Florida Senate - 2013                             CS for SB 1844
       
       
       
       By the Committees on Appropriations; and Health Policy
       
       
       
       
       576-04989-13                                          20131844c1
    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; providing that the Florida
    5         Insurance Code is not applicable in certain
    6         circumstances; creating s. 408.9105, F.S.; creating
    7         the Health Choice Plus Program; providing legislative
    8         intent; providing requirements of the program;
    9         providing definitions; providing eligibility
   10         requirements; providing for enrollment in the program;
   11         providing requirements and procedures for the deposit
   12         and use of funds in a health benefits account;
   13         providing that the marketplace is encouraged to use
   14         existing community programs and partnerships to
   15         deliver services and to include traditional safety net
   16         providers for the delivery of services to enrollees;
   17         requiring Florida Health Choices, Inc., to establish a
   18         refund process; authorizing the corporation to accept
   19         funds from various sources to deposit into health
   20         benefits accounts, subsidize the costs of coverage,
   21         and administer and support the program; requiring the
   22         corporation to manage the health benefits accounts and
   23         provide the marketplace of options which an enrollee
   24         in the program may use; providing for payment for
   25         achieving healthy living performance goals; requiring
   26         the program to post on its website a list of optional
   27         healthy living performance goals and to establish a
   28         procedure for documentation, achievement, and payment
   29         regarding the healthy living performance goals;
   30         providing that coverage under the program is not an
   31         entitlement; prohibiting a cause of action against
   32         certain entities under certain circumstances;
   33         requiring the corporation to submit to the Governor
   34         and the Legislature information about the program in
   35         its annual report and an evaluation of the
   36         effectiveness of the program; providing for a program
   37         review and repeal date; providing an appropriation;
   38         providing an effective date.
   39  
   40  Be It Enacted by the Legislature of the State of Florida:
   41  
   42         Section 1. Paragraphs (a), (b), (e), and (f) of subsection
   43  (4) and paragraph (b) of subsection (7) of section 408.910,
   44  Florida Statutes, are amended, and paragraph (c) is added to
   45  subsection (10) of that section, to read
   46         408.910 Florida Health Choices Program.—
   47         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
   48  program is voluntary and shall be available to employers,
   49  individuals, vendors, and health insurance agents as specified
   50  in this subsection.
   51         (a) Employers eligible to enroll in the program include
   52  those employers:
   53         1. Employers that meet criteria established by the
   54  corporation and elect to make their employees eligible through
   55  the program.
   56         2. Fiscally constrained counties described in s. 218.67.
   57         3. Municipalities having populations of fewer than 50,000
   58  residents.
   59         4. School districts in fiscally constrained counties.
   60         5. Statutory rural hospitals.
   61         (b) Individuals eligible to participate in the program
   62  include:
   63         1. Individual employees of enrolled employers.
   64         2. Other individuals that meet criteria established by the
   65  corporation State employees not eligible for state employee
   66  health benefits.
   67         3. State retirees.
   68         4. Medicaid participants who opt out.
   69         (e) Eligible individuals may participate in the program
   70  voluntarily continue participation in the program regardless of
   71  subsequent changes in job status or Medicaid eligibility.
   72  Individuals who join the program may participate by complying
   73  with the procedures established by the corporation. These
   74  procedures must include, but are not limited to:
   75         1. Submission of required information.
   76         2. Authorization for payroll deduction.
   77         3. Compliance with federal tax requirements.
   78         4. Arrangements for payment in the event of job changes.
   79         5. Selection of products and services.
   80         (f) Vendors who choose to participate in the program may
   81  enroll by complying with the procedures established by the
   82  corporation. These procedures may include, but are not limited
   83  to:
   84         1. Submission of required information, including a complete
   85  description of the coverage, services, provider network, payment
   86  restrictions, and other requirements of each product offered
   87  through the program.
   88         2. Execution of an agreement to comply with requirements
   89  established by the corporation.
   90         3. Execution of an agreement that prohibits refusal to sell
   91  any offered non-risk-bearing product or service to a participant
   92  who elects to buy it.
   93         4. Establishment of product prices based on applicable
   94  criteria age, gender, and location of the individual
   95  participant, which may include medical underwriting.
