Florida Senate - 2013                                    SB 1844
       
       
       
       By the Committee on Health Policy
       
       
       
       
       588-03428-13                                          20131844__
    1                        A bill to be entitled                      
    2         An act relating to the Health Choice Plus Program;
    3         amending s. 408.910, F.S.; conforming provisions to
    4         changes made by the act; creating s. 408.9105, F.S.;
    5         creating the Health Choice Plus Program; providing
    6         legislative intent; providing definitions; providing
    7         eligibility requirements; providing exceptions in
    8         specific situations; providing for enrollment in the
    9         program; providing for disenrollment in specific
   10         situations; providing for reenrollment in specific
   11         situations; providing requirements and procedures for
   12         use of funds in a health benefits account; authorizing
   13         the Florida Health Choices, Inc., to accept funds from
   14         various sources to deposit into health benefits
   15         accounts, subsidize the costs of coverage, and
   16         administer and support the program; requiring the
   17         corporation to manage the health benefits accounts and
   18         provide the marketplace of options that an enrollee in
   19         the program may use; providing for payment for
   20         achieving health living performance goals; providing
   21         that the Florida Insurance Code is not applicable to
   22         the program; providing that coverage under the program
   23         is not an entitlement; prohibiting a cause of action
   24         against certain entities under certain circumstances;
   25         requiring the corporation to submit to the Governor
   26         and the Legislature information about the program in
   27         its annual report and an evaluation of the
   28         effectiveness of the program; providing for a program
   29         review and repeal date; providing an effective date.
   30  
   31  Be It Enacted by the Legislature of the State of Florida:
   32  
   33         Section 1. Subsection (1) of section 408.910, Florida
   34  Statutes, is amended to read:
   35         408.910 Florida Health Choices Program.—
   36         (1) LEGISLATIVE INTENT.—The Legislature finds that a
   37  significant number of the residents of this state do not have
   38  adequate access to affordable, quality health care. The
   39  Legislature further finds that increasing access to affordable,
   40  quality health care can be best accomplished by establishing a
   41  competitive markets market for purchasing health insurance and
   42  health services. It is therefore the intent of the Legislature
   43  to create the Florida Health Choices Program and the Health
   44  Choice Plus Program to:
   45         (a) Expand opportunities for Floridians to purchase
   46  affordable health insurance and health services.
   47         (b) Preserve the benefits of employment-sponsored insurance
   48  while easing the administrative burden for employers who offer
   49  these benefits.
   50         (c) Enable individual choice in both the manner and amount
   51  of health care purchased.
   52         (d) Provide for the purchase of individual, portable health
   53  care coverage.
   54         (e) Disseminate information to consumers on the price and
   55  quality of health services.
   56         (f) Sponsor a competitive markets market that stimulate
   57  stimulates product innovation, quality improvement, and
   58  efficiency in the production and delivery of health services.
   59         Section 2. Section 408.9105, Florida Statutes, is created
   60  to read:
   61         408.9105Health Choice Plus Program.—
   62         (1) LEGISLATIVE INTENT.—The Legislature recognizes that
   63  there are more than 600,000 uninsured residents in this state
   64  who have incomes at or below 100 percent of the federal poverty
   65  level. Many insurance options are not affordable, and the
   66  Legislature intends to provide a benefit program to those
   67  individuals who seek assistance with coverage and who assume
   68  individual responsibility for their own health care needs. It is
   69  therefore the intent of the Legislature to expand the services
   70  provided by the Florida Health Choices Program and begin the
   71  phase-in of the Health Choice Plus Program starting July 1,
   72  2013. The Health Choice Plus Program must:
   73         (a) Use the existing Florida Health Choices Corporation’s
   74  infrastructure and governance to manage the program described in
   75  this section.
   76         (b) Offer goods and services to individuals who are between
   77  19 to 64 years of age, inclusive.
   78         (c) Establish guidelines for financial participation in the
   79  program which allows for enrollees and others to contribute
   80  toward a health benefits account.
   81         1. An enrollee shall contribute at least $20 per month
   82  toward the health benefits account. This amount may be adjusted
   83  annually in the General Appropriations Act.
   84         2. The level of benefit paid into an enrollee’s account
   85  using state funds is to be determined by the corporation based
   86  upon the availability of state, local, and federal funding. The
   87  amount may not exceed $10 per individual per month. This amount
   88  may be adjusted annually in the General Appropriations Act.
   89         (d) Implement an employer-based contribution option.
   90         (e) Develop and maintain an education and public outreach
   91  campaign for the Health Choice Plus Program.
