Bill Amendment: FL S0002 | 2015 | 1st Special Session

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: Health Insurance Affordability Exchange

Status: 2015-06-05 - CS failed to pass; YEAS 41 NAYS 72 [S0002 Detail]

Download: Florida-2015-S0002-Senate_Committee_Amendment_260258.html

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       Florida Senate - 2015                        COMMITTEE AMENDMENT
       Bill No. SB 2-A
       
       
       
       
       
       
                                Ì2602584Î260258                         
       
                              LEGISLATIVE ACTION                        
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       The Committee on Health Policy (Bean) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. The Division of Law Revision and Information is
    6  directed to rename part II of chapter 409, Florida Statutes, as
    7  “Insurance Affordability Programs” and to incorporate ss.
    8  409.72-409.731, Florida Statutes, under this part.
    9         Section 2. 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 3. 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 4. 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 qualified
   96  alien who is domiciled in this state.
   97         Section 5. 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 that are
  150  validated through registration with CareerSource Florida.
  151         3. Educational pursuits.
  152  
  153  A participant who is a disabled adult or the caregiver of a
  154  disabled child or adult may submit a request to the department
  155  for an exception to the requirements in this paragraph. Such
  156  participant shall annually submit to the department a request to
  157  renew the exception. The term “disabled” means any person who
  158  has one or more permanent physical or mental impairments that
  159  substantially limit his or her ability to perform one or more
  160  major life activities of daily living, as defined by the
  161  Americans with Disabilities Act, without receiving more than 8
  162  hours of assistance per day.
  163         (c) Engage in the activities required under paragraph (b)
  164  at the following minimum levels:
  165         1. For a parent of a child younger than 18 years of age, a
  166  minimum of 20 hours weekly.
  167         2. For a childless adult, a minimum of 30 hours weekly.
  168         (d) Learn and remain informed about the choices available
  169  in the FHIX marketplace or the federal exchange and the
  170  allowable uses of credits in the individual accounts.
  171         (e) Execute a contract with the department which
  172  acknowledges that:
  173         1. FHIX is not an entitlement and state and federal funding
  174  may end at any time;
  175         2. Failure to pay required premiums or cost sharing will
  176  result in a transition to inactive status; and
  177         3. Noncompliance with the participation requirements as
  178  established under s. 409.723 will result in a transition to
  179  inactive status.
  180         (f) Select plans and other products in a timely manner.
  181         (g) Comply with program rules and the prohibitions against
  182  fraud, as described in s. 414.39.
  183         (h) Timely make monthly premium and any other cost-sharing
  184  payments.
  185         (i) Meet minimum coverage requirements by selecting either
  186  a high-deductible health plan combined with a health savings or
  187  a reimbursement account or a combination of plans or products
  188  with an actuarial value that meets or exceeds benefits available
  189  under the federal exchange.
  190         (5) COST SHARING.—
  191         (a) Enrollees are assessed monthly premiums based on their
  192  modified adjusted gross income. The maximum monthly premium
  193  payments are set at the following income levels:
  194         1. At or below 22 percent of the federal poverty level: $3.
  195         2. Greater than 22 percent, but at or below 50 percent, of
  196  the federal poverty level: $8.
  197         3. Greater than 50 percent, but at or below 75 percent, of
  198  the federal poverty level: $15.
  199         4. Greater than 75 percent, but at or below 100 percent, of
  200  the federal poverty level: $20.
  201         5. Greater than 100 percent of the federal poverty level:
  202  $25.
  203         (b) Depending on the products and services selected by the
  204  enrollee, the enrollee may also incur additional cost sharing,
  205  such as copayments, deductibles, or other out-of-pocket costs.
  206         (c) An enrollee may be subject to charge for an
  207  inappropriate emergency room visit of up to $8 for the first
  208  visit and up to $25 for any subsequent visit, based on the
  209  enrollee’s benefit plan, to discourage inappropriate use of the
  210  emergency room.
  211         (d) Cumulative annual cost sharing per enrollee may not
  212  exceed 5 percent of an enrollee’s annual modified adjusted gross
  213  income.
  214         (e) If, after a 30-day grace period, a full premium payment
  215  has not been received, the enrollee shall be transitioned from
  216  coverage to inactive status and may not reenroll for a minimum
  217  of 6 months, unless a hardship exception has been granted.
  218  Enrollees may seek a hardship exception under the Medicaid Fair
  219  Hearing Process.
  220         Section 6. Section 409.724, Florida Statutes, is created to
  221  read:
  222         409.724 Available assistance.—
  223         (1) PREMIUM CREDITS.—
  224         (a) Standard amount.—The standard monthly premium credit is
  225  equivalent to the applicable risk-adjusted capitation rate paid
  226  to Medicaid managed care plans under part IV of this chapter.
  227         (b) Supplemental funding.—Subject to federal approval,
  228  additional resources may be made available to enrollees and
  229  incorporated into FHIX.
  230         (c) Savings accounts.—In addition to the benefits provided
  231  under this section, the corporation must offer each enrollee
  232  access to an individual account that qualifies as a health
  233  reimbursement account or a health savings account.
  234         1. Unexpended Funds.—Eligible unexpended funds from the
  235  monthly premium credit must be deposited into each enrollee’s
  236  individual account in a timely manner. Funds deposited into
  237  these individual accounts may be used to pay cost-sharing
  238  obligations or to purchase other health-related items to the
  239  extent permitted under federal and state law.
  240         2. Healthy Behaviors.—Enrollees may receive credits to
  241  their individual accounts for healthy behaviors, adherence to
  242  wellness programs, and other activities that demonstrate
  243  compliance with prevention or disease management guidelines.
  244         3. Enrollee contributions.—The enrollee may make deposits
  245  to his or her account at any time to supplement the premium
  246  credit, to purchase additional FHIX products, or to offset other
  247  cost-sharing obligations.
  248         4. Third parties.—Third parties, including, but not limited
  249  to, an employer or relative, may also make deposits on behalf of
  250  the enrollee into the enrollee’s FHIX marketplace account. The
  251  enrollee may not withdraw any funds as a refund, except those
  252  funds the enrollee has deposited into his or her account.
  253         (2) CHOICE COUNSELING.—The agency, in consultation with the
  254  Florida Healthy Kids Corporation and the corporation, shall
  255  develop a choice counseling program for FHIX. The choice
  256  counseling program must ensure that participants have
  257  information about the FHIX marketplace program, the federal
  258  exchange, products, and services and that participants know
  259  where and whom to call for questions or to make their plan
  260  selections. The choice counseling program must provide
  261  culturally sensitive materials and must take into consideration
  262  the demographics of the projected population.
  263         (3) EDUCATION CAMPAIGN.—The agency, the corporation, and
  264  the Florida Healthy Kids Corporation must coordinate in advance
  265  of Phase One an ongoing education campaign to inform
  266  participants, at a minimum, of the following:
  267         (a) How the FHIX marketplace operates and the timeline for
  268  enrollment.
  269         (b) Plans that are available and how to find information
  270  about these plans.
  271         (c) Information about other available insurance
  272  affordability programs for the participant and his or her
  273  family.
  274         (d) Information about health benefits coverage, provider
  275  networks, and cost sharing for available plans in each region.
  276         (e) Information on how to complete the required annual
  277  renewal process, including renewal dates and deadlines.
  278         (f) Information on how to update eligibility if the
  279  participant’s data have changed since his or her last renewal or
  280  application date.
  281         (4) CUSTOMER SUPPORT.—The Florida Healthy Kids Corporation
  282  shall provide customer support for FHIX, including, but not
  283  limited to, general program information, financial information,
  284  and enrollee payments. Customer support must also provide a
  285  toll-free telephone number and maintain a website that is
  286  available in multiple languages and that meets the needs of the
  287  enrollee population.
  288         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  289  inactive participant about other insurance affordability
  290  programs and electronically refer the participant to the federal
  291  exchange or other insurance affordability programs, as
  292  appropriate.
  293         Section 7. Section 409.725, Florida Statutes, is created to
  294  read:
  295         409.725 Available products and services.—The FHIX
  296  marketplace shall offer the following products and services:
  297         (1) Products and services authorized pursuant to s.
