Florida Senate - 2017                                     SB 900
       
       
        
       By Senator Lee
       
       
       
       
       
       20-00358A-17                                           2017900__
    1                        A bill to be entitled                      
    2         An act relating to the state group insurance program;
    3         amending s. 110.123, F.S.; revising applicability of
    4         certain definitions; defining the term “plan year”;
    5         authorizing the program to include additional
    6         benefits; authorizing an employee to use a specified
    7         portion of the state’s contribution to purchase
    8         additional program benefits and supplemental benefits
    9         under certain circumstances; providing for the program
   10         to offer health plans in specified benefit levels;
   11         requiring the Department of Management Services to
   12         develop a plan for implementation of the benefit
   13         levels; providing reporting requirements; providing
   14         for expiration of the implementation plan; creating s.
   15         110.12303, F.S.; authorizing additional benefits to be
   16         included in the program; requiring the department to
   17         contract with at least one entity that provides
   18         comprehensive pricing and inclusive services for
   19         surgery and other medical procedures; providing
   20         contract and reporting requirements; requiring the
   21         department to contract with an entity to provide
   22         enrollees with online information on health care
   23         services and providers; providing contract and
   24         reporting requirements; creating s. 110.12304, F.S.;
   25         directing the department to contract with an
   26         independent benefits consultant; providing
   27         qualifications and duties of the independent benefits
   28         consultant; providing reporting requirements;
   29         providing that the department shall determine and
   30         recommend premiums for enrollees for the 2018 plan
   31         year; providing requirements for the determination of
   32         premiums; requiring the department to submit premium
   33         rates to the Legislative Budget Commission by a
   34         specified date for review and approval; requiring
   35         premium rates to be consistent with the total budgeted
   36         amount for the program in the General Appropriations
   37         Act for the 2017-2018 fiscal year; providing an
   38         appropriation and authorizing positions; providing an
   39         effective date.
   40          
   41  Be It Enacted by the Legislature of the State of Florida:
   42  
   43         Section 1. Subsection (2) and paragraphs (b), (f), (h), and
   44  (j) of subsection (3) of section 110.123, Florida Statutes, are
   45  amended, and paragraph (k) is added to subsection (3) of that
   46  section, to read:
   47         110.123 State group insurance program.—
   48         (2) DEFINITIONS.—As used in ss. 110.123-110.1239 this
   49  section, the term:
   50         (a) “Department” means the Department of Management
   51  Services.
   52         (b) “Enrollee” means all state officers and employees,
   53  retired state officers and employees, surviving spouses of
   54  deceased state officers and employees, and terminated employees
   55  or individuals with continuation coverage who are enrolled in an
   56  insurance plan offered by the state group insurance program.
   57  “Enrollee” includes all state university officers and employees,
   58  retired state university officers and employees, surviving
   59  spouses of deceased state university officers and employees, and
   60  terminated state university employees or individuals with
   61  continuation coverage who are enrolled in an insurance plan
   62  offered by the state group insurance program.
   63         (c) “Full-time state employees” means employees of all
   64  branches or agencies of state government holding salaried
   65  positions who are paid by state warrant or from agency funds and
   66  who work or are expected to work an average of at least 30 or
   67  more hours per week; employees paid from regular salary
   68  appropriations for 8 months’ employment, including university
   69  personnel on academic contracts; and employees paid from other
   70  personal-services (OPS) funds as described in subparagraphs 1.
   71  and 2. The term includes all full-time employees of the state
   72  universities. The term does not include seasonal workers who are
   73  paid from OPS funds.
   74         1. For persons hired before April 1, 2013, the term
   75  includes any person paid from OPS funds who:
   76         a. Has worked an average of at least 30 hours or more per
   77  week during the initial measurement period from April 1, 2013,
   78  through September 30, 2013; or
   79         b. Has worked an average of at least 30 hours or more per
   80  week during a subsequent measurement period.
   81         2. For persons hired after April 1, 2013, the term includes
   82  any person paid from OPS funds who:
   83         a. Is reasonably expected to work an average of at least 30
   84  hours or more per week; or
   85         b. Has worked an average of at least 30 hours or more per
   86  week during the person’s measurement period.
