Bill Text: FL S2512 | 2015 | Regular Session | Engrossed


Bill Title: Medicaid

Spectrum: Committee Bill

Status: (Failed) 2015-05-01 - Died in returning Messages [S2512 Detail]

Download: Florida-2015-S2512-Engrossed.html
       SB 2512                                          First Engrossed
       
       
       
       
       
       
       
       
       20152512e1
       
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 395.602,
    3         F.S.; revising the term “rural hospital”; amending s.
    4         409.908, F.S.; deleting provisions that authorized the
    5         agency to receive funds from certain state entities,
    6         local governments, and other political subdivisions
    7         for a specific purpose; providing that the Agency for
    8         Health Care Administration is authorized to receive
    9         intergovernmental transfers of funds from governmental
   10         entities for specified purposes; requiring the agency
   11         to seek Medicaid waiver authority for the use of local
   12         intergovernmental transfers under certain parameters;
   13         revising the list of provider types that are subject
   14         to certain statutory provisions relating to the
   15         establishment of rates; amending s. 409.909, F.S.;
   16         revising definitions; altering the annual allocation
   17         cap for hospitals participating in the Statewide
   18         Medicaid Residency Program; creating the Graduate
   19         Medical Education Startup Bonus Program; providing
   20         allocations for the program; amending s. 409.911,
   21         F.S.; updating references to data used for calculating
   22         disproportionate share program payments to certain
   23         hospitals for the 2015-2016 fiscal year; repealing s.
   24         409.97, F.S, relating to state and local Medicaid
   25         partnerships; amending s. 409.983, F.S.; providing
   26         parameters for the reconciliation of managed care plan
   27         payments in the long-term care managed care program;
   28         amending s. 408.07, F.S.; conforming a cross
   29         reference; creating s. 409.720, F.S.; providing a
   30         short title; creating s. 409.721, F.S.; creating the
   31         Florida Health Insurance Affordability Exchange
   32         Program or FHIX in the Agency for Health Care
   33         Administration; providing program authority and
   34         principles; creating s. 409.722, F.S.; defining terms;
   35         creating s. 409.723, F.S.; providing eligibility and
   36         enrollment criteria; providing patient rights and
   37         responsibilities; providing premium levels; creating
   38         s. 409.724, F.S.; providing for premium credits and
   39         choice counseling; establishing an education campaign;
   40         providing for customer support and disenrollment;
   41         creating s. 409.725, F.S.; providing for available
   42         products and services; creating s. 409.726, F.S.;
   43         providing for program accountability; creating s.
   44         409.727, F.S.; providing an implementation schedule;
   45         creating s. 409.728, F.S.; providing program operation
   46         and management duties; creating s. 409.729, F.S.;
   47         providing for the development of a long-term
   48         reorganization plan and the formation of the FHIX
   49         Workgroup; creating s. 409.730, F.S.; authorizing the
   50         agency to seek federal approval; creating s. 409.731,
   51         F.S.; providing for program expiration; repealing s.
   52         408.70, F.S., relating to legislative findings
   53         regarding access to affordable health care; amending
   54         s. 408.910, F.S.; revising legislative intent;
   55         redefining terms; revising the scope of the Florida
   56         Health Choices Program and the pricing of services
   57         under the program; providing requirements for
   58         operation of the marketplace; providing additional
   59         duties for the corporation to perform; requiring an
   60         annual report to the Governor and the Legislature;
   61         amending s. 409.904, F.S.; establishing a date when
   62         new enrollment in the Medically Needy program is
   63         suspended; providing an expiration date for the
   64         program; amending s. 624.91, F.S.; revising
   65         eligibility requirements for state-funded assistance;
   66         revising the duties and powers of the Florida Healthy
   67         Kids Corporation; revising provisions for the
   68         appointment of members of the board of the Florida
   69         Healthy Kids Corporation; requiring transition plans;
   70         amending chapter 2012-33, Laws of Florida; requiring a
   71         Program of All-Inclusive Care for the Elderly
   72         organization in Broward County to serve frail elders
   73         in Miami-Dade County; repealing s. 624.915, F.S.,
   74         relating to the operating fund of the Florida Healthy
   75         Kids Corporation; providing a directive to the
   76         Division of Law Revision and Information; providing
   77         effective dates.
   78          
   79  Be It Enacted by the Legislature of the State of Florida:
   80  
   81         Section 1. Paragraph (e) of subsection (2) of section
   82  395.602, Florida Statutes, is amended to read:
   83         395.602 Rural hospitals.—
   84         (2) DEFINITIONS.—As used in this part, the term:
   85         (e) “Rural hospital” means an acute care hospital licensed
   86  under this chapter, having 100 or fewer licensed beds and an
   87  emergency room, which is:
   88         1. The sole provider within a county with a population
   89  density of up to 100 persons per square mile;
   90         2. An acute care hospital, in a county with a population
   91  density of up to 100 persons per square mile, which is at least
   92  30 minutes of travel time, on normally traveled roads under
   93  normal traffic conditions, from any other acute care hospital
   94  within the same county;
   95         3. A hospital supported by a tax district or subdistrict
   96  whose boundaries encompass a population of up to 100 persons per
   97  square mile;
   98         4. A hospital classified as a sole community hospital under
   99  42 C.F.R. s. 412.92 which has up to 340 licensed beds;
  100         4.5. A hospital with a service area that has a population
  101  of up to 100 persons per square mile. As used in this
  102  subparagraph, the term “service area” means the fewest number of
  103  zip codes that account for 75 percent of the hospital’s
  104  discharges for the most recent 5-year period, based on
  105  information available from the hospital inpatient discharge
  106  database in the Florida Center for Health Information and Policy
  107  Analysis at the agency; or
  108         5.6. A hospital designated as a critical access hospital,
  109  as defined in s. 408.07.
  110  
  111  Population densities used in this paragraph must be based upon
  112  the most recently completed United States census. A hospital
  113  that received funds under s. 409.9116 for a quarter beginning no
  114  later than July 1, 2002, is deemed to have been and shall
  115  continue to be a rural hospital from that date through June 30,
  116  2021 2015, if the hospital continues to have up to 100 licensed
  117  beds and an emergency room. An acute care hospital that has not
  118  previously been designated as a rural hospital and that meets
  119  the criteria of this paragraph shall be granted such designation
  120  upon application, including supporting documentation, to the
  121  agency. A hospital that was licensed as a rural hospital during
  122  the 2010-2011 or 2011-2012 fiscal year shall continue to be a
  123  rural hospital from the date of designation through June 30,
  124  2021 2015, if the hospital continues to have up to 100 licensed
  125  beds and an emergency room.
  126         Section 2. Effective upon this act becoming a law,
  127  subsection (1) of section 409.908, Florida Statutes, is amended
  128  to read:
  129         409.908 Reimbursement of Medicaid providers.—Subject to
  130  specific appropriations, the agency shall reimburse Medicaid
  131  providers, in accordance with state and federal law, according
  132  to methodologies set forth in the rules of the agency and in
  133  policy manuals and handbooks incorporated by reference therein.
  134  These methodologies may include fee schedules, reimbursement
  135  methods based on cost reporting, negotiated fees, competitive
  136  bidding pursuant to s. 287.057, and other mechanisms the agency
  137  considers efficient and effective for purchasing services or
  138  goods on behalf of recipients. If a provider is reimbursed based
  139  on cost reporting and submits a cost report late and that cost
  140  report would have been used to set a lower reimbursement rate
  141  for a rate semester, then the provider’s rate for that semester
  142  shall be retroactively calculated using the new cost report, and
  143  full payment at the recalculated rate shall be effected
  144  retroactively. Medicare-granted extensions for filing cost
  145  reports, if applicable, shall also apply to Medicaid cost
  146  reports. Payment for Medicaid compensable services made on
  147  behalf of Medicaid eligible persons is subject to the
  148  availability of moneys and any limitations or directions
  149  provided for in the General Appropriations Act or chapter 216.
  150  Further, nothing in this section shall be construed to prevent
  151  or limit the agency from adjusting fees, reimbursement rates,
  152  lengths of stay, number of visits, or number of services, or
  153  making any other adjustments necessary to comply with the
  154  availability of moneys and any limitations or directions
  155  provided for in the General Appropriations Act, provided the
  156  adjustment is consistent with legislative intent.
  157         (1) Reimbursement to hospitals licensed under part I of
  158  chapter 395 must be made prospectively or on the basis of
  159  negotiation.
  160         (a) Reimbursement for inpatient care is limited as provided
  161  in s. 409.905(5), except as otherwise provided in this
  162  subsection.
  163         1. If authorized by the General Appropriations Act, the
  164  agency may modify reimbursement for specific types of services
  165  or diagnoses, recipient ages, and hospital provider types.
  166         2. The agency may establish an alternative methodology to
  167  the DRG-based prospective payment system to set reimbursement
  168  rates for:
  169         a. State-owned psychiatric hospitals.
  170         b. Newborn hearing screening services.
  171         c. Transplant services for which the agency has established
  172  a global fee.
  173         d. Recipients who have tuberculosis that is resistant to
  174  therapy who are in need of long-term, hospital-based treatment
  175  pursuant to s. 392.62.
  176         3. The agency shall modify reimbursement according to other
  177  methodologies recognized in the General Appropriations Act.
  178  
  179  The agency may receive funds from state entities, including, but
  180  not limited to, the Department of Health, local governments, and
  181  other local political subdivisions, for the purpose of making
  182  special exception payments, including federal matching funds,
  183  through the Medicaid inpatient reimbursement methodologies.
  184  Funds received for this purpose shall be separately accounted
  185  for and may not be commingled with other state or local funds in
  186  any manner. The agency may certify all local governmental funds
  187  used as state match under Title XIX of the Social Security Act,
  188  to the extent and in the manner authorized under the General
  189  Appropriations Act and pursuant to an agreement between the
  190  agency and the local governmental entity. In order for the
  191  agency to certify such local governmental funds, a local
  192  governmental entity must submit a final, executed letter of
  193  agreement to the agency, which must be received by October 1 of
  194  each fiscal year and provide the total amount of local
  195  governmental funds authorized by the entity for that fiscal year
  196  under this paragraph, paragraph (b), or the General
  197  Appropriations Act. The local governmental entity shall use a
  198  certification form prescribed by the agency. At a minimum, the
  199  certification form must identify the amount being certified and
  200  describe the relationship between the certifying local
  201  governmental entity and the local health care provider. The
  202  agency shall prepare an annual statement of impact which
  203  documents the specific activities undertaken during the previous
  204  fiscal year pursuant to this paragraph, to be submitted to the
  205  Legislature annually by January 1.
  206         (b) Reimbursement for hospital outpatient care is limited
  207  to $1,500 per state fiscal year per recipient, except for:
  208         1. Such care provided to a Medicaid recipient under age 21,
  209  in which case the only limitation is medical necessity.
  210         2. Renal dialysis services.
  211         3. Other exceptions made by the agency.
  212  
  213  The agency is authorized to receive funds from state entities,
  214  including, but not limited to, the Department of Health, the
  215  Board of Governors of the State University System, local
  216  governments, and other local political subdivisions, for the
  217  purpose of making payments, including federal matching funds,
  218  through the Medicaid outpatient reimbursement methodologies.
  219  Funds received from state entities and local governments for
  220  this purpose shall be separately accounted for and shall not be
  221  commingled with other state or local funds in any manner.
  222         (c)1. The agency may receive intergovernmental transfers of
  223  funds from governmental entities, including, but not limited to,
  224  the Department of Health, local governments, and other local
  225  political subdivisions, for the purpose of making special
  226  exception payments or to enhance provider reimbursement,
  227  including federal matching funds, through the Medicaid inpatient
  228  or outpatient reimbursement methodologies. Funds received by
  229  intergovernmental transfer for these purposes shall be
  230  separately accounted for and may not be commingled with other
  231  state or local funds in any manner. The agency may certify all
  232  local intergovernmental transfers used as state match under
  233  Title XIX of the Social Security Act to the extent and in the
  234  manner authorized under the General Appropriations Act and
  235  pursuant to an agreement between the agency and the local
  236  governmental entity. In order for the agency to certify such
  237  local intergovernmental transfers, a local governmental entity
  238  must submit a final, executed letter of agreement to the agency
  239  which must be received by October 1 of each fiscal year and
  240  provide the total amount of intergovernmental transfers
  241  authorized by the entity for that fiscal year under this
  242  paragraph or the General Appropriations Act. The local
  243  governmental entity shall use a certification form prescribed by
  244  the agency. At a minimum, the certification form must identify
  245  the amount being certified.