  298  408.910.
  299         (2) Products authorized by the federal exchange.
  300         (3) Products authorized by the Florida Healthy Kids
  301  Corporation pursuant to s. 624.91.
  302         (4) Premium credits for participation in employer-sponsored
  303  plans.
  304         Section 8. Section 409.726, Florida Statutes, is created to
  305  read:
  306         409.726 Program accountability.—
  307         (1) All managed care plans that participate in FHIX must
  308  collect and maintain encounter level data in accordance with the
  309  encounter data requirements under s. 409.967(2)(d) and are
  310  subject to the accompanying penalties under s. 409.967(2)(h)2.
  311  The agency is responsible for the collection and maintenance of
  312  the encounter level data.
  313         (2) The corporation, in consultation with the agency, shall
  314  establish access and network standards for contracts on the FHIX
  315  marketplace, shall ensure that contracted plans have sufficient
  316  providers to meet enrollee needs, and shall develop quality of
  317  coverage and provider standards specific to the adult
  318  population.
  319         (3) The department shall develop accountability measures
  320  and performance standards to be applied to initial and renewal
  321  FHIX applications that are submitted online, by mail, by
  322  facsimile, or through referrals from a third party. The minimum
  323  performance standards are:
  324         (a) Application processing speed.—Ninety percent of all
  325  applications, regardless of the method of submission, must be
  326  processed within 45 days.
  327         (b) Application processing speed from online sources.
  328  Ninety-five percent of all applications received from online
  329  sources must be processed within 45 days.
  330         (c) Renewal application processing speed.—Ninety percent of
  331  all renewals, regardless of the method of submission, must be
  332  processed within 45 days.
  333         (d) Renewal application processing speed from online
  334  sources.—Ninety-five percent of all applications received from
  335  online sources must be processed within 45 days.
  336         (4) The agency, the department, and the Florida Healthy
  337  Kids Corporation must meet the following standards for their
  338  respective roles in the program:
  339         (a) Eighty-five percent of calls must be answered in 20
  340  seconds or less.
  341         (b) All contacts, including, but not limited to, telephone
  342  calls, faxed documents and requests, and e-mails, must be
  343  handled within 2 business days.
  344         (c) Any self-service tools available to participants, such
  345  as interactive voice response systems, must be operational 7
  346  days a week, 24 hours a day, at least 98 percent of each month.
  347         (5) The agency, the department, and the Florida Healthy
  348  Kids Corporation shall conduct an annual satisfaction survey to
  349  address all measures that require participant input specific to
  350  the FHIX marketplace program. The parties may elect to
  351  incorporate these elements into the annual report required under
  352  subsection (7).
  353         (6) The agency and the corporation shall post online
  354  monthly enrollment reports for FHIX.
  355         (7) Beginning in 2016, an annual report is due no later
  356  than July 1 to the Governor, the President of the Senate, and
  357  the Speaker of the House of Representatives. The annual report
  358  must be coordinated by the agency and the corporation and must
  359  include at least the following:
  360         (a) Enrollment and application trends and issues.
  361         (b) Utilization and cost data.
  362         (c) Customer satisfaction.
  363         (d) Funding sources in health savings accounts or health
  364  reimbursement accounts.
  365         (e) Enrollee use of funds in health savings accounts or
  366  health reimbursement accounts.
  367         (f) Types of products and plans purchased.
  368         (g) Movement of enrollees across different insurance
  369  affordability programs.
  370         (h) Recommendations for program improvement.
  371         Section 9. Section 409.727, Florida Statutes, is created to
  372  read:
  373         409.727 Readiness review and implementation schedule.—The
  374  agency, the corporation, the department, and the Florida Healthy
  375  Kids Corporation shall begin implementation of FHIX on the
  376  effective date of this act, with enrollment for Phase One
  377  beginning by January 1, 2016.
  378         (1) READINESS REVIEW.—Before implementation of any phase
  379  under this part or in any region, the agency shall conduct a
  380  readiness review in consultation with the FHIX Workgroup
  381  established pursuant to s. 409.729. The agency shall determine,
  382  at a minimum, the following readiness milestones:
  383         (a) Functional readiness of the service delivery platform.
  384         (b) Plan availability and presence of plan choice.
  385         (c) Provider network capacity and adequacy of the available
  386  plans.
  387         (d) Availability of customer support.
  388         (e) Other factors critical to the success of FHIX.
  389         (2) PHASE ONE.—The agency, the corporation, and the Florida
  390  Healthy Kids Corporation shall coordinate implementation
  391  activities to ensure that enrollment begins by January 1, 2016,
  392  and is available in all regions by July 1, 2016.
  393         (a) Beginning no later than January 1, 2016, and contingent
  394  upon federal approval, participants may enroll in health
  395  benefits coverage under the FHIX marketplace or the federal
  396  exchange, if eligible.
  397         (b) To be eligible for enrollment during this phase, a
  398  participant must meet the requirements under s. 409.723(1)(a)
  399  and (b).
  400         (c) An enrollee may select any benefit, service, or product
  401  available in the region.
  402         (d) The corporation shall notify an enrollee of his or her
  403  premium credit amount and how to access the FHIX marketplace
  404  selection process or the federal exchange.
  405         (e) An enrollee must have a choice of at least two managed
  406  care plans in each region which meet or exceed the Affordable
  407  Care Act’s requirements and which qualify for a premium credit
  408  on the FHIX marketplace or federal exchange.
  409         (f) Choice counseling and customer service must be provided
  410  in accordance with s. 409.724(2) and (4).
  411         (3) PHASE TWO.—
  412         (a) No later than July 1, 2016, the corporation and the
  413  Florida Healthy Kids Corporation shall begin the transition of
  414  enrollees under s. 624.91 to the FHIX marketplace.
  415         (b) Eligibility during this phase is based on meeting the
  416  requirements of s. 409.723(1)(c) and (4).
  417         (c) An enrollee may select any available benefit, service,
  418  or product available under s. 409.725.
  419         (d) A Florida Healthy Kids enrollee who selects a FHIX
  420  marketplace plan or federal exchange plan shall be provided a
  421  premium credit equivalent to the average capitation rate paid in
  422  his or her county of residence under Florida Healthy Kids as of
  423  June 30, 2016. The enrollee is responsible for any difference in
  424  costs and may use any unexpended funds deposited in his or her
  425  savings account under s. 409.724(1)(c) for supplemental benefits
  426  on the FHIX marketplace or federal exchange.
  427         (e) The corporation shall notify an enrollee of his or her
  428  premium credit amount and how to access the FHIX marketplace
  429  selection process or federal exchange.
  430         (f) Choice counseling and customer service must be provided
  431  in accordance with s. 409.724(2) and (4).
  432         (g) Enrollees under s. 624.91 must transition to the FHIX
  433  marketplace and coverage under s. 409.725 by September 30, 2016.
  434         Section 10. Section 409.728, Florida Statutes, is created
  435  to read:
  436         409.728 Program operation and management.—In order to
  437  implement ss. 409.72-409.731:
  438         (1) The agency shall do all of the following:
  439         (a) Contract with the corporation for the development,
  440  implementation, and administration of the Florida Health
  441  Insurance Affordability Exchange Program and for the release of
  442  any federal, state, or other funds appropriated to the
  443  corporation.
  444         (b) Provide administrative support to the FHIX Workgroup
  445  established pursuant to s. 409.729.
  446         (c) Consult with stakeholders that serve low-income
  447  individuals and families during implementation, using a public
  448  input process.
  449         (d) Timely transmit enrollee information to the
  450  corporation.
  451         (e) Annually determine the risk-adjusted rate to be paid
  452  per month based on historical utilization and spending data for
  453  the medical and behavioral health of enrollee population,
  454  projected forward, and adjusted to reflect the eligibility
  455  category, medical and dental trends, geographic areas, and the
  456  clinical risk profile of the enrollees.