   87         (d) “Health maintenance organization” or “HMO” means an
   88  entity certified under part I of chapter 641.
   89         (e) “Health plan member” means any person participating in
   90  a state group health insurance plan, a TRICARE supplemental
   91  insurance plan, or a health maintenance organization plan under
   92  the state group insurance program, including enrollees and
   93  covered dependents thereof.
   94         (f) “Part-time state employee” means an employee of any
   95  branch or agency of state government paid by state warrant from
   96  salary appropriations or from agency funds, and who is employed
   97  for less than an average of 30 hours per week or, if on academic
   98  contract or seasonal or other type of employment which is less
   99  than year-round, is employed for less than 8 months during any
  100  12-month period, but does not include a person paid from other
  101  personal-services (OPS) funds. The term includes all part-time
  102  employees of the state universities.
  103         (g) “Plan year” means a calendar year.
  104         (h)(g) “Retired state officer or employee” or “retiree”
  105  means any state or state university officer or employee who
  106  retires under a state retirement system or a state optional
  107  annuity or retirement program or is placed on disability
  108  retirement, and who was insured under the state group insurance
  109  program at the time of retirement, and who begins receiving
  110  retirement benefits immediately after retirement from state or
  111  state university office or employment. The term also includes
  112  any state officer or state employee who retires under the
  113  Florida Retirement System Investment Plan established under part
  114  II of chapter 121 if he or she:
  115         1. Meets the age and service requirements to qualify for
  116  normal retirement as set forth in s. 121.021(29); or
  117         2. Has attained the age specified by s. 72(t)(2)(A)(i) of
  118  the Internal Revenue Code and has 6 years of creditable service.
  119         (i)(h) “State agency” or “agency” means any branch,
  120  department, or agency of state government. “State agency” or
  121  “agency” includes any state university for purposes of this
  122  section only.
  123         (j)(i) “Seasonal workers” has the same meaning as provided
  124  under 29 C.F.R. s. 500.20(s)(1).
  125         (k)(j) “State group health insurance plan or plans” or
  126  “state plan or plans” mean the state self-insured health
  127  insurance plan or plans offered to state officers and employees,
  128  retired state officers and employees, and surviving spouses of
  129  deceased state officers and employees pursuant to this section.
  130         (l)(k) “State-contracted HMO” means any health maintenance
  131  organization under contract with the department to participate
  132  in the state group insurance program.
  133         (m)(l) “State group insurance program” or “programs” means
  134  the package of insurance plans offered to state officers and
  135  employees, retired state officers and employees, and surviving
  136  spouses of deceased state officers and employees pursuant to
  137  this section, including the state group health insurance plan or
  138  plans, health maintenance organization plans, TRICARE
  139  supplemental insurance plans, and other plans required or
  140  authorized by law.
  141         (n)(m) “State officer” means any constitutional state
  142  officer, any elected state officer paid by state warrant, or any
  143  appointed state officer who is commissioned by the Governor and
  144  who is paid by state warrant.
  145         (o)(n) “Surviving spouse” means the widow or widower of a
  146  deceased state officer, full-time state employee, part-time
  147  state employee, or retiree if such widow or widower was covered
  148  as a dependent under the state group health insurance plan, a
  149  TRICARE supplemental insurance plan, or a health maintenance
  150  organization plan established pursuant to this section at the
  151  time of the death of the deceased officer, employee, or retiree.
  152  “Surviving spouse” also means any widow or widower who is
  153  receiving or eligible to receive a monthly state warrant from a
  154  state retirement system as the beneficiary of a state officer,
  155  full-time state employee, or retiree who died prior to July 1,
  156  1979. For the purposes of this section, any such widow or
  157  widower shall cease to be a surviving spouse upon his or her
  158  remarriage.
  159         (p)(o) “TRICARE supplemental insurance plan” means the
  160  Department of Defense Health Insurance Program for eligible
  161  members of the uniformed services authorized by 10 U.S.C. s.
  162  1097.