  246         2. The agency shall seek Medicaid waiver authority to use
  247  local intergovernmental transfers for the advancement of the
  248  Medicaid program and for enhancing or supplementing provider
  249  reimbursement under this part and part IV in ways that incent
  250  donations of local intergovernmental transfers and prevent
  251  providers from being penalized in the calculations of Medicaid
  252  cost limits by virtue of having donated intergovernmental
  253  transfers under waiver authority granted under this paragraph.
  254  The agency shall prepare an annual statement of impact which
  255  documents the specific activities undertaken during the previous
  256  fiscal year pursuant to this paragraph, to be submitted to the
  257  Legislature annually by January 1.
  258         (d)(c) Hospitals that provide services to a
  259  disproportionate share of low-income Medicaid recipients, or
  260  that participate in the regional perinatal intensive care center
  261  program under chapter 383, or that participate in the statutory
  262  teaching hospital disproportionate share program may receive
  263  additional reimbursement. The total amount of payment for
  264  disproportionate share hospitals shall be fixed by the General
  265  Appropriations Act. The computation of these payments must be
  266  made in compliance with all federal regulations and the
  267  methodologies described in ss. 409.911 and 409.9113.
  268         (e)(d) The agency is authorized to limit inflationary
  269  increases for outpatient hospital services as directed by the
  270  General Appropriations Act.
  271         Section 3. Paragraph (c) of subsection (23) of section
  272  409.908, Florida Statutes, is amended to read:
  273         409.908 Reimbursement of Medicaid providers.—Subject to
  274  specific appropriations, the agency shall reimburse Medicaid
  275  providers, in accordance with state and federal law, according
  276  to methodologies set forth in the rules of the agency and in
  277  policy manuals and handbooks incorporated by reference therein.
  278  These methodologies may include fee schedules, reimbursement
  279  methods based on cost reporting, negotiated fees, competitive
  280  bidding pursuant to s. 287.057, and other mechanisms the agency
  281  considers efficient and effective for purchasing services or
  282  goods on behalf of recipients. If a provider is reimbursed based
  283  on cost reporting and submits a cost report late and that cost
  284  report would have been used to set a lower reimbursement rate
  285  for a rate semester, then the provider’s rate for that semester
  286  shall be retroactively calculated using the new cost report, and
  287  full payment at the recalculated rate shall be effected
  288  retroactively. Medicare-granted extensions for filing cost
  289  reports, if applicable, shall also apply to Medicaid cost
  290  reports. Payment for Medicaid compensable services made on
  291  behalf of Medicaid eligible persons is subject to the
  292  availability of moneys and any limitations or directions
  293  provided for in the General Appropriations Act or chapter 216.
  294  Further, nothing in this section shall be construed to prevent
  295  or limit the agency from adjusting fees, reimbursement rates,
  296  lengths of stay, number of visits, or number of services, or
  297  making any other adjustments necessary to comply with the
  298  availability of moneys and any limitations or directions
  299  provided for in the General Appropriations Act, provided the
  300  adjustment is consistent with legislative intent.
  301         (23)
  302         (c) This subsection applies to the following provider
  303  types:
  304         1. Inpatient hospitals.
  305         2. Outpatient hospitals.
  306         3. Nursing homes.
  307         4. County health departments.
  308         5. Community intermediate care facilities for the
  309  developmentally disabled.
  310         5.6. Prepaid health plans.
  311         Section 4. Section 409.909, Florida Statutes, is amended to
  312  read:
  313         409.909 Statewide Medicaid Residency Program.—
  314         (1) The Statewide Medicaid Residency Program is established
  315  to improve the quality of care and access to care for Medicaid
  316  recipients, expand graduate medical education on an equitable
  317  basis, and increase the supply of highly trained physicians
  318  statewide. The agency shall make payments to hospitals licensed
  319  under part I of chapter 395 for graduate medical education
  320  associated with the Medicaid program. This system of payments is
  321  designed to generate federal matching funds under Medicaid and
  322  distribute the resulting funds to participating hospitals on a
  323  quarterly basis in each fiscal year for which an appropriation
  324  is made.
  325         (2) On or before September 15 of each year, the agency
  326  shall calculate an allocation fraction to be used for
  327  distributing funds to participating hospitals. On or before the
  328  final business day of each quarter of a state fiscal year, the
  329  agency shall distribute to each participating hospital one
  330  fourth of that hospital’s annual allocation calculated under
  331  subsection (4). The allocation fraction for each participating
  332  hospital is based on the hospital’s number of full-time
  333  equivalent residents and the amount of its Medicaid payments. As
  334  used in this section, the term:
  335         (a) “Full-time equivalent,” or “FTE,” means a resident who
  336  is in his or her residency period, with the initial residency
  337  period, which is defined as the minimum number of years of
  338  training required before the resident may become eligible for
  339  board certification by the American Osteopathic Association
  340  Bureau of Osteopathic Specialists or the American Board of
  341  Medical Specialties in the specialty in which he or she first
  342  began training, not to exceed 5 years. The residency specialty
  343  is defined as reported using the current resident code in the
  344  Intern and Resident Information System (IRIS), required by
  345  Medicare. A resident training beyond the initial residency
  346  period is counted as 0.5 FTE, unless his or her chosen specialty
  347  is in general surgery or primary care, in which case the
  348  resident is counted as 1.0 FTE. For the purposes of this
  349  section, primary care specialties include:
  350         1. Family medicine;
  351         2. General internal medicine;
  352         3. General pediatrics;
  353         4. Preventive medicine;
  354         5. Geriatric medicine;
  355         6. Osteopathic general practice;
  356         7. Obstetrics and gynecology; and
  357         8. Emergency medicine; and
  358         9. General surgery.
  359         (b) “Medicaid payments” means the estimated total payments
  360  for reimbursing a hospital for direct inpatient services for the
  361  fiscal year in which the allocation fraction is calculated based
  362  on the hospital inpatient appropriation and the parameters for
  363  the inpatient diagnosis-related group base rate, including
  364  applicable intergovernmental transfers, specified in the General
  365  Appropriations Act, as determined by the agency.
  366         (c) “Resident” means a medical intern, fellow, or resident
  367  enrolled in a program accredited by the Accreditation Council
  368  for Graduate Medical Education, the American Association of
  369  Colleges of Osteopathic Medicine, or the American Osteopathic
  370  Association at the beginning of the state fiscal year during
  371  which the allocation fraction is calculated, as reported by the
  372  hospital to the agency.
  373         (3) The agency shall use the following formula to calculate
  374  a participating hospital’s allocation fraction:
  375  
  376             HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]           
  377  
  378         Where:
  379         HAF=A hospital’s allocation fraction.
  380         HFTE=A hospital’s total number of FTE residents.
  381         TFTE=The total FTE residents for all participating
  382  hospitals.
  383         HMP=A hospital’s Medicaid payments.
  384         TMP=The total Medicaid payments for all participating
  385  hospitals.
  386  
  387         (4) A hospital’s annual allocation shall be calculated by
  388  multiplying the funds appropriated for the Statewide Medicaid
  389  Residency Program in the General Appropriations Act by that
  390  hospital’s allocation fraction. If the calculation results in an
  391  annual allocation that exceeds 2 times the average $50,000 per
  392  FTE resident amount for all hospitals, the hospital’s annual
  393  allocation shall be reduced to a sum equaling no more than 2
  394  times the average $50,000 per FTE resident. The funds calculated
  395  for that hospital in excess of 2 times the average $50,000 per
  396  FTE resident amount for all hospitals shall be redistributed to
  397  participating hospitals whose annual allocation does not exceed
  398  2 times the average $50,000 per FTE resident amount for all
  399  hospitals, using the same methodology and payment schedule
  400  specified in this section.
  401         (5)Graduate Medical Education Startup Bonus Program—
  402  Hospitals eligible for participation in subsection (1) are
  403  eligible to participate in the graduate medical education
  404  startup bonus program established under this subsection.
  405  Notwithstanding subsection (4) or an FTE’s residency period, and
  406  in any state fiscal year in which funds are appropriated for the
  407  startup bonus program, the agency shall allocate a $100,000
  408  startup bonus for each newly created resident position that is
  409  authorized by the Accreditation Council for Graduate Medical
  410  Education or Osteopathic Postdoctoral Training Institution in an
  411  initial or established accredited training program that is in a
  412  physician specialty in statewide supply/demand deficit. In any
  413  year in which funding is not sufficient to provide $100,000 for
  414  each newly created resident position, funding shall be reduced
  415  pro rata across all newly created resident positions in
  416  physician specialties in statewide supply/demand deficit.
  417         (a)Hospitals applying for a startup bonus must submit to
  418  the agency by March 1 their Accreditation Council for Graduate
  419  Medical Education or Osteopathic Postdoctoral Training
  420  Institution approval validating the new resident positions
  421  approved in physician specialties in statewide supply/demand
  422  deficit in the current fiscal year. An applicant hospital may
  423  validate a change in the number of residents by comparing the
  424  prior period Accreditation Council for Graduate Medical
  425  Education or Osteopathic Postdoctoral Training Institution
  426  approval to the current year.
  427         (b)Any unobligated startup bonus funds on April 15 of each
  428  fiscal year shall be proportionally allocated to hospitals
  429  participating under subsection (3) for existing FTE residents in
  430  the physician specialties in statewide supply/demand deficit.
  431  This nonrecurring allocation shall be in addition to the funds
  432  allocated in subsection (4). Notwithstanding subsection (4), the
  433  allocation under this subsection shall not exceed $100,000 per
  434  FTE resident.
  435         (c)For purposes of this subsection, physician specialties
  436  and subspecialties, both adult and pediatric, in statewide
  437  supply/demand deficit are those identified in the General
  438  Appropriations Act.
  439         (d)The agency shall distribute all funds authorized under
  440  the Graduate Medical Education Startup Bonus program on or
  441  before the final business day of the fourth quarter of a state
  442  fiscal year.
  443         (6)(5) Beginning in the 2015-2016 state fiscal year, the
  444  agency shall reconcile each participating hospital’s total
  445  number of FTE residents calculated for the state fiscal year 2
  446  years prior with its most recently available Medicare cost
  447  reports covering the same time period. Reconciled FTE counts
  448  shall be prorated according to the portion of the state fiscal
  449  year covered by a Medicare cost report. Using the same
  450  definitions, methodology, and payment schedule specified in this
  451  section, the reconciliation shall apply any differences in
  452  annual allocations calculated under subsection (4) to the
  453  current year’s annual allocations.
  454         (7)(6) The agency may adopt rules to administer this
  455  section.
  456         Section 5. Paragraph (a) of subsection (2) of section
  457  409.911, Florida Statutes, is amended to read:
  458         409.911 Disproportionate share program.—Subject to specific
  459  allocations established within the General Appropriations Act
  460  and any limitations established pursuant to chapter 216, the
  461  agency shall distribute, pursuant to this section, moneys to
  462  hospitals providing a disproportionate share of Medicaid or
  463  charity care services by making quarterly Medicaid payments as
  464  required. Notwithstanding the provisions of s. 409.915, counties
  465  are exempt from contributing toward the cost of this special
  466  reimbursement for hospitals serving a disproportionate share of
  467  low-income patients.
  468         (2) The Agency for Health Care Administration shall use the
  469  following actual audited data to determine the Medicaid days and
  470  charity care to be used in calculating the disproportionate
  471  share payment:
  472         (a) The average of the 2005, 2006, and 2007, 2008, and 2009
  473  audited disproportionate share data to determine each hospital’s
  474  Medicaid days and charity care for the 2015-2016 2014-2015 state
  475  fiscal year.
