Florida Senate - 2015                              CS for SB 2-A
       By the Committee on Health Policy; and Senator Bean
       588-00037-15A                                           20152Ac1
    1                        A bill to be entitled                      
    2         An act relating to the health insurance affordability
    3         exchange; providing a directive to the Division of Law
    4         Revision and Information; creating s. 409.72, F.S.;
    5         providing a short title; creating s. 409.721, F.S.;
    6         creating the Florida Health Insurance Affordability
    7         Exchange Program (FHIX) within the Agency for Health
    8         Care Administration; providing program authority and
    9         principles; creating s. 409.722, F.S.; defining terms;
   10         creating s. 409.723, F.S.; providing eligibility and
   11         enrollment criteria; providing patient rights and
   12         responsibilities; defining the term “disabled”
   13         providing premium levels; creating s. 409.724, F.S.;
   14         providing for premium credits and choice counseling;
   15         establishing an education campaign; providing for
   16         customer support and disenrollment; creating s.
   17         409.725, F.S.; providing for available products and
   18         services; creating s. 409.726, F.S.; requiring the
   19         department to develop accountability measures and
   20         performance standards governing the administration of
   21         the program; creating s. 409.727, F.S.; providing for
   22         a readiness review and a two-phase implementation
   23         schedule; creating s. 409.728, F.S.; providing program
   24         operation and management duties; creating s. 409.729,
   25         F.S.; providing for the development of a long-term
   26         reorganization plan and the formation of the FHIX
   27         Workgroup; creating s. 409.73, F.S.; authorizing the
   28         agency to seek federal approval; prohibiting the
   29         agency from implementing the FHIX waiver under certain
   30         circumstances; creating s. 409.731, F.S.; providing
   31         for program expiration; repealing s. 408.70, F.S.,
   32         relating to legislative findings regarding access to
   33         affordable health care; amending s. 408.910, F.S.;
   34         revising legislative intent; redefining terms;
   35         revising the scope of the Florida Health Choices
   36         Program and the pricing of services under the program;
   37         providing requirements for operation of the
   38         marketplace; providing additional duties for the
   39         corporation to perform; requiring an annual report to
   40         the Governor and the Legislature; amending s. 409.904,
   41         F.S.; limiting eligible persons in the Medically Needy
   42         program to those under the age of 21 and pregnant
   43         women, and specifying an effective date; providing an
   44         expiration date for the program; amending s. 624.91,
   45         F.S.; revising eligibility requirements for state
   46         funded assistance; revising the duties and powers of
   47         the Florida Healthy Kids Corporation; revising
   48         provisions for the appointment of members of the board
   49         of the Florida Healthy Kids Corporation; requiring
   50         transition plans; repealing s. 624.915, F.S., relating
   51         to the operating fund of the Florida Healthy Kids
   52         Corporation; providing a directive to the Division of
   53         Law Revision and Information; providing for
   54         construction of the act in pari materia with laws
   55         enacted during the 2015 Regular Session of the
   56         Legislature; providing an effective date.
   58  Be It Enacted by the Legislature of the State of Florida:
   60         Section 1. The Division of Law Revision and Information is
   61  directed to rename part II of chapter 409, Florida Statutes, as
   62  “Insurance Affordability Programs” and to incorporate ss.
   63  409.72-409.731, Florida Statutes, under this part.
   64         Section 2. Section 409.72, Florida Statutes, is created to
   65  read:
   66         409.72 Short title.—Sections 409.72-409.731 may be cited as
   67  the “Florida Health Insurance Affordability Exchange Program”
   68  (“FHIX”).
   69         Section 3. Section 409.721, Florida Statutes, is created to
   70  read:
   71         409.721 Program authority.—The Florida Health Insurance
   72  Affordability Exchange Program (FHIX) is created within the
   73  Agency for Health Care Administration to assist Floridians in
   74  purchasing health benefits coverage and gaining access to health
   75  services. The products and services offered by FHIX are based on
   76  the following principles:
   77         (1) FAIR VALUE.—Financial assistance will be rationally
   78  allocated regardless of differences in categorical eligibility.
   79         (2) CONSUMER CHOICE.—Participants will be offered
   80  meaningful choices in the way the participants can redeem the
   81  value of the available assistance.
   82         (3) SIMPLICITY.—Obtaining assistance will be consumer
   83  friendly, and customer support will be available when needed.
   84         (4) PORTABILITY.—Participants can continue to access the
   85  FHIX services and products despite changes in their
   86  circumstances.
   87         (5) EMPLOYMENT.—Assistance will be offered in a way that
   88  incentivizes employment.
   89         (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a
   90  manner that maximizes individual control over available
   91  resources.
   92         (7) RISK ADJUSTMENT.—The amount of assistance will reflect
   93  participants’ medical risk.
   94         Section 4. Section 409.722, Florida Statutes, is created to
   95  read:
   96         409.722 Definitions.—As used in ss. 409.72-409.731, the
   97  term:
   98         (1) “Agency” means the Agency for Health Care
   99  Administration.
  100         (2) “Applicant” means an individual who applies for
  101  determination of eligibility for health benefits coverage under
  102  this part.
  103         (3) “Corporation” means Florida Health Choices, Inc., as
  104  established under s. 408.910.
  105         (4) “Enrollee” means a participant who has been determined
  106  eligible for and is receiving health benefits coverage under
  107  this part.
  108         (5) “Federal exchange” or “exchange” means an insurance
  109  platform regulated by the Federal Government which offers tiers
  110  of health plans from the least comprehensive plan to the most
  111  comprehensive plan.
  112         (6) “FHIX marketplace” or “marketplace” means the single,
  113  centralized market established under s. 408.910 which
  114  facilitates health benefits coverage.
  115         (7) “Florida Health Insurance Affordability Exchange
  116  Program” or “FHIX” means the program created under ss. 409.72
  117  409.731.
  118         (8) “Florida Healthy Kids Corporation” means the entity
  119  created under s. 624.91.
  120         (9) “Florida Kidcare program” or “Kidcare program” means
  121  the health benefits coverage administered through ss. 409.810
  122  409.821.
  123         (10) “Health benefits coverage” means the payment of
  124  benefits for covered health care services or the availability,
  125  directly or through arrangements with other persons, of covered
  126  health care services on a prepaid per capita basis or on a
  127  prepaid aggregate fixed-sum basis.
  128         (11) “Inactive status” means the enrollment status of a
  129  participant previously enrolled in health benefits coverage
  130  through FHIX who lost coverage for noncompliance pursuant to s.
  131  409.723, but who maintains access to his or her balance in a
  132  health savings account or health reimbursement account.
  133         (12) “Medicaid” means the medical assistance program
  134  authorized by Title XIX of the Social Security Act, and
  135  regulations thereunder, and parts III and IV of this chapter, as
  136  administered in this state by the agency.
  137         (13) “Modified adjusted gross income” means the
  138  individual’s or household’s annual adjusted gross income, as
  139  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986,
  140  which is used to determine eligibility for FHIX.
  141         (14) “Patient Protection and Affordable Care Act” or
  142  “Affordable Care Act” means Pub. L. No. 111-148, as amended by
  143  the Health Care and Education Reconciliation Act of 2010, Pub.
  144  L. No. 111-152, and regulations adopted pursuant to those acts.
  145         (15) “Premium credit” means the monthly amount paid by the
  146  agency per enrollee in the Florida Health Insurance
  147  Affordability Exchange Program toward health benefits coverage.
  148         (16) “Qualified alien” means an alien as defined in 8
  149  U.S.C. s. 1641(b) or (c).
  150         (17) “Resident” means a United States citizen or qualified
  151  alien who is domiciled in this state.
  152         Section 5. Section 409.723, Florida Statutes, is created to
  153  read:
  154         409.723Participation.—
  155         (1) ELIGIBILITY.—To participate in FHIX, an individual must
  156  be a resident and meet the following requirements, as
  157  applicable:
  158         (a) Qualify as a newly eligible enrollee, and be an
  159  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
  160  Social Security Act or s. 2001 of the Affordable Care Act and as
  161  may be further defined by federal regulation.
  162         (b) Meet and maintain the responsibilities under subsection
  163  (4).
  164         (c) Qualify for participation in the Florida Healthy Kids
  165  program under s. 624.91, subject to the implementation of Phase
  166  Two under s. 409.727.
  167         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
  168  an application to the department for an eligibility
  169  determination.
  170         (a) Applications may be submitted online, or by mail,
  171  facsimile, or any other method permitted by law or regulation.
  172         (b) The department is responsible for any eligibility
  173  correspondence and status updates to the participant and other
  174  agencies.
  175         (c) The department shall review a participant’s eligibility
  176  at least every 12 months.
  177         (d) An application or renewal is deemed complete when the
  178  participant has met all the requirements under subsection (4),
  179  as applicable.
