection, the enrollee is disenrolled from the program at the
  244  end of the month in which the enrollee fails to meet the
  245  requirements. The enrollee may receive one 30-day extension to
  246  comply before cancellation of coverage. If an enrollee’s
  247  coverage is canceled, the enrollee may not reapply for coverage
  248  until the next open enrollment period or 90 days after
  249  cancellation of coverage occurs, whichever occurs later. The
  250  individual’s reenrollment is subject to available funding.
  251         (4) ENROLLMENT.—
  252         (a) Enrollment in the Health Choice Plus Program may occur
  253  through the portal of the Florida Health Choices Program, a
  254  referral process from the Department of Children and Families,
  255  the Florida Healthy Kids Corporation, or the exchange as defined
  256  by the federal Patient Protection and Affordable Care Act.
  257         (b) Subject to available funding, the corporation shall
  258  establish at least one open enrollment period each year. When
  259  the program is full based on available funding, enrollment must
  260  cease.
  261         (c) Eligibility is determined by using electronic means to
  262  the fullest extent practicable before requesting any written
  263  documentation from an applicant.
  264         (5) HEALTH BENEFITS ACCOUNT.—
  265         (a) A health benefits account is established for each
  266  enrollee upon confirmation of eligibility in the program. The
  267  corporation shall determine the deposit amount and frequency of
  268  deposits based on the availability of funds, the number of
  269  enrollees, and other factors.
  270         (b) An enrollee shall make a financial contribution toward
  271  his or her own health benefits account in order to maintain
  272  enrollment in accordance with paragraph (1)(c).
  273         1. The corporation shall establish disenrollment criteria
  274  for failure to pay the required minimum contribution.
  275         2. The disenrollment criteria must include waiting periods
  276  of not more than 1 month before reinstatement to the program if
  277  the enrollee is still eligible and has paid all required
  278  financial obligations.
  279         3. The enrollee’s employer may contribute toward an
  280  employee’s health benefits account under the program, including
  281  making the enrollee’s required contribution, in whole or in
  282  part, to the enrollee’s health benefits account at any time.
  283         (c) Subject to appropriations available for this specific
  284  purpose, the corporation shall establish a procedure for the
  285  deposit of supplemental or bonus funds into an enrollee’s health
  286  benefits account if certain healthy living performance goals are
  287  achieved. These goals must be established no later than July 1
  288  in each fiscal year and distributed to all enrollees, published
  289  on the corporation’s website, and distributed to new enrollees
  290  within 30 calendar days after enrollment. For the 2014 calendar
  291  year, the goals must be established no later than October 1,
  292  2013.
  293         1. An enrollee may use funds deposited in a health benefits
  294  account to offset other health care costs or to purchase other
  295  products and services offered by the marketplace, subject to
  296  guidelines established by the corporation and in accordance with
  297  federal law.
  298         2. Bonus funds may accumulate in the enrollee’s health
  299  benefits account for the duration of the program and must
  300  automatically expire and return to the corporation upon the
  301  termination of the program.
  302         (d) The marketplace is encouraged to use existing community
  303  programs and partnerships to deliver services and to include
  304  traditional safety net providers for the delivery of services to
  305  enrollees, including, but not limited to, rural health clinics,
  306  federally qualified health centers, county health departments,
  307  emergency room diversion programs, and community mental health
  308  centers. A health care entity that receives state funding must
  309  participate in the Health Choice Plus Program and offer services
  310  or products through the marketplace or to enrollees, as
  311  appropriate. An enrollee may be required to make nominal
  312  copayments to providers for nonpreventive services. The
  313  corporation may establish the amount of the copayments when
  314  applicable.
  315         (e) Except for supplemental funds described under paragraph
  316  (c), funds deposited in a health benefits account belong to the
  317  enrollee when deposited and are available for health-care
  318  related expenditures, including, but not limited to, physician’s
  319  fees, hospital costs, prescriptions, insurance premium payments,
  320  copayments, and coinsurance. The corporation shall establish a
  321  process or contract with another entity for the management of
  322  the funds. The process must ensure the timely distribution and
  323  the appropriate expenditure of the state’s contributions.
  324         (f) The corporation shall establish a refund process for an
  325  enrollee who requests the closure of a health benefits account
  326  and the return of any unspent individual contributions. The
  327  enrollee may be refunded only those funds that the enrollee or
  328  employer has contributed to his or her health benefits account.
  329  All other state funds in the enrollee’s health benefits account
  330  revert to the corporation.
  331         (6) FUNDING.—
  332         (a) The corporation may accept funds from an employer to
  333  deposit into an enrollee’s health benefits account to supplement
  334  funds if such a deposit is not in conflict with other provisions
  335  of this section.
  336         (b) The corporation may accept state and federal funds to
  337  further subsidize the costs of coverage and to administer the
  338  program.