  476         Section 6. Section 409.97, Florida Statutes, is repealed.
  477         Section 7. Subsection (6) of section 409.983, Florida
  478  Statutes, is amended to read:
  479         409.983 Long-term care managed care plan payment.—In
  480  addition to the payment provisions of s. 409.968, the agency
  481  shall provide payment to plans in the long-term care managed
  482  care program pursuant to this section.
  483         (6) The agency shall establish nursing-facility-specific
  484  payment rates for each licensed nursing home based on facility
  485  costs adjusted for inflation and other factors as authorized in
  486  the General Appropriations Act. Payments to long-term care
  487  managed care plans shall be reconciled to reimburse actual
  488  payments to nursing facilities resulting from changes in nursing
  489  home per diem rates but may not be reconciled to actual days
  490  experienced by the long-term care managed care plans.
  491         Section 8. Subsection (43) of section 408.07, Florida
  492  Statutes, is amended to read:
  493         408.07 Definitions.—As used in this chapter, with the
  494  exception of ss. 408.031-408.045, the term:
  495         (43) “Rural hospital” means an acute care hospital licensed
  496  under chapter 395, having 100 or fewer licensed beds and an
  497  emergency room, and which is:
  498         (a) The sole provider within a county with a population
  499  density of no greater than 100 persons per square mile;
  500         (b) An acute care hospital, in a county with a population
  501  density of no greater than 100 persons per square mile, which is
  502  at least 30 minutes of travel time, on normally traveled roads
  503  under normal traffic conditions, from another acute care
  504  hospital within the same county;
  505         (c) A hospital supported by a tax district or subdistrict
  506  whose boundaries encompass a population of 100 persons or fewer
  507  per square mile;
  508         (d) A hospital with a service area that has a population of
  509  100 persons or fewer per square mile. As used in this paragraph,
  510  the term “service area” means the fewest number of zip codes
  511  that account for 75 percent of the hospital’s discharges for the
  512  most recent 5-year period, based on information available from
  513  the hospital inpatient discharge database in the Florida Center
  514  for Health Information and Policy Analysis at the Agency for
  515  Health Care Administration; or
  516         (e) A critical access hospital.
  517  
  518  Population densities used in this subsection must be based upon
  519  the most recently completed United States census. A hospital
  520  that received funds under s. 409.9116 for a quarter beginning no
  521  later than July 1, 2002, is deemed to have been and shall
  522  continue to be a rural hospital from that date through June 30,
  523  2015, if the hospital continues to have 100 or fewer licensed
  524  beds and an emergency room, or meets the criteria of s.
  525  395.602(2)(e)4. An acute care hospital that has not previously
  526  been designated as a rural hospital and that meets the criteria
  527  of this subsection shall be granted such designation upon
  528  application, including supporting documentation, to the Agency
  529  for Health Care Administration.
  530         Section 9. Effective upon this act becoming a law, the
  531  Division of Law Revision and Information is directed to rename
  532  part II of chapter 409, Florida Statutes, as “Insurance
  533  Affordability Programs” and to incorporate ss. 409.720-409.731,
  534  Florida Statutes, under this part.
  535         Section 10. Effective upon this act becoming a law, section
  536  409.720, Florida Statutes, is created to read:
  537         409.720 Short title.—Sections 409.720-409.731 may be cited
  538  as the “Florida Health Insurance Affordability Exchange Program”
  539  or “FHIX.”
  540         Section 11. Effective upon this act becoming a law, section
  541  409.721, Florida Statutes, is created to read:
  542         409.721 Program authority.—The Florida Health Insurance
  543  Affordability Exchange Program, or FHIX, is created in the
  544  agency to assist Floridians in purchasing health benefits
  545  coverage and gaining access to health services. The products and
  546  services offered by FHIX are based on the following principles:
  547         (1) FAIR VALUE.—Financial assistance will be rationally
  548  allocated regardless of differences in categorical eligibility.
  549         (2) CONSUMER CHOICE.—Participants will be offered
  550  meaningful choices in the way they can redeem the value of the
  551  available assistance.
  552         (3) SIMPLICITY.—Obtaining assistance will be consumer
  553  friendly, and customer support will be available when needed.
  554         (4) PORTABILITY.—Participants can continue to access the
  555  services and products of FHIX despite changes in their
  556  circumstances.
  557         (5) PROMOTES EMPLOYMENT.—Assistance will be offered in a
  558  way that incentivizes employment.
  559         (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a
  560  manner that maximizes individual control over available
  561  resources.
  562         (7) RISK ADJUSTMENT.—The amount of assistance will reflect
  563  participants’ medical risk.
  564         Section 12. Effective upon this act becoming a law, section
  565  409.722, Florida Statutes, is created to read:
  566         409.722 Definitions.—As used in ss. 409.720-409.731, the
  567  term:
  568         (1) “Agency” means the Agency for Health Care
  569  Administration.
  570         (2) “Applicant” means an individual who applies for
  571  determination of eligibility for health benefits coverage under
  572  this part.
  573         (3) “Corporation” means Florida Health Choices, Inc., as
  574  established under s. 408.910.
  575         (4) “Enrollee” means an individual who has been determined
  576  eligible for and is receiving health benefits coverage under
  577  this part.
  578         (5) “FHIX marketplace” or “marketplace” means the single,
  579  centralized market established under s. 408.910 which
  580  facilitates health benefits coverage.
  581         (6) “Florida Health Insurance Affordability Exchange
  582  Program” or “FHIX” means the program created under ss. 409.720
  583  409.731.
  584         (7) “Florida Healthy Kids Corporation” means the entity
  585  created under s. 624.91.
  586         (8) “Florida Kidcare program” or “Kidcare program” means
  587  the health benefits coverage administered through ss. 409.810
  588  409.821.
  589         (9) “Health benefits coverage” means the payment of
  590  benefits for covered health care services or the availability,
  591  directly or through arrangements with other persons, of covered
  592  health care services on a prepaid per capita basis or on a
  593  prepaid aggregate fixed-sum basis.
  594         (10) “Inactive status” means the enrollment status of a
  595  participant previously enrolled in health benefits coverage
  596  through the FHIX marketplace who lost coverage through the
  597  marketplace for non-payment, but maintains access to his or her
  598  balance in a health savings account or health reimbursement
  599  account.
  600         (11) “Medicaid” means the medical assistance program
  601  authorized by Title XIX of the Social Security Act, and
  602  regulations thereunder, and part III and part IV of this
  603  chapter, as administered in this state by the agency.
  604         (l2) “Modified adjusted gross income” means the
  605  individual’s or household’s annual adjusted gross income as
  606  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986 and
  607  which is used to determine eligibility for FHIX.
  608         (13) “Patient Protection and Affordable Care Act” or
  609  “Affordable Care Act” means Pub. L. No. 111-148, as further
  610  amended by the Health Care and Education Reconciliation Act of
  611  2010, Pub. L. No. 111-152, and any amendments to, and
  612  regulations or guidance under, those acts.
  613         (14) “Premium credit” means the monthly amount paid by the
  614  agency per enrollee in the Florida Health Insurance
  615  Affordability Exchange Program toward health benefits coverage.
  616         (15) “Qualified alien” means an alien as defined in 8
  617  U.S.C. s. 1641(b) or (c).
  618         (16) “Resident” means a United States citizen or qualified
  619  alien who is domiciled in this state.
  620         Section 13. Effective upon this act becoming a law, section
  621  409.723, Florida Statutes, is created to read:
  622         409.723Participation.—
  623         (1) ELIGIBILITY.—In order to participate in FHIX, an
  624  individual must be a resident and must meet the following
  625  requirements, as applicable:
  626         (a) Qualify as a newly eligible enrollee, who must be an
  627  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
  628  Social Security Act or s. 2001 of the Affordable Care Act and as
  629  may be further defined by federal regulation.
  630         (b) Meet and maintain the responsibilities under subsection
  631  (4).
  632         (c) Qualify as a participant in the Florida Healthy Kids
  633  program under s. 624.91, subject to the implementation of Phase
  634  Three under s. 409.727.
  635         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
  636  an application to the department for an eligibility
  637  determination.
  638         (a) Applications may be submitted by mail, fax, online, or
  639  any other method permitted by law or regulation.
  640         (b) The department is responsible for any eligibility
  641  correspondence and status updates to the participant and other
  642  agencies.
  643         (c) The department shall review a participant’s eligibility
  644  every 12 months.
  645         (d) An application or renewal is deemed complete when the
  646  participant has met all the requirements under subsection (4).
  647         (3) PARTICIPANT RIGHTS.—A participant has all of the
  648  following rights:
  649         (a)Access to the FHIX marketplace to select the scope,
  650  amount, and type of health care coverage and other services to
  651  purchase.
  652         (b) Continuity and portability of coverage to avoid
  653  disruption of coverage and other health care services when the
  654  participant’s economic circumstances change.
  655         (c) Retention of applicable unspent credits in the
  656  participant’s health savings or health reimbursement account
  657  following a change in the participant’s eligibility status.
  658  Credits are valid for an inactive status participant for up to 5
  659  years after the participant first enters an inactive status.
  660         (d) Ability to select more than one product or plan on the
  661  FHIX marketplace.
  662         (e) Choice of at least two health benefits products that
  663  meet the requirements of the Affordable Care Act.
  664         (4) PARTICIPANT RESPONSIBILITIES.—A participant has all of
  665  the following responsibilities:
  666         (a) Complete an initial application for health benefits
  667  coverage and an annual renewal process;
  668         (b) Annually provide evidence of participation in one of
  669  the following activities at the levels required under paragraph
  670  (c):
  671         1. Proof of employment.
  672         2. On-the-job training or job placement activities.
  673         3. Pursuit of educational opportunities.
  674         (c) Engage in the activities required under paragraph (b)
  675  at the following minimum levels:
  676         1. For a parent of a child younger than 18 years of age, a
  677  minimum of 20 hours weekly.
  678         2. For a childless adult, a minimum of 30 hours weekly.
  679  
  680  A participant who is a disabled adult or a caregiver of a
  681  disabled child or adult may submit a request for an exception to
  682  these requirements to the corporation and, thereafter, shall
  683  annually submit to the department a request to renew the
  684  exception to the hourly level requirements.
  685         (d) Learn and remain informed about the choices available
  686  on the FHIX marketplace and the uses of credits in the
  687  individual accounts.
  688         (e) Execute a contract with the department to acknowledge
  689  that:
  690         1. FHIX is not an entitlement and state and federal funding
  691  may end at any time;
  692         2. Failure to pay required premiums or cost sharing will
  693  result in a transition to inactive status; and
  694         3. Noncompliance with work or educational requirements will
  695  result in a transition to inactive status.
  696         (f) Select plans and other products in a timely manner.
  697         (g) Comply with program rules and the prohibitions against
  698  fraud, as described in s. 414.39.
  699         (h) Timely make monthly premium and any other cost-sharing
  700  payments.
  701         (i) Meet minimum coverage requirements by selecting a high
  702  deductible health plan combined with a health savings or health
  703  reimbursement account if not selecting a plan offering more
  704  extensive coverage.
  705         (5) COST SHARING.—
  706         (a) Enrollees are assessed monthly premiums based on their
  707  modified adjusted gross income. The maximum monthly premium
  708  payments are set at the following income levels:
  709         1. At or below 22 percent of the federal poverty level: $3.
  710         2. Greater than 22 percent, but at or below 50 percent, of
  711  the federal poverty level: $8.
  712         3. Greater than 50 percent, but at or below 75 percent, of
  713  the federal poverty level: $15.
  714         4. Greater than 75 percent, but at or below 100 percent, of
  715  the federal poverty level: $20.
  716         5. Greater than 100 percent of the federal poverty level:
  717  $25.
  718         (b) Depending on the products and services selected by the
  719  enrollee, the enrollee may also incur additional cost-sharing,
  720  such as copayments, deductibles, or other out-of-pocket costs.
