Senate Bill 1556
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Florida Senate - 1999 SB 1556
By Senator Scott
31-944B-99
1 A bill to be entitled
2 An act relating to health insurance; amending
3 s. 408.70, F.S.; providing legislative intent
4 for the organization of a nonprofit corporation
5 for providing affordable group health
6 insurance; amending s. 408.701, F.S.; revising
7 definitions; amending s. 408.702, F.S.;
8 creating the Health Alliance for Small
9 Business; deleting authorization for community
10 health purchasing alliances; creating a board
11 of governors for the alliance; specifying
12 organizational requirements; specifying that
13 the alliance is not a state agency;
14 redesignating community health purchasing
15 alliances as regional boards of the alliance;
16 revising provisions related to liability of
17 board members, number and boundary of alliance
18 districts, eligibility for alliance membership,
19 and powers of the state board and regional
20 boards of the alliance; authorizing the Office
21 of the Auditor General to audit and inspect the
22 alliance; amending s. 408.703, F.S.; providing
23 eligibility requirements for small employer
24 members of the alliance; amending s. 408.704,
25 F.S.; providing responsibilities for the Agency
26 for Health Care Administration; amending s.
27 408.7041, F.S.; conforming provisions; amending
28 s. 408.7045, F.S.; revising marketing
29 requirements of the alliance; amending s.
30 627.6699, F.S.; revising restrictions related
31 to premium rates for small employer health
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1 benefit plans; repealing ss. 408.7042,
2 408.7055, 408.706, F.S., relating to purchasing
3 coverage for state employees and Medicaid
4 recipients through community health purchasing
5 alliances, relating to the establishment of
6 practitioner advisory groups by the Agency for
7 Health Care Administration, and relating to
8 requirements for accountable health
9 partnerships; providing an effective date.
10
11 Be It Enacted by the Legislature of the State of Florida:
12
13 Section 1. Section 408.70, Florida Statutes, is
14 amended to read:
15 408.70 Health Alliance for Small Business Community
16 health purchasing; legislative findings and intent.--It is the
17 intent of the Legislature that a nonprofit corporation, to be
18 known as the "Health Alliance for Small Business," be
19 organized for the purpose of pooling groups of individuals
20 employed by small employers and the dependents of such
21 employees into larger groups in order to facilitate the
22 purchase of affordable group health insurance coverage.
23 (1) The Legislature finds that the current health care
24 system in this state does not provide access to affordable
25 health care for all persons in this state. Almost one in five
26 persons is without health insurance. For many, entry into the
27 health care system is through a hospital emergency room rather
28 than a primary care setting. The availability of preventive
29 and primary care and managed, family-based care is limited.
30 Health insurance underwriting practices have led to the
31 avoidance, rather than to the sharing, of insurance risks,
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1 limiting access to coverages for small-sized employer groups
2 and high-risk populations. Spiraling premium costs have
3 placed health insurance policies out of the reach of many
4 small-sized and medium-sized businesses and their employees.
5 Lack of outcome and cost information has forced individuals
6 and businesses to make critical health care decisions with
7 little guidance or leverage. Health care resources have not
8 been allocated efficiently, leading to excess and unevenly
9 distributed capacity. These factors have contributed to the
10 high cost of health care. Rural and other medically
11 underserved areas have too few health care resources.
12 Comprehensive, first-dollar coverages have allowed individuals
13 to seek care without regard to cost. Provider competition and
14 liability concerns have led to a medical technology arms race.
15 Rather than competing on the basis of price and patient
16 outcome, health care providers compete for patients on the
17 basis of service, equipping themselves with the latest and
18 best technologies. Managed-care and group-purchasing
19 mechanisms are not widely available to small group purchasers.
20 Health care regulation has placed undue burdens on health care
21 insurers and providers, driving up costs, limiting
22 competition, and preventing market-based solutions to cost and
23 quality problems. Health care costs have been increasing at
24 several times the rate of general inflation, eroding employer
25 profits and investments, increasing government revenue
26 requirements, reducing consumer coverages and purchasing
27 power, and limiting public investments in other vital
28 governmental services.
29 (2) It is the intent of the Legislature that a
30 structured health care competition model, known as "managed
31 competition," be implemented throughout the state to improve
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1 the efficiency of the health care markets in this state. The
2 managed competition model will promote the pooling of
3 purchaser and consumer buying power; ensure informed
4 cost-conscious consumer choice of managed care plans; reward
5 providers for high-quality, economical care; increase access
6 to care for uninsured persons; and control the rate of
7 inflation in health care costs.
8 (3) The Legislature intends that state-chartered,
9 nonprofit private purchasing organizations, to be known as
10 "community health purchasing alliances," be established. The
11 community health purchasing alliances shall be responsible for
12 assisting alliance members in securing the highest quality of
13 health care, based on current standards, at the lowest
14 possible prices.