   96         5. Arrangements for receiving payment for enrolled
   97  participants.
   98         6. Participation in ongoing reporting processes established
   99  by the corporation.
  100         7. Compliance with grievance procedures established by the
  101  corporation.
  102         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  103  single, centralized market for purchase of health insurance,
  104  health maintenance contracts, and other health products and
  105  services. Purchases may be made by participating individuals
  106  over the Internet or through the services of a participating
  107  health insurance agent. Information about each product and
  108  service available through the program shall be made available
  109  through printed material and an interactive Internet website. A
  110  participant needing personal assistance to select products and
  111  services shall be referred to a participating agent in his or
  112  her area.
  113         (b) Initial selection of products and services must be made
  114  by an individual participant within the applicable open
  115  enrollment period 60 days after the date the individual’s
  116  employer qualified for participation. An individual who fails to
  117  enroll in products and services by the end of this period is
  118  limited to participation in flexible spending account services
  119  until the next annual enrollment period.
  120         (10) EXEMPTIONS.—
  121         (c) Any standard forms, website design, or marketing
  122  communication developed by the corporation and used by the
  123  corporation, or any vendor that meets the requirements of s.
  124  408.910(4)(f) is not subject to the Florida Insurance Code, as
  125  established in s. 624.01.
  126         Section 2. Section 408.9105, Florida Statutes, is created
  127  to read:
  128         408.9105Health Choice Plus Program.—
  129         (1) LEGISLATIVE INTENT.—The Legislature recognizes that
  130  there are more than 600,000 uninsured residents in this state
  131  who have incomes at or below 100 percent of the federal poverty
  132  level. Many insurance options are not affordable, and the
  133  Legislature intends to provide a benefit program to those
  134  individuals who seek assistance with coverage and who assume
  135  individual responsibility for their own health care needs. It is
  136  therefore the intent of the Legislature to expand the services
  137  provided by the Florida Health Choices Program and begin the
  138  phase-in of the Health Choice Plus Program starting July 1,
  139  2013. The Health Choice Plus Program shall:
  140         (a) Use the existing infrastructure and governance of
  141  Florida Health Choices, Inc., to manage the program described in
  142  this section.
  143         (b) Offer goods and services to individuals who are between
  144  19 to 64 years of age, inclusive.
  145         (c) Establish guidelines for financial participation in the
  146  program which allow for enrollees and others to contribute
  147  toward a health benefits account.
  148         1. An enrollee shall contribute at least $20 per month
  149  toward the health benefits account. This contribution amount may
  150  be adjusted annually in the General Appropriations Act.
  151         2. The level of benefit paid into an enrollee’s account
  152  using state funds is determined by the corporation based upon
  153  the availability of state, local, and federal funds. The amount
  154  may not exceed $10 per individual per month. This amount may be
  155  adjusted annually in the General Appropriations Act.
  156         (d) Implement an employer-based contribution option.
  157         (e) Develop and maintain an education and public outreach
  158  campaign for the Health Choice Plus Program.
  159         (f) Provide a secure website to facilitate the purchase of
  160  goods and services and to provide public information about the
  161  program. The website must also provide information about the
  162  availability of insurance affordability programs targeted at
  163  this population.
  164         (g) Establish an incentive program that rewards enrollees
  165  for achievements in reaching healthy living goals.
  166         (2) DEFINITIONS.—As used in this section, the term:
  167         (a) “CHIP” means Children’s Health Insurance Program as
  168  authorized under Title XXI of the Social Security Act.
  169         (b) “Corporation” means Florida Health Choices, Inc., as
  170  established under s. 408.910.
  171         (c) “Corporation’s marketplace” means the single,
  172  centralized market established by the corporation which
  173  facilitates the purchase of products made available in the
  174  marketplace.
  175         (d) “Enrollee” means an individual who participates in or
  176  receives benefits under the Health Choice Plus Program.
  177         (e) “Goods and services” means the individual products
  178  offered for sale to an enrollee on the corporation’s marketplace
  179  or other health care-related items that may be purchased by an
  180  enrollee in the private market. An enrollee may purchase these
  181  products using funds accumulated in his or her health benefits
  182  account.
