Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. CS for SB 524
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Appropriations (Diaz) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 110.12303, Florida Statutes, is amended
    6  to read:
    7         110.12303 State group insurance program; additional
    8  benefits; price transparency program; reporting.—Beginning with
    9  the 2018 plan year:
   10         (1) In addition to the comprehensive package of health
   11  insurance and other benefits required or authorized to be
   12  included in the state group insurance program, the package of
   13  benefits may also include products and services offered by:
   14         (a) Prepaid limited health service organizations authorized
   15  pursuant to part I of chapter 636.
   16         (b) Discount medical plan organizations authorized pursuant
   17  to part II of chapter 636.
   18         (c) Prepaid health clinics licensed under part II of
   19  chapter 641.
   20         (d) Licensed health care providers, including hospitals and
   21  other health care facilities, health care clinics, and health
   22  professionals, who sell service contracts and arrangements for a
   23  specified amount and type of health services.
   24         (e) Provider organizations, including service networks,
   25  group practices, professional associations, and other
   26  incorporated organizations of providers, who sell service
   27  contracts and arrangements for a specified amount and type of
   28  health services.
   29         (f) Entities that provide specific health services in
   30  accordance with applicable state law and sell service contracts
   31  and arrangements for a specified amount and type of health
   32  services.
   33         (g) Entities that provide health services or treatments
   34  through a bidding process.
   35         (h) Entities that provide health services or treatments
   36  through the bundling or aggregating of health services or
   37  treatments.
   38         (i) Entities that provide optional participation in the
   39  Medicare Advantage Prescription Drug Plan.
   40         (j) Entities that provide other innovative and cost
   41  effective health service delivery methods.
   42         (2)(a) The department shall contract with at least one
   43  entity that provides comprehensive pricing and inclusive
   44  services for surgery and other medical procedures which may be
   45  accessed at the option of the enrollee. The contract shall
   46  require the entity to:
   47         1. Have procedures and evidence-based standards to ensure
   48  the inclusion of only high-quality health care providers.
   49         2. Provide assistance to the enrollee in accessing and
   50  coordinating care.
   51         3. Provide cost savings to the state group insurance
   52  program to be shared with both the state and the enrollee. Cost
   53  savings payable to an enrollee may be:
   54         a. Credited to the enrollee’s flexible spending account;
   55         b. Credited to the enrollee’s health savings account;
   56         c. Credited to the enrollee’s health reimbursement account;
   57  or
   58         d. Paid as additional health plan reimbursements not
   59  exceeding the amount of the enrollee’s out-of-pocket medical
   60  expenses.
   61         4. Provide an educational campaign for enrollees to learn
   62  about the services offered by the entity.
   63         (b) On or before January 15 of each year, the department
   64  shall report to the Governor, the President of the Senate, and
   65  the Speaker of the House of Representatives on the participation
   66  level and cost-savings to both the enrollee and the state
   67  resulting from the contract or contracts described in this
   68  subsection.
   69         (3) The department shall contract with an entity that
   70  provides enrollees with online information on the cost and
   71  quality of health care services and providers, allows an
   72  enrollee to shop for health care services and providers, and
   73  rewards the enrollee by sharing savings generated by the
   74  enrollee’s choice of services or providers. The contract shall
   75  require the entity to:
   76         (a) Establish an Internet-based, consumer-friendly platform
   77  that educates and informs enrollees about the price and quality
   78  of health care services and providers, including the average
   79  amount paid in each county for health care services and
   80  providers. The average amounts paid for such services and
   81  providers may be expressed for service bundles, which include
   82  all products and services associated with a particular treatment
   83  or episode of care, or for separate and distinct products and
   84  services.
   85         (b) Allow enrollees to shop for health care services and
   86  providers using the price and quality information provided on
   87  the Internet-based platform.
   88         (c) Permit a certified bargaining agent of state employees
   89  to provide educational materials and counseling to enrollees
   90  regarding the Internet-based platform.
   91         (d) Identify the savings realized to the enrollee and state
   92  if the enrollee chooses high-quality, lower-cost health care
   93  services or providers, and facilitate a shared savings payment
   94  to the enrollee. The amount of shared savings shall be
   95  determined by a methodology approved by the department and shall
   96  maximize value-based purchasing by enrollees. The amount payable
   97  to the enrollee may be:
   98         1. Credited to the enrollee’s flexible spending account;
   99         2. Credited to the enrollee’s health savings account;
  100         3. Credited to the enrollee’s health reimbursement account;
  101  or
  102         4. Paid as additional health plan reimbursements not
  103  exceeding the amount of the enrollee’s out-of-pocket medical
  104  expenses.
