Florida Senate - 2015                       CS for CS for SB 2-A
       By the Committees on Appropriations; and Health Policy; and
       Senator Bean
       576-00041-15A                                           20152Ac2
    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; providing for the
   32         establishment of a commission; providing purposes and
   33         duties of the commission and for the appointment of
   34         members; requiring a commission report to be submitted
   35         to the Governor and the Legislature; repealing s.
   36         408.70, F.S., relating to legislative findings
   37         regarding access to affordable health care; amending
   38         s. 408.910, F.S.; revising legislative intent;
   39         redefining terms; revising the scope of the Florida
   40         Health Choices Program and the pricing of services
   41         under the program; providing requirements for
   42         operation of the marketplace; providing additional
   43         duties for the corporation to perform; requiring an
   44         annual report to the Governor and the Legislature;
   45         amending s. 409.904, F.S.; limiting eligible persons
   46         in the Medically Needy program to those under the age
   47         of 21 and pregnant women, and specifying an effective
   48         date; providing an expiration date for the program;
   49         amending s. 624.91, F.S.; revising eligibility
   50         requirements for state-funded assistance; revising the
   51         duties and powers of the Florida Healthy Kids
   52         Corporation; revising provisions for the appointment
   53         of members of the board of the Florida Healthy Kids
   54         Corporation; requiring transition plans; repealing s.
   55         624.915, F.S., relating to the operating fund of the
   56         Florida Healthy Kids Corporation; providing a
   57         directive to the Division of Law Revision and
   58         Information; providing for construction of the act in
   59         pari materia with laws enacted during the 2015 Regular
   60         Session of the Legislature; providing an effective
   61         date.
   63  Be It Enacted by the Legislature of the State of Florida:
   65         Section 1. The Division of Law Revision and Information is
   66  directed to rename part II of chapter 409, Florida Statutes, as
   67  “Insurance Affordability Programs” and to incorporate ss.
   68  409.72-409.731, Florida Statutes, under this part.
   69         Section 2. Section 409.72, Florida Statutes, is created to
   70  read:
   71         409.72 Short title.—Sections 409.72-409.731 may be cited as
   72  the “Florida Health Insurance Affordability Exchange Program”
   73  (“FHIX”).
   74         Section 3. Section 409.721, Florida Statutes, is created to
   75  read:
   76         409.721 Program authority.—The Florida Health Insurance
   77  Affordability Exchange Program (FHIX) is created within the
   78  Agency for Health Care Administration to assist Floridians in
   79  purchasing health benefits coverage and gaining access to health
   80  services. The products and services offered by FHIX are based on
   81  the following principles:
   82         (1) FAIR VALUE.—Financial assistance will be rationally
   83  allocated regardless of differences in categorical eligibility.
   84         (2) CONSUMER CHOICE.—Participants will be offered
   85  meaningful choices in the way the participants can redeem the
   86  value of the available assistance.
   87         (3) SIMPLICITY.—Obtaining assistance will be consumer
   88  friendly, and customer support will be available when needed.
   89         (4) PORTABILITY.—Participants can continue to access the
   90  FHIX services and products despite changes in their
   91  circumstances.
   92         (5) EMPLOYMENT.—Assistance will be offered in a way that
   93  incentivizes employment.
   94         (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a
   95  manner that maximizes individual control over available
   96  resources.
   97         (7) RISK ADJUSTMENT.—The amount of assistance will reflect
   98  participants’ medical risk.
   99         Section 4. Section 409.722, Florida Statutes, is created to
  100  read:
  101         409.722 Definitions.—As used in ss. 409.72-409.731, the
  102  term:
  103         (1) “Agency” means the Agency for Health Care
  104  Administration.
  105         (2) “Applicant” means an individual who applies for
  106  determination of eligibility for health benefits coverage under
  107  this part.
  108         (3) “Corporation” means Florida Health Choices, Inc., as
  109  established under s. 408.910.
  110         (4) “Enrollee” means a participant who has been determined
  111  eligible for and is receiving health benefits coverage under
  112  this part.
  113         (5) “Federal exchange” or “exchange” means an insurance
  114  platform regulated by the Federal Government which offers tiers
  115  of health plans from the least comprehensive plan to the most
  116  comprehensive plan.
  117         (6) “FHIX marketplace” or “marketplace” means the single,
  118  centralized market established under s. 408.910 which
  119  facilitates health benefits coverage.
  120         (7) “Florida Health Insurance Affordability Exchange
  121  Program” or “FHIX” means the program created under ss. 409.72
  122  409.731.
  123         (8) “Florida Healthy Kids Corporation” means the entity
  124  created under s. 624.91.
  125         (9) “Florida Kidcare program” or “Kidcare program” means
  126  the health benefits coverage administered through ss. 409.810
  127  409.821.
  128         (10) “Health benefits coverage” means the payment of
  129  benefits for covered health care services or the availability,
  130  directly or through arrangements with other persons, of covered
  131  health care services on a prepaid per capita basis or on a
  132  prepaid aggregate fixed-sum basis.
  133         (11) “Inactive status” means the enrollment status of a
  134  participant previously enrolled in health benefits coverage
  135  through FHIX who lost coverage for noncompliance pursuant to s.
  136  409.723, but who maintains access to his or her balance in a
  137  health savings account or health reimbursement account.
  138         (12) “Medicaid” means the medical assistance program
  139  authorized by Title XIX of the Social Security Act, and
  140  regulations thereunder, and parts III and IV of this chapter, as
  141  administered in this state by the agency.
  142         (13) “Modified adjusted gross income” means the
  143  individual’s or household’s annual adjusted gross income, as
  144  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986,
  145  which is used to determine eligibility for FHIX.
  146         (14) “Patient Protection and Affordable Care Act” or
  147  “Affordable Care Act” means Pub. L. No. 111-148, as amended by
  148  the Health Care and Education Reconciliation Act of 2010, Pub.
  149  L. No. 111-152, and regulations adopted pursuant to those acts.
  150         (15) “Premium credit” means the monthly amount paid by the
  151  agency per enrollee in the Florida Health Insurance
  152  Affordability Exchange Program toward health benefits coverage.
  153         (16) “Qualified alien” means an alien as defined in 8
  154  U.S.C. s. 1641(b) or (c).
  155         (17) “Resident” means a United States citizen or qualified
  156  alien who is domiciled in this state.
  157         Section 5. Section 409.723, Florida Statutes, is created to
  158  read:
  159         409.723Participation.—
  160         (1) ELIGIBILITY.—To participate in FHIX, an individual must
  161  be a resident and meet the following requirements, as
  162  applicable:
  163         (a) Qualify as a newly eligible enrollee, and be an
  164  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
  165  Social Security Act or s. 2001 of the Affordable Care Act and as
  166  may be further defined by federal regulation.
  167         (b) Meet and maintain the responsibilities under subsection
  168  (4).
  169         (c) Qualify for participation in the Florida Healthy Kids
  170  program under s. 624.91, subject to the implementation of Phase
  171  Two under s. 409.727.
  172         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
  173  an application to the department for an eligibility
  174  determination.
  175         (a) Applications may be submitted online, or by mail,
  176  facsimile, or any other method permitted by law or regulation.
  177         (b) The department is responsible for any eligibility
  178  correspondence and status updates to the participant and other
  179  agencies.
  180         (c) The department shall review a participant’s eligibility
  181  at least every 12 months.
  182         (d) An application or renewal is deemed complete when the
  183  participant has met all the requirements under subsection (4),
  184  as applicable.
  185         (3) PARTICIPANT RIGHTS.—A participant has all of the
  186  following rights:
  187         (a)Access to the FHIX marketplace or federal exchange to
  188  select the scope, amount, and type of health care coverage and
  189  other services to be purchased.
  190         (b) Continuity and portability of coverage to avoid
  191  disruption of coverage and other health care services when the
  192  participant’s economic circumstances change.
  193         (c) Retention of applicable unspent credits in the
  194  participant’s health savings or health reimbursement account
  195  following a change in the participant’s eligibility status.
  196  Credits are valid for a participant in an inactive status for up
  197  to 5 years after the participant’s status first becomes
  198  inactive.
  199         (d) Ability to select more than one product or plan on the
  200  FHIX marketplace or federal exchange.
  201         (e) Choice of at least two health benefits products that
  202  meet the requirements of the Affordable Care Act.
  203         (4) PARTICIPANT RESPONSIBILITIES.—A participant must:
  204         (a) Complete an initial application for health benefits
  205  coverage and the annual renewal process.
  206         (b) Provide evidence of participation in one or more of the
  207  following activities at the levels required under paragraph (c):
  208         1. Paid employment.
  209         2. On the job training or job placement activities that are
  210  validated through registration with CareerSource Florida.
  211         3. Educational pursuits.