   92         (f) Provide a secure website to facilitate the purchase of
   93  goods and services and to provide public information about the
   94  program. The website must also provide information about the
   95  availability of insurance affordability programs targeted at
   96  this population.
   97         (g) Establish an incentive program that rewards enrollees
   98  for achievements in reaching healthy living goals.
   99         (2) DEFINITIONS.—For the Health Choice Plus Program, the
  100  following terms are applicable:
  101         (a) “CHIP” means Children’s Health Insurance Program as
  102  authorized under Title XXI of the Social Security Act.
  103         (b) “Corporation” means Florida Health Choices, Inc., as
  104  established under s. 408.910.
  105         (c) “Corporation’s marketplace” means the single,
  106  centralized market established by the corporation which
  107  facilitates the purchase of products made available in the
  108  marketplace.
  109         (d) “Enrollee” means an individual who participates in or
  110  receives benefits under the Health Choice Plus Program.
  111         (e) “Program” means the Health Choice Plus Program
  112  established under this section.
  113         (f) ”Vendor” means an entity that meets the requirements
  114  under s. 408.910(4)(d) and is accepted by the corporation.
  115         (g) “Health benefits account” means the account established
  116  for an enrollee at the corporation into which funds may be
  117  deposited by the state, the enrollee, other individuals, or
  118  organizations for the purchase of health care goods and services
  119  on the enrollee’s behalf.
  120         (h) “Parent” or “caretaker relative” means an individual
  121  who is a relative that has primary custody or legal guardianship
  122  of a dependent child and provides the primary care and
  123  supervision to that dependent child in the same household. A
  124  caretaker relative must be related to the dependent child by
  125  blood, marriage, or adoption within the fifth degree of kinship.
  126         (i) ”Goods and services” means the individual products
  127  offered for sale to an enrollee on the corporation’s marketplace
  128  or other health care-related items that may be purchased by an
  129  enrollee in the private market. An enrollee may purchase these
  130  products using funds accumulated in his or her health benefits
  131  account.
  132         (j) “Lawful permanent resident” means a non-United States
  133  citizen who resides in the United States under legally
  134  recognized and lawfully recorded permanent residence as an
  135  immigrant. This individual may also be known as a permanent
  136  resident alien.
  137         (k) “Patient Protection and Affordable Care Act” or “PPACA”
  138  means the federal law enacted as Pub. L. No. 111-148, as further
  139  amended by the federal Health Care and Education Reconciliation
  140  Act of 2010, Pub. L. No. 111-152, and any amendments.
  141         (3) ELIGIBILITY.—
  142         (a) To be eligible for the Health Choice Plus Program, an
  143  individual must be a resident of this state and meet all of the
  144  following criteria:
  145         1. Be between 19 and 64 years of age, inclusive.
  146         2. Have a modified adjusted gross income that does not
  147  exceed 100 percent of the federal poverty level based on the
  148  individual’s most recent federal tax return, or if the
  149  individual did not file a tax return, the individual’s most
  150  recent monthly income.
  151         3. Be a United States citizen or a lawful permanent
  152  resident.
  153         4. Not be eligible for Medicaid.
  154         5. Not be eligible for employer-sponsored insurance
  155  coverage. If the enrollee is eligible for employer-sponsored
  156  coverage but the cost of that coverage for the enrollee’s share
  157  for individual coverage would exceed 5 percent of the enrollee’s
  158  total modified adjusted gross household income or the enrollee’s
  159  share of family coverage would exceed 5 percent of enrollee’s
  160  total modified adjusted gross household income, the enrollee is
  161  not eligible for employer-sponsored coverage under this section.
  162         6. Not be enrolled in other coverage that meets the
  163  definition of essential benefits coverage under PPACA.
  164         (b) In addition to the requirements in paragraph (a), an
  165  enrollee must meet the following categorical requirements in
  166  order to maintain enrollment in the program:
  167         1. For an enrollee who is also a parent or a caretaker
  168  relative, the enrollee must do all of the following:
  169         a. Maintain enrollment in Medicaid or CHIP for any
  170  dependent child in the household who is eligible for Medicaid or
  171  CHIP and who must be enrolled in Medicaid or CHIP throughout the
  172  enrollee’s participation in the Health Choice Plus program.
  173         b. Complete a health assessment within the first 3 months
  174  after enrollment at a county health department, federally
  175  qualified health center, or other approved health care provider.
  176         c. Schedule and keep at least one preventive visit with a
  177  primary care provider within 6 months after enrollment and
  178  repeat the preventive visit at least once every 18 months
  179  thereafter.