  180         (3) PARTICIPANT RIGHTS.—A participant has all of the
  181  following rights:
  182         (a)Access to the FHIX marketplace or federal exchange to
  183  select the scope, amount, and type of health care coverage and
  184  other services to be purchased.
  185         (b) Continuity and portability of coverage to avoid
  186  disruption of coverage and other health care services when the
  187  participant’s economic circumstances change.
  188         (c) Retention of applicable unspent credits in the
  189  participant’s health savings or health reimbursement account
  190  following a change in the participant’s eligibility status.
  191  Credits are valid for a participant in an inactive status for up
  192  to 5 years after the participant’s status first becomes
  193  inactive.
  194         (d) Ability to select more than one product or plan on the
  195  FHIX marketplace or federal exchange.
  196         (e) Choice of at least two health benefits products that
  197  meet the requirements of the Affordable Care Act.
  198         (4) PARTICIPANT RESPONSIBILITIES.—A participant must:
  199         (a) Complete an initial application for health benefits
  200  coverage and the annual renewal process.
  201         (b) Provide evidence of participation in one or more of the
  202  following activities at the levels required under paragraph (c):
  203         1. Paid employment.
  204         2. On the job training or job placement activities that are
  205  validated through registration with CareerSource Florida.
  206         3. Educational pursuits.
  208  A participant who is a disabled adult or the caregiver of a
  209  disabled child or adult may submit a request to the department
  210  for an exception to the requirements in this paragraph. Such
  211  participant shall annually submit to the department a request to
  212  renew the exception. The term “disabled” means any person who
  213  has one or more permanent physical or mental impairments that
  214  substantially limit his or her ability to perform one or more
  215  major life activities of daily living, as defined by the
  216  Americans with Disabilities Act, without receiving more than 8
  217  hours of assistance per day.
  218         (c) Engage in the activities required under paragraph (b)
  219  at the following minimum levels:
  220         1. For a parent of a child younger than 18 years of age, a
  221  minimum of 20 hours weekly.
  222         2. For a childless adult, a minimum of 30 hours weekly.
  223         (d) Learn and remain informed about the choices available
  224  in the FHIX marketplace or the federal exchange and the
  225  allowable uses of credits in the individual accounts.
  226         (e) Execute a contract with the department which
  227  acknowledges that:
  228         1. FHIX is not an entitlement and state and federal funding
  229  may end at any time;
  230         2. Failure to pay required premiums or cost sharing will
  231  result in a transition to inactive status; and
  232         3. Noncompliance with the participation requirements as
  233  established under s. 409.723 will result in a transition to
  234  inactive status.
  235         (f) Select plans and other products in a timely manner.
  236         (g) Comply with program rules and the prohibitions against
  237  fraud, as described in s. 414.39.
  238         (h) Timely make monthly premium and any other cost-sharing
  239  payments.
  240         (i) Meet minimum coverage requirements by selecting either
  241  a high-deductible health plan combined with a health savings or
  242  a reimbursement account or a combination of plans or products
  243  with an actuarial value that meets or exceeds benefits available
  244  under the federal exchange.
  245         (5) COST SHARING.—
  246         (a) Enrollees are assessed monthly premiums based on their
  247  modified adjusted gross income. The maximum monthly premium
  248  payments are set at the following income levels:
  249         1. At or below 22 percent of the federal poverty level: $3.
  250         2. Greater than 22 percent, but at or below 50 percent, of
  251  the federal poverty level: $8.
  252         3. Greater than 50 percent, but at or below 75 percent, of
  253  the federal poverty level: $15.
  254         4. Greater than 75 percent, but at or below 100 percent, of
  255  the federal poverty level: $20.
  256         5. Greater than 100 percent of the federal poverty level:
  257  $25.
  258         (b) Depending on the products and services selected by the
  259  enrollee, the enrollee may also incur additional cost sharing,
  260  such as copayments, deductibles, or other out-of-pocket costs.
  261         (c) An enrollee may be subject to charge for an
  262  inappropriate emergency room visit of up to $8 for the first
  263  visit and up to $25 for any subsequent visit, based on the
  264  enrollee’s benefit plan, to discourage inappropriate use of the
  265  emergency room.
  266         (d) Cumulative annual cost sharing per enrollee may not
  267  exceed 5 percent of an enrollee’s annual modified adjusted gross
  268  income.
  269         (e) If, after a 30-day grace period, a full premium payment
  270  has not been received, the enrollee shall be transitioned from
  271  coverage to inactive status and may not reenroll for a minimum
  272  of 6 months, unless a hardship exception has been granted.
  273  Enrollees may seek a hardship exception under the Medicaid Fair
  274  Hearing Process.
  275         Section 6. Section 409.724, Florida Statutes, is created to
  276  read:
  277         409.724Available assistance.—
  278         (1)PREMIUM CREDITS.—
  279         (a) Standard amount.—The standard monthly premium credit is
  280  equivalent to the applicable risk-adjusted capitation rate paid
  281  to Medicaid managed care plans under part IV of this chapter.
  282         (b) Supplemental funding.—Subject to federal approval,
  283  additional resources may be made available to enrollees and
  284  incorporated into FHIX.
  285         (c) Savings accounts.—In addition to the benefits provided
  286  under this section, the corporation must offer each enrollee
  287  access to an individual account that qualifies as a health
  288  reimbursement account or a health savings account.
  289         1. Unexpended Funds.—Eligible unexpended funds from the
  290  monthly premium credit must be deposited into each enrollee’s
  291  individual account in a timely manner. Funds deposited into
  292  these individual accounts may be used to pay cost-sharing
  293  obligations or to purchase other health-related items to the
  294  extent permitted under federal and state law.
  295         2.Healthy Behaviors.—Enrollees may receive credits to
  296  their individual accounts for healthy behaviors, adherence to
  297  wellness programs, and other activities that demonstrate
  298  compliance with prevention or disease management guidelines.
  299         3. Enrollee contributions.—The enrollee may make deposits
  300  to his or her account at any time to supplement the premium
  301  credit, to purchase additional FHIX products, or to offset other
  302  cost-sharing obligations.
  303         4. Third parties.—Third parties, including, but not limited
  304  to, an employer or relative, may also make deposits on behalf of
  305  the enrollee into the enrollee’s FHIX marketplace account. The
  306  enrollee may not withdraw any funds as a refund, except those
  307  funds the enrollee has deposited into his or her account.
  308         (2) CHOICE COUNSELING.—The agency, in consultation with the
  309  Florida Healthy Kids Corporation and the corporation, shall
  310  develop a choice counseling program for FHIX. The choice
  311  counseling program must ensure that participants have
  312  information about the FHIX marketplace program, the federal
  313  exchange, products, and services and that participants know
  314  where and whom to call for questions or to make their plan
  315  selections. The choice counseling program must provide
  316  culturally sensitive materials and must take into consideration
  317  the demographics of the projected population.
  318         (3)EDUCATION CAMPAIGN.—The agency, the corporation, and
  319  the Florida Healthy Kids Corporation must coordinate in advance
  320  of Phase One an ongoing education campaign to inform
  321  participants, at a minimum, of the following:
  322         (a) How the FHIX marketplace operates and the timeline for
  323  enrollment.
  324         (b) Plans that are available and how to find information
  325  about these plans.
  326         (c) Information about other available insurance
  327  affordability programs for the participant and his or her
  328  family.
  329         (d) Information about health benefits coverage, provider
  330  networks, and cost sharing for available plans in each region.
  331         (e) Information on how to complete the required annual
  332  renewal process, including renewal dates and deadlines.
  333         (f) Information on how to update eligibility if the
  334  participant’s data have changed since his or her last renewal or
  335  application date.
  336         (4) CUSTOMER SUPPORT.—The Florida Healthy Kids Corporation
  337  shall provide customer support for FHIX, including, but not
  338  limited to, general program information, financial information,
  339  and enrollee payments. Customer support must also provide a
  340  toll-free telephone number and maintain a website that is
  341  available in multiple languages and that meets the needs of the
  342  enrollee population.
  343         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  344  inactive participant about other insurance affordability
  345  programs and electronically refer the participant to the federal
  346  exchange or other insurance affordability programs, as
  347  appropriate.
  348         Section 7. Section 409.725, Florida Statutes, is created to
  349  read:
  350         409.725Available products and services.—The FHIX
  351  marketplace shall offer the following products and services:
  352         (1) Products and services authorized pursuant to s.
  353  408.910.
  354         (2) Products authorized by the federal exchange.
  355         (3) Products authorized by the Florida Healthy Kids
  356  Corporation pursuant to s. 624.91.
  357         (4) Premium credits for participation in employer-sponsored
  358  plans.
