Bill Amendment: FL S0322 | 2019 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Health Plans
Status: 2019-06-26 - Chapter No. 2019-129 [S0322 Detail]
Download: Florida-2019-S0322-Senate_Floor_Amendment_925284.html
Bill Title: Health Plans
Status: 2019-06-26 - Chapter No. 2019-129 [S0322 Detail]
Download: Florida-2019-S0322-Senate_Floor_Amendment_925284.html
Florida Senate - 2019 SENATOR AMENDMENT Bill No. CS for CS for SB 322 Ì9252849Î925284 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Thurston moved the following: 1 Senate Amendment (with title amendment) 2 3 Delete line 135 4 and insert: 5 Section 4. The Division of Law Revision is directed to 6 rename part II of chapter 409, Florida Statutes, as “Insurance 7 Affordability Programs” and to incorporate ss. 409.72-409.731, 8 Florida Statutes, under this part. 9 Section 5. Section 409.72, Florida Statutes, is created to 10 read: 11 409.72 Short title.—Sections 409.72-409.731 may be cited as 12 the “Florida Health Insurance Affordability Exchange Program” 13 (“FHIX”). 14 Section 6. Section 409.721, Florida Statutes, is created to 15 read: 16 409.721 Program authority.—The Florida Health Insurance 17 Affordability Exchange Program (FHIX) is created within the 18 Agency for Health Care Administration to assist Floridians in 19 purchasing health benefits coverage and gaining access to health 20 services. The products and services offered by FHIX are based on 21 the following principles: 22 (1) FAIR VALUE.—Financial assistance will be rationally 23 allocated regardless of differences in categorical eligibility. 24 (2) CONSUMER CHOICE.—Participants will be offered 25 meaningful choices in the way the participants can redeem the 26 value of the available assistance. 27 (3) SIMPLICITY.—Obtaining assistance will be consumer 28 friendly, and customer support will be available when needed. 29 (4) PORTABILITY.—Participants can continue to access the 30 FHIX services and products despite changes in their 31 circumstances. 32 (5) EMPLOYMENT.—Assistance will be offered in a way that 33 incentivizes employment. 34 (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a 35 manner that maximizes individual control over available 36 resources. 37 (7) RISK ADJUSTMENT.—The amount of assistance will reflect 38 participants’ medical risk. 39 Section 7. Section 409.722, Florida Statutes, is created to 40 read: 41 409.722 Definitions.—As used in ss. 409.72-409.731, the 42 term: 43 (1) “Agency” means the Agency for Health Care 44 Administration. 45 (2) “Applicant” means an individual who applies for 46 determination of eligibility for health benefits coverage under 47 this part. 48 (3) “Corporation” means Florida Health Choices, Inc., as 49 established under s. 408.910. 50 (4) “Enrollee” means a participant who has been determined 51 eligible for and is receiving health benefits coverage under 52 this part. 53 (5) “Federal exchange” or “exchange” means an insurance 54 platform regulated by the Federal Government which offers tiers 55 of health plans from the least comprehensive plan to the most 56 comprehensive plan. 57 (6) “FHIX marketplace” or “marketplace” means the single, 58 centralized market established under s. 408.910 which 59 facilitates health benefits coverage. 60 (7) “Florida Health Insurance Affordability Exchange 61 Program” or “FHIX” means the program created under ss. 409.72 62 409.731. 63 (8) “Florida Healthy Kids Corporation” means the entity 64 created under s. 624.91. 65 (9) “Florida Kidcare program” or “Kidcare program” means 66 the health benefits coverage administered through ss. 409.810 67 409.821. 68 (10) “Health benefits coverage” means the payment of 69 benefits for covered health care services or the availability, 70 directly or through arrangements with other persons, of covered 71 health care services on a prepaid per capita basis or on a 72 prepaid aggregate fixed-sum basis. 73 (11) “Inactive status” means the enrollment status of a 74 participant previously enrolled in health benefits coverage 75 through FHIX who lost coverage for noncompliance pursuant to s. 76 409.723, but who maintains access to his or her balance in a 77 health savings account or health reimbursement account. 78 (12) “Medicaid” means the medical assistance program 79 authorized by Title XIX of the Social Security Act, and 80 regulations thereunder, and parts III and IV of this chapter, as 81 administered in this state by the agency. 82 (13) “Modified adjusted gross income” means the 83 individual’s or household’s annual adjusted gross income, as 84 defined in s. 36B(d)(2) of the Internal Revenue Code of 1986, 85 which is used to determine eligibility for FHIX. 86 (14) “Patient Protection and Affordable Care Act” or 87 “Affordable Care Act” means Pub. L. No. 111-148, as amended by 88 the Health Care and Education Reconciliation Act of 2010, Pub. 89 L. No. 111-152, and regulations adopted pursuant to those acts. 90 (15) “Premium credit” means the monthly amount paid by the 91 agency per enrollee in the Florida Health Insurance 92 Affordability Exchange Program toward health benefits coverage. 93 (16) “Qualified alien” means an alien as defined in 8 94 U.S.C. s. 1641(b) or (c). 95 (17) “Resident” means a United States citizen or a 96 qualified alien who is domiciled in this state. 97 Section 8. Section 409.723, Florida Statutes, is created to 98 read: 99 409.723 Participation.— 100 (1) ELIGIBILITY.—To participate in FHIX, an individual must 101 be a resident and meet the following requirements, as 102 applicable: 103 (a) Qualify as a newly eligible enrollee, and be an 104 individual as described in s. 1902(a)(10)(A)(i)(VIII) of the 105 Social Security Act or s. 2001 of the Affordable Care Act and as 106 may be further defined by federal regulation. 107 (b) Meet and maintain the responsibilities under subsection 108 (4). 109 (c) Qualify for participation in the Florida Healthy Kids 110 program under s. 624.91, subject to the implementation of Phase 111 Two under s. 409.727. 112 (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit 113 an application to the department for an eligibility 114 determination. 115 (a) Applications may be submitted online, or by mail, 116 facsimile, or any other method permitted by law or regulation. 117 (b) The department is responsible for any eligibility 118 correspondence and status updates to the participant and other 119 agencies. 120 (c) The department shall review a participant’s eligibility 121 at least every 12 months. 122 (d) An application or renewal is deemed complete when the 123 participant has met all the requirements under subsection (4), 124 as applicable. 125 (3) PARTICIPANT RIGHTS.—A participant has all of the 126 following rights: 127 (a) Access to the FHIX marketplace or federal exchange to 128 select the scope, amount, and type of health care coverage and 129 other services to be purchased. 130 (b) Continuity and portability of coverage to avoid 131 disruption of coverage and other health care services when the 132 participant’s economic circumstances change. 133 (c) Retention of applicable unspent credits in the 134 participant’s health savings or health reimbursement account 135 following a change in the participant’s eligibility status. 136 Credits are valid for a participant in an inactive status for up 137 to 5 years after the participant’s status first becomes 138 inactive. 139 (d) Ability to select more than one product or plan on the 140 FHIX marketplace or federal exchange. 141 (e) Choice of at least two health benefits products that 142 meet the requirements of the Affordable Care Act. 143 (4) PARTICIPANT RESPONSIBILITIES.—A participant must: 144 (a) Complete an initial application for health benefits 145 coverage and the annual renewal process. 146 (b) Provide evidence of participation in one or more of the 147 following activities at the levels required under paragraph (c): 148 1. Paid employment. 149 2. On-the-job training or job placement activities. 150 Evidence of participation in job placement activities must 151 include registration with CareerSource Florida and may include 152 other documentation such as, but not limited to, written 153 acknowledgment from a potential employer of receipt of an 154 employment application from the participant; confirmation from a 155 potential employer of a job interview with the participant; 156 documentation of job-seeking activities; and documentation of 157 assistance or training related to preparing a resume, completing 158 an employment application, or interviewing skills. 159 3. Educational pursuits. 160 161 A participant who is a disabled adult or the caregiver of a 162 disabled child or adult may submit a request to the department 163 for an exception to the requirements in this paragraph. Such 164 participant shall annually submit to the department a request to 165 renew the exception. The term “disabled” means any person who 166 has one or more permanent physical or mental impairments that 167 substantially limit his or her ability to perform one or more 168 major life activities of daily living, as defined by the 169 Americans with Disabilities Act, without receiving more than 8 170 hours of assistance per day. 171 (c) Engage in the activities required under paragraph (b) 172 at the following minimum levels: 173 1. For a parent of a child younger than 18 years of age, a 174 minimum of 20 hours weekly. 175 2. For a childless adult, a minimum of 30 hours weekly. 176 (d) Learn and remain informed about the choices available 177 in the FHIX marketplace or the federal exchange and the 178 allowable uses of credits in the individual accounts. 179 (e) Execute a contract with the department which 180 acknowledges that: 181 1. FHIX is not an entitlement and state and federal funding 182 may end at any time; 183 2. Failure to pay required premiums or cost sharing will 184 result in a transition to inactive status; and 185 3. Noncompliance with the participation requirements as 186 established under this section will result in a transition to 187 inactive status. 188 (f) Select plans and other products in a timely manner. 189 (g) Comply with program rules and the prohibitions against 190 fraud, as described in s. 414.39. 191 (h) Timely make monthly premium and any other cost-sharing 192 payments. 193 (i) Meet minimum coverage requirements by selecting either 194 a high-deductible health plan combined with a health savings or 195 a reimbursement account or a combination of plans or products 196 with an actuarial value that meets or exceeds benefits available 197 under the federal exchange. 