  213  A participant who is a disabled adult or the caregiver of a
  214  disabled child or adult may submit a request to the department
  215  for an exception to the requirements in this paragraph. Such
  216  participant shall annually submit to the department a request to
  217  renew the exception. The term “disabled” means any person who
  218  has one or more permanent physical or mental impairments that
  219  substantially limit his or her ability to perform one or more
  220  major life activities of daily living, as defined by the
  221  Americans with Disabilities Act, without receiving more than 8
  222  hours of assistance per day.
  223         (c) Engage in the activities required under paragraph (b)
  224  at the following minimum levels:
  225         1. For a parent of a child younger than 18 years of age, a
  226  minimum of 20 hours weekly.
  227         2. For a childless adult, a minimum of 30 hours weekly.
  228         (d) Learn and remain informed about the choices available
  229  in the FHIX marketplace or the federal exchange and the
  230  allowable uses of credits in the individual accounts.
  231         (e) Execute a contract with the department which
  232  acknowledges that:
  233         1. FHIX is not an entitlement and state and federal funding
  234  may end at any time;
  235         2. Failure to pay required premiums or cost sharing will
  236  result in a transition to inactive status; and
  237         3. Noncompliance with the participation requirements as
  238  established under s. 409.723 will result in a transition to
  239  inactive status.
  240         (f) Select plans and other products in a timely manner.
  241         (g) Comply with program rules and the prohibitions against
  242  fraud, as described in s. 414.39.
  243         (h) Timely make monthly premium and any other cost-sharing
  244  payments.
  245         (i) Meet minimum coverage requirements by selecting either
  246  a high-deductible health plan combined with a health savings or
  247  a reimbursement account or a combination of plans or products
  248  with an actuarial value that meets or exceeds benefits available
  249  under the federal exchange.
  250         (5) COST SHARING.—
  251         (a) Enrollees are assessed monthly premiums based on their
  252  modified adjusted gross income. The maximum monthly premium
  253  payments are set at the following income levels:
  254         1. At or below 22 percent of the federal poverty level: $3.
  255         2. Greater than 22 percent, but at or below 50 percent, of
  256  the federal poverty level: $8.
  257         3. Greater than 50 percent, but at or below 75 percent, of
  258  the federal poverty level: $15.
  259         4. Greater than 75 percent, but at or below 100 percent, of
  260  the federal poverty level: $20.
  261         5. Greater than 100 percent of the federal poverty level:
  262  $25.
  263         (b) Depending on the products and services selected by the
  264  enrollee, the enrollee may also incur additional cost sharing,
  265  such as copayments, deductibles, or other out-of-pocket costs.
  266         (c) An enrollee may be subject to charge for an
  267  inappropriate emergency room visit of up to $8 for the first
  268  visit and up to $25 for any subsequent visit, based on the
  269  enrollee’s benefit plan, to discourage inappropriate use of the
  270  emergency room.
  271         (d) Cumulative annual cost sharing per enrollee may not
  272  exceed 5 percent of an enrollee’s annual modified adjusted gross
  273  income.
  274         (e) If, after a 30-day grace period, a full premium payment
  275  has not been received, the enrollee shall be transitioned from
  276  coverage to inactive status and may not reenroll for a minimum
  277  of 6 months, unless a hardship exception has been granted.
  278  Enrollees may seek a hardship exception under the Medicaid Fair
  279  Hearing Process.
  280         Section 6. Section 409.724, Florida Statutes, is created to
  281  read:
  282         409.724Available assistance.—
  283         (1)PREMIUM CREDITS.—
  284         (a) Standard amount.—The standard monthly premium credit is
  285  equivalent to the applicable risk-adjusted capitation rate paid
  286  to Medicaid managed care plans under part IV of this chapter.
  287         (b) Supplemental funding.—Subject to federal approval,
  288  additional resources may be made available to enrollees and
  289  incorporated into FHIX.
  290         (c) Savings accounts.—In addition to the benefits provided
  291  under this section, the corporation must offer each enrollee
  292  access to an individual account that qualifies as a health
  293  reimbursement account or a health savings account.
  294         1. Unexpended Funds.—Eligible unexpended funds from the
  295  monthly premium credit must be deposited into each enrollee’s
  296  individual account in a timely manner. Funds deposited into
  297  these individual accounts may be used to pay cost-sharing
  298  obligations or to purchase other health-related items to the
  299  extent permitted under federal and state law.
  300         2.Healthy Behaviors.—Enrollees may receive credits to
  301  their individual accounts for healthy behaviors, adherence to
  302  wellness programs, and other activities that demonstrate
  303  compliance with prevention or disease management guidelines.
  304         3. Enrollee contributions.—The enrollee may make deposits
  305  to his or her account at any time to supplement the premium
  306  credit, to purchase additional FHIX products, or to offset other
  307  cost-sharing obligations.
  308         4. Third parties.—Third parties, including, but not limited
  309  to, an employer or relative, may also make deposits on behalf of
  310  the enrollee into the enrollee’s FHIX marketplace account. The
  311  enrollee may not withdraw any funds as a refund, except those
  312  funds the enrollee has deposited into his or her account.
  313         (2) CHOICE COUNSELING.—The agency, in consultation with the
  314  Florida Healthy Kids Corporation and the corporation, shall
  315  develop a choice counseling program for FHIX. The choice
  316  counseling program must ensure that participants have
  317  information about the FHIX marketplace program, the federal
  318  exchange, products, and services and that participants know
  319  where and whom to call for questions or to make their plan
  320  selections. The choice counseling program must provide
  321  culturally sensitive materials and must take into consideration
  322  the demographics of the projected population.
  323         (3)EDUCATION CAMPAIGN.—The agency, the corporation, and
  324  the Florida Healthy Kids Corporation must coordinate in advance
  325  of Phase One an ongoing education campaign to inform
  326  participants, at a minimum, of the following:
  327         (a) How the FHIX marketplace operates and the timeline for
  328  enrollment.
  329         (b) Plans that are available and how to find information
  330  about these plans.
  331         (c) Information about other available insurance
  332  affordability programs for the participant and his or her
  333  family.
  334         (d) Information about health benefits coverage, provider
  335  networks, and cost sharing for available plans in each region.
  336         (e) Information on how to complete the required annual
  337  renewal process, including renewal dates and deadlines.
  338         (f) Information on how to update eligibility if the
  339  participant’s data have changed since his or her last renewal or
  340  application date.
  341         (4) CUSTOMER SUPPORT.—The Florida Healthy Kids Corporation
  342  shall provide customer support for FHIX, including, but not
  343  limited to, general program information, financial information,
  344  and enrollee payments. Customer support must also provide a
  345  toll-free telephone number and maintain a website that is
  346  available in multiple languages and that meets the needs of the
  347  enrollee population.
  348         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  349  inactive participant about other insurance affordability
  350  programs and electronically refer the participant to the federal
  351  exchange or other insurance affordability programs, as
  352  appropriate.
  353         Section 7. Section 409.725, Florida Statutes, is created to
  354  read:
  355         409.725Available products and services.—The FHIX
  356  marketplace shall offer the following products and services:
  357         (1) Products and services authorized pursuant to s.
  358  408.910.
  359         (2) Products authorized by the federal exchange.
  360         (3) Products authorized by the Florida Healthy Kids
  361  Corporation pursuant to s. 624.91.
  362         (4) Premium credits for participation in employer-sponsored
  363  plans.
  364         Section 8. Section 409.726, Florida Statutes, is created to
  365  read:
  366         409.726Program accountability.—
  367         (1) All managed care plans that participate in FHIX must
  368  collect and maintain encounter level data in accordance with the
  369  encounter data requirements under s. 409.967(2)(d) and are
  370  subject to the accompanying penalties under s. 409.967(2)(h)2.
  371  The agency is responsible for the collection and maintenance of
  372  the encounter level data.
  373         (2)The corporation, in consultation with the agency, shall
  374  establish access and network standards for contracts on the FHIX
  375  marketplace, shall ensure that contracted plans have sufficient
  376  providers to meet enrollee needs, and shall develop quality of
  377  coverage and provider standards specific to the adult
  378  population.
  379         (3)The department shall develop accountability measures
  380  and performance standards to be applied to initial and renewal
  381  FHIX applications that are submitted online, by mail, by
  382  facsimile, or through referrals from a third party. The minimum
  383  performance standards are:
  384         (a) Application processing speed.—Ninety percent of all
  385  applications, regardless of the method of submission, must be
  386  processed within 45 days.
  387         (b) Application processing speed from online sources.
  388  Ninety-five percent of all applications received from online
  389  sources must be processed within 45 days.
  390         (c) Renewal application processing speed.—Ninety percent of
  391  all renewals, regardless of the method of submission, must be
  392  processed within 45 days.
  393         (d) Renewal application processing speed from online
  394  sources.—Ninety-five percent of all applications received from
  395  online sources must be processed within 45 days.