  180         d. Provide proof of employment for at least 20 hours a week
  181  or of efforts made to seek employment. In lieu of employment,
  182  the enrollee may provide proof of volunteering for at least 10
  183  hours a month at a school or at a nonprofit organization or
  184  enrollment as a full-time student at an accredited educational
  185  institution. Exceptions to this requirement may be made on a
  186  case-by-case basis for medical conditions for the enrollee or if
  187  the enrollee is the primary caretaker for a family member who
  188  has a chronic and severe medical condition that requires a
  189  minimum of 40 hours a week of care.
  190         2. For an enrollee who is also a childless adult, the
  191  enrollee must do all of the following:
  192         a. Provide proof of employment for at least 20 hours a week
  193  or of efforts made to seek employment. In lieu of employment,
  194  the enrollee may provide proof of volunteering for at least 20
  195  hours a month at a school or at a nonprofit organization or
  196  enrollment as a full-time student at an accredited educational
  197  institution. Exceptions to this requirement may be made on a
  198  case-by-case basis for medical conditions for the enrollee or if
  199  the enrollee is the primary caretaker for a family member who
  200  has a chronic and severe medical condition that requires a
  201  minimum of 40 hours a week of care.
  202         b. Complete a health assessment within the first 3 months
  203  after enrollment at a county health department, federally
  204  qualified health center, or other approved health care provider;
  205         c. Schedule and keep at least one preventive visit with a
  206  primary care provider within the first 6 months after enrollment
  207  and repeat the preventive visit at least once every 18 months
  208  thereafter.
  209  
  210  If the enrollee fails to meet the requirements specified in this
  211  subsection, the enrollee is disenrolled from the program at the
  212  end of the month in which the enrollee has not met the
  213  requirements. The enrollee may receive one 30-day extension to
  214  comply before cancellation of coverage. If an enrollee’s
  215  coverage is canceled, the enrollee may not reapply for coverage
  216  until the next open enrollment period or 90 days after
  217  cancellation of coverage occurs, whichever occurs later. The
  218  individual’s reenrollment is subject to available funding.
  219         (4) ENROLLMENT.—
  220         (a) Enrollment in the Health Choice Plus Program may occur
  221  through the portal of the Florida Health Choices Program, a
  222  referral process from the Department of Children and Families,
  223  the Florida Healthy Kids Corporation, or the exchange as defined
  224  by the federal Patient Protection and Affordable Care Act.
  225         (b) Subject to available funding, the corporation shall
  226  establish at least one open enrollment period each year. When
  227  the program is full based on available funding, enrollment must
  228  cease.
  229         (c) Eligibility is determined by using electronic means to
  230  the fullest extent practicable before requesting any written
  231  documentation from an applicant.
  232         (5) HEALTH BENEFITS ACCOUNT.—
  233         (a) A health benefits account is established for each
  234  enrollee upon confirmation of eligibility in the program. The
  235  corporation shall determine the deposit amount and frequency of
  236  deposits based on the availability of funds, the number of
  237  enrollees, and other factors.
  238         (b) An enrollee shall make a financial contribution toward
  239  his or her own health benefits account in order to maintain
  240  enrollment in accordance with paragraph (1)(c).
  241         1. The corporation shall establish disenrollment criteria
  242  for failure to pay the required minimum contribution.
  243         2. The disenrollment criteria must include waiting periods
  244  of not more than 1 month before reinstatement to the program if
  245  the enrollee is still eligible and has paid all required
  246  financial obligations.
  247         3. The enrollee’s employer may contribute toward an
  248  employee’s health benefits account under the program, including
  249  making the enrollee’s required contribution, in whole or in
  250  part, to the enrollee’s health benefits account at any time.
  251         (c) Subject to appropriations available for this specific
  252  purpose, the corporation shall establish a procedure for the
  253  deposit of supplemental or bonus funds into an enrollee’s health
  254  benefits account if certain healthy living performance goals are
  255  achieved. These goals must be established no later than July 1
  256  in each fiscal year and distributed to all enrollees, published
  257  on the corporation’s website, and distributed to new enrollees
  258  within 30 calendar days after enrollment. For calendar year
  259  2014, the goals must be established no later than October 1,
  260  2013.
  261         1. An enrollee may use funds deposited in a health benefits
  262  account to offset other health care costs or to purchase other
  263  products and services offered by the marketplace, subject to
  264  guidelines established by the corporation and in accordance with
  265  federal law.
  266         2. Bonus funds may accumulate in the enrollee’s health
  267  benefits account for the duration of the program and must
  268  automatically expire and return to the corporation upon the
  269  termination of the program.