198 (5) COST SHARING.— 199 (a) Except for enrollees eligible under paragraph (1)(c), 200 enrollees are assessed monthly premiums based on their modified 201 adjusted gross income. The maximum monthly premium payments are 202 set at the following income levels: 203 1. At or below 22 percent of the federal poverty level: $3. 204 2. Greater than 22 percent, but at or below 50 percent, of 205 the federal poverty level: $8. 206 3. Greater than 50 percent, but at or below 75 percent, of 207 the federal poverty level: $15. 208 4. Greater than 75 percent, but at or below 100 percent, of 209 the federal poverty level: $20. 210 5. Greater than 100 percent of the federal poverty level: 211 $25. 212 (b) Depending on the products and services selected by the 213 enrollee, the enrollee may also incur additional cost sharing, 214 such as copayments, deductibles, or other out-of-pocket costs. 215 (c) An enrollee may be subject to charges for an 216 inappropriate emergency room visit of up to $8 for the first 217 visit and up to $25 for any subsequent visit, based on the 218 enrollee’s benefit plan, to discourage inappropriate use of the 219 emergency room. 220 (d) Cumulative annual cost sharing per enrollee may not 221 exceed 5 percent of an enrollee’s annual modified adjusted gross 222 income. 223 (e) If, after a 30-day grace period, a full premium payment 224 has not been received, the enrollee shall be transitioned from 225 coverage to inactive status and may not reenroll for a minimum 226 of 6 months, unless a hardship exception has been granted. 227 Enrollees may seek a hardship exception under the Medicaid Fair 228 Hearing Process. 229 (f) Enrollees eligible under paragraph (1)(c) must pay 230 premiums according to the Title XXI state plan amendment and 231 follow disenrollment criteria for noncompliance in accordance 232 with s. 624.91. 233 Section 9. Section 409.724, Florida Statutes, is created to 234 read: 235 409.724 Available assistance.— 236 (1) PREMIUM CREDITS.— 237 (a) Standard amount.—The agency shall develop a monthly 238 premium credit structure appropriate to a benefit plan that 239 meets the bronze metal standard of the Affordable Care Act. 240 (b) Supplemental funding.—Subject to federal approval, 241 additional resources may be made available to enrollees and 242 incorporated into FHIX. 243 (c) Savings accounts.—In addition to the benefits provided 244 under this section, the corporation shall offer each enrollee 245 access to an individual account that qualifies as a health 246 reimbursement account or a health savings account. 247 1. Unexpended funds.—Eligible unexpended funds from the 248 monthly premium credit must be deposited into each enrollee’s 249 individual account in a timely manner. Funds deposited into 250 these individual accounts may be used to pay cost-sharing 251 obligations or to purchase other health-related items to the 252 extent permitted under federal and state law. 253 2. Healthy behaviors.—Enrollees may receive credits to 254 their individual accounts for healthy behaviors, adherence to 255 wellness programs, and other activities that demonstrate 256 compliance with prevention or disease management guidelines. 257 3. Enrollee contributions.—The enrollee may make deposits 258 to his or her account at any time to supplement the premium 259 credit, to purchase additional FHIX products, or to offset other 260 cost-sharing obligations. 261 4. Third parties.—Third parties, including, but not limited 262 to, an employer or relative, may also make deposits on behalf of 263 the enrollee into the enrollee’s FHIX marketplace account. The 264 enrollee may not withdraw any funds as a refund, except those 265 funds the enrollee has deposited into his or her account. 266 (2) CHOICE COUNSELING.—The agency, in consultation with the 267 Florida Healthy Kids Corporation and the corporation, shall 268 develop a choice counseling program for FHIX. The choice 269 counseling program must ensure that participants have 270 information about the FHIX marketplace program, the federal 271 exchange, products, and services and that participants know 272 where and whom to call for questions or to make their plan 273 selections. The choice counseling program must provide 274 culturally sensitive materials and must take into consideration 275 the demographics of the projected population. 276 (3) EDUCATION CAMPAIGN.—The agency, the corporation, and 277 the Florida Healthy Kids Corporation must coordinate in advance 278 of Phase One an ongoing education campaign to inform 279 participants, at a minimum, of the following: 280 (a) How the FHIX marketplace operates and the timeline for 281 enrollment. 282 (b) Plans that are available and how to find information 283 about these plans. 284 (c) Information about other available insurance 285 affordability programs for the participant and his or her 286 family. 287 (d) Information about health benefits coverage, provider 288 networks, and cost sharing for available plans in each region. 289 (e) Information about how to complete the required annual 290 renewal process, including renewal dates and deadlines. 291 (f) Information about how to update eligibility if the 292 participant’s data have changed since his or her last renewal or 293 application date. 294 (4) CUSTOMER SUPPORT.—The Florida Healthy Kids Corporation 295 shall provide customer support for FHIX, including, but not 296 limited to, general program information, financial information, 297 and enrollee payments. Customer support must also provide a 298 toll-free telephone number and maintain a website that is 299 available in multiple languages and that meets the needs of the 300 enrollee population. 301 (5) INACTIVE PARTICIPANTS.—The corporation must inform the 302 inactive participant about other insurance affordability 303 programs and electronically refer the participant to the federal 304 exchange or other insurance affordability programs, as 305 appropriate. 306 Section 10. Section 409.725, Florida Statutes, is created 307 to read: 308 409.725 Available products and services.—The FHIX 309 marketplace shall offer the following products and services: 310 (1) Those authorized pursuant to s. 408.910. 311 (2) Products authorized by the federal exchange. 312 (3) Products authorized by the Florida Healthy Kids 313 Corporation pursuant to s. 624.91. 314 (4) Premium credits for participation in employer-sponsored 315 plans. 316 Section 11. Section 409.726, Florida Statutes, is created 317 to read: 318 409.726 Program accountability.— 319 (1) All managed care plans that participate in FHIX must 320 collect and maintain encounter level data in accordance with the 321 encounter data requirements under s. 409.967(2)(e) and are 322 subject to the accompanying penalties under s. 409.967(2)(i)2. 323 The agency is responsible for the collection and maintenance of 324 the encounter level data. 325 (2) The corporation, in consultation with the agency, shall 326 establish access and network standards for contracts on the FHIX 327 marketplace, shall ensure that contracted plans have sufficient 328 providers to meet enrollee needs, and shall develop quality of 329 coverage and provider standards specific to the adult 330 population. 331 (3) The department shall develop accountability measures 332 and performance standards to be applied to initial and renewal 333 FHIX applications that are submitted online, by mail, by 334 facsimile, or through referrals from a third party. The minimum 335 performance standards are: 336 (a) Application processing speed.—Ninety percent of all 337 applications, regardless of the method of submission, must be 338 processed within 45 days. 339 (b) Application processing speed from online sources. 340 Ninety-five percent of all applications received from online 341 sources must be processed within 45 days. 342 (c) Renewal application processing speed.—Ninety percent of 343 all renewals, regardless of the method of submission, must be 344 processed within 45 days. 345 (d) Renewal application processing speed from online 346 sources.—Ninety-five percent of all applications received from 347 online sources must be processed within 45 days. 348 (4) The agency, the department, and the Florida Healthy 349 Kids Corporation must meet the following standards for their 350 respective roles in the program: 351 (a) Eighty-five percent of calls must be answered in 20 352 seconds or less. 353 (b) All contacts, including, but not limited to, telephone 354 calls, faxed documents and requests, and e-mails, must be 355 handled within 2 business days. 356 (c) Any self-service tools available to participants, such 357 as interactive voice response systems, must be operational 7 358 days a week, 24 hours a day, at least 98 percent of each month. 359 (5) The agency, the department, and the Florida Healthy 360 Kids Corporation shall conduct an annual satisfaction survey to 361 address all measures that require participant input specific to 362 the FHIX marketplace program. The parties may elect to 363 incorporate these elements into the annual report required under 364 subsection (7). 365 (6) The agency and the corporation shall post online 366 monthly enrollment reports for FHIX. 367 (7) Beginning in 2020, an annual report is due no later 368 than July 1 to the Governor, the President of the Senate, and 369 the Speaker of the House of Representatives. The annual report 370 must be coordinated by the agency and the corporation and must 371 include at least the following: 372 (a) Enrollment and application trends and issues. 373 (b) Utilization and cost data. 374 (c) Customer satisfaction. 375 (d) Funding sources in health savings accounts or health 376 reimbursement accounts. 377 (e) Enrollee use of funds in health savings accounts or 378 health reimbursement accounts. 379 (f) Types of products and plans purchased. 380 (g) Movement of enrollees across different insurance 381 affordability programs. 382 (h) Recommendations for program improvement. 383 Section 12. Section 409.727, Florida Statutes, is created 384 to read: 385 409.727 Readiness review and implementation schedule.—The 386 agency, the corporation, the department, and the Florida Healthy 387 Kids Corporation shall begin implementation of FHIX on the 388 effective date of this act, with enrollment for Phase One 389 beginning by January 1, 2020. 