Florida Senate - 2018 SB 1872 By Senator Torres 15-01229-18 20181872__ 1 A bill to be entitled 2 An act relating to health care coverage; creating part 3 V of chapter 408, F.S., entitled the "Healthy Florida 4 Act”; creating s. 408.95, F.S.; providing a short 5 title; creating s. 408.951, F.S.; providing 6 legislative findings and intent; creating s. 408.952, 7 F.S.; defining terms; creating s. 408.953, F.S.; 8 creating the Healthy Florida program, to be 9 administered by the Healthy Florida Board; creating 10 the Healthy Florida Board; declaring that the board is 11 an independent public entity not affiliated with an 12 agency or department; specifying the composition and 13 governance of the board; specifying appointment 14 procedures and requirements; specifying terms of board 15 members; providing duties, qualifications, and 16 prohibited acts of board members; specifying that 17 board members may not receive compensation for service 18 but may be reimbursed for certain per diem and travel 19 expenses; defining the term “health care provider”; 20 providing immunity from liability for certain acts 21 performed or obligations entered into by the board or 22 by board members, officers, or employees; requiring 23 the board to hire an executive director who is exempt 24 from civil service and who serves at the pleasure of 25 the board; providing that the board’s meetings are 26 subject to public meetings requirements; authorizing 27 the board to adopt rules; creating s. 408.954, F.S.; 28 requiring the State Surgeon General of the Department 29 of Health to establish a public advisory committee to 30 advise the board on policy matters; specifying the 31 composition of the committee and the authority 32 appointing each member; providing requirements for the 33 Governor, President of the Senate, and Speaker of the 34 House of Representatives in making appointments; 35 specifying terms of appointments and reappointments; 36 providing requirements for filling vacancies; 37 specifying that committee members serve without 38 compensation, except for reimbursement for per diem 39 and travel expenses and a specified amount under 40 certain circumstances; defining the term “full day of 41 attending a meeting”; providing requirements for the 42 minimum frequency and location of committee meetings; 43 requiring such meetings to be open to the public; 44 requiring the committee to elect a chair; specifying 45 terms of the chair; providing qualifications and 46 prohibited acts of committee members; creating s. 47 408.955, F.S.; specifying powers and duties of the 48 board in establishing and implementing comprehensive 49 universal single-payer health care coverage and a 50 health care cost control system for the benefit of 51 state residents; prohibiting carriers from offering 52 benefits or covering services for which coverage is 53 offered to individuals under the Healthy Florida 54 program; specifying benefits that may be offered by 55 carriers; requiring, after a certain timeframe, 56 certain board members to be program members; requiring 57 the board to develop certain proposals within a 58 specified timeframe; authorizing the board to contract 59 with nonprofit organizations to provide certain 60 assistance to consumers and health care providers; 61 requiring the board to provide grants from certain 62 sources to the Agency for Health Care Administration 63 and the Department of Economic Opportunity for certain 64 purposes; requiring the board to provide for the 65 collection and availability of specified health care 66 data; requiring the board to make such data publicly 67 available in a specified manner; requiring the board 68 to conduct programs to promote and protect public, 69 environmental, and occupational health, using certain 70 data; requiring the board to provide for the 71 collection and availability of certain data within a 72 certain timeframe; creating s. 408.956, F.S.; 73 prohibiting law enforcement agencies from using 74 Healthy Florida moneys, facilities, property, 75 equipment, or personnel for certain purposes; creating 76 s. 408.957, F.S.; providing that every resident of 77 this state is eligible and entitled to enroll under 78 the Healthy Florida program; specifying that members 79 may not be required to pay any charge for enrollment 80 or membership; specifying that members may not be 81 required to pay any form of cost-sharing for a covered 82 benefit; authorizing institutions of higher education 83 to purchase coverage under the program for nonresident 84 students and their dependents; creating s. 408.958, 85 F.S.; specifying covered health care benefits for 86 members; creating s. 408.96, F.S.; providing health 87 care provider qualifications for participation in the 88 program; requiring the board to establish and maintain 89 certain procedures and standards for out-of-state 90 health care providers providing services under certain 91 circumstances; providing that members may choose to 92 receive health care services from any participating 93 provider, subject to certain conditions; providing 94 requirements for retaining membership under, and 95 procedures for withdrawing from, certain enrollments; 96 creating s. 408.961, F.S.; providing requirements for 97 care coordination provided by care coordinators; 98 specifying qualifications for care coordinators; 99 authorizing a health care provider to be reimbursed 100 for a health care service only if the member is 101 enrolled with a care coordinator at the time the 102 service is provided; requiring the program to assist 103 certain members in choosing a care coordinator; 104 requiring that a member be enrolled with a care 105 coordinator until the member enrolls with a different 106 care coordinator or ceases to be a member; specifying 107 a member’s right to change care coordinators; 108 authorizing health care organizations to establish 109 certain rules relating to care coordination; providing 110 construction; requiring the board to develop by rule 111 and implement certain procedures and standards; 112 specifying requirements for a care coordinator to 113 maintain approval under the program; creating s. 114 408.962, F.S.; requiring the board to adopt rules 115 relating to contracting and payment methodologies for 116 covered health care services and care coordination; 117 providing a requirement for payment rates; requiring 118 certain health care services to be paid for on a fee 119 for-service basis unless and until the board 120 establishes another methodology; authorizing a certain 121 payment methodology for certain entities; requiring 122 that the program engage in good faith negotiations 123 with health care providers’ representatives; requiring 124 that negotiations for drugs be through a single entity 125 on behalf of the entire program; providing 126 construction; prohibiting participating providers from 127 charging certain rates or soliciting or accepting 128 certain payments; providing exceptions; authorizing 129 the board to adopt rules for payment methodologies for 130 the payment of certain capital-related expenses of 131 certain health facilities; defining the term “health 132 facility”; providing a prior approval requirement for 133 the payment of such expenses; requiring that payment 134 methodologies and payment rates include a 135 reimbursement component for direct and indirect 136 graduate medical education expenses; requiring the 137 board to adopt rules for payment methodologies and 138 procedures for services provided to members while out 139 of the state; creating s. 408.963, F.S.; authorizing 140 members to enroll with and receive certain services 141 from a health care organization; specifying 142 qualifications for a health care organization; 143 requiring the board to develop and implement by rule 144 certain procedures and standards for health care 145 organizations; requiring the board, in developing and 146 implementing such standards, to consult with the 147 Substance Abuse and Mental Health Program Office 148 within the Department of Children and Families; 149 providing requirements for health care organizations 150 to maintain approval under the program; authorizing 151 the board to adopt certain rules relating to 152 compliance; providing construction; prohibiting health 153 care organizations from using health information 154 technology or clinical practice guidelines for certain 155 purposes; providing that physicians and registered 156 nurses may override such technology and guidelines 157 under certain circumstances; creating s. 408.964, 158 F.S.; requiring the board to adopt rules establishing 159 program requirements and standards for the program, 160 health care organizations, care coordinators, and 161 health care providers; specifying the objectives of 162 such requirements and standards; requiring the board 163 to adopt rules establishing requirements and standards 164 for replacing and merging services provided by certain 165 other programs; providing requirements for for-profit 166 participating providers and care coordinators; 167 requiring participating providers to furnish certain 168 information for certain purposes; requiring the board 169 to consult with certain entities in developing 170 requirements and standards and making certain policy 171 determinations; creating s. 408.97, F.S.; requiring 172 the board to seek necessary federal