  457         (f) Transfer funds allocated for premium credits by General
  458  Appropriations Act to the corporation.
  459         (g) Adopt rules in coordination with the corporation and
  460  the Florida Healthy Kids Corporation in order to implement FHIX,
  461  including modifying existing rules implementing the Children’s
  462  Health Insurance Program and adapting adult focused provisions
  463  for children to accommodate the seamless transition of Healthy
  464  Kids enrollees to FHIX.
  465         (2) The department shall, in coordination with the
  466  corporation, the agency, and the Florida Healthy Kids
  467  Corporation, determine eligibility of applications and
  468  application renewals for FHIX in accordance with s. 409.902 and
  469  shall transmit eligibility determination information on a timely
  470  basis to the agency and corporation.
  471         (3) The Florida Healthy Kids Corporation shall do all of
  472  the following:
  473         (a) Retain its duties and responsibilities under s. 624.91
  474  during Phase One of the program.
  475         (b) In coordination with the agency and the corporation,
  476  provide customer service for the FHIX marketplace.
  477         (c) Transfer funds and provide financial support to the
  478  FHIX marketplace, including the collection of monthly cost
  479  sharing payments.
  480         (d) Conduct financial reporting related to such activities,
  481  in coordination with the corporation and the agency.
  482         (e) Coordinate program activities with the agency, the
  483  department, and the corporation.
  484         (4) Florida Health Choices, Inc., shall do all of the
  485  following:
  486         (a) Develop and maintain the FHIX marketplace.
  487         (b) Implement and administer Phase One and Phase Two of the
  488  FHIX marketplace and the ongoing operations of the program.
  489         (c) Offer health benefits coverage packages on the FHIX
  490  marketplace, including plans compliant with the Affordable Care
  491  Act.
  492         (d) Offer FHIX enrollees a choice of at least two plans per
  493  county at each benefit level which meet the requirements under
  494  the Affordable Care Act.
  495         (e) Offer the opportunity to participate in the federal
  496  exchange.
  497         (f) Offer enhanced or customized benefits to FHIX
  498  marketplace enrollees.
  499         (g) Provide sufficient staff and resources to meet the
  500  program needs of enrollees.
  501         (h) Provide an opportunity for plans contracted with or
  502  previously contracted with the Florida Healthy Kids Corporation
  503  under s. 624.91 to participate with FHIX if those plans meet the
  504  requirements of the program.
  505         (i) Encourage insurance agents licensed under chapter 626
  506  to identify and assist enrollees. This act does not prohibit
  507  these agents from receiving usual and customary commissions from
  508  insurers and health maintenance organizations that offer plans
  509  in the FHIX marketplace.
  510         Section 11. Section 409.729, Florida Statutes, is created
  511  to read:
  512         409.729 Long-term reorganization.—The FHIX Workgroup is
  513  created to facilitate the implementation of FHIX and to plan for
  514  the reorganization of the state’s insurance affordability
  515  programs. The FHIX Workgroup consists of two representatives
  516  each from the agency, the department, the Florida Healthy Kids
  517  Corporation, and the corporation. An additional representative
  518  of the agency serves as chair. The FHIX Workgroup must hold its
  519  organizational meeting no later than 30 days after the effective
  520  date of this act and must meet at least bimonthly. The role of
  521  the FHIX Workgroup is to make recommendations to the agency. The
  522  responsibilities of the workgroup include, but are not limited
  523  to:
  524         (1) Developing and presenting a final implementation plan
  525  that meets the requirements of this part in a report submitted
  526  to the Governor, the President of the Senate, and the Speaker of
  527  the House of Representatives no later than November 1, 2015.
  528         (2) Reviewing network and access standards for plans and
  529  products.
  530         (3) Assessing readiness and recommending actions needed to
  531  reorganize the state’s insurance affordability programs for each
  532  phase or region. If a phase or region receives a nonreadiness
  533  recommendation, the agency shall notify the Legislature of that
  534  recommendation, the reasons for such a recommendation, and
  535  proposed plans for achieving readiness.
  536         (4) Recommending any proposed change to the Title XIX
  537  funded or Title XXI-funded programs based on the continued
  538  availability and reauthorization of the Title XXI program and
  539  its federal funding.
  540         (5) Identifying duplication of services by the corporation,
  541  the agency, and the Florida Healthy Kids Corporation currently
  542  and under FHIX’s proposed Phase Two program.
  543         (6) Evaluating any fiscal impacts based on the proposed
  544  transition plan under Phase Two.
  545         (7) Compiling a schedule of impacted contracts, leases, and
  546  other assets.
  547         (8) Determining staff requirements for Phase Two.
  548         Section 12. Section 409.73, Florida Statutes, is created to
  549  read:
  550         409.73 Legislative Review.—The agency may seek federal
  551  approval to implement FHIX as provided in ss. 409.72-409.731.
  552  The agency is prohibited from implementing the FHIX waiver
  553  without specific legislative approval unless the terms and
  554  conditions of the approved waiver are substantially consistent
  555  with the statutory requirements for this program.
  556         Section 13. Section 409.731, Florida Statutes, is created
  557  to read:
  558         409.731 Program expiration.—The Florida Health Insurance
  559  Affordability Exchange Program expires at the end of the state
  560  fiscal year in which any of these conditions occurs:
  561         (1) The federal match contribution for the newly eligible
  562  under the Affordable Care Act falls below 90 percent.
  563         (2) The federal match contribution falls below the
  564  increased Federal Medical Assistance Percentage for medical
  565  assistance for newly eligible mandatory individuals as specified
  566  in the Affordable Care Act.
  567         (3) The federal match for the FHIX program and the Medicaid
  568  program are blended under federal law or regulation in such a
  569  manner that causes the overall federal contribution to diminish
  570  when compared to separate, nonblended federal contributions.
  571         Section 14. Section 408.70, Florida Statutes, is repealed.
  572         Section 15. Section 408.910, Florida Statutes, is amended
  573  to read:
  574         408.910 Florida Health Choices Program.—
  575         (1) LEGISLATIVE INTENT.—The Legislature finds that a
  576  significant number of the residents of this state do not have
  577  adequate access to affordable, quality health care. The
  578  Legislature further finds that increasing access to affordable,
  579  quality health care can be best accomplished by establishing a
  580  competitive market for purchasing health insurance and health
  581  services. It is therefore the intent of the Legislature to
  582  create and expand the Florida Health Choices Program to:
  583         (a) Expand opportunities for Floridians to purchase
  584  affordable health insurance and health services.
  585         (b) Preserve the benefits of employment-sponsored insurance
  586  while easing the administrative burden for employers who offer
  587  these benefits.
  588         (c) Enable individual choice in both the manner and amount
  589  of health care purchased.
  590         (d) Provide for the purchase of individual, portable health
  591  care coverage.
  592         (e) Disseminate information to consumers on the price and
  593  quality of health services.
  594         (f) Sponsor a competitive market that stimulates product
  595  innovation, quality improvement, and efficiency in the
  596  production and delivery of health services.
  597         (2) DEFINITIONS.—As used in this section, the term:
  598         (a) “Corporation” means the Florida Health Choices, Inc.,
  599  established under this section.
  600         (b) “Corporation’s marketplace” means the single,
  601  centralized market established by the program that facilitates
  602  the purchase of products made available in the marketplace.
  603         (c) “Florida Health Insurance Affordability Exchange
  604  Program” or “FHIX” is the program created under ss. 409.72
  605  409.731 for low-income, uninsured residents of this state.
  606         (d)(c) “Health insurance agent” means an agent licensed
  607  under part IV of chapter 626.
  608         (e)(d) “Insurer” means an entity licensed under chapter 624
  609  which offers an individual health insurance policy or a group
  610  health insurance policy, a preferred provider organization as
  611  defined in s. 627.6471, an exclusive provider organization as
  612  defined in s. 627.6472, or a health maintenance organization
  613  licensed under part I of chapter 641, or a prepaid limited
  614  health service organization or discount medical plan
  615  organization licensed under chapter 636.
  616         (f) “Patient Protection and Affordable Care Act” or
  617  “Affordable Care Act” means Pub. L. No. 111-148, as further
  618  amended by the Health Care and Education Reconciliation Act of
  619  2010, Pub. L. No. 111-152, and regulations adopted pursuant to
  620  those acts.