  183         (f) “Health benefits account” means the account established
  184  for an enrollee at the corporation into which funds may be
  185  deposited by the state, the enrollee, other individuals, or
  186  organizations for the purchase of health care goods and services
  187  on the enrollee’s behalf.
  188         (g) “Lawful permanent resident” means a non-United States
  189  citizen who resides in the United States under legally
  190  recognized and lawfully recorded permanent residence as an
  191  immigrant. This individual may also be known as a permanent
  192  resident alien.
  193         (h) “Parent” or “caretaker relative” means an individual
  194  who is a relative that has primary custody or legal guardianship
  195  of a dependent child and provides the primary care and
  196  supervision of that dependent child in the same household. A
  197  caretaker relative must be related to the dependent child by
  198  blood, marriage, or adoption within the fifth degree of kinship.
  199         (i) “Patient Protection and Affordable Care Act” or “PPACA”
  200  means the federal law enacted as Pub. L. No. 111-148, as further
  201  amended by the federal Health Care and Education Reconciliation
  202  Act of 2010, Pub. L. No. 111-152, and any amendments.
  203         (j) “Program” means the Health Choice Plus Program
  204  established under this section.
  205         (k) “Vendor” means an entity that meets the requirements
  206  under s. 408.910(4)(d) and is accepted by the corporation.
  207         (3) ELIGIBILITY.—
  208         (a) To be eligible for the Health Choice Plus Program, an
  209  individual must be a resident of this state and meet all of the
  210  following criteria:
  211         1. Be between 19 and 64 years of age, inclusive.
  212         2. Have a modified adjusted gross income that does not
  213  exceed 100 percent of the federal poverty level based on the
  214  individual’s most recent federal tax return, or if the
  215  individual did not file a tax return, the individual’s most
  216  recent monthly income.
  217         3. Be a United States citizen or a lawful permanent
  218  resident.
  219         4. Be ineligible for Medicaid.
  220         5. Be ineligible for employer-sponsored insurance coverage.
  221  If the enrollee is eligible for employer-sponsored coverage but
  222  the cost of that coverage for the enrollee’s share for
  223  individual coverage would exceed 5 percent of the enrollee’s
  224  total modified adjusted gross household income or the enrollee’s
  225  share of family coverage would exceed 5 percent of enrollee’s
  226  total modified adjusted gross household income, the enrollee is
  227  not considered eligible for employer-sponsored coverage for
  228  purposes of this section.
  229         6. Not be enrolled in other coverage that meets the
  230  definition of essential benefits coverage under PPACA.
  231         (b) In addition to the requirements in paragraph (a), an
  232  enrollee must meet the following categorical requirements in
  233  order to maintain enrollment in the program:
  234         1. For an enrollee who is also a parent or a caretaker
  235  relative, the enrollee must do all of the following:
  236         a. Maintain enrollment in Medicaid or CHIP for any
  237  dependent child in the household who is eligible for Medicaid or
  238  CHIP and who must be enrolled in Medicaid or CHIP throughout the
  239  enrollee’s participation in the Health Choice Plus Program.
  240         b. Complete a health assessment within the first 3 months
  241  after enrollment at a county health department, federally
  242  qualified health center, or other approved health care provider.
  243         c. Schedule and keep at least one preventive visit with a
  244  primary care provider within 6 months after enrollment and
  245  repeat the preventive visit at least once every 18 months
  246  thereafter.
  247         d. Provide proof of employment for at least 20 hours a week
  248  or proof of efforts made to seek employment. In lieu of
  249  employment, the enrollee may provide proof of volunteering for
  250  at least 10 hours a month at a school or at a nonprofit
  251  organization or enrollment as a full-time student at an
  252  accredited educational institution. Exceptions to this
  253  requirement may be made on a case-by-case basis for medical
  254  conditions for an enrollee or if the enrollee is the primary
  255  caretaker for a family member who has a chronic and severe
  256  medical condition that requires a minimum of 40 hours a week of
  257  care.