waivers, 173 approvals, and arrangements and submit necessary state 174 plan amendments to operate the program; specifying 175 requirements for the board in applying for such 176 waivers and in making such arrangements; requiring the 177 board to negotiate certain arrangements with the 178 Federal Government; authorizing the board to require 179 members or applicants to provide information for a 180 certain purpose; prohibiting other uses of such 181 information; authorizing the board to take additional 182 actions necessary to effectively implement the 183 program; providing requirements and authorizing 184 certain acts with respect to the program’s 185 administration of federally matched public health 186 programs and Medicare; requiring the board to take 187 certain actions, upon a finding approved by the Chief 188 Financial Officer and the board, to reduce or 189 eliminate certain individual obligations or increase 190 an individual’s eligibility for certain financial 191 support; providing applicability; authorizing the 192 board to require members or applicants to provide 193 certain information for certain purposes; requiring 194 members eligible for Medicare benefits to enroll in 195 Medicare to maintain eligibility in the program; 196 requiring the program to provide premium assistance to 197 members enrolling in a certain Medicare drug coverage 198 plan; requiring a member to provide the program, and 199 authorize the program to obtain, certain information 200 relating to a subsidy under the Social Security Act 201 for a certain purpose; requiring the board to attempt 202 to obtain such information from records available to 203 it; requiring the program to make a reasonable effort 204 to notify members of certain obligations; providing 205 procedures for notifying members and for the 206 termination of coverage; prohibiting certain uses of 207 member information by the board; providing that the 208 board assumes responsibility for certain benefits and 209 services; creating s. 408.972, F.S.; providing 210 legislative intent regarding a revenue plan for the 211 program; creating s. 408.98, F.S.; defining terms; 212 specifying requirements for collective negotiation 213 rights between health care providers and the program; 214 requiring representatives of negotiating parties to 215 pay a fee to the board; requiring the board to set 216 certain fees by rule; prohibiting certain collective 217 actions; providing construction; creating s. 408.99, 218 F.S.; providing that the act does not become operative 219 until the State Surgeon General of the Department of 220 Health provides a specified notice to the Legislature; 221 requiring the Department of Health to publish the 222 notice on its website; creating s. 408.991, F.S.; 223 providing for severability; providing an effective 224 date. 225 226 Be It Enacted by the Legislature of the State of Florida: 227 228 Section 1. The Division of Law Revision and Information is 229 directed to create part V of chapter 408, Florida Statutes, 230 consisting of ss. 408.95-408.991, Florida Statutes, to be 231 entitled the “Healthy Florida Act.” 232 Section 2. Section 408.95, Florida Statutes, is created to 233 read: 234 408.95 Short title.—This part may be cited as the “Healthy 235 Florida Act.” 236 Section 3. Section 408.951, Florida Statutes, is created to 237 read: 238 408.951 Legislative findings and intent.— 239 (1) The Legislature finds and declares all of the 240 following: 241 (a) All residents of this state have the right to health 242 care. While the federal Patient Protection and Affordable Care 243 Act (PPACA) brought many improvements in health care and health 244 care coverage, it still leaves many residents without coverage 245 or with inadequate coverage. 246 (b) Residents of this state, as individuals, employers, and 247 taxpayers, have experienced increases in the cost of health care 248 and health care coverage in recent years, including rising 249 premiums, deductibles, and copays, as well as restricted 250 provider networks and high out-of-network charges. 251 (c) Businesses have also experienced increases in the costs 252 of health care benefits for their employees and many employers 253 are shifting a larger share of the coverage costs to their 254 employees or dropping coverage entirely. 255 (d) Individuals often find that they are deprived of 256 affordable care and choice because of decisions by health 257 benefit plans guided by the plan’s economic needs rather than by 258 consumers’ health care needs. 259 (e) To address the fiscal crisis facing the health care 260 system and the state, and to ensure that residents of this state 261 can exercise their right to health care, comprehensive health 262 care coverage needs to be provided. 263 (f) It is the intent of the Legislature to establish a 264 comprehensive universal single-payer health care coverage 265 program and a health care cost control system for the benefit of 266 all residents of this state. 267 (2)(a) It is further the intent of the Legislature to 268 establish the Healthy Florida (HF) program to provide universal 269 health coverage for every resident of this state based on his or 270 her ability to pay and to be funded by broad-based revenue. 271 (b) It is the intent of the Legislature for the state to 272 work to obtain waivers and other approvals relating to Medicaid, 273 the Children’s Health Insurance Program, Medicare, the PPACA, 274 and any other federal programs so that any federal funds and 275 other subsidies that would otherwise be paid to the state, 276 residents of this state, and health care providers would be paid 277 by the Federal Government to this state and deposited in the 278 Healthy Florida Trust Fund. 279 (c) Under such waivers and approvals, such funds would be 280 used for health coverage that provides health benefits equal to 281 or exceeding those federal programs as well as other program 282 modifications, including elimination of cost-sharing and 283 insurance premiums. 284 (d) The Legislature intends for the programs in paragraph 285 (b) to be replaced and merged into the HF program, which will 286 operate as a true single-payer program. 287 (e) If any necessary waivers or approvals are not obtained, 288 it is the intent of the Legislature that the state use Medicaid 289 state plan amendments and seek waivers and approvals to 290 maximize, and make as seamless as possible, the use of federally 291 matched public health programs and federal health programs in 292 the HF program. 293 (f) Thus, even if other programs such as Medicaid or 294 Medicare may contribute to paying for care, it is the goal of 295 this act that the coverage be delivered by the HF program, and, 296 as much as possible, that the multiple sources of funding be 297 pooled with other HF program funds and not be apparent to HF 298 program members or participating providers. 299 (3) This act does not create any employment benefit, nor 300 does it require, prohibit, or limit the provision of any 301 employment benefit. 302 (4)(a) It is the intent of the Legislature not to change or 303 impact in any way the role or authority of any licensing board 304 or state agency that regulates the standards for or provision of 305 health care and the standards for health care providers as 306 established under current law, including, but not limited to, 307 chapters 381 through 408; chapters 410, 411, 413, and 429; 308 chapters 455 through 467; parts I through IV, X, and XIV of 309 chapter 468; chapters 486, 490, and 491; and the Florida 310 Insurance Code, as applicable. 311 (b) This act does not authorize the Healthy Florida Board, 312 the HF program, or the State Surgeon General of the Department 313 of Health to establish or revise licensure standards for health 314 care providers. 315 (5) It is the intent of the Legislature that neither health 316 information technology nor clinical practice guidelines limit 317 the effective exercise of the professional judgment of 318 physicians and registered nurses. Physicians and registered 319 nurses are free to override health information technology and 320 clinical practice guidelines, if, in their professional 321 judgment, it is in the best interest of the patient and 322 consistent with the patient’s wishes. 323 (6)(a) It is the intent of the Legislature to provide an 324 exemption from public records requirements for the personal 325 identifying information of HF program members as set forth in s. 326 408.985. 327 (b) This act would also prohibit law enforcement agencies 328 from using the HF program’s funds, facilities, property, 329 equipment, or personnel to investigate, enforce, or assist in 330 the investigation or enforcement of any criminal, civil, or 331 administrative violation or warrant for a violation of any law 332 that individuals register with the Federal Government or any 333 federal agency based on religion, national origin, ethnicity, or 334 immigration status. 335 (7) It is the further intent of the Legislature to address 336 the high cost of prescription drugs and ensure they are 337 affordable for patients. 338 Section 4. Section 408.952, Florida Statutes, is created to 339 read: 340 408.952 Definitions.