  721         (c) An enrollee may be subject to an inappropriate
  722  emergency room visit charge of up to $8 for the first visit and
  723  up to $25 for any subsequent visit, based on the enrollee’s
  724  benefit plan, to discourage inappropriate use of the emergency
  725  room.
  726         (d) Cumulative annual cost sharing per enrollee may not
  727  exceed 5 percent of an enrollee’s annual modified adjusted gross
  728  income.
  729         (e) If, after a 30-day grace period, a full premium payment
  730  has not been received, the enrollee shall be transitioned from
  731  coverage to inactive status and may not reenroll for a minimum
  732  of 6 months, unless a hardship exception has been granted.
  733  Enrollees may seek a hardship exception under the Medicaid Fair
  734  Hearing Process.
  735         Section 14. Effective upon this act becoming a law, section
  736  409.724, Florida Statutes, is created to read:
  737         409.724Available assistance.—
  738         (1)PREMIUM CREDITS.—
  739         (a) Standard amount.—The standard monthly premium credit is
  740  equivalent to the applicable risk-adjusted capitation rate paid
  741  to Medicaid managed care plans under part IV of this chapter.
  742         (b) Supplemental funding.—Subject to federal approval,
  743  additional resources may be made available to enrollees and
  744  incorporated into FHIX.
  745         (c) Savings accounts.—In addition to the benefits provided
  746  under this section, the corporation must offer each enrollee
  747  access to an individual account that qualifies as a health
  748  reimbursement account or a health savings account. Eligible
  749  unexpended funds from the monthly premium credit must be
  750  deposited into each enrollee’s individual account in a timely
  751  manner. Enrollees may also be rewarded for healthy behaviors,
  752  adherence to wellness programs, and other activities established
  753  by the corporation which demonstrate compliance with prevention
  754  or disease management guidelines. Funds deposited into these
  755  accounts may be used to pay cost-sharing obligations or to
  756  purchase other health-related items to the extent permitted
  757  under federal law.
  758         (d) Enrollee contributions.—The enrollee may make deposits
  759  to his or her account at any time to supplement the premium
  760  credit, to purchase additional FHIX products, or to offset other
  761  cost-sharing obligations.
  762         (e) Third parties.—Third parties, including, but not
  763  limited to, an employer or relative, may also make deposits on
  764  behalf of the enrollee into the enrollee’s FHIX marketplace
  765  account. The enrollee may not withdraw any funds as a refund,
  766  except those funds the enrollee has deposited into his or her
  767  account.
  768         (2) CHOICE COUNSELING.—The agency and the corporation shall
  769  work together to develop a choice counseling program for FHIX.
  770  The choice counseling program must ensure that participants have
  771  information about the FHIX marketplace program, products, and
  772  services and that participants know where and whom to call for
  773  questions or to make their plan selections. The choice
  774  counseling program must provide culturally sensitive materials
  775  and must take into consideration the demographics of the
  776  projected population.
  777         (3)EDUCATION CAMPAIGN.—The agency, the corporation, and
  778  the Florida Healthy Kids Corporation must coordinate an ongoing
  779  enrollee education campaign beginning in Phase One, as provided
  780  in s. 409.27, informing participants, at a minimum:
  781         (a) How the transition process to the FHIX marketplace will
  782  occur and the timeline for the enrollee’s specific transition.
  783         (b) What plans are available and how to research
  784  information about available plans.
  785         (c) Information about other available insurance
  786  affordability programs for the individual and his or her family.
  787         (d) Information about health benefits coverage, provider
  788  networks, and cost sharing for available plans in each region.
  789         (e) Information on how to complete the required annual
  790  renewal process, including renewal dates and deadlines.
  791         (f) Information on how to update eligibility if the
  792  participant’s data have changed since his or her last renewal or
  793  application date.
  794         (4) CUSTOMER SUPPORT.—Beginning in Phase Two, the Florida
  795  Healthy Kids Corporation shall provide customer support for
  796  FHIX, shall address general program information, financial
  797  information, and customer service issues, and shall provide
  798  status updates on bill payments. Customer support must also
  799  provide a toll-free number and maintain a website that is
  800  available in multiple languages and that meets the needs of the
  801  enrollee population.
  802         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  803  inactive participant about other insurance affordability
  804  programs and electronically refer the participant to the federal
  805  exchange or other insurance affordability programs, as
  806  appropriate.
  807         Section 15. Effective upon this act becoming a law, section
  808  409.725, Florida Statutes, is created to read:
  809         409.725Available products and services.—The FHIX
  810  marketplace shall offer the following products and services:
  811         (1) Authorized products and services pursuant to s.
  812  408.910.
  813         (2) Medicaid managed care plans under part IV of this
  814  chapter.
  815         (3) Authorized products under the Florida Healthy Kids
  816  Corporation pursuant to s. 624.91.
  817         (4) Employer-sponsored plans.
  818         Section 16. Effective upon this act becoming a law, section
  819  409.726, Florida Statutes, is created to read:
  820         409.726Program accountability.—
  821         (1) All managed care plans that participate in FHIX must
  822  collect and maintain encounter level data in accordance with the
  823  encounter data requirements under s. 409.967(2)(d) and are
  824  subject to the accompanying penalties under s. 409.967(2)(h)2.
  825  The agency is responsible for the collection and maintenance of
  826  the encounter level data.
  827         (2)The corporation, in consultation with the agency, shall
  828  establish access and network standards for contracts on the FHIX
  829  marketplace and shall ensure that contracted plans have
  830  sufficient providers to meet enrollee needs. The corporation, in
  831  consultation with the agency, shall develop quality of coverage
  832  and provider standards specific to the adult population.
  833         (3)The department shall develop accountability measures
  834  and performance standards to be applied to applications and
  835  renewal applications for FHIX which are submitted online, by
  836  mail, by fax, or through referrals from a third party. The
  837  minimum performance standards are:
  838         (a) Application processing speed.—Ninety percent of all
  839  applications, from all sources, must be processed within 45
  840  days.
  841         (b) Applications processing speed from online sources.
  842  Ninety-five percent of all applications received from online
  843  sources must be processed within 45 days.
  844         (c) Renewal application processing speed.—Ninety percent of
  845  all renewals, from all sources, must be processed within 45
  846  days.
  847         (d) Renewal application processing speed from online
  848  sources.—Ninety-five percent of all applications received from
  849  online sources must be processed within 45 days.
  850         (4) The agency, the department, and the Florida Healthy
  851  Kids Corporation must meet the following standards for their
  852  respective roles in the program:
  853         (a) Eighty-five percent of calls must be answered in 20
  854  seconds or less.
  855         (b) One hundred percent of all contacts, which include, but
  856  are not limited to, telephone calls, faxed documents and
  857  requests, and e-mails, must be handled within 2 business days.
  858         (c)Any self-service tools available to participants, such
  859  as interactive voice response systems, must be operational 7
  860  days a week, 24 hours a day, at least 98 percent of each month.
  861         (5) The agency, the department, and the Florida Healthy
  862  Kids Corporation must conduct an annual satisfaction survey to
  863  address all measures that require participant input specific to
  864  the FHIX marketplace program. The parties may elect to
  865  incorporate these elements into the annual report required under
  866  subsection (7).
  867         (6) The agency and the corporation shall post online
  868  monthly enrollment reports for FHIX.
  869         (7) An annual report is due no later than July 1 to the
  870  Governor, the President of the Senate, and the Speaker of the
  871  House of Representatives. The annual report must be coordinated
  872  by the agency and the corporation and must include, but is not
  873  limited to:
  874         (a) Enrollment and application trends and issues.
  875         (b) Utilization and cost data.
  876         (c) Customer satisfaction.
  877         (d) Funding sources in health savings accounts or health
  878  reimbursement accounts.
  879         (e) Enrollee use of funds in health savings accounts or
  880  health reimbursement accounts.
  881         (f) Types of products and plans purchased.
  882         (g) Movement of enrollees across different insurance
  883  affordability programs.
  884         (h) Recommendations for program improvement.
  885         Section 17. Effective upon this act becoming a law, section
  886  409.727, Florida Statutes, is created to read:
  887         409.727Implementation schedule.—The agency, the
  888  corporation, the department, and the Florida Healthy Kids
  889  Corporation shall begin implementation of FHIX immediately, with
  890  statewide implementation in all regions, as described in s.
  891  409.966(2), by January 1, 2016.
  892         (1) READINESS REVIEW.—Before implementation of any phase
  893  under this section, the agency shall conduct a readiness review
  894  in consultation with the FHIX Workgroup described in s. 409.729.
  895  The agency must determine, at a minimum, the following readiness
  896  milestones:
  897         (a) Functional readiness of the service delivery platform
  898  for the phase.
  899         (b) Plan availability and presence of plan choice.
  900         (c) Provider network capacity and adequacy of the available
  901  plans in the region.
  902         (d) Availability of customer support.
  903         (e) Other factors critical to the success of FHIX.
  904         (2) PHASE ONE.—
  905         (a) Phase One begins on July 1, 2015. The agency, the
  906  corporation, the department, and the Florida Healthy Kids
  907  Corporation shall coordinate activities to ensure that
  908  enrollment begins by July 1, 2015.
  909         (b) To be eligible during this phase, a participant must
  910  meet the requirements under s. 409.723(1)(a).
  911         (c)An enrollee is entitled to receive health benefits
  912  coverage in the same manner as provided under and through the
  913  selected managed care plans in the Medicaid managed care program
  914  in part IV of this chapter.
  915         (d) An enrollee shall have a choice of at least two managed
  916  care plans in each region.
  917         (e) Choice counseling and customer service must be provided
  918  in accordance with s. 409.724(2).
  919         (3) PHASE TWO.—
  920         (a) Beginning no later than January 1, 2016, and contingent
  921  upon federal approval, participants may enroll or transition to
  922  health benefits coverage under the FHIX marketplace.
  923         (b)To be eligible during this phase, a participant must
  924  meet the requirements under s. 409.723(1)(a) and (b).
  925         (c) An enrollee may select any benefit, service, or product
  926  available.
  927         (d) The corporation shall notify an enrollee of his or her
  928  premium credit amount and how to access the FHIX marketplace
  929  selection process.
  930         (e) A Phase One enrollee must be transitioned to the FHIX
  931  marketplace by April 1, 2016. An enrollee who does not select a
  932  plan or service on the FHIX marketplace by that deadline shall
  933  be moved to inactive status.
  934         (f) An enrollee shall have a choice of at least two managed
  935  care plans in each region which meet or exceed the Affordable
  936  Care Act’s requirements and which qualify for a premium credit
  937  on the FHIX marketplace.
  938         (g) Choice counseling and customer service must be provided
  939  in accordance with s. 409.724(2) and (4).
  940         (4) PHASE THREE.—
  941         (a) No later than July 1, 2016, the corporation and the
  942  Florida Healthy Kids Corporation must begin the transition of
  943  enrollees under s. 624.91 to the FHIX marketplace.
  944         (b)Eligibility during this phase is based on meeting the
  945  requirements of Phase Two and s. 409.723(1)(c).
  946         (c) An enrollee may select any benefit, service, or product
  947  available under s. 409.725.
  948         (d) A Florida Healthy Kids enrollee who selects a FHIX
  949  marketplace plan must be provided a premium credit equivalent to
  950  the average capitation rate paid in his or her county of
  951  residence under Florida Healthy Kids as of June 30, 2016. The
  952  enrollee is responsible for any difference in costs and may use
  953  any remaining funds for supplemental benefits on the FHIX
  954  marketplace.
  955         (e) The corporation shall notify an enrollee of his or her
  956  premium credit amount and how to access the FHIX marketplace
  957  selection process.
  958         (f) Choice counseling and customer service must be provided
  959  in accordance with s. 409.724(2) and (4).
  960         (g) Enrollees under s. 624.91 must transition to the FHIX
  961  marketplace by September 30, 2016.
  962         Section 18. Effective upon this act becoming a law, section
  963  409.728, Florida Statutes, is created to read:
  964         409.728Program operation and management.—In order to
  965  implement ss. 409.720-409.731:
  966         (1) The Agency for Health Care Administration shall do all
  967  of the following:
  968         (a) Contract with the corporation for the development,
  969  implementation, and administration of the Florida Health
  970  Insurance Affordability Exchange Program and for the release of
  971  any federal, state, or other funds appropriated to the
  972  corporation.