  339         (c) The corporation shall seek other grants and donations
  340  to support the program.
  341         (d) An assessment on vendors that participate in the
  342  marketplace may be used to fund the administration of the
  343  program.
  344         (7) SERVICES.—The corporation shall manage the health
  345  benefits accounts and provide a marketplace of options from
  346  which an enrollee may also use his or her health benefits
  347  account to purchase individual services and products, including,
  348  but not limited to, discount medical plans, limited benefit
  349  plans, health flex plans, individual health insurance plans,
  350  prepaid health clinic plans, bundled services, or other prepaid
  351  health care coverage.
  352         (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.—
  353         (a) To the extent that funds are made available for this
  354  purpose, an enrollee is rewarded for achieving a healthy
  355  lifestyle and using preventive health care services
  356  appropriately.
  357         (b) The program shall post on its website, by July 1 of
  358  each fiscal year, a list of optional healthy living performance
  359  goals and the proposed incentives for achievement of each goal.
  360  The corporation shall establish a procedure for the
  361  documentation of such goals, timeframes for achievement of the
  362  optional goals, and the payment of supplemental amounts into an
  363  enrollee’s health benefits account, subject to available
  364  funding.
  365         (c) Bonus payments for achieving a healthy living
  366  performance goal shall be paid into an enrollee’s health
  367  benefits account at the end of the quarter in which the goal is
  368  achieved. The amount of the payment is based upon the schedule
  369  posted by the program on July 1 of that fiscal year.
  370         (9) LIABILITY.—Coverage under the Health Choice Plus
  371  Program is not an entitlement, and a cause of action does not
  372  arise against the state, a local governmental entity, any other
  373  political subdivision of the state, or the corporation or its
  374  board of directors for failure to make coverage under this
  375  section available to an eligible person or for discontinuation
  376  of any coverage.
  377         (10)PROGRAM EVALUATION.—The corporation shall include
  378  information about the Health Choice Plus Program in its annual
  379  report under s. 408.910. The corporation shall complete and
  380  submit by January 1, 2016, a separate independent evaluation of
  381  the effectiveness of the Health Choice Plus Program to the
  382  Governor, the President of the Senate, and the Speaker of the
  383  House of Representatives.
  384         (11) PROGRAM REVIEW.—The Health Choice Plus Program is
  385  subject to repeal on July 1, 2016, unless reviewed and saved
  386  from repeal through reenactment by the Legislature.
  387         Section 3. The sum of $15,275,000 from the General Revenue
  388  Fund is appropriated to the Agency for Health Care
  389  Administration beginning in the 2013-2014 fiscal year to provide
  390  funding for the Health Choice Plus Program within Florida Health
  391  Choices, Inc., and to fund the corporation’s administrative
  392  costs necessary for implementing and operating the program.
  393         Section 4. This act shall take effect July 1, 2013.
  394  
  395  ================= T I T L E  A M E N D M E N T ================
  396         And the title is amended as follows:
  397         Delete everything before the enacting clause
  398  and insert:
  399                        A bill to be entitled                      
  400         An act relating to the Health Choice Plus Program;
  401         amending s. 408.910, F.S.; conforming provisions to
  402         changes made by the act; providing that the Florida
  403         Insurance Code is not applicable in certain
  404         circumstances; creating s. 408.9105, F.S.; creating
  405         the Health Choice Plus Program; providing legislative
  406         intent; providing requirements of the program;
  407         providing definitions; providing eligibility
  408         requirements; providing for enrollment in the program;
  409         providing requirements and procedures for the deposit
  410         and use of funds in a health benefits account;
  411         providing that the marketplace is encouraged to use
  412         existing community programs and partnerships to
  413         deliver services and to include traditional safety net
  414         providers for the delivery of services to enrollees;
  415         requiring Florida Health Choices, Inc., to establish a
  416         refund process; authorizing the corporation to accept
  417         funds from various sources to deposit into health
  418         benefits accounts, subsidize the costs of coverage,
  419         and administer and support the program; requiring the
  420         corporation to manage the health benefits accounts and
  421         provide the marketplace of options which an enrollee
  422         in the program may use; providing for payment for
  423         achieving healthy living performance goals; requiring
  424         the program to post on its website a list of optional
  425         healthy living performance goals and to establish a
  426         procedure for documentation, achievement, and payment
  427         regarding the healthy living performance goals;
  428         providing that coverage under the program is not an
  429         entitlement; prohibiting a cause of action against
  430         certain entities under certain circumstances;
  431         requiring the corporation to submit to the Governor
  432         and the Legislature information about the program in
  433         its annual report and an evaluation of the
  434         effectiveness of the program; providing for a program
  435         review and repeal date; providing an appropriation;
  436         providing an effective date.