HB 783

1
A bill to be entitled
2An act relating to wellness programs for state employees;
3amending s. 110.123, F.S.; defining the term "aged-based
4and gender-based benefits" for purposes of the state group
5insurance program; creating the Florida State Employee
6Wellness Council within the Department of Management
7Services; providing for the appointment and qualification
8of members; providing terms of membership; providing for
9the appointment of members to fill vacant positions;
10requiring the council to elect a chair and vice chair;
11providing that the chair shall call the initial meeting of
12the council within a time certain; requiring the council
13to meet quarterly; providing that council members shall
14serve without compensation; providing for reimbursement of
15per diem and travel expenses; providing purpose and duties
16of the council; providing an effective date.
17
18Be It Enacted by the Legislature of the State of Florida:
19
20     Section 1.  Paragraph (h) of subsection (3) of section
21110.123, Florida Statutes, is amended, and subsection (13) is
22added to that section, to read:
23     110.123  State group insurance program.--
24     (3)  STATE GROUP INSURANCE PROGRAM.--
25     (h)1.  A person eligible to participate in the state group
26insurance program may be authorized by rules adopted by the
27department, in lieu of participating in the state group health
28insurance plan, to exercise an option to elect membership in a
29health maintenance organization plan which is under contract
30with the state in accordance with criteria established by this
31section and by said rules. The offer of optional membership in a
32health maintenance organization plan permitted by this paragraph
33may be limited or conditioned by rule as may be necessary to
34meet the requirements of state and federal laws.
35     2.  The department shall contract with health maintenance
36organizations seeking to participate in the state group
37insurance program through a request for proposal or other
38procurement process, as developed by the Department of
39Management Services and determined to be appropriate.
40     a.  The department shall establish a schedule of minimum
41benefits for health maintenance organization coverage, and that
42schedule shall include: physician services; inpatient and
43outpatient hospital services; emergency medical services,
44including out-of-area emergency coverage; diagnostic laboratory
45and diagnostic and therapeutic radiologic services; mental
46health, alcohol, and chemical dependency treatment services
47meeting the minimum requirements of state and federal law;
48skilled nursing facilities and services; prescription drugs;
49age-based and gender-based wellness benefits; and other benefits
50as may be required by the department. Additional services may be
51provided subject to the contract between the department and the
52HMO. As used in this paragraph, the term "age-based and gender-
53based wellness benefits" includes aerobic exercise, education in
54alcohol and substance abuse prevention, blood cholesterol
55screening, health risk appraisals, blood pressure screening and
56education, nutrition education, program planning, safety belt
57education, smoking cessation, stress management, weight loss,
58and women's health education.
59     b.  The department may establish uniform deductibles,
60copayments, coverage tiers, or coinsurance schedules for all
61participating HMO plans.
62     c.  The department may require detailed information from
63each health maintenance organization participating in the
64procurement process, including information pertaining to
65organizational status, experience in providing prepaid health
66benefits, accessibility of services, financial stability of the
67plan, quality of management services, accreditation status,
68quality of medical services, network access and adequacy,
69performance measurement, ability to meet the department's
70reporting requirements, and the actuarial basis of the proposed
71rates and other data determined by the director to be necessary
72for the evaluation and selection of health maintenance
73organization plans and negotiation of appropriate rates for
74these plans. Upon receipt of proposals by health maintenance
75organization plans and the evaluation of those proposals, the
76department may enter into negotiations with all of the plans or
77a subset of the plans, as the department determines appropriate.
78Nothing shall preclude the department from negotiating regional
79or statewide contracts with health maintenance organization
80plans when this is cost-effective and when the department
81determines that the plan offers high value to enrollees.
82     d.  The department may limit the number of HMOs that it
83contracts with in each service area based on the nature of the
84bids the department receives, the number of state employees in
85the service area, or any unique geographical characteristics of
86the service area. The department shall establish by rule service
87areas throughout the state.