  973         (b) Administer Phase One of FHIX.
  974         (c) Provide administrative support to the FHIX Workgroup
  975  under s. 409.729.
  976         (d) Transition the FHIX enrollees to the FHIX marketplace
  977  beginning January 1, 2016, in accordance with the transition
  978  workplan. Stakeholders that serve low-income individuals and
  979  families must be consulted during the implementation and
  980  transition process through a public input process. All regions
  981  must complete the transition no later than April 1, 2016.
  982         (e) Timely transmit enrollee information to the
  983  corporation.
  984         (f) Beginning with Phase Two, determine annually the risk
  985  adjusted rate to be paid per month based on historical
  986  utilization and spending data for the medical and behavioral
  987  health of this population, projected forward, and adjusted to
  988  reflect the eligibility category, medical and dental trends,
  989  geographic areas, and the clinical risk profile of the
  990  enrollees.
  991         (g) Transfer to the corporation such funds as approved in
  992  the General Appropriations Act for the premium credits.
  993         (h) Encourage Medicaid managed care plans to apply as
  994  vendors to the marketplace to facilitate continuity of care and
  995  family care coordination.
  996         (2) The Department of Children and Families shall, in
  997  coordination with the corporation, the agency, and the Florida
  998  Healthy Kids Corporation, determine eligibility of applications
  999  and application renewals for FHIX in accordance with s. 409.902
 1000  and shall transmit eligibility determination information on a
 1001  timely basis to the agency and corporation.
 1002         (3) The Florida Healthy Kids Corporation shall do all of
 1003  the following:
 1004         (a) Retain its duties and responsibilities under s. 624.91
 1005  for Phase One and Phase Two of the program.
 1006         (b) Provide customer service for the FHIX marketplace, in
 1007  coordination with the agency and the corporation.
 1008         (c) Transfer funds and provide financial support to the
 1009  FHIX marketplace, including the collection of monthly cost
 1010  sharing.
 1011         (d) Conduct financial reporting related to such activities,
 1012  in coordination with the corporation and the agency.
 1013         (e) Coordinate activities for the program with the agency,
 1014  the department, and the corporation.
 1015         (4) Florida Health Choices, Inc., shall do all of the
 1016  following:
 1017         (a) Begin the development of FHIX during Phase One.
 1018         (b) Implement and administer Phase Two and Phase Three of
 1019  the FHIX marketplace and the ongoing operations of the program.
 1020         (c) Offer health benefits coverage packages on the FHIX
 1021  marketplace, including plans compliant with the Affordable Care
 1022  Act.
 1023         (d) Offer FHIX enrollees a choice of at least two plans per
 1024  county at each benefit level which meet the requirements under
 1025  the Affordable Care Act.
 1026         (e) Provide an opportunity for participation in Medicaid
 1027  managed care plans if those plans meet the requirements of the
 1028  FHIX marketplace.
 1029         (f) Offer enhanced or customized benefits to FHIX
 1030  marketplace enrollees.
 1031         (g) Provide sufficient staff and resources to meet the
 1032  program needs of enrollees.
 1033         (h) Provide an opportunity for plans contracted with or
 1034  previously contracted with the Florida Healthy Kids Corporation
 1035  under s. 624.91 to participate with FHIX if those plans meet the
 1036  requirements of the program.
 1037         (i) Encourage insurance agents licensed under chapter 626
 1038  to identify and assist enrollees. This act does not prohibit
 1039  these agents from receiving usual and customary commissions from
 1040  insurers and health maintenance organizations that offer plans
 1041  in the FHIX marketplace.
 1042         Section 19. Effective upon this act becoming a law, section
 1043  409.729, Florida Statutes, is created to read:
 1044         409.729 Long-term reorganization.—The FHIX Workgroup is
 1045  created to facilitate the implementation of FHIX and to plan for
 1046  a multiyear reorganization of the state’s insurance
 1047  affordability programs. The FHIX Workgroup consists of two
 1048  representatives each from the agency, the department, the
 1049  Florida Healthy Kids Corporation, and the corporation. An
 1050  additional representative of the agency serves as chair. The
 1051  FHIX Workgroup must hold its organizational meeting no later
 1052  than 30 days after the effective date of this act and must meet
 1053  at least bimonthly. The role of the FHIX Workgroup is to make
 1054  recommendations to the agency. The responsibilities of the
 1055  workgroup include, but are not limited to:
 1056         (1) Recommend a Phase Two implementation plan no later than
 1057  October 1, 2015.
 1058         (2) Review network and access standards for plans and
 1059  products.
 1060         (3) Assess readiness and recommend actions needed to
 1061  reorganize the state’s insurance affordability programs for each
 1062  phase or region. If a phase or region receives a nonreadiness
 1063  recommendation, the agency must notify the Legislature of that
 1064  recommendation, the reasons for such a recommendation, and
 1065  proposed plans for achieving readiness.
 1066         (4) Recommend any proposed change to the Title XIX-funded
 1067  or Title XXI-funded programs based on the continued availability
 1068  and reauthorization of the Title XXI program and its federal
 1069  funding.
 1070         (5) Identify duplication of services among the corporation,
 1071  the agency, and the Florida Healthy Kids Corporation currently
 1072  and under FHIX’s proposed Phase Three program.
 1073         (6) Evaluate any fiscal impacts based on the proposed
 1074  transition plan under Phase Three.
 1075         (7) Compile a schedule of impacted contracts, leases, and
 1076  other assets.
 1077         (8) Determine staff requirements for Phase Three.
 1078         (9) Develop and present a final transition plan that
 1079  incorporates all elements under this section no later than
 1080  December 1, 2015, in a report to the Governor, the President of
 1081  the Senate, and the Speaker of the House of Representatives.
 1082         Section 20. Effective upon this act becoming a law, section
 1083  409.730, Florida Statutes, is created to read:
 1084         409.730 Federal participation.—The agency may seek federal
 1085  approval to implement FHIX.
 1086         Section 21. Effective upon this act becoming a law, section
 1087  409.731, Florida Statutes, is created to read:
 1088         409.731 Program expiration.The Florida Health Insurance
 1089  Affordability Exchange Program expires at the end of Phase One
 1090  if the state does not receive federal approval for Phase Two or
 1091  at the end of the state fiscal year in which any of these
 1092  conditions occurs:
 1093         (1) The federal match contribution falls below 90 percent.
 1094         (2) The federal match contribution falls below the
 1095  increased Federal Medical Assistance Percentage for medical
 1096  assistance for newly eligible mandatory individuals as specified
 1097  in the Affordable Care Act.
 1098         (3) The federal match for the FHIX program and the Medicaid
 1099  program are blended under federal law or regulation in such a
 1100  manner that causes the overall federal contribution to diminish
 1101  when compared to separate, nonblended federal contributions.
 1102         Section 22. Effective upon this act becoming a law, section
 1103  408.70, Florida Statutes, is repealed.
 1104         Section 23. Effective upon this act becoming a law, section
 1105  408.910, Florida Statutes, is amended to read:
 1106         408.910 Florida Health Choices Program.—
 1107         (1) LEGISLATIVE INTENT.—The Legislature finds that a
 1108  significant number of the residents of this state do not have
 1109  adequate access to affordable, quality health care. The
 1110  Legislature further finds that increasing access to affordable,
 1111  quality health care can be best accomplished by establishing a
 1112  competitive market for purchasing health insurance and health
 1113  services. It is therefore the intent of the Legislature to
 1114  create and expand the Florida Health Choices Program to:
 1115         (a) Expand opportunities for Floridians to purchase
 1116  affordable health insurance and health services.
 1117         (b) Preserve the benefits of employment-sponsored insurance
 1118  while easing the administrative burden for employers who offer
 1119  these benefits.
 1120         (c) Enable individual choice in both the manner and amount
 1121  of health care purchased.
 1122         (d) Provide for the purchase of individual, portable health
 1123  care coverage.
 1124         (e) Disseminate information to consumers on the price and
 1125  quality of health services.
 1126         (f) Sponsor a competitive market that stimulates product
 1127  innovation, quality improvement, and efficiency in the
 1128  production and delivery of health services.
 1129         (2) DEFINITIONS.—As used in this section, the term:
 1130         (a) “Corporation” means the Florida Health Choices, Inc.,
 1131  established under this section.
 1132         (b) “Corporation’s marketplace” means the single,
 1133  centralized market established by the program that facilitates
 1134  the purchase of products made available in the marketplace.
 1135         (c) “Florida Health Insurance Affordability Exchange
 1136  Program” or “FHIX” is the program created under ss. 409.720
 1137  409.731 for low-income, uninsured residents of this state.
 1138         (d)(c) “Health insurance agent” means an agent licensed
 1139  under part IV of chapter 626.
 1140         (e)(d) “Insurer” means an entity licensed under chapter 624
 1141  which offers an individual health insurance policy or a group
 1142  health insurance policy, a preferred provider organization as
 1143  defined in s. 627.6471, an exclusive provider organization as
 1144  defined in s. 627.6472, or a health maintenance organization
 1145  licensed under part I of chapter 641, or a prepaid limited
 1146  health service organization or discount medical plan
 1147  organization licensed under chapter 636, or a managed care plan
 1148  contracted with the Agency for Health Care Administration under
 1149  the managed medical assistance program under part IV of chapter
 1150  409.
 1151         (f) “Patient Protection and Affordable Care Act” or
 1152  “Affordable Care Act” means Pub. L. No. 111-148, as further
 1153  amended by the Health Care and Education Reconciliation Act of
 1154  2010, Pub. L. No. 111-152, and any amendments to or regulations
 1155  or guidance under those acts.
 1156         (g)(e) “Program” means the Florida Health Choices Program
 1157  established by this section.
 1158         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
 1159  Choices Program is created as a single, centralized market for
 1160  the sale and purchase of various products that enable
 1161  individuals to pay for health care. These products include, but
 1162  are not limited to, health insurance plans, health maintenance
 1163  organization plans, prepaid services, service contracts, and
 1164  flexible spending accounts. The components of the program
 1165  include:
 1166         (a) Enrollment of employers.
 1167         (b) Administrative services for participating employers,
 1168  including:
 1169         1. Assistance in seeking federal approval of cafeteria
 1170  plans.
 1171         2. Collection of premiums and other payments.
 1172         3. Management of individual benefit accounts.
 1173         4. Distribution of premiums to insurers and payments to
 1174  other eligible vendors.
 1175         5. Assistance for participants in complying with reporting
 1176  requirements.
 1177         (c) Services to individual participants, including:
 1178         1. Information about available products and participating
 1179  vendors.
 1180         2. Assistance with assessing the benefits and limits of
 1181  each product, including information necessary to distinguish
 1182  between policies offering creditable coverage and other products
 1183  available through the program.
 1184         3. Account information to assist individual participants
 1185  with managing available resources.
 1186         4. Services that promote healthy behaviors.
 1187         5.Health benefits coverage information about health
 1188  insurance plans compliant with the Affordable Care Act.
 1189         6. Consumer assistance and enrollment services for the
 1190  Florida Health Insurance Affordability Exchange Program, or
 1191  FHIX.
 1192         (d) Recruitment of vendors, including insurers, health
 1193  maintenance organizations, prepaid clinic service providers,
 1194  provider service networks, and other providers.
 1195         (e) Certification of vendors to ensure capability,
 1196  reliability, and validity of offerings.
 1197         (f) Collection of data, monitoring, assessment, and
 1198  reporting of vendor performance.
 1199         (g) Information services for individuals and employers.
 1200         (h) Program evaluation.
 1201         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
 1202  program is voluntary and shall be available to employers,
 1203  individuals, vendors, and health insurance agents as specified
 1204  in this subsection.
 1205         (a) Employers eligible to enroll in the program include
 1206  those employers that meet criteria established by the
 1207  corporation and elect to make their employees eligible through
 1208  the program.