  359         Section 8. Section 409.726, Florida Statutes, is created to
  360  read:
  361         409.726Program accountability.—
  362         (1) All managed care plans that participate in FHIX must
  363  collect and maintain encounter level data in accordance with the
  364  encounter data requirements under s. 409.967(2)(d) and are
  365  subject to the accompanying penalties under s. 409.967(2)(h)2.
  366  The agency is responsible for the collection and maintenance of
  367  the encounter level data.
  368         (2)The corporation, in consultation with the agency, shall
  369  establish access and network standards for contracts on the FHIX
  370  marketplace, shall ensure that contracted plans have sufficient
  371  providers to meet enrollee needs, and shall develop quality of
  372  coverage and provider standards specific to the adult
  373  population.
  374         (3)The department shall develop accountability measures
  375  and performance standards to be applied to initial and renewal
  376  FHIX applications that are submitted online, by mail, by
  377  facsimile, or through referrals from a third party. The minimum
  378  performance standards are:
  379         (a) Application processing speed.—Ninety percent of all
  380  applications, regardless of the method of submission, must be
  381  processed within 45 days.
  382         (b) Application processing speed from online sources.
  383  Ninety-five percent of all applications received from online
  384  sources must be processed within 45 days.
  385         (c) Renewal application processing speed.—Ninety percent of
  386  all renewals, regardless of the method of submission, must be
  387  processed within 45 days.
  388         (d) Renewal application processing speed from online
  389  sources.—Ninety-five percent of all applications received from
  390  online sources must be processed within 45 days.
  391         (4) The agency, the department, and the Florida Healthy
  392  Kids Corporation must meet the following standards for their
  393  respective roles in the program:
  394         (a) Eighty-five percent of calls must be answered in 20
  395  seconds or less.
  396         (b) All contacts, including, but not limited to, telephone
  397  calls, faxed documents and requests, and e-mails, must be
  398  handled within 2 business days.
  399         (c)Any self-service tools available to participants, such
  400  as interactive voice response systems, must be operational 7
  401  days a week, 24 hours a day, at least 98 percent of each month.
  402         (5) The agency, the department, and the Florida Healthy
  403  Kids Corporation shall conduct an annual satisfaction survey to
  404  address all measures that require participant input specific to
  405  the FHIX marketplace program. The parties may elect to
  406  incorporate these elements into the annual report required under
  407  subsection (7).
  408         (6) The agency and the corporation shall post online
  409  monthly enrollment reports for FHIX.
  410         (7) Beginning in 2016, an annual report is due no later
  411  than July 1 to the Governor, the President of the Senate, and
  412  the Speaker of the House of Representatives. The annual report
  413  must be coordinated by the agency and the corporation and must
  414  include at least the following:
  415         (a) Enrollment and application trends and issues.
  416         (b) Utilization and cost data.
  417         (c) Customer satisfaction.
  418         (d) Funding sources in health savings accounts or health
  419  reimbursement accounts.
  420         (e) Enrollee use of funds in health savings accounts or
  421  health reimbursement accounts.
  422         (f) Types of products and plans purchased.
  423         (g) Movement of enrollees across different insurance
  424  affordability programs.
  425         (h) Recommendations for program improvement.
  426         Section 9. Section 409.727, Florida Statutes, is created to
  427  read:
  428         409.727Readiness review and implementation schedule.—The
  429  agency, the corporation, the department, and the Florida Healthy
  430  Kids Corporation shall begin implementation of FHIX on the
  431  effective date of this act, with enrollment for Phase One
  432  beginning by January 1, 2016.
  433         (1) READINESS REVIEW.—Before implementation of any phase
  434  under this part or in any region, the agency shall conduct a
  435  readiness review in consultation with the FHIX Workgroup
  436  established pursuant to s. 409.729. The agency shall determine,
  437  at a minimum, the following readiness milestones:
  438         (a) Functional readiness of the service delivery platform.
  439         (b) Plan availability and presence of plan choice.
  440         (c) Provider network capacity and adequacy of the available
  441  plans.
  442         (d) Availability of customer support.
  443         (e) Other factors critical to the success of FHIX.
  444         (2) PHASE ONE.—The agency, the corporation, and the Florida
  445  Healthy Kids Corporation shall coordinate implementation
  446  activities to ensure that enrollment begins by January 1, 2016,
  447  and is available in all regions by July 1, 2016.
  448         (a) Beginning no later than January 1, 2016, and contingent
  449  upon federal approval, participants may enroll in health
  450  benefits coverage under the FHIX marketplace or the federal
  451  exchange, if eligible.
  452         (b)To be eligible for enrollment during this phase, a
  453  participant must meet the requirements under s. 409.723(1)(a)
  454  and (b).
  455         (c) An enrollee may select any benefit, service, or product
  456  available in the region.
  457         (d) The corporation shall notify an enrollee of his or her
  458  premium credit amount and how to access the FHIX marketplace
  459  selection process or the federal exchange.
  460         (e) An enrollee must have a choice of at least two managed
  461  care plans in each region which meet or exceed the Affordable
  462  Care Act’s requirements and which qualify for a premium credit
  463  on the FHIX marketplace or federal exchange.
  464         (f) Choice counseling and customer service must be provided
  465  in accordance with s. 409.724(2) and (4).
  466         (3) PHASE TWO.—
  467         (a) No later than July 1, 2016, the corporation and the
  468  Florida Healthy Kids Corporation shall begin the transition of
  469  enrollees under s. 624.91 to the FHIX marketplace.
  470         (b)Eligibility during this phase is based on meeting the
  471  requirements of s. 409.723(1)(c) and (4).
  472         (c) An enrollee may select any available benefit, service,
  473  or product available under s. 409.725.
  474         (d) A Florida Healthy Kids enrollee who selects a FHIX
  475  marketplace plan or federal exchange plan shall be provided a
  476  premium credit equivalent to the average capitation rate paid in
  477  his or her county of residence under Florida Healthy Kids as of
  478  June 30, 2016. The enrollee is responsible for any difference in
  479  costs and may use any unexpended funds deposited in his or her
  480  savings account under s. 409.724(1)(c) for supplemental benefits
  481  on the FHIX marketplace or federal exchange.
  482         (e) The corporation shall notify an enrollee of his or her
  483  premium credit amount and how to access the FHIX marketplace
  484  selection process or federal exchange.
  485         (f) Choice counseling and customer service must be provided
  486  in accordance with s. 409.724(2) and (4).
  487         (g) Enrollees under s. 624.91 must transition to the FHIX
  488  marketplace and coverage under s. 409.725 by September 30, 2016.
  489         Section 10. Section 409.728, Florida Statutes, is created
  490  to read:
  491         409.728Program operation and management.—In order to
  492  implement ss. 409.72-409.731:
  493         (1) The agency shall do all of the following:
  494         (a) Contract with the corporation for the development,
  495  implementation, and administration of the Florida Health
  496  Insurance Affordability Exchange Program and for the release of
  497  any federal, state, or other funds appropriated to the
  498  corporation.
  499         (b) Provide administrative support to the FHIX Workgroup
  500  established pursuant to s. 409.729.
  501         (c) Consult with stakeholders that serve low-income
  502  individuals and families during implementation, using a public
  503  input process.
  504         (d) Timely transmit enrollee information to the
  505  corporation.
  506         (e) Annually determine the risk-adjusted rate to be paid
  507  per month based on historical utilization and spending data for
  508  the medical and behavioral health of enrollee population,
  509  projected forward, and adjusted to reflect the eligibility
  510  category, medical and dental trends, geographic areas, and the
  511  clinical risk profile of the enrollees.
  512         (f) Transfer funds allocated for premium credits by General
  513  Appropriations Act to the corporation.
  514         (g) Adopt rules in coordination with the corporation and
  515  the Florida Healthy Kids Corporation in order to implement FHIX,
  516  including modifying existing rules implementing the Children’s
  517  Health Insurance Program and adapting adult focused provisions
  518  for children to accommodate the seamless transition of Healthy
  519  Kids enrollees to FHIX.
  520         (2) The department shall, in coordination with the
  521  corporation, the agency, and the Florida Healthy Kids
  522  Corporation, determine eligibility of applications and
  523  application renewals for FHIX in accordance with s. 409.902 and
  524  shall transmit eligibility determination information on a timely
  525  basis to the agency and corporation.
  526         (3) The Florida Healthy Kids Corporation shall do all of
  527  the following:
  528         (a) Retain its duties and responsibilities under s. 624.91
  529  during Phase One of the program.
  530         (b) In coordination with the agency and the corporation,
  531  provide customer service for the FHIX marketplace.
  532         (c) Transfer funds and provide financial support to the
  533  FHIX marketplace, including the collection of monthly cost
  534  sharing payments.
  535         (d) Conduct financial reporting related to such activities,
  536  in coordination with the corporation and the agency.
  537         (e) Coordinate program activities with the agency, the
  538  department, and the corporation.