15 Section 2. Section 408.701, Florida Statutes, 1998
16 Supplement, is amended to read:
17 408.701 Health Alliance for Small Business Community
18 health purchasing; definitions.--As used in ss.
19 408.70-408.7045 ss. 408.70-408.706, the term:
20 (1) "Accountable health partnership" means an
21 organization that integrates health care providers and
22 facilities and assumes risk, in order to provide health care
23 services, as certified by the agency under s. 408.704.
24 (1)(2) "Agency" means the Agency for Health Care
25 Administration.
26 (2)(3) "Alliance" means the Health Alliance for Small
27 Business a community health purchasing alliance.
28 (3)(4) "Alliance member" means:
29 (a) a small employer as defined in s. 627.6699 who, or
30 (b) The state, for the purpose of providing health
31 benefits to state employees and their dependents through the
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1 state group insurance program and to Medicaid recipients,
2 participants in the MedAccess program, and participants in the
3 Medicaid buy-in program,
4
5 if such entities voluntarily elects choose to join an
6 alliance.
7 (5) "Antitrust laws" means federal and state laws
8 intended to protect commerce from unlawful restraints,
9 monopolies, and unfair business practices.
10 (6) "Associate alliance member" means any purchaser
11 who joins an alliance for the purposes of participating on the
12 alliance board and receiving data from the alliance at no
13 charge as a benefit of membership.
14 (7) "Benefit standard" means a specified set of health
15 services that are the minimum that must be covered under a
16 basic health benefit plan, as defined in s. 627.6699.
17 (8) "Business health coalition" means a group of
18 employers organized to share information about health services
19 and insurance coverage, to enable the employers to obtain more
20 cost-effective care for their employees.
21 (9) "Community health purchasing alliance" means a
22 state-chartered, nonprofit organization that provides
23 member-purchasing services and detailed information to its
24 members on comparative prices, usage, outcomes, quality, and
25 enrollee satisfaction with accountable health partnerships.
26 (10) "Consumer" means an individual user of health
27 care services.
28 (11) "Department" means the Department of Insurance.
29 (12) "Grievance procedure" means an established set of
30 rules that specify a process for appeal of an organizational
31 decision.
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1 (4)(13) "Health care provider" or "provider" means a
2 state-licensed or state-authorized facility, a facility
3 principally supported by a local government or by funds from a
4 charitable organization that holds a current exemption from
5 federal income tax under s. 501(c)(3) of the Internal Revenue
6 Code, a licensed practitioner, a county health department
7 established under part I of chapter 154, a prescribed
8 pediatric extended care center defined in s. 400.902, a
9 federally supported primary care program such as a migrant
10 health center or a community health center authorized under s.
11 329 or s. 330 of the United States Public Health Services Act
12 that delivers health care services to individuals, or a
13 community facility that receives funds from the state under
14 the Community Alcohol, Drug Abuse, and Mental Health Services
15 Act and provides mental health services to individuals.
16 (5)(14) "Health insurer" or "insurer" means a health
17 insurer or health maintenance organization that is issued a
18 certificate of authority an organization licensed by the
19 Department of Insurance under part III of chapter 624 or part
20 I of chapter 641.
21 (6)(15) "Health plan" or "health insurance" means any
22 health insurance policy or health maintenance organization
23 contract issued by a health insurer hospital or medical policy
24 or contract or certificate, hospital or medical service plan
25 contract, or health maintenance organization contract as
26 defined in the insurance code or Health Maintenance
27 Organization Act. The term does not include accident-only,
28 specific disease, individual hospital indemnity, credit,
29 dental-only, vision-only, Medicare supplement, long-term care,
30 or disability income insurance; coverage issued as a
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1 supplement to liability insurance; workers' compensation or
2 similar insurance; or automobile medical-payment insurance.
3 (7) "Regional board" means the board of directors of
4 each region of the alliance, as established under s.
5 408.702(1).
6 (8) "State board" or "board" means the board of
7 directors of the alliance, as established under s. 408.702(2).
8 (16) "Health status" means an assessment of an
9 individual's mental and physical condition.
10 (17) "Managed care" means systems or techniques
11 generally used by third-party payors or their agents to affect
12 access to and control payment for health care services.
13 Managed-care techniques most often include one or more of the
14 following: prior, concurrent, and retrospective review of the
15 medical necessity and appropriateness of services or site of
16 services; contracts with selected health care providers;
17 financial incentives or disincentives related to the use of
18 specific providers, services, or service sites; controlled
19 access to and coordination of services by a case manager; and
20 payor efforts to identify treatment alternatives and modify
21 benefit restrictions for high-cost patient care.
22 (18) "Managed competition" means a process by which
23 purchasers form alliances to obtain information on, and
24 purchase from, competing accountable health partnerships.