  621         (g)(e) “Program” means the Florida Health Choices Program
  622  established by this section.
  623         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
  624  Choices Program is created as a single, centralized market for
  625  the sale and purchase of various products that enable
  626  individuals to pay for health care. These products include, but
  627  are not limited to, health insurance plans, health maintenance
  628  organization plans, prepaid services, service contracts, and
  629  flexible spending accounts. The components of the program
  630  include:
  631         (a) Enrollment of employers.
  632         (b) Administrative services for participating employers,
  633  including:
  634         1. Assistance in seeking federal approval of cafeteria
  635  plans.
  636         2. Collection of premiums and other payments.
  637         3. Management of individual benefit accounts.
  638         4. Distribution of premiums to insurers and payments to
  639  other eligible vendors.
  640         5. Assistance for participants in complying with reporting
  641  requirements.
  642         (c) Services to individual participants, including:
  643         1. Information about available products and participating
  644  vendors.
  645         2. Assistance with assessing the benefits and limits of
  646  each product, including information necessary to distinguish
  647  between policies offering creditable coverage and other products
  648  available through the program.
  649         3. Account information to assist individual participants
  650  with managing available resources.
  651         4. Services that promote healthy behaviors.
  652         5. Health benefits coverage information about health
  653  insurance plans compliant with the Affordable Care Act.
  654         6. Consumer assistance with web-based information services
  655  for the Florida Health Insurance Affordability Exchange Program,
  656  or (”FHIX”).
  657         (d) Recruitment of vendors, including insurers, health
  658  maintenance organizations, prepaid clinic service providers,
  659  provider service networks, and other providers.
  660         (e) Certification of vendors to ensure capability,
  661  reliability, and validity of offerings.
  662         (f) Collection of data, monitoring, assessment, and
  663  reporting of vendor performance.
  664         (g) Information services for individuals and employers.
  665         (h) Program evaluation.
  666         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  667  program is voluntary and shall be available to employers,
  668  individuals, vendors, and health insurance agents as specified
  669  in this subsection.
  670         (a) Employers eligible to enroll in the program include
  671  those employers that meet criteria established by the
  672  corporation and elect to make their employees eligible through
  673  the program.
  674         (b) Individuals eligible to participate in the program
  675  include:
  676         1. Individual employees of enrolled employers.
  677         2. Other individuals that meet criteria established by the
  678  corporation.
  679         (c) Employers who choose to participate in the program may
  680  enroll by complying with the procedures established by the
  681  corporation. The procedures must include, but are not limited
  682  to:
  683         1. Submission of required information.
  684         2. Compliance with federal tax requirements for the
  685  establishment of a cafeteria plan, pursuant to s. 125 of the
  686  Internal Revenue Code, including designation of the employer’s
  687  plan as a premium payment plan, a salary reduction plan that has
  688  flexible spending arrangements, or a salary reduction plan that
  689  has a premium payment and flexible spending arrangements.
  690         3. Determination of the employer’s contribution, if any,
  691  per employee, provided that such contribution is equal for each
  692  eligible employee.
  693         4. Establishment of payroll deduction procedures, subject
  694  to the agreement of each individual employee who voluntarily
  695  participates in the program.
  696         5. Designation of the corporation as the third-party
  697  administrator for the employer’s health benefit plan.
  698         6. Identification of eligible employees.
  699         7. Arrangement for periodic payments.
  700         8. Employer notification to employees of the intent to
  701  transfer from an existing employee health plan to the program at
  702  least 90 days before the transition.
  703         (d) All eligible vendors who choose to participate and the
  704  products and services that the vendors are permitted to sell are
  705  as follows:
  706         1. Insurers licensed under chapter 624 may sell health
  707  insurance policies, limited benefit policies, other risk-bearing
  708  coverage, and other products or services.
  709         2. Health maintenance organizations licensed under part I
  710  of chapter 641 may sell health maintenance contracts, limited
  711  benefit policies, other risk-bearing products, and other
  712  products or services.
  713         3. Prepaid limited health service organizations may sell
  714  products and services as authorized under part I of chapter 636,
  715  and discount medical plan organizations may sell products and
  716  services as authorized under part II of chapter 636.
  717         4. Prepaid health clinic service providers licensed under
  718  part II of chapter 641 may sell prepaid service contracts and
  719  other arrangements for a specified amount and type of health
  720  services or treatments.
  721         5. Health care providers, including hospitals and other
  722  licensed health facilities, health care clinics, licensed health
  723  professionals, pharmacies, and other licensed health care
  724  providers, may sell service contracts and arrangements for a
  725  specified amount and type of health services or treatments.
  726         6. Provider organizations, including service networks,
  727  group practices, professional associations, and other
  728  incorporated organizations of providers, may sell service
  729  contracts and arrangements for a specified amount and type of
  730  health services or treatments.
  731         7. Corporate entities providing specific health services in
  732  accordance with applicable state law may sell service contracts
  733  and arrangements for a specified amount and type of health
  734  services or treatments.
  735  
  736  A vendor described in subparagraphs 3.-7. may not sell products
  737  that provide risk-bearing coverage unless that vendor is
  738  authorized under a certificate of authority issued by the Office
  739  of Insurance Regulation and is authorized to provide coverage in
  740  the relevant geographic area. Otherwise eligible vendors may be
  741  excluded from participating in the program for deceptive or
  742  predatory practices, financial insolvency, or failure to comply
  743  with the terms of the participation agreement or other standards
  744  set by the corporation.
  745         (e) Eligible individuals may participate in the program
  746  voluntarily. Individuals who join the program may participate by
  747  complying with the procedures established by the corporation.
  748  These procedures must include, but are not limited to:
  749         1. Submission of required information.
  750         2. Authorization for payroll deduction, if applicable.
  751         3. Compliance with federal tax requirements.
  752         4. Arrangements for payment.
  753         5. Selection of products and services.
  754         (f) Vendors who choose to participate in the program may
  755  enroll by complying with the procedures established by the
  756  corporation. These procedures may include, but are not limited
  757  to:
  758         1. Submission of required information, including a complete
  759  description of the coverage, services, provider network, payment
  760  restrictions, and other requirements of each product offered
  761  through the program.
  762         2. Execution of an agreement to comply with requirements
  763  established by the corporation.
  764         3. Execution of an agreement that prohibits refusal to sell
  765  any offered product or service to a participant who elects to
  766  buy it.
  767         4. Establishment of product prices based on applicable
  768  criteria.
  769         5. Arrangements for receiving payment for enrolled
  770  participants.
  771         6. Participation in ongoing reporting processes established
  772  by the corporation.
  773         7. Compliance with grievance procedures established by the
  774  corporation.
  775         (g) Health insurance agents licensed under part IV of
  776  chapter 626 are eligible to voluntarily participate as buyers’
  777  representatives. A buyer’s representative acts on behalf of an
  778  individual purchasing health insurance and health services
  779  through the program by providing information about products and
  780  services available through the program and assisting the
  781  individual with both the decision and the procedure of selecting
  782  specific products. Serving as a buyer’s representative does not
  783  constitute a conflict of interest with continuing
  784  responsibilities as a health insurance agent if the relationship
  785  between each agent and any participating vendor is disclosed
  786  before advising an individual participant about the products and
  787  services available through the program. In order to participate,
  788  a health insurance agent shall comply with the procedures
  789  established by the corporation, including:
  790         1. Completion of training requirements.
  791         2. Execution of a participation agreement specifying the
  792  terms and conditions of participation.
  793         3. Disclosure of any appointments to solicit insurance or
  794  procure applications for vendors participating in the program.
  795         4. Arrangements to receive payment from the corporation for
  796  services as a buyer’s representative.
  797         (5) PRODUCTS.—
  798         (a) The products that may be made available for purchase
  799  through the program include, but are not limited to:
  800         1. Health insurance policies.
  801         2. Health maintenance contracts.
  802         3. Limited benefit plans.
  803         4. Prepaid clinic services.
  804         5. Service contracts.