390 (1) READINESS REVIEW.—Before implementation of any phase 391 under this part or in any region, the agency shall conduct a 392 readiness review in consultation with the FHIX Workgroup 393 established pursuant to s. 409.729. The agency shall determine, 394 at a minimum, the following readiness milestones: 395 (a) Functional readiness of the service delivery platform. 396 (b) Plan availability and presence of plan choice. 397 (c) Provider network capacity and adequacy of the available 398 plans. 399 (d) Availability of customer support. 400 (e) Other factors critical to the success of FHIX. 401 (2) PHASE ONE.—The agency, the corporation, and the Florida 402 Healthy Kids Corporation shall coordinate implementation 403 activities to ensure that enrollment begins by January 1, 2020, 404 and is available in all regions by July 1, 2020. 405 (a) Beginning no later than January 1, 2020, and contingent 406 upon federal approval, participants may enroll in health 407 benefits coverage under the FHIX marketplace or the federal 408 exchange, if eligible. 409 (b) To be eligible for enrollment during this phase, a 410 participant must meet the requirements under s. 409.723(1)(a) 411 and (b). 412 (c) An enrollee may select any benefit, service, or product 413 available in the region. 414 (d) The corporation shall notify an enrollee of his or her 415 premium credit amount and how to access the FHIX marketplace 416 selection process or the federal exchange. 417 (e) An enrollee must have a choice of at least two managed 418 care plans in each region which meet or exceed the Affordable 419 Care Act’s requirements and which qualify for a premium credit 420 on the FHIX marketplace or federal exchange. 421 (f) Choice counseling and customer service must be provided 422 in accordance with s. 409.724(2) and (4). 423 (3) PHASE TWO.— 424 (a) Not later than July 1, 2020, the corporation and the 425 Florida Healthy Kids Corporation shall begin the transition of 426 enrollees under s. 624.91 to the FHIX marketplace. 427 (b) Eligibility during this phase is based on meeting the 428 requirements of s. 409.723(1)(c) and (4). 429 (c) An enrollee may select any available benefit, service, 430 or product available under s. 409.725. 431 (d) A Florida Healthy Kids enrollee who selects an FHIX 432 marketplace plan or federal exchange plan shall be provided a 433 premium credit equivalent to the average capitation rate paid in 434 his or her county of residence under Florida Healthy Kids as of 435 June 30, 2020. The enrollee is responsible for any difference in 436 costs and may use any unexpended funds deposited in his or her 437 savings account under s. 409.724(1)(c) for supplemental benefits 438 on the FHIX marketplace or federal exchange. 439 (e) The corporation shall notify an enrollee of his or her 440 premium credit amount and how to access the FHIX marketplace 441 selection process or federal exchange. 442 (f) Choice counseling and customer service must be provided 443 in accordance with s. 409.724(2) and (4). 444 (g) Enrollees under s. 624.91 must transition to the FHIX 445 marketplace and coverage under s. 409.725 by September 30, 2020. 446 (h) A provision that is applicable to an individual under 447 s. 624.91 is available and applicable to an enrollee who is 448 eligible under s. 409.723(1)(c). 449 Section 13. Section 409.728, Florida Statutes, is created 450 to read: 451 409.728 Program operation and management.—In order to 452 implement ss. 409.72-409.731: 453 (1) The agency shall do all of the following: 454 (a) Contract with the corporation for the development, 455 implementation, and administration of the Florida Health 456 Insurance Affordability Exchange Program and for the release of 457 any federal, state, or other funds appropriated to the 458 corporation. 459 (b) Provide administrative support to the FHIX Workgroup 460 established pursuant to s. 409.729. 461 (c) Consult with stakeholders that serve low-income 462 individuals and families during implementation, using a public 463 input process. 464 (d) Timely transmit enrollee information to the 465 corporation. 466 (e) Annually determine the appropriate premium credit based 467 on the difference in the price of a benchmark product on the 468 FHIX marketplace and the enrollee premium contribution as 469 outlined in s. 409.723(5)(a). For purposes of this paragraph, 470 the benchmark product on the FHIX marketplace is the bronze 471 level plan under the Affordable Care Act. For plans on the FHIX 472 marketplace, the agency shall annually establish a retroactive 473 methodology to adjust premium revenue to the relative clinical 474 risk profile of each plan’s enrollees. 475 (f) Transfer funds allocated for premium credits by General 476 Appropriations Act to the corporation. 477 (g) Adopt rules in coordination with the corporation and 478 the Florida Healthy Kids Corporation in order to implement FHIX, 479 including modifying existing rules implementing the Children’s 480 Health Insurance Program and adapting adult-focused provisions 481 for children to accommodate the seamless transition of Healthy 482 Kids enrollees to FHIX. 483 (2) The department shall, in coordination with the 484 corporation, the agency, and the Florida Healthy Kids 485 Corporation, determine eligibility of applications and 486 application renewals for FHIX in accordance with s. 409.902 and 487 shall transmit eligibility determination information on a timely 488 basis to the agency and corporation. 489 (3) The Florida Healthy Kids Corporation shall do all of 490 the following: 491 (a) Retain its duties and responsibilities under s. 624.91 492 during Phase One of the program. 493 (b) In coordination with the agency and the corporation, 494 provide customer service for the FHIX marketplace. 495 (c) Transfer funds and provide financial support to the 496 FHIX marketplace, including the collection of monthly cost 497 sharing payments. 498 (d) Conduct financial reporting related to such activities, 499 in coordination with the corporation and the agency. 500 (e) Coordinate program activities with the agency, the 501 department, and the corporation. 502 (4) Florida Health Choices, Inc., shall do all of the 503 following: 504 (a) Develop and maintain the FHIX marketplace. 505 (b) Implement and administer Phase One and Phase Two of the 506 FHIX marketplace and the ongoing operations of the program. 507 (c) Offer health benefits coverage packages on the FHIX 508 marketplace, including plans compliant with the Affordable Care 509 Act. 510 (d) Offer FHIX enrollees a choice of at least two plans per 511 county at each benefit level which meet the requirements under 512 the Affordable Care Act. 513 (e) Offer the opportunity to participate in the federal 514 exchange. 515 (f) Offer enhanced or customized benefits to FHIX 516 marketplace enrollees. 517 (g) Provide sufficient staff and resources to meet the 518 program needs of enrollees. 519 (h) Provide an opportunity for plans contracted with or 520 previously contracted with the Florida Healthy Kids Corporation 521 under s. 624.91 to participate in FHIX if those plans meet the 522 requirements of the program. 523 (i) Encourage insurance agents licensed under chapter 626 524 to identify and assist enrollees. This act does not prohibit 525 these agents from receiving usual and customary commissions from 526 insurers and health maintenance organizations that offer plans 527 in the FHIX marketplace. 528 Section 14. Section 409.729, Florida Statutes, is created 529 to read: 530 409.729 Long-term reorganization.—The FHIX Workgroup is 531 created to facilitate the implementation of FHIX and to plan for 532 the reorganization of the state’s insurance affordability 533 programs. The FHIX Workgroup consists of two representatives 534 each from the agency, the department, the Florida Healthy Kids 535 Corporation, and the corporation. An additional representative 536 of the agency serves as chair. The FHIX Workgroup must hold its 537 organizational meeting no later than 30 days after the effective 538 date of this act and must meet at least bimonthly. The role of 539 the FHIX Workgroup is to make recommendations to the agency. The 540 responsibilities of the workgroup include, but are not limited 541 to: 542 (1) Developing and presenting a final implementation plan 543 that meets the requirements of this part in a report submitted 544 to the Governor, the President of the Senate, and the Speaker of 545 the House of Representatives no later than November 1, 2019. 546 (2) Reviewing network and access standards for plans and 547 products. 548 (3) Assessing readiness and recommending actions needed to 549 reorganize the state’s insurance affordability programs for each 550 phase or region. If a phase or region receives a nonreadiness 551 recommendation, the agency shall notify the Legislature of that 552 recommendation, the reasons for such a recommendation, and 553 proposed plans for achieving readiness. 554 (4) Recommending any proposed change to the Title XIX 555 funded or Title XXI-funded programs based on the continued 556 availability and reauthorization of the Title XXI program and 557 its federal funding. 558 (5) Identifying duplication of services by the corporation, 559 the agency, and the Florida Healthy Kids Corporation currently 560 and under FHIX’s proposed Phase Two program. 561 (6) Evaluating any fiscal impacts based on the proposed 562 transition plan under Phase Two. 563 (7) Compiling a schedule of impacted contracts, leases, and 564 other assets. 565 (8) Determining staff requirements for Phase Two. 566 Section 15. Section 409.73, Florida Statutes, is created to 567 read: 568 409.73 Legislative review.—The agency may seek federal 569 approval to implement FHIX as provided in ss. 409.72-409.731. 570 The agency is prohibited from implementing the FHIX waiver 571 without specific legislative approval unless the terms and 572 conditions of the approved waiver are substantially consistent 573 with the statutory requirements for this program. 574 Section 16. Section 409.731, Florida Statutes, is created 575 to read: 576 409.731 Program expiration.— 577 (1) The Florida Health Insurance Affordability Exchange 578 Program expires at the end of the state fiscal year in which any 579 of these conditions occurs: 580 (a) The federal match contribution for the newly eligible 581 under the Affordable Care Act falls below 90 percent. 