  163         (3) STATE GROUP INSURANCE PROGRAM.—
  164         (b) It is the intent of the Legislature to offer a
  165  comprehensive package of health insurance and retirement
  166  benefits and a personnel system for state employees which are
  167  provided in a cost-efficient and prudent manner, and to allow
  168  state employees the option to choose benefit plans which best
  169  suit their individual needs. Therefore, The state group
  170  insurance program is established which may include the state
  171  group health insurance plan or plans, health maintenance
  172  organization plans, group life insurance plans, TRICARE
  173  supplemental insurance plans, group accidental death and
  174  dismemberment plans, and group disability insurance plans,.
  175  Furthermore, the department is additionally authorized to
  176  establish and provide as part of the state group insurance
  177  program any other group insurance plans or coverage choices, and
  178  other benefits authorized by law that are consistent with the
  179  provisions of this section.
  180         (f) Except as provided for in subparagraph (h)2., the state
  181  contribution toward the cost of any plan in the state group
  182  insurance program shall be uniform with respect to all state
  183  employees in a state collective bargaining unit participating in
  184  the same coverage tier in the same plan. This section does not
  185  prohibit the development of separate benefit plans for officers
  186  and employees exempt from the career service or the development
  187  of separate benefit plans for each collective bargaining unit.
  188  For the 2020 plan year and thereafter, if the state’s
  189  contribution is more than the premium cost of the health plan
  190  selected by the employee, subject to federal limitation, the
  191  employee may elect to have the balance:
  192         1. Credited to the employee’s flexible spending account;
  193         2. Credited to the employee’s health savings account;
  194         3. Used to purchase additional benefits offered through the
  195  state group insurance program; or
  196         4. Used to increase the employee’s salary.
  197         (h)1. A person eligible to participate in the state group
  198  insurance program may be authorized by rules adopted by the
  199  department, in lieu of participating in the state group health
  200  insurance plan, to exercise an option to elect membership in a
  201  health maintenance organization plan which is under contract
  202  with the state in accordance with criteria established by this
  203  section and by said rules. The offer of optional membership in a
  204  health maintenance organization plan permitted by this paragraph
  205  may be limited or conditioned by rule as may be necessary to
  206  meet the requirements of state and federal laws.
  207         2. The department shall contract with health maintenance
  208  organizations seeking to participate in the state group
  209  insurance program through a request for proposal or other
  210  procurement process, as developed by the Department of
  211  Management Services and determined to be appropriate.
  212         a. The department shall establish a schedule of minimum
  213  benefits for health maintenance organization coverage, and that
  214  schedule shall include: physician services; inpatient and
  215  outpatient hospital services; emergency medical services,
  216  including out-of-area emergency coverage; diagnostic laboratory
  217  and diagnostic and therapeutic radiologic services; mental
  218  health, alcohol, and chemical dependency treatment services
  219  meeting the minimum requirements of state and federal law;
  220  skilled nursing facilities and services; prescription drugs;
  221  age-based and gender-based wellness benefits; and other benefits
  222  as may be required by the department. Additional services may be
  223  provided subject to the contract between the department and the
  224  HMO. As used in this paragraph, the term “age-based and gender
  225  based wellness benefits” includes aerobic exercise, education in
  226  alcohol and substance abuse prevention, blood cholesterol
  227  screening, health risk appraisals, blood pressure screening and
  228  education, nutrition education, program planning, safety belt
  229  education, smoking cessation, stress management, weight
  230  management, and women’s health education.
  231         b. The department may establish uniform deductibles,
  232  copayments, coverage tiers, or coinsurance schedules for all
  233  participating HMO plans.
  234         c. The department may require detailed information from
  235  each health maintenance organization participating in the
  236  procurement process, including information pertaining to
  237  organizational status, experience in providing prepaid health
  238  benefits, accessibility of services, financial stability of the
  239  plan, quality of management services, accreditation status,
  240  quality of medical services, network access and adequacy,
  241  performance measurement, ability to meet the department’s
  242  reporting requirements, and the actuarial basis of the proposed
  243  rates and other data determined by the director to be necessary
  244  for the evaluation and selection of health maintenance
  245  organization plans and negotiation of appropriate rates for
  246  these plans. Upon receipt of proposals by health maintenance
  247  organization plans and the evaluation of those proposals, the
  248  department may enter into negotiations with all of the plans or
  249  a subset of the plans, as the department determines appropriate.