  396         (4) The agency, the department, and the Florida Healthy
  397  Kids Corporation must meet the following standards for their
  398  respective roles in the program:
  399         (a) Eighty-five percent of calls must be answered in 20
  400  seconds or less.
  401         (b) All contacts, including, but not limited to, telephone
  402  calls, faxed documents and requests, and e-mails, must be
  403  handled within 2 business days.
  404         (c)Any self-service tools available to participants, such
  405  as interactive voice response systems, must be operational 7
  406  days a week, 24 hours a day, at least 98 percent of each month.
  407         (5) The agency, the department, and the Florida Healthy
  408  Kids Corporation shall conduct an annual satisfaction survey to
  409  address all measures that require participant input specific to
  410  the FHIX marketplace program. The parties may elect to
  411  incorporate these elements into the annual report required under
  412  subsection (7).
  413         (6) The agency and the corporation shall post online
  414  monthly enrollment reports for FHIX.
  415         (7) Beginning in 2016, an annual report is due no later
  416  than July 1 to the Governor, the President of the Senate, and
  417  the Speaker of the House of Representatives. The annual report
  418  must be coordinated by the agency and the corporation and must
  419  include at least the following:
  420         (a) Enrollment and application trends and issues.
  421         (b) Utilization and cost data.
  422         (c) Customer satisfaction.
  423         (d) Funding sources in health savings accounts or health
  424  reimbursement accounts.
  425         (e) Enrollee use of funds in health savings accounts or
  426  health reimbursement accounts.
  427         (f) Types of products and plans purchased.
  428         (g) Movement of enrollees across different insurance
  429  affordability programs.
  430         (h) Recommendations for program improvement.
  431         Section 9. Section 409.727, Florida Statutes, is created to
  432  read:
  433         409.727Readiness review and implementation schedule.—The
  434  agency, the corporation, the department, and the Florida Healthy
  435  Kids Corporation shall begin implementation of FHIX on the
  436  effective date of this act, with enrollment for Phase One
  437  beginning by January 1, 2016.
  438         (1) READINESS REVIEW.—Before implementation of any phase
  439  under this part or in any region, the agency shall conduct a
  440  readiness review in consultation with the FHIX Workgroup
  441  established pursuant to s. 409.729. The agency shall determine,
  442  at a minimum, the following readiness milestones:
  443         (a) Functional readiness of the service delivery platform.
  444         (b) Plan availability and presence of plan choice.
  445         (c) Provider network capacity and adequacy of the available
  446  plans.
  447         (d) Availability of customer support.
  448         (e) Other factors critical to the success of FHIX.
  449         (2) PHASE ONE.—The agency, the corporation, and the Florida
  450  Healthy Kids Corporation shall coordinate implementation
  451  activities to ensure that enrollment begins by January 1, 2016,
  452  and is available in all regions by July 1, 2016.
  453         (a) Beginning no later than January 1, 2016, and contingent
  454  upon federal approval, participants may enroll in health
  455  benefits coverage under the FHIX marketplace or the federal
  456  exchange, if eligible.
  457         (b)To be eligible for enrollment during this phase, a
  458  participant must meet the requirements under s. 409.723(1)(a)
  459  and (b).
  460         (c) An enrollee may select any benefit, service, or product
  461  available in the region.
  462         (d) The corporation shall notify an enrollee of his or her
  463  premium credit amount and how to access the FHIX marketplace
  464  selection process or the federal exchange.
  465         (e) An enrollee must have a choice of at least two managed
  466  care plans in each region which meet or exceed the Affordable
  467  Care Act’s requirements and which qualify for a premium credit
  468  on the FHIX marketplace or federal exchange.
  469         (f) Choice counseling and customer service must be provided
  470  in accordance with s. 409.724(2) and (4).
  471         (3) PHASE TWO.—
  472         (a) No later than July 1, 2016, the corporation and the
  473  Florida Healthy Kids Corporation shall begin the transition of
  474  enrollees under s. 624.91 to the FHIX marketplace.
  475         (b)Eligibility during this phase is based on meeting the
  476  requirements of s. 409.723(1)(c) and (4).
  477         (c) An enrollee may select any available benefit, service,
  478  or product available under s. 409.725.
  479         (d) A Florida Healthy Kids enrollee who selects a FHIX
  480  marketplace plan or federal exchange plan shall be provided a
  481  premium credit equivalent to the average capitation rate paid in
  482  his or her county of residence under Florida Healthy Kids as of
  483  June 30, 2016. The enrollee is responsible for any difference in
  484  costs and may use any unexpended funds deposited in his or her
  485  savings account under s. 409.724(1)(c) for supplemental benefits
  486  on the FHIX marketplace or federal exchange.
  487         (e) The corporation shall notify an enrollee of his or her
  488  premium credit amount and how to access the FHIX marketplace
  489  selection process or federal exchange.
  490         (f) Choice counseling and customer service must be provided
  491  in accordance with s. 409.724(2) and (4).
  492         (g) Enrollees under s. 624.91 must transition to the FHIX
  493  marketplace and coverage under s. 409.725 by September 30, 2016.
  494         Section 10. Section 409.728, Florida Statutes, is created
  495  to read:
  496         409.728Program operation and management.—In order to
  497  implement ss. 409.72-409.731:
  498         (1) The agency shall do all of the following:
  499         (a) Contract with the corporation for the development,
  500  implementation, and administration of the Florida Health
  501  Insurance Affordability Exchange Program and for the release of
  502  any federal, state, or other funds appropriated to the
  503  corporation.
  504         (b) Provide administrative support to the FHIX Workgroup
  505  established pursuant to s. 409.729.
  506         (c) Consult with stakeholders that serve low-income
  507  individuals and families during implementation, using a public
  508  input process.
  509         (d) Timely transmit enrollee information to the
  510  corporation.
  511         (e) Annually determine the risk-adjusted rate to be paid
  512  per month based on historical utilization and spending data for
  513  the medical and behavioral health of enrollee population,
  514  projected forward, and adjusted to reflect the eligibility
  515  category, medical and dental trends, geographic areas, and the
  516  clinical risk profile of the enrollees.
  517         (f) Transfer funds allocated for premium credits by General
  518  Appropriations Act to the corporation.
  519         (g) Adopt rules in coordination with the corporation and
  520  the Florida Healthy Kids Corporation in order to implement FHIX,
  521  including modifying existing rules implementing the Children’s
  522  Health Insurance Program and adapting adult focused provisions
  523  for children to accommodate the seamless transition of Healthy
  524  Kids enrollees to FHIX.
  525         (2) The department shall, in coordination with the
  526  corporation, the agency, and the Florida Healthy Kids
  527  Corporation, determine eligibility of applications and
  528  application renewals for FHIX in accordance with s. 409.902 and
  529  shall transmit eligibility determination information on a timely
  530  basis to the agency and corporation.
  531         (3) The Florida Healthy Kids Corporation shall do all of
  532  the following:
  533         (a) Retain its duties and responsibilities under s. 624.91
  534  during Phase One of the program.
  535         (b) In coordination with the agency and the corporation,
  536  provide customer service for the FHIX marketplace.
  537         (c) Transfer funds and provide financial support to the
  538  FHIX marketplace, including the collection of monthly cost
  539  sharing payments.
  540         (d) Conduct financial reporting related to such activities,
  541  in coordination with the corporation and the agency.
  542         (e) Coordinate program activities with the agency, the
  543  department, and the corporation.
  544         (4) Florida Health Choices, Inc., shall do all of the
  545  following:
  546         (a) Develop and maintain the FHIX marketplace.
  547         (b) Implement and administer Phase One and Phase Two of the
  548  FHIX marketplace and the ongoing operations of the program.
  549         (c) Offer health benefits coverage packages on the FHIX
  550  marketplace, including plans compliant with the Affordable Care
  551  Act.
  552         (d) Offer FHIX enrollees a choice of at least two plans per
  553  county at each benefit level which meet the requirements under
  554  the Affordable Care Act.
  555         (e) Offer the opportunity to participate in the federal
  556  exchange.
  557         (f) Offer enhanced or customized benefits to FHIX
  558  marketplace enrollees.
  559         (g) Provide sufficient staff and resources to meet the
  560  program needs of enrollees.
  561         (h) Provide an opportunity for plans contracted with or
  562  previously contracted with the Florida Healthy Kids Corporation
  563  under s. 624.91 to participate with FHIX if those plans meet the
  564  requirements of the program.
  565         (i) Encourage insurance agents licensed under chapter 626
  566  to identify and assist enrollees. This act does not prohibit
  567  these agents from receiving usual and customary commissions from
  568  insurers and health maintenance organizations that offer plans
  569  in the FHIX marketplace.
  570         Section 11. Section 409.729, Florida Statutes, is created
  571  to read:
  572         409.729 Long-term reorganization.—The FHIX Workgroup is
  573  created to facilitate the implementation of FHIX and to plan for
  574  the reorganization of the state’s insurance affordability
  575  programs. The FHIX Workgroup consists of two representatives
  576  each from the agency, the department, the Florida Healthy Kids
  577  Corporation, and the corporation. An additional representative
  578  of the agency serves as chair. The FHIX Workgroup must hold its
  579  organizational meeting no later than 30 days after the effective
  580  date of this act and must meet at least bimonthly. The role of
  581  the FHIX Workgroup is to make recommendations to the agency. The
  582  responsibilities of the workgroup include, but are not limited
  583  to:
  584         (1) Developing and presenting a final implementation plan
  585  that meets the requirements of this part in a report submitted
  586  to the Governor, the President of the Senate, and the Speaker of
  587  the House of Representatives no later than November 1, 2015.
  588         (2) Reviewing network and access standards for plans and
  589  products.
  590         (3) Assessing readiness and recommending actions needed to
  591  reorganize the state’s insurance affordability programs for each
  592  phase or region. If a phase or region receives a nonreadiness
  593  recommendation, the agency shall notify the Legislature of that
  594  recommendation, the reasons for such a recommendation, and
  595  proposed plans for achieving readiness.
  596         (4) Recommending any proposed change to the Title XIX
  597  funded or Title XXI-funded programs based on the continued
  598  availability and reauthorization of the Title XXI program and
  599  its federal funding.
  600         (5) Identifying duplication of services by the corporation,
  601  the agency, and the Florida Healthy Kids Corporation currently
  602  and under FHIX’s proposed Phase Two program.
  603         (6) Evaluating any fiscal impacts based on the proposed
  604  transition plan under Phase Two.
  605         (7) Compiling a schedule of impacted contracts, leases, and
  606  other assets.
  607         (8) Determining staff requirements for Phase Two.
  608         Section 12. Section 409.73, Florida Statutes, is created to
  609  read:
  610         409.73Legislative Review.—The agency may seek federal
  611  approval to implement FHIX as provided in ss. 409.72-409.731.
  612  The agency is prohibited from implementing the FHIX waiver
  613  without specific legislative approval unless the terms and
  614  conditions of the approved waiver are substantially consistent
  615  with the statutory requirements for this program.
  616         Section 13. Section 409.731, Florida Statutes, is created
  617  to read:
  618         409.731 Program expiration.—
  619         (1) The Florida Health Insurance Affordability Exchange
  620  Program expires at the end of the state fiscal year in which any
  621  of these conditions occurs:
  622         (a) The federal match contribution for the newly eligible
  623  under the Affordable Care Act falls below 90 percent.
  624         (b) The federal match contribution falls below the
  625  increased Federal Medical Assistance Percentage for medical
  626  assistance for newly eligible mandatory individuals as specified
  627  in the Affordable Care Act.
  628         (c) The federal match for the FHIX program and the Medicaid
  629  program are blended under federal law or regulation in such a
  630  manner that causes the overall federal contribution to diminish
  631  when compared to separate, nonblended federal contributions.
  632         (2) Provided the conditions specified in subsection (1)
  633  have not previously occurred, the Florida Health Insurance
  634  Affordability Exchange Program shall expire on July 1, 2018,
  635  unless reviewed and reenacted by the Legislature.
  636         (3)The Health Outcomes Review Commission is established to
  637  assess the following indicators:
  638         (a) Patient outcomes.Selected measures from the National
  639  Healthcare Quality Report or similarly credible sources will be
  640  applied to FHIX enrollees and compared to outcomes for Managed
  641  Medical Assistance enrollees and uninsured patients.
  642         (b) Fiscal impact.Actual annual state general revenue
  643  expenditures for the FHIX program will be compared to predicted
  644  expenditures.
  645         (c) Access to care.Potentially preventable hospitalization
  646  rates for acute and chronic conditions and potentially
  647  preventable emergency department visits among FHIX enrollees
  648  will be compared to Managed Medical Assistance enrollees and
  649  uninsured patients.
  650         (4)The Health Outcomes Review Commission shall consist of
  651  nine members appointed by the Governor, the President of the
  652  Senate, and the Speaker of the House. The Governor and each
  653  presiding officer shall appoint one healthcare professional, one
  654  private business representative, and one elected official.
  655         (5)The commission shall be appointed no later than January
  656  1, 2017, and shall meet regularly to select specific indicators,
  657  review preliminary data, and develop a framework for a final
  658  report. Staff support shall be provided to the commission by the
  659  Agency for Health Care Administration.
  660         (6)The commission’s final report shall be submitted to the
  661  Governor, the President of the Senate, and the Speaker of the
  662  House by January 1, 2018.
  663         Section 14. Section 408.70, Florida Statutes, is repealed.
  664         Section 15. Section 408.910, Florida Statutes, is amended
  665  to read:
  666         408.910 Florida Health Choices Program.—
  667         (1) LEGISLATIVE INTENT.—The Legislature finds that a
  668  significant number of the residents of this state do not have
  669  adequate access to affordable, quality health care. The
  670  Legislature further finds that increasing access to affordable,
  671  quality health care can be best accomplished by establishing a
  672  competitive market for purchasing health insurance and health
  673  services. It is therefore the intent of the Legislature to
  674  create and expand the Florida Health Choices Program to:
  675         (a) Expand opportunities for Floridians to purchase
  676  affordable health insurance and health services.
  677         (b) Preserve the benefits of employment-sponsored insurance
  678  while easing the administrative burden for employers who offer
  679  these benefits.
  680         (c) Enable individual choice in both the manner and amount
  681  of health care purchased.
  682         (d) Provide for the purchase of individual, portable health
  683  care coverage.
  684         (e) Disseminate information to consumers on the price and
  685  quality of health services.
  686         (f) Sponsor a competitive market that stimulates product
  687  innovation, quality improvement, and efficiency in the
  688  production and delivery of health services.
  689         (2) DEFINITIONS.—As used in this section, the term:
  690         (a) “Corporation” means the Florida Health Choices, Inc.,
  691  established under this section.
  692         (b) “Corporation’s marketplace” means the single,
  693  centralized market established by the program that facilitates
  694  the purchase of products made available in the marketplace.
  695         (c) “Florida Health Insurance Affordability Exchange
  696  Program” or “FHIX” is the program created under ss. 409.72
  697  409.731 for low-income, uninsured residents of this state.
  698         (d)(c) “Health insurance agent” means an agent licensed
  699  under part IV of chapter 626.
  700         (e)(d) “Insurer” means an entity licensed under chapter 624
  701  which offers an individual health insurance policy or a group
  702  health insurance policy, a preferred provider organization as
  703  defined in s. 627.6471, an exclusive provider organization as
  704  defined in s. 627.6472, or a health maintenance organization
  705  licensed under part I of chapter 641, or a prepaid limited
  706  health service organization or discount medical plan
  707  organization licensed under chapter 636.
  708         (f) “Patient Protection and Affordable Care Act” or
  709  “Affordable Care Act” means Pub. L. No. 111-148, as further
  710  amended by the Health Care and Education Reconciliation Act of
  711  2010, Pub. L. No. 111-152, and regulations adopted pursuant to
  712  those acts.
  713         (g)(e) “Program” means the Florida Health Choices Program
  714  established by this section.
  715         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
  716  Choices Program is created as a single, centralized market for
  717  the sale and purchase of various products that enable
  718  individuals to pay for health care. These products include, but
  719  are not limited to, health insurance plans, health maintenance
  720  organization plans, prepaid services, service contracts, and
  721  flexible spending accounts. The components of the program
  722  include:
  723         (a) Enrollment of employers.
  724         (b) Administrative services for participating employers,
  725  including:
  726         1. Assistance in seeking federal approval of cafeteria
  727  plans.
  728         2. Collection of premiums and other payments.
  729         3. Management of individual benefit accounts.
  730         4. Distribution of premiums to insurers and payments to
  731  other eligible vendors.
  732         5. Assistance for participants in complying with reporting
  733  requirements.
  734         (c) Services to individual participants, including:
  735         1. Information about available products and participating
  736  vendors.
  737         2. Assistance with assessing the benefits and limits of
  738  each product, including information necessary to distinguish
  739  between policies offering creditable coverage and other products
  740  available through the program.
  741         3. Account information to assist individual participants
  742  with managing available resources.
  743         4. Services that promote healthy behaviors.
  744         5.Health benefits coverage information about health
  745  insurance plans compliant with the Affordable Care Act.
  746         6. Consumer assistance with web-based information services
  747  for the Florida Health Insurance Affordability Exchange Program,
  748  or (”FHIX”).
  749         (d) Recruitment of vendors, including insurers, health
  750  maintenance organizations, prepaid clinic service providers,
  751  provider service networks, and other providers.
  752         (e) Certification of vendors to ensure capability,
  753  reliability, and validity of offerings.
  754         (f) Collection of data, monitoring, assessment, and
  755  reporting of vendor performance.
  756         (g) Information services for individuals and employers.
  757         (h) Program evaluation.
  758         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  759  program is voluntary and shall be available to employers,
  760  individuals, vendors, and health insurance agents as specified
  761  in this subsection.
  762         (a) Employers eligible to enroll in the program include
  763  those employers that meet criteria established by the
  764  corporation and elect to make their employees eligible through
  765  the program.
  766         (b) Individuals eligible to participate in the program
  767  include:
  768         1. Individual employees of enrolled employers.
  769         2. Other individuals that meet criteria established by the
  770  corporation.
  771         (c) Employers who choose to participate in the program may
  772  enroll by complying with the procedures established by the
  773  corporation. The procedures must include, but are not limited
  774  to:
  775         1. Submission of required information.
  776         2. Compliance with federal tax requirements for the
  777  establishment of a cafeteria plan, pursuant to s. 125 of the
  778  Internal Revenue Code, including designation of the employer’s
  779  plan as a premium payment plan, a salary reduction plan that has
  780  flexible spending arrangements, or a salary reduction plan that
  781  has a premium payment and flexible spending arrangements.
  782         3. Determination of the employer’s contribution, if any,
  783  per employee, provided that such contribution is equal for each
  784  eligible employee.
  785         4. Establishment of payroll deduction procedures, subject
  786  to the agreement of each individual employee who voluntarily
  787  participates in the program.
  788         5. Designation of the corporation as the third-party
  789  administrator for the employer’s health benefit plan.
  790         6. Identification of eligible employees.
  791         7. Arrangement for periodic payments.
  792         8. Employer notification to employees of the intent to
  793  transfer from an existing employee health plan to the program at
  794  least 90 days before the transition.
  795         (d) All eligible vendors who choose to participate and the
  796  products and services that the vendors are permitted to sell are
  797  as follows:
  798         1. Insurers licensed under chapter 624 may sell health
  799  insurance policies, limited benefit policies, other risk-bearing
  800  coverage, and other products or services.
  801         2. Health maintenance organizations licensed under part I
  802  of chapter 641 may sell health maintenance contracts, limited
  803  benefit policies, other risk-bearing products, and other
  804  products or services.
  805         3. Prepaid limited health service organizations may sell
  806  products and services as authorized under part I of chapter 636,
  807  and discount medical plan organizations may sell products and
  808  services as authorized under part II of chapter 636.
  809         4. Prepaid health clinic service providers licensed under
  810  part II of chapter 641 may sell prepaid service contracts and
  811  other arrangements for a specified amount and type of health
  812  services or treatments.
  813         5. Health care providers, including hospitals and other
  814  licensed health facilities, health care clinics, licensed health
  815  professionals, pharmacies, and other licensed health care
  816  providers, may sell service contracts and arrangements for a
  817  specified amount and type of health services or treatments.
  818         6. Provider organizations, including service networks,
  819  group practices, professional associations, and other
  820  incorporated organizations of providers, may sell service
  821  contracts and arrangements for a specified amount and type of
  822  health services or treatments.
  823         7. Corporate entities providing specific health services in
  824  accordance with applicable state law may sell service contracts
  825  and arrangements for a specified amount and type of health
  826  services or treatments.
  828  A vendor described in subparagraphs 3.-7. may not sell products
  829  that provide risk-bearing coverage unless that vendor is
  830  authorized under a certificate of authority issued by the Office
  831  of Insurance Regulation and is authorized to provide coverage in
  832  the relevant geographic area. Otherwise eligible vendors may be
  833  excluded from participating in the program for deceptive or
  834  predatory practices, financial insolvency, or failure to comply
  835  with the terms of the participation agreement or other standards
  836  set by the corporation.
  837         (e) Eligible individuals may participate in the program
  838  voluntarily. Individuals who join the program may participate by
  839  complying with the procedures established by the corporation.
  840  These procedures must include, but are not limited to:
  841         1. Submission of required information.
  842         2. Authorization for payroll deduction, if applicable.
  843         3. Compliance with federal tax requirements.
  844         4. Arrangements for payment.
  845         5. Selection of products and services.
  846         (f) Vendors who choose to participate in the program may
  847  enroll by complying with the procedures established by the
  848  corporation. These procedures may include, but are not limited
  849  to:
  850         1. Submission of required information, including a complete
  851  description of the coverage, services, provider network, payment
  852  restrictions, and other requirements of each product offered
  853  through the program.
  854         2. Execution of an agreement to comply with requirements
  855  established by the corporation.
  856         3. Execution of an agreement that prohibits refusal to sell
  857  any offered product or service to a participant who elects to
  858  buy it.
  859         4. Establishment of product prices based on applicable
  860  criteria.
  861         5. Arrangements for receiving payment for enrolled
  862  participants.
  863         6. Participation in ongoing reporting processes established
  864  by the corporation.
  865         7. Compliance with grievance procedures established by the
  866  corporation.
  867         (g) Health insurance agents licensed under part IV of
  868  chapter 626 are eligible to voluntarily participate as buyers’
  869  representatives. A buyer’s representative acts on behalf of an
  870  individual purchasing health insurance and health services
  871  through the program by providing information about products and
  872  services available through the program and assisting the
  873  individual with both the decision and the procedure of selecting
  874  specific products. Serving as a buyer’s representative does not
  875  constitute a conflict of interest with continuing
  876  responsibilities as a health insurance agent if the relationship
  877  between each agent and any participating vendor is disclosed
  878  before advising an individual participant about the products and
  879  services available through the program. In order to participate,
  880  a health insurance agent shall comply with the procedures
  881  established by the corporation, including:
  882         1. Completion of training requirements.
  883         2. Execution of a participation agreement specifying the
  884  terms and conditions of participation.
  885         3. Disclosure of any appointments to solicit insurance or
  886  procure applications for vendors participating in the program.
  887         4. Arrangements to receive payment from the corporation for
  888  services as a buyer’s representative.
  889         (5) PRODUCTS.—
  890         (a) The products that may be made available for purchase
  891  through the program include, but are not limited to:
  892         1. Health insurance policies.
  893         2. Health maintenance contracts.
  894         3. Limited benefit plans.
  895         4. Prepaid clinic services.
  896         5. Service contracts.
  897         6. Arrangements for purchase of specific amounts and types
  898  of health services and treatments.
  899         7. Flexible spending accounts.
  900         (b) Health insurance policies, health maintenance
  901  contracts, limited benefit plans, prepaid service contracts, and
  902  other contracts for services must ensure the availability of
  903  covered services.
  904         (c) Products may be offered for multiyear periods provided
  905  the price of the product is specified for the entire period or
  906  for each separately priced segment of the policy or contract.
  907         (d) The corporation shall provide a disclosure form for
  908  consumers to acknowledge their understanding of the nature of,
  909  and any limitations to, the benefits provided by the products
  910  and services being purchased by the consumer.
  911         (e) The corporation must determine that making the plan
  912  available through the program is in the interest of eligible
  913  individuals and eligible employers in the state.
  914         (6) PRICING.—Prices for the products and services sold
  915  through the program must be transparent to participants and
  916  established by the vendors. The corporation may shall annually
  917  assess a surcharge for each premium or price set by a
  918  participating vendor. Any The surcharge may not be more than 2.5
  919  percent of the price and shall be used to generate funding for
  920  administrative services provided by the corporation and payments
  921  to buyers’ representatives; however, a surcharge may not be
  922  assessed for products and services sold in the FHIX marketplace.
  923         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  924  single, centralized market for purchase of health insurance,
  925  health maintenance contracts, and other health products and
  926  services. Purchases may be made by participating individuals
  927  over the Internet or through the services of a participating
  928  health insurance agent. Information about each product and
  929  service available through the program shall be made available
  930  through printed material and an interactive Internet website.
  931         (a)Marketplace purchasing.A participant needing personal
  932  assistance to select products and services shall be referred to
  933  a participating agent in his or her area.
  934         1.(a) Participation in the program may begin at any time
  935  during a year after the employer completes enrollment and meets
  936  the requirements specified by the corporation pursuant to
  937  paragraph (4)(c).
  938         2.(b) Initial selection of products and services must be
  939  made by an individual participant within the applicable open
  940  enrollment period.
  941         3.(c) Initial enrollment periods for each product selected
  942  by an individual participant must last at least 12 months,
  943  unless the individual participant specifically agrees to a
  944  different enrollment period.
  945         4.(d) If an individual has selected one or more products
  946  and enrolled in those products for at least 12 months or any
  947  other period specifically agreed to by the individual
  948  participant, changes in selected products and services may only
  949  be made during the annual enrollment period established by the
  950  corporation.
  951         5.(e) The limits established in subparagraphs 2., 3., and
  952  4. paragraphs (b)-(d) apply to any risk-bearing product that
  953  promises future payment or coverage for a variable amount of
  954  benefits or services. The limits do not apply to initiation of
  955  flexible spending plans if those plans are not associated with
  956  specific high-deductible insurance policies or the use of
  957  spending accounts for any products offering individual
  958  participants specific amounts and types of health services and
  959  treatments at a contracted price.
  960         (b) FHIX marketplace purchasing.
  961         1. Participation in the FHIX marketplace may begin at any
  962  time during the year.
  963         2. Initial enrollment periods for certain products selected
  964  by an individual enrollee which are noncompliant with the
  965  Affordable Care Act may be required to last at least 12 months,
  966  unless the individual participant specifically agrees to a
  967  different enrollment period.
  968         (8) CONSUMER INFORMATION.—The corporation shall:
  969         (a) Establish a secure website to facilitate the purchase
  970  of products and services by participating individuals. The
  971  website must provide information about each product or service
  972  available through the program.
  973         (b) Inform individuals about other public health care
  974  programs.
  975         (9) RISK POOLING.—The program may use methods for pooling
  976  the risk of individual participants and preventing selection
  977  bias. These methods may include, but are not limited to, a
  978  postenrollment risk adjustment of the premium payments to the
  979  vendors. The corporation may establish a methodology for
  980  assessing the risk of enrolled individual participants based on
  981  data reported annually by the vendors about their enrollees.
  982  Distribution of payments to the vendors may be adjusted based on
  983  the assessed relative risk profile of the enrollees in each
  984  risk-bearing product for the most recent period for which data
  985  is available.
  986         (10) EXEMPTIONS.—
  987         (a) Products, other than the products set forth in
  988  subparagraphs (4)(d)1.-4., sold as part of the program are not
  989  subject to the licensing requirements of the Florida Insurance
  990  Code, as defined in s. 624.01 or the mandated offerings or
  991  coverages established in part VI of chapter 627 and chapter 641.
  992         (b) The corporation may act as an administrator as defined
  993  in s. 626.88 but is not required to be certified pursuant to
  994  part VII of chapter 626. However, a third-party third party
  995  administrator used by the corporation must be certified under
  996  part VII of chapter 626.
  997         (c) Any standard forms, website design, or marketing
  998  communication developed by the corporation and used by the
  999  corporation, or any vendor that meets the requirements of
 1000  paragraph (4)(f) is not subject to the Florida Insurance Code,
 1001  as established in s. 624.01.
 1002         (11) CORPORATION.—There is created the Florida Health
 1003  Choices, Inc., which shall be registered, incorporated,
 1004  organized, and operated in compliance with part III of chapter
 1005  112 and chapters 119, 286, and 617. The purpose of the
 1006  corporation is to administer the program created in this section
 1007  and to conduct such other business as may further the
 1008  administration of the program.
 1009         (a) The corporation shall be governed by a 15-member board
 1010  of directors consisting of:
 1011         1. Three ex officio, nonvoting members to include:
 1012         a. The Secretary of Health Care Administration or a
 1013  designee with expertise in health care services.
 1014         b. The Secretary of Management Services or a designee with
 1015  expertise in state employee benefits.
 1016         c. The commissioner of the Office of Insurance Regulation
 1017  or a designee with expertise in insurance regulation.
 1018         2. Four members appointed by and serving at the pleasure of
 1019  the Governor.
 1020         3. Four members appointed by and serving at the pleasure of
 1021  the President of the Senate.
 1022         4. Four members appointed by and serving at the pleasure of
 1023  the Speaker of the House of Representatives.
 1024         5. Board members may not include insurers, health insurance
 1025  agents or brokers, health care providers, health maintenance
 1026  organizations, prepaid service providers, or any other entity,
 1027  affiliate, or subsidiary of eligible vendors.
 1028         (b) Members shall be appointed for terms of up to 3 years.
 1029  Any member is eligible for reappointment. A vacancy on the board
 1030  shall be filled for the unexpired portion of the term in the
 1031  same manner as the original appointment.
 1032         (c) The board shall select a chief executive officer for
 1033  the corporation who shall be responsible for the selection of
 1034  such other staff as may be authorized by the corporation’s
 1035  operating budget as adopted by the board.
 1036         (d) Board members are entitled to receive, from funds of
 1037  the corporation, reimbursement for per diem and travel expenses
 1038  as provided by s. 112.061. No other compensation is authorized.
 1039         (e) There is no liability on the part of, and no cause of
 1040  action shall arise against, any member of the board or its
 1041  employees or agents for any action taken by them in the
 1042  performance of their powers and duties under this section.
 1043         (f) The board shall develop and adopt bylaws and other
 1044  corporate procedures as necessary for the operation of the
 1045  corporation and carrying out the purposes of this section. The
 1046  bylaws shall:
 1047         1. Specify procedures for selection of officers and
 1048  qualifications for reappointment, provided that no board member
 1049  shall serve more than 9 consecutive years.
 1050         2. Require an annual membership meeting that provides an
 1051  opportunity for input and interaction with individual
 1052  participants in the program.
 1053         3. Specify policies and procedures regarding conflicts of
 1054  interest, including the provisions of part III of chapter 112,
 1055  which prohibit a member from participating in any decision that
 1056  would inure to the benefit of the member or the organization
 1057  that employs the member. The policies and procedures shall also
 1058  require public disclosure of the interest that prevents the
 1059  member from participating in a decision on a particular matter.
 1060         (g) The corporation may exercise all powers granted to it
 1061  under chapter 617 necessary to carry out the purposes of this
 1062  section, including, but not limited to, the power to receive and
 1063  accept grants, loans, or advances of funds from any public or
 1064  private agency and to receive and accept from any source
 1065  contributions of money, property, labor, or any other thing of
 1066  value to be held, used, and applied for the purposes of this
 1067  section.
 1068         (h) The corporation may establish technical advisory panels
 1069  consisting of interested parties, including consumers, health
 1070  care providers, individuals with expertise in insurance
 1071  regulation, and insurers.
 1072         (i) The corporation shall:
 1073         1. Determine eligibility of employers, vendors,
 1074  individuals, and agents in accordance with subsection (4).
 1075         2. Establish procedures necessary for the operation of the
 1076  program, including, but not limited to, procedures for
 1077  application, enrollment, risk assessment, risk adjustment, plan
 1078  administration, performance monitoring, and consumer education.
 1079         3. Arrange for collection of contributions from
 1080  participating employers, third parties, governmental entities,
 1081  and individuals.
 1082         4. Arrange for payment of premiums and other appropriate
 1083  disbursements based on the selections of products and services
 1084  by the individual participants.
 1085         5. Establish criteria for disenrollment of participating
 1086  individuals based on failure to pay the individual’s share of
 1087  any contribution required to maintain enrollment in selected
 1088  products.
 1089         6. Establish criteria for exclusion of vendors pursuant to
 1090  paragraph (4)(d).
 1091         7. Develop and implement a plan for promoting public
 1092  awareness of and participation in the program.
 1093         8. Secure staff and consultant services necessary to the
 1094  operation of the program.
 1095         9. Establish policies and procedures regarding
 1096  participation in the program for individuals, vendors, health
 1097  insurance agents, and employers.
 1098         10. Provide for the operation of a toll-free hotline to
 1099  respond to requests for assistance.
 1100         11. Provide for initial, open, and special enrollment
 1101  periods.
 1102         12. Evaluate options for employer participation which may
 1103  conform to with common insurance practices.
 1104         13. Administer the Florida Health Insurance Affordability
 1105  Exchange Program in accordance with ss. 409.72-409.731.
 1106         14. Coordinate with the Agency for Health Care
 1107  Administration, the Department of Children and Families, and the
 1108  Florida Healthy Kids Corporation in developing and implementing
 1109  the enrollee transition plan.
 1110         15. Coordinate with the federal exchange to provide FHIX
 1111  enrollees with the option of selecting plans from either the
 1112  FHIX marketplace or the federal exchange.
 1113         (12) REPORT.—The board of the corporation shall Beginning
 1114  in the 2009-2010 fiscal year, submit by February 1 an annual
 1115  report to the Governor, the President of the Senate, and the
 1116  Speaker of the House of Representatives documenting the
 1117  corporation’s activities in compliance with the duties
 1118  delineated in this section.
 1119         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1120  safeguard the financial transactions made under the auspices of
 1121  the program, the corporation is authorized to establish
 1122  qualifying criteria and certification procedures for vendors,
 1123  require performance bonds or other guarantees of ability to
 1124  complete contractual obligations, monitor the performance of
 1125  vendors, and enforce the agreements of the program through
 1126  financial penalty or disqualification from the program.
 1128         (a) Definitions.—For purposes of this subsection, the term:
 1129         1. “Buyer’s representative” means a participating insurance
 1130  agent as described in paragraph (4)(g).
 1131         2. “Enrollee” means an employer who is eligible to enroll
 1132  in the program pursuant to paragraph (4)(a).
 1133         3. “Participant” means an individual who is eligible to
 1134  participate in the program pursuant to paragraph (4)(b).
 1135         4. “Proprietary confidential business information” means
 1136  information, regardless of form or characteristics, that is
 1137  owned or controlled by a vendor requesting confidentiality under
 1138  this section; that is intended to be and is treated by the
 1139  vendor as private in that the disclosure of the information
 1140  would cause harm to the business operations of the vendor; that
 1141  has not been disclosed unless disclosed pursuant to a statutory
 1142  provision, an order of a court or administrative body, or a
 1143  private agreement providing that the information may be released
 1144  to the public; and that is information concerning:
 1145         a. Business plans.
 1146         b. Internal auditing controls and reports of internal
 1147  auditors.
 1148         c. Reports of external auditors for privately held
 1149  companies.
 1150         d. Client and customer lists.
 1151         e. Potentially patentable material.
 1152         f. A trade secret as defined in s. 688.002.
 1153         5. “Vendor” means a participating insurer or other provider
 1154  of services as described in paragraph (4)(d).
 1155         (b) Public record exemptions.—
 1156         1. Personal identifying information of an enrollee or
 1157  participant who has applied for or participates in the Florida
 1158  Health Choices Program is confidential and exempt from s.
 1159  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1160         2. Client and customer lists of a buyer’s representative
 1161  held by the corporation are confidential and exempt from s.
 1162  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1163         3. Proprietary confidential business information held by
 1164  the corporation is confidential and exempt from s. 119.07(1) and
 1165  s. 24(a), Art. I of the State Constitution.
 1166         (c) Retroactive application.—The public record exemptions
 1167  provided for in paragraph (b) apply to information held by the
 1168  corporation before, on, or after the effective date of this
 1169  exemption.
 1170         (d) Authorized release.—
 1171         1. Upon request, information made confidential and exempt
 1172  pursuant to this subsection shall be disclosed to:
 1173         a. Another governmental entity in the performance of its
 1174  official duties and responsibilities.
 1175         b. Any person who has the written consent of the program
 1176  applicant.
 1177         c. The Florida Kidcare program for the purpose of
 1178  administering the program authorized in ss. 409.810-409.821.
 1179         2. Paragraph (b) does not prohibit a participant’s legal
 1180  guardian from obtaining confirmation of coverage, dates of
 1181  coverage, the name of the participant’s health plan, and the
 1182  amount of premium being paid.
 1183         (e) Penalty.—A person who knowingly and willfully violates
 1184  this subsection commits a misdemeanor of the second degree,
 1185  punishable as provided in s. 775.082 or s. 775.083.
 1186         (f) Review and repeal.—This subsection is subject to the
 1187  Open Government Sunset Review Act in accordance with s. 119.15,
 1188  and shall stand repealed on October 2, 2016, unless reviewed and
 1189  saved from repeal through reenactment by the Legislature.
 1190         Section 16. Subsection (2) of section 409.904, Florida
 1191  Statutes, is amended to read:
 1192         409.904 Optional payments for eligible persons.—The agency
 1193  may make payments for medical assistance and related services on
 1194  behalf of the following persons who are determined to be
 1195  eligible subject to the income, assets, and categorical
 1196  eligibility tests set forth in federal and state law. Payment on
 1197  behalf of these Medicaid eligible persons is subject to the
 1198  availability of moneys and any limitations established by the
 1199  General Appropriations Act or chapter 216.
 1200         (2) A family, a pregnant woman, a child under age 21, a
 1201  person age 65 or over, or a blind or disabled person, who would
 1202  be eligible under any group listed in s. 409.903(1), (2), or
 1203  (3), except that the income or assets of such family or person
 1204  exceed established limitations. For a family or person in one of
 1205  these coverage groups, medical expenses are deductible from
 1206  income in accordance with federal requirements in order to make
 1207  a determination of eligibility. A family or person eligible
 1208  under the coverage known as the “medically needy,” is eligible
 1209  to receive the same services as other Medicaid recipients, with
 1210  the exception of services in skilled nursing facilities and
 1211  intermediate care facilities for the developmentally disabled.
 1212  Effective July 1, 2016, persons eligible under “medically needy”
 1213  shall be limited to children under 21 years of age and pregnant
 1214  women. This subsection expires October 1, 2019.
 1215         Section 17. Section 624.91, Florida Statutes, is amended to
 1216  read:
 1217         624.91 The Florida Healthy Kids Corporation Act.—
 1218         (1) SHORT TITLE.—This section may be cited as the “William
 1219  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1220         (2) LEGISLATIVE INTENT.—
 1221         (a) The Legislature finds that increased access to health
 1222  care services could improve children’s health and reduce the
 1223  incidence and costs of childhood illness and disabilities among
 1224  children in this state. Many children do not have comprehensive,
 1225  affordable health care services available. It is the intent of
 1226  the Legislature that the Florida Healthy Kids Corporation
 1227  provide comprehensive health insurance coverage to such
 1228  children. The corporation is encouraged to cooperate with any
 1229  existing health service programs funded by the public or the
 1230  private sector.
 1231         (b) It is the intent of the Legislature that the Florida
 1232  Healthy Kids Corporation serve as one of several providers of
 1233  services to children eligible for medical assistance under Title
 1234  XXI of the Social Security Act. Although the corporation may
 1235  serve other children, the Legislature intends the primary
 1236  recipients of services provided through the corporation be
 1237  school-age children with a family income below 200 percent of
 1238  the federal poverty level, who do not qualify for Medicaid. It
 1239  is also the intent of the Legislature that state and local
 1240  government Florida Healthy Kids funds be used to continue
 1241  coverage, subject to specific appropriations in the General
 1242  Appropriations Act, to children not eligible for federal
 1243  matching funds under Title XXI.
 1244         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1245  of this state are eligible the following individuals are
 1246  eligible for state-funded assistance in paying Florida Healthy
 1247  Kids premiums pursuant to s. 409.814.:
 1248         (a) Residents of this state who are eligible for the
 1249  Florida Kidcare program pursuant to s. 409.814.
 1250         (b) Notwithstanding s. 409.814, legal aliens who are
 1251  enrolled in the Florida Healthy Kids program as of January 31,
 1252  2004, who do not qualify for Title XXI federal funds because
 1253  they are not qualified aliens as defined in s. 409.811.
 1254         (4) NONENTITLEMENT.—Nothing in this section shall be
 1255  construed as providing an individual with an entitlement to
 1256  health care services. No cause of action shall arise against the
 1257  state, the Florida Healthy Kids Corporation, or a unit of local
 1258  government for failure to make health services available under
 1259  this section.
 1261         (a) There is created the Florida Healthy Kids Corporation,
 1262  a not-for-profit corporation.
 1263         (b) The Florida Healthy Kids Corporation shall:
 1264         1. Arrange for the collection of any individual, family,
 1265  local contributions, or employer payment or premium, in an
 1266  amount to be determined by the board of directors, to provide
 1267  for payment of premiums for comprehensive insurance coverage and
 1268  for the actual or estimated administrative expenses.
 1269         2. Arrange for the collection of any voluntary
 1270  contributions to provide for payment of Florida Kidcare program
 1271  or Florida Health Insurance Affordability Exchange Program
 1272  (FHIX) premiums for children who are not eligible for medical
 1273  assistance under Title XIX or Title XXI of the Social Security
 1274  Act.
 1275         3. Subject to the provisions of s. 409.8134, accept
 1276  voluntary supplemental local match contributions that comply
 1277  with the requirements of Title XXI of the Social Security Act
 1278  for the purpose of providing additional Florida Kidcare coverage
 1279  in contributing counties under Title XXI.
 1280         4. Establish the administrative and accounting procedures
 1281  for the operation of the corporation.
 1282         4.5. Establish, with consultation from appropriate
 1283  professional organizations, standards for preventive health
 1284  services and providers and comprehensive insurance benefits
 1285  appropriate to children, provided that such standards for rural
 1286  areas shall not limit primary care providers to board-certified
 1287  pediatricians.
 1288         5.6. Determine eligibility for children seeking to
 1289  participate in the Title XXI-funded components of the Florida
 1290  Kidcare program consistent with the requirements specified in s.
 1291  409.814, as well as the non-Title-XXI-eligible children as
 1292  provided in subsection (3).
 1293         6.7. Establish procedures under which providers of local
 1294  match to, applicants to and participants in the program may have
 1295  grievances reviewed by an impartial body and reported to the
 1296  board of directors of the corporation.
 1297         7.8. Establish participation criteria and, if appropriate,
 1298  contract with an authorized insurer, health maintenance
 1299  organization, or third-party administrator to provide
 1300  administrative services to the corporation.
 1301         8.9. Establish enrollment criteria that include penalties
 1302  or waiting periods of 30 days for reinstatement of coverage upon
 1303  voluntary cancellation for nonpayment of family or individual
 1304  premiums.
 1305         9.10. Contract with authorized insurers or any provider of
 1306  health care services, meeting standards established by the
 1307  corporation, for the provision of comprehensive insurance
 1308  coverage to participants. Such standards shall include criteria
 1309  under which the corporation may contract with more than one
 1310  provider of health care services in program sites.
 1311         a. Health plans shall be selected through a competitive bid
 1312  process. The Florida Healthy Kids Corporation shall purchase
 1313  goods and services in the most cost-effective manner consistent
 1314  with the delivery of quality medical care.
 1315         b. The maximum administrative cost for a Florida Healthy
 1316  Kids Corporation contract shall be 15 percent. For health and
 1317  dental care contracts, the minimum medical loss ratio for a
 1318  Florida Healthy Kids Corporation contract shall be 85 percent.
 1319  The calculations must use uniform financial data collected from
 1320  all plans in a format established by the corporation and shall
 1321  be computed for each plan on a statewide basis. Funds shall be
 1322  classified in a manner consistent with 45 C.F.R. part 158 For
 1323  dental contracts, the remaining compensation to be paid to the
 1324  authorized insurer or provider under a Florida Healthy Kids
 1325  Corporation contract shall be no less than an amount which is 85
 1326  percent of premium; to the extent any contract provision does
 1327  not provide for this minimum compensation, this section shall
 1328  prevail.
 1329         c. The health plan selection criteria and scoring system,
 1330  and the scoring results, shall be available upon request for
 1331  inspection after the bids have been awarded.
 1332         d. Effective July 1, 2016, health and dental services
 1333  contracts of the corporation must transition to the FHIX
 1334  marketplace under s. 409.722. Qualifying plans may enroll as
 1335  vendors with the FHIX marketplace to maintain continuity of care
 1336  for participants.
 1337         10.11. Establish disenrollment criteria in the event local
 1338  matching funds are insufficient to cover enrollments.
 1339         11.12. Develop and implement a plan to publicize the
 1340  Florida Kidcare program, the eligibility requirements of the
 1341  program, and the procedures for enrollment in the program and to
 1342  maintain public awareness of the corporation and the program.
 1343         12.13. Secure staff necessary to properly administer the
 1344  corporation. Staff costs shall be funded from state and local
 1345  matching funds and such other private or public funds as become
 1346  available. The board of directors shall determine the number of
 1347  staff members necessary to administer the corporation.
 1348         13.14. In consultation with the partner agencies, provide a
 1349  report on the Florida Kidcare program annually to the Governor,
 1350  the Chief Financial Officer, the Commissioner of Education, the
 1351  President of the Senate, the Speaker of the House of
 1352  Representatives, and the Minority Leaders of the Senate and the
 1353  House of Representatives.
 1354         14.15. Provide information on a quarterly basis online to
 1355  the Legislature and the Governor which compares the costs and
 1356  utilization of the full-pay enrolled population and the Title
 1357  XXI-subsidized enrolled population in the Florida Kidcare
 1358  program. The information, at a minimum, must include:
 1359         a. The monthly enrollment and expenditure for full-pay
 1360  enrollees in the Medikids and Florida Healthy Kids programs
 1361  compared to the Title XXI-subsidized enrolled population; and
 1362         b. The costs and utilization by service of the full-pay
 1363  enrollees in the Medikids and Florida Healthy Kids programs and
 1364  the Title XXI-subsidized enrolled population.
 1365         15.16. Establish benefit packages that conform to the
 1366  provisions of the Florida Kidcare program, as created in ss.
 1367  409.810-409.821.
 1368         16. Contract with other insurance affordability programs to
 1369  provide such services that are consistent with this act.
 1370         17. Annually develop performance metrics for the following
 1371  focus areas:
 1372         a. Administrative functions.
 1373         b. Contracting with vendors.
 1374         c. Customer service.
 1375         d. Enrollee education.
 1376         e. Financial services.
 1377         f. Program integrity.
 1378         (c) Coverage under the corporation’s program is secondary
 1379  to any other available private coverage held by, or applicable
 1380  to, the participant child or family member. Insurers under
 1381  contract with the corporation are the payors of last resort and
 1382  must coordinate benefits with any other third-party payor that
 1383  may be liable for the participant’s medical care.
 1384         (d) The Florida Healthy Kids Corporation shall be a private
 1385  corporation not for profit, organized pursuant to chapter 617,
 1386  and shall have all powers necessary to carry out the purposes of
 1387  this act, including, but not limited to, the power to receive
 1388  and accept grants, loans, or advances of funds from any public
 1389  or private agency and to receive and accept from any source
 1390  contributions of money, property, labor, or any other thing of
 1391  value, to be held, used, and applied for the purposes of this
 1392  act.
 1394         (a) The Florida Healthy Kids Corporation shall operate
 1395  subject to the supervision and approval of a board of directors.
 1396  The board chair shall be an appointee designated by the
 1397  Governor, and the board shall be chaired by the Chief Financial
 1398  Officer or her or his designee, and composed of 12 other
 1399  members. The Senate shall confirm the designated chair and other
 1400  board appointees. The board members shall be appointed selected
 1401  for 3-year terms. of office as follows:
 1402         1. The Secretary of Health Care Administration, or his or
 1403  her designee.
 1404         2. One member appointed by the Commissioner of Education
 1405  from the Office of School Health Programs of the Florida
 1406  Department of Education.
 1407         3. One member appointed by the Chief Financial Officer from
 1408  among three members nominated by the Florida Pediatric Society.
 1409         4. One member, appointed by the Governor, who represents
 1410  the Children’s Medical Services Program.
 1411         5. One member appointed by the Chief Financial Officer from
 1412  among three members nominated by the Florida Hospital
 1413  Association.
 1414         6. One member, appointed by the Governor, who is an expert
 1415  on child health policy.
 1416         7. One member, appointed by the Chief Financial Officer,
 1417  from among three members nominated by the Florida Academy of
 1418  Family Physicians.
 1419         8. One member, appointed by the Governor, who represents
 1420  the state Medicaid program.
 1421         9. One member, appointed by the Chief Financial Officer,
 1422  from among three members nominated by the Florida Association of
 1423  Counties.
 1424         10. The State Health Officer or her or his designee.
 1425         11. The Secretary of Children and Families, or his or her
 1426  designee.
 1427         12. One member, appointed by the Governor, from among three
 1428  members nominated by the Florida Dental Association.
 1429         (b) A member of the board of directors shall be appointed
 1430  by and serve at the pleasure of the Governor may be removed by
 1431  the official who appointed that member. The board shall appoint
 1432  an executive director, who is responsible for other staff
 1433  authorized by the board.
 1434         (c) Board members are entitled to receive, from funds of
 1435  the corporation, reimbursement for per diem and travel expenses
 1436  as provided by s. 112.061.
 1437         (d) There shall be no liability on the part of, and no
 1438  cause of action shall arise against, any member of the board of
 1439  directors, or its employees or agents, for any action they take
 1440  in the performance of their powers and duties under this act.
 1441         (e) Terms for board members appointed under this act are
 1442  effective January 1, 2016.
 1444         (a) The corporation shall not be deemed an insurer. The
 1445  officers, directors, and employees of the corporation shall not
 1446  be deemed to be agents of an insurer. Neither the corporation
 1447  nor any officer, director, or employee of the corporation is
 1448  subject to the licensing requirements of the insurance code or
 1449  the rules of the Department of Financial Services. However, any
 1450  marketing representative utilized and compensated by the
 1451  corporation must be appointed as a representative of the
 1452  insurers or health services providers with which the corporation
 1453  contracts.
 1454         (b) The board has complete fiscal control over the
 1455  corporation and is responsible for all corporate operations.
 1456         (c) The Department of Financial Services shall supervise
 1457  any liquidation or dissolution of the corporation and shall
 1458  have, with respect to such liquidation or dissolution, all power
 1459  granted to it pursuant to the insurance code.
 1460         (8) TRANSITION PLANS.—The corporation shall confer with the
 1461  Agency for Health Care Administration, the Department of
 1462  Children and Families, and Florida Health Choices, Inc., to
 1463  develop transition plans for the Florida Health Insurance
 1464  Affordability Exchange Program as created under ss. 409.72
 1465  409.731.
 1466         Section 18. Section 624.915, Florida Statutes, is repealed.
 1467         Section 19. The Division of Law Revision and Information is
 1468  directed to replace the phrase “the effective date of this act”
 1469  wherever it occurs in this act with the date the act becomes a
 1470  law.
 1471         Section 20. If any law amended by this act was also amended
 1472  by a law enacted during the 2015 Regular Session of the
 1473  Legislature, such laws shall be construed as if enacted during
 1474  the same session of the Legislature, and full effect shall be
 1475  given to each if possible.
 1476         Section 21. This act shall take effect upon becoming a law.