582 (b) The federal match contribution falls below the 583 increased Federal Medical Assistance Percentage for medical 584 assistance for newly eligible mandatory individuals as specified 585 in the Affordable Care Act. 586 (c) The federal match for the FHIX program and the Medicaid 587 program are blended under federal law or regulation in such a 588 manner that causes the overall federal contribution to diminish 589 when compared to separate, nonblended federal contributions. 590 (2) Provided the conditions specified in subsection (1) 591 have not previously occurred, the Florida Health Insurance 592 Affordability Exchange Program shall expire on July 1, 2022, 593 unless reviewed and reenacted by the Legislature. 594 (3) The Health Outcomes Review Commission is established to 595 assess the following indicators: 596 (a) Patient outcomes.—Selected measures from the National 597 Healthcare Quality Report or similarly credible sources will be 598 applied to FHIX enrollees and compared to outcomes for Managed 599 Medical Assistance enrollees and uninsured patients. 600 (b) Fiscal impact.—Actual annual state general revenue 601 expenditures for the FHIX program will be compared to predicted 602 expenditures. 603 (c) Access to care.—Potentially preventable hospitalization 604 rates for acute and chronic conditions and potentially 605 preventable emergency department visits among FHIX enrollees 606 will be compared to Managed Medical Assistance enrollees and 607 uninsured patients. 608 (4) The Health Outcomes Review Commission shall consist of 609 nine members appointed by the Governor, the President of the 610 Senate, and the Speaker of the House. The Governor and each 611 presiding officer shall appoint one healthcare professional, one 612 private business representative, and one elected official. 613 (5) The commission shall be appointed no later than January 614 1, 2021, and shall meet regularly to select specific indicators, 615 review preliminary data, and develop a framework for a final 616 report. Staff support shall be provided to the commission by the 617 Agency for Health Care Administration. 618 (6) The commission’s final report shall be submitted to the 619 Governor, the President of the Senate, and the Speaker of the 620 House by January 1, 2022. 621 Section 17. Section 408.70, Florida Statutes, is repealed. 622 Section 18. Section 408.910, Florida Statutes, is amended 623 to read: 624 408.910 Florida Health Choices Program.— 625 (1) LEGISLATIVE INTENT.—The Legislature finds that a 626 significant number of the residents of this state do not have 627 adequate access to affordable, quality health care. The 628 Legislature further finds that increasing access to affordable, 629 quality health care can be best accomplished by establishing a 630 competitive market for purchasing health insurance and health 631 services. It is therefore the intent of the Legislature to 632 create and expand the Florida Health Choices Program to: 633 (a) Expand opportunities for Floridians to purchase 634 affordable health insurance and health services. 635 (b) Preserve the benefits of employment-sponsored insurance 636 while easing the administrative burden for employers who offer 637 these benefits. 638 (c) Enable individual choice in both the manner and amount 639 of health care purchased. 640 (d) Provide for the purchase of individual, portable health 641 care coverage. 642 (e) Disseminate information to consumers on the price and 643 quality of health services. 644 (f) Sponsor a competitive market that stimulates product 645 innovation, quality improvement, and efficiency in the 646 production and delivery of health services. 647 (2) DEFINITIONS.—As used in this section, the term: 648 (a) “Corporation” means the Florida Health Choices, Inc., 649 established under this section. 650 (b) “Corporation’s marketplace” means the single, 651 centralized market established by the program that facilitates 652 the purchase of products made available in the marketplace. 653 (c) “Florida Health Insurance Affordability Exchange 654 Program” or “FHIX” is the program created under ss. 409.72 655 409.731 for low-income, uninsured residents of this state. 656 (d)(c)“Health insurance agent” means an agent licensed 657 under part IV of chapter 626. 658 (e)(d)“Insurer” means an entity licensed under chapter 624 659 which offers an individual health insurance policy or a group 660 health insurance policy, a preferred provider organization as 661 defined in s. 627.6471, an exclusive provider organization as 662 defined in s. 627.6472, a health maintenance organization 663 licensed under part I of chapter 641,ora prepaid limited 664 health service organization or discount plan organization 665 licensed under chapter 636. 666 (f) “Patient Protection and Affordable Care Act” or 667 “Affordable Care Act” means Pub. L. No. 111-148, as further 668 amended by the Health Care and Education Reconciliation Act of 669 2010, Pub. L. No. 111-152, and regulations adopted pursuant to 670 those acts. 671 (g)(e)“Program” means the Florida Health Choices Program 672 established by this section. 673 (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health 674 Choices Program is created as a single, centralized market for 675 the sale and purchase of various products that enable 676 individuals to pay for health care. These products include, but 677 are not limited to, health insurance plans, health maintenance 678 organization plans, prepaid services, service contracts, and 679 flexible spending accounts. The components of the program 680 include: 681 (a) Enrollment of employers. 682 (b) Administrative services for participating employers, 683 including: 684 1. Assistance in seeking federal approval of cafeteria 685 plans. 686 2. Collection of premiums and other payments. 687 3. Management of individual benefit accounts. 688 4. Distribution of premiums to insurers and payments to 689 other eligible vendors. 690 5. Assistance for participants in complying with reporting 691 requirements. 692 (c) Services to individual participants, including: 693 1. Information about available products and participating 694 vendors. 695 2. Assistance with assessing the benefits and limits of 696 each product, including information necessary to distinguish 697 between policies offering creditable coverage and other products 698 available through the program. 699 3. Account information to assist individual participants 700 with managing available resources. 701 4. Services that promote healthy behaviors. 702 5. Health benefits coverage information about health 703 insurance plans compliant with the Affordable Care Act. 704 6. Consumer assistance with web-based information services 705 for the Florida Health Insurance Affordability Exchange Program, 706 or (”FHIX”). 707 (d) Recruitment of vendors, including insurers, health 708 maintenance organizations, prepaid clinic service providers, 709 provider service networks, and other providers. 710 (e) Certification of vendors to ensure capability, 711 reliability, and validity of offerings. 712 (f) Collection of data, monitoring, assessment, and 713 reporting of vendor performance. 714 (g) Information services for individuals and employers. 715 (h) Program evaluation. 716 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the 717 program is voluntary and shall be available to employers, 718 individuals, vendors, and health insurance agents as specified 719 in this subsection. 720 (a) Employers eligible to enroll in the program include 721 those employers that meet criteria established by the 722 corporation and elect to make their employees eligible through 723 the program. 724 (b) Individuals eligible to participate in the program 725 include: 726 1. Individual employees of enrolled employers. 727 2. Other individuals that meet criteria established by the 728 corporation. 729 (c) Employers who choose to participate in the program may 730 enroll by complying with the procedures established by the 731 corporation. The procedures must include, but are not limited 732 to: 733 1. Submission of required information. 734 2. Compliance with federal tax requirements for the 735 establishment of a cafeteria plan, pursuant to s. 125 of the 736 Internal Revenue Code, including designation of the employer’s 737 plan as a premium payment plan, a salary reduction plan that has 738 flexible spending arrangements, or a salary reduction plan that 739 has a premium payment and flexible spending arrangements. 740 3. Determination of the employer’s contribution, if any, 741 per employee, provided that such contribution is equal for each 742 eligible employee. 743 4. Establishment of payroll deduction procedures, subject 744 to the agreement of each individual employee who voluntarily 745 participates in the program. 746 5. Designation of the corporation as the third-party 747 administrator for the employer’s health benefit plan. 748 6. Identification of eligible employees. 749 7. Arrangement for periodic payments. 750 8. Employer notification to employees of the intent to 751 transfer from an existing employee health plan to the program at 752 least 90 days before the transition. 753 (d) All eligible vendors who choose to participate and the 754 products and services that the vendors are permitted to sell are 755 as follows: 756 1. Insurers licensed under chapter 624 may sell health 757 insurance policies, limited benefit policies, other risk-bearing 758 coverage, and other products or services. 759 2. Health maintenance organizations licensed under part I 760 of chapter 641 may sell health maintenance contracts, limited 761 benefit policies, other risk-bearing products, and other 762 products or services. 763 3. Prepaid limited health service organizations may sell 764 products and services as authorized under part I of chapter 636, 765 and discount plan organizations may sell products and services 766 as authorized under part II of chapter 636. 767 4. Prepaid health clinic service providers licensed under 768 part II of chapter 641 may sell prepaid service contracts and 769 other arrangements for a specified amount and type of health 770 services or treatments. 771 5. Health care providers, including hospitals and other 772 licensed health facilities, health care clinics, licensed health 773 professionals, pharmacies, and other licensed health care 774 providers, may sell service contracts and arrangements for a 775 specified amount and type of health services or treatments. 