  250  Nothing shall preclude the department from negotiating regional
  251  or statewide contracts with health maintenance organization
  252  plans when this is cost-effective and when the department
  253  determines that the plan offers high value to enrollees.
  254         d. The department may limit the number of HMOs that it
  255  contracts with in each service area based on the nature of the
  256  bids the department receives, the number of state employees in
  257  the service area, or any unique geographical characteristics of
  258  the service area. The department shall establish by rule service
  259  areas throughout the state.
  260         e. All persons participating in the state group insurance
  261  program may be required to contribute towards a total state
  262  group health premium that may vary depending upon the plan,
  263  coverage level, and coverage tier selected by the enrollee and
  264  the level of state contribution authorized by the Legislature.
  265         3. The department is authorized to negotiate and to
  266  contract with specialty psychiatric hospitals for mental health
  267  benefits, on a regional basis, for alcohol, drug abuse, and
  268  mental and nervous disorders. The department may establish,
  269  subject to the approval of the Legislature pursuant to
  270  subsection (5), any such regional plan upon completion of an
  271  actuarial study to determine any impact on plan benefits and
  272  premiums.
  273         4. In addition to contracting pursuant to subparagraph 2.,
  274  the department may enter into contract with any HMO to
  275  participate in the state group insurance program which:
  276         a. Serves greater than 5,000 recipients on a prepaid basis
  277  under the Medicaid program;
  278         b. Does not currently meet the 25-percent non-Medicare/non
  279  Medicaid enrollment composition requirement established by the
  280  Department of Health excluding participants enrolled in the
  281  state group insurance program;
  282         c. Meets the minimum benefit package and copayments and
  283  deductibles contained in sub-subparagraphs 2.a. and b.;
  284         d. Is willing to participate in the state group insurance
  285  program at a cost of premiums that is not greater than 95
  286  percent of the cost of HMO premiums accepted by the department
  287  in each service area; and
  288         e. Meets the minimum surplus requirements of s. 641.225.
  289  
  290  The department is authorized to contract with HMOs that meet the
  291  requirements of sub-subparagraphs a.-d. prior to the open
  292  enrollment period for state employees. The department is not
  293  required to renew the contract with the HMOs as set forth in
  294  this paragraph more than twice. Thereafter, the HMOs shall be
  295  eligible to participate in the state group insurance program
  296  only through the request for proposal or invitation to negotiate
  297  process described in subparagraph 2.
  298         5. All enrollees in a state group health insurance plan, a
  299  TRICARE supplemental insurance plan, or any health maintenance
  300  organization plan have the option of changing to any other
  301  health plan that is offered by the state within any open
  302  enrollment period designated by the department. Open enrollment
  303  shall be held at least once each calendar year.
  304         6. When a contract between a treating provider and the
  305  state-contracted health maintenance organization is terminated
  306  for any reason other than for cause, each party shall allow any
  307  enrollee for whom treatment was active to continue coverage and
  308  care when medically necessary, through completion of treatment
  309  of a condition for which the enrollee was receiving care at the
  310  time of the termination, until the enrollee selects another
  311  treating provider, or until the next open enrollment period
  312  offered, whichever is longer, but no longer than 6 months after
  313  termination of the contract. Each party to the terminated
  314  contract shall allow an enrollee who has initiated a course of
  315  prenatal care, regardless of the trimester in which care was
  316  initiated, to continue care and coverage until completion of
  317  postpartum care. This does not prevent a provider from refusing
  318  to continue to provide care to an enrollee who is abusive,
  319  noncompliant, or in arrears in payments for services provided.
  320  For care continued under this subparagraph, the program and the
  321  provider shall continue to be bound by the terms of the
  322  terminated contract. Changes made within 30 days before
  323  termination of a contract are effective only if agreed to by
  324  both parties.
  325         7. Any HMO participating in the state group insurance
  326  program shall submit health care utilization and cost data to
  327  the department, in such form and in such manner as the
  328  department shall require, as a condition of participating in the
  329  program. The department shall enter into negotiations with its
  330  contracting HMOs to determine the nature and scope of the data
  331  submission and the final requirements, format, penalties
  332  associated with noncompliance, and timetables for submission.