—As used in this part, the term: 341 (1) “Affordable Care Act” or “PPACA” means the federal 342 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 343 as amended by the federal Health Care and Education 344 Reconciliation Act of 2010, Pub. L. No. 111-152, and any 345 amendments to, or regulations or guidance issued under, those 346 acts. 347 (2) “Allied health practitioner” means a group of health 348 professionals who apply their expertise in all specialties to 349 prevent disease transmission and diagnose, treat, and 350 rehabilitate people of all ages. Together with a range of 351 technical and support staff, they may deliver direct patient 352 care, rehabilitation, treatment, diagnostics, and health 353 improvement interventions to restore and maintain optimal 354 physical, sensory, psychological, cognitive, and social 355 functions. As used in this subsection, the term “health 356 professional” includes, but is not limited to, an audiologist, 357 an occupational therapist, a social worker, or a radiographer. 358 (3) “Board” means the Healthy Florida Board created in s. 359 408.953. 360 (4) “Care coordination” means services provided by a care 361 coordinator under s. 408.961. 362 (5) “Care coordinator” means an individual or entity 363 approved by the board to provide care coordination under s. 364 408.961. 365 (6) “Carrier” means a private health insurer holding a 366 valid certificate of authority under chapter 624, or a health 367 maintenance organization holding a valid certificate of 368 authority under chapter 641, issued by the Office of Insurance 369 Regulation. 370 (7) “Committee” means the public advisory committee 371 established under s. 408.954. 372 (8) “Essential community providers” means persons or 373 entities acting as safety net clinics, safety net health care 374 providers, or rural hospitals. 375 (9) “Federally matched public health program” means the 376 state’s Medicaid program under Title XIX of the Social Security 377 Act, 42 U.S.C. ss. 1396 et seq., and the Florida Kidcare Act, 378 the state’s Children’s Health Insurance Program under Title XXI 379 of the Social Security Act, 42 U.S.C. ss. 1397aa et seq. 380 (10) “Fund” means the Healthy Florida Trust Fund created 381 under s. 408.971. 382 (11) “Health care organization” means an entity that is 383 approved by the board under s. 408.963 to provide health care 384 services to members under the program. 385 (12) “Health care service” means any health care service, 386 including care coordination, which is included as a benefit 387 under the program. 388 (13) “Healthy Florida,” “HF,” or “program” means the 389 Healthy Florida program created in s. 408.953. 390 (14) “Implementation period” means the period under s. 391 408.955(6) during which the program is subject to special 392 eligibility and financing provisions until it is fully 393 implemented under that subsection. 394 (15) “Integrated health care delivery system” means a 395 provider organization that: 396 (a) Is fully integrated, operationally and clinically, in 397 order to provide a broad range of health care services, 398 including preventive care, prenatal and well-baby care, 399 immunizations, screening diagnostics, emergency services, 400 hospital and medical services, surgical services, and ancillary 401 services; and 402 (b) Is compensated by Healthy Florida using capitation or 403 facility budgets for the provision of health care services. 404 (16) “Long-term care” means long-term care, treatment, 405 maintenance, or services not covered under the Florida Kidcare 406 Act, as appropriate, with the exception of short-term 407 rehabilitation, and as defined by the board. 408 (17) “Medicaid” or “medical assistance” means a program 409 that is one of the following: 410 (a) The state Medicaid program under Title XIX of the 411 Social Security Act, 42 U.S.C. ss. 1396 et seq. 412 (b) The Florida Kidcare Act, the state’s Children’s Health 413 Insurance Program under Title XXI of the Social Security Act, 42 414 U.S.C. ss. 1397aa et seq. 415 (18) “Medicare” means Title XVIII of the Social Security 416 Act, 42 U.S.C. ss. 1395 et seq., and the programs thereunder. 417 (19) “Member” means an individual who is enrolled in the 418 program. 419 (20) “Out-of-state health care service” means a health care 420 service provided in person to a member while he or she is 421 physically located out of the state under either of the 422 following circumstances: 423 (a) It is medically necessary that the health care service 424 be provided while the member is physically out of the state. 425 (b) It is clinically appropriate and necessary, and cannot 426 be provided in this state, because the health care service can 427 only be provided by a particular health care provider physically 428 located out of the state. However, any health care service 429 provided to an HF member by a health care provider located 430 outside the state and qualified under s. 408.96 is not 431 considered an out-of-state service and must be covered as 432 otherwise provided in this part. 433 (21) “Participating provider” means any individual or 434 entity that is a health care organization or that is a health 435 care provider qualified under s. 408.96 which provides health 436 care services to members under the program. 437 (22) “Prescription drug” has the same meaning as provided 438 in s. 499.003. 439 (23) “Resident” means an individual whose primary place of 440 abode is in this state, without regard to the individual’s 441 immigration status. 442 Section 5. Section 408.953, Florida Statutes, is created to 443 read: 444 408.953 The Healthy Florida program; the Healthy Florida 445 Board; board appointments and governance.— 446 (1) The Healthy Florida program is hereby created and is to 447 be administered by the Healthy Florida Board created under this 448 section. 449 (2) The Healthy Florida Board is hereby created. The board 450 shall be an independent public entity not affiliated with an 451 agency or department. The board shall be governed by an 452 executive board consisting of nine members who are residents of 453 this state. Of the members of the executive board, four shall be 454 appointed by the Governor, two shall be appointed by the 455 President of the Senate, and two shall be appointed by the 456 Speaker of the House of Representatives. The State Surgeon 457 General of the Department of Health or his or her designee shall 458 serve as a voting, ex officio member of the board. 459 (3) Members of the board, other than an ex officio member, 460 shall be appointed for a term of 4 years. Appointments by the 461 Governor shall be subject to confirmation by the Senate. A 462 member of the board may continue to serve until the appointment 463 and qualification of his or her successor. Vacancies shall be 464 filled by appointment for an unexpired term. The board shall 465 elect a chair on an annual basis. 466 (4)(a) Each person appointed to the board must have 467 demonstrated and acknowledged expertise in health care. 468 (b) Appointing authorities shall also consider the 469 expertise of the other members of the board and attempt to make 470 appointments so that the board’s composition reflects a 471 diversity of expertise in the various aspects of health care. 472 (c) Appointments to the board by the Governor, the 473 President of the Senate, and the Speaker of the House of 474 Representatives must consist of: 475 1. At least one representative of a labor organization 476 representing registered nurses. 477 2. At least one representative of the general public. 478 3. At least one representative of a labor organization. 479 4. At least one representative of the medical provider 480 community. 481 (5) Each member of the board shall have the responsibility 482 and duty to meet the requirements of this part, the Affordable 483 Care Act, and all applicable state and federal laws and 484 regulations, to serve the public interest of the individuals, 485 employers, and taxpayers seeking health care coverage through 486 the program, and to ensure the operational well-being and fiscal 487 solvency of the program. 488 (6) In making appointments to the board, the appointing 489 authorities shall take into consideration the cultural, ethnic, 490 and geographical diversity of the state so that the board’s 491 composition reflects the communities of this state. 492 (7)(a) A member of the board or of its staff may not be 493 employed by, a consultant to, a member of the board of directors 494 of, affiliated with, or otherwise be a representative of a 495 health care provider, a health care facility, or a health clinic 496 while serving on the board or on the board staff. A member of 497 the board or of its staff may not be a member, a board member, 498 or an employee of a trade association of health facilities, 499 health clinics, or health care providers while serving on the 500 board or on the staff of the board. A member of the board or of 501 its staff may not be a health care provider unless he or she 502 receives no compensation for rendering services as a health care 503 provider and does not have an ownership interest in a health 504 care practice. 505 (b) A board member may not receive compensation for his or 506 her service on the board, but may be reimbursed for per diem and 507 travel expenses in accordance with s. 112.061 while engaged in 508 the performance of official duties of the board. 