776 6. Provider organizations, including service networks, 777 group practices, professional associations, and other 778 incorporated organizations of providers, may sell service 779 contracts and arrangements for a specified amount and type of 780 health services or treatments. 781 7. Corporate entities providing specific health services in 782 accordance with applicable state law may sell service contracts 783 and arrangements for a specified amount and type of health 784 services or treatments. 785 786 A vendor described in subparagraphs 3.-7. may not sell products 787 that provide risk-bearing coverage unless that vendor is 788 authorized under a certificate of authority issued by the Office 789 of Insurance Regulation and is authorized to provide coverage in 790 the relevant geographic area. Otherwise eligible vendors may be 791 excluded from participating in the program for deceptive or 792 predatory practices, financial insolvency, or failure to comply 793 with the terms of the participation agreement or other standards 794 set by the corporation. 795 (e) Eligible individuals may participate in the program 796 voluntarily. Individuals who join the program may participate by 797 complying with the procedures established by the corporation. 798 These procedures must include, but are not limited to: 799 1. Submission of required information. 800 2. Authorization for payroll deduction, if applicable. 801 3. Compliance with federal tax requirements. 802 4. Arrangements for payment. 803 5. Selection of products and services. 804 (f) Vendors who choose to participate in the program may 805 enroll by complying with the procedures established by the 806 corporation. These procedures may include, but are not limited 807 to: 808 1. Submission of required information, including a complete 809 description of the coverage, services, provider network, payment 810 restrictions, and other requirements of each product offered 811 through the program. 812 2. Execution of an agreement to comply with requirements 813 established by the corporation. 814 3. Execution of an agreement that prohibits refusal to sell 815 any offered product or service to a participant who elects to 816 buy it. 817 4. Establishment of product prices based on applicable 818 criteria. 819 5. Arrangements for receiving payment for enrolled 820 participants. 821 6. Participation in ongoing reporting processes established 822 by the corporation. 823 7. Compliance with grievance procedures established by the 824 corporation. 825 (g) Health insurance agents licensed under part IV of 826 chapter 626 are eligible to voluntarily participate as buyers’ 827 representatives. A buyer’s representative acts on behalf of an 828 individual purchasing health insurance and health services 829 through the program by providing information about products and 830 services available through the program and assisting the 831 individual with both the decision and the procedure of selecting 832 specific products. Serving as a buyer’s representative does not 833 constitute a conflict of interest with continuing 834 responsibilities as a health insurance agent if the relationship 835 between each agent and any participating vendor is disclosed 836 before advising an individual participant about the products and 837 services available through the program. In order to participate, 838 a health insurance agent shall comply with the procedures 839 established by the corporation, including: 840 1. Completion of training requirements. 841 2. Execution of a participation agreement specifying the 842 terms and conditions of participation. 843 3. Disclosure of any appointments to solicit insurance or 844 procure applications for vendors participating in the program. 845 4. Arrangements to receive payment from the corporation for 846 services as a buyer’s representative. 847 (5) PRODUCTS.— 848 (a) The products that may be made available for purchase 849 through the program include, but are not limited to: 850 1. Health insurance policies. 851 2. Health maintenance contracts. 852 3. Limited benefit plans. 853 4. Prepaid clinic services. 854 5. Service contracts. 855 6. Arrangements for purchase of specific amounts and types 856 of health services and treatments. 857 7. Flexible spending accounts. 858 (b) Health insurance policies, health maintenance 859 contracts, limited benefit plans, prepaid service contracts, and 860 other contracts for services must ensure the availability of 861 covered services. 862 (c) Products may be offered for multiyear periods provided 863 the price of the product is specified for the entire period or 864 for each separately priced segment of the policy or contract. 865 (d) The corporation shall provide a disclosure form for 866 consumers to acknowledge their understanding of the nature of, 867 and any limitations to, the benefits provided by the products 868 and services being purchased by the consumer. 869 (e) The corporation must determine that making the plan 870 available through the program is in the interest of eligible 871 individuals and eligible employers in the state. 872 (6) PRICING.—Prices for the products and services sold 873 through the program must be transparent to participants and 874 established by the vendors. The corporation mayshallannually 875 assess a surcharge for each premium or price set by a 876 participating vendor. AnyThesurcharge may not be more than 2.5 877 percent of the price and shall be used to generate funding for 878 administrative services provided by the corporation and payments 879 to buyers’ representatives; however, a surcharge may not be 880 assessed for products and services sold in the FHIX marketplace. 881 (7) THE MARKETPLACE PROCESS.—The program shall provide a 882 single, centralized market for purchase of health insurance, 883 health maintenance contracts, and other health products and 884 services. Purchases may be made by participating individuals 885 over the Internet or through the services of a participating 886 health insurance agent. Information about each product and 887 service available through the program shall be made available 888 through printed material and an interactive Internet website. 889 (a) Marketplace purchasing.—A participant needing personal 890 assistance to select products and services shall be referred to 891 a participating agent in his or her area. 892 1.(a)Participation in the program may begin at any time 893 during a year after the employer completes enrollment and meets 894 the requirements specified by the corporation pursuant to 895 paragraph (4)(c). 896 2.(b)Initial selection of products and services must be 897 made by an individual participant within the applicable open 898 enrollment period. 899 3.(c)Initial enrollment periods for each product selected 900 by an individual participant must last at least 12 months, 901 unless the individual participant specifically agrees to a 902 different enrollment period. 903 4.(d)If an individual has selected one or more products 904 and enrolled in those products for at least 12 months or any 905 other period specifically agreed to by the individual 906 participant, changes in selected products and services may only 907 be made during the annual enrollment period established by the 908 corporation. 909 5.(e)The limits established in subparagraphs 2., 3., and 910 4.paragraphs (b)-(d)apply to any risk-bearing product that 911 promises future payment or coverage for a variable amount of 912 benefits or services. The limits do not apply to initiation of 913 flexible spending plans if those plans are not associated with 914 specific high-deductible insurance policies or the use of 915 spending accounts for any products offering individual 916 participants specific amounts and types of health services and 917 treatments at a contracted price. 918 (b) FHIX marketplace purchasing.— 919 1. Participation in the FHIX marketplace may begin at any 920 time during the year. 921 2. Initial enrollment periods for certain products selected 922 by an individual enrollee which are noncompliant with the 923 Affordable Care Act may be required to last at least 12 months, 924 unless the individual participant specifically agrees to a 925 different enrollment period. 926 (8) CONSUMER INFORMATION.—The corporation shall: 927 (a) Establish a secure website to facilitate the purchase 928 of products and services by participating individuals. The 929 website must provide information about each product or service 930 available through the program. 931 (b) Inform individuals about other public health care 932 programs. 933 (9) RISK POOLING.—The program may use methods for pooling 934 the risk of individual participants and preventing selection 935 bias. These methods may include, but are not limited to, a 936 postenrollment risk adjustment of the premium payments to the 937 vendors. The corporation may establish a methodology for 938 assessing the risk of enrolled individual participants based on 939 data reported annually by the vendors about their enrollees. 940 Distribution of payments to the vendors may be adjusted based on 941 the assessed relative risk profile of the enrollees in each 942 risk-bearing product for the most recent period for which data 943 is available. 944 (10) EXEMPTIONS.— 945 (a) Products, other than the products set forth in 946 subparagraphs (4)(d)1.-4., sold as part of the program are not 947 subject to the licensing requirements of the Florida Insurance 948 Code, as defined in s. 624.01 or the mandated offerings or 949 coverages established in part VI of chapter 627 and chapter 641. 950 (b) The corporation may act as an administrator as defined 951 in s. 626.88 but is not required to be certified pursuant to 952 part VII of chapter 626. However, a third-partythird party953 administrator used by the corporation must be certified under 954 part VII of chapter 626. 955 (c) Any standard forms, website design, or marketing 956 communication developed by the corporation and used by the 957 corporation, or any vendor that meets the requirements of 958 paragraph (4)(f) is not subject to the Florida Insurance Code, 959 as established in s. 624.01. 960 (11) CORPORATION.