88     e.  All persons participating in the state group insurance
89program may be required to contribute towards a total state
90group health premium that may vary depending upon the plan and
91coverage tier selected by the enrollee and the level of state
92contribution authorized by the Legislature.
93     3.  The department is authorized to negotiate and to
94contract with specialty psychiatric hospitals for mental health
95benefits, on a regional basis, for alcohol, drug abuse, and
96mental and nervous disorders. The department may establish,
97subject to the approval of the Legislature pursuant to
98subsection (5), any such regional plan upon completion of an
99actuarial study to determine any impact on plan benefits and
100premiums.
101     4.  In addition to contracting pursuant to subparagraph 2.,
102the department may enter into contract with any HMO to
103participate in the state group insurance program which:
104     a.  Serves greater than 5,000 recipients on a prepaid basis
105under the Medicaid program;
106     b.  Does not currently meet the 25-percent non-
107Medicare/non-Medicaid enrollment composition requirement
108established by the Department of Health excluding participants
109enrolled in the state group insurance program;
110     c.  Meets the minimum benefit package and copayments and
111deductibles contained in sub-subparagraphs 2.a. and b.;
112     d.  Is willing to participate in the state group insurance
113program at a cost of premiums that is not greater than 95
114percent of the cost of HMO premiums accepted by the department
115in each service area; and
116     e.  Meets the minimum surplus requirements of s. 641.225.
117
118The department is authorized to contract with HMOs that meet the
119requirements of sub-subparagraphs a.-d. prior to the open
120enrollment period for state employees. The department is not
121required to renew the contract with the HMOs as set forth in
122this paragraph more than twice. Thereafter, the HMOs shall be
123eligible to participate in the state group insurance program
124only through the request for proposal or invitation to negotiate
125process described in subparagraph 2.
126     5.  All enrollees in a state group health insurance plan, a
127TRICARE supplemental insurance plan, or any health maintenance
128organization plan have the option of changing to any other
129health plan that is offered by the state within any open
130enrollment period designated by the department. Open enrollment
131shall be held at least once each calendar year.
132     6.  When a contract between a treating provider and the
133state-contracted health maintenance organization is terminated
134for any reason other than for cause, each party shall allow any
135enrollee for whom treatment was active to continue coverage and
136care when medically necessary, through completion of treatment
137of a condition for which the enrollee was receiving care at the
138time of the termination, until the enrollee selects another
139treating provider, or until the next open enrollment period
140offered, whichever is longer, but no longer than 6 months after
141termination of the contract. Each party to the terminated
142contract shall allow an enrollee who has initiated a course of
143prenatal care, regardless of the trimester in which care was
144initiated, to continue care and coverage until completion of
145postpartum care. This does not prevent a provider from refusing
146to continue to provide care to an enrollee who is abusive,
147noncompliant, or in arrears in payments for services provided.
148For care continued under this subparagraph, the program and the
149provider shall continue to be bound by the terms of the
150terminated contract. Changes made within 30 days before
151termination of a contract are effective only if agreed to by
152both parties.
153     7.  Any HMO participating in the state group insurance
154program shall submit health care utilization and cost data to
155the department, in such form and in such manner as the
156department shall require, as a condition of participating in the
157program. The department shall enter into negotiations with its
158contracting HMOs to determine the nature and scope of the data
159submission and the final requirements, format, penalties
160associated with noncompliance, and timetables for submission.
161These determinations shall be adopted by rule.
162     8.  The department may establish and direct, with respect
163to collective bargaining issues, a comprehensive package of
164insurance benefits that may include supplemental health and life
165coverage, dental care, long-term care, vision care, and other
166benefits it determines necessary to enable state employees to
167select from among benefit options that best suit their
168individual and family needs.
169     a.  Based upon a desired benefit package, the department
170shall issue a request for proposal or invitation to negotiate
171for health insurance providers interested in participating in
172the state group insurance program, and the department shall
173issue a request for proposal or invitation to negotiate for
174insurance providers interested in participating in the non-
175health-related components of the state group insurance program.