509 (c) For purposes of this subsection, the term “health care 510 provider” means a health care professional licensed under 511 chapter 458, chapter 459, chapter 460, chapter 461, chapter 463, 512 chapter 464, chapter 465, chapter 466, part I, part III, part 513 IV, part V, or part X of chapter 468, chapter 483, chapter 484, 514 chapter 486, chapter 490, or chapter 491. 515 (8) A member of the board may not make, participate in 516 making, or in any way attempt to use his or her official 517 position to influence the making of a decision that he or she 518 knows, or has reason to know, will have a reasonably foreseeable 519 material financial effect, distinguishable from its effect on 520 the public generally, on him or her or a member of his or her 521 immediate family, or on either of the following: 522 (a) Any source of income aggregating $250 or more in value 523 provided to, received by, or promised to the member within 12 524 months before the time when the decision is made, other than 525 gifts and other than loans by a commercial lending institution 526 in the regular course of business on terms available to the 527 public without regard to official status. 528 (b) Any business entity in which the member is a director, 529 officer, partner, trustee, or employee, or holds any position of 530 management. 531 (9) There may not be liability in a private capacity on the 532 part of the board or a member of the board, or an officer or 533 employee of the board, for or on account of an act performed or 534 obligation entered into in an official capacity when done in 535 good faith, without intent to defraud, and in connection with 536 the administration, management, or conduct of this part or 537 affairs related to this part. 538 (10) The board shall hire an executive director to 539 organize, administer, and manage the operations of the board. 540 The executive director is exempt from civil service and shall 541 serve at the pleasure of the board. 542 (11) The board’s meetings are subject to s. 286.011. 543 (12) The board may adopt rules necessary to implement and 544 administer this part in accordance with chapter 120. 545 Section 6. Section 408.954, Florida Statutes, is created to 546 read: 547 408.954 Public advisory committee; composition; 548 appointments; duties.— 549 (1) The State Surgeon General of the Department of Health 550 shall establish a public advisory committee to advise the board 551 on all matters of policy for the program. 552 (2) The members of the committee must include all of the 553 following: 554 (a) Four physicians, all of whom must be board certified in 555 their fields, and at least one of whom must be a psychiatrist. 556 The President of the Senate and the Governor shall each appoint 557 one member. The Speaker of the House of Representatives shall 558 appoint two of these members, both of whom shall be primary care 559 providers. 560 (b) Two registered nurses, to be appointed by the President 561 of the Senate. 562 (c) One licensed allied health practitioner, to be 563 appointed by the Speaker of the House of Representatives. 564 (d) One mental health care provider, to be appointed by the 565 President of the Senate. 566 (e) One dentist, to be appointed by the Governor. 567 (f) One representative of private hospitals, to be 568 appointed by the Governor. 569 (g) One representative of public hospitals, to be appointed 570 by the Governor. 571 (h) One representative of an integrated health care 572 delivery system, to be appointed by the Governor. 573 (i) Four consumers of health care. The Governor shall 574 appoint two of these members, one of whom shall be a member of 575 the disabled community. The President of the Senate shall 576 appoint a member who is 65 years of age or older. The Speaker of 577 the House of Representatives shall appoint the fourth member. 578 (j) One representative of organized labor, to be appointed 579 by the Speaker of the House of Representatives. 580 (k) One member of organized labor, to be appointed by the 581 President of the Senate. 582 (l) One representative of essential community providers, to 583 be appointed by the President of the Senate. 584 (m) One representative of small business, which is a 585 business that employs less than 25 people, to be appointed by 586 the Governor. 587 (n) One representative of large business, which is a 588 business that employs more than 250 people, to be appointed by 589 the Speaker of the House of Representatives. 590 (o) One pharmacist, to be appointed by the Speaker of the 591 House of Representatives. 592 (3) In making appointments pursuant to this section, the 593 Governor, the President of the Senate, and the Speaker of the 594 House of Representatives shall make good faith efforts to ensure 595 that their appointments, as a whole, reflect, to the greatest 596 extent feasible, the social and geographic diversity of the 597 state. 598 (4) Any member appointed by the Governor, the President of 599 the Senate, or the Speaker of the House of Representatives shall 600 serve a 4-year term. These members may be reappointed for 601 succeeding 4-year terms. 602 (5) A vacancy that occurs must be filled within 30 days 603 after it occurs and in the same manner in which the vacating 604 member was initially selected or appointed. The State Surgeon 605 General of the Department of Health shall notify the appropriate 606 appointing authority of any expected vacancy on the public 607 advisory committee. 608 (6) Members of the committee shall serve without 609 compensation, but shall be reimbursed for per diem and travel 610 expenses in accordance with s. 112.061, and except that a member 611 shall receive $100 for each full day of attending meetings of 612 the committee. As used in this subsection, the term “full day of 613 attending a meeting” means presence at, and participation in, 614 not less than 75 percent of the total meeting time of the 615 committee during any particular 24-hour period. 616 (7) The public advisory committee shall meet at least 6 617 times per year in a place convenient to the public. All meetings 618 of the committee must be open to the public pursuant to s. 619 286.011. 620 (8) The public advisory committee shall elect a chair who 621 shall serve for 2 years and who may be reelected for an 622 additional 2 years. 623 (9) Appointed committee members must have worked in the 624 field they represent on the committee for a period of at least 2 625 years before being appointed to the committee. 626 (10) It is unlawful for the committee members or any of 627 their assistants, clerks, or deputies to use for personal 628 benefit any information that is filed with, or obtained by, the 629 committee and that is not generally available to the public. 630 Section 7. Section 408.955, Florida Statutes, is created to 631 read: 632 408.955 Board powers and duties.— 633 (1) The board has all powers and duties necessary to 634 establish and implement the Healthy Florida program under this 635 part. The program must provide comprehensive universal single 636 payer health care coverage and a health care cost control system 637 for the benefit of all residents of this state. 638 (2) The board shall, to the maximum extent possible, 639 organize, administer, and market the program and services as a 640 single-payer program under the name “HF,” “Healthy Florida,” or 641 any other name as the board determines, regardless of the law or 642 source where the definition of a benefit is found, including, on 643 a voluntary basis, retiree health benefits. In implementing this 644 part, the board shall avoid jeopardizing federal financial 645 participation in the programs that are incorporated into Healthy 646 Florida and shall take care to promote public understanding and 647 awareness of available benefits and programs. 648 (3) The board shall consider any matter necessary to carry 649 out the provisions and purposes of this part. The board may have 650 no executive, administrative, or appointive duties except as 651 otherwise provided by law. 652 (4) The board shall employ necessary staff and authorize 653 reasonable expenditures, as necessary, from the Healthy Florida 654 Trust Fund to pay program expenses and to administer the 655 program. 656 (5) The board may do all of the following: 657 (a) Negotiate and enter into any necessary contracts, 658 including, but not limited to, contracts with health care 659 providers, integrated health care delivery systems, and care 660 coordinators. 661 (b) Sue and be sued. 662 (c) Receive and accept gifts, grants, or donations of 663 moneys from any agency of the Federal Government, any agency of 664 the state, and any municipality, county, or other political 665 subdivision of the state. 666 (d) Receive and accept gifts, grants, or donations from 667 individuals, associations, private foundations, and 668 corporations, in compliance with the conflict of interest 669 provisions to be adopted by the board by rule. 670 (e) Share information with relevant state agencies, 671 consistent with the confidentiality provisions in this part, 672 which is necessary for the administration of the program. 673 (6) The board shall determine when individuals may begin 674 enrolling in the program. There must be an implementation period 675 that begins on the date that individuals may begin enrolling in 676 the program and ends on a date determined by the board. 