—There is created the Florida Health 961 Choices, Inc., which shall be registered, incorporated, 962 organized, and operated in compliance with part III of chapter 963 112 and chapters 119, 286, and 617. The purpose of the 964 corporation is to administer the program created in this section 965 and to conduct such other business as may further the 966 administration of the program. 967 (a) The corporation shall be governed by a 15-member board 968 of directors consisting of: 969 1. Three ex officio, nonvoting members to include: 970 a. The Secretary of Health Care Administration or a 971 designee with expertise in health care services. 972 b. The Secretary of Management Services or a designee with 973 expertise in state employee benefits. 974 c. The commissioner of the Office of Insurance Regulation 975 or a designee with expertise in insurance regulation. 976 2. Four members appointed by and serving at the pleasure of 977 the Governor. 978 3. Four members appointed by and serving at the pleasure of 979 the President of the Senate. 980 4. Four members appointed by and serving at the pleasure of 981 the Speaker of the House of Representatives. 982 5. Board members may not include insurers, health insurance 983 agents or brokers, health care providers, health maintenance 984 organizations, prepaid service providers, or any other entity, 985 affiliate, or subsidiary of eligible vendors. 986 (b) Members shall be appointed for terms of up to 3 years. 987 Any member is eligible for reappointment. A vacancy on the board 988 shall be filled for the unexpired portion of the term in the 989 same manner as the original appointment. 990 (c) The board shall select a chief executive officer for 991 the corporation who shall be responsible for the selection of 992 such other staff as may be authorized by the corporation’s 993 operating budget as adopted by the board. 994 (d) Board members are entitled to receive, from funds of 995 the corporation, reimbursement for per diem and travel expenses 996 as provided by s. 112.061. No other compensation is authorized. 997 (e) There is no liability on the part of, and no cause of 998 action shall arise against, any member of the board or its 999 employees or agents for any action taken by them in the 1000 performance of their powers and duties under this section. 1001 (f) The board shall develop and adopt bylaws and other 1002 corporate procedures as necessary for the operation of the 1003 corporation and carrying out the purposes of this section. The 1004 bylaws shall: 1005 1. Specify procedures for selection of officers and 1006 qualifications for reappointment, provided that no board member 1007 shall serve more than 9 consecutive years. 1008 2. Require an annual membership meeting that provides an 1009 opportunity for input and interaction with individual 1010 participants in the program. 1011 3. Specify policies and procedures regarding conflicts of 1012 interest, including the provisions of part III of chapter 112, 1013 which prohibit a member from participating in any decision that 1014 would inure to the benefit of the member or the organization 1015 that employs the member. The policies and procedures shall also 1016 require public disclosure of the interest that prevents the 1017 member from participating in a decision on a particular matter. 1018 (g) The corporation may exercise all powers granted to it 1019 under chapter 617 necessary to carry out the purposes of this 1020 section, including, but not limited to, the power to receive and 1021 accept grants, loans, or advances of funds from any public or 1022 private agency and to receive and accept from any source 1023 contributions of money, property, labor, or any other thing of 1024 value to be held, used, and applied for the purposes of this 1025 section. 1026 (h) The corporation may establish technical advisory panels 1027 consisting of interested parties, including consumers, health 1028 care providers, individuals with expertise in insurance 1029 regulation, and insurers. 1030 (i) The corporation shall: 1031 1. Determine eligibility of employers, vendors, 1032 individuals, and agents in accordance with subsection (4). 1033 2. Establish procedures necessary for the operation of the 1034 program, including, but not limited to, procedures for 1035 application, enrollment, risk assessment, risk adjustment, plan 1036 administration, performance monitoring, and consumer education. 1037 3. Arrange for collection of contributions from 1038 participating employers, third parties, governmental entities, 1039 and individuals. 1040 4. Arrange for payment of premiums and other appropriate 1041 disbursements based on the selections of products and services 1042 by the individual participants. 1043 5. Establish criteria for disenrollment of participating 1044 individuals based on failure to pay the individual’s share of 1045 any contribution required to maintain enrollment in selected 1046 products. 1047 6. Establish criteria for exclusion of vendors pursuant to 1048 paragraph (4)(d). 1049 7. Develop and implement a plan for promoting public 1050 awareness of and participation in the program. 1051 8. Secure staff and consultant services necessary to the 1052 operation of the program. 1053 9. Establish policies and procedures regarding 1054 participation in the program for individuals, vendors, health 1055 insurance agents, and employers. 1056 10. Provide for the operation of a toll-free hotline to 1057 respond to requests for assistance. 1058 11. Provide for initial, open, and special enrollment 1059 periods. 1060 12. Evaluate options for employer participation which may 1061 conform towithcommon insurance practices. 1062 13. Administer the Florida Health Insurance Affordability 1063 Exchange Program in accordance with ss. 409.72-409.731. 1064 14. Coordinate with the Agency for Health Care 1065 Administration, the Department of Children and Families, and the 1066 Florida Healthy Kids Corporation in developing and implementing 1067 the enrollee transition plan. 1068 15. Coordinate with the federal exchange to provide FHIX 1069 enrollees with the option of selecting plans from either the 1070 FHIX marketplace or the federal exchange. 1071 (12) REPORT.—The board of the corporation shallBeginning1072in the 2009-2010 fiscal year,submit by February 1 an annual 1073 report to the Governor, the President of the Senate, and the 1074 Speaker of the House of Representatives documenting the 1075 corporation’s activities in compliance with the duties 1076 delineated in this section. 1077 (13) PROGRAM INTEGRITY.—To ensure program integrity and to 1078 safeguard the financial transactions made under the auspices of 1079 the program, the corporation is authorized to establish 1080 qualifying criteria and certification procedures for vendors, 1081 require performance bonds or other guarantees of ability to 1082 complete contractual obligations, monitor the performance of 1083 vendors, and enforce the agreements of the program through 1084 financial penalty or disqualification from the program. 1085 (14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS.— 1086 (a) Definitions.—For purposes of this subsection, the term: 1087 1. “Buyer’s representative” means a participating insurance 1088 agent as described in paragraph (4)(g). 1089 2. “Enrollee” means an employer who is eligible to enroll 1090 in the program pursuant to paragraph (4)(a). 1091 3. “Participant” means an individual who is eligible to 1092 participate in the program pursuant to paragraph (4)(b). 1093 4. “Proprietary confidential business information” means 1094 information, regardless of form or characteristics, that is 1095 owned or controlled by a vendor requesting confidentiality under 1096 this section; that is intended to be and is treated by the 1097 vendor as private in that the disclosure of the information 1098 would cause harm to the business operations of the vendor; that 1099 has not been disclosed unless disclosed pursuant to a statutory 1100 provision, an order of a court or administrative body, or a 1101 private agreement providing that the information may be released 1102 to the public; and that is information concerning: 1103 a. Business plans. 1104 b. Internal auditing controls and reports of internal 1105 auditors. 1106 c. Reports of external auditors for privately held 1107 companies. 1108 d. Client and customer lists. 1109 e. Potentially patentable material. 1110 f. A trade secret as defined in s. 688.002. 1111 5. “Vendor” means a participating insurer or other provider 1112 of services as described in paragraph (4)(d). 1113 (b) Public record exemptions.— 1114 1. Personal identifying information of an enrollee or 1115 participant who has applied for or participates in the Florida 1116 Health Choices Program is confidential and exempt from s. 1117 119.07(1) and s. 24(a), Art. I of the State Constitution. 1118 2. Client and customer lists of a buyer’s representative 1119 held by the corporation are confidential and exempt from s. 1120 119.07(1) and s. 24(a), Art. I of the State Constitution. 1121 3. Proprietary confidential business information held by 1122 the corporation is confidential and exempt from s. 119.07(1) and 1123 s. 24(a), Art. I of the State Constitution. 1124 (c) Retroactive application.—The public record exemptions 1125 provided for in paragraph (b) apply to information held by the 1126 corporation before, on, or after the effective date of this 1127 exemption. 1128 (d) Authorized release.— 1129 1. Upon request, information made confidential and exempt 1130 pursuant to this subsection shall be disclosed to: 1131 a. Another governmental entity in the performance of its 1132 official duties and responsibilities. 1133 b. Any person who has the written consent of the program 1134 applicant. 1135 c. The Florida Kidcare program for the purpose of 1136 administering the program authorized in ss. 409.810-409.821. 1137 2. Paragraph (b) does not prohibit a participant’s legal 1138 guardian from obtaining confirmation of coverage, dates of 1139 coverage, the name of the participant’s health plan, and the 1140 amount of premium being paid. 1141 (e) Penalty.—A person who knowingly and willfully violates 1142 this subsection commits a misdemeanor of the second degree, 1143 punishable as provided in s. 775.082 or s. 775.083. 1144 Section 19. Subsection (2) of section 409.904, Florida 1145 Statutes, is amended to read: 1146 409.904 Optional payments for eligible persons.