25 (19) "Medical outcome" means a change in an
26 individual's health status after the provision of health
27 services.
28 (20) "Provider network" means an affiliated group of
29 varied health care providers that is established to provide a
30 continuum of health care services to individuals.
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1 (21) "Purchaser" means an individual, an organization,
2 or the state that makes health-benefit purchasing decisions on
3 behalf of a group of individuals.
4 (22) "Self-funded plan" means a group health insurance
5 plan in which the sponsoring organization assumes the
6 financial risk of paying for all covered services provided to
7 its enrollees.
8 (23) "Utilization management" means programs designed
9 to control the overutilization of health services by reviewing
10 their appropriateness relative to established standards or
11 norms.
12 (24) "24-hour coverage" means the consolidation of
13 such time-limited health care coverage as personal injury
14 protection under automobile insurance into a general health
15 insurance plan.
16 (25) "Agent" means a person who is licensed to sell
17 insurance in this state pursuant to chapter 626.
18 (26) "Primary care physician" means a physician
19 licensed under chapter 458 or chapter 459 who practices family
20 medicine, general internal medicine, general pediatrics, or
21 general obstetrics/ gynecology.
22 Section 3. Section 408.702, Florida Statutes, is
23 amended to read:
24 408.702 Health Alliance for Small Business Community
25 health purchasing alliance; establishment; state and regional
26 boards.--
27 (1) There is created the Health Alliance for Small
28 Business, which shall operate as a nonprofit corporation
29 organized under chapter 617. The alliance is not a state
30 agency. The alliance shall operate subject to the supervision
31 and approval of a board of directors composed of the chairman
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1 of each of the regional boards of the alliance or, in lieu of
2 the chairman, a member of a regional board designated by the
3 chairman of that board.
4 (2)(a) The board of directors of each community health
5 purchasing alliance is redesignated as a regional board of the
6 Health Alliance for Small Business. Each regional board shall
7 operate as a nonprofit corporation organized under chapter
8 617. A regional board is not a state agency.
9 (b) The regional board replacing such community health
10 purchasing alliance shall assume the rights and obligations of
11 each former community health purchasing alliance as necessary
12 to fulfill the former alliance's contractual obligations
13 existing on the effective date of this act. Nothing in this
14 section shall impair or otherwise affect any such contract.
15 (3)(1) There is created a community health purchasing
16 alliance in each of the 11 health service planning districts
17 established under s. 408.032. Each alliance must be operated
18 as a state-chartered, nonprofit private organization organized
19 pursuant to chapter 617. There shall be no liability on the
20 part of, and no cause of action of any nature shall arise
21 against, any member of the board of directors of the a
22 community health purchasing alliance or of any regional board,
23 or their its employees or agents, for any action taken by a
24 the board in the performance of its powers and duties under
25 ss. 408.70-408.7045 ss. 408.70-408.706.
26 (4)(2) The number and geographical boundaries of
27 alliance districts may be revised by the state board Three or
28 fewer alliances located in contiguous districts that are not
29 primarily urban may merge into a single alliance upon approval
30 of the agency based on upon a showing by the alliance board
31 members that the members of the each alliance would be better
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1 served under a combined alliance. If the number or boundaries
2 of regional alliances are revised, the members of the new
3 regional boards for the affected regions must be
4 representative of the members of the former regional boards of
5 the affected regions in a method established by the state
6 board which reasonably provides for proportionate
7 representation of former board members. Board members of each
8 alliance shall serve as the board of the combined alliance.
9 (5)(3) The An alliance is the only entity that is
10 allowed to operate as an alliance in a particular district and
11 must operate for the benefit of its members who are: small
12 employers, as defined in s. 627.6699; the state on behalf of
13 its employees and the dependents of such employees; Medicaid
14 recipients; and associate alliance members. The An alliance
15 is the exclusive entity for the oversight and coordination of
16 alliance member purchases. Any health plan offered through the
17 an alliance must be offered by a health insurer an accountable
18 health partnership and the an alliance may not directly
19 provide insurance; directly contract, for purposes of
20 providing insurance, with a health care provider or provider
21 network; or bear any risk, or form self-insurance plans among
22 its members. An alliance may form a network with other
23 alliances in order to improve services provided to alliance
24 members. Nothing in ss. 408.70-408.7045 ss. 408.70-408.706
25 limits or authorizes the formation of business health
26 coalitions; however, a person or entity that pools together or
27 assists in purchasing health coverage for small employers, as
28 defined in s. 627.6699, state employees and their dependents,
29 and Medicaid, Medicaid buy-in, and MedAccess recipients may
30 not discriminate in its activities based on the health status
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1 or historical or projected claims experience of such employers
2 or recipients.
3 (4) Each alliance shall capitalize on the expertise of
4 existing business health coalitions.