677 (7) A carrier may not offer benefits or cover any services 678 for which coverage is offered to individuals under the program, 679 but may, if otherwise authorized, offer benefits to cover health 680 care services that are not offered to individuals under the 681 program. However, this part does not prohibit a carrier from 682 offering: 683 (a) Any benefits to or for individuals, including their 684 families, who are employed or self-employed in the state but who 685 are not residents of the state; or 686 (b) Any benefits during the implementation period to 687 individuals who enrolled or may enroll as members of the 688 program. 689 (8) After the end of the implementation period, a person 690 may not be a board member unless he or she is a member of the 691 program, except the ex officio member. 692 (9) No later than July 1, 2020, the board shall develop the 693 following proposals: 694 (a) A proposal, consistent with the principles of this 695 part, for the program to provide long-term care coverage, 696 including the development of a proposal, consistent with the 697 principles of this part, for the program’s funding. In 698 developing the proposal, the board shall consult with an 699 advisory committee, appointed by the board chair, which includes 700 representatives of consumers and potential consumers of long 701 term care, providers of long-term care, members of organized 702 labor, and other interested parties. 703 (b) Proposals for: 704 1. Accommodating employer retiree health benefits for 705 people who have been members of HF but live as retirees out of 706 this state; and 707 2. Accommodating employer retiree health benefits for 708 people who earned or accrued those benefits while residing in 709 this state before the implementation of HF and live as retirees 710 out of this state. 711 (c) A proposal for HF coverage of health care services 712 currently covered under the workers’ compensation system, 713 including whether and how to continue funding for those services 714 under that system and whether and how to incorporate an element 715 of experience rating. 716 (10) The board may contract with nonprofit organizations to 717 provide: 718 (a) Assistance to consumers with respect to selection of a 719 care coordinator or health care organization, enrolling, 720 obtaining health care services, disenrolling, and other matters 721 relating to the program; and 722 (b) Assistance to health care providers providing, seeking, 723 or considering whether to provide health care services under the 724 program, with respect to participating in a health care 725 organization and interacting with a health care organization. 726 (11) The board shall provide grants from funds in the 727 Healthy Florida Trust Fund or from funds otherwise appropriated 728 for this purpose to the Agency for Health Care Administration 729 for its functions as the state health planning agency under s. 730 408.034. 731 (12) The board shall provide funds from the Healthy Florida 732 Trust Fund or funds otherwise appropriated for this purpose to 733 the Department of Economic Opportunity for a program for 734 retraining and assisting with job transition for individuals 735 employed or previously employed in the fields of health 736 insurance, for health care service plans, and for other third 737 party payments for health care or those individuals providing 738 services to health care providers to deal with third-party 739 payers for health care and whose jobs may be or have been ended 740 as a result of the implementation of the program, consistent 741 with otherwise applicable law. 742 (13)(a) The board shall provide for the collection and 743 availability of all of the following data to promote 744 transparency, assess adherence to patient care standards, 745 compare patient outcomes, and review utilization of health care 746 services paid for by the program: 747 1. Inpatient discharge data, including acuity and risk of 748 mortality. 749 2. Emergency department and ambulatory surgery data, 750 including charge data, length of stay, and patients’ unit of 751 observation. 752 3. Hospital annual financial data, including all of the 753 following: 754 a. Community benefits by hospital in dollar value. 755 b. Number of employees and classification by hospital unit. 756 c. Number of hours worked by hospital unit. 757 d. Employee wage information by job title and hospital 758 unit. 759 e. Number of registered nurses per staffed bed by hospital 760 unit. 761 f. Type and value of healthy information technology. 762 g. Annual spending on health information technology, 763 including purchases, upgrades, and maintenance. 764 (b) The board shall make all disclosed data collected under 765 paragraph (a) publicly available and searchable through a 766 website and through the Department of Health’s public data sets. 767 (c) The board shall, directly and through grants to 768 nonprofit entities, conduct programs using data collected 769 through the Healthy Florida program to promote and protect 770 public, environmental, and occupational health, including 771 cooperation with other data collection and research programs of 772 the Department of Health, consistent with this part and 773 otherwise applicable law. 774 (d) Before full implementation of the program, the board 775 shall provide for the collection and availability of data on the 776 number of patients served by hospitals and the dollar value of 777 the care provided, at cost, for all of the following categories 778 of Department of Health data items: 779 1. Patients receiving charity care. 780 2. Contractual adjustments of county and indigent programs, 781 including traditional and managed care. 782 3. Bad debts. 783 Section 8. Section 408.956, Florida Statutes, is created to 784 read: 785 408.956 Law enforcement agencies; prohibited acts relating 786 to Healthy Florida.—Notwithstanding any other law, a law 787 enforcement agency may not use Healthy Florida moneys, 788 facilities, property, equipment, or personnel to investigate, 789 enforce, or assist in the investigation or enforcement of any 790 criminal, civil, or administrative violation or warrant for a 791 violation of any requirement that individuals register with the 792 Federal Government or any federal agency based on religion, 793 national origin, ethnicity, or immigration status. 794 Section 9. Section 408.957, Florida Statutes, is created to 795 read: 796 408.957 Eligibility and enrollment.— 797 (1) Every resident of this state is eligible and entitled 798 to enroll as a member under the program. 799 (2)(a) A member may not be required to pay any fee, 800 payment, or other charge for enrolling in or being a member 801 under the program. 802 (b) A member may not be required to pay any premium, 803 copayment, coinsurance, deductible, or any other form of cost 804 sharing for all covered benefits. 805 (3) A college, university, or other institution of higher 806 education in this state may purchase coverage under the program 807 for a student, or a student’s dependent, who is not a resident 808 of the state. 809 Section 10. Section 408.958, Florida Statutes, is created 810 to read: 811 408.958 Benefits.— 812 (1) Covered health care benefits under the program include 813 all medical care determined to be medically appropriate by the 814 member’s health care provider. 815 (2) Covered health care benefits for members must include, 816 but are not limited to, all of the following: 817 (a) Licensed inpatient and licensed outpatient medical and 818 health facility services. 819 (b) Inpatient and outpatient professional health care 820 provider medical services. 821 (c) Diagnostic imaging, laboratory services, and other 822 diagnostic and evaluative services. 823 (d) Medical equipment, appliances, and assistive 824 technology, including prosthetics, eyeglasses, and hearing aids 825 and the repair, technical support, and customization needed for 826 individual use. 827 (e) Inpatient and outpatient rehabilitative care. 828 (f) Emergency care services. 829 (g) Emergency transportation. 830 (h) Necessary transportation for health care services for 831 persons with disabilities or who may qualify as low income. 832 (i) Child and adult immunizations and preventive care. 833 (j) Health and wellness education. 834 (k) Hospice care. 835 (l) Care in a skilled nursing facility. 836 (m) Home health care, including health care provided in an 837 assisted living facility. 838 (n) Mental health services. 839 (o) Substance abuse treatment. 840 (p) Dental care. 841 (q) Vision care. 842 (r) Prescription drugs. 843 (s) Pediatric care. 844 (t) Prenatal and postnatal care. 845 (u) Podiatric care. 846 (v) Chiropractic care. 847 (w) Acupuncture. 848 (x) Therapies that are shown by the National Center for 849 Complementary and Integrative Health, National Institutes of 850 Health, to be safe and effective. 851 (y) Blood and blood products. 852 (z) Dialysis. 853 (aa) Adult day care. 854 (bb) Rehabilitative services. 855 (cc) Ancillary health care or social services previously 856 covered by county primary care programs under part I of chapter 857 154. 858 (dd) Ancillary health care or social services for persons 859 with developmental disabilities which were previously 860 administered by the Developmental Disabilities Council under 861 chapter 393. 862 (ee) Case management and care coordination. 863 (ff) Language interpretation and translation for health 864 care services, including sign language and Braille or other 865 services needed for individuals to overcome communication 866 barriers. 