  805         6. Arrangements for purchase of specific amounts and types
  806  of health services and treatments.
  807         7. Flexible spending accounts.
  808         (b) Health insurance policies, health maintenance
  809  contracts, limited benefit plans, prepaid service contracts, and
  810  other contracts for services must ensure the availability of
  811  covered services.
  812         (c) Products may be offered for multiyear periods provided
  813  the price of the product is specified for the entire period or
  814  for each separately priced segment of the policy or contract.
  815         (d) The corporation shall provide a disclosure form for
  816  consumers to acknowledge their understanding of the nature of,
  817  and any limitations to, the benefits provided by the products
  818  and services being purchased by the consumer.
  819         (e) The corporation must determine that making the plan
  820  available through the program is in the interest of eligible
  821  individuals and eligible employers in the state.
  822         (6) PRICING.—Prices for the products and services sold
  823  through the program must be transparent to participants and
  824  established by the vendors. The corporation may shall annually
  825  assess a surcharge for each premium or price set by a
  826  participating vendor. Any The surcharge may not be more than 2.5
  827  percent of the price and shall be used to generate funding for
  828  administrative services provided by the corporation and payments
  829  to buyers’ representatives; however, a surcharge may not be
  830  assessed for products and services sold in the FHIX marketplace.
  831         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  832  single, centralized market for purchase of health insurance,
  833  health maintenance contracts, and other health products and
  834  services. Purchases may be made by participating individuals
  835  over the Internet or through the services of a participating
  836  health insurance agent. Information about each product and
  837  service available through the program shall be made available
  838  through printed material and an interactive Internet website.
  839         (a) Marketplace purchasing.—A participant needing personal
  840  assistance to select products and services shall be referred to
  841  a participating agent in his or her area.
  842         1.(a) Participation in the program may begin at any time
  843  during a year after the employer completes enrollment and meets
  844  the requirements specified by the corporation pursuant to
  845  paragraph (4)(c).
  846         2.(b) Initial selection of products and services must be
  847  made by an individual participant within the applicable open
  848  enrollment period.
  849         3.(c) Initial enrollment periods for each product selected
  850  by an individual participant must last at least 12 months,
  851  unless the individual participant specifically agrees to a
  852  different enrollment period.
  853         4.(d) If an individual has selected one or more products
  854  and enrolled in those products for at least 12 months or any
  855  other period specifically agreed to by the individual
  856  participant, changes in selected products and services may only
  857  be made during the annual enrollment period established by the
  858  corporation.
  859         5.(e) The limits established in subparagraphs 2., 3., and
  860  4. paragraphs (b)-(d) apply to any risk-bearing product that
  861  promises future payment or coverage for a variable amount of
  862  benefits or services. The limits do not apply to initiation of
  863  flexible spending plans if those plans are not associated with
  864  specific high-deductible insurance policies or the use of
  865  spending accounts for any products offering individual
  866  participants specific amounts and types of health services and
  867  treatments at a contracted price.
  868         (b) FHIX marketplace purchasing.—
  869         1. Participation in the FHIX marketplace may begin at any
  870  time during the year.
  871         2. Initial enrollment periods for certain products selected
  872  by an individual enrollee which are noncompliant with the
  873  Affordable Care Act may be required to last at least 12 months,
  874  unless the individual participant specifically agrees to a
  875  different enrollment period.
  876         (8) CONSUMER INFORMATION.—The corporation shall:
  877         (a) Establish a secure website to facilitate the purchase
  878  of products and services by participating individuals. The
  879  website must provide information about each product or service
  880  available through the program.
  881         (b) Inform individuals about other public health care
  882  programs.
  883         (9) RISK POOLING.—The program may use methods for pooling
  884  the risk of individual participants and preventing selection
  885  bias. These methods may include, but are not limited to, a
  886  postenrollment risk adjustment of the premium payments to the
  887  vendors. The corporation may establish a methodology for
  888  assessing the risk of enrolled individual participants based on
  889  data reported annually by the vendors about their enrollees.
  890  Distribution of payments to the vendors may be adjusted based on
  891  the assessed relative risk profile of the enrollees in each
  892  risk-bearing product for the most recent period for which data
  893  is available.
  894         (10) EXEMPTIONS.—
  895         (a) Products, other than the products set forth in
  896  subparagraphs (4)(d)1.-4., sold as part of the program are not
  897  subject to the licensing requirements of the Florida Insurance
  898  Code, as defined in s. 624.01 or the mandated offerings or
  899  coverages established in part VI of chapter 627 and chapter 641.
  900         (b) The corporation may act as an administrator as defined
  901  in s. 626.88 but is not required to be certified pursuant to
  902  part VII of chapter 626. However, a third-party third party
  903  administrator used by the corporation must be certified under
  904  part VII of chapter 626.
  905         (c) Any standard forms, website design, or marketing
  906  communication developed by the corporation and used by the
  907  corporation, or any vendor that meets the requirements of
  908  paragraph (4)(f) is not subject to the Florida Insurance Code,
  909  as established in s. 624.01.
  910         (11) CORPORATION.—There is created the Florida Health
  911  Choices, Inc., which shall be registered, incorporated,
  912  organized, and operated in compliance with part III of chapter
  913  112 and chapters 119, 286, and 617. The purpose of the
  914  corporation is to administer the program created in this section
  915  and to conduct such other business as may further the
  916  administration of the program.
  917         (a) The corporation shall be governed by a 15-member board
  918  of directors consisting of:
  919         1. Three ex officio, nonvoting members to include:
  920         a. The Secretary of Health Care Administration or a
  921  designee with expertise in health care services.
  922         b. The Secretary of Management Services or a designee with
  923  expertise in state employee benefits.
  924         c. The commissioner of the Office of Insurance Regulation
  925  or a designee with expertise in insurance regulation.
  926         2. Four members appointed by and serving at the pleasure of
  927  the Governor.
  928         3. Four members appointed by and serving at the pleasure of
  929  the President of the Senate.
  930         4. Four members appointed by and serving at the pleasure of
  931  the Speaker of the House of Representatives.
  932         5. Board members may not include insurers, health insurance
  933  agents or brokers, health care providers, health maintenance
  934  organizations, prepaid service providers, or any other entity,
  935  affiliate, or subsidiary of eligible vendors.
  936         (b) Members shall be appointed for terms of up to 3 years.
  937  Any member is eligible for reappointment. A vacancy on the board
  938  shall be filled for the unexpired portion of the term in the
  939  same manner as the original appointment.
  940         (c) The board shall select a chief executive officer for
  941  the corporation who shall be responsible for the selection of
  942  such other staff as may be authorized by the corporation’s
  943  operating budget as adopted by the board.
  944         (d) Board members are entitled to receive, from funds of
  945  the corporation, reimbursement for per diem and travel expenses
  946  as provided by s. 112.061. No other compensation is authorized.
  947         (e) There is no liability on the part of, and no cause of
  948  action shall arise against, any member of the board or its
  949  employees or agents for any action taken by them in the
  950  performance of their powers and duties under this section.
  951         (f) The board shall develop and adopt bylaws and other
  952  corporate procedures as necessary for the operation of the
  953  corporation and carrying out the purposes of this section. The
  954  bylaws shall:
  955         1. Specify procedures for selection of officers and
  956  qualifications for reappointment, provided that no board member
  957  shall serve more than 9 consecutive years.
  958         2. Require an annual membership meeting that provides an
  959  opportunity for input and interaction with individual
  960  participants in the program.
  961         3. Specify policies and procedures regarding conflicts of
  962  interest, including the provisions of part III of chapter 112,
  963  which prohibit a member from participating in any decision that
  964  would inure to the benefit of the member or the organization
  965  that employs the member. The policies and procedures shall also
  966  require public disclosure of the interest that prevents the
  967  member from participating in a decision on a particular matter.
  968         (g) The corporation may exercise all powers granted to it
  969  under chapter 617 necessary to carry out the purposes of this
  970  section, including, but not limited to, the power to receive and
  971  accept grants, loans, or advances of funds from any public or
  972  private agency and to receive and accept from any source
  973  contributions of money, property, labor, or any other thing of
  974  value to be held, used, and applied for the purposes of this
  975  section.