  105         (e) On or before January 1 of 2019, 2020, and 2021, the
  106  department shall report to the Governor, the President of the
  107  Senate, and the Speaker of the House of Representatives on the
  108  participation level, amount paid to enrollees, and cost-savings
  109  to both the enrollees and the state resulting from the
  110  implementation of this subsection.
  111         Section 2. Subsection (9) is added to section 110.12315,
  112  Florida Statutes, to read:
  113         110.12315 Prescription drug program.—The state employees’
  114  prescription drug program is established. This program shall be
  115  administered by the Department of Management Services, according
  116  to the terms and conditions of the plan as established by the
  117  relevant provisions of the annual General Appropriations Act and
  118  implementing legislation, subject to the following conditions:
  119         (9)(a) Beginning with the 2020 plan year, the department
  120  must implement formulary management for prescription drugs and
  121  supplies. Such management practices must require prescription
  122  drugs to be subject to formulary inclusion or exclusion but may
  123  not restrict access to the most clinically appropriate,
  124  clinically effective, and lowest net-cost prescription drugs and
  125  supplies. Drugs excluded from the formulary must be available
  126  for inclusion if a physician, advanced registered nurse
  127  practitioner, or physician assistant prescribing a
  128  pharmaceutical clearly states on the prescription that the
  129  excluded drug is medically necessary. Prescription drugs and
  130  supplies first made available in the marketplace after January
  131  1, 2020, may not be covered by the prescription drug program
  132  until specifically included in the list of covered prescription
  133  drugs and supplies.
  134         (b) No later than August 15, 2019, and by each August 15
  135  thereafter, the department must submit to the Governor, the
  136  President of the Senate, and the Speaker of the House of
  137  Representatives the list of prescription drugs and supplies that
  138  will be excluded from program coverage for the next plan year.
  139  If the department proposes to exclude prescription drugs and
  140  supplies after the plan year has commenced, the department must
  141  provide notice to the Governor, the President of the Senate, and
  142  the Speaker of the House of Representatives of such exclusions
  143  at least 30 days before implementation of such exclusions.
  144         Section 3. Effective December 31, 2019, section 8 of
  145  chapter 99-255, Laws of Florida, is repealed.
  146         Section 4. Effective January 1, 2020, section 627.6387,
  147  Florida Statutes, is created to read:
  148         627.6387Shared savings incentive program.—
  149         (1)This section may be cited as the “Patient Savings Act.”
  150         (2)As used in this section, the term:
  151         (a)“Health care provider” means a hospital or facility
  152  licensed under chapter 395; an entity licensed under chapter
  153  400; a health care practitioner as defined in s. 456.001; a
  154  blood bank, plasma center, industrial clinic, or renal dialysis
  155  facility; or a professional association, partnership,
  156  corporation, joint venture, or other association for
  157  professional activity by health care providers. The term
  158  includes entities and professionals outside of this state with
  159  an active, unencumbered license for an equivalent facility or
  160  practitioner type issued by another state, the District of
  161  Columbia, or a possession or territory of the United States.
  162         (b)“Health insurer” means an authorized insurer offering
  163  health insurance as defined in s. 624.603 or a health
  164  maintenance organization as defined in s. 641.19. The term does
  165  not include the state group health insurance program provided
  166  under s. 110.123.
  167         (c)“Shared savings incentive” means a voluntary and
  168  optional financial incentive that a health insurer may provide
  169  to an insured for choosing certain shoppable health care
  170  services under a shared savings incentive program and may
  171  include, but is not limited to, the incentives described in s.
  172  626.9541(4)(a).
  173         (d)“Shared savings incentive program” means a voluntary
  174  and optional incentive program established by a health insurer
  175  pursuant to this section.
  176         (e)“Shoppable health care service” means a lower-cost,
  177  high-quality nonemergency health care service for which a shared
  178  savings incentive is available for insureds under a health
  179  insurer’s shared savings incentive program. Shoppable health
  180  care services may be provided within or outside of this state
  181  and include, but are not limited to:
  182         1.Clinical laboratory services.
  183         2.Infusion therapy.
  184         3.Inpatient and outpatient surgical procedures.
  185         4.Obstetrical and gynecological services.
  186         5.Inpatient and outpatient nonsurgical diagnostic tests
  187  and procedures.
  188         6.Physical and occupational therapy services.
  189         7.Radiology and imaging services.
  190         8.Prescription drugs.
  191         9.Services provided through telehealth.
  192         (3)A health insurer may offer a shared savings incentive
  193  program to provide incentives to an insured when the insured
  194  obtains a shoppable health care service from the health
  195  insurer’s shared savings list. An insured may not be required to
  196  participate in a shared savings incentive program. A health
  197  insurer that offers a shared savings incentive program must:
  198         (a)Establish the program as a component part of the
  199  policy, contract, or certificate of insurance provided by the
  200  health insurer and notify the insureds and the office at least
  201  30 days before program termination.