867 (gg) Health care and long-term supportive services 868 currently covered under Medicaid or the Florida Kidcare Act. 869 (3) Covered benefits for members must also include all 870 health care services required to be covered under any of the 871 following provisions, without regard to whether the member would 872 otherwise be eligible for or covered by the program or source 873 referred to: 874 (a) The Florida Kidcare Act. 875 (b) The state Medicaid program. 876 (c) The Medicare program pursuant to Title XVIII of the 877 Social Security Act, 42 U.S.C. ss. 1395 et seq. 878 (d) Chapter 641. 879 (e) Parts II, VI, and VII of chapter 627, relating to 880 health insurers. 881 (f) Any additional health care services authorized to be 882 added to the program’s benefits by the program. 883 (g) All essential health benefits mandated by the 884 Affordable Care Act as of July 1, 2018. 885 Section 11. Section 408.96, Florida Statutes, is created to 886 read: 887 408.96 Delivery of care; health care providers.— 888 (1)(a) Any health care provider who is licensed to practice 889 in this state and is otherwise in good standing is qualified to 890 participate in the program as long as the health care provider’s 891 services are performed within this state. 892 (b) The board shall establish and maintain procedures and 893 standards for recognizing health care providers located out of 894 this state for purposes of providing coverage under the program 895 for a member who requires out-of-state health care services 896 while he or she is temporarily located out of this state. 897 (2) Any health care provider qualified to participate under 898 this section may provide covered health care services under the 899 program as long as the health care provider is legally 900 authorized to perform the health care service for the individual 901 and under the circumstances involved. 902 (3) A member may choose to receive health care services 903 under the program from any participating provider, consistent 904 with this part and the willingness or availability of the 905 provider, subject to provisions of this part relating to 906 discrimination and the appropriate clinically relevant 907 circumstances. 908 (4) A person who chooses to enroll with an integrated 909 health care delivery system, group medical practice, or 910 essential community provider that offers comprehensive services 911 shall retain membership for at least 1 year after an initial 3 912 month evaluation period, during which time the person may 913 withdraw for any reason. 914 (a) The 3-month period must commence on the date when a 915 member first sees a primary care provider. 916 (b) A person who wishes to withdraw after the initial 3 917 month period shall request a withdrawal pursuant to the dispute 918 resolution procedures established by the board and may request 919 assistance from the patient advocate, which must be provided for 920 in the dispute resolution procedures, in resolving the dispute. 921 The dispute must be resolved in a timely fashion and may not 922 have an adverse effect on the care a patient receives. 923 Section 12. Section 408.961, Florida Statutes, is created 924 to read: 925 408.961 Care coordination.— 926 (1) Care coordination must be provided to the member by his 927 or her care coordinator. A care coordinator may employ or use 928 the services of other individuals or entities to assist in 929 providing care coordination for the member, consistent with 930 regulations of the board and with the statutory requirements and 931 regulations of the care coordinator’s licensure. 932 (2) Care coordination includes administrative tracking and 933 medical recordkeeping services for members, except as otherwise 934 specified for integrated health care delivery systems. 935 (3) Care coordination administrative tracking and medical 936 recordkeeping services for members are not required in order to 937 use a certified electronic health record, meet any other 938 requirements of the federal Health Information Technology for 939 Economic and Clinical Health Act enacted under the federal 940 American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, 941 or meet certification requirements of the federal Centers for 942 Medicare and Medicaid Services’ Electronic Health Records 943 Incentive Programs, including meaningful use requirements. 944 (4) The care coordinator shall comply with all state and 945 federal privacy laws, including, but not limited to, s. 381.004, 946 s. 395.3025, s. 456.057, and the Health Insurance Portability 947 and Accountability Act, 42 U.S.C. ss. 1320d et seq., and its 948 implementing regulations. 949 (5) Referrals from a care coordinator are not required for 950 a member to see any eligible provider. 951 (6) A care coordinator may be an individual or entity that 952 is approved under the program and that is any of the following: 953 (a) A health care practitioner that is any of the 954 following: 955 1. The member’s primary care provider. 956 2. The member’s provider of primary gynecological care. 957 3. At the option of a member who has a chronic condition 958 that requires specialty care, a specialist health care 959 practitioner who regularly and continually provides treatment to 960 the member for that condition. 961 (b) An entity authorized by law to provide: 962 1. Hospital services in accordance with chapter 395; 963 2. Nursing home care services in accordance with chapter 964 400; 965 3. Life care services in accordance with chapter 651; 966 4. Services for the developmentally disabled under chapter 967 393; 968 5. Services for the mentally ill under chapter 394; 969 6. Assisted living services in accordance with chapter 429; 970 or 971 7. Hospice services in accordance with chapter 400. 972 (c) A health care organization. 973 (d) A Taft-Hartley health and welfare fund, with respect to 974 its members and their family members. This paragraph does not 975 preclude a Taft-Hartley health and welfare fund from becoming a 976 care coordinator under paragraph (e) or a health care 977 organization under s. 408.963. 978 (e) Any nonprofit or governmental entity approved under the 979 program. 980 (7)(a) A health care provider may be reimbursed for a 981 health care service only if the member is enrolled with a care 982 coordinator at the time the service is provided. 983 (b) Every member is encouraged to enroll with a care 984 coordinator that agrees to provide care coordination before the 985 member receives health care services to be paid for under the 986 program. If a member receives health care services before 987 choosing a care coordinator, the program shall assist the 988 member, when appropriate, with choosing a care coordinator. 989 (c) The member must remain enrolled with his or her care 990 coordinator until the member enrolls with a different care 991 coordinator or ceases to be a member. A member has the right to 992 change his or her care coordinators on terms at least as 993 permissive as provided in part III or part IV of chapter 409. 994 (8) A health care organization may establish rules relating 995 to care coordination for members in the health care organization 996 which are different from this section but otherwise consistent 997 with this part and other applicable laws. 998 (9) This section does not authorize any individual to 999 engage in any act in violation of the applicable chapter under 1000 which he or she is licensed to practice. 1001 (10) An individual or entity may not be a care coordinator 1002 unless the services included in care coordination are within the 1003 individual’s professional scope of practice or the entity’s 1004 legal authority. 1005 (11)(a) The board shall develop by rule and implement 1006 procedures and standards for an individual or entity to be 1007 approved as a care coordinator in the program, including, but 1008 not limited to, procedures and standards relating to the 1009 revocation, suspension, or limitation of approval on a 1010 determination that the individual or entity is incompetent to be 1011 a care coordinator or has exhibited conduct that is inconsistent 1012 with program standards and regulations, or that exhibits an 1013 unwillingness to meet those standards and regulations, or is a 1014 potential threat to the public health or safety. 1015 (b) The procedures and standards the board adopts must be 1016 consistent with established professional practice, licensure 1017 standards, and regulations for health care practitioners and 1018 providers. 1019 (c) In developing and implementing standards of approval of 1020 care coordinators for individuals receiving chronic mental 1021 health care services, the board shall consult with the Substance 1022 Abuse and Mental Health Program Office within the Department of 1023 Children and Families. 1024 (12) To maintain approval under the program, a care 1025 coordinator must do all of the following: 1026 (a) Renew the approval every 3 years pursuant to rules the 1027 board adopts. 1028 (b) Provide to the program any data required by the 1029 Department of Health which would enable the board to evaluate 1030 the impact of care coordinators on quality, outcomes, and cost 1031 of health care. 1032 Section 13. Section 408.962, Florida Statutes, is created 1033 to read: 1034 408.962 Payment for health care services and care 1035 coordination.