—The agency 1147 may make payments for medical assistance and related services on 1148 behalf of the following persons who are determined to be 1149 eligible subject to the income, assets, and categorical 1150 eligibility tests set forth in federal and state law. Payment on 1151 behalf of these Medicaid eligible persons is subject to the 1152 availability of moneys and any limitations established by the 1153 General Appropriations Act or chapter 216. 1154 (2) A family, a pregnant woman, a child under age 21, a 1155 person age 65 or over, or a blind or disabled person, who would 1156 be eligible under any group listed in s. 409.903(1), (2), or 1157 (3), except that the income or assets of such family or person 1158 exceed established limitations. For a family or person in one of 1159 these coverage groups, medical expenses are deductible from 1160 income in accordance with federal requirements in order to make 1161 a determination of eligibility. A family or person eligible 1162 under the coverage known as the “medically needy,” is eligible 1163 to receive the same services as other Medicaid recipients, with 1164 the exception of services in skilled nursing facilities and 1165 intermediate care facilities for the developmentally disabled. 1166 Effective July 1, 2020, persons eligible under “medically needy” 1167 shall be limited to children under 21 years of age and pregnant 1168 women. This subsection expires October 1, 2023. 1169 Section 20. Section 624.91, Florida Statutes, is amended to 1170 read: 1171 624.91 The Florida Healthy Kids Corporation Act.— 1172 (1) SHORT TITLE.—This section may be cited as the “William 1173 G. ‘Doc’ Myers Healthy Kids Corporation Act.” 1174 (2) LEGISLATIVE INTENT.— 1175 (a) The Legislature finds that increased access to health 1176 care services could improve children’s health and reduce the 1177 incidence and costs of childhood illness and disabilities among 1178 children in this state. Many children do not have comprehensive, 1179 affordable health care services available. It is the intent of 1180 the Legislature that the Florida Healthy Kids Corporation 1181 provide comprehensive health insurance coverage to such 1182 children. The corporation is encouraged to cooperate with any 1183 existing health service programs funded by the public or the 1184 private sector. 1185 (b) It is the intent of the Legislature that the Florida 1186 Healthy Kids Corporation serve as one of several providers of 1187 services to children eligible for medical assistance under Title 1188 XXI of the Social Security Act. Although the corporation may 1189 serve other children, the Legislature intends the primary 1190 recipients of services provided through the corporation be 1191 school-age children with a family income below 200 percent of 1192 the federal poverty level, who do not qualify for Medicaid. It 1193 is also the intent of the Legislature that state and local 1194 government Florida Healthy Kids funds be used to continue 1195 coverage, subject to specific appropriations in the General 1196 Appropriations Act, to children not eligible for federal 1197 matching funds under Title XXI. 1198 (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents 1199 of this state are eligiblethe following individuals are1200eligiblefor state-funded assistance in paying Florida Healthy 1201 Kids premiums pursuant to s. 409.814.:1202(a) Residents of this state who are eligible for the1203Florida Kidcare program pursuant to s. 409.814.1204(b) Notwithstanding s. 409.814, a legal alien who is1205enrolled in the Florida Healthy Kids program as of January 31,12062004, who does not qualify for Title XXI federal funds because1207he or she is not a lawfully residing child as defined in s.1208409.811.1209 (4) NONENTITLEMENT.—Nothing in this section shall be 1210 construed as providing an individual with an entitlement to 1211 health care services. No cause of action shall arise against the 1212 state, the Florida Healthy Kids Corporation, or a unit of local 1213 government for failure to make health services available under 1214 this section. 1215 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.— 1216 (a) There is created the Florida Healthy Kids Corporation, 1217 a not-for-profit corporation. 1218 (b) The Florida Healthy Kids Corporation shall: 1219 1. Arrange for the collection of any individual, family, 1220local contributions,or employer payment or premium, in an 1221 amount to be determined by the board of directors, to provide 1222 for payment of premiums for comprehensive insurance coverage and 1223 for the actual or estimated administrative expenses. 1224 2. Arrange for the collection of any voluntary 1225 contributions to provide for payment of Florida Kidcare program 1226 or Florida Health Insurance Affordability Exchange Program 1227 (FHIX) premiumsfor children who are not eligible for medical1228assistance under Title XIX or Title XXI of the Social Security1229Act. 1230 3.Subject to the provisions of s. 409.8134, accept1231voluntary supplemental local match contributions that comply1232with the requirements of Title XXI of the Social Security Act1233for the purpose of providing additional Florida Kidcare coverage1234in contributing counties under Title XXI.12354.Establish the administrative and accounting procedures 1236 for the operation of the corporation. 1237 4.5.Establish, with consultation from appropriate 1238 professional organizations, standards for preventive health 1239 services and providers and comprehensive insurance benefits 1240 appropriate to children, provided that such standards for rural 1241 areas shall not limit primary care providers to board-certified 1242 pediatricians. 1243 5.6.Determine eligibility for children seeking to 1244 participate in the Title XXI-funded components of the Florida 1245 Kidcare program consistent with the requirements specified in s. 1246 409.814, as well as the non-Title-XXI-eligible children as1247provided in subsection (3). 1248 6.7.Establish procedures under whichproviders of local1249match to,applicants to and participants in the program may have 1250 grievances reviewed by an impartial body and reported to the 1251 board of directors of the corporation. 1252 7.8.Establish participation criteria and, if appropriate, 1253 contract with an authorized insurer, health maintenance 1254 organization, or third-party administrator to provide 1255 administrative services to the corporation. 1256 8.9.Establish enrollment criteria that include penalties 1257 or waiting periods of 30 days for reinstatement of coverage upon 1258 voluntary cancellation for nonpayment of family or individual 1259 premiums. 1260 9.10.Contract with authorized insurers or any provider of 1261 health care services, meeting standards established by the 1262 corporation, for the provision of comprehensive insurance 1263 coverage to participants. Such standards shall include criteria 1264 under which the corporation may contract with more than one 1265 provider of health care services in program sites. 1266 a. Health plans shall be selected through a competitive bid 1267 process. The Florida Healthy Kids Corporation shall purchase 1268 goods and services in the most cost-effective manner consistent 1269 with the delivery of quality medical care. 1270 b. The maximum administrative cost for a Florida Healthy 1271 Kids Corporation contract shall be 15 percent. For health and 1272 dental care contracts, the minimum medical loss ratio for a 1273 Florida Healthy Kids Corporation contract shall be 85 percent. 1274 The calculations must use uniform financial data collected from 1275 all plans in a format established by the corporation and shall 1276 be computed for each plan on a statewide basis. Funds shall be 1277 classified in a manner consistent with 45 C.F.R. part 158For1278dental contracts, the remaining compensation to be paid to the1279authorized insurer or provider under a Florida Healthy Kids1280Corporation contract shall be no less than an amount which is 851281percent of premium; to the extent any contract provision does1282not provide for this minimum compensation, this section shall1283prevail. 1284 c. The health plan selection criteria and scoring system, 1285 and the scoring results, shall be available upon request for 1286 inspection after the bids have been awarded. 1287 d. Effective July 1, 2020, health and dental services 1288 contracts of the corporation must transition to the FHIX 1289 marketplace under s. 409.722. Qualifying plans may enroll as 1290 vendors with the FHIX marketplace to maintain continuity of care 1291 for participants. 1292 10.11.Establish disenrollment criteria in the eventlocal1293matchingfunds are insufficient to cover enrollments. 1294 11.12.Develop and implement a plan to publicize the 1295 Florida Kidcare program, the eligibility requirements of the 1296 program, and the procedures for enrollment in the program and to 1297 maintain public awareness of the corporation and the program. 1298 12.13.Secure staff necessary to properly administer the 1299 corporation. Staff costs shall be funded from stateand local1300matching fundsand such other private or public funds as become 1301 available. The board of directors shall determine the number of 1302 staff members necessary to administer the corporation. 1303 13.14.In consultation with the partner agencies, provide a 1304 report on the Florida Kidcare program annually to the Governor, 1305 the Chief Financial Officer, the Commissioner of Education, the 1306 President of the Senate, the Speaker of the House of 1307 Representatives, and the Minority Leaders of the Senate and the 1308 House of Representatives. 1309 14.15.Provide information on a quarterly basis online to 1310 the Legislature and the Governor which compares the costs and 1311 utilization of the full-pay enrolled population and the Title 1312 XXI-subsidized enrolled population in the Florida Kidcare 1313 program. The information, at a minimum, must include: 1314 a. The monthly enrollment and expenditure for full-pay 1315 enrollees in the Medikids and Florida Healthy Kids programs 1316 compared to the Title XXI-subsidized enrolled population; and 1317 b. The costs and utilization by service of the full-pay 1318 enrollees in the Medikids and Florida Healthy Kids programs and 1319 the Title XXI-subsidized enrolled population. 1320 15.16.Establish benefit packages that conform to the 1321 provisions of the Florida Kidcare program, as created in ss. 1322 409.810-409.821. 