5 (6)(5) Membership or associate membership in the an
6 alliance and participation by health insurers are is
7 voluntary.
8 (7) The state board of the alliance may:
9 (a) Negotiate with health insurers to offer health
10 plans to alliance members in one or more regions under terms
11 and conditions as agreed to between the board, as group
12 policyholder, and the health insurer. The board and the
13 insurer may negotiate and agree to health plan selection,
14 benefit design, premium rates, and other terms of coverage,
15 subject to the requirements of the Florida Insurance Code.
16 (b) Establish minimum requirements of alliance
17 membership, consistent with the definition of the term "small
18 employer" in s. 627.6699, including any documentation that an
19 applicant must submit to establish eligibility for membership.
20 (c) Establish administrative and accounting procedures
21 for its operation and for the operation of the regional
22 boards, and require regional boards to submit program reports
23 to the state board or the agency.
24 (d) Receive and accept grants, loans, advances, or
25 funds from any public or private agency, and receive and
26 accept, from any source, contributions of money, property,
27 labor, or any other thing of value.
28 (e) Hire employees or contract with qualified,
29 independent third parties for any service necessary to carry
30 out the board's powers and duties, as authorized under ss.
31 408.70-408.7045.
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1 (f) Perform any of the activities that may be
2 performed by a regional board under subsection (6), subject to
3 coordination with the regional boards to avoid duplication of
4 effort.
5 (8) Each regional board of the alliance may:
6 (a) Establish conditions of alliance membership
7 consistent with the minimum requirements established by the
8 state board.
9 (b) Provide to alliance members standardized
10 information for comparing health plans offered through the
11 alliance.
12 (c) Offer health plans to alliance members, subject to
13 the terms and conditions agreed to by the state board and
14 participating health insurers.
15 (d) Market and publicize the coverage and services
16 offered by the alliance.
17 (e) Collect premiums from alliance members on behalf
18 of participating health insurers.
19 (f) Assist members in resolving disputes between
20 health insurers and alliance members, consistent with
21 grievance procedures required by law.
22 (g) Set reasonable fees for alliance membership,
23 services offered by the alliance, and late payment of premiums
24 by alliance members for which the alliance is responsible.
25 (h) Receive and accept grants, loans, advances, or
26 funds from any public or private agency, and receive and
27 accept, from any source, contributions of money, property,
28 labor, or any other thing of value.
29 (i) Hire employees or contract with qualified,
30 independent third parties for any service necessary to carry
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1 out the regional board's powers and duties as authorized under
2 ss. 408.70-408.7045.
3 (6) Each community health purchasing alliance has the
4 following powers, duties, and responsibilities:
5 (a) Establishing the conditions of alliance membership
6 in accordance with ss. 408.70-408.706.
7 (b) Providing to alliance members clear, standardized
8 information on each accountable health partnership and each
9 health plan offered by each accountable health partnership,
10 including information on price, enrollee costs, quality,
11 patient satisfaction, enrollment, and enrollee
12 responsibilities and obligations; and providing accountable
13 health partnership comparison sheets in accordance with agency
14 rule to be used in providing members and their employees with
15 information regarding standard, basic, and specialized
16 coverage that may be obtained through the accountable health
17 partnerships.
18 (c) Annually offering to all alliance members all
19 accountable health partnerships and health plans offered by
20 the accountable health partnerships which meet the
21 requirements of ss. 408.70-408.706, and which submit a
22 responsive proposal as to information necessary for
23 accountable health partnership comparison sheets, and
24 providing assistance to alliance members in selecting and
25 obtaining coverage through accountable health partnerships
26 that meet those requirements.
27 (d) Requesting proposals for the standard and basic
28 health plans, as defined in s. 627.6699, from all accountable
29 health partnerships in the district; providing, in the format
30 required by the alliance in the request for proposals, the
31 necessary information for accountable health partnership
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1 comparison sheets; and offering to its members health plans of
2 accountable health partnerships which meet those requirements.
3 (e) Requesting proposals from all accountable health
4 partnerships in the district for specialized benefits approved
5 by the alliance board based on input from alliance members,
6 determining if the proposals submitted by the accountable
7 health partnerships meet the requirements of the request for
8 proposals, and offering them as options through riders to
9 standard plans and basic plans. This paragraph does not limit
10 an accountable health partnership's ability to offer other
11 specialized benefits to alliance members.
12 (f) Distributing to health care purchasers, placing
13 special emphasis on the elderly, retail price data on
14 prescription drugs and their generic equivalents, durable
15 medical equipment, and disposable medical supplies which is
16 provided by the agency pursuant to s. 408.063(3) and (4).
17 (g) Establishing administrative and accounting
18 procedures for the operation of the alliance and members'
19 services, preparing an annual alliance budget, and preparing
20 annual program and fiscal reports on alliance operations as
21 required by the agency.