 1209         (b) Individuals eligible to participate in the program
 1210  include:
 1211         1. Individual employees of enrolled employers.
 1212         2. Other individuals that meet criteria established by the
 1213  corporation.
 1214         (c) Employers who choose to participate in the program may
 1215  enroll by complying with the procedures established by the
 1216  corporation. The procedures must include, but are not limited
 1217  to:
 1218         1. Submission of required information.
 1219         2. Compliance with federal tax requirements for the
 1220  establishment of a cafeteria plan, pursuant to s. 125 of the
 1221  Internal Revenue Code, including designation of the employer’s
 1222  plan as a premium payment plan, a salary reduction plan that has
 1223  flexible spending arrangements, or a salary reduction plan that
 1224  has a premium payment and flexible spending arrangements.
 1225         3. Determination of the employer’s contribution, if any,
 1226  per employee, provided that such contribution is equal for each
 1227  eligible employee.
 1228         4. Establishment of payroll deduction procedures, subject
 1229  to the agreement of each individual employee who voluntarily
 1230  participates in the program.
 1231         5. Designation of the corporation as the third-party
 1232  administrator for the employer’s health benefit plan.
 1233         6. Identification of eligible employees.
 1234         7. Arrangement for periodic payments.
 1235         8. Employer notification to employees of the intent to
 1236  transfer from an existing employee health plan to the program at
 1237  least 90 days before the transition.
 1238         (d) All eligible vendors who choose to participate and the
 1239  products and services that the vendors are permitted to sell are
 1240  as follows:
 1241         1. Insurers licensed under chapter 624 may sell health
 1242  insurance policies, limited benefit policies, other risk-bearing
 1243  coverage, and other products or services.
 1244         2. Health maintenance organizations licensed under part I
 1245  of chapter 641 may sell health maintenance contracts, limited
 1246  benefit policies, other risk-bearing products, and other
 1247  products or services.
 1248         3. Prepaid limited health service organizations may sell
 1249  products and services as authorized under part I of chapter 636,
 1250  and discount medical plan organizations may sell products and
 1251  services as authorized under part II of chapter 636.
 1252         4. Prepaid health clinic service providers licensed under
 1253  part II of chapter 641 may sell prepaid service contracts and
 1254  other arrangements for a specified amount and type of health
 1255  services or treatments.
 1256         5. Health care providers, including hospitals and other
 1257  licensed health facilities, health care clinics, licensed health
 1258  professionals, pharmacies, and other licensed health care
 1259  providers, may sell service contracts and arrangements for a
 1260  specified amount and type of health services or treatments.
 1261         6. Provider organizations, including service networks,
 1262  group practices, professional associations, and other
 1263  incorporated organizations of providers, may sell service
 1264  contracts and arrangements for a specified amount and type of
 1265  health services or treatments.
 1266         7. Corporate entities providing specific health services in
 1267  accordance with applicable state law may sell service contracts
 1268  and arrangements for a specified amount and type of health
 1269  services or treatments.
 1270  
 1271  A vendor described in subparagraphs 3.-7. may not sell products
 1272  that provide risk-bearing coverage unless that vendor is
 1273  authorized under a certificate of authority issued by the Office
 1274  of Insurance Regulation and is authorized to provide coverage in
 1275  the relevant geographic area. Otherwise eligible vendors may be
 1276  excluded from participating in the program for deceptive or
 1277  predatory practices, financial insolvency, or failure to comply
 1278  with the terms of the participation agreement or other standards
 1279  set by the corporation.
 1280         (e) Eligible individuals may participate in the program
 1281  voluntarily. Individuals who join the program may participate by
 1282  complying with the procedures established by the corporation.
 1283  These procedures must include, but are not limited to:
 1284         1. Submission of required information.
 1285         2. Authorization for payroll deduction, if applicable.
 1286         3. Compliance with federal tax requirements.
 1287         4. Arrangements for payment.
 1288         5. Selection of products and services.
 1289         (f) Vendors who choose to participate in the program may
 1290  enroll by complying with the procedures established by the
 1291  corporation. These procedures may include, but are not limited
 1292  to:
 1293         1. Submission of required information, including a complete
 1294  description of the coverage, services, provider network, payment
 1295  restrictions, and other requirements of each product offered
 1296  through the program.
 1297         2. Execution of an agreement to comply with requirements
 1298  established by the corporation.
 1299         3. Execution of an agreement that prohibits refusal to sell
 1300  any offered product or service to a participant who elects to
 1301  buy it.
 1302         4. Establishment of product prices based on applicable
 1303  criteria.
 1304         5. Arrangements for receiving payment for enrolled
 1305  participants.
 1306         6. Participation in ongoing reporting processes established
 1307  by the corporation.
 1308         7. Compliance with grievance procedures established by the
 1309  corporation.
 1310         (g) Health insurance agents licensed under part IV of
 1311  chapter 626 are eligible to voluntarily participate as buyers’
 1312  representatives. A buyer’s representative acts on behalf of an
 1313  individual purchasing health insurance and health services
 1314  through the program by providing information about products and
 1315  services available through the program and assisting the
 1316  individual with both the decision and the procedure of selecting
 1317  specific products. Serving as a buyer’s representative does not
 1318  constitute a conflict of interest with continuing
 1319  responsibilities as a health insurance agent if the relationship
 1320  between each agent and any participating vendor is disclosed
 1321  before advising an individual participant about the products and
 1322  services available through the program. In order to participate,
 1323  a health insurance agent shall comply with the procedures
 1324  established by the corporation, including:
 1325         1. Completion of training requirements.
 1326         2. Execution of a participation agreement specifying the
 1327  terms and conditions of participation.
 1328         3. Disclosure of any appointments to solicit insurance or
 1329  procure applications for vendors participating in the program.
 1330         4. Arrangements to receive payment from the corporation for
 1331  services as a buyer’s representative.
 1332         (5) PRODUCTS.—
 1333         (a) The products that may be made available for purchase
 1334  through the program include, but are not limited to:
 1335         1. Health insurance policies.
 1336         2. Health maintenance contracts.
 1337         3. Limited benefit plans.
 1338         4. Prepaid clinic services.
 1339         5. Service contracts.
 1340         6. Arrangements for purchase of specific amounts and types
 1341  of health services and treatments.
 1342         7. Flexible spending accounts.
 1343         (b) Health insurance policies, health maintenance
 1344  contracts, limited benefit plans, prepaid service contracts, and
 1345  other contracts for services must ensure the availability of
 1346  covered services.
 1347         (c) Products may be offered for multiyear periods provided
 1348  the price of the product is specified for the entire period or
 1349  for each separately priced segment of the policy or contract.
 1350         (d) The corporation shall provide a disclosure form for
 1351  consumers to acknowledge their understanding of the nature of,
 1352  and any limitations to, the benefits provided by the products
 1353  and services being purchased by the consumer.
 1354         (e) The corporation must determine that making the plan
 1355  available through the program is in the interest of eligible
 1356  individuals and eligible employers in the state.
 1357         (6) PRICING.—Prices for the products and services sold
 1358  through the program must be transparent to participants and
 1359  established by the vendors. The corporation may shall annually
 1360  assess a surcharge for each premium or price set by a
 1361  participating vendor. Any The surcharge may not be more than 2.5
 1362  percent of the price and shall be used to generate funding for
 1363  administrative services provided by the corporation and payments
 1364  to buyers’ representatives; however, a surcharge may not be
 1365  assessed for products and services sold in the FHIX marketplace.
 1366         (7) THE MARKETPLACE PROCESS.—The program shall provide a
 1367  single, centralized market for purchase of health insurance,
 1368  health maintenance contracts, and other health products and
 1369  services. Purchases may be made by participating individuals
 1370  over the Internet or through the services of a participating
 1371  health insurance agent. Information about each product and
 1372  service available through the program shall be made available
 1373  through printed material and an interactive Internet website.
 1374         (a)Marketplace purchasing.A participant needing personal
 1375  assistance to select products and services shall be referred to
 1376  a participating agent in his or her area.
 1377         1.(a) Participation in the program may begin at any time
 1378  during a year after the employer completes enrollment and meets
 1379  the requirements specified by the corporation pursuant to
 1380  paragraph (4)(c).
 1381         2.(b) Initial selection of products and services must be
 1382  made by an individual participant within the applicable open
 1383  enrollment period.
 1384         3.(c) Initial enrollment periods for each product selected
 1385  by an individual participant must last at least 12 months,
 1386  unless the individual participant specifically agrees to a
 1387  different enrollment period.
 1388         4.(d) If an individual has selected one or more products
 1389  and enrolled in those products for at least 12 months or any
 1390  other period specifically agreed to by the individual
 1391  participant, changes in selected products and services may only
 1392  be made during the annual enrollment period established by the
 1393  corporation.
 1394         5.(e) The limits established in subparagraphs 2., 3., and
 1395  4. paragraphs (b)-(d) apply to any risk-bearing product that
 1396  promises future payment or coverage for a variable amount of
 1397  benefits or services. The limits do not apply to initiation of
 1398  flexible spending plans if those plans are not associated with
 1399  specific high-deductible insurance policies or the use of
 1400  spending accounts for any products offering individual
 1401  participants specific amounts and types of health services and
 1402  treatments at a contracted price.
 1403         (b) FHIX marketplace purchasing.
 1404         1. Participation in the FHIX marketplace may begin at any
 1405  time during the year.
 1406         2. Initial enrollment periods for certain products selected
 1407  by an individual enrollee which are noncompliant with the
 1408  Affordable Care Act may be required to last at least 12 months,
 1409  unless the individual participant specifically agrees to a
 1410  different enrollment period.
 1411         (8) CONSUMER INFORMATION.—The corporation shall:
 1412         (a) Establish a secure website to facilitate the purchase
 1413  of products and services by participating individuals. The
 1414  website must provide information about each product or service
 1415  available through the program.
 1416         (b) Inform individuals about other public health care
 1417  programs.
 1418         (9) RISK POOLING.—The program may use methods for pooling
 1419  the risk of individual participants and preventing selection
 1420  bias. These methods may include, but are not limited to, a
 1421  postenrollment risk adjustment of the premium payments to the
 1422  vendors. The corporation may establish a methodology for
 1423  assessing the risk of enrolled individual participants based on
 1424  data reported annually by the vendors about their enrollees.
 1425  Distribution of payments to the vendors may be adjusted based on
 1426  the assessed relative risk profile of the enrollees in each
 1427  risk-bearing product for the most recent period for which data
 1428  is available.
 1429         (10) EXEMPTIONS.—
 1430         (a) Products, other than the products set forth in
 1431  subparagraphs (4)(d)1.-4., sold as part of the program are not
 1432  subject to the licensing requirements of the Florida Insurance
 1433  Code, as defined in s. 624.01 or the mandated offerings or
 1434  coverages established in part VI of chapter 627 and chapter 641.
 1435         (b) The corporation may act as an administrator as defined
 1436  in s. 626.88 but is not required to be certified pursuant to
 1437  part VII of chapter 626. However, a third party administrator
 1438  used by the corporation must be certified under part VII of
 1439  chapter 626.
 1440         (c) Any standard forms, website design, or marketing
 1441  communication developed by the corporation and used by the
 1442  corporation, or any vendor that meets the requirements of
 1443  paragraph (4)(f) is not subject to the Florida Insurance Code,
 1444  as established in s. 624.01.
 1445         (11) CORPORATION.—There is created the Florida Health
 1446  Choices, Inc., which shall be registered, incorporated,
 1447  organized, and operated in compliance with part III of chapter
 1448  112 and chapters 119, 286, and 617. The purpose of the
 1449  corporation is to administer the program created in this section
 1450  and to conduct such other business as may further the
 1451  administration of the program.
 1452         (a) The corporation shall be governed by a 15-member board
 1453  of directors consisting of:
 1454         1. Three ex officio, nonvoting members to include:
 1455         a. The Secretary of Health Care Administration or a
 1456  designee with expertise in health care services.
 1457         b. The Secretary of Management Services or a designee with
 1458  expertise in state employee benefits.
 1459         c. The commissioner of the Office of Insurance Regulation
 1460  or a designee with expertise in insurance regulation.