  333  These determinations shall be adopted by rule.
  334         8. The department may establish and direct, with respect to
  335  collective bargaining issues, a comprehensive package of
  336  insurance benefits that may include supplemental health and life
  337  coverage, dental care, long-term care, vision care, and other
  338  benefits it determines necessary to enable state employees to
  339  select from among benefit options that best suit their
  340  individual and family needs. Beginning with the 2018 plan year,
  341  the package of benefits may also include products and services
  342  described in s. 110.12303.
  343         a. Based upon a desired benefit package, the department
  344  shall issue a request for proposal or invitation to negotiate
  345  for health insurance providers interested in participating in
  346  the state group insurance program, and the department shall
  347  issue a request for proposal or invitation to negotiate for
  348  insurance providers interested in participating in the non
  349  health-related components of the state group insurance program.
  350  Upon receipt of all proposals, the department may enter into
  351  contract negotiations with insurance providers submitting bids
  352  or negotiate a specially designed benefit package. Insurance
  353  providers offering or providing supplemental coverage as of May
  354  30, 1991, which qualify for pretax benefit treatment pursuant to
  355  s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
  356  state employees currently enrolled may be included by the
  357  department in the supplemental insurance benefit plan
  358  established by the department without participating in a request
  359  for proposal, submitting bids, negotiating contracts, or
  360  negotiating a specially designed benefit package. These
  361  contracts shall provide state employees with the most cost
  362  effective and comprehensive coverage available; however, except
  363  as provided in subparagraph (f)3., no state or agency funds
  364  shall be contributed toward the cost of any part of the premium
  365  of such supplemental benefit plans. With respect to dental
  366  coverage, the division shall include in any solicitation or
  367  contract for any state group dental program made after July 1,
  368  2001, a comprehensive indemnity dental plan option which offers
  369  enrollees a completely unrestricted choice of dentists. If a
  370  dental plan is endorsed, or in some manner recognized as the
  371  preferred product, such plan shall include a comprehensive
  372  indemnity dental plan option which provides enrollees with a
  373  completely unrestricted choice of dentists.
  374         b. Pursuant to the applicable provisions of s. 110.161, and
  375  s. 125 of the Internal Revenue Code of 1986, the department
  376  shall enroll in the pretax benefit program those state employees
  377  who voluntarily elect coverage in any of the supplemental
  378  insurance benefit plans as provided by sub-subparagraph a.
  379         c. Nothing herein contained shall be construed to prohibit
  380  insurance providers from continuing to provide or offer
  381  supplemental benefit coverage to state employees as provided
  382  under existing agency plans.
  383         (j) For the 2020 plan year and thereafter, health plans
  384  shall be offered in the following benefit levels:
  385         1. Platinum level, which shall have an actuarial value of
  386  at least 90 percent.
  387         2. Gold level, which shall have an actuarial value of at
  388  least 80 percent.
  389         3. Silver level, which shall have an actuarial value of at
  390  least 70 percent.
  391         4. Bronze level, which shall have an actuarial value of at
  392  least 60 percent Notwithstanding paragraph (f) requiring uniform
  393  contributions, and for the 2011-2012 fiscal year only, the state
  394  contribution toward the cost of any plan in the state group
  395  insurance plan is the difference between the overall premium and
  396  the employee contribution. This subsection expires June 30,
  397  2012.
  398         (k) In consultation with the independent benefits
  399  consultant described in s. 110.12304, the department shall
  400  develop a plan for implementation of the benefit levels
  401  described in paragraph (j). The plan shall be submitted to the
  402  Governor, the President of the Senate, and the Speaker of the
  403  House of Representatives by January 1, 2019, and include
  404  recommendations for:
  405         1. Employer and employee contribution policies.
  406         2. Steps necessary for maintaining or improving total
  407  employee compensation levels when the transition is initiated.
  408         3. An education strategy to inform employees of the
  409  additional choices available in the state group insurance
  410  program.