22 (h) Developing and implementing a marketing plan to
23 publicize the alliance to potential members and associate
24 members and developing and implementing methods for informing
25 the public about the alliance and its services.
26 (i) Developing grievance procedures to be used in
27 resolving disputes between members and the alliance and
28 disputes between the accountable health partnerships and the
29 alliance. Any member of, or accountable health partnership
30 that serves, an alliance may appeal to the agency any
31 grievance that is not resolved by the alliance.
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1 (j) Ensuring that accountable health partnerships have
2 grievance procedures to be used in resolving disputes between
3 members and an accountable health partnership. A member may
4 appeal to the alliance any grievance that is not resolved by
5 the accountable health partnership. An accountable health
6 partnership that is a health maintenance organization must
7 follow the grievance procedures established in ss. 408.7056
8 and 641.31(5).
9 (k) Maintaining all records, reports, and other
10 information required by the agency, ss. 408.70-408.706, or
11 other state and local laws.
12 (l) Receiving and accepting grants, loans, advances,
13 or funds from any public or private agency; and receiving and
14 accepting contributions, from any source, of money, property,
15 labor, or any other thing of value.
16 (m) Contracting, as authorized by alliance members,
17 with a qualified, independent third party for any service
18 necessary to carry out the powers and duties required by ss.
19 408.70-408.706.
20 (n) Developing a plan to facilitate participation of
21 providers in the district in an accountable health
22 partnership, placing special emphasis on ensuring
23 participation by minority physicians in accountable health
24 partnerships if such physicians are available. The use of the
25 term "minority" in ss. 408.70-408.706 is consistent with the
26 definition of "minority person" provided in s. 288.703(3).
27 (o) Ensuring that any health plan reasonably available
28 within the jurisdiction of an alliance, through a preferred
29 provider network, a point of service product, an exclusive
30 provider organization, a health maintenance organization, or a
31 pure indemnity product, is offered to members of the alliance.
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1 For the purposes of this paragraph, "pure indemnity product"
2 means a health insurance policy or contract that does not
3 provide different rates of reimbursement for a specified list
4 of physicians and a "point of service product" means a
5 preferred provider network or a health maintenance
6 organization which allows members to select at a higher cost a
7 provider outside of the network or the health maintenance
8 organization.
9 (p) Petitioning the agency for a determination as to
10 the cost-effectiveness of collecting premiums on behalf of
11 participating accountable health partnerships. If determined
12 by the agency to be cost-effective, the alliance may establish
13 procedures for collecting premiums from members and distribute
14 them to the participating accountable health partnerships.
15 This may include the remittance of the share of the group
16 premium paid by both an employer and an enrollee. If an
17 alliance assumes premium collection responsibility, it shall
18 also assume liability for uncollected premium. This liability
19 may be collected through a bad debt surcharge on alliance
20 members to finance the cost of uncollected premiums. The
21 alliance shall pay participating accountable health
22 partnerships their contracting premium amounts on a prepaid
23 monthly basis, or as otherwise mutually agreed upon.
24 (7) Each alliance shall set reasonable fees for
25 membership in the alliance which will finance all reasonable
26 and necessary costs incurred in administering the alliance.
27 (9)(8) Each regional board alliance shall annually
28 report to the state board on the operations of the alliance in
29 that region, including program and financial operations, and
30 shall provide for annual internal and independent audits.
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1 (10)(9) The alliance, the state board, and regional
2 boards A community health purchasing alliance may not engage
3 in any activities for which an insurance agent's license is
4 required by chapter 626.
5 (11)(10) The powers and responsibilities of the a
6 community health purchasing alliance with respect to
7 purchasing health plans services from health insurers
8 accountable health partnerships do not extend beyond those
9 enumerated in ss. 408.70-408.7045 ss. 408.70-408.706.
10 (12) The Office of the Auditor General may audit and
11 inspect the operations and records of the alliance.
12 Section 4. Section 408.703, Florida Statutes, is
13 amended to read:
14 408.703 Small employer members of the alliance
15 community health purchasing alliances; eligibility
16 requirements.--
17 (1) The board agency shall establish conditions of
18 participation in the alliance for small employers, as defined
19 in s. 627.6699, which must include, but need not be limited
20 to:
21 (a) Assurance that the group is a valid small employer
22 and is not formed for the purpose of securing health benefit
23 coverage. This assurance must include requirements for sole
24 proprietors and self-employed individuals which must be based
25 on a specified requirement for the time that the sole
26 proprietor or self-employed individual has been in business,
27 required filings to verify employment status, and other
28 requirements to ensure that the individual is working.
29 (b) Assurance that the individuals in the small
30 employer group are employees and have not been added for the
31 purpose of securing health benefit coverage.
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1 (2) The agency may not require a small employer to pay
2 any portion of premiums as a condition of participation in an
3 alliance.