  270         (d) The marketplace is encouraged to use existing community
  271  programs and partnerships to deliver services and to include
  272  traditional safety net providers for the delivery of services to
  273  enrollees, including, but not limited to, rural health clinics,
  274  federally qualified health centers, county health departments,
  275  emergency room diversion programs, and community mental health
  276  centers. A health care entity that receives state funding must
  277  participate in the Health Choice Plus Program and offer services
  278  or products through the marketplace or to enrollees, as
  279  appropriate. An enrollee may be required to make nominal
  280  copayments to providers for any nonpreventive services. The
  281  corporation may establish the amount of the copayments when
  282  applicable.
  283         (e) Except for supplemental funds described under paragraph
  284  (c), funds deposited in a health benefits account belong to the
  285  enrollee when deposited and are available for health-care
  286  related expenditures, including, but not limited to, physician’s
  287  fees, hospital costs, prescriptions, insurance premium payments,
  288  copayments, and coinsurance. The corporation shall establish a
  289  process or contract with another entity for the management of
  290  the funds. The process must ensure the timely distribution and
  291  the appropriate expenditure of the state’s contributions.
  292         (f) The corporation shall establish a refund process for an
  293  enrollee who requests the closure of a health benefits account
  294  and the return of any unspent individual contributions. The
  295  enrollee may be refunded only those funds that the enrollee or
  296  employer has contributed to his or her health benefits account.
  297  All other state funds in the enrollee’s health benefits account
  298  revert to the corporation.
  299         (6) FUNDING.—
  300         (a) The corporation may accept funds from an employer to
  301  deposit in an enrollee’s health benefits account to supplement
  302  funds if such a deposit is not in conflict with other provisions
  303  of this section.
  304         (b) The corporation may accept state and federal funds to
  305  further subsidize the costs of coverage and to administer the
  306  program.
  307         (c) The corporation shall seek other grants and donations
  308  to support the program.
  309         (d) An assessment on vendors that participate in the
  310  marketplace may be used to fund the administration of the
  311  program.
  312         (7) SERVICES.—The corporation shall manage the health
  313  benefits accounts and provide a marketplace of options from
  314  which an enrollee may also use his or her health benefits
  315  account to purchase individual services and products, including,
  316  but not limited to, discount medical plans, limited benefit
  317  plans, health flex plans, individual health insurance plans,
  318  bundled services, or other prepaid health care coverage.
  319         (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.—
  320         (a) To the extent that funds are made available for this
  321  purpose, an enrollee is rewarded for achieving a healthy
  322  lifestyle and using preventive health care services
  323  appropriately.
  324         (b) The program shall post on its website, by July 1 of
  325  each fiscal year, a list of optional healthy living performance
  326  goals and the proposed incentives for achievement of each goal.
  327  The corporation shall establish a procedure for the
  328  documentation of such goals, timeframes for achievement of the
  329  optional goals, and the payment of supplemental amounts into an
  330  enrollee’s health benefits account, subject to available
  331  funding.
  332         (c) Bonus payments for achieving a healthy living
  333  performance goal shall be paid into an enrollee’s health
  334  benefits account at the end of the quarter in which the goal is
  335  achieved. The amount of the payment is based upon the schedule
  336  posted by the program on July 1 of that fiscal year.
  337         (9) APPLICABILITY OF INSURANCE CODE.—Coverage offered under
  338  this program is not insurance. Any standard forms, website
  339  design, or marketing communication developed by the corporation
  340  and used by the corporation or any vendor that meets the
  341  requirements of s. 408.910(4)(f) is not subject to the Florida
  342  Insurance Code.
  343         (10) LIABILITY.—Coverage under the Health Choice Plus
  344  Program is not an entitlement, and a cause of action does not
  345  arise against the state, a local governmental entity, any other
  346  political subdivision of the state, or the corporation or its
  347  board of directors for failure to make coverage under this
  348  section available to an eligible person or for discontinuation
  349  of any coverage.
  350         (11)PROGRAM EVALUATION.—The corporation shall include
  351  information about the Health Choice Plus Program in its annual
  352  report under s. 408.910. The corporation shall complete and
  353  submit by January 1, 2016, a separate independent evaluation of
  354  the effectiveness of the Health Choice Plus Program to the
  355  Governor, the President of the Senate, and the Speaker of the
  356  House of Representatives.
  357         (12) PROGRAM REVIEW.—The Health Choice Plus Program is
  358  subject to repeal on July 1, 2016, unless reviewed and saved
  359  from repeal through reenactment by the Legislature.
  360         Section 3. This act shall take effect July 1, 2013.