 1461         2. Four members appointed by and serving at the pleasure of
 1462  the Governor.
 1463         3. Four members appointed by and serving at the pleasure of
 1464  the President of the Senate.
 1465         4. Four members appointed by and serving at the pleasure of
 1466  the Speaker of the House of Representatives.
 1467         5. Board members may not include insurers, health insurance
 1468  agents or brokers, health care providers, health maintenance
 1469  organizations, prepaid service providers, or any other entity,
 1470  affiliate, or subsidiary of eligible vendors.
 1471         (b) Members shall be appointed for terms of up to 3 years.
 1472  Any member is eligible for reappointment. A vacancy on the board
 1473  shall be filled for the unexpired portion of the term in the
 1474  same manner as the original appointment.
 1475         (c) The board shall select a chief executive officer for
 1476  the corporation who shall be responsible for the selection of
 1477  such other staff as may be authorized by the corporation’s
 1478  operating budget as adopted by the board.
 1479         (d) Board members are entitled to receive, from funds of
 1480  the corporation, reimbursement for per diem and travel expenses
 1481  as provided by s. 112.061. No other compensation is authorized.
 1482         (e) There is no liability on the part of, and no cause of
 1483  action shall arise against, any member of the board or its
 1484  employees or agents for any action taken by them in the
 1485  performance of their powers and duties under this section.
 1486         (f) The board shall develop and adopt bylaws and other
 1487  corporate procedures as necessary for the operation of the
 1488  corporation and carrying out the purposes of this section. The
 1489  bylaws shall:
 1490         1. Specify procedures for selection of officers and
 1491  qualifications for reappointment, provided that no board member
 1492  shall serve more than 9 consecutive years.
 1493         2. Require an annual membership meeting that provides an
 1494  opportunity for input and interaction with individual
 1495  participants in the program.
 1496         3. Specify policies and procedures regarding conflicts of
 1497  interest, including the provisions of part III of chapter 112,
 1498  which prohibit a member from participating in any decision that
 1499  would inure to the benefit of the member or the organization
 1500  that employs the member. The policies and procedures shall also
 1501  require public disclosure of the interest that prevents the
 1502  member from participating in a decision on a particular matter.
 1503         (g) The corporation may exercise all powers granted to it
 1504  under chapter 617 necessary to carry out the purposes of this
 1505  section, including, but not limited to, the power to receive and
 1506  accept grants, loans, or advances of funds from any public or
 1507  private agency and to receive and accept from any source
 1508  contributions of money, property, labor, or any other thing of
 1509  value to be held, used, and applied for the purposes of this
 1510  section.
 1511         (h) The corporation may establish technical advisory panels
 1512  consisting of interested parties, including consumers, health
 1513  care providers, individuals with expertise in insurance
 1514  regulation, and insurers.
 1515         (i) The corporation shall:
 1516         1. Determine eligibility of employers, vendors,
 1517  individuals, and agents in accordance with subsection (4).
 1518         2. Establish procedures necessary for the operation of the
 1519  program, including, but not limited to, procedures for
 1520  application, enrollment, risk assessment, risk adjustment, plan
 1521  administration, performance monitoring, and consumer education.
 1522         3. Arrange for collection of contributions from
 1523  participating employers, third parties, governmental entities,
 1524  and individuals.
 1525         4. Arrange for payment of premiums and other appropriate
 1526  disbursements based on the selections of products and services
 1527  by the individual participants.
 1528         5. Establish criteria for disenrollment of participating
 1529  individuals based on failure to pay the individual’s share of
 1530  any contribution required to maintain enrollment in selected
 1531  products.
 1532         6. Establish criteria for exclusion of vendors pursuant to
 1533  paragraph (4)(d).
 1534         7. Develop and implement a plan for promoting public
 1535  awareness of and participation in the program.
 1536         8. Secure staff and consultant services necessary to the
 1537  operation of the program.
 1538         9. Establish policies and procedures regarding
 1539  participation in the program for individuals, vendors, health
 1540  insurance agents, and employers.
 1541         10. Provide for the operation of a toll-free hotline to
 1542  respond to requests for assistance.
 1543         11. Provide for initial, open, and special enrollment
 1544  periods.
 1545         12. Evaluate options for employer participation which may
 1546  conform to with common insurance practices.
 1547         13. Administer the Florida Health Insurance Affordability
 1548  Exchange Program in accordance with ss. 409.720-409.731.
 1549         14. Coordinate with the Agency for Health Care
 1550  Administration, the Department of Children and Families, and the
 1551  Florida Healthy Kids Corporation on the transition plan for FHIX
 1552  and any subsequent transition activities.
 1553         (12) REPORT.—The board of the corporation shall Beginning
 1554  in the 2009-2010 fiscal year, submit by February 1 an annual
 1555  report to the Governor, the President of the Senate, and the
 1556  Speaker of the House of Representatives documenting the
 1557  corporation’s activities in compliance with the duties
 1558  delineated in this section.
 1559         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1560  safeguard the financial transactions made under the auspices of
 1561  the program, the corporation is authorized to establish
 1562  qualifying criteria and certification procedures for vendors,
 1563  require performance bonds or other guarantees of ability to
 1564  complete contractual obligations, monitor the performance of
 1565  vendors, and enforce the agreements of the program through
 1566  financial penalty or disqualification from the program.
 1567         (14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS.—
 1568         (a) Definitions.—For purposes of this subsection, the term:
 1569         1. “Buyer’s representative” means a participating insurance
 1570  agent as described in paragraph (4)(g).
 1571         2. “Enrollee” means an employer who is eligible to enroll
 1572  in the program pursuant to paragraph (4)(a).
 1573         3. “Participant” means an individual who is eligible to
 1574  participate in the program pursuant to paragraph (4)(b).
 1575         4. “Proprietary confidential business information” means
 1576  information, regardless of form or characteristics, that is
 1577  owned or controlled by a vendor requesting confidentiality under
 1578  this section; that is intended to be and is treated by the
 1579  vendor as private in that the disclosure of the information
 1580  would cause harm to the business operations of the vendor; that
 1581  has not been disclosed unless disclosed pursuant to a statutory
 1582  provision, an order of a court or administrative body, or a
 1583  private agreement providing that the information may be released
 1584  to the public; and that is information concerning:
 1585         a. Business plans.
 1586         b. Internal auditing controls and reports of internal
 1587  auditors.
 1588         c. Reports of external auditors for privately held
 1589  companies.
 1590         d. Client and customer lists.
 1591         e. Potentially patentable material.
 1592         f. A trade secret as defined in s. 688.002.
 1593         5. “Vendor” means a participating insurer or other provider
 1594  of services as described in paragraph (4)(d).
 1595         (b) Public record exemptions.—
 1596         1. Personal identifying information of an enrollee or
 1597  participant who has applied for or participates in the Florida
 1598  Health Choices Program is confidential and exempt from s.
 1599  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1600         2. Client and customer lists of a buyer’s representative
 1601  held by the corporation are confidential and exempt from s.
 1602  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1603         3. Proprietary confidential business information held by
 1604  the corporation is confidential and exempt from s. 119.07(1) and
 1605  s. 24(a), Art. I of the State Constitution.
 1606         (c) Retroactive application.—The public record exemptions
 1607  provided for in paragraph (b) apply to information held by the
 1608  corporation before, on, or after the effective date of this
 1609  exemption.
 1610         (d) Authorized release.—
 1611         1. Upon request, information made confidential and exempt
 1612  pursuant to this subsection shall be disclosed to:
 1613         a. Another governmental entity in the performance of its
 1614  official duties and responsibilities.
 1615         b. Any person who has the written consent of the program
 1616  applicant.
 1617         c. The Florida Kidcare program for the purpose of
 1618  administering the program authorized in ss. 409.810-409.821.
 1619         2. Paragraph (b) does not prohibit a participant’s legal
 1620  guardian from obtaining confirmation of coverage, dates of
 1621  coverage, the name of the participant’s health plan, and the
 1622  amount of premium being paid.
 1623         (e) Penalty.—A person who knowingly and willfully violates
 1624  this subsection commits a misdemeanor of the second degree,
 1625  punishable as provided in s. 775.082 or s. 775.083.
 1626         (f) Review and repeal.—This subsection is subject to the
 1627  Open Government Sunset Review Act in accordance with s. 119.15,
 1628  and shall stand repealed on October 2, 2016, unless reviewed and
 1629  saved from repeal through reenactment by the Legislature.
 1630         Section 24. Effective upon this act becoming a law,
 1631  subsection (2) of section 409.904, Florida Statutes, is amended
 1632  to read:
 1633         409.904 Optional payments for eligible persons.—The agency
 1634  may make payments for medical assistance and related services on
 1635  behalf of the following persons who are determined to be
 1636  eligible subject to the income, assets, and categorical
 1637  eligibility tests set forth in federal and state law. Payment on
 1638  behalf of these Medicaid eligible persons is subject to the
 1639  availability of moneys and any limitations established by the
 1640  General Appropriations Act or chapter 216.
 1641         (2) A family, a pregnant woman, a child under age 21, a
 1642  person age 65 or over, or a blind or disabled person, who would
 1643  be eligible under any group listed in s. 409.903(1), (2), or
 1644  (3), except that the income or assets of such family or person
 1645  exceed established limitations. For a family or person in one of
 1646  these coverage groups, medical expenses are deductible from
 1647  income in accordance with federal requirements in order to make
 1648  a determination of eligibility. A family or person eligible
 1649  under the coverage known as the “medically needy,” is eligible
 1650  to receive the same services as other Medicaid recipients, with
 1651  the exception of services in skilled nursing facilities and
 1652  intermediate care facilities for the developmentally disabled.
 1653  Effective October 1, 2015, persons eligible under “medically
 1654  needy” shall be limited to children under the age of 21 and
 1655  pregnant women. This subsection expires October 1, 2019.
 1656         Section 25. Effective upon this act becoming a law, section
 1657  624.91, Florida Statutes, is amended to read:
 1658         624.91 The Florida Healthy Kids Corporation Act.—
 1659         (1) SHORT TITLE.—This section may be cited as the “William
 1660  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1661         (2) LEGISLATIVE INTENT.—
 1662         (a) The Legislature finds that increased access to health
 1663  care services could improve children’s health and reduce the
 1664  incidence and costs of childhood illness and disabilities among
 1665  children in this state. Many children do not have comprehensive,
 1666  affordable health care services available. It is the intent of
 1667  the Legislature that the Florida Healthy Kids Corporation
 1668  provide comprehensive health insurance coverage to such
 1669  children. The corporation is encouraged to cooperate with any
 1670  existing health service programs funded by the public or the
 1671  private sector.
 1672         (b) It is the intent of the Legislature that the Florida
 1673  Healthy Kids Corporation serve as one of several providers of
 1674  services to children eligible for medical assistance under Title
 1675  XXI of the Social Security Act. Although the corporation may
 1676  serve other children, the Legislature intends the primary
 1677  recipients of services provided through the corporation be
 1678  school-age children with a family income below 200 percent of
 1679  the federal poverty level, who do not qualify for Medicaid. It
 1680  is also the intent of the Legislature that state and local
 1681  government Florida Healthy Kids funds be used to continue
 1682  coverage, subject to specific appropriations in the General
 1683  Appropriations Act, to children not eligible for federal
 1684  matching funds under Title XXI.
 1685         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1686  of this state are eligible the following individuals are
 1687  eligible for state-funded assistance in paying Florida Healthy
 1688  Kids premiums pursuant to s. 409.814.:
 1689         (a) Residents of this state who are eligible for the
 1690  Florida Kidcare program pursuant to s. 409.814.
 1691         (b) Notwithstanding s. 409.814, legal aliens who are
 1692  enrolled in the Florida Healthy Kids program as of January 31,
 1693  2004, who do not qualify for Title XXI federal funds because
 1694  they are not qualified aliens as defined in s. 409.811.
 1695         (4) NONENTITLEMENT.—Nothing in this section shall be
 1696  construed as providing an individual with an entitlement to
 1697  health care services. No cause of action shall arise against the
 1698  state, the Florida Healthy Kids Corporation, or a unit of local
 1699  government for failure to make health services available under
 1700  this section.