  976         (h) The corporation may establish technical advisory panels
  977  consisting of interested parties, including consumers, health
  978  care providers, individuals with expertise in insurance
  979  regulation, and insurers.
  980         (i) The corporation shall:
  981         1. Determine eligibility of employers, vendors,
  982  individuals, and agents in accordance with subsection (4).
  983         2. Establish procedures necessary for the operation of the
  984  program, including, but not limited to, procedures for
  985  application, enrollment, risk assessment, risk adjustment, plan
  986  administration, performance monitoring, and consumer education.
  987         3. Arrange for collection of contributions from
  988  participating employers, third parties, governmental entities,
  989  and individuals.
  990         4. Arrange for payment of premiums and other appropriate
  991  disbursements based on the selections of products and services
  992  by the individual participants.
  993         5. Establish criteria for disenrollment of participating
  994  individuals based on failure to pay the individual’s share of
  995  any contribution required to maintain enrollment in selected
  996  products.
  997         6. Establish criteria for exclusion of vendors pursuant to
  998  paragraph (4)(d).
  999         7. Develop and implement a plan for promoting public
 1000  awareness of and participation in the program.
 1001         8. Secure staff and consultant services necessary to the
 1002  operation of the program.
 1003         9. Establish policies and procedures regarding
 1004  participation in the program for individuals, vendors, health
 1005  insurance agents, and employers.
 1006         10. Provide for the operation of a toll-free hotline to
 1007  respond to requests for assistance.
 1008         11. Provide for initial, open, and special enrollment
 1009  periods.
 1010         12. Evaluate options for employer participation which may
 1011  conform to with common insurance practices.
 1012         13. Administer the Florida Health Insurance Affordability
 1013  Exchange Program in accordance with ss. 409.72-409.731.
 1014         14. Coordinate with the Agency for Health Care
 1015  Administration, the Department of Children and Families, and the
 1016  Florida Healthy Kids Corporation in developing and implementing
 1017  the enrollee transition plan.
 1018         15. Coordinate with the federal exchange to provide FHIX
 1019  enrollees with the option of selecting plans from either the
 1020  FHIX marketplace or the federal exchange.
 1021         (12) REPORT.—The board of the corporation shall Beginning
 1022  in the 2009-2010 fiscal year, submit by February 1 an annual
 1023  report to the Governor, the President of the Senate, and the
 1024  Speaker of the House of Representatives documenting the
 1025  corporation’s activities in compliance with the duties
 1026  delineated in this section.
 1027         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1028  safeguard the financial transactions made under the auspices of
 1029  the program, the corporation is authorized to establish
 1030  qualifying criteria and certification procedures for vendors,
 1031  require performance bonds or other guarantees of ability to
 1032  complete contractual obligations, monitor the performance of
 1033  vendors, and enforce the agreements of the program through
 1034  financial penalty or disqualification from the program.
 1035         (14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS.—
 1036         (a) Definitions.—For purposes of this subsection, the term:
 1037         1. “Buyer’s representative” means a participating insurance
 1038  agent as described in paragraph (4)(g).
 1039         2. “Enrollee” means an employer who is eligible to enroll
 1040  in the program pursuant to paragraph (4)(a).
 1041         3. “Participant” means an individual who is eligible to
 1042  participate in the program pursuant to paragraph (4)(b).
 1043         4. “Proprietary confidential business information” means
 1044  information, regardless of form or characteristics, that is
 1045  owned or controlled by a vendor requesting confidentiality under
 1046  this section; that is intended to be and is treated by the
 1047  vendor as private in that the disclosure of the information
 1048  would cause harm to the business operations of the vendor; that
 1049  has not been disclosed unless disclosed pursuant to a statutory
 1050  provision, an order of a court or administrative body, or a
 1051  private agreement providing that the information may be released
 1052  to the public; and that is information concerning:
 1053         a. Business plans.
 1054         b. Internal auditing controls and reports of internal
 1055  auditors.
 1056         c. Reports of external auditors for privately held
 1057  companies.
 1058         d. Client and customer lists.
 1059         e. Potentially patentable material.
 1060         f. A trade secret as defined in s. 688.002.
 1061         5. “Vendor” means a participating insurer or other provider
 1062  of services as described in paragraph (4)(d).
 1063         (b) Public record exemptions.—
 1064         1. Personal identifying information of an enrollee or
 1065  participant who has applied for or participates in the Florida
 1066  Health Choices Program is confidential and exempt from s.
 1067  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1068         2. Client and customer lists of a buyer’s representative
 1069  held by the corporation are confidential and exempt from s.
 1070  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1071         3. Proprietary confidential business information held by
 1072  the corporation is confidential and exempt from s. 119.07(1) and
 1073  s. 24(a), Art. I of the State Constitution.
 1074         (c) Retroactive application.—The public record exemptions
 1075  provided for in paragraph (b) apply to information held by the
 1076  corporation before, on, or after the effective date of this
 1077  exemption.
 1078         (d) Authorized release.—
 1079         1. Upon request, information made confidential and exempt
 1080  pursuant to this subsection shall be disclosed to:
 1081         a. Another governmental entity in the performance of its
 1082  official duties and responsibilities.
 1083         b. Any person who has the written consent of the program
 1084  applicant.
 1085         c. The Florida Kidcare program for the purpose of
 1086  administering the program authorized in ss. 409.810-409.821.
 1087         2. Paragraph (b) does not prohibit a participant’s legal
 1088  guardian from obtaining confirmation of coverage, dates of
 1089  coverage, the name of the participant’s health plan, and the
 1090  amount of premium being paid.
 1091         (e) Penalty.—A person who knowingly and willfully violates
 1092  this subsection commits a misdemeanor of the second degree,
 1093  punishable as provided in s. 775.082 or s. 775.083.
 1094         (f) Review and repeal.—This subsection is subject to the
 1095  Open Government Sunset Review Act in accordance with s. 119.15,
 1096  and shall stand repealed on October 2, 2016, unless reviewed and
 1097  saved from repeal through reenactment by the Legislature.
 1098         Section 16. Subsection (2) of section 409.904, Florida
 1099  Statutes, is amended to read:
 1100         409.904 Optional payments for eligible persons.—The agency
 1101  may make payments for medical assistance and related services on
 1102  behalf of the following persons who are determined to be
 1103  eligible subject to the income, assets, and categorical
 1104  eligibility tests set forth in federal and state law. Payment on
 1105  behalf of these Medicaid eligible persons is subject to the
 1106  availability of moneys and any limitations established by the
 1107  General Appropriations Act or chapter 216.
 1108         (2) A family, a pregnant woman, a child under age 21, a
 1109  person age 65 or over, or a blind or disabled person, who would
 1110  be eligible under any group listed in s. 409.903(1), (2), or
 1111  (3), except that the income or assets of such family or person
 1112  exceed established limitations. For a family or person in one of
 1113  these coverage groups, medical expenses are deductible from
 1114  income in accordance with federal requirements in order to make
 1115  a determination of eligibility. A family or person eligible
 1116  under the coverage known as the “medically needy,” is eligible
 1117  to receive the same services as other Medicaid recipients, with
 1118  the exception of services in skilled nursing facilities and
 1119  intermediate care facilities for the developmentally disabled.
 1120  Effective July 1, 2016, persons eligible under “medically needy”
 1121  shall be limited to children under 21 years of age and pregnant
 1122  women. This subsection expires October 1, 2019.
 1123         Section 17. Section 624.91, Florida Statutes, is amended to
 1124  read:
 1125         624.91 The Florida Healthy Kids Corporation Act.—
 1126         (1) SHORT TITLE.—This section may be cited as the “William
 1127  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1128         (2) LEGISLATIVE INTENT.—
 1129         (a) The Legislature finds that increased access to health
 1130  care services could improve children’s health and reduce the
 1131  incidence and costs of childhood illness and disabilities among
 1132  children in this state. Many children do not have comprehensive,
 1133  affordable health care services available. It is the intent of
 1134  the Legislature that the Florida Healthy Kids Corporation
 1135  provide comprehensive health insurance coverage to such
 1136  children. The corporation is encouraged to cooperate with any
 1137  existing health service programs funded by the public or the
 1138  private sector.
 1139         (b) It is the intent of the Legislature that the Florida
 1140  Healthy Kids Corporation serve as one of several providers of
 1141  services to children eligible for medical assistance under Title
 1142  XXI of the Social Security Act. Although the corporation may
 1143  serve other children, the Legislature intends the primary
 1144  recipients of services provided through the corporation be
 1145  school-age children with a family income below 200 percent of
 1146  the federal poverty level, who do not qualify for Medicaid. It
 1147  is also the intent of the Legislature that state and local
 1148  government Florida Healthy Kids funds be used to continue
 1149  coverage, subject to specific appropriations in the General
 1150  Appropriations Act, to children not eligible for federal
 1151  matching funds under Title XXI.
 1152         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1153  of this state are eligible the following individuals are
 1154  eligible for state-funded assistance in paying Florida Healthy
 1155  Kids premiums pursuant to s. 409.814.:
 1156         (a) Residents of this state who are eligible for the
 1157  Florida Kidcare program pursuant to s. 409.814.
 1158         (b) Notwithstanding s. 409.814, legal aliens who are
 1159  enrolled in the Florida Healthy Kids program as of January 31,
 1160  2004, who do not qualify for Title XXI federal funds because
 1161  they are not qualified aliens as defined in s. 409.811.
 1162         (4) NONENTITLEMENT.—Nothing in this section shall be
 1163  construed as providing an individual with an entitlement to
 1164  health care services. No cause of action shall arise against the
 1165  state, the Florida Healthy Kids Corporation, or a unit of local
 1166  government for failure to make health services available under
 1167  this section.
 1168         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
 1169         (a) There is created the Florida Healthy Kids Corporation,
 1170  a not-for-profit corporation.
 1171         (b) The Florida Healthy Kids Corporation shall:
 1172         1. Arrange for the collection of any individual, family,
 1173  local contributions, or employer payment or premium, in an
 1174  amount to be determined by the board of directors, to provide
 1175  for payment of premiums for comprehensive insurance coverage and
 1176  for the actual or estimated administrative expenses.
 1177         2. Arrange for the collection of any voluntary
 1178  contributions to provide for payment of Florida Kidcare program
 1179  or Florida Health Insurance Affordability Exchange Program
 1180  (FHIX) premiums for children who are not eligible for medical
 1181  assistance under Title XIX or Title XXI of the Social Security
 1182  Act.
 1183         3. Subject to the provisions of s. 409.8134, accept
 1184  voluntary supplemental local match contributions that comply
 1185  with the requirements of Title XXI of the Social Security Act
 1186  for the purpose of providing additional Florida Kidcare coverage
 1187  in contributing counties under Title XXI.
 1188         4. Establish the administrative and accounting procedures
 1189  for the operation of the corporation.
 1190         4.5. Establish, with consultation from appropriate
 1191  professional organizations, standards for preventive health
 1192  services and providers and comprehensive insurance benefits
 1193  appropriate to children, provided that such standards for rural
 1194  areas shall not limit primary care providers to board-certified
 1195  pediatricians.
 1196         5.6. Determine eligibility for children seeking to
 1197  participate in the Title XXI-funded components of the Florida
 1198  Kidcare program consistent with the requirements specified in s.
 1199  409.814, as well as the non-Title-XXI-eligible children as
 1200  provided in subsection (3).
 1201         6.7. Establish procedures under which providers of local
 1202  match to, applicants to and participants in the program may have
 1203  grievances reviewed by an impartial body and reported to the
 1204  board of directors of the corporation.
 1205         7.8. Establish participation criteria and, if appropriate,
 1206  contract with an authorized insurer, health maintenance
 1207  organization, or third-party administrator to provide
 1208  administrative services to the corporation.
 1209         8.9. Establish enrollment criteria that include penalties
 1210  or waiting periods of 30 days for reinstatement of coverage upon
 1211  voluntary cancellation for nonpayment of family or individual
 1212  premiums.
 1213         9.10. Contract with authorized insurers or any provider of
 1214  health care services, meeting standards established by the
 1215  corporation, for the provision of comprehensive insurance
 1216  coverage to participants. Such standards shall include criteria
 1217  under which the corporation may contract with more than one
 1218  provider of health care services in program sites.
 1219         a. Health plans shall be selected through a competitive bid
 1220  process. The Florida Healthy Kids Corporation shall purchase
 1221  goods and services in the most cost-effective manner consistent
 1222  with the delivery of quality medical care.
 1223         b. The maximum administrative cost for a Florida Healthy
 1224  Kids Corporation contract shall be 15 percent. For health and
 1225  dental care contracts, the minimum medical loss ratio for a
 1226  Florida Healthy Kids Corporation contract shall be 85 percent.
 1227  The calculations must use uniform financial data collected from
 1228  all plans in a format established by the corporation and shall
 1229  be computed for each plan on a statewide basis. Funds shall be
 1230  classified in a manner consistent with 45 C.F.R. part 158 For
 1231  dental contracts, the remaining compensation to be paid to the
 1232  authorized insurer or provider under a Florida Healthy Kids
 1233  Corporation contract shall be no less than an amount which is 85
 1234  percent of premium; to the extent any contract provision does
 1235  not provide for this minimum compensation, this section shall
 1236  prevail.
 1237         c. The health plan selection criteria and scoring system,
 1238  and the scoring results, shall be available upon request for
 1239  inspection after the bids have been awarded.
 1240         d. Effective July 1, 2016, health and dental services
 1241  contracts of the corporation must transition to the FHIX
 1242  marketplace under s. 409.722. Qualifying plans may enroll as
 1243  vendors with the FHIX marketplace to maintain continuity of care
 1244  for participants.
 1245         10.11. Establish disenrollment criteria in the event local
 1246  matching funds are insufficient to cover enrollments.
 1247         11.12. Develop and implement a plan to publicize the
 1248  Florida Kidcare program, the eligibility requirements of the
 1249  program, and the procedures for enrollment in the program and to
 1250  maintain public awareness of the corporation and the program.
 1251         12.13. Secure staff necessary to properly administer the
 1252  corporation. Staff costs shall be funded from state and local
 1253  matching funds and such other private or public funds as become
 1254  available. The board of directors shall determine the number of
 1255  staff members necessary to administer the corporation.
 1256         13.14. In consultation with the partner agencies, provide a
 1257  report on the Florida Kidcare program annually to the Governor,
 1258  the Chief Financial Officer, the Commissioner of Education, the
 1259  President of the Senate, the Speaker of the House of
 1260  Representatives, and the Minority Leaders of the Senate and the
 1261  House of Representatives.
 1262         14.15. Provide information on a quarterly basis online to
 1263  the Legislature and the Governor which compares the costs and
 1264  utilization of the full-pay enrolled population and the Title
 1265  XXI-subsidized enrolled population in the Florida Kidcare
 1266  program. The information, at a minimum, must include:
 1267         a. The monthly enrollment and expenditure for full-pay
 1268  enrollees in the Medikids and Florida Healthy Kids programs
 1269  compared to the Title XXI-subsidized enrolled population; and
 1270         b. The costs and utilization by service of the full-pay
 1271  enrollees in the Medikids and Florida Healthy Kids programs and
 1272  the Title XXI-subsidized enrolled population.
 1273         15.16. Establish benefit packages that conform to the
 1274  provisions of the Florida Kidcare program, as created in ss.
 1275  409.810-409.821.
 1276         16. Contract with other insurance affordability programs to
 1277  provide such services that are consistent with this act.
 1278         17. Annually develop performance metrics for the following
 1279  focus areas:
 1280         a. Administrative functions.
 1281         b. Contracting with vendors.
 1282         c. Customer service.
 1283         d. Enrollee education.
 1284         e. Financial services.
 1285         f. Program integrity.