  539         (4) Florida Health Choices, Inc., shall do all of the
  540  following:
  541         (a) Develop and maintain the FHIX marketplace.
  542         (b) Implement and administer Phase One and Phase Two of the
  543  FHIX marketplace and the ongoing operations of the program.
  544         (c) Offer health benefits coverage packages on the FHIX
  545  marketplace, including plans compliant with the Affordable Care
  546  Act.
  547         (d) Offer FHIX enrollees a choice of at least two plans per
  548  county at each benefit level which meet the requirements under
  549  the Affordable Care Act.
  550         (e) Offer the opportunity to participate in the federal
  551  exchange.
  552         (f) Offer enhanced or customized benefits to FHIX
  553  marketplace enrollees.
  554         (g) Provide sufficient staff and resources to meet the
  555  program needs of enrollees.
  556         (h) Provide an opportunity for plans contracted with or
  557  previously contracted with the Florida Healthy Kids Corporation
  558  under s. 624.91 to participate with FHIX if those plans meet the
  559  requirements of the program.
  560         (i) Encourage insurance agents licensed under chapter 626
  561  to identify and assist enrollees. This act does not prohibit
  562  these agents from receiving usual and customary commissions from
  563  insurers and health maintenance organizations that offer plans
  564  in the FHIX marketplace.
  565         Section 11. Section 409.729, Florida Statutes, is created
  566  to read:
  567         409.729 Long-term reorganization.—The FHIX Workgroup is
  568  created to facilitate the implementation of FHIX and to plan for
  569  the reorganization of the state’s insurance affordability
  570  programs. The FHIX Workgroup consists of two representatives
  571  each from the agency, the department, the Florida Healthy Kids
  572  Corporation, and the corporation. An additional representative
  573  of the agency serves as chair. The FHIX Workgroup must hold its
  574  organizational meeting no later than 30 days after the effective
  575  date of this act and must meet at least bimonthly. The role of
  576  the FHIX Workgroup is to make recommendations to the agency. The
  577  responsibilities of the workgroup include, but are not limited
  578  to:
  579         (1) Developing and presenting a final implementation plan
  580  that meets the requirements of this part in a report submitted
  581  to the Governor, the President of the Senate, and the Speaker of
  582  the House of Representatives no later than November 1, 2015.
  583         (2) Reviewing network and access standards for plans and
  584  products.
  585         (3) Assessing readiness and recommending actions needed to
  586  reorganize the state’s insurance affordability programs for each
  587  phase or region. If a phase or region receives a nonreadiness
  588  recommendation, the agency shall notify the Legislature of that
  589  recommendation, the reasons for such a recommendation, and
  590  proposed plans for achieving readiness.
  591         (4) Recommending any proposed change to the Title XIX
  592  funded or Title XXI-funded programs based on the continued
  593  availability and reauthorization of the Title XXI program and
  594  its federal funding.
  595         (5) Identifying duplication of services by the corporation,
  596  the agency, and the Florida Healthy Kids Corporation currently
  597  and under FHIX’s proposed Phase Two program.
  598         (6) Evaluating any fiscal impacts based on the proposed
  599  transition plan under Phase Two.
  600         (7) Compiling a schedule of impacted contracts, leases, and
  601  other assets.
  602         (8) Determining staff requirements for Phase Two.
  603         Section 12. Section 409.73, Florida Statutes, is created to
  604  read:
  605         409.73Legislative Review.—The agency may seek federal
  606  approval to implement FHIX as provided in ss. 409.72-409.731.
  607  The agency is prohibited from implementing the FHIX waiver
  608  without specific legislative approval unless the terms and
  609  conditions of the approved waiver are substantially consistent
  610  with the statutory requirements for this program.
  611         Section 13. Section 409.731, Florida Statutes, is created
  612  to read:
  613         409.731 Program expiration.—The Florida Health Insurance
  614  Affordability Exchange Program expires at the end of the state
  615  fiscal year in which any of these conditions occurs:
  616         (1) The federal match contribution for the newly eligible
  617  under the Affordable Care Act falls below 90 percent.
  618         (2) The federal match contribution falls below the
  619  increased Federal Medical Assistance Percentage for medical
  620  assistance for newly eligible mandatory individuals as specified
  621  in the Affordable Care Act.
  622         (3) The federal match for the FHIX program and the Medicaid
  623  program are blended under federal law or regulation in such a
  624  manner that causes the overall federal contribution to diminish
  625  when compared to separate, nonblended federal contributions.
  626         Section 14. Section 408.70, Florida Statutes, is repealed.
  627         Section 15. Section 408.910, Florida Statutes, is amended
  628  to read:
  629         408.910 Florida Health Choices Program.—
  630         (1) LEGISLATIVE INTENT.—The Legislature finds that a
  631  significant number of the residents of this state do not have
  632  adequate access to affordable, quality health care. The
  633  Legislature further finds that increasing access to affordable,
  634  quality health care can be best accomplished by establishing a
  635  competitive market for purchasing health insurance and health
  636  services. It is therefore the intent of the Legislature to
  637  create and expand the Florida Health Choices Program to:
  638         (a) Expand opportunities for Floridians to purchase
  639  affordable health insurance and health services.
  640         (b) Preserve the benefits of employment-sponsored insurance
  641  while easing the administrative burden for employers who offer
  642  these benefits.
  643         (c) Enable individual choice in both the manner and amount
  644  of health care purchased.
  645         (d) Provide for the purchase of individual, portable health
  646  care coverage.
  647         (e) Disseminate information to consumers on the price and
  648  quality of health services.
  649         (f) Sponsor a competitive market that stimulates product
  650  innovation, quality improvement, and efficiency in the
  651  production and delivery of health services.
  652         (2) DEFINITIONS.—As used in this section, the term:
  653         (a) “Corporation” means the Florida Health Choices, Inc.,
  654  established under this section.
  655         (b) “Corporation’s marketplace” means the single,
  656  centralized market established by the program that facilitates
  657  the purchase of products made available in the marketplace.
  658         (c) “Florida Health Insurance Affordability Exchange
  659  Program” or “FHIX” is the program created under ss. 409.72
  660  409.731 for low-income, uninsured residents of this state.
  661         (d)(c) “Health insurance agent” means an agent licensed
  662  under part IV of chapter 626.
  663         (e)(d) “Insurer” means an entity licensed under chapter 624
  664  which offers an individual health insurance policy or a group
  665  health insurance policy, a preferred provider organization as
  666  defined in s. 627.6471, an exclusive provider organization as
  667  defined in s. 627.6472, or a health maintenance organization
  668  licensed under part I of chapter 641, or a prepaid limited
  669  health service organization or discount medical plan
  670  organization licensed under chapter 636.
  671         (f) “Patient Protection and Affordable Care Act” or
  672  “Affordable Care Act” means Pub. L. No. 111-148, as further
  673  amended by the Health Care and Education Reconciliation Act of
  674  2010, Pub. L. No. 111-152, and regulations adopted pursuant to
  675  those acts.
  676         (g)(e) “Program” means the Florida Health Choices Program
  677  established by this section.
  678         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
  679  Choices Program is created as a single, centralized market for
  680  the sale and purchase of various products that enable
  681  individuals to pay for health care. These products include, but
  682  are not limited to, health insurance plans, health maintenance
  683  organization plans, prepaid services, service contracts, and
  684  flexible spending accounts. The components of the program
  685  include:
  686         (a) Enrollment of employers.
  687         (b) Administrative services for participating employers,
  688  including:
  689         1. Assistance in seeking federal approval of cafeteria
  690  plans.
  691         2. Collection of premiums and other payments.
  692         3. Management of individual benefit accounts.
  693         4. Distribution of premiums to insurers and payments to
  694  other eligible vendors.
  695         5. Assistance for participants in complying with reporting
  696  requirements.
  697         (c) Services to individual participants, including:
  698         1. Information about available products and participating
  699  vendors.
  700         2. Assistance with assessing the benefits and limits of
  701  each product, including information necessary to distinguish
  702  between policies offering creditable coverage and other products
  703  available through the program.
  704         3. Account information to assist individual participants
  705  with managing available resources.
  706         4. Services that promote healthy behaviors.
  707         5.Health benefits coverage information about health
  708  insurance plans compliant with the Affordable Care Act.
  709         6. Consumer assistance with web-based information services
  710  for the Florida Health Insurance Affordability Exchange Program,
  711  or (”FHIX”).
  712         (d) Recruitment of vendors, including insurers, health
  713  maintenance organizations, prepaid clinic service providers,
  714  provider service networks, and other providers.
  715         (e) Certification of vendors to ensure capability,
  716  reliability, and validity of offerings.
  717         (f) Collection of data, monitoring, assessment, and
  718  reporting of vendor performance.
  719         (g) Information services for individuals and employers.
  720         (h) Program evaluation.