 1701         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
 1702         (a) There is created the Florida Healthy Kids Corporation,
 1703  a not-for-profit corporation.
 1704         (b) The Florida Healthy Kids Corporation shall:
 1705         1. Arrange for the collection of any individual, family,
 1706  local contributions, or employer payment or premium, in an
 1707  amount to be determined by the board of directors, to provide
 1708  for payment of premiums for comprehensive insurance coverage and
 1709  for the actual or estimated administrative expenses.
 1710         2. Arrange for the collection of any voluntary
 1711  contributions to provide for payment of Florida Kidcare program
 1712  or Florida Health Insurance Affordability Exchange Program
 1713  premiums for children who are not eligible for medical
 1714  assistance under Title XIX or Title XXI of the Social Security
 1715  Act.
 1716         3. Subject to the provisions of s. 409.8134, accept
 1717  voluntary supplemental local match contributions that comply
 1718  with the requirements of Title XXI of the Social Security Act
 1719  for the purpose of providing additional Florida Kidcare coverage
 1720  in contributing counties under Title XXI.
 1721         4. Establish the administrative and accounting procedures
 1722  for the operation of the corporation.
 1723         4.5. Establish, with consultation from appropriate
 1724  professional organizations, standards for preventive health
 1725  services and providers and comprehensive insurance benefits
 1726  appropriate to children, provided that such standards for rural
 1727  areas shall not limit primary care providers to board-certified
 1728  pediatricians.
 1729         5.6. Determine eligibility for children seeking to
 1730  participate in the Title XXI-funded components of the Florida
 1731  Kidcare program consistent with the requirements specified in s.
 1732  409.814, as well as the non-Title-XXI-eligible children as
 1733  provided in subsection (3).
 1734         6.7. Establish procedures under which providers of local
 1735  match to, applicants to and participants in the program may have
 1736  grievances reviewed by an impartial body and reported to the
 1737  board of directors of the corporation.
 1738         7.8. Establish participation criteria and, if appropriate,
 1739  contract with an authorized insurer, health maintenance
 1740  organization, or third-party administrator to provide
 1741  administrative services to the corporation.
 1742         8.9. Establish enrollment criteria that include penalties
 1743  or waiting periods of 30 days for reinstatement of coverage upon
 1744  voluntary cancellation for nonpayment of family or individual
 1745  premiums.
 1746         9.10. Contract with authorized insurers or any provider of
 1747  health care services, meeting standards established by the
 1748  corporation, for the provision of comprehensive insurance
 1749  coverage to participants. Such standards shall include criteria
 1750  under which the corporation may contract with more than one
 1751  provider of health care services in program sites.
 1752         a. Health plans shall be selected through a competitive bid
 1753  process. The Florida Healthy Kids Corporation shall purchase
 1754  goods and services in the most cost-effective manner consistent
 1755  with the delivery of quality medical care.
 1756         b. The maximum administrative cost for a Florida Healthy
 1757  Kids Corporation contract shall be 15 percent. For health and
 1758  dental care contracts, the minimum medical loss ratio for a
 1759  Florida Healthy Kids Corporation contract shall be 85 percent.
 1760  The calculations must use uniform financial data collected from
 1761  all plans in a format established by the corporation and shall
 1762  be computed for each plan on a statewide basis. Funds shall be
 1763  classified in a manner consistent with 45 C.F.R. part 158 For
 1764  dental contracts, the remaining compensation to be paid to the
 1765  authorized insurer or provider under a Florida Healthy Kids
 1766  Corporation contract shall be no less than an amount which is 85
 1767  percent of premium; to the extent any contract provision does
 1768  not provide for this minimum compensation, this section shall
 1769  prevail.
 1770         c. The health plan selection criteria and scoring system,
 1771  and the scoring results, shall be available upon request for
 1772  inspection after the bids have been awarded.
 1773         d. Effective July 1, 2016, health and dental services
 1774  contracts of the corporation must transition to the FHIX
 1775  marketplace under s. 409.722. Qualifying plans may enroll as
 1776  vendors with the FHIX marketplace to maintain continuity of care
 1777  for participants.
 1778         10.11. Establish disenrollment criteria in the event local
 1779  matching funds are insufficient to cover enrollments.
 1780         11.12. Develop and implement a plan to publicize the
 1781  Florida Kidcare program, the eligibility requirements of the
 1782  program, and the procedures for enrollment in the program and to
 1783  maintain public awareness of the corporation and the program.
 1784         12.13. Secure staff necessary to properly administer the
 1785  corporation. Staff costs shall be funded from state and local
 1786  matching funds and such other private or public funds as become
 1787  available. The board of directors shall determine the number of
 1788  staff members necessary to administer the corporation.
 1789         13.14. In consultation with the partner agencies, provide a
 1790  report on the Florida Kidcare program annually to the Governor,
 1791  the Chief Financial Officer, the Commissioner of Education, the
 1792  President of the Senate, the Speaker of the House of
 1793  Representatives, and the Minority Leaders of the Senate and the
 1794  House of Representatives.
 1795         14.15. Provide information on a quarterly basis online to
 1796  the Legislature and the Governor which compares the costs and
 1797  utilization of the full-pay enrolled population and the Title
 1798  XXI-subsidized enrolled population in the Florida Kidcare
 1799  program. The information, at a minimum, must include:
 1800         a. The monthly enrollment and expenditure for full-pay
 1801  enrollees in the Medikids and Florida Healthy Kids programs
 1802  compared to the Title XXI-subsidized enrolled population; and
 1803         b. The costs and utilization by service of the full-pay
 1804  enrollees in the Medikids and Florida Healthy Kids programs and
 1805  the Title XXI-subsidized enrolled population.
 1806         15.16. Establish benefit packages that conform to the
 1807  provisions of the Florida Kidcare program, as created in ss.
 1808  409.810-409.821.
 1809         16. Contract with other insurance affordability programs
 1810  and FHIX to provide customer service or other enrollment-focused
 1811  services.
 1812         17. Annually develop performance metrics for the following
 1813  focus areas:
 1814         a. Administrative functions.
 1815         b. Contracting with vendors.
 1816         c. Customer service.
 1817         d. Enrollee education.
 1818         e. Financial services.
 1819         f. Program integrity.
 1820         (c) Coverage under the corporation’s program is secondary
 1821  to any other available private coverage held by, or applicable
 1822  to, the participant child or family member. Insurers under
 1823  contract with the corporation are the payors of last resort and
 1824  must coordinate benefits with any other third-party payor that
 1825  may be liable for the participant’s medical care.
 1826         (d) The Florida Healthy Kids Corporation shall be a private
 1827  corporation not for profit, organized pursuant to chapter 617,
 1828  and shall have all powers necessary to carry out the purposes of
 1829  this act, including, but not limited to, the power to receive
 1830  and accept grants, loans, or advances of funds from any public
 1831  or private agency and to receive and accept from any source
 1832  contributions of money, property, labor, or any other thing of
 1833  value, to be held, used, and applied for the purposes of this
 1834  act.
 1835         (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.—
 1836         (a) The Florida Healthy Kids Corporation shall operate
 1837  subject to the supervision and approval of a board of directors.
 1838  The board chair shall be an appointee designated by the
 1839  Governor, and the board shall be chaired by the Chief Financial
 1840  Officer or her or his designee, and composed of 12 other
 1841  members. The Senate shall confirm the designated chair and other
 1842  board appointees. The board members shall be appointed selected
 1843  for 3-year terms. of office as follows:
 1844         1. The Secretary of Health Care Administration, or his or
 1845  her designee.
 1846         2. One member appointed by the Commissioner of Education
 1847  from the Office of School Health Programs of the Florida
 1848  Department of Education.
 1849         3. One member appointed by the Chief Financial Officer from
 1850  among three members nominated by the Florida Pediatric Society.
 1851         4. One member, appointed by the Governor, who represents
 1852  the Children’s Medical Services Program.
 1853         5. One member appointed by the Chief Financial Officer from
 1854  among three members nominated by the Florida Hospital
 1855  Association.
 1856         6. One member, appointed by the Governor, who is an expert
 1857  on child health policy.
 1858         7. One member, appointed by the Chief Financial Officer,
 1859  from among three members nominated by the Florida Academy of
 1860  Family Physicians.
 1861         8. One member, appointed by the Governor, who represents
 1862  the state Medicaid program.
 1863         9. One member, appointed by the Chief Financial Officer,
 1864  from among three members nominated by the Florida Association of
 1865  Counties.
 1866         10. The State Health Officer or her or his designee.
 1867         11. The Secretary of Children and Families, or his or her
 1868  designee.
 1869         12. One member, appointed by the Governor, from among three
 1870  members nominated by the Florida Dental Association.
 1871         (b) A member of the board of directors serves at the
 1872  pleasure of the Governor may be removed by the official who
 1873  appointed that member. The board shall appoint an executive
 1874  director, who is responsible for other staff authorized by the
 1875  board.
 1876         (c) Board members are entitled to receive, from funds of
 1877  the corporation, reimbursement for per diem and travel expenses
 1878  as provided by s. 112.061.
 1879         (d) There shall be no liability on the part of, and no
 1880  cause of action shall arise against, any member of the board of
 1881  directors, or its employees or agents, for any action they take
 1882  in the performance of their powers and duties under this act.
 1883         (e) Board members who are serving as of the effective date
 1884  of this act may remain on the board until January 1, 2016.
 1885         (7) LICENSING NOT REQUIRED; FISCAL OPERATION.—
 1886         (a) The corporation shall not be deemed an insurer. The
 1887  officers, directors, and employees of the corporation shall not
 1888  be deemed to be agents of an insurer. Neither the corporation
 1889  nor any officer, director, or employee of the corporation is
 1890  subject to the licensing requirements of the insurance code or
 1891  the rules of the Department of Financial Services. However, any
 1892  marketing representative utilized and compensated by the
 1893  corporation must be appointed as a representative of the
 1894  insurers or health services providers with which the corporation
 1895  contracts.
 1896         (b) The board has complete fiscal control over the
 1897  corporation and is responsible for all corporate operations.
 1898         (c) The Department of Financial Services shall supervise
 1899  any liquidation or dissolution of the corporation and shall
 1900  have, with respect to such liquidation or dissolution, all power
 1901  granted to it pursuant to the insurance code.
 1902         (8) TRANSITION PLANS.—The corporation shall confer with the
 1903  Agency for Health Care Administration, the Department of
 1904  Children and Families, and Florida Health Choices, Inc., to
 1905  develop transition plans for the Florida Health Insurance
 1906  Affordability Exchange Program as created under ss. 409.720
 1907  409.731.
 1908         Section 26. Section 18 of chapter 2012-33, 2012 Laws of
 1909  Florida, is amended to read:
 1910         Section 18. Notwithstanding s. 430.707, Florida Statutes,
 1911  and subject to federal approval of an additional site for the
 1912  Program of All-Inclusive Care for the Elderly (PACE), the Agency
 1913  for Health Care Administration shall contract with a current
 1914  PACE organization authorized to provide PACE services in
 1915  Southeast Florida to develop and operate a PACE program in
 1916  Broward County to serve frail elders who reside in Broward
 1917  County or Miami-Dade County. The organization shall be exempt
 1918  from chapter 641, Florida Statutes. The agency, in consultation
 1919  with the Department of Elderly Affairs and subject to an
 1920  appropriation, shall approve up to 150 initial enrollee slots in
 1921  the Broward program established by the organization.
 1922         Section 27. Effective upon this act becoming a law, section
 1923  624.915, Florida Statutes, is repealed.
 1924         Section 28. Effective upon this act becoming a law, the
 1925  Division of Law Revision and Information is directed to replace
 1926  the phrase “the effective date of this act” wherever it occurs
 1927  in this act with the date the act becomes a law.
 1928         Section 29. Except as otherwise expressly provided in this
 1929  act and except for this section, which shall take effect upon
 1930  this act becoming a law, this act shall take effect July 1,
 1931  2015.

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