4 (2)(3) The board agency may require a small employer
5 seeking membership to agree to participate in the alliance for
6 a specified minimum period of time, not to exceed 1 year.
7 (4) If a member small employer offers more than one
8 accountable health partnership or health plan and the employer
9 contributes to coverage of employees or dependents of the
10 employee, the alliance shall require that the employer
11 contribute the same dollar amount for each employee,
12 regardless of the accountable health partnership or benefit
13 plan chosen by the employee.
14 (5) An employer that employs 30 or fewer employees
15 must offer at least 2 accountable health partnerships or
16 health plans to its employees, and an employer that employs 31
17 or more employees must offer 3 or more accountable health
18 partnerships or health plans to its employees.
19 (3)(6) Notwithstanding any other law, if a small
20 employer member loses eligibility to purchase health care
21 through the a community health purchasing alliance solely
22 because the business of the small employer member expands to
23 more than 50 and less than 75 eligible employees, the small
24 employer member may, at its next renewal date, purchase
25 coverage through the alliance for not more than 1 additional
26 year.
27 Section 5. Section 408.704, Florida Statutes, 1998
28 Supplement, is amended to read:
29 408.704 Agency duties and responsibilities related to
30 community health purchasing alliances.--
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1 (1) The agency shall assist the alliance in purchasing
2 health insurance for its members and supervise its operation.
3 in developing a statewide system of community health
4 purchasing alliances. To this end, the agency is responsible
5 for:
6 (1) Initially and thereafter annually certifying that
7 each community health purchasing alliance complies with ss.
8 408.70-408.706 and rules adopted pursuant to ss.
9 408.70-408.706. The agency may decertify any community health
10 purchasing alliance if the alliance fails to comply with ss.
11 408.70-408.706 and rules adopted by the agency.
12 (2) The agency shall conduct Providing administrative
13 startup funds. Each contract for startup funds is limited to
14 $275,000.
15 (3) Conducting an annual review of the performance of
16 the each alliance to ensure that the alliance is in compliance
17 with ss. 408.70-408.706. To assist the agency in its review,
18 the each alliance shall submit, quarterly, data to the agency,
19 including, but not limited to, employer enrollment by employer
20 size, industry sector, previous insurance status, and count;
21 number of total eligible employers in the alliance district
22 participating in the alliance; number of insured lives by
23 county and insured category, including employees, dependents,
24 and other insured categories, represented by alliance members;
25 profiles of potential employer membership by county; premium
26 ranges for each health insurer accountable health partnership
27 for alliance member categories; type and resolution of member
28 grievances; membership fees; and alliance financial
29 statements. A summary of this annual review shall be provided
30 to the Legislature and to each alliance.
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1 (3) The agency shall assist the alliance in
2 developing, collecting, and analyzing market information that
3 would support the purchasing decisions of the alliance.
4 (4) Developing accountable health partnership
5 comparison sheets to be used in providing members and their
6 employees with information regarding the accountable health
7 partnership.
8 (5) Establishing a data system for accountable health
9 partnerships.
10 (a) The agency shall establish an advisory data
11 committee comprised of the following representatives of
12 employers, medical providers, hospitals, health maintenance
13 organizations, and insurers:
14 1. Two representatives appointed by each of the
15 following organizations: Associated Industries of Florida,
16 the Florida Chamber of Commerce, the National Federation of
17 Independent Businesses, and the Florida Retail Federation;
18 2. One representative of each of the following
19 organizations: the Florida League of Hospitals, the
20 Association of Voluntary Hospitals of Florida, the Florida
21 Hospital Association, the Florida Medical Association, the
22 Florida Osteopathic Medical Association, the Florida
23 Chiropractic Association, the Florida Chapter of the National
24 Medical Association, the Association of Managed Care
25 Physicians, the Florida Insurance Council, the Florida
26 Association of Domestic Insurers, the Florida Association of
27 Health Maintenance Organizations; and
28 3. One representative of governmental health care
29 purchasers and three consumer representatives, to be appointed
30 by the agency.
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1 (b) The advisory data committee shall issue a report
2 and recommendations on each of the following subjects as each
3 is completed. A final report covering all subjects must be
4 included in the final Florida Health Plan to be submitted to
5 the Legislature on December 31, 1993. The report shall
6 include recommendations regarding:
7 1. Types of data to be collected. Careful
8 consideration shall be given to other data collection projects
9 and standards for electronic data interchanges already in
10 process in this state and nationally, to evaluating and
11 recommending the feasibility and cost-effectiveness of various
12 data collection activities, and to ensuring that data
13 reporting is necessary to support the evaluation of providers
14 with respect to cost containment, access, quality, control of
15 expensive technologies, and customer satisfaction analysis.