  721         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  722  program is voluntary and shall be available to employers,
  723  individuals, vendors, and health insurance agents as specified
  724  in this subsection.
  725         (a) Employers eligible to enroll in the program include
  726  those employers that meet criteria established by the
  727  corporation and elect to make their employees eligible through
  728  the program.
  729         (b) Individuals eligible to participate in the program
  730  include:
  731         1. Individual employees of enrolled employers.
  732         2. Other individuals that meet criteria established by the
  733  corporation.
  734         (c) Employers who choose to participate in the program may
  735  enroll by complying with the procedures established by the
  736  corporation. The procedures must include, but are not limited
  737  to:
  738         1. Submission of required information.
  739         2. Compliance with federal tax requirements for the
  740  establishment of a cafeteria plan, pursuant to s. 125 of the
  741  Internal Revenue Code, including designation of the employer’s
  742  plan as a premium payment plan, a salary reduction plan that has
  743  flexible spending arrangements, or a salary reduction plan that
  744  has a premium payment and flexible spending arrangements.
  745         3. Determination of the employer’s contribution, if any,
  746  per employee, provided that such contribution is equal for each
  747  eligible employee.
  748         4. Establishment of payroll deduction procedures, subject
  749  to the agreement of each individual employee who voluntarily
  750  participates in the program.
  751         5. Designation of the corporation as the third-party
  752  administrator for the employer’s health benefit plan.
  753         6. Identification of eligible employees.
  754         7. Arrangement for periodic payments.
  755         8. Employer notification to employees of the intent to
  756  transfer from an existing employee health plan to the program at
  757  least 90 days before the transition.
  758         (d) All eligible vendors who choose to participate and the
  759  products and services that the vendors are permitted to sell are
  760  as follows:
  761         1. Insurers licensed under chapter 624 may sell health
  762  insurance policies, limited benefit policies, other risk-bearing
  763  coverage, and other products or services.
  764         2. Health maintenance organizations licensed under part I
  765  of chapter 641 may sell health maintenance contracts, limited
  766  benefit policies, other risk-bearing products, and other
  767  products or services.
  768         3. Prepaid limited health service organizations may sell
  769  products and services as authorized under part I of chapter 636,
  770  and discount medical plan organizations may sell products and
  771  services as authorized under part II of chapter 636.
  772         4. Prepaid health clinic service providers licensed under
  773  part II of chapter 641 may sell prepaid service contracts and
  774  other arrangements for a specified amount and type of health
  775  services or treatments.
  776         5. Health care providers, including hospitals and other
  777  licensed health facilities, health care clinics, licensed health
  778  professionals, pharmacies, and other licensed health care
  779  providers, may sell service contracts and arrangements for a
  780  specified amount and type of health services or treatments.
  781         6. Provider organizations, including service networks,
  782  group practices, professional associations, and other
  783  incorporated organizations of providers, may sell service
  784  contracts and arrangements for a specified amount and type of
  785  health services or treatments.
  786         7. Corporate entities providing specific health services in
  787  accordance with applicable state law may sell service contracts
  788  and arrangements for a specified amount and type of health
  789  services or treatments.
  791  A vendor described in subparagraphs 3.-7. may not sell products
  792  that provide risk-bearing coverage unless that vendor is
  793  authorized under a certificate of authority issued by the Office
  794  of Insurance Regulation and is authorized to provide coverage in
  795  the relevant geographic area. Otherwise eligible vendors may be
  796  excluded from participating in the program for deceptive or
  797  predatory practices, financial insolvency, or failure to comply
  798  with the terms of the participation agreement or other standards
  799  set by the corporation.
  800         (e) Eligible individuals may participate in the program
  801  voluntarily. Individuals who join the program may participate by
  802  complying with the procedures established by the corporation.
  803  These procedures must include, but are not limited to:
  804         1. Submission of required information.
  805         2. Authorization for payroll deduction, if applicable.
  806         3. Compliance with federal tax requirements.
  807         4. Arrangements for payment.
  808         5. Selection of products and services.
  809         (f) Vendors who choose to participate in the program may
  810  enroll by complying with the procedures established by the
  811  corporation. These procedures may include, but are not limited
  812  to:
  813         1. Submission of required information, including a complete
  814  description of the coverage, services, provider network, payment
  815  restrictions, and other requirements of each product offered
  816  through the program.
  817         2. Execution of an agreement to comply with requirements
  818  established by the corporation.
  819         3. Execution of an agreement that prohibits refusal to sell
  820  any offered product or service to a participant who elects to
  821  buy it.
  822         4. Establishment of product prices based on applicable
  823  criteria.
  824         5. Arrangements for receiving payment for enrolled
  825  participants.
  826         6. Participation in ongoing reporting processes established
  827  by the corporation.
  828         7. Compliance with grievance procedures established by the
  829  corporation.
  830         (g) Health insurance agents licensed under part IV of
  831  chapter 626 are eligible to voluntarily participate as buyers’
  832  representatives. A buyer’s representative acts on behalf of an
  833  individual purchasing health insurance and health services
  834  through the program by providing information about products and
  835  services available through the program and assisting the
  836  individual with both the decision and the procedure of selecting
  837  specific products. Serving as a buyer’s representative does not
  838  constitute a conflict of interest with continuing
  839  responsibilities as a health insurance agent if the relationship
  840  between each agent and any participating vendor is disclosed
  841  before advising an individual participant about the products and
  842  services available through the program. In order to participate,
  843  a health insurance agent shall comply with the procedures
  844  established by the corporation, including:
  845         1. Completion of training requirements.
  846         2. Execution of a participation agreement specifying the
  847  terms and conditions of participation.
  848         3. Disclosure of any appointments to solicit insurance or
  849  procure applications for vendors participating in the program.
  850         4. Arrangements to receive payment from the corporation for
  851  services as a buyer’s representative.
  852         (5) PRODUCTS.—
  853         (a) The products that may be made available for purchase
  854  through the program include, but are not limited to:
  855         1. Health insurance policies.
  856         2. Health maintenance contracts.
  857         3. Limited benefit plans.
  858         4. Prepaid clinic services.
  859         5. Service contracts.
  860         6. Arrangements for purchase of specific amounts and types
  861  of health services and treatments.
  862         7. Flexible spending accounts.
  863         (b) Health insurance policies, health maintenance
  864  contracts, limited benefit plans, prepaid service contracts, and
  865  other contracts for services must ensure the availability of
  866  covered services.
  867         (c) Products may be offered for multiyear periods provided
  868  the price of the product is specified for the entire period or
  869  for each separately priced segment of the policy or contract.
  870         (d) The corporation shall provide a disclosure form for
  871  consumers to acknowledge their understanding of the nature of,
  872  and any limitations to, the benefits provided by the products
  873  and services being purchased by the consumer.
  874         (e) The corporation must determine that making the plan
  875  available through the program is in the interest of eligible
  876  individuals and eligible employers in the state.
  877         (6) PRICING.—Prices for the products and services sold
  878  through the program must be transparent to participants and
  879  established by the vendors. The corporation may shall annually
  880  assess a surcharge for each premium or price set by a
  881  participating vendor. Any The surcharge may not be more than 2.5
  882  percent of the price and shall be used to generate funding for
  883  administrative services provided by the corporation and payments
  884  to buyers’ representatives; however, a surcharge may not be
  885  assessed for products and services sold in the FHIX marketplace.
  886         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  887  single, centralized market for purchase of health insurance,
  888  health maintenance contracts, and other health products and
  889  services. Purchases may be made by participating individuals
  890  over the Internet or through the services of a participating
  891  health insurance agent. Information about each product and
  892  service available through the program shall be made available
  893  through printed material and an interactive Internet website.
  894         (a)Marketplace purchasing.A participant needing personal
  895  assistance to select products and services shall be referred to
  896  a participating agent in his or her area.
  897         1.(a) Participation in the program may begin at any time
  898  during a year after the employer completes enrollment and meets
  899  the requirements specified by the corporation pursuant to
  900  paragraph (4)(c).
  901         2.(b) Initial selection of products and services must be
  902  made by an individual participant within the applicable open
  903  enrollment period.
  904         3.(c) Initial enrollment periods for each product selected
  905  by an individual participant must last at least 12 months,
  906  unless the individual participant specifically agrees to a
  907  different enrollment period.
  908         4.(d) If an individual has selected one or more products
  909  and enrolled in those products for at least 12 months or any
  910  other period specifically agreed to by the individual
  911  participant, changes in selected products and services may only
  912  be made during the annual enrollment period established by the
  913  corporation.
  914         5.(e) The limits established in subparagraphs 2., 3., and
  915  4. paragraphs (b)-(d) apply to any risk-bearing product that
  916  promises future payment or coverage for a variable amount of
  917  benefits or services. The limits do not apply to initiation of
  918  flexible spending plans if those plans are not associated with
  919  specific high-deductible insurance policies or the use of
  920  spending accounts for any products offering individual
  921  participants specific amounts and types of health services and
  922  treatments at a contracted price.