— 1036 (1) The board shall adopt rules regarding contracting for, 1037 and establishing payment methodologies for, covered health care 1038 services and care coordination provided to members under the 1039 program by participating providers, care coordinators, and 1040 health care organizations. There may be a variety of different 1041 payment methodologies, including those established on a 1042 demonstration basis. All payment rates under the program must be 1043 reasonable and reasonably related to the cost of efficiently 1044 providing the health care service and ensuring an adequate and 1045 accessible supply of health care services. 1046 (2) Health care services provided to members under the 1047 program, except for care coordination, must be paid for on a 1048 fee-for-service basis unless and until another payment 1049 methodology is established by the board. 1050 (3) Notwithstanding subsection (2), integrated health care 1051 delivery systems, essential community providers, and group 1052 medical practices that provide comprehensive, coordinated 1053 services may choose to be reimbursed on the basis of a capitated 1054 system operating budget or a noncapitated system operating 1055 budget that covers all costs of providing health care services. 1056 (4) The program shall engage in good faith negotiations 1057 with health care providers’ representatives under s. 408.98, 1058 including, but not limited to, in relation to rates of payment 1059 for health care services, rates of payment for prescription and 1060 nonprescription drugs, and payment methodologies. For 1061 prescription and nonprescription drugs, the negotiations must be 1062 conducted through a single entity on behalf of the entire 1063 program. 1064 (5)(a) Payments for health care services established under 1065 this part are considered payment in full. 1066 (b) A participating provider may not charge any rate in 1067 excess of the payment established under this part for any health 1068 care service provided to a member under the program and may not 1069 solicit or accept payment from any member or third party for any 1070 health care service, except as provided under a federal program. 1071 (c) However, this section does not preclude the program 1072 from acting as a primary or secondary payer in conjunction with 1073 another third-party payer when permitted by a federal program. 1074 (6) The board may adopt by rule payment methodologies for 1075 the payment of capital-related expenses for specifically 1076 identified capital expenditures incurred by a nonprofit or 1077 governmental entity that is a health facility. As used in this 1078 subsection, the term “health facility” has the same meaning as 1079 provided in s. 154.205(8). Any capital-related expense generated 1080 by a capital expenditure that requires prior approval must have 1081 received that approval in order to be paid by the program. That 1082 approval must be based on achievement of the program standards 1083 described in s. 408.964. 1084 (7) Payment methodologies and payment rates must include a 1085 distinct component for reimbursement of direct and indirect 1086 graduate medical education expenses. 1087 (8) The board shall adopt by rule payment methodologies and 1088 procedures for paying for health care services provided to a 1089 member while he or she is located out of the state. 1090 Section 14. Section 408.963, Florida Statutes, is created 1091 to read: 1092 408.963 Health care organizations.— 1093 (1) A member may choose to enroll with and receive program 1094 care coordination and ancillary health care services from a 1095 health care organization. 1096 (2) A health care organization must be a nonprofit or 1097 governmental entity that is approved by the board and that is 1098 either of the following: 1099 (a) The county health department delivery system 1100 established by the Department of Health under s. 154.01. 1101 (b) A facility licensed by the Agency for Persons for 1102 Disabilities which provides developmental disabilities services 1103 under chapter 393. 1104 (3)(a) The board shall by rule develop and implement 1105 procedures and standards for an entity to be approved as a 1106 health care organization in the program, including, but not 1107 limited to, procedures and standards relating to the revocation, 1108 suspension, or limitation of approval on a determination that 1109 the entity is incompetent to be a health care organization or 1110 has exhibited a course of conduct that is inconsistent with 1111 program standards and regulations, or that exhibits an 1112 unwillingness to meet those standards and regulations, or is a 1113 potential threat to the public health or safety. 1114 (b) The procedures and standards adopted by the board must 1115 be consistent with established professional practice, licensure 1116 standards, and regulations for health care practitioners and 1117 providers. 1118 (c) In developing and implementing standards of approval of 1119 health care organizations, the board shall consult with the 1120 Substance Abuse and Mental Health Program Office within the 1121 Department of Children and Families. 1122 (4) To maintain approval under the program, a health care 1123 organization must: 1124 (a) Renew its approval at a frequency determined by the 1125 board; and 1126 (b) Provide data to the Department of Health, as required 1127 by the board, to enable the board to evaluate the health care 1128 organization in relation to the quality of health care services 1129 provided, health care outcomes, and cost. 1130 (5) The board may adopt rules relating specifically to 1131 health care organizations for the sole and specific purpose of 1132 ensuring compliance with this part. 1133 (6) This part may not be construed to alter in any way the 1134 professional practice of health care providers or their 1135 licensure standards. 1136 (7) Health care organizations may not use health 1137 information technology or clinical practice guidelines that 1138 limit the effective exercise of the professional judgment of 1139 physicians and registered nurses. Physicians and registered 1140 nurses are free to override health information technology and 1141 clinical practice guidelines if, in their professional judgment, 1142 it is in the best interest of the patient and consistent with 1143 the patient’s wishes. 1144 Section 15. Section 408.964, Florida Statutes, is created 1145 to read: 1146 408.964 Program standards.—The Healthy Florida Board shall 1147 establish a single standard of safe, therapeutic care for all 1148 residents of the state by the following means: 1149 (1) The board shall establish by rule requirements and 1150 standards for the program and for health care organizations, 1151 care coordinators, and health care providers consistent with 1152 this part and consistent with the applicable professional 1153 practice and licensure standards of health care providers and 1154 health care professionals, including requirements and standards 1155 for, as applicable: 1156 (a) The scope, quality, and accessibility of health care 1157 services. 1158 (b) Relations between health care organizations or health 1159 care providers and members. 1160 (c) Relations between health care organizations and health 1161 care providers, including credentialing and participation in the 1162 health care organization, and terms, methods, and rates of 1163 payment. 1164 (2) The board shall establish by rule requirements and 1165 standards under the program which include, but are not limited 1166 to, provisions to promote all of the following: 1167 (a) Simplification of, transparency in, uniformity in, and 1168 fairness in health care provider credentialing and participation 1169 in health care organization networks, referrals, payment 1170 procedures and rates, claims processing, and approval of health 1171 care services, as applicable. 1172 (b) In-person primary and preventive care, care 1173 coordination, efficient and effective health care services, 1174 quality assurance, and promotion of public, environmental, and 1175 occupational health. 1176 (c) Elimination of health care disparities. 1177 (d) Nondiscrimination with respect to members and health 1178 care providers on the basis of race, color, ancestry, national 1179 origin, religion, citizenship, immigration status, primary 1180 language, mental or physical disability, age, sex, gender, 1181 sexual orientation, gender identity or expression, medical 1182 condition, genetic information, marital status, familial status, 1183 military or veteran status, or source of income; however, health 1184 care services provided under the program must be appropriate to 1185 the patient’s clinically relevant circumstances. 1186 (e) Accessibility of care coordination, health care 1187 organization services, and health care services, including 1188 accessibility for people with disabilities and people with 1189 limited ability to speak or understand English. 1190 (f) Providing care coordination, health care organization 1191 services, and health care services in a culturally competent 1192 manner. 1193 (3) The board shall establish by rule requirements and 1194 standards, to the extent authorized by federal law, for 1195 replacing and merging with the Healthy Florida program health 1196 care services and ancillary services currently provided by other 1197 programs, including, but not limited to, Medicare, the 1198 Affordable Care Act, and federally matched public health 1199 programs. 