16 Data elements to be collected from providers include prices,
17 utilization, patient outcomes, quality, and patient
18 satisfaction. The completion of this task is the first
19 priority of the advisory data committee. The agency shall
20 begin implementing these data collection activities
21 immediately upon receipt of the recommendations, but no later
22 than January 1, 1994. The data shall be submitted by
23 hospitals, other licensed health care facilities, pharmacists,
24 and group practices as defined in s. 455.654(3)(f).
25 2. A standard data set, a standard cost-effective
26 format for collecting the data, and a standard methodology for
27 reporting the data to the agency, or its designee, and to the
28 alliances. The reporting mechanisms must be designed to
29 minimize the administrative burden and cost to health care
30 providers and carriers. A methodology shall be developed for
31 aggregating data in a standardized format for making
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1 comparisons between accountable health partnerships which
2 takes advantage of national models and activities.
3 3. Methods by which the agency should collect,
4 process, analyze, and distribute the data.
5 4. Standards for data interpretation. The advisory
6 data committee shall actively solicit broad input from the
7 provider community, carriers, the business community, and the
8 general public.
9 5. Structuring the data collection process to:
10 a. Incorporate safeguards to ensure that the health
11 care services utilization data collected is reviewed by
12 experienced, practicing physicians licensed to practice
13 medicine in this state;
14 b. Require that carrier customer satisfaction data
15 conclusions are validated by the agency;
16 c. Protect the confidentiality of medical information
17 to protect the patient's identity and to protect the privacy
18 of individual physicians and patients. Proprietary data
19 submitted by insurers, providers, and purchasers are
20 confidential pursuant to s. 408.061; and
21 d. Afford all interested professional medical and
22 hospital associations and carriers a minimum of 60 days to
23 review and comment before data is released to the public.
24 6. Developing a data collection implementation
25 schedule, based on the data collection capabilities of
26 carriers and providers.
27 (c) In developing data recommendations, the advisory
28 data committee shall assess the cost-effectiveness of
29 collecting data from individual physician providers. The
30 initial emphasis must be placed on collecting data from those
31 providers with whom the highest percentages of the health care
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1 dollars are spent: hospitals, large physician group practices,
2 outpatient facilities, and pharmacies.
3 (d) The agency shall, to the maximum extent possible,
4 adopt and implement the recommendations of the advisory data
5 committee. The agency shall report all recommendations of the
6 advisory data committee to the Legislature and submit an
7 implementation plan.
8 (e) The travel expenses of the participants of the
9 advisory data committee must be paid by the participant or by
10 the organization that nominated the participant.
11 (6) Collecting, compiling, and analyzing data on
12 accountable health partnerships and providing statistical
13 information to alliances.
14 (7) Receiving appeals by members of an alliance and
15 accountable health partnerships whose grievances were not
16 resolved by the alliance. The agency shall review these
17 appeals pursuant to chapter 120. Records or reports submitted
18 as a part of a grievance proceeding conducted as provided for
19 under this subsection are confidential and exempt from the
20 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
21 Constitution. Records or reports of patient care quality
22 assurance proceedings obtained or made by any member of a
23 community health purchasing alliance or any member of an
24 accountable health partnership and received by the agency as a
25 part of a proceeding conducted pursuant to this subsection are
26 confidential and exempt from s. 119.07(1) and s. 24(a), Art. I
27 of the State Constitution. Portions of meetings held pursuant
28 to the provisions of this subsection during which records held
29 confidential pursuant to the provisions of this subsection are
30 discussed are exempt from the provisions of s. 286.011 and s.
31 24(b), Art. I of the State Constitution. All portions of any
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1 meeting closed to the public shall be recorded by a certified
2 court reporter. For any portion of a meeting that is closed,
3 the reporter shall record the times of commencement and
4 termination of the meeting, all discussion and proceedings,
5 the names of all persons present at any time, and the names of
6 all persons speaking. No portion of the closed meeting shall
7 be off the record. The court reporter's notes shall be fully
8 transcribed and given to the appropriate records custodian
9 within a reasonable time after the meeting. A copy of the
10 original transcript, with information otherwise confidential
11 or exempt from public disclosure redacted, shall be made
12 available for public inspection and copying 3 years after the
13 date of the closed meeting.
14 Section 6. Section 408.7041, Florida Statutes, is
15 amended to read:
16 408.7041 Antitrust protection.--In addition to the
17 duties described in s. 408.704, the agency shall actively
18 supervise the alliance community health purchasing alliances
19 to ensure that actions that affect market competition are not
20 for private interests, but accomplish the legislative intent
21 found in s. 408.70, so as to provide state and federal
22 antitrust protection of the alliance and state and regional
23 alliances and their board members.
24 Section 7. Section 408.7045, Florida Statutes, is
25 amended to read:
26 408.7045 Community health purchasing Alliance
27 marketing requirements.--
28 (1) The Each alliance shall use appropriate,
29 efficient, and standardized means to notify members of the
30 availability of sponsored health coverage from the alliance.