  411  
  412  This paragraph expires July 1, 2019.
  413         Section 2. Section 110.12303, Florida Statutes, is created
  414  to read:
  415         110.12303 State group insurance program; additional
  416  benefits; price transparency program; reporting.—Beginning with
  417  the 2018 plan year:
  418         (1) In addition to the comprehensive package of health
  419  insurance and other benefits required or authorized to be
  420  included in the state group insurance program, the package of
  421  benefits may also include products and services offered by:
  422         (a) Prepaid limited health service organizations authorized
  423  pursuant to part I of chapter 636.
  424         (b) Discount medical plan organizations authorized pursuant
  425  to part II of chapter 636.
  426         (c) Prepaid health clinics licensed under part II of
  427  chapter 641.
  428         (d) Licensed health care providers, including hospitals and
  429  other health facilities, health care clinics, and health
  430  professionals, who sell service contracts and arrangements for a
  431  specified amount and type of health services.
  432         (e) Provider organizations, including service networks,
  433  group practices, professional associations, and other
  434  incorporated organizations of providers, who sell service
  435  contracts and arrangements for a specified amount and type of
  436  health services.
  437         (f) Entities that provide specific health services in
  438  accordance with applicable state law and sell service contracts
  439  and arrangements for a specified amount and type of health
  440  services.
  441         (g) Entities that provide health services or treatments
  442  through a bidding process.
  443         (h) Entities that provide health services or treatments
  444  through the bundling or aggregating of health services or
  445  treatments.
  446         (i) Entities that provide other innovative and cost
  447  effective health service delivery methods.
  448         (2)(a) The department shall contract with at least one
  449  entity that provides comprehensive pricing and inclusive
  450  services for surgery and other medical procedures which may be
  451  accessed at the option of the enrollee. The contract shall
  452  require the entity to:
  453         1. Have procedures and evidence-based standards to ensure
  454  the inclusion of only high-quality health care providers.
  455         2. Provide assistance to the enrollee in accessing and
  456  coordinating care.
  457         3. Provide cost savings to the state group insurance
  458  program to be shared with both the state and the enrollee. Cost
  459  savings payable to an enrollee may be:
  460         a. Credited to the enrollee’s flexible spending account;
  461         b. Credited to the enrollee’s health savings account;
  462         c. Credited to the enrollee’s health reimbursement account;
  463  or
  464         d. Paid as additional health plan reimbursements not
  465  exceeding the amount of the enrollee’s out-of-pocket medical
  466  expenses.
  467         4. Provide an educational campaign for enrollees to learn
  468  about the services offered by the entity.
  469         (b) On or before January 15 of each year, the department
  470  shall report to the Governor, the President of the Senate, and
  471  the Speaker of the House of Representatives on the participation
  472  level and cost-savings to both the enrollee and the state
  473  resulting from the contract or contracts described in this
  474  subsection.
  475         (3) The department shall contract with an entity that
  476  provides enrollees with online information on the cost and
  477  quality of health care services and providers, allows an
  478  enrollee to shop for health care services and providers, and
  479  rewards the enrollee by sharing savings generated by the
  480  enrollee’s choice of services or providers. The contract shall
  481  require the entity to:
  482         (a) Establish an Internet-based, consumer-friendly platform
  483  that educates and informs enrollees about the price and quality
  484  of health care services and providers, including the average
  485  amount paid in each county for health care services and
  486  providers. The average amounts paid for such services and
  487  providers may be expressed for service bundles, which include
  488  all products and services associated with a particular treatment
  489  or episode of care, or for separate and distinct products and
  490  services.
  491         (b) Allow enrollees to shop for health care services and
  492  providers using the price and quality information provided on
  493  the Internet-based platform.
  494         (c) Permit a certified bargaining agent of state employees
  495  to provide educational materials and counseling to enrollees
  496  regarding the Internet-based platform.
  497         (d) Identify the savings realized to the enrollee and state
  498  if the enrollee chooses high-quality, lower-cost health care
  499  services or providers, and facilitate a shared savings payment
  500  to the enrollee. The amount of shared savings shall be
  501  determined by a methodology approved by the department and shall
  502  maximize value-based purchasing by enrollees. The amount payable
  503  to the enrollee may be:
  504         1. Credited to the enrollee’s flexible spending account;
  505         2. Credited to the enrollee’s health savings account;
  506         3. Credited to the enrollee’s health reimbursement account;
  507  or
  508         4. Paid as additional health plan reimbursements not
  509  exceeding the amount of the enrollee’s out-of-pocket medical
  510  expenses.