  923         (b) FHIX marketplace purchasing.
  924         1. Participation in the FHIX marketplace may begin at any
  925  time during the year.
  926         2. Initial enrollment periods for certain products selected
  927  by an individual enrollee which are noncompliant with the
  928  Affordable Care Act may be required to last at least 12 months,
  929  unless the individual participant specifically agrees to a
  930  different enrollment period.
  931         (8) CONSUMER INFORMATION.—The corporation shall:
  932         (a) Establish a secure website to facilitate the purchase
  933  of products and services by participating individuals. The
  934  website must provide information about each product or service
  935  available through the program.
  936         (b) Inform individuals about other public health care
  937  programs.
  938         (9) RISK POOLING.—The program may use methods for pooling
  939  the risk of individual participants and preventing selection
  940  bias. These methods may include, but are not limited to, a
  941  postenrollment risk adjustment of the premium payments to the
  942  vendors. The corporation may establish a methodology for
  943  assessing the risk of enrolled individual participants based on
  944  data reported annually by the vendors about their enrollees.
  945  Distribution of payments to the vendors may be adjusted based on
  946  the assessed relative risk profile of the enrollees in each
  947  risk-bearing product for the most recent period for which data
  948  is available.
  949         (10) EXEMPTIONS.—
  950         (a) Products, other than the products set forth in
  951  subparagraphs (4)(d)1.-4., sold as part of the program are not
  952  subject to the licensing requirements of the Florida Insurance
  953  Code, as defined in s. 624.01 or the mandated offerings or
  954  coverages established in part VI of chapter 627 and chapter 641.
  955         (b) The corporation may act as an administrator as defined
  956  in s. 626.88 but is not required to be certified pursuant to
  957  part VII of chapter 626. However, a third-party third party
  958  administrator used by the corporation must be certified under
  959  part VII of chapter 626.
  960         (c) Any standard forms, website design, or marketing
  961  communication developed by the corporation and used by the
  962  corporation, or any vendor that meets the requirements of
  963  paragraph (4)(f) is not subject to the Florida Insurance Code,
  964  as established in s. 624.01.
  965         (11) CORPORATION.—There is created the Florida Health
  966  Choices, Inc., which shall be registered, incorporated,
  967  organized, and operated in compliance with part III of chapter
  968  112 and chapters 119, 286, and 617. The purpose of the
  969  corporation is to administer the program created in this section
  970  and to conduct such other business as may further the
  971  administration of the program.
  972         (a) The corporation shall be governed by a 15-member board
  973  of directors consisting of:
  974         1. Three ex officio, nonvoting members to include:
  975         a. The Secretary of Health Care Administration or a
  976  designee with expertise in health care services.
  977         b. The Secretary of Management Services or a designee with
  978  expertise in state employee benefits.
  979         c. The commissioner of the Office of Insurance Regulation
  980  or a designee with expertise in insurance regulation.
  981         2. Four members appointed by and serving at the pleasure of
  982  the Governor.
  983         3. Four members appointed by and serving at the pleasure of
  984  the President of the Senate.
  985         4. Four members appointed by and serving at the pleasure of
  986  the Speaker of the House of Representatives.
  987         5. Board members may not include insurers, health insurance
  988  agents or brokers, health care providers, health maintenance
  989  organizations, prepaid service providers, or any other entity,
  990  affiliate, or subsidiary of eligible vendors.
  991         (b) Members shall be appointed for terms of up to 3 years.
  992  Any member is eligible for reappointment. A vacancy on the board
  993  shall be filled for the unexpired portion of the term in the
  994  same manner as the original appointment.
  995         (c) The board shall select a chief executive officer for
  996  the corporation who shall be responsible for the selection of
  997  such other staff as may be authorized by the corporation’s
  998  operating budget as adopted by the board.
  999         (d) Board members are entitled to receive, from funds of
 1000  the corporation, reimbursement for per diem and travel expenses
 1001  as provided by s. 112.061. No other compensation is authorized.
 1002         (e) There is no liability on the part of, and no cause of
 1003  action shall arise against, any member of the board or its
 1004  employees or agents for any action taken by them in the
 1005  performance of their powers and duties under this section.
 1006         (f) The board shall develop and adopt bylaws and other
 1007  corporate procedures as necessary for the operation of the
 1008  corporation and carrying out the purposes of this section. The
 1009  bylaws shall:
 1010         1. Specify procedures for selection of officers and
 1011  qualifications for reappointment, provided that no board member
 1012  shall serve more than 9 consecutive years.
 1013         2. Require an annual membership meeting that provides an
 1014  opportunity for input and interaction with individual
 1015  participants in the program.
 1016         3. Specify policies and procedures regarding conflicts of
 1017  interest, including the provisions of part III of chapter 112,
 1018  which prohibit a member from participating in any decision that
 1019  would inure to the benefit of the member or the organization
 1020  that employs the member. The policies and procedures shall also
 1021  require public disclosure of the interest that prevents the
 1022  member from participating in a decision on a particular matter.
 1023         (g) The corporation may exercise all powers granted to it
 1024  under chapter 617 necessary to carry out the purposes of this
 1025  section, including, but not limited to, the power to receive and
 1026  accept grants, loans, or advances of funds from any public or
 1027  private agency and to receive and accept from any source
 1028  contributions of money, property, labor, or any other thing of
 1029  value to be held, used, and applied for the purposes of this
 1030  section.
 1031         (h) The corporation may establish technical advisory panels
 1032  consisting of interested parties, including consumers, health
 1033  care providers, individuals with expertise in insurance
 1034  regulation, and insurers.
 1035         (i) The corporation shall:
 1036         1. Determine eligibility of employers, vendors,
 1037  individuals, and agents in accordance with subsection (4).
 1038         2. Establish procedures necessary for the operation of the
 1039  program, including, but not limited to, procedures for
 1040  application, enrollment, risk assessment, risk adjustment, plan
 1041  administration, performance monitoring, and consumer education.
 1042         3. Arrange for collection of contributions from
 1043  participating employers, third parties, governmental entities,
 1044  and individuals.
 1045         4. Arrange for payment of premiums and other appropriate
 1046  disbursements based on the selections of products and services
 1047  by the individual participants.
 1048         5. Establish criteria for disenrollment of participating
 1049  individuals based on failure to pay the individual’s share of
 1050  any contribution required to maintain enrollment in selected
 1051  products.
 1052         6. Establish criteria for exclusion of vendors pursuant to
 1053  paragraph (4)(d).
 1054         7. Develop and implement a plan for promoting public
 1055  awareness of and participation in the program.
 1056         8. Secure staff and consultant services necessary to the
 1057  operation of the program.
 1058         9. Establish policies and procedures regarding
 1059  participation in the program for individuals, vendors, health
 1060  insurance agents, and employers.
 1061         10. Provide for the operation of a toll-free hotline to
 1062  respond to requests for assistance.
 1063         11. Provide for initial, open, and special enrollment
 1064  periods.
 1065         12. Evaluate options for employer participation which may
 1066  conform to with common insurance practices.
 1067         13. Administer the Florida Health Insurance Affordability
 1068  Exchange Program in accordance with ss. 409.72-409.731.
 1069         14. Coordinate with the Agency for Health Care
 1070  Administration, the Department of Children and Families, and the
 1071  Florida Healthy Kids Corporation in developing and implementing
 1072  the enrollee transition plan.
 1073         15. Coordinate with the federal exchange to provide FHIX
 1074  enrollees with the option of selecting plans from either the
 1075  FHIX marketplace or the federal exchange.
 1076         (12) REPORT.—The board of the corporation shall Beginning
 1077  in the 2009-2010 fiscal year, submit by February 1 an annual
 1078  report to the Governor, the President of the Senate, and the
 1079  Speaker of the House of Representatives documenting the
 1080  corporation’s activities in compliance with the duties
 1081  delineated in this section.
 1082         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1083  safeguard the financial transactions made under the auspices of
 1084  the program, the corporation is authorized to establish
 1085  qualifying criteria and certification procedures for vendors,
 1086  require performance bonds or other guarantees of ability to
 1087  complete contractual obligations, monitor the performance of
 1088  vendors, and enforce the agreements of the program through
 1089  financial penalty or disqualification from the program.
 1091         (a) Definitions.—For purposes of this subsection, the term:
 1092         1. “Buyer’s representative” means a participating insurance
 1093  agent as described in paragraph (4)(g).
 1094         2. “Enrollee” means an employer who is eligible to enroll
 1095  in the program pursuant to paragraph (4)(a).
 1096         3. “Participant” means an individual who is eligible to
 1097  participate in the program pursuant to paragraph (4)(b).