  202         (b)File a description of the program on a form prescribed
  203  by commission rule. The office must review the filing and
  204  determine whether the shared savings incentive program complies
  205  with this section.
  206         (c)Notify an insured annually and at the time of renewal,
  207  and an applicant for insurance at the time of enrollment, of the
  208  availability of the shared savings incentive program and the
  209  procedure to participate in the program.
  210         (d)Publish on a webpage easily accessible to insureds and
  211  to applicants for insurance a list of shoppable health care
  212  services and health care providers and the shared savings
  213  incentive amount applicable for each service. A shared savings
  214  incentive may not be less than 25 percent of the savings
  215  generated by the insured’s participation in any shared savings
  216  incentive offered by the health insurer. The baseline for the
  217  savings calculation is the average in-network amount paid for
  218  that service in the most recent 12-month period or some other
  219  methodology established by the health insurer and approved by
  220  the office.
  221         (e)At least quarterly, credit or deposit the shared
  222  savings incentive amount to the insured’s account as a return or
  223  reduction in premium, or credit the shared savings incentive
  224  amount to the insured’s flexible spending account, health
  225  savings account, or health reimbursement account, such that the
  226  amount does not constitute income to the insured.
  227         (f)Submit an annual report to the office within 90
  228  business days after the close of each plan year. At a minimum,
  229  the report must include the following information:
  230         1.The number of insureds who participated in the program
  231  during the plan year and the number of instances of
  232  participation.
  233         2.The total cost of services provided as a part of the
  234  program.
  235         3.The total value of the shared savings incentive payments
  236  made to insureds participating in the program and the values
  237  distributed as premium reductions, credits to flexible spending
  238  accounts, credits to health savings accounts, or credits to
  239  health reimbursement accounts.
  240         4.An inventory of the shoppable health care services
  241  offered by the health insurer.
  242         (4)(a)A shared savings incentive offered by a health
  243  insurer in accordance with this section:
  244         1.Is not an administrative expense for rate development or
  245  rate filing purposes.
  246         2.Does not constitute an unfair method of competition or
  247  an unfair or deceptive act or practice under s. 626.9541 and is
  248  presumed to be appropriate unless credible data clearly
  249  demonstrates otherwise.
  250         (b)A shared saving incentive amount provided as a return
  251  or reduction in premium reduces the health insurer’s direct
  252  written premium by the shared saving incentive dollar amount for
  253  the purposes of the taxes in ss. 624.509 and 624.5091.
  254         (5)The commission may adopt rules necessary to implement
  255  and enforce this section.
  256         Section 5. Except as otherwise expressly provided in this
  257  act, this act shall take effect July 1, 2019.
  259  ================= T I T L E  A M E N D M E N T ================
  260  And the title is amended as follows:
  261         Delete everything before the enacting clause
  262  and insert:
  263                        A bill to be entitled                      
  264         An act relating to health insurance; amending s.
  265         110.12303, F.S.; removing an obsolete date;
  266         authorizing the inclusion in the state group insurance
  267         program of products and services offered by entities
  268         providing optional participation in the Medicare
  269         Advantage Prescription Drug Plan; amending s.
  270         110.12315, F.S.; requiring the Department of
  271         Management Services to implement formulary management
  272         cost-saving measures beginning with the 2020 plan
  273         year; specifying requirements for such measures;
  274         requiring the department to report to the Governor and
  275         the Legislature regarding formulary exclusions;
  276         repealing s. 8 of ch. 99-255, Laws of Florida;
  277         repealing a restriction prohibiting the department
  278         from implementing prior authorization or restricted
  279         formulary programs within the state employees’
  280         prescription drug program; creating s. 627.6387, F.S.;
  281         providing a short title; defining terms; authorizing
  282         health insurers, which include health maintenance
  283         organizations, to offer shared savings incentive
  284         programs to insureds; providing that insureds are not
  285         required to participate in such programs; specifying
  286         requirements for health insurers offering such
  287         programs; requiring the Office of Insurance Regulation
  288         to review filed descriptions of programs and make a
  289         certain determination; providing notification and
  290         account credit or deposit requirements for insurers;
  291         specifying the minimum shared savings incentive and
  292         the basis for calculating savings; specifying
  293         requirements for annual reports submitted by insurers
  294         to the office; providing construction; providing that
  295         certain shared saving incentive amounts reduce an
  296         insurer’s direct written premium for purposes of the
  297         insurance premium tax and the retaliatory tax;
  298         authorizing the Financial Services Commission to adopt
  299         rules; providing effective dates.