176Upon receipt of all proposals, the department may enter into
177contract negotiations with insurance providers submitting bids
178or negotiate a specially designed benefit package. Insurance
179providers offering or providing supplemental coverage as of May
18030, 1991, which qualify for pretax benefit treatment pursuant to
181s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
182state employees currently enrolled may be included by the
183department in the supplemental insurance benefit plan
184established by the department without participating in a request
185for proposal, submitting bids, negotiating contracts, or
186negotiating a specially designed benefit package. These
187contracts shall provide state employees with the most cost-
188effective and comprehensive coverage available; however, no
189state or agency funds shall be contributed toward the cost of
190any part of the premium of such supplemental benefit plans. With
191respect to dental coverage, the division shall include in any
192solicitation or contract for any state group dental program made
193after July 1, 2001, a comprehensive indemnity dental plan option
194which offers enrollees a completely unrestricted choice of
195dentists. If a dental plan is endorsed, or in some manner
196recognized as the preferred product, such plan shall include a
197comprehensive indemnity dental plan option which provides
198enrollees with a completely unrestricted choice of dentists.
199     b.  Pursuant to the applicable provisions of s. 110.161,
200and s. 125 of the Internal Revenue Code of 1986, the department
201shall enroll in the pretax benefit program those state employees
202who voluntarily elect coverage in any of the supplemental
203insurance benefit plans as provided by sub-subparagraph a.
204     c.  Nothing herein contained shall be construed to prohibit
205insurance providers from continuing to provide or offer
206supplemental benefit coverage to state employees as provided
207under existing agency plans.
208     (13)  WELLNESS COUNCIL.--
209     (a)  There is created within the department the Florida
210State Employee Wellness Council.
211     (b)  The council shall be an advisory body to the
212department to provide health education information to employees
213and to assist the department in developing minimum benefits for
214health maintenance organizations when providing age-based and
215gender-based wellness benefits.
216     (c)  The council shall be composed of nine members
217appointed by the Governor. When making appointments to the
218council, the Governor shall appoint persons who are residents of
219the state and who are highly knowledgeable concerning, active
220in, and recognized leaders in the health and medical field.
221Council members shall equitably represent the broadest spectrum
222of the health industry and the geographic areas of the state.
223Not more than one member of the council may be from any one
224company, organization, or association.
225     (d)1.  Council members shall be appointed to 4-year terms,
226except that the initial terms shall be staggered. The Governor
227shall appoint three members to 2-year terms, three members to 3-
228year terms, and three members to 4-year terms.
229     2.  A member's absence from three consecutive meetings
230shall result in his or her automatic removal from the council. A
231vacancy on the council shall be filled for the remainder of the
232unexpired term.
233     (e)  The council shall annually elect from its membership
234one member to serve as chair of the council and one member to
235serve as vice chair.
236     (f)  The first meeting of the council shall be called by
237the chair not more than 60 days after the council members are
238appointed by the Governor. The council shall thereafter meet at
239least once quarterly and may meet more often as necessary. The
240department shall provide staff assistance to the council, which
241shall include, but not be limited to, keeping records of the
242proceedings of the council and serving as custodian of all
243books, documents, and papers filed with the council.
244     (g)  A majority of the members of the council constitutes a
245quorum.
246     (h)  Members of the council shall serve without
247compensation but are entitled to reimbursement for per diem and
248travel expenses while performing their duties as provided in s.
249112.061.
250     (i)  The council shall:
251     1.  Work to encourage participation in wellness programs by
252state employees. The council may prepare informational programs
253and brochures for state agencies and employees.
254     2.  In consultation with the department, develop standards
255and criteria for age-based and gender-based wellness programs.
256     3.  In consultation with the department, recommend a
257healthy food and beverage menu for cafeterias and other food-
258service establishments located in buildings owned, operated, or
259leased by the state.
260     Section 2.  This act shall take effect July 1, 2006.


CODING: Words stricken are deletions; words underlined are additions.