 1098         4. “Proprietary confidential business information” means
 1099  information, regardless of form or characteristics, that is
 1100  owned or controlled by a vendor requesting confidentiality under
 1101  this section; that is intended to be and is treated by the
 1102  vendor as private in that the disclosure of the information
 1103  would cause harm to the business operations of the vendor; that
 1104  has not been disclosed unless disclosed pursuant to a statutory
 1105  provision, an order of a court or administrative body, or a
 1106  private agreement providing that the information may be released
 1107  to the public; and that is information concerning:
 1108         a. Business plans.
 1109         b. Internal auditing controls and reports of internal
 1110  auditors.
 1111         c. Reports of external auditors for privately held
 1112  companies.
 1113         d. Client and customer lists.
 1114         e. Potentially patentable material.
 1115         f. A trade secret as defined in s. 688.002.
 1116         5. “Vendor” means a participating insurer or other provider
 1117  of services as described in paragraph (4)(d).
 1118         (b) Public record exemptions.—
 1119         1. Personal identifying information of an enrollee or
 1120  participant who has applied for or participates in the Florida
 1121  Health Choices Program is confidential and exempt from s.
 1122  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1123         2. Client and customer lists of a buyer’s representative
 1124  held by the corporation are confidential and exempt from s.
 1125  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1126         3. Proprietary confidential business information held by
 1127  the corporation is confidential and exempt from s. 119.07(1) and
 1128  s. 24(a), Art. I of the State Constitution.
 1129         (c) Retroactive application.—The public record exemptions
 1130  provided for in paragraph (b) apply to information held by the
 1131  corporation before, on, or after the effective date of this
 1132  exemption.
 1133         (d) Authorized release.—
 1134         1. Upon request, information made confidential and exempt
 1135  pursuant to this subsection shall be disclosed to:
 1136         a. Another governmental entity in the performance of its
 1137  official duties and responsibilities.
 1138         b. Any person who has the written consent of the program
 1139  applicant.
 1140         c. The Florida Kidcare program for the purpose of
 1141  administering the program authorized in ss. 409.810-409.821.
 1142         2. Paragraph (b) does not prohibit a participant’s legal
 1143  guardian from obtaining confirmation of coverage, dates of
 1144  coverage, the name of the participant’s health plan, and the
 1145  amount of premium being paid.
 1146         (e) Penalty.—A person who knowingly and willfully violates
 1147  this subsection commits a misdemeanor of the second degree,
 1148  punishable as provided in s. 775.082 or s. 775.083.
 1149         (f) Review and repeal.—This subsection is subject to the
 1150  Open Government Sunset Review Act in accordance with s. 119.15,
 1151  and shall stand repealed on October 2, 2016, unless reviewed and
 1152  saved from repeal through reenactment by the Legislature.
 1153         Section 16. Subsection (2) of section 409.904, Florida
 1154  Statutes, is amended to read:
 1155         409.904 Optional payments for eligible persons.—The agency
 1156  may make payments for medical assistance and related services on
 1157  behalf of the following persons who are determined to be
 1158  eligible subject to the income, assets, and categorical
 1159  eligibility tests set forth in federal and state law. Payment on
 1160  behalf of these Medicaid eligible persons is subject to the
 1161  availability of moneys and any limitations established by the
 1162  General Appropriations Act or chapter 216.
 1163         (2) A family, a pregnant woman, a child under age 21, a
 1164  person age 65 or over, or a blind or disabled person, who would
 1165  be eligible under any group listed in s. 409.903(1), (2), or
 1166  (3), except that the income or assets of such family or person
 1167  exceed established limitations. For a family or person in one of
 1168  these coverage groups, medical expenses are deductible from
 1169  income in accordance with federal requirements in order to make
 1170  a determination of eligibility. A family or person eligible
 1171  under the coverage known as the “medically needy,” is eligible
 1172  to receive the same services as other Medicaid recipients, with
 1173  the exception of services in skilled nursing facilities and
 1174  intermediate care facilities for the developmentally disabled.
 1175  Effective July 1, 2016, persons eligible under “medically needy”
 1176  shall be limited to children under 21 years of age and pregnant
 1177  women. This subsection expires October 1, 2019.
 1178         Section 17. Section 624.91, Florida Statutes, is amended to
 1179  read:
 1180         624.91 The Florida Healthy Kids Corporation Act.—
 1181         (1) SHORT TITLE.—This section may be cited as the “William
 1182  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1183         (2) LEGISLATIVE INTENT.—
 1184         (a) The Legislature finds that increased access to health
 1185  care services could improve children’s health and reduce the
 1186  incidence and costs of childhood illness and disabilities among
 1187  children in this state. Many children do not have comprehensive,
 1188  affordable health care services available. It is the intent of
 1189  the Legislature that the Florida Healthy Kids Corporation
 1190  provide comprehensive health insurance coverage to such
 1191  children. The corporation is encouraged to cooperate with any
 1192  existing health service programs funded by the public or the
 1193  private sector.
 1194         (b) It is the intent of the Legislature that the Florida
 1195  Healthy Kids Corporation serve as one of several providers of
 1196  services to children eligible for medical assistance under Title
 1197  XXI of the Social Security Act. Although the corporation may
 1198  serve other children, the Legislature intends the primary
 1199  recipients of services provided through the corporation be
 1200  school-age children with a family income below 200 percent of
 1201  the federal poverty level, who do not qualify for Medicaid. It
 1202  is also the intent of the Legislature that state and local
 1203  government Florida Healthy Kids funds be used to continue
 1204  coverage, subject to specific appropriations in the General
 1205  Appropriations Act, to children not eligible for federal
 1206  matching funds under Title XXI.
 1207         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1208  of this state are eligible the following individuals are
 1209  eligible for state-funded assistance in paying Florida Healthy
 1210  Kids premiums pursuant to s. 409.814.:
 1211         (a) Residents of this state who are eligible for the
 1212  Florida Kidcare program pursuant to s. 409.814.
 1213         (b) Notwithstanding s. 409.814, legal aliens who are
 1214  enrolled in the Florida Healthy Kids program as of January 31,
 1215  2004, who do not qualify for Title XXI federal funds because
 1216  they are not qualified aliens as defined in s. 409.811.
 1217         (4) NONENTITLEMENT.—Nothing in this section shall be
 1218  construed as providing an individual with an entitlement to
 1219  health care services. No cause of action shall arise against the
 1220  state, the Florida Healthy Kids Corporation, or a unit of local
 1221  government for failure to make health services available under
 1222  this section.
 1224         (a) There is created the Florida Healthy Kids Corporation,
 1225  a not-for-profit corporation.
 1226         (b) The Florida Healthy Kids Corporation shall:
 1227         1. Arrange for the collection of any individual, family,
 1228  local contributions, or employer payment or premium, in an
 1229  amount to be determined by the board of directors, to provide
 1230  for payment of premiums for comprehensive insurance coverage and
 1231  for the actual or estimated administrative expenses.
 1232         2. Arrange for the collection of any voluntary
 1233  contributions to provide for payment of Florida Kidcare program
 1234  or Florida Health Insurance Affordability Exchange Program
 1235  (FHIX) premiums for children who are not eligible for medical
 1236  assistance under Title XIX or Title XXI of the Social Security
 1237  Act.
 1238         3. Subject to the provisions of s. 409.8134, accept
 1239  voluntary supplemental local match contributions that comply
 1240  with the requirements of Title XXI of the Social Security Act
 1241  for the purpose of providing additional Florida Kidcare coverage
 1242  in contributing counties under Title XXI.
 1243         4. Establish the administrative and accounting procedures
 1244  for the operation of the corporation.
 1245         4.5. Establish, with consultation from appropriate
 1246  professional organizations, standards for preventive health
 1247  services and providers and comprehensive insurance benefits
 1248  appropriate to children, provided that such standards for rural
 1249  areas shall not limit primary care providers to board-certified
 1250  pediatricians.
 1251         5.6. Determine eligibility for children seeking to
 1252  participate in the Title XXI-funded components of the Florida
 1253  Kidcare program consistent with the requirements specified in s.
 1254  409.814, as well as the non-Title-XXI-eligible children as
 1255  provided in subsection (3).
 1256         6.7. Establish procedures under which providers of local
 1257  match to, applicants to and participants in the program may have
 1258  grievances reviewed by an impartial body and reported to the
 1259  board of directors of the corporation.
 1260         7.8. Establish participation criteria and, if appropriate,
 1261  contract with an authorized insurer, health maintenance
 1262  organization, or third-party administrator to provide
 1263  administrative services to the corporation.
 1264         8.9. Establish enrollment criteria that include penalties
 1265  or waiting periods of 30 days for reinstatement of coverage upon
 1266  voluntary cancellation for nonpayment of family or individual
 1267  premiums.