1200 (4) Any participating provider or care coordinator that is 1201 organized as a for-profit entity shall be required to meet the 1202 same requirements and standards as entities organized as 1203 nonprofits, and payments under the program paid to those 1204 entities may not be calculated to accommodate the generation of 1205 profit, revenue for dividends, or other return on investment or 1206 the payment of taxes that would not be paid by a nonprofit 1207 entity. 1208 (5) Every participating provider shall furnish information 1209 as required by the Department of Health and allow the 1210 examination of that information by the program as may be 1211 reasonably required for purposes of reviewing accessibility and 1212 utilization of health care services, quality assurance, cost 1213 containment, the making of payments, and statistical or other 1214 studies of the operation of the program or for protection and 1215 promotion of public, environmental, and occupational health. 1216 (6) In developing requirements and standards and making 1217 other policy determinations under this section, the board shall 1218 consult with representatives of members, health care providers, 1219 care coordinators, health care organizations, labor 1220 organizations representing health care employees, and other 1221 interested parties. 1222 Section 16. Section 408.97, Florida Statutes, is created to 1223 read: 1224 408.97 Federal health programs and funding.— 1225 (1) The board shall seek all federal waivers and other 1226 federal approvals and arrangements and submit state plan 1227 amendments as necessary to operate the Healthy Florida program 1228 consistent with this part. 1229 (2)(a) The board shall apply to the United States Secretary 1230 of Health and Human Services or other appropriate federal 1231 official for all waivers of requirements, and make other 1232 arrangements necessary, under Medicare, any federally matched 1233 public health program, the Affordable Care Act, and any other 1234 federal program that provides federal funds for payment of 1235 health care services, to enable all Healthy Florida members to 1236 receive all benefits under the program, to enable the state to 1237 implement this part, and to allow the state to receive and 1238 deposit all federal payments under those programs, including 1239 funds that may be provided in lieu of premium tax credits, cost 1240 sharing subsidies, and small business tax credits, in the State 1241 Treasury to the credit of the Healthy Florida Trust Fund, 1242 created under s. 408.971, and to use those funds for the program 1243 and other provisions under this part. 1244 (b) To the fullest extent possible, the board shall 1245 negotiate arrangements with the Federal Government to ensure 1246 that federal payments are paid to Healthy Florida in place of 1247 federal funding of, or tax benefits for, federally matched 1248 public health programs or federal health programs. 1249 (c) The board may require members or applicants to provide 1250 information necessary for the program to comply with any waiver 1251 or arrangement under this part. Information provided by members 1252 to the board for the purposes of this paragraph may not be used 1253 for any other purpose. 1254 (d) The board may take any additional actions necessary to 1255 effectively implement Healthy Florida to the maximum extent 1256 possible as a single-payer program consistent with this part. 1257 (3) The board may take actions consistent with this part to 1258 enable the program to administer Medicare in this state. The 1259 program must be a provider of supplemental insurance coverage 1260 under Medicare Part B and must provide premium assistance for 1261 drug coverage under Medicare Part D for eligible members of the 1262 program. 1263 (4) The board may waive or modify the applicability of any 1264 provision of this section relating to any federally matched 1265 public health program or Medicare, as necessary, to implement 1266 any waiver or arrangement under this section or to maximize the 1267 federal benefits to the program under this section, provided 1268 that the board, in consultation with the Chief Financial 1269 Officer, determines that the waiver or modification is in the 1270 best interest of the state and members affected by the action. 1271 (5) The board may apply for coverage for, and enroll, any 1272 eligible member under any federally matched public health 1273 program or Medicare. Enrollment in a federally matched public 1274 health program or Medicare may not cause any member to lose any 1275 health care service provided by the program or diminish any 1276 right the member would otherwise have. 1277 (6)(a) Notwithstanding any other law, the board shall 1278 increase by rule the income eligibility level, increase or 1279 eliminate the resource test for eligibility, simplify any 1280 procedural or documentation requirement for enrollment, and 1281 increase the benefits for any federally matched public health 1282 program and for any program in order to reduce or eliminate an 1283 individual’s coinsurance, cost-sharing, or premium obligations 1284 or increase an individual’s eligibility for any federal 1285 financial support related to Medicare or the Affordable Care 1286 Act. 1287 (b) The board may act under this subsection upon a finding 1288 approved by the Chief Financial Officer and the board that the 1289 action: 1290 1. Will help to increase the number of members who are 1291 eligible for and enrolled in federally matched public health 1292 programs; or, for any program, to reduce or eliminate an 1293 individual’s coinsurance, cost-sharing, or premium obligations; 1294 or increase an individual’s eligibility for any federal 1295 financial support related to Medicare or the Affordable Care 1296 Act; 1297 2. Will not diminish any individual’s access to any health 1298 care service or any right the individual would otherwise have; 1299 3. Is in the interest of the program; and 1300 4. Has received any necessary federal waivers or approvals 1301 to ensure federal financial participation, or does not require 1302 any such waiver or approval. 1303 (c) Actions under this subsection do not apply to 1304 eligibility for payment for long-term care. 1305 (7) To enable the board to apply for coverage for, and 1306 enroll, any eligible member under any federally matched public 1307 health program or Medicare, the board may require that every 1308 member or applicant provide the information necessary to enable 1309 the board to determine whether the applicant is eligible for a 1310 federally matched public health program or for Medicare, or any 1311 program or benefit under Medicare. 1312 (8) As a condition of continued eligibility for health care 1313 services under the program, a member who is eligible for 1314 benefits under Medicare must enroll in Medicare, including Parts 1315 A, B, and D. 1316 (9) The program shall provide premium assistance for all 1317 members enrolling in a Medicare Part D drug coverage plan under 1318 s. 1860D of Title XVIII of the Social Security Act, 42 U.S.C. 1319 ss. 1395w-101 et seq., limited to the low-income benchmark 1320 premium amount established by the federal Centers for Medicare 1321 and Medicaid Services and any other amount the federal agency 1322 establishes under its de minimis premium policy, except that 1323 those payments made on behalf of members enrolled in a Medicare 1324 advantage plan may exceed the low-income benchmark premium 1325 amount if determined to be cost effective to the program. 1326 (10) If the board has reasonable grounds to believe that a 1327 member may be eligible for an income-related subsidy under s. 1328 1860D-14 of Title XVIII of the Social Security Act, 42 U.S.C. s. 1329 1395w-114, the member must provide, and authorize the program to 1330 obtain, any information or documentation required to establish 1331 the member’s eligibility for that subsidy; however, the board 1332 shall attempt to obtain as much of the information and 1333 documentation as possible from records that are available to it. 1334 (11) The program shall make a reasonable effort to notify 1335 members of their obligations under this section. After a 1336 reasonable effort has been made to contact the member, the 1337 member must be notified in writing that he or she has 60 days to 1338 provide the required information. If the required information is 1339 not provided within the 60-day period, the member’s coverage 1340 under the program may be terminated. Information members provide 1341 to the board for the purposes of this section may not be used 1342 for any other purpose. 1343 (12) The board shall assume responsibility for all benefits 1344 and services paid for by the Federal Government with federal 1345 funds. 1346 Section 17. Section 408.972, Florida Statutes, is created 1347 to read: 1348 408.972 Healthy Florida financing.— 1349 (1) It is the intent of the Legislature to enact 1350 legislation that would develop a revenue plan, taking into 1351 consideration anticipated federal revenue available for the 1352 Healthy Florida program. In developing the revenue plan, it is 1353 the intent of the Legislature to consult with appropriate 1354 officials and stakeholders. 1355 (2) It is the intent of the Legislature to enact 1356 legislