Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for CS for SB 322
       
       
       
       
       
       
                                Ì9252849Î925284                         
       
                              LEGISLATIVE ACTION                        
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       Senator Thurston moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete line 135
    4  and insert:
    5         Section 4. The Division of Law Revision is directed to
    6  rename part II of chapter 409, Florida Statutes, as “Insurance
    7  Affordability Programs” and to incorporate ss. 409.72-409.731,
    8  Florida Statutes, under this part.
    9         Section 5. Section 409.72, Florida Statutes, is created to
   10  read:
   11         409.72 Short title.—Sections 409.72-409.731 may be cited as
   12  the “Florida Health Insurance Affordability Exchange Program”
   13  (“FHIX”).
   14         Section 6. Section 409.721, Florida Statutes, is created to
   15  read:
   16         409.721 Program authority.—The Florida Health Insurance
   17  Affordability Exchange Program (FHIX) is created within the
   18  Agency for Health Care Administration to assist Floridians in
   19  purchasing health benefits coverage and gaining access to health
   20  services. The products and services offered by FHIX are based on
   21  the following principles:
   22         (1) FAIR VALUE.—Financial assistance will be rationally
   23  allocated regardless of differences in categorical eligibility.
   24         (2) CONSUMER CHOICE.—Participants will be offered
   25  meaningful choices in the way the participants can redeem the
   26  value of the available assistance.
   27         (3) SIMPLICITY.—Obtaining assistance will be consumer
   28  friendly, and customer support will be available when needed.
   29         (4) PORTABILITY.—Participants can continue to access the
   30  FHIX services and products despite changes in their
   31  circumstances.
   32         (5) EMPLOYMENT.—Assistance will be offered in a way that
   33  incentivizes employment.
   34         (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a
   35  manner that maximizes individual control over available
   36  resources.
   37         (7) RISK ADJUSTMENT.—The amount of assistance will reflect
   38  participants’ medical risk.
   39         Section 7. Section 409.722, Florida Statutes, is created to
   40  read:
   41         409.722 Definitions.—As used in ss. 409.72-409.731, the
   42  term:
   43         (1) “Agency” means the Agency for Health Care
   44  Administration.
   45         (2) “Applicant” means an individual who applies for
   46  determination of eligibility for health benefits coverage under
   47  this part.
   48         (3) “Corporation” means Florida Health Choices, Inc., as
   49  established under s. 408.910.
   50         (4) “Enrollee” means a participant who has been determined
   51  eligible for and is receiving health benefits coverage under
   52  this part.
   53         (5) “Federal exchange” or “exchange” means an insurance
   54  platform regulated by the Federal Government which offers tiers
   55  of health plans from the least comprehensive plan to the most
   56  comprehensive plan.
   57         (6) “FHIX marketplace” or “marketplace” means the single,
   58  centralized market established under s. 408.910 which
   59  facilitates health benefits coverage.
   60         (7) “Florida Health Insurance Affordability Exchange
   61  Program” or “FHIX” means the program created under ss. 409.72
   62  409.731.
   63         (8) “Florida Healthy Kids Corporation” means the entity
   64  created under s. 624.91.
   65         (9) “Florida Kidcare program” or “Kidcare program” means
   66  the health benefits coverage administered through ss. 409.810
   67  409.821.
   68         (10) “Health benefits coverage” means the payment of
   69  benefits for covered health care services or the availability,
   70  directly or through arrangements with other persons, of covered
   71  health care services on a prepaid per capita basis or on a
   72  prepaid aggregate fixed-sum basis.
   73         (11) “Inactive status” means the enrollment status of a
   74  participant previously enrolled in health benefits coverage
   75  through FHIX who lost coverage for noncompliance pursuant to s.
   76  409.723, but who maintains access to his or her balance in a
   77  health savings account or health reimbursement account.
   78         (12) “Medicaid” means the medical assistance program
   79  authorized by Title XIX of the Social Security Act, and
   80  regulations thereunder, and parts III and IV of this chapter, as
   81  administered in this state by the agency.
   82         (13) “Modified adjusted gross income” means the
   83  individual’s or household’s annual adjusted gross income, as
   84  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986,
   85  which is used to determine eligibility for FHIX.
   86         (14) “Patient Protection and Affordable Care Act” or
   87  “Affordable Care Act” means Pub. L. No. 111-148, as amended by
   88  the Health Care and Education Reconciliation Act of 2010, Pub.
   89  L. No. 111-152, and regulations adopted pursuant to those acts.
   90         (15) “Premium credit” means the monthly amount paid by the
   91  agency per enrollee in the Florida Health Insurance
   92  Affordability Exchange Program toward health benefits coverage.
   93         (16) “Qualified alien” means an alien as defined in 8
   94  U.S.C. s. 1641(b) or (c).
   95         (17) “Resident” means a United States citizen or a
   96  qualified alien who is domiciled in this state.
   97         Section 8. Section 409.723, Florida Statutes, is created to
   98  read:
   99         409.723 Participation.—
  100         (1) ELIGIBILITY.—To participate in FHIX, an individual must
  101  be a resident and meet the following requirements, as
  102  applicable:
  103         (a) Qualify as a newly eligible enrollee, and be an
  104  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
  105  Social Security Act or s. 2001 of the Affordable Care Act and as
  106  may be further defined by federal regulation.
  107         (b) Meet and maintain the responsibilities under subsection
  108  (4).
  109         (c) Qualify for participation in the Florida Healthy Kids
  110  program under s. 624.91, subject to the implementation of Phase
  111  Two under s. 409.727.
  112         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
  113  an application to the department for an eligibility
  114  determination.
  115         (a) Applications may be submitted online, or by mail,
  116  facsimile, or any other method permitted by law or regulation.
  117         (b) The department is responsible for any eligibility
  118  correspondence and status updates to the participant and other
  119  agencies.
  120         (c) The department shall review a participant’s eligibility
  121  at least every 12 months.
  122         (d) An application or renewal is deemed complete when the
  123  participant has met all the requirements under subsection (4),
  124  as applicable.
  125         (3) PARTICIPANT RIGHTS.—A participant has all of the
  126  following rights:
  127         (a) Access to the FHIX marketplace or federal exchange to
  128  select the scope, amount, and type of health care coverage and
  129  other services to be purchased.
  130         (b) Continuity and portability of coverage to avoid
  131  disruption of coverage and other health care services when the
  132  participant’s economic circumstances change.
  133         (c) Retention of applicable unspent credits in the
  134  participant’s health savings or health reimbursement account
  135  following a change in the participant’s eligibility status.
  136  Credits are valid for a participant in an inactive status for up
  137  to 5 years after the participant’s status first becomes
  138  inactive.
  139         (d) Ability to select more than one product or plan on the
  140  FHIX marketplace or federal exchange.
  141         (e) Choice of at least two health benefits products that
  142  meet the requirements of the Affordable Care Act.
  143         (4) PARTICIPANT RESPONSIBILITIES.—A participant must:
  144         (a) Complete an initial application for health benefits
  145  coverage and the annual renewal process.
  146         (b) Provide evidence of participation in one or more of the
  147  following activities at the levels required under paragraph (c):
  148         1. Paid employment.
  149         2. On-the-job training or job placement activities.
  150  Evidence of participation in job placement activities must
  151  include registration with CareerSource Florida and may include
  152  other documentation such as, but not limited to, written
  153  acknowledgment from a potential employer of receipt of an
  154  employment application from the participant; confirmation from a
  155  potential employer of a job interview with the participant;
  156  documentation of job-seeking activities; and documentation of
  157  assistance or training related to preparing a resume, completing
  158  an employment application, or interviewing skills.
  159         3. Educational pursuits.
  160  
  161  A participant who is a disabled adult or the caregiver of a
  162  disabled child or adult may submit a request to the department
  163  for an exception to the requirements in this paragraph. Such
  164  participant shall annually submit to the department a request to
  165  renew the exception. The term “disabled” means any person who
  166  has one or more permanent physical or mental impairments that
  167  substantially limit his or her ability to perform one or more
  168  major life activities of daily living, as defined by the
  169  Americans with Disabilities Act, without receiving more than 8
  170  hours of assistance per day.
  171         (c) Engage in the activities required under paragraph (b)
  172  at the following minimum levels:
  173         1. For a parent of a child younger than 18 years of age, a
  174  minimum of 20 hours weekly.
  175         2. For a childless adult, a minimum of 30 hours weekly.
  176         (d) Learn and remain informed about the choices available
  177  in the FHIX marketplace or the federal exchange and the
  178  allowable uses of credits in the individual accounts.
  179         (e) Execute a contract with the department which
  180  acknowledges that:
  181         1. FHIX is not an entitlement and state and federal funding
  182  may end at any time;
  183         2. Failure to pay required premiums or cost sharing will
  184  result in a transition to inactive status; and
  185         3. Noncompliance with the participation requirements as
  186  established under this section will result in a transition to
  187  inactive status.
  188         (f) Select plans and other products in a timely manner.
  189         (g) Comply with program rules and the prohibitions against
  190  fraud, as described in s. 414.39.
  191         (h) Timely make monthly premium and any other cost-sharing
  192  payments.
  193         (i) Meet minimum coverage requirements by selecting either
  194  a high-deductible health plan combined with a health savings or
  195  a reimbursement account or a combination of plans or products
  196  with an actuarial value that meets or exceeds benefits available
  197  under the federal exchange.
  198         (5) COST SHARING.—
  199         (a) Except for enrollees eligible under paragraph (1)(c),
  200  enrollees are assessed monthly premiums based on their modified
  201  adjusted gross income. The maximum monthly premium payments are
  202  set at the following income levels:
  203         1. At or below 22 percent of the federal poverty level: $3.
  204         2. Greater than 22 percent, but at or below 50 percent, of
  205  the federal poverty level: $8.
  206         3. Greater than 50 percent, but at or below 75 percent, of
  207  the federal poverty level: $15.
  208         4. Greater than 75 percent, but at or below 100 percent, of
  209  the federal poverty level: $20.
  210         5. Greater than 100 percent of the federal poverty level:
  211  $25.
  212         (b) Depending on the products and services selected by the
  213  enrollee, the enrollee may also incur additional cost sharing,
  214  such as copayments, deductibles, or other out-of-pocket costs.
  215         (c) An enrollee may be subject to charges for an
  216  inappropriate emergency room visit of up to $8 for the first
  217  visit and up to $25 for any subsequent visit, based on the
  218  enrollee’s benefit plan, to discourage inappropriate use of the
  219  emergency room.
  220         (d) Cumulative annual cost sharing per enrollee may not
  221  exceed 5 percent of an enrollee’s annual modified adjusted gross
  222  income.
  223         (e) If, after a 30-day grace period, a full premium payment
  224  has not been received, the enrollee shall be transitioned from
  225  coverage to inactive status and may not reenroll for a minimum
  226  of 6 months, unless a hardship exception has been granted.
  227  Enrollees may seek a hardship exception under the Medicaid Fair
  228  Hearing Process.
  229         (f) Enrollees eligible under paragraph (1)(c) must pay
  230  premiums according to the Title XXI state plan amendment and
  231  follow disenrollment criteria for noncompliance in accordance
  232  with s. 624.91.
  233         Section 9. Section 409.724, Florida Statutes, is created to
  234  read:
  235         409.724 Available assistance.—
  236         (1) PREMIUM CREDITS.—
  237         (a) Standard amount.—The agency shall develop a monthly
  238  premium credit structure appropriate to a benefit plan that
  239  meets the bronze metal standard of the Affordable Care Act.
  240         (b) Supplemental funding.—Subject to federal approval,
  241  additional resources may be made available to enrollees and
  242  incorporated into FHIX.
  243         (c) Savings accounts.—In addition to the benefits provided
  244  under this section, the corporation shall offer each enrollee
  245  access to an individual account that qualifies as a health
  246  reimbursement account or a health savings account.
  247         1. Unexpended funds.—Eligible unexpended funds from the
  248  monthly premium credit must be deposited into each enrollee’s
  249  individual account in a timely manner. Funds deposited into
  250  these individual accounts may be used to pay cost-sharing
  251  obligations or to purchase other health-related items to the
  252  extent permitted under federal and state law.
  253         2. Healthy behaviors.—Enrollees may receive credits to
  254  their individual accounts for healthy behaviors, adherence to
  255  wellness programs, and other activities that demonstrate
  256  compliance with prevention or disease management guidelines.
  257         3. Enrollee contributions.—The enrollee may make deposits
  258  to his or her account at any time to supplement the premium
  259  credit, to purchase additional FHIX products, or to offset other
  260  cost-sharing obligations.
  261         4. Third parties.—Third parties, including, but not limited
  262  to, an employer or relative, may also make deposits on behalf of
  263  the enrollee into the enrollee’s FHIX marketplace account. The
  264  enrollee may not withdraw any funds as a refund, except those
  265  funds the enrollee has deposited into his or her account.
  266         (2) CHOICE COUNSELING.—The agency, in consultation with the
  267  Florida Healthy Kids Corporation and the corporation, shall
  268  develop a choice counseling program for FHIX. The choice
  269  counseling program must ensure that participants have
  270  information about the FHIX marketplace program, the federal
  271  exchange, products, and services and that participants know
  272  where and whom to call for questions or to make their plan
  273  selections. The choice counseling program must provide
  274  culturally sensitive materials and must take into consideration
  275  the demographics of the projected population.
  276         (3) EDUCATION CAMPAIGN.—The agency, the corporation, and
  277  the Florida Healthy Kids Corporation must coordinate in advance
  278  of Phase One an ongoing education campaign to inform
  279  participants, at a minimum, of the following:
  280         (a) How the FHIX marketplace operates and the timeline for
  281  enrollment.
  282         (b) Plans that are available and how to find information
  283  about these plans.
  284         (c) Information about other available insurance
  285  affordability programs for the participant and his or her
  286  family.
  287         (d) Information about health benefits coverage, provider
  288  networks, and cost sharing for available plans in each region.
  289         (e) Information about how to complete the required annual
  290  renewal process, including renewal dates and deadlines.
  291         (f) Information about how to update eligibility if the
  292  participant’s data have changed since his or her last renewal or
  293  application date.
  294         (4) CUSTOMER SUPPORT.—The Florida Healthy Kids Corporation
  295  shall provide customer support for FHIX, including, but not
  296  limited to, general program information, financial information,
  297  and enrollee payments. Customer support must also provide a
  298  toll-free telephone number and maintain a website that is
  299  available in multiple languages and that meets the needs of the
  300  enrollee population.
  301         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  302  inactive participant about other insurance affordability
  303  programs and electronically refer the participant to the federal
  304  exchange or other insurance affordability programs, as
  305  appropriate.
  306         Section 10. Section 409.725, Florida Statutes, is created
  307  to read:
  308         409.725 Available products and services.—The FHIX
  309  marketplace shall offer the following products and services:
  310         (1) Those authorized pursuant to s. 408.910.
  311         (2) Products authorized by the federal exchange.
  312         (3) Products authorized by the Florida Healthy Kids
  313  Corporation pursuant to s. 624.91.
  314         (4) Premium credits for participation in employer-sponsored
  315  plans.
  316         Section 11. Section 409.726, Florida Statutes, is created
  317  to read:
  318         409.726 Program accountability.—
  319         (1) All managed care plans that participate in FHIX must
  320  collect and maintain encounter level data in accordance with the
  321  encounter data requirements under s. 409.967(2)(e) and are
  322  subject to the accompanying penalties under s. 409.967(2)(i)2.
  323  The agency is responsible for the collection and maintenance of
  324  the encounter level data.
  325         (2) The corporation, in consultation with the agency, shall
  326  establish access and network standards for contracts on the FHIX
  327  marketplace, shall ensure that contracted plans have sufficient
  328  providers to meet enrollee needs, and shall develop quality of
  329  coverage and provider standards specific to the adult
  330  population.
  331         (3) The department shall develop accountability measures
  332  and performance standards to be applied to initial and renewal
  333  FHIX applications that are submitted online, by mail, by
  334  facsimile, or through referrals from a third party. The minimum
  335  performance standards are:
  336         (a) Application processing speed.—Ninety percent of all
  337  applications, regardless of the method of submission, must be
  338  processed within 45 days.
  339         (b) Application processing speed from online sources.
  340  Ninety-five percent of all applications received from online
  341  sources must be processed within 45 days.
  342         (c) Renewal application processing speed.—Ninety percent of
  343  all renewals, regardless of the method of submission, must be
  344  processed within 45 days.
  345         (d) Renewal application processing speed from online
  346  sources.—Ninety-five percent of all applications received from
  347  online sources must be processed within 45 days.
  348         (4) The agency, the department, and the Florida Healthy
  349  Kids Corporation must meet the following standards for their
  350  respective roles in the program:
  351         (a) Eighty-five percent of calls must be answered in 20
  352  seconds or less.
  353         (b) All contacts, including, but not limited to, telephone
  354  calls, faxed documents and requests, and e-mails, must be
  355  handled within 2 business days.
  356         (c) Any self-service tools available to participants, such
  357  as interactive voice response systems, must be operational 7
  358  days a week, 24 hours a day, at least 98 percent of each month.
  359         (5) The agency, the department, and the Florida Healthy
  360  Kids Corporation shall conduct an annual satisfaction survey to
  361  address all measures that require participant input specific to
  362  the FHIX marketplace program. The parties may elect to
  363  incorporate these elements into the annual report required under
  364  subsection (7).
  365         (6) The agency and the corporation shall post online
  366  monthly enrollment reports for FHIX.
  367         (7) Beginning in 2020, an annual report is due no later
  368  than July 1 to the Governor, the President of the Senate, and
  369  the Speaker of the House of Representatives. The annual report
  370  must be coordinated by the agency and the corporation and must
  371  include at least the following:
  372         (a) Enrollment and application trends and issues.
  373         (b) Utilization and cost data.
  374         (c) Customer satisfaction.
  375         (d) Funding sources in health savings accounts or health
  376  reimbursement accounts.
  377         (e) Enrollee use of funds in health savings accounts or
  378  health reimbursement accounts.
  379         (f) Types of products and plans purchased.
  380         (g) Movement of enrollees across different insurance
  381  affordability programs.
  382         (h) Recommendations for program improvement.
  383         Section 12. Section 409.727, Florida Statutes, is created
  384  to read:
  385         409.727 Readiness review and implementation schedule.—The
  386  agency, the corporation, the department, and the Florida Healthy
  387  Kids Corporation shall begin implementation of FHIX on the
  388  effective date of this act, with enrollment for Phase One
  389  beginning by January 1, 2020.
  390         (1) READINESS REVIEW.—Before implementation of any phase
  391  under this part or in any region, the agency shall conduct a
  392  readiness review in consultation with the FHIX Workgroup
  393  established pursuant to s. 409.729. The agency shall determine,
  394  at a minimum, the following readiness milestones:
  395         (a) Functional readiness of the service delivery platform.
  396         (b) Plan availability and presence of plan choice.
  397         (c) Provider network capacity and adequacy of the available
  398  plans.
  399         (d) Availability of customer support.
  400         (e) Other factors critical to the success of FHIX.
  401         (2) PHASE ONE.—The agency, the corporation, and the Florida
  402  Healthy Kids Corporation shall coordinate implementation
  403  activities to ensure that enrollment begins by January 1, 2020,
  404  and is available in all regions by July 1, 2020.
  405         (a) Beginning no later than January 1, 2020, and contingent
  406  upon federal approval, participants may enroll in health
  407  benefits coverage under the FHIX marketplace or the federal
  408  exchange, if eligible.
  409         (b) To be eligible for enrollment during this phase, a
  410  participant must meet the requirements under s. 409.723(1)(a)
  411  and (b).
  412         (c) An enrollee may select any benefit, service, or product
  413  available in the region.
  414         (d) The corporation shall notify an enrollee of his or her
  415  premium credit amount and how to access the FHIX marketplace
  416  selection process or the federal exchange.
  417         (e) An enrollee must have a choice of at least two managed
  418  care plans in each region which meet or exceed the Affordable
  419  Care Act’s requirements and which qualify for a premium credit
  420  on the FHIX marketplace or federal exchange.
  421         (f) Choice counseling and customer service must be provided
  422  in accordance with s. 409.724(2) and (4).
  423         (3) PHASE TWO.—
  424         (a) Not later than July 1, 2020, the corporation and the
  425  Florida Healthy Kids Corporation shall begin the transition of
  426  enrollees under s. 624.91 to the FHIX marketplace.
  427         (b) Eligibility during this phase is based on meeting the
  428  requirements of s. 409.723(1)(c) and (4).
  429         (c) An enrollee may select any available benefit, service,
  430  or product available under s. 409.725.
  431         (d) A Florida Healthy Kids enrollee who selects an FHIX
  432  marketplace plan or federal exchange plan shall be provided a
  433  premium credit equivalent to the average capitation rate paid in
  434  his or her county of residence under Florida Healthy Kids as of
  435  June 30, 2020. The enrollee is responsible for any difference in
  436  costs and may use any unexpended funds deposited in his or her
  437  savings account under s. 409.724(1)(c) for supplemental benefits
  438  on the FHIX marketplace or federal exchange.
  439         (e) The corporation shall notify an enrollee of his or her
  440  premium credit amount and how to access the FHIX marketplace
  441  selection process or federal exchange.
  442         (f) Choice counseling and customer service must be provided
  443  in accordance with s. 409.724(2) and (4).
  444         (g) Enrollees under s. 624.91 must transition to the FHIX
  445  marketplace and coverage under s. 409.725 by September 30, 2020.
  446         (h) A provision that is applicable to an individual under
  447  s. 624.91 is available and applicable to an enrollee who is
  448  eligible under s. 409.723(1)(c).
  449         Section 13. Section 409.728, Florida Statutes, is created
  450  to read:
  451         409.728 Program operation and management.—In order to
  452  implement ss. 409.72-409.731:
  453         (1) The agency shall do all of the following:
  454         (a) Contract with the corporation for the development,
  455  implementation, and administration of the Florida Health
  456  Insurance Affordability Exchange Program and for the release of
  457  any federal, state, or other funds appropriated to the
  458  corporation.
  459         (b) Provide administrative support to the FHIX Workgroup
  460  established pursuant to s. 409.729.
  461         (c) Consult with stakeholders that serve low-income
  462  individuals and families during implementation, using a public
  463  input process.
  464         (d) Timely transmit enrollee information to the
  465  corporation.
  466         (e) Annually determine the appropriate premium credit based
  467  on the difference in the price of a benchmark product on the
  468  FHIX marketplace and the enrollee premium contribution as
  469  outlined in s. 409.723(5)(a). For purposes of this paragraph,
  470  the benchmark product on the FHIX marketplace is the bronze
  471  level plan under the Affordable Care Act. For plans on the FHIX
  472  marketplace, the agency shall annually establish a retroactive
  473  methodology to adjust premium revenue to the relative clinical
  474  risk profile of each plan’s enrollees.
  475         (f) Transfer funds allocated for premium credits by General
  476  Appropriations Act to the corporation.
  477         (g) Adopt rules in coordination with the corporation and
  478  the Florida Healthy Kids Corporation in order to implement FHIX,
  479  including modifying existing rules implementing the Children’s
  480  Health Insurance Program and adapting adult-focused provisions
  481  for children to accommodate the seamless transition of Healthy
  482  Kids enrollees to FHIX.
  483         (2) The department shall, in coordination with the
  484  corporation, the agency, and the Florida Healthy Kids
  485  Corporation, determine eligibility of applications and
  486  application renewals for FHIX in accordance with s. 409.902 and
  487  shall transmit eligibility determination information on a timely
  488  basis to the agency and corporation.
  489         (3) The Florida Healthy Kids Corporation shall do all of
  490  the following:
  491         (a) Retain its duties and responsibilities under s. 624.91
  492  during Phase One of the program.
  493         (b) In coordination with the agency and the corporation,
  494  provide customer service for the FHIX marketplace.
  495         (c) Transfer funds and provide financial support to the
  496  FHIX marketplace, including the collection of monthly cost
  497  sharing payments.
  498         (d) Conduct financial reporting related to such activities,
  499  in coordination with the corporation and the agency.
  500         (e) Coordinate program activities with the agency, the
  501  department, and the corporation.
  502         (4) Florida Health Choices, Inc., shall do all of the
  503  following:
  504         (a) Develop and maintain the FHIX marketplace.
  505         (b) Implement and administer Phase One and Phase Two of the
  506  FHIX marketplace and the ongoing operations of the program.
  507         (c) Offer health benefits coverage packages on the FHIX
  508  marketplace, including plans compliant with the Affordable Care
  509  Act.
  510         (d) Offer FHIX enrollees a choice of at least two plans per
  511  county at each benefit level which meet the requirements under
  512  the Affordable Care Act.
  513         (e) Offer the opportunity to participate in the federal
  514  exchange.
  515         (f) Offer enhanced or customized benefits to FHIX
  516  marketplace enrollees.
  517         (g) Provide sufficient staff and resources to meet the
  518  program needs of enrollees.
  519         (h) Provide an opportunity for plans contracted with or
  520  previously contracted with the Florida Healthy Kids Corporation
  521  under s. 624.91 to participate in FHIX if those plans meet the
  522  requirements of the program.
  523         (i) Encourage insurance agents licensed under chapter 626
  524  to identify and assist enrollees. This act does not prohibit
  525  these agents from receiving usual and customary commissions from
  526  insurers and health maintenance organizations that offer plans
  527  in the FHIX marketplace.
  528         Section 14. Section 409.729, Florida Statutes, is created
  529  to read:
  530         409.729 Long-term reorganization.—The FHIX Workgroup is
  531  created to facilitate the implementation of FHIX and to plan for
  532  the reorganization of the state’s insurance affordability
  533  programs. The FHIX Workgroup consists of two representatives
  534  each from the agency, the department, the Florida Healthy Kids
  535  Corporation, and the corporation. An additional representative
  536  of the agency serves as chair. The FHIX Workgroup must hold its
  537  organizational meeting no later than 30 days after the effective
  538  date of this act and must meet at least bimonthly. The role of
  539  the FHIX Workgroup is to make recommendations to the agency. The
  540  responsibilities of the workgroup include, but are not limited
  541  to:
  542         (1) Developing and presenting a final implementation plan
  543  that meets the requirements of this part in a report submitted
  544  to the Governor, the President of the Senate, and the Speaker of
  545  the House of Representatives no later than November 1, 2019.
  546         (2) Reviewing network and access standards for plans and
  547  products.
  548         (3) Assessing readiness and recommending actions needed to
  549  reorganize the state’s insurance affordability programs for each
  550  phase or region. If a phase or region receives a nonreadiness
  551  recommendation, the agency shall notify the Legislature of that
  552  recommendation, the reasons for such a recommendation, and
  553  proposed plans for achieving readiness.
  554         (4) Recommending any proposed change to the Title XIX
  555  funded or Title XXI-funded programs based on the continued
  556  availability and reauthorization of the Title XXI program and
  557  its federal funding.
  558         (5) Identifying duplication of services by the corporation,
  559  the agency, and the Florida Healthy Kids Corporation currently
  560  and under FHIX’s proposed Phase Two program.
  561         (6) Evaluating any fiscal impacts based on the proposed
  562  transition plan under Phase Two.
  563         (7) Compiling a schedule of impacted contracts, leases, and
  564  other assets.
  565         (8) Determining staff requirements for Phase Two.
  566         Section 15. Section 409.73, Florida Statutes, is created to
  567  read:
  568         409.73 Legislative review.—The agency may seek federal
  569  approval to implement FHIX as provided in ss. 409.72-409.731.
  570  The agency is prohibited from implementing the FHIX waiver
  571  without specific legislative approval unless the terms and
  572  conditions of the approved waiver are substantially consistent
  573  with the statutory requirements for this program.
  574         Section 16. Section 409.731, Florida Statutes, is created
  575  to read:
  576         409.731 Program expiration.—
  577         (1) The Florida Health Insurance Affordability Exchange
  578  Program expires at the end of the state fiscal year in which any
  579  of these conditions occurs:
  580         (a) The federal match contribution for the newly eligible
  581  under the Affordable Care Act falls below 90 percent.
  582         (b) The federal match contribution falls below the
  583  increased Federal Medical Assistance Percentage for medical
  584  assistance for newly eligible mandatory individuals as specified
  585  in the Affordable Care Act.
  586         (c) The federal match for the FHIX program and the Medicaid
  587  program are blended under federal law or regulation in such a
  588  manner that causes the overall federal contribution to diminish
  589  when compared to separate, nonblended federal contributions.
  590         (2) Provided the conditions specified in subsection (1)
  591  have not previously occurred, the Florida Health Insurance
  592  Affordability Exchange Program shall expire on July 1, 2022,
  593  unless reviewed and reenacted by the Legislature.
  594         (3) The Health Outcomes Review Commission is established to
  595  assess the following indicators:
  596         (a) Patient outcomes.—Selected measures from the National
  597  Healthcare Quality Report or similarly credible sources will be
  598  applied to FHIX enrollees and compared to outcomes for Managed
  599  Medical Assistance enrollees and uninsured patients.
  600         (b) Fiscal impact.—Actual annual state general revenue
  601  expenditures for the FHIX program will be compared to predicted
  602  expenditures.
  603         (c) Access to care.—Potentially preventable hospitalization
  604  rates for acute and chronic conditions and potentially
  605  preventable emergency department visits among FHIX enrollees
  606  will be compared to Managed Medical Assistance enrollees and
  607  uninsured patients.
  608         (4) The Health Outcomes Review Commission shall consist of
  609  nine members appointed by the Governor, the President of the
  610  Senate, and the Speaker of the House. The Governor and each
  611  presiding officer shall appoint one healthcare professional, one
  612  private business representative, and one elected official.
  613         (5) The commission shall be appointed no later than January
  614  1, 2021, and shall meet regularly to select specific indicators,
  615  review preliminary data, and develop a framework for a final
  616  report. Staff support shall be provided to the commission by the
  617  Agency for Health Care Administration.
  618         (6) The commission’s final report shall be submitted to the
  619  Governor, the President of the Senate, and the Speaker of the
  620  House by January 1, 2022.
  621         Section 17. Section 408.70, Florida Statutes, is repealed.
  622         Section 18. Section 408.910, Florida Statutes, is amended
  623  to read:
  624         408.910 Florida Health Choices Program.—
  625         (1) LEGISLATIVE INTENT.—The Legislature finds that a
  626  significant number of the residents of this state do not have
  627  adequate access to affordable, quality health care. The
  628  Legislature further finds that increasing access to affordable,
  629  quality health care can be best accomplished by establishing a
  630  competitive market for purchasing health insurance and health
  631  services. It is therefore the intent of the Legislature to
  632  create and expand the Florida Health Choices Program to:
  633         (a) Expand opportunities for Floridians to purchase
  634  affordable health insurance and health services.
  635         (b) Preserve the benefits of employment-sponsored insurance
  636  while easing the administrative burden for employers who offer
  637  these benefits.
  638         (c) Enable individual choice in both the manner and amount
  639  of health care purchased.
  640         (d) Provide for the purchase of individual, portable health
  641  care coverage.
  642         (e) Disseminate information to consumers on the price and
  643  quality of health services.
  644         (f) Sponsor a competitive market that stimulates product
  645  innovation, quality improvement, and efficiency in the
  646  production and delivery of health services.
  647         (2) DEFINITIONS.—As used in this section, the term:
  648         (a) “Corporation” means the Florida Health Choices, Inc.,
  649  established under this section.
  650         (b) “Corporation’s marketplace” means the single,
  651  centralized market established by the program that facilitates
  652  the purchase of products made available in the marketplace.
  653         (c) “Florida Health Insurance Affordability Exchange
  654  Program” or “FHIX” is the program created under ss. 409.72
  655  409.731 for low-income, uninsured residents of this state.
  656         (d)(c) “Health insurance agent” means an agent licensed
  657  under part IV of chapter 626.
  658         (e)(d) “Insurer” means an entity licensed under chapter 624
  659  which offers an individual health insurance policy or a group
  660  health insurance policy, a preferred provider organization as
  661  defined in s. 627.6471, an exclusive provider organization as
  662  defined in s. 627.6472, a health maintenance organization
  663  licensed under part I of chapter 641, or a prepaid limited
  664  health service organization or discount plan organization
  665  licensed under chapter 636.
  666         (f) “Patient Protection and Affordable Care Act” or
  667  “Affordable Care Act” means Pub. L. No. 111-148, as further
  668  amended by the Health Care and Education Reconciliation Act of
  669  2010, Pub. L. No. 111-152, and regulations adopted pursuant to
  670  those acts.
  671         (g)(e) “Program” means the Florida Health Choices Program
  672  established by this section.
  673         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
  674  Choices Program is created as a single, centralized market for
  675  the sale and purchase of various products that enable
  676  individuals to pay for health care. These products include, but
  677  are not limited to, health insurance plans, health maintenance
  678  organization plans, prepaid services, service contracts, and
  679  flexible spending accounts. The components of the program
  680  include:
  681         (a) Enrollment of employers.
  682         (b) Administrative services for participating employers,
  683  including:
  684         1. Assistance in seeking federal approval of cafeteria
  685  plans.
  686         2. Collection of premiums and other payments.
  687         3. Management of individual benefit accounts.
  688         4. Distribution of premiums to insurers and payments to
  689  other eligible vendors.
  690         5. Assistance for participants in complying with reporting
  691  requirements.
  692         (c) Services to individual participants, including:
  693         1. Information about available products and participating
  694  vendors.
  695         2. Assistance with assessing the benefits and limits of
  696  each product, including information necessary to distinguish
  697  between policies offering creditable coverage and other products
  698  available through the program.
  699         3. Account information to assist individual participants
  700  with managing available resources.
  701         4. Services that promote healthy behaviors.
  702         5. Health benefits coverage information about health
  703  insurance plans compliant with the Affordable Care Act.
  704         6. Consumer assistance with web-based information services
  705  for the Florida Health Insurance Affordability Exchange Program,
  706  or (”FHIX”).
  707         (d) Recruitment of vendors, including insurers, health
  708  maintenance organizations, prepaid clinic service providers,
  709  provider service networks, and other providers.
  710         (e) Certification of vendors to ensure capability,
  711  reliability, and validity of offerings.
  712         (f) Collection of data, monitoring, assessment, and
  713  reporting of vendor performance.
  714         (g) Information services for individuals and employers.
  715         (h) Program evaluation.
  716         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  717  program is voluntary and shall be available to employers,
  718  individuals, vendors, and health insurance agents as specified
  719  in this subsection.
  720         (a) Employers eligible to enroll in the program include
  721  those employers that meet criteria established by the
  722  corporation and elect to make their employees eligible through
  723  the program.
  724         (b) Individuals eligible to participate in the program
  725  include:
  726         1. Individual employees of enrolled employers.
  727         2. Other individuals that meet criteria established by the
  728  corporation.
  729         (c) Employers who choose to participate in the program may
  730  enroll by complying with the procedures established by the
  731  corporation. The procedures must include, but are not limited
  732  to:
  733         1. Submission of required information.
  734         2. Compliance with federal tax requirements for the
  735  establishment of a cafeteria plan, pursuant to s. 125 of the
  736  Internal Revenue Code, including designation of the employer’s
  737  plan as a premium payment plan, a salary reduction plan that has
  738  flexible spending arrangements, or a salary reduction plan that
  739  has a premium payment and flexible spending arrangements.
  740         3. Determination of the employer’s contribution, if any,
  741  per employee, provided that such contribution is equal for each
  742  eligible employee.
  743         4. Establishment of payroll deduction procedures, subject
  744  to the agreement of each individual employee who voluntarily
  745  participates in the program.
  746         5. Designation of the corporation as the third-party
  747  administrator for the employer’s health benefit plan.
  748         6. Identification of eligible employees.
  749         7. Arrangement for periodic payments.
  750         8. Employer notification to employees of the intent to
  751  transfer from an existing employee health plan to the program at
  752  least 90 days before the transition.
  753         (d) All eligible vendors who choose to participate and the
  754  products and services that the vendors are permitted to sell are
  755  as follows:
  756         1. Insurers licensed under chapter 624 may sell health
  757  insurance policies, limited benefit policies, other risk-bearing
  758  coverage, and other products or services.
  759         2. Health maintenance organizations licensed under part I
  760  of chapter 641 may sell health maintenance contracts, limited
  761  benefit policies, other risk-bearing products, and other
  762  products or services.
  763         3. Prepaid limited health service organizations may sell
  764  products and services as authorized under part I of chapter 636,
  765  and discount plan organizations may sell products and services
  766  as authorized under part II of chapter 636.
  767         4. Prepaid health clinic service providers licensed under
  768  part II of chapter 641 may sell prepaid service contracts and
  769  other arrangements for a specified amount and type of health
  770  services or treatments.
  771         5. Health care providers, including hospitals and other
  772  licensed health facilities, health care clinics, licensed health
  773  professionals, pharmacies, and other licensed health care
  774  providers, may sell service contracts and arrangements for a
  775  specified amount and type of health services or treatments.
  776         6. Provider organizations, including service networks,
  777  group practices, professional associations, and other
  778  incorporated organizations of providers, may sell service
  779  contracts and arrangements for a specified amount and type of
  780  health services or treatments.
  781         7. Corporate entities providing specific health services in
  782  accordance with applicable state law may sell service contracts
  783  and arrangements for a specified amount and type of health
  784  services or treatments.
  785  
  786  A vendor described in subparagraphs 3.-7. may not sell products
  787  that provide risk-bearing coverage unless that vendor is
  788  authorized under a certificate of authority issued by the Office
  789  of Insurance Regulation and is authorized to provide coverage in
  790  the relevant geographic area. Otherwise eligible vendors may be
  791  excluded from participating in the program for deceptive or
  792  predatory practices, financial insolvency, or failure to comply
  793  with the terms of the participation agreement or other standards
  794  set by the corporation.
  795         (e) Eligible individuals may participate in the program
  796  voluntarily. Individuals who join the program may participate by
  797  complying with the procedures established by the corporation.
  798  These procedures must include, but are not limited to:
  799         1. Submission of required information.
  800         2. Authorization for payroll deduction, if applicable.
  801         3. Compliance with federal tax requirements.
  802         4. Arrangements for payment.
  803         5. Selection of products and services.
  804         (f) Vendors who choose to participate in the program may
  805  enroll by complying with the procedures established by the
  806  corporation. These procedures may include, but are not limited
  807  to:
  808         1. Submission of required information, including a complete
  809  description of the coverage, services, provider network, payment
  810  restrictions, and other requirements of each product offered
  811  through the program.
  812         2. Execution of an agreement to comply with requirements
  813  established by the corporation.
  814         3. Execution of an agreement that prohibits refusal to sell
  815  any offered product or service to a participant who elects to
  816  buy it.
  817         4. Establishment of product prices based on applicable
  818  criteria.
  819         5. Arrangements for receiving payment for enrolled
  820  participants.
  821         6. Participation in ongoing reporting processes established
  822  by the corporation.
  823         7. Compliance with grievance procedures established by the
  824  corporation.
  825         (g) Health insurance agents licensed under part IV of
  826  chapter 626 are eligible to voluntarily participate as buyers’
  827  representatives. A buyer’s representative acts on behalf of an
  828  individual purchasing health insurance and health services
  829  through the program by providing information about products and
  830  services available through the program and assisting the
  831  individual with both the decision and the procedure of selecting
  832  specific products. Serving as a buyer’s representative does not
  833  constitute a conflict of interest with continuing
  834  responsibilities as a health insurance agent if the relationship
  835  between each agent and any participating vendor is disclosed
  836  before advising an individual participant about the products and
  837  services available through the program. In order to participate,
  838  a health insurance agent shall comply with the procedures
  839  established by the corporation, including:
  840         1. Completion of training requirements.
  841         2. Execution of a participation agreement specifying the
  842  terms and conditions of participation.
  843         3. Disclosure of any appointments to solicit insurance or
  844  procure applications for vendors participating in the program.
  845         4. Arrangements to receive payment from the corporation for
  846  services as a buyer’s representative.
  847         (5) PRODUCTS.—
  848         (a) The products that may be made available for purchase
  849  through the program include, but are not limited to:
  850         1. Health insurance policies.
  851         2. Health maintenance contracts.
  852         3. Limited benefit plans.
  853         4. Prepaid clinic services.
  854         5. Service contracts.
  855         6. Arrangements for purchase of specific amounts and types
  856  of health services and treatments.
  857         7. Flexible spending accounts.
  858         (b) Health insurance policies, health maintenance
  859  contracts, limited benefit plans, prepaid service contracts, and
  860  other contracts for services must ensure the availability of
  861  covered services.
  862         (c) Products may be offered for multiyear periods provided
  863  the price of the product is specified for the entire period or
  864  for each separately priced segment of the policy or contract.
  865         (d) The corporation shall provide a disclosure form for
  866  consumers to acknowledge their understanding of the nature of,
  867  and any limitations to, the benefits provided by the products
  868  and services being purchased by the consumer.
  869         (e) The corporation must determine that making the plan
  870  available through the program is in the interest of eligible
  871  individuals and eligible employers in the state.
  872         (6) PRICING.—Prices for the products and services sold
  873  through the program must be transparent to participants and
  874  established by the vendors. The corporation may shall annually
  875  assess a surcharge for each premium or price set by a
  876  participating vendor. Any The surcharge may not be more than 2.5
  877  percent of the price and shall be used to generate funding for
  878  administrative services provided by the corporation and payments
  879  to buyers’ representatives; however, a surcharge may not be
  880  assessed for products and services sold in the FHIX marketplace.
  881         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  882  single, centralized market for purchase of health insurance,
  883  health maintenance contracts, and other health products and
  884  services. Purchases may be made by participating individuals
  885  over the Internet or through the services of a participating
  886  health insurance agent. Information about each product and
  887  service available through the program shall be made available
  888  through printed material and an interactive Internet website.
  889         (a) Marketplace purchasing.—A participant needing personal
  890  assistance to select products and services shall be referred to
  891  a participating agent in his or her area.
  892         1.(a) Participation in the program may begin at any time
  893  during a year after the employer completes enrollment and meets
  894  the requirements specified by the corporation pursuant to
  895  paragraph (4)(c).
  896         2.(b) Initial selection of products and services must be
  897  made by an individual participant within the applicable open
  898  enrollment period.
  899         3.(c) Initial enrollment periods for each product selected
  900  by an individual participant must last at least 12 months,
  901  unless the individual participant specifically agrees to a
  902  different enrollment period.
  903         4.(d) If an individual has selected one or more products
  904  and enrolled in those products for at least 12 months or any
  905  other period specifically agreed to by the individual
  906  participant, changes in selected products and services may only
  907  be made during the annual enrollment period established by the
  908  corporation.
  909         5.(e) The limits established in subparagraphs 2., 3., and
  910  4. paragraphs (b)-(d) apply to any risk-bearing product that
  911  promises future payment or coverage for a variable amount of
  912  benefits or services. The limits do not apply to initiation of
  913  flexible spending plans if those plans are not associated with
  914  specific high-deductible insurance policies or the use of
  915  spending accounts for any products offering individual
  916  participants specific amounts and types of health services and
  917  treatments at a contracted price.
  918         (b) FHIX marketplace purchasing.—
  919         1. Participation in the FHIX marketplace may begin at any
  920  time during the year.
  921         2. Initial enrollment periods for certain products selected
  922  by an individual enrollee which are noncompliant with the
  923  Affordable Care Act may be required to last at least 12 months,
  924  unless the individual participant specifically agrees to a
  925  different enrollment period.
  926         (8) CONSUMER INFORMATION.—The corporation shall:
  927         (a) Establish a secure website to facilitate the purchase
  928  of products and services by participating individuals. The
  929  website must provide information about each product or service
  930  available through the program.
  931         (b) Inform individuals about other public health care
  932  programs.
  933         (9) RISK POOLING.—The program may use methods for pooling
  934  the risk of individual participants and preventing selection
  935  bias. These methods may include, but are not limited to, a
  936  postenrollment risk adjustment of the premium payments to the
  937  vendors. The corporation may establish a methodology for
  938  assessing the risk of enrolled individual participants based on
  939  data reported annually by the vendors about their enrollees.
  940  Distribution of payments to the vendors may be adjusted based on
  941  the assessed relative risk profile of the enrollees in each
  942  risk-bearing product for the most recent period for which data
  943  is available.
  944         (10) EXEMPTIONS.—
  945         (a) Products, other than the products set forth in
  946  subparagraphs (4)(d)1.-4., sold as part of the program are not
  947  subject to the licensing requirements of the Florida Insurance
  948  Code, as defined in s. 624.01 or the mandated offerings or
  949  coverages established in part VI of chapter 627 and chapter 641.
  950         (b) The corporation may act as an administrator as defined
  951  in s. 626.88 but is not required to be certified pursuant to
  952  part VII of chapter 626. However, a third-party third party
  953  administrator used by the corporation must be certified under
  954  part VII of chapter 626.
  955         (c) Any standard forms, website design, or marketing
  956  communication developed by the corporation and used by the
  957  corporation, or any vendor that meets the requirements of
  958  paragraph (4)(f) is not subject to the Florida Insurance Code,
  959  as established in s. 624.01.
  960         (11) CORPORATION.—There is created the Florida Health
  961  Choices, Inc., which shall be registered, incorporated,
  962  organized, and operated in compliance with part III of chapter
  963  112 and chapters 119, 286, and 617. The purpose of the
  964  corporation is to administer the program created in this section
  965  and to conduct such other business as may further the
  966  administration of the program.
  967         (a) The corporation shall be governed by a 15-member board
  968  of directors consisting of:
  969         1. Three ex officio, nonvoting members to include:
  970         a. The Secretary of Health Care Administration or a
  971  designee with expertise in health care services.
  972         b. The Secretary of Management Services or a designee with
  973  expertise in state employee benefits.
  974         c. The commissioner of the Office of Insurance Regulation
  975  or a designee with expertise in insurance regulation.
  976         2. Four members appointed by and serving at the pleasure of
  977  the Governor.
  978         3. Four members appointed by and serving at the pleasure of
  979  the President of the Senate.
  980         4. Four members appointed by and serving at the pleasure of
  981  the Speaker of the House of Representatives.
  982         5. Board members may not include insurers, health insurance
  983  agents or brokers, health care providers, health maintenance
  984  organizations, prepaid service providers, or any other entity,
  985  affiliate, or subsidiary of eligible vendors.
  986         (b) Members shall be appointed for terms of up to 3 years.
  987  Any member is eligible for reappointment. A vacancy on the board
  988  shall be filled for the unexpired portion of the term in the
  989  same manner as the original appointment.
  990         (c) The board shall select a chief executive officer for
  991  the corporation who shall be responsible for the selection of
  992  such other staff as may be authorized by the corporation’s
  993  operating budget as adopted by the board.
  994         (d) Board members are entitled to receive, from funds of
  995  the corporation, reimbursement for per diem and travel expenses
  996  as provided by s. 112.061. No other compensation is authorized.
  997         (e) There is no liability on the part of, and no cause of
  998  action shall arise against, any member of the board or its
  999  employees or agents for any action taken by them in the
 1000  performance of their powers and duties under this section.
 1001         (f) The board shall develop and adopt bylaws and other
 1002  corporate procedures as necessary for the operation of the
 1003  corporation and carrying out the purposes of this section. The
 1004  bylaws shall:
 1005         1. Specify procedures for selection of officers and
 1006  qualifications for reappointment, provided that no board member
 1007  shall serve more than 9 consecutive years.
 1008         2. Require an annual membership meeting that provides an
 1009  opportunity for input and interaction with individual
 1010  participants in the program.
 1011         3. Specify policies and procedures regarding conflicts of
 1012  interest, including the provisions of part III of chapter 112,
 1013  which prohibit a member from participating in any decision that
 1014  would inure to the benefit of the member or the organization
 1015  that employs the member. The policies and procedures shall also
 1016  require public disclosure of the interest that prevents the
 1017  member from participating in a decision on a particular matter.
 1018         (g) The corporation may exercise all powers granted to it
 1019  under chapter 617 necessary to carry out the purposes of this
 1020  section, including, but not limited to, the power to receive and
 1021  accept grants, loans, or advances of funds from any public or
 1022  private agency and to receive and accept from any source
 1023  contributions of money, property, labor, or any other thing of
 1024  value to be held, used, and applied for the purposes of this
 1025  section.
 1026         (h) The corporation may establish technical advisory panels
 1027  consisting of interested parties, including consumers, health
 1028  care providers, individuals with expertise in insurance
 1029  regulation, and insurers.
 1030         (i) The corporation shall:
 1031         1. Determine eligibility of employers, vendors,
 1032  individuals, and agents in accordance with subsection (4).
 1033         2. Establish procedures necessary for the operation of the
 1034  program, including, but not limited to, procedures for
 1035  application, enrollment, risk assessment, risk adjustment, plan
 1036  administration, performance monitoring, and consumer education.
 1037         3. Arrange for collection of contributions from
 1038  participating employers, third parties, governmental entities,
 1039  and individuals.
 1040         4. Arrange for payment of premiums and other appropriate
 1041  disbursements based on the selections of products and services
 1042  by the individual participants.
 1043         5. Establish criteria for disenrollment of participating
 1044  individuals based on failure to pay the individual’s share of
 1045  any contribution required to maintain enrollment in selected
 1046  products.
 1047         6. Establish criteria for exclusion of vendors pursuant to
 1048  paragraph (4)(d).
 1049         7. Develop and implement a plan for promoting public
 1050  awareness of and participation in the program.
 1051         8. Secure staff and consultant services necessary to the
 1052  operation of the program.
 1053         9. Establish policies and procedures regarding
 1054  participation in the program for individuals, vendors, health
 1055  insurance agents, and employers.
 1056         10. Provide for the operation of a toll-free hotline to
 1057  respond to requests for assistance.
 1058         11. Provide for initial, open, and special enrollment
 1059  periods.
 1060         12. Evaluate options for employer participation which may
 1061  conform to with common insurance practices.
 1062         13. Administer the Florida Health Insurance Affordability
 1063  Exchange Program in accordance with ss. 409.72-409.731.
 1064         14. Coordinate with the Agency for Health Care
 1065  Administration, the Department of Children and Families, and the
 1066  Florida Healthy Kids Corporation in developing and implementing
 1067  the enrollee transition plan.
 1068         15. Coordinate with the federal exchange to provide FHIX
 1069  enrollees with the option of selecting plans from either the
 1070  FHIX marketplace or the federal exchange.
 1071         (12) REPORT.—The board of the corporation shall Beginning
 1072  in the 2009-2010 fiscal year, submit by February 1 an annual
 1073  report to the Governor, the President of the Senate, and the
 1074  Speaker of the House of Representatives documenting the
 1075  corporation’s activities in compliance with the duties
 1076  delineated in this section.
 1077         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1078  safeguard the financial transactions made under the auspices of
 1079  the program, the corporation is authorized to establish
 1080  qualifying criteria and certification procedures for vendors,
 1081  require performance bonds or other guarantees of ability to
 1082  complete contractual obligations, monitor the performance of
 1083  vendors, and enforce the agreements of the program through
 1084  financial penalty or disqualification from the program.
 1085         (14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS.—
 1086         (a) Definitions.—For purposes of this subsection, the term:
 1087         1. “Buyer’s representative” means a participating insurance
 1088  agent as described in paragraph (4)(g).
 1089         2. “Enrollee” means an employer who is eligible to enroll
 1090  in the program pursuant to paragraph (4)(a).
 1091         3. “Participant” means an individual who is eligible to
 1092  participate in the program pursuant to paragraph (4)(b).
 1093         4. “Proprietary confidential business information” means
 1094  information, regardless of form or characteristics, that is
 1095  owned or controlled by a vendor requesting confidentiality under
 1096  this section; that is intended to be and is treated by the
 1097  vendor as private in that the disclosure of the information
 1098  would cause harm to the business operations of the vendor; that
 1099  has not been disclosed unless disclosed pursuant to a statutory
 1100  provision, an order of a court or administrative body, or a
 1101  private agreement providing that the information may be released
 1102  to the public; and that is information concerning:
 1103         a. Business plans.
 1104         b. Internal auditing controls and reports of internal
 1105  auditors.
 1106         c. Reports of external auditors for privately held
 1107  companies.
 1108         d. Client and customer lists.
 1109         e. Potentially patentable material.
 1110         f. A trade secret as defined in s. 688.002.
 1111         5. “Vendor” means a participating insurer or other provider
 1112  of services as described in paragraph (4)(d).
 1113         (b) Public record exemptions.—
 1114         1. Personal identifying information of an enrollee or
 1115  participant who has applied for or participates in the Florida
 1116  Health Choices Program is confidential and exempt from s.
 1117  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1118         2. Client and customer lists of a buyer’s representative
 1119  held by the corporation are confidential and exempt from s.
 1120  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1121         3. Proprietary confidential business information held by
 1122  the corporation is confidential and exempt from s. 119.07(1) and
 1123  s. 24(a), Art. I of the State Constitution.
 1124         (c) Retroactive application.—The public record exemptions
 1125  provided for in paragraph (b) apply to information held by the
 1126  corporation before, on, or after the effective date of this
 1127  exemption.
 1128         (d) Authorized release.—
 1129         1. Upon request, information made confidential and exempt
 1130  pursuant to this subsection shall be disclosed to:
 1131         a. Another governmental entity in the performance of its
 1132  official duties and responsibilities.
 1133         b. Any person who has the written consent of the program
 1134  applicant.
 1135         c. The Florida Kidcare program for the purpose of
 1136  administering the program authorized in ss. 409.810-409.821.
 1137         2. Paragraph (b) does not prohibit a participant’s legal
 1138  guardian from obtaining confirmation of coverage, dates of
 1139  coverage, the name of the participant’s health plan, and the
 1140  amount of premium being paid.
 1141         (e) Penalty.—A person who knowingly and willfully violates
 1142  this subsection commits a misdemeanor of the second degree,
 1143  punishable as provided in s. 775.082 or s. 775.083.
 1144         Section 19. Subsection (2) of section 409.904, Florida
 1145  Statutes, is amended to read:
 1146         409.904 Optional payments for eligible persons.—The agency
 1147  may make payments for medical assistance and related services on
 1148  behalf of the following persons who are determined to be
 1149  eligible subject to the income, assets, and categorical
 1150  eligibility tests set forth in federal and state law. Payment on
 1151  behalf of these Medicaid eligible persons is subject to the
 1152  availability of moneys and any limitations established by the
 1153  General Appropriations Act or chapter 216.
 1154         (2) A family, a pregnant woman, a child under age 21, a
 1155  person age 65 or over, or a blind or disabled person, who would
 1156  be eligible under any group listed in s. 409.903(1), (2), or
 1157  (3), except that the income or assets of such family or person
 1158  exceed established limitations. For a family or person in one of
 1159  these coverage groups, medical expenses are deductible from
 1160  income in accordance with federal requirements in order to make
 1161  a determination of eligibility. A family or person eligible
 1162  under the coverage known as the “medically needy,” is eligible
 1163  to receive the same services as other Medicaid recipients, with
 1164  the exception of services in skilled nursing facilities and
 1165  intermediate care facilities for the developmentally disabled.
 1166  Effective July 1, 2020, persons eligible under “medically needy”
 1167  shall be limited to children under 21 years of age and pregnant
 1168  women. This subsection expires October 1, 2023.
 1169         Section 20. Section 624.91, Florida Statutes, is amended to
 1170  read:
 1171         624.91 The Florida Healthy Kids Corporation Act.—
 1172         (1) SHORT TITLE.—This section may be cited as the “William
 1173  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1174         (2) LEGISLATIVE INTENT.—
 1175         (a) The Legislature finds that increased access to health
 1176  care services could improve children’s health and reduce the
 1177  incidence and costs of childhood illness and disabilities among
 1178  children in this state. Many children do not have comprehensive,
 1179  affordable health care services available. It is the intent of
 1180  the Legislature that the Florida Healthy Kids Corporation
 1181  provide comprehensive health insurance coverage to such
 1182  children. The corporation is encouraged to cooperate with any
 1183  existing health service programs funded by the public or the
 1184  private sector.
 1185         (b) It is the intent of the Legislature that the Florida
 1186  Healthy Kids Corporation serve as one of several providers of
 1187  services to children eligible for medical assistance under Title
 1188  XXI of the Social Security Act. Although the corporation may
 1189  serve other children, the Legislature intends the primary
 1190  recipients of services provided through the corporation be
 1191  school-age children with a family income below 200 percent of
 1192  the federal poverty level, who do not qualify for Medicaid. It
 1193  is also the intent of the Legislature that state and local
 1194  government Florida Healthy Kids funds be used to continue
 1195  coverage, subject to specific appropriations in the General
 1196  Appropriations Act, to children not eligible for federal
 1197  matching funds under Title XXI.
 1198         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1199  of this state are eligible the following individuals are
 1200  eligible for state-funded assistance in paying Florida Healthy
 1201  Kids premiums pursuant to s. 409.814.:
 1202         (a) Residents of this state who are eligible for the
 1203  Florida Kidcare program pursuant to s. 409.814.
 1204         (b) Notwithstanding s. 409.814, a legal alien who is
 1205  enrolled in the Florida Healthy Kids program as of January 31,
 1206  2004, who does not qualify for Title XXI federal funds because
 1207  he or she is not a lawfully residing child as defined in s.
 1208  409.811.
 1209         (4) NONENTITLEMENT.—Nothing in this section shall be
 1210  construed as providing an individual with an entitlement to
 1211  health care services. No cause of action shall arise against the
 1212  state, the Florida Healthy Kids Corporation, or a unit of local
 1213  government for failure to make health services available under
 1214  this section.
 1215         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
 1216         (a) There is created the Florida Healthy Kids Corporation,
 1217  a not-for-profit corporation.
 1218         (b) The Florida Healthy Kids Corporation shall:
 1219         1. Arrange for the collection of any individual, family,
 1220  local contributions, or employer payment or premium, in an
 1221  amount to be determined by the board of directors, to provide
 1222  for payment of premiums for comprehensive insurance coverage and
 1223  for the actual or estimated administrative expenses.
 1224         2. Arrange for the collection of any voluntary
 1225  contributions to provide for payment of Florida Kidcare program
 1226  or Florida Health Insurance Affordability Exchange Program
 1227  (FHIX) premiums for children who are not eligible for medical
 1228  assistance under Title XIX or Title XXI of the Social Security
 1229  Act.
 1230         3. Subject to the provisions of s. 409.8134, accept
 1231  voluntary supplemental local match contributions that comply
 1232  with the requirements of Title XXI of the Social Security Act
 1233  for the purpose of providing additional Florida Kidcare coverage
 1234  in contributing counties under Title XXI.
 1235         4. Establish the administrative and accounting procedures
 1236  for the operation of the corporation.
 1237         4.5. Establish, with consultation from appropriate
 1238  professional organizations, standards for preventive health
 1239  services and providers and comprehensive insurance benefits
 1240  appropriate to children, provided that such standards for rural
 1241  areas shall not limit primary care providers to board-certified
 1242  pediatricians.
 1243         5.6. Determine eligibility for children seeking to
 1244  participate in the Title XXI-funded components of the Florida
 1245  Kidcare program consistent with the requirements specified in s.
 1246  409.814, as well as the non-Title-XXI-eligible children as
 1247  provided in subsection (3).
 1248         6.7. Establish procedures under which providers of local
 1249  match to, applicants to and participants in the program may have
 1250  grievances reviewed by an impartial body and reported to the
 1251  board of directors of the corporation.
 1252         7.8. Establish participation criteria and, if appropriate,
 1253  contract with an authorized insurer, health maintenance
 1254  organization, or third-party administrator to provide
 1255  administrative services to the corporation.
 1256         8.9. Establish enrollment criteria that include penalties
 1257  or waiting periods of 30 days for reinstatement of coverage upon
 1258  voluntary cancellation for nonpayment of family or individual
 1259  premiums.
 1260         9.10. Contract with authorized insurers or any provider of
 1261  health care services, meeting standards established by the
 1262  corporation, for the provision of comprehensive insurance
 1263  coverage to participants. Such standards shall include criteria
 1264  under which the corporation may contract with more than one
 1265  provider of health care services in program sites.
 1266         a. Health plans shall be selected through a competitive bid
 1267  process. The Florida Healthy Kids Corporation shall purchase
 1268  goods and services in the most cost-effective manner consistent
 1269  with the delivery of quality medical care.
 1270         b. The maximum administrative cost for a Florida Healthy
 1271  Kids Corporation contract shall be 15 percent. For health and
 1272  dental care contracts, the minimum medical loss ratio for a
 1273  Florida Healthy Kids Corporation contract shall be 85 percent.
 1274  The calculations must use uniform financial data collected from
 1275  all plans in a format established by the corporation and shall
 1276  be computed for each plan on a statewide basis. Funds shall be
 1277  classified in a manner consistent with 45 C.F.R. part 158 For
 1278  dental contracts, the remaining compensation to be paid to the
 1279  authorized insurer or provider under a Florida Healthy Kids
 1280  Corporation contract shall be no less than an amount which is 85
 1281  percent of premium; to the extent any contract provision does
 1282  not provide for this minimum compensation, this section shall
 1283  prevail.
 1284         c. The health plan selection criteria and scoring system,
 1285  and the scoring results, shall be available upon request for
 1286  inspection after the bids have been awarded.
 1287         d. Effective July 1, 2020, health and dental services
 1288  contracts of the corporation must transition to the FHIX
 1289  marketplace under s. 409.722. Qualifying plans may enroll as
 1290  vendors with the FHIX marketplace to maintain continuity of care
 1291  for participants.
 1292         10.11. Establish disenrollment criteria in the event local
 1293  matching funds are insufficient to cover enrollments.
 1294         11.12. Develop and implement a plan to publicize the
 1295  Florida Kidcare program, the eligibility requirements of the
 1296  program, and the procedures for enrollment in the program and to
 1297  maintain public awareness of the corporation and the program.
 1298         12.13. Secure staff necessary to properly administer the
 1299  corporation. Staff costs shall be funded from state and local
 1300  matching funds and such other private or public funds as become
 1301  available. The board of directors shall determine the number of
 1302  staff members necessary to administer the corporation.
 1303         13.14. In consultation with the partner agencies, provide a
 1304  report on the Florida Kidcare program annually to the Governor,
 1305  the Chief Financial Officer, the Commissioner of Education, the
 1306  President of the Senate, the Speaker of the House of
 1307  Representatives, and the Minority Leaders of the Senate and the
 1308  House of Representatives.
 1309         14.15. Provide information on a quarterly basis online to
 1310  the Legislature and the Governor which compares the costs and
 1311  utilization of the full-pay enrolled population and the Title
 1312  XXI-subsidized enrolled population in the Florida Kidcare
 1313  program. The information, at a minimum, must include:
 1314         a. The monthly enrollment and expenditure for full-pay
 1315  enrollees in the Medikids and Florida Healthy Kids programs
 1316  compared to the Title XXI-subsidized enrolled population; and
 1317         b. The costs and utilization by service of the full-pay
 1318  enrollees in the Medikids and Florida Healthy Kids programs and
 1319  the Title XXI-subsidized enrolled population.
 1320         15.16. Establish benefit packages that conform to the
 1321  provisions of the Florida Kidcare program, as created in ss.
 1322  409.810-409.821.
 1323         16. Contract with other insurance affordability programs to
 1324  provide such services that are consistent with this act.
 1325         17. Annually develop performance metrics for the following
 1326  focus areas:
 1327         a. Administrative functions.
 1328         b. Contracting with vendors.
 1329         c. Customer service.
 1330         d. Enrollee education.
 1331         e. Financial services.
 1332         f. Program integrity.
 1333         (c) Coverage under the corporation’s program is secondary
 1334  to any other available private coverage held by, or applicable
 1335  to, the participant child or family member. Insurers under
 1336  contract with the corporation are the payors of last resort and
 1337  must coordinate benefits with any other third-party payor that
 1338  may be liable for the participant’s medical care.
 1339         (d) The Florida Healthy Kids Corporation shall be a private
 1340  corporation not for profit, organized pursuant to chapter 617,
 1341  and shall have all powers necessary to carry out the purposes of
 1342  this act, including, but not limited to, the power to receive
 1343  and accept grants, loans, or advances of funds from any public
 1344  or private agency and to receive and accept from any source
 1345  contributions of money, property, labor, or any other thing of
 1346  value, to be held, used, and applied for the purposes of this
 1347  act.
 1348         (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.—
 1349         (a) The Florida Healthy Kids Corporation shall operate
 1350  subject to the supervision and approval of a board of directors.
 1351  The board chair shall be an appointee designated by the
 1352  Governor, and the board shall be chaired by the Chief Financial
 1353  Officer or her or his designee, and composed of 12 other
 1354  members. The Senate shall confirm the designated chair and other
 1355  board appointees. The board members shall be appointed selected
 1356  for 3-year terms. of office as follows:
 1357         1. The Secretary of Health Care Administration, or his or
 1358  her designee.
 1359         2. One member appointed by the Commissioner of Education
 1360  from the Office of School Health Programs of the Florida
 1361  Department of Education.
 1362         3. One member appointed by the Chief Financial Officer from
 1363  among three members nominated by the Florida Pediatric Society.
 1364         4. One member, appointed by the Governor, who represents
 1365  the Children’s Medical Services Program.
 1366         5. One member appointed by the Chief Financial Officer from
 1367  among three members nominated by the Florida Hospital
 1368  Association.
 1369         6. One member, appointed by the Governor, who is an expert
 1370  on child health policy.
 1371         7. One member, appointed by the Chief Financial Officer,
 1372  from among three members nominated by the Florida Academy of
 1373  Family Physicians.
 1374         8. One member, appointed by the Governor, who represents
 1375  the state Medicaid program.
 1376         9. One member, appointed by the Chief Financial Officer,
 1377  from among three members nominated by the Florida Association of
 1378  Counties.
 1379         10. The State Health Officer or her or his designee.
 1380         11. The Secretary of Children and Families, or his or her
 1381  designee.
 1382         12. One member, appointed by the Governor, from among three
 1383  members nominated by the Florida Dental Association.
 1384         (b) A member of the board of directors shall be appointed
 1385  by and serve at the pleasure of the Governor may be removed by
 1386  the official who appointed that member. The board shall appoint
 1387  an executive director, who is responsible for other staff
 1388  authorized by the board.
 1389         (c) Board members are entitled to receive, from funds of
 1390  the corporation, reimbursement for per diem and travel expenses
 1391  as provided by s. 112.061.
 1392         (d) There shall be no liability on the part of, and no
 1393  cause of action shall arise against, any member of the board of
 1394  directors, or its employees or agents, for any action they take
 1395  in the performance of their powers and duties under this act.
 1396         (e) Terms for board members appointed under this act are
 1397  effective January 1, 2020.
 1398         (7) LICENSING NOT REQUIRED; FISCAL OPERATION.—
 1399         (a) The corporation shall not be deemed an insurer. The
 1400  officers, directors, and employees of the corporation shall not
 1401  be deemed to be agents of an insurer. Neither the corporation
 1402  nor any officer, director, or employee of the corporation is
 1403  subject to the licensing requirements of the insurance code or
 1404  the rules of the Department of Financial Services. However, any
 1405  marketing representative utilized and compensated by the
 1406  corporation must be appointed as a representative of the
 1407  insurers or health services providers with which the corporation
 1408  contracts.
 1409         (b) The board has complete fiscal control over the
 1410  corporation and is responsible for all corporate operations.
 1411         (c) The Department of Financial Services shall supervise
 1412  any liquidation or dissolution of the corporation and shall
 1413  have, with respect to such liquidation or dissolution, all power
 1414  granted to it pursuant to the insurance code.
 1415         (8) TRANSITION PLANS.—The corporation shall confer with the
 1416  Agency for Health Care Administration, the Department of
 1417  Children and Families, and Florida Health Choices, Inc., to
 1418  develop transition plans for the Florida Health Insurance
 1419  Affordability Exchange Program as created under ss. 409.72
 1420  409.731.
 1421         Section 21. Section 624.915, Florida Statutes, is repealed.
 1422         Section 22. The Division of Law Revision and Information is
 1423  directed to replace the phrase “the effective date of this act”
 1424  wherever it occurs in this act with the date the act becomes a
 1425  law.
 1426         Section 23. This act shall take effect upon becoming a law.
 1427  
 1428  ================= T I T L E  A M E N D M E N T ================
 1429  And the title is amended as follows:
 1430         Delete lines 2 - 30
 1431  and insert:
 1432         An act relating to health care coverage; creating ss.
 1433         627.6046 and 627.65612, F.S.; defining the terms
 1434         “operative date” and “preexisting medical condition”
 1435         with respect to individual and group health insurance
 1436         policies, respectively; requiring insurers, contingent
 1437         upon the occurrence of either of two specified events,
 1438         to make at least one comprehensive major medical
 1439         health insurance policy available to all residents of
 1440         this state within a specified timeframe; prohibiting
 1441         such insurers from excluding, limiting, denying, or
 1442         delaying coverage under such policies due to
 1443         preexisting medical conditions; requiring such
 1444         policies to have been actively marketed on a specified
 1445         date and during a certain timeframe before that date;
 1446         providing applicability; amending s. 641.31, F.S.;
 1447         defining the terms “operative date” and “preexisting
 1448         medical condition” with respect to health maintenance
 1449         contracts; requiring health maintenance organizations,
 1450         contingent upon the occurrence of either of two
 1451         specified events, to make at least one comprehensive
 1452         major medical health maintenance contract available to
 1453         all residents of this state within a specified
 1454         timeframe; prohibiting such health maintenance
 1455         organizations from excluding, limiting, denying, or
 1456         delaying coverage under such contracts due to
 1457         preexisting medical conditions; requiring such
 1458         contracts to have been actively marketed on a
 1459         specified date and during a certain timeframe before
 1460         that date; providing a directive to the Division of
 1461         Law Revision and Information; creating s. 409.72,
 1462         F.S.; providing a short title; creating s. 409.721,
 1463         F.S.; creating the Florida Health Insurance
 1464         Affordability Exchange Program (FHIX) within the
 1465         Agency for Health Care Administration; providing
 1466         program authority and principles; creating s. 409.722,
 1467         F.S.; defining terms; creating s. 409.723, F.S.;
 1468         providing eligibility and enrollment criteria;
 1469         providing patient rights and responsibilities;
 1470         defining the term “disabled”; providing premium
 1471         levels; creating s. 409.724, F.S.; providing for
 1472         premium credits and choice counseling; establishing an
 1473         education campaign; providing for customer support and
 1474         disenrollment; creating s. 409.725, F.S.; providing
 1475         for available products and services; creating s.
 1476         409.726, F.S.; requiring the department to develop
 1477         accountability measures and performance standards
 1478         governing the administration of the program; creating
 1479         s. 409.727, F.S.; providing for a readiness review and
 1480         a two-phase implementation schedule; creating s.
 1481         409.728, F.S.; providing program operation and
 1482         management duties; creating s. 409.729, F.S.;
 1483         providing for the development of a long-term
 1484         reorganization plan and the formation of the FHIX
 1485         Workgroup; creating s. 409.73, F.S.; authorizing the
 1486         agency to seek federal approval; prohibiting the
 1487         agency from implementing the FHIX waiver under certain
 1488         circumstances; creating s. 409.731, F.S.; providing
 1489         for program expiration; providing for the
 1490         establishment of a commission; providing purposes and
 1491         duties of the commission and for the appointment of
 1492         members; requiring a commission report to be submitted
 1493         to the Governor and the Legislature; repealing s.
 1494         408.70, F.S., relating to legislative findings
 1495         regarding access to affordable health care; amending
 1496         s. 408.910, F.S.; revising legislative intent;
 1497         redefining terms; revising the scope of the Florida
 1498         Health Choices Program and the pricing of services
 1499         under the program; providing requirements for
 1500         operation of the marketplace; providing additional
 1501         duties for the corporation to perform; requiring an
 1502         annual report to the Governor and the Legislature;
 1503         amending s. 409.904, F.S.; limiting eligible persons
 1504         in the Medically Needy program to those under the age
 1505         of 21 and pregnant women, and specifying an effective
 1506         date; providing an expiration date for the program;
 1507         amending s. 624.91, F.S.; revising eligibility
 1508         requirements for state-funded assistance; revising the
 1509         duties and powers of the Florida Healthy Kids
 1510         Corporation; revising provisions for the appointment
 1511         of members of the board of the Florida Healthy Kids
 1512         Corporation; requiring transition plans; repealing s.
 1513         624.915, F.S., relating to the operating fund of the
 1514         Florida Healthy Kids Corporation; providing a
 1515         directive to the Division of Law Revision and
 1516         Information; providing an effective date.