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1 (2) The Each alliance shall make available to members
2 marketing materials that accurately summarize the benefit
3 plans that are offered by its health insurer accountable
4 health partnerships and the rates, costs, and accreditation
5 information relating to those plans.
6 (3) Annually, the alliance shall offer each member
7 small employer all accountable health partnerships available
8 in the alliance and provide them with the appropriate
9 materials relating to those plans. The member small employer
10 may choose which health benefit plans shall be offered to
11 eligible employees and may change the selection each year.
12 The employee may be given options with regard to health plans
13 and the type of managed care system under which his or her
14 benefits will be provided.
15 (4) An alliance may notify the agency of any marketing
16 practices or materials that it finds are contrary to the fair
17 and affirmative marketing requirements of the program. Upon
18 the request of an alliance, the agency shall request the
19 Department of Insurance to investigate the practices and the
20 Department of Insurance may take any action authorized for a
21 violation of the insurance code or the Health Maintenance
22 Organization Act.
23 Section 8. Paragraph (b) of subsection (6) of section
24 627.6699, Florida Statutes, 1998 Supplement, is amended to
25 read:
26 627.6699 Employee Health Care Access Act.--
27 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
28 (b) For all small employer health benefit plans that
29 are subject to this section and are issued by small employer
30 carriers on or after January 1, 1994, premium rates for health
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1 benefit plans subject to this section are subject to the
2 following:
3 1. Small employer carriers must use a modified
4 community rating methodology in which the premium for each
5 small employer must be determined solely on the basis of the
6 eligible employee's and eligible dependent's gender, age,
7 family composition, tobacco use, or geographic area as
8 determined under paragraph (5)(j) (5)(k).
9 2. Rating factors related to age, gender, family
10 composition, tobacco use, or geographic location may be
11 developed by each carrier to reflect the carrier's experience.
12 The factors used by carriers are subject to department review
13 and approval.
14 3. Small employer carriers may not modify the rate for
15 a small employer for 12 months from the initial issue date or
16 renewal date, unless the composition of the group changes or
17 benefits are changed. However, a small employer carrier may
18 modify the rate one time prior to 12 months after the initial
19 issue date for a small employer who enrolls under a previously
20 issued group policy that has a common anniversary date for all
21 employers covered under the policy, if the carrier discloses
22 to the employer in a clear and conspicuous manner the date of
23 the first renewal and the fact that the premium may increase
24 on or after that date and if the insurer demonstrates to the
25 department that efficiencies in administration are achieved
26 and reflected in the rates charged to small employers covered
27 under the policy.
28 4. A small employer carrier may issue a policy to a
29 group association with rates that reflect a premium credit for
30 expense savings attributable to administrative activities
31 being performed by the group association, if these expense
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1 savings are specifically documented in the carrier's rate
2 filing and are approved by the department. Any such credit may
3 not be based on different morbidity assumptions or on any
4 other factor related to the health status or claims experience
5 of the group or its members. Carriers participating in the
6 alliance program, in accordance with ss. 408.700-408.707, may
7 apply a different community rate to business written in that
8 program.
9 (c) For all small employer health benefit plans that
10 are subject to this section, that are issued by small employer
11 carriers before January 1, 1994, and that are renewed on or
12 after January 1, 1995, renewal rates must be based on the same
13 modified community rating standard applied to new business.
14 (d) Notwithstanding s. 627.401(2), this section and
15 ss. 627.410 and 627.411 apply to any health benefit plan
16 provided by a small employer carrier that provides coverage to
17 one or more employees of a small employer regardless of where
18 the policy, certificate, or contract is issued or delivered,
19 if the health benefit plan covers employees or their covered
20 dependents who are residents of this state.
21 Section 9. Sections 408.7042, 408.7055, and 408.706,
22 Florida Statutes, are repealed.
23 Section 10. This act shall take effect upon becoming a
24 law.
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2 SENATE SUMMARY
3 Creates the Health Alliance for Small Business, replacing
community health purchasing alliances, for the purpose of
4 providing affordable group health insurance to employees
of small employers. Specifies organizational
5 requirements. Authorizes the Office of Auditor General to
audit and inspect the alliance. Provides eligibility
6 requirements for small employer members. Prescribes
responsibilities for the Agency for Health Care
7 Administration. Revises marketing requirements of the
alliance. Revises restrictions relating to premium rates
8 for small employer health benefit plans. Repeals ss.
408.7042, 408.7055, and 408.706, F.S., deleting
9 provisions related to purchasing coverage for state
employees and Medicaid recipients through community
10 health purchasing alliances. Deletes provisions related
to establishment of practitioner advisory groups by the
11 Agency for Health Care Administration. Deletes
requirements for accountable health partnerships.
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