 1286         (c) Coverage under the corporation’s program is secondary
 1287  to any other available private coverage held by, or applicable
 1288  to, the participant child or family member. Insurers under
 1289  contract with the corporation are the payors of last resort and
 1290  must coordinate benefits with any other third-party payor that
 1291  may be liable for the participant’s medical care.
 1292         (d) The Florida Healthy Kids Corporation shall be a private
 1293  corporation not for profit, organized pursuant to chapter 617,
 1294  and shall have all powers necessary to carry out the purposes of
 1295  this act, including, but not limited to, the power to receive
 1296  and accept grants, loans, or advances of funds from any public
 1297  or private agency and to receive and accept from any source
 1298  contributions of money, property, labor, or any other thing of
 1299  value, to be held, used, and applied for the purposes of this
 1300  act.
 1301         (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.—
 1302         (a) The Florida Healthy Kids Corporation shall operate
 1303  subject to the supervision and approval of a board of directors.
 1304  The board chair shall be an appointee designated by the
 1305  Governor, and the board shall be chaired by the Chief Financial
 1306  Officer or her or his designee, and composed of 12 other
 1307  members. The Senate shall confirm the designated chair and other
 1308  board appointees. The board members shall be appointed selected
 1309  for 3-year terms. of office as follows:
 1310         1. The Secretary of Health Care Administration, or his or
 1311  her designee.
 1312         2. One member appointed by the Commissioner of Education
 1313  from the Office of School Health Programs of the Florida
 1314  Department of Education.
 1315         3. One member appointed by the Chief Financial Officer from
 1316  among three members nominated by the Florida Pediatric Society.
 1317         4. One member, appointed by the Governor, who represents
 1318  the Children’s Medical Services Program.
 1319         5. One member appointed by the Chief Financial Officer from
 1320  among three members nominated by the Florida Hospital
 1321  Association.
 1322         6. One member, appointed by the Governor, who is an expert
 1323  on child health policy.
 1324         7. One member, appointed by the Chief Financial Officer,
 1325  from among three members nominated by the Florida Academy of
 1326  Family Physicians.
 1327         8. One member, appointed by the Governor, who represents
 1328  the state Medicaid program.
 1329         9. One member, appointed by the Chief Financial Officer,
 1330  from among three members nominated by the Florida Association of
 1331  Counties.
 1332         10. The State Health Officer or her or his designee.
 1333         11. The Secretary of Children and Families, or his or her
 1334  designee.
 1335         12. One member, appointed by the Governor, from among three
 1336  members nominated by the Florida Dental Association.
 1337         (b) A member of the board of directors shall be appointed
 1338  by and serve at the pleasure of the Governor may be removed by
 1339  the official who appointed that member. The board shall appoint
 1340  an executive director, who is responsible for other staff
 1341  authorized by the board.
 1342         (c) Board members are entitled to receive, from funds of
 1343  the corporation, reimbursement for per diem and travel expenses
 1344  as provided by s. 112.061.
 1345         (d) There shall be no liability on the part of, and no
 1346  cause of action shall arise against, any member of the board of
 1347  directors, or its employees or agents, for any action they take
 1348  in the performance of their powers and duties under this act.
 1349         (e) Terms for board members appointed under this act are
 1350  effective January 1, 2016.
 1351         (7) LICENSING NOT REQUIRED; FISCAL OPERATION.—
 1352         (a) The corporation shall not be deemed an insurer. The
 1353  officers, directors, and employees of the corporation shall not
 1354  be deemed to be agents of an insurer. Neither the corporation
 1355  nor any officer, director, or employee of the corporation is
 1356  subject to the licensing requirements of the insurance code or
 1357  the rules of the Department of Financial Services. However, any
 1358  marketing representative utilized and compensated by the
 1359  corporation must be appointed as a representative of the
 1360  insurers or health services providers with which the corporation
 1361  contracts.
 1362         (b) The board has complete fiscal control over the
 1363  corporation and is responsible for all corporate operations.
 1364         (c) The Department of Financial Services shall supervise
 1365  any liquidation or dissolution of the corporation and shall
 1366  have, with respect to such liquidation or dissolution, all power
 1367  granted to it pursuant to the insurance code.
 1368         (8) TRANSITION PLANS.—The corporation shall confer with the
 1369  Agency for Health Care Administration, the Department of
 1370  Children and Families, and Florida Health Choices, Inc., to
 1371  develop transition plans for the Florida Health Insurance
 1372  Affordability Exchange Program as created under ss. 409.72
 1373  409.731.
 1374         Section 18. Section 624.915, Florida Statutes, is repealed.
 1375         Section 19. The Division of Law Revision and Information is
 1376  directed to replace the phrase “the effective date of this act”
 1377  wherever it occurs in this act with the date the act becomes a
 1378  law.
 1379         Section 20. If any law amended by this act was also amended
 1380  by a law enacted at the 2015 Regular Session of the Legislature,
 1381  such laws shall be construed as if they had been enacted at the
 1382  same session of the Legislature, and full effect shall be given
 1383  to each if possible.
 1384         Section 21. This act shall take effect upon becoming a law.
 1385  
 1386  ================= T I T L E  A M E N D M E N T ================
 1387  And the title is amended as follows:
 1388         Delete everything before the enacting clause
 1389  and insert:
 1390                        A bill to be entitled                      
 1391         An act relating to the health insurance affordability
 1392         exchange; providing a directive to the Division of Law
 1393         Revision and Information; creating s. 409.72, F.S.;
 1394         providing a short title; creating s. 409.721, F.S.;
 1395         creating the Florida Health Insurance Affordability
 1396         Exchange Program (FHIX) within the Agency for Health
 1397         Care Administration; providing program authority and
 1398         principles; creating s. 409.722, F.S.; defining terms;
 1399         creating s. 409.723, F.S.; providing eligibility and
 1400         enrollment criteria; providing patient rights and
 1401         responsibilities; defining the term “disabled”
 1402         providing premium levels; creating s. 409.724, F.S.;
 1403         providing for premium credits and choice counseling;
 1404         establishing an education campaign; providing for
 1405         customer support and disenrollment; creating s.
 1406         409.725, F.S.; providing for available products and
 1407         services; creating s. 409.726, F.S.; requiring the
 1408         department to develop accountability measures and
 1409         performance standards governing the administration of
 1410         the program; creating s. 409.727, F.S.; providing for
 1411         a readiness review and a two-phase implementation
 1412         schedule; creating s. 409.728, F.S.; providing program
 1413         operation and management duties; creating s. 409.729,
 1414         F.S.; providing for the development of a long-term
 1415         reorganization plan and the formation of the FHIX
 1416         Workgroup; creating s. 409.73, F.S.; authorizing the
 1417         agency to seek federal approval; prohibiting the
 1418         agency from implementing the FHIX waiver under certain
 1419         circumstances; creating s. 409.731, F.S.; providing
 1420         for program expiration; repealing s. 408.70, F.S.,
 1421         relating to legislative findings regarding access to
 1422         affordable health care; amending s. 408.910, F.S.;
 1423         revising legislative intent; redefining terms;
 1424         revising the scope of the Florida Health Choices
 1425         Program and the pricing of services under the program;
 1426         providing requirements for operation of the
 1427         marketplace; providing additional duties for the
 1428         corporation to perform; requiring an annual report to
 1429         the Governor and the Legislature; amending s. 409.904,
 1430         F.S.; limiting eligible persons in the Medically Needy
 1431         program to those under the age of 21 and pregnant
 1432         women, and specifying an effective date; providing an
 1433         expiration date for the program; amending s. 624.91,
 1434         F.S.; revising eligibility requirements for state
 1435         funded assistance; revising the duties and powers of
 1436         the Florida Healthy Kids Corporation; revising
 1437         provisions for the appointment of members of the board
 1438         of the Florida Healthy Kids Corporation; requiring
 1439         transition plans; repealing s. 624.915, F.S., relating
 1440         to the operating fund of the Florida Healthy Kids
 1441         Corporation; providing a directive to the Division of
 1442         Law Revision and Information; providing for
 1443         construction of the act in pari materia with laws
 1444         enacted during the 2015 Regular Session of the
 1445         Legislature; providing an effective date.