  258         2. For an enrollee who is also a childless adult, the
  259  enrollee must do all of the following:
  260         a. Provide proof of employment for at least 20 hours a week
  261  or proof of efforts made to seek employment. In lieu of
  262  employment, the enrollee may provide proof of volunteering for
  263  at least 20 hours a month at a school or at a nonprofit
  264  organization or enrollment as a full-time student at an
  265  accredited educational institution. Exceptions to this
  266  requirement may be made on a case-by-case basis for medical
  267  conditions for the enrollee or if the enrollee is the primary
  268  caretaker for a family member who has a chronic and severe
  269  medical condition that requires a minimum of 40 hours a week of
  270  care.
  271         b. Complete a health assessment within the first 3 months
  272  after enrollment at a county health department, federally
  273  qualified health center, or other approved health care provider.
  274         c. Schedule and keep at least one preventive visit with a
  275  primary care provider within the first 6 months after enrollment
  276  and repeat the preventive visit at least once every 18 months
  277  thereafter.
  278  
  279  If the enrollee fails to meet the requirements specified in this
  280  subsection, the enrollee is disenrolled from the program at the
  281  end of the month in which the enrollee fails to meet the
  282  requirements. The enrollee may receive one 30-day extension to
  283  comply before cancellation of coverage. If an enrollee’s
  284  coverage is canceled, the enrollee may not reapply for coverage
  285  until the next open enrollment period or 90 days after
  286  cancellation of coverage occurs, whichever occurs later. The
  287  individual’s reenrollment is subject to available funding.
  288         (4) ENROLLMENT.—
  289         (a) Enrollment in the Health Choice Plus Program may occur
  290  through the portal of the Florida Health Choices Program, a
  291  referral process from the Department of Children and Families,
  292  the Florida Healthy Kids Corporation, or the exchange as defined
  293  by the federal Patient Protection and Affordable Care Act.
  294         (b) Subject to available funding, the corporation shall
  295  establish at least one open enrollment period each year. When
  296  the program is full based on available funding, enrollment must
  297  cease.
  298         (c) Eligibility is determined by using electronic means to
  299  the fullest extent practicable before requesting any written
  300  documentation from an applicant.
  301         (5) HEALTH BENEFITS ACCOUNT.—
  302         (a) A health benefits account is established for each
  303  enrollee upon confirmation of eligibility in the program. The
  304  corporation shall determine the deposit amount and frequency of
  305  deposits based on the availability of funds, the number of
  306  enrollees, and other factors.
  307         (b) An enrollee shall make a financial contribution toward
  308  his or her own health benefits account in order to maintain
  309  enrollment in accordance with paragraph (1)(c).
  310         1. The corporation shall establish disenrollment criteria
  311  for failure to pay the required minimum contribution.
  312         2. The disenrollment criteria must include waiting periods
  313  of not more than 1 month before reinstatement to the program if
  314  the enrollee is still eligible and has paid all required
  315  financial obligations.
  316         3. The enrollee’s employer may contribute toward an
  317  employee’s health benefits account under the program, including
  318  making the enrollee’s required contribution, in whole or in
  319  part, to the enrollee’s health benefits account at any time.
  320         (c) Subject to appropriations available for this specific
  321  purpose, the corporation shall establish a procedure for the
  322  deposit of supplemental or bonus funds into an enrollee’s health
  323  benefits account if certain healthy living performance goals are
  324  achieved. These goals must be established no later than July 1
  325  in each fiscal year and distributed to all enrollees, published
  326  on the corporation’s website, and distributed to new enrollees
  327  within 30 calendar days after enrollment. For the 2014 calendar
  328  year, the goals must be established no later than October 1,
  329  2013.
  330         1. An enrollee may use funds deposited in a health benefits
  331  account to offset other health care costs or to purchase other
  332  products and services offered by the marketplace, subject to
  333  guidelines established by the corporation and in accordance with
  334  federal law.
  335         2. Bonus funds may accumulate in the enrollee’s health
  336  benefits account for the duration of the program and must
  337  automatically expire and return to the corporation upon the
  338  termination of the program.
  339         (d) The marketplace is encouraged to use existing community
  340  programs and partnerships to deliver services and to include
  341  traditional safety net providers for the delivery of services to
  342  enrollees, including, but not limited to, rural health clinics,
  343  federally qualified health centers, county health departments,
  344  emergency room diversion programs, and community mental health
  345  centers. A health care entity that receives state funding must
  346  participate in the Health Choice Plus Program and offer services
  347  or products through the marketplace or to enrollees, as
  348  appropriate. An enrollee may be required to make nominal
  349  copayments to providers for nonpreventive services. The
  350  corporation may establish the amount of the copayments when
  351  applicable.