  511         (e) On or before January 1 of 2019, 2020, and 2021, the
  512  department shall report to the Governor, the President of the
  513  Senate, and the Speaker of the House of Representatives on the
  514  participation level, amount paid to enrollees, and cost-savings
  515  to both the enrollees and the state resulting from the
  516  implementation of this subsection.
  517         Section 3. Section 110.12304, Florida Statutes, is created
  518  to read:
  519         110.12304 Independent benefits consultant.—
  520         (1) The department shall competitively procure an
  521  independent benefits consultant.
  522         (2) The independent benefits consultant may not:
  523         (a) Be owned or controlled by a health maintenance
  524  organization or insurer.
  525         (b) Have an ownership interest in a health maintenance
  526  organization or insurer.
  527         (c) Have a direct or indirect financial interest in a
  528  health maintenance organization or insurer.
  529         (3) The independent benefits consultant must have
  530  substantial experience in consultation and design of employee
  531  benefit programs for large employers and public employers,
  532  including experience with plans that qualify as cafeteria plans
  533  under s. 125 of the Internal Revenue Code of 1986.
  534         (4) The independent benefits consultant shall:
  535         (a) Provide an ongoing assessment of trends in benefits and
  536  employer-sponsored insurance that affect the state group
  537  insurance program.
  538         (b) Conduct a comprehensive analysis of the state group
  539  insurance program, including available benefits, coverage
  540  options, and claims experience.
  541         (c) Identify and establish appropriate adjustment
  542  procedures necessary to respond to any risk segmentation that
  543  may occur when increased choices are offered to employees.
  544         (d) Assist the department with the submission of any
  545  necessary plan revisions for federal review.
  546         (e) Assist the department in ensuring compliance with
  547  applicable federal and state regulations.
  548         (f) Assist the department in monitoring the adequacy of
  549  funding and reserves for the state self-insured plan.
  550         (g) Assist the department in preparing recommendations for
  551  any modifications to the state group insurance program which
  552  shall be submitted to the Governor, the President of the Senate,
  553  and the Speaker of the House of Representatives by January 1 of
  554  each year.
  555         Section 4. For the 2018 plan year, the Department of
  556  Management Services shall determine and recommend premiums for
  557  enrollees that reflect the actual differences in costs to the
  558  program for each of the health maintenance organization and the
  559  preferred provider organization plan options offered in the
  560  state group insurance program for both self-insured and fully
  561  insured plans. The premium alternatives for the plan options
  562  shall reflect the costs to the program for both medical and
  563  prescription drug benefits. By July 1, 2017, the department
  564  shall submit the proposed enrollee premium rates for the 2018
  565  plan year to the Legislative Budget Commission for review and
  566  approval. If the Legislative Budget Commission does not approve
  567  the proposed rates, the rates provided in the 2017-2018 General
  568  Appropriations Act shall apply. The premium rates for employers
  569  shall be the same as those established for the state group
  570  insurance program in the General Appropriations Act for the
  571  2017-2018 fiscal year.
  572         Section 5. (1) For the 2017-2018 fiscal year, the sums of
  573  $151,216 in recurring funds and $507,546 in nonrecurring funds
  574  are appropriated from the State Employees Health Insurance Trust
  575  Fund to the Department of Management Services, and two full-time
  576  equivalent positions and associated salary rate of 120,000 are
  577  authorized, for the purpose of implementing this act.
  578         (2)(a) The recurring funds appropriated in this section
  579  shall be allocated to the following specific appropriation
  580  categories within the Insurance Benefits Administration Program:
  581  $150,528 in Salaries and Benefits and $688 in Special Categories
  582  Transfer to Department of Management Services—Human Resources
  583  Purchased per Statewide Contract.
  584         (b) The nonrecurring funds appropriated in this section
  585  shall be allocated to the following specific appropriation
  586  categories: $500,000 in Special Categories Contracted Services
  587  and $7,546 in Expenses.
  588         Section 6. This act shall take effect July 1, 2017.