1323 16. Contract with other insurance affordability programs to 1324 provide such services that are consistent with this act. 1325 17. Annually develop performance metrics for the following 1326 focus areas: 1327 a. Administrative functions. 1328 b. Contracting with vendors. 1329 c. Customer service. 1330 d. Enrollee education. 1331 e. Financial services. 1332 f. Program integrity. 1333 (c) Coverage under the corporation’s program is secondary 1334 to any other available private coverage held by, or applicable 1335 to, the participant child or family member. Insurers under 1336 contract with the corporation are the payors of last resort and 1337 must coordinate benefits with any other third-party payor that 1338 may be liable for the participant’s medical care. 1339 (d) The Florida Healthy Kids Corporation shall be a private 1340 corporation not for profit, organized pursuant to chapter 617, 1341 and shall have all powers necessary to carry out the purposes of 1342 this act, including, but not limited to, the power to receive 1343 and accept grants, loans, or advances of funds from any public 1344 or private agency and to receive and accept from any source 1345 contributions of money, property, labor, or any other thing of 1346 value, to be held, used, and applied for the purposes of this 1347 act. 1348 (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.— 1349 (a) The Florida Healthy Kids Corporation shall operate 1350 subject to the supervision and approval of a board of directors. 1351 The board chair shall be an appointee designated by the 1352 Governor, and the board shall bechaired by theChief Financial1353Officer or her or his designee, andcomposed of 12 other 1354 members. The Senate shall confirm the designated chair and other 1355 board appointees. The board members shall be appointedselected1356 for 3-year terms.of office as follows:13571. The Secretary of Health Care Administration, or his or1358her designee.13592. One member appointed by the Commissioner of Education1360from the Office of School Health Programs of the Florida1361Department of Education.13623. One member appointed by the Chief Financial Officer from1363among three members nominated by the Florida Pediatric Society.13644. One member, appointed by the Governor, who represents1365the Children’s Medical Services Program.13665. One member appointed by the Chief Financial Officer from1367among three members nominated by the Florida Hospital1368Association.13696. One member, appointed by the Governor, who is an expert1370on child health policy.13717. One member, appointed by the Chief Financial Officer,1372from among three members nominated by the Florida Academy of1373Family Physicians.13748. One member, appointed by the Governor, who represents1375the state Medicaid program.13769. One member, appointed by the Chief Financial Officer,1377from among three members nominated by the Florida Association of1378Counties.137910. The State Health Officer or her or his designee.138011. The Secretary of Children and Families, or his or her1381designee.138212. One member, appointed by the Governor, from among three1383members nominated by the Florida Dental Association.1384 (b) A member of the board of directors shall be appointed 1385 by and serve at the pleasure of the Governormay be removed by1386the official who appointed that member. The board shall appoint 1387 an executive director, who is responsible for other staff 1388 authorized by the board. 1389 (c) Board members are entitled to receive, from funds of 1390 the corporation, reimbursement for per diem and travel expenses 1391 as provided by s. 112.061. 1392 (d) There shall be no liability on the part of, and no 1393 cause of action shall arise against, any member of the board of 1394 directors, or its employees or agents, for any action they take 1395 in the performance of their powers and duties under this act. 1396 (e) Terms for board members appointed under this act are 1397 effective January 1, 2020. 1398 (7) LICENSING NOT REQUIRED; FISCAL OPERATION.— 1399 (a) The corporation shall not be deemed an insurer. The 1400 officers, directors, and employees of the corporation shall not 1401 be deemed to be agents of an insurer. Neither the corporation 1402 nor any officer, director, or employee of the corporation is 1403 subject to the licensing requirements of the insurance code or 1404 the rules of the Department of Financial Services. However, any 1405 marketing representative utilized and compensated by the 1406 corporation must be appointed as a representative of the 1407 insurers or health services providers with which the corporation 1408 contracts. 1409 (b) The board has complete fiscal control over the 1410 corporation and is responsible for all corporate operations. 1411 (c) The Department of Financial Services shall supervise 1412 any liquidation or dissolution of the corporation and shall 1413 have, with respect to such liquidation or dissolution, all power 1414 granted to it pursuant to the insurance code. 1415 (8) TRANSITION PLANS.—The corporation shall confer with the 1416 Agency for Health Care Administration, the Department of 1417 Children and Families, and Florida Health Choices, Inc., to 1418 develop transition plans for the Florida Health Insurance 1419 Affordability Exchange Program as created under ss. 409.72 1420 409.731. 1421 Section 21. Section 624.915, Florida Statutes, is repealed. 1422 Section 22. The Division of Law Revision and Information is 1423 directed to replace the phrase “the effective date of this act” 1424 wherever it occurs in this act with the date the act becomes a 1425 law. 1426 Section 23. This act shall take effect upon becoming a law. 1427 1428 ================= T I T L E A M E N D M E N T ================ 1429 And the title is amended as follows: 1430 Delete lines 2 - 30 1431 and insert: 1432 An act relating to health care coverage; creating ss. 1433 627.6046 and 627.65612, F.S.; defining the terms 1434 “operative date” and “preexisting medical condition” 1435 with respect to individual and group health insurance 1436 policies, respectively; requiring insurers, contingent 1437 upon the occurrence of either of two specified events, 1438 to make at least one comprehensive major medical 1439 health insurance policy available to all residents of 1440 this state within a specified timeframe; prohibiting 1441 such insurers from excluding, limiting, denying, or 1442 delaying coverage under such policies due to 1443 preexisting medical conditions; requiring such 1444 policies to have been actively marketed on a specified 1445 date and during a certain timeframe before that date; 1446 providing applicability; amending s. 641.31, F.S.; 1447 defining the terms “operative date” and “preexisting 1448 medical condition” with respect to health maintenance 1449 contracts; requiring health maintenance organizations, 1450 contingent upon the occurrence of either of two 1451 specified events, to make at least one comprehensive 1452 major medical health maintenance contract available to 1453 all residents of this state within a specified 1454 timeframe; prohibiting such health maintenance 1455 organizations from excluding, limiting, denying, or 1456 delaying coverage under such contracts due to 1457 preexisting medical conditions; requiring such 1458 contracts to have been actively marketed on a 1459 specified date and during a certain timeframe before 1460 that date; providing a directive to the Division of 1461 Law Revision and Information; creating s. 409.72, 1462 F.S.; providing a short title; creating s. 409.721, 1463 F.S.; creating the Florida Health Insurance 1464 Affordability Exchange Program (FHIX) within the 1465 Agency for Health Care Administration; providing 1466 program authority and principles; creating s. 409.722, 1467 F.S.; defining terms; creating s. 409.723, F.S.; 1468 providing eligibility and enrollment criteria; 1469 providing patient rights and responsibilities; 1470 defining the term “disabled”; providing premium 1471 levels; creating s. 409.724, F.S.; providing for 1472 premium credits and choice counseling; establishing an 1473 education campaign; providing for customer support and 1474 disenrollment; creating s. 409.725, F.S.; providing 1475 for available products and services; creating s. 1476 409.726, F.S.; requiring the department to develop 1477 accountability measures and performance standards 1478 governing the administration of the program; creating 1479 s. 409.727, F.S.; providing for a readiness review and 1480 a two-phase implementation schedule; creating s. 1481 409.728, F.S.; providing program operation and 1482 management duties; creating s. 409.729, F.S.; 1483 providing for the development of a long-term 1484 reorganization plan and the formation of the FHIX 1485 Workgroup; creating s. 409.73, F.S.; authorizing the 1486 agency to seek federal approval; prohibiting the 1487 agency from implementing the FHIX waiver under certain 1488 circumstances; creating s. 409.731, F.S.; providing 1489 for program expiration; providing for the 1490 establishment of a commission; providing purposes and 1491 duties of the commission and for the appointment of 1492 members; requiring a commission report to be submitted 1493 to the Governor and the Legislature; repealing s. 1494 408.70, F.S., relating to legislative findings 1495 regarding access to affordable health care; amending 1496 s. 408.910, F.S.; revising legislative intent; 1497 redefining terms; revising the scope of the Florida 1498 Health Choices Program and the pricing of services 1499 under the program; providing requirements for 1500 operation of the marketplace; providing additional 1501 duties for the corporation to perform; requiring an 1502 annual report to the Governor and the Legislature; 1503 amending s. 409.904, F.S.; limiting eligible persons 1504 in the Medically Needy program to those under the age 1505 of 21 and pregnant women, and specifying an effective 1506 date; providing an expiration date for the program; 1507 amending s. 624.91, F.S.; revising eligibility 1508 requirements for state-funded assistance; revising the 1509 duties and powers of the Florida Healthy Kids 1510 Corporation; revising provisions for the appointment 1511 of members of the board of the Florida Healthy Kids 1512 Corporation; requiring transition plans; repealing s. 1513 624.915, F.S., relating to the operating fund of the 1514 Florida Healthy Kids Corporation; providing a 1515 directive to the Division of Law Revision and 1516 Information; providing an effective date.