  352         (e) Except for supplemental funds described under paragraph
  353  (c), funds deposited in a health benefits account belong to the
  354  enrollee when deposited and are available for health-care
  355  related expenditures, including, but not limited to, physician’s
  356  fees, hospital costs, prescriptions, insurance premium payments,
  357  copayments, and coinsurance. The corporation shall establish a
  358  process or contract with another entity for the management of
  359  the funds. The process must ensure the timely distribution and
  360  the appropriate expenditure of the state’s contributions.
  361         (f) The corporation shall establish a refund process for an
  362  enrollee who requests the closure of a health benefits account
  363  and the return of any unspent individual contributions. The
  364  enrollee may be refunded only those funds that the enrollee or
  365  employer has contributed to his or her health benefits account.
  366  All other state funds in the enrollee’s health benefits account
  367  revert to the corporation.
  368         (6) FUNDING.—
  369         (a) The corporation may accept funds from an employer to
  370  deposit into an enrollee’s health benefits account to supplement
  371  funds if such a deposit is not in conflict with other provisions
  372  of this section.
  373         (b) The corporation may accept state and federal funds to
  374  further subsidize the costs of coverage and to administer the
  375  program.
  376         (c) The corporation shall seek other grants and donations
  377  to support the program.
  378         (d) An assessment on vendors that participate in the
  379  marketplace may be used to fund the administration of the
  380  program.
  381         (7) SERVICES.—The corporation shall manage the health
  382  benefits accounts and provide a marketplace of options from
  383  which an enrollee may also use his or her health benefits
  384  account to purchase individual services and products, including,
  385  but not limited to, discount medical plans, limited benefit
  386  plans, health flex plans, individual health insurance plans,
  387  prepaid health clinic plans, bundled services, or other prepaid
  388  health care coverage.
  389         (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.—
  390         (a) To the extent that funds are made available for this
  391  purpose, an enrollee is rewarded for achieving a healthy
  392  lifestyle and using preventive health care services
  393  appropriately.
  394         (b) The program shall post on its website, by July 1 of
  395  each fiscal year, a list of optional healthy living performance
  396  goals and the proposed incentives for achievement of each goal.
  397  The corporation shall establish a procedure for the
  398  documentation of such goals, timeframes for achievement of the
  399  optional goals, and the payment of supplemental amounts into an
  400  enrollee’s health benefits account, subject to available
  401  funding.
  402         (c) Bonus payments for achieving a healthy living
  403  performance goal shall be paid into an enrollee’s health
  404  benefits account at the end of the quarter in which the goal is
  405  achieved. The amount of the payment is based upon the schedule
  406  posted by the program on July 1 of that fiscal year.
  407         (9) LIABILITY.—Coverage under the Health Choice Plus
  408  Program is not an entitlement, and a cause of action does not
  409  arise against the state, a local governmental entity, any other
  410  political subdivision of the state, or the corporation or its
  411  board of directors for failure to make coverage under this
  412  section available to an eligible person or for discontinuation
  413  of any coverage.
  414         (10)PROGRAM EVALUATION.—The corporation shall include
  415  information about the Health Choice Plus Program in its annual
  416  report under s. 408.910. The corporation shall complete and
  417  submit by January 1, 2016, a separate independent evaluation of
  418  the effectiveness of the Health Choice Plus Program to the
  419  Governor, the President of the Senate, and the Speaker of the
  420  House of Representatives.
  421         (11) PROGRAM REVIEW.—The Health Choice Plus Program is
  422  subject to repeal on July 1, 2016, unless reviewed and saved
  423  from repeal through reenactment by the Legislature.
  424         Section 3. The sum of $15,275,000 from the General Revenue
  425  Fund is appropriated to the Agency for Health Care
  426  Administration beginning in the 2013-2014 fiscal year to provide
  427  funding for the Health Choice Plus Program within Florida Health
  428  Choices, Inc., and to fund the corporation’s administrative
  429  costs necessary for implementing and operating the program.
  430         Section 4. This act shall take effect July 1, 2013.