 1268         9.10. Contract with authorized insurers or any provider of
 1269  health care services, meeting standards established by the
 1270  corporation, for the provision of comprehensive insurance
 1271  coverage to participants. Such standards shall include criteria
 1272  under which the corporation may contract with more than one
 1273  provider of health care services in program sites.
 1274         a. Health plans shall be selected through a competitive bid
 1275  process. The Florida Healthy Kids Corporation shall purchase
 1276  goods and services in the most cost-effective manner consistent
 1277  with the delivery of quality medical care.
 1278         b. The maximum administrative cost for a Florida Healthy
 1279  Kids Corporation contract shall be 15 percent. For health and
 1280  dental care contracts, the minimum medical loss ratio for a
 1281  Florida Healthy Kids Corporation contract shall be 85 percent.
 1282  The calculations must use uniform financial data collected from
 1283  all plans in a format established by the corporation and shall
 1284  be computed for each plan on a statewide basis. Funds shall be
 1285  classified in a manner consistent with 45 C.F.R. part 158 For
 1286  dental contracts, the remaining compensation to be paid to the
 1287  authorized insurer or provider under a Florida Healthy Kids
 1288  Corporation contract shall be no less than an amount which is 85
 1289  percent of premium; to the extent any contract provision does
 1290  not provide for this minimum compensation, this section shall
 1291  prevail.
 1292         c. The health plan selection criteria and scoring system,
 1293  and the scoring results, shall be available upon request for
 1294  inspection after the bids have been awarded.
 1295         d. Effective July 1, 2016, health and dental services
 1296  contracts of the corporation must transition to the FHIX
 1297  marketplace under s. 409.722. Qualifying plans may enroll as
 1298  vendors with the FHIX marketplace to maintain continuity of care
 1299  for participants.
 1300         10.11. Establish disenrollment criteria in the event local
 1301  matching funds are insufficient to cover enrollments.
 1302         11.12. Develop and implement a plan to publicize the
 1303  Florida Kidcare program, the eligibility requirements of the
 1304  program, and the procedures for enrollment in the program and to
 1305  maintain public awareness of the corporation and the program.
 1306         12.13. Secure staff necessary to properly administer the
 1307  corporation. Staff costs shall be funded from state and local
 1308  matching funds and such other private or public funds as become
 1309  available. The board of directors shall determine the number of
 1310  staff members necessary to administer the corporation.
 1311         13.14. In consultation with the partner agencies, provide a
 1312  report on the Florida Kidcare program annually to the Governor,
 1313  the Chief Financial Officer, the Commissioner of Education, the
 1314  President of the Senate, the Speaker of the House of
 1315  Representatives, and the Minority Leaders of the Senate and the
 1316  House of Representatives.
 1317         14.15. Provide information on a quarterly basis online to
 1318  the Legislature and the Governor which compares the costs and
 1319  utilization of the full-pay enrolled population and the Title
 1320  XXI-subsidized enrolled population in the Florida Kidcare
 1321  program. The information, at a minimum, must include:
 1322         a. The monthly enrollment and expenditure for full-pay
 1323  enrollees in the Medikids and Florida Healthy Kids programs
 1324  compared to the Title XXI-subsidized enrolled population; and
 1325         b. The costs and utilization by service of the full-pay
 1326  enrollees in the Medikids and Florida Healthy Kids programs and
 1327  the Title XXI-subsidized enrolled population.
 1328         15.16. Establish benefit packages that conform to the
 1329  provisions of the Florida Kidcare program, as created in ss.
 1330  409.810-409.821.
 1331         16. Contract with other insurance affordability programs to
 1332  provide such services that are consistent with this act.
 1333         17. Annually develop performance metrics for the following
 1334  focus areas:
 1335         a. Administrative functions.
 1336         b. Contracting with vendors.
 1337         c. Customer service.
 1338         d. Enrollee education.
 1339         e. Financial services.
 1340         f. Program integrity.
 1341         (c) Coverage under the corporation’s program is secondary
 1342  to any other available private coverage held by, or applicable
 1343  to, the participant child or family member. Insurers under
 1344  contract with the corporation are the payors of last resort and
 1345  must coordinate benefits with any other third-party payor that
 1346  may be liable for the participant’s medical care.
 1347         (d) The Florida Healthy Kids Corporation shall be a private
 1348  corporation not for profit, organized pursuant to chapter 617,
 1349  and shall have all powers necessary to carry out the purposes of
 1350  this act, including, but not limited to, the power to receive
 1351  and accept grants, loans, or advances of funds from any public
 1352  or private agency and to receive and accept from any source
 1353  contributions of money, property, labor, or any other thing of
 1354  value, to be held, used, and applied for the purposes of this
 1355  act.
 1357         (a) The Florida Healthy Kids Corporation shall operate
 1358  subject to the supervision and approval of a board of directors.
 1359  The board chair shall be an appointee designated by the
 1360  Governor, and the board shall be chaired by the Chief Financial
 1361  Officer or her or his designee, and composed of 12 other
 1362  members. The Senate shall confirm the designated chair and other
 1363  board appointees. The board members shall be appointed selected
 1364  for 3-year terms. of office as follows:
 1365         1. The Secretary of Health Care Administration, or his or
 1366  her designee.
 1367         2. One member appointed by the Commissioner of Education
 1368  from the Office of School Health Programs of the Florida
 1369  Department of Education.
 1370         3. One member appointed by the Chief Financial Officer from
 1371  among three members nominated by the Florida Pediatric Society.
 1372         4. One member, appointed by the Governor, who represents
 1373  the Children’s Medical Services Program.
 1374         5. One member appointed by the Chief Financial Officer from
 1375  among three members nominated by the Florida Hospital
 1376  Association.
 1377         6. One member, appointed by the Governor, who is an expert
 1378  on child health policy.
 1379         7. One member, appointed by the Chief Financial Officer,
 1380  from among three members nominated by the Florida Academy of
 1381  Family Physicians.
 1382         8. One member, appointed by the Governor, who represents
 1383  the state Medicaid program.
 1384         9. One member, appointed by the Chief Financial Officer,
 1385  from among three members nominated by the Florida Association of
 1386  Counties.
 1387         10. The State Health Officer or her or his designee.
 1388         11. The Secretary of Children and Families, or his or her
 1389  designee.
 1390         12. One member, appointed by the Governor, from among three
 1391  members nominated by the Florida Dental Association.
 1392         (b) A member of the board of directors shall be appointed
 1393  by and serve at the pleasure of the Governor may be removed by
 1394  the official who appointed that member. The board shall appoint
 1395  an executive director, who is responsible for other staff
 1396  authorized by the board.
 1397         (c) Board members are entitled to receive, from funds of
 1398  the corporation, reimbursement for per diem and travel expenses
 1399  as provided by s. 112.061.
 1400         (d) There shall be no liability on the part of, and no
 1401  cause of action shall arise against, any member of the board of
 1402  directors, or its employees or agents, for any action they take
 1403  in the performance of their powers and duties under this act.
 1404         (e) Terms for board members appointed under this act are
 1405  effective January 1, 2016.
 1407         (a) The corporation shall not be deemed an insurer. The
 1408  officers, directors, and employees of the corporation shall not
 1409  be deemed to be agents of an insurer. Neither the corporation
 1410  nor any officer, director, or employee of the corporation is
 1411  subject to the licensing requirements of the insurance code or
 1412  the rules of the Department of Financial Services. However, any
 1413  marketing representative utilized and compensated by the
 1414  corporation must be appointed as a representative of the
 1415  insurers or health services providers with which the corporation
 1416  contracts.
 1417         (b) The board has complete fiscal control over the
 1418  corporation and is responsible for all corporate operations.
 1419         (c) The Department of Financial Services shall supervise
 1420  any liquidation or dissolution of the corporation and shall
 1421  have, with respect to such liquidation or dissolution, all power
 1422  granted to it pursuant to the insurance code.
 1423         (8) TRANSITION PLANS.—The corporation shall confer with the
 1424  Agency for Health Care Administration, the Department of
 1425  Children and Families, and Florida Health Choices, Inc., to
 1426  develop transition plans for the Florida Health Insurance
 1427  Affordability Exchange Program as created under ss. 409.72
 1428  409.731.
 1429         Section 18. Section 624.915, Florida Statutes, is repealed.
 1430         Section 19. The Division of Law Revision and Information is
 1431  directed to replace the phrase “the effective date of this act”
 1432  wherever it occurs in this act with the date the act becomes a
 1433  law.
 1434         Section 20. If any law amended by this act was also amended
 1435  by a law enacted during the 2015 Regular Session of the
 1436  Legislature, such laws shall be construed as if enacted during
 1437  the same session of the Legislature, and full effect shall be
 1438  given to each if possible.
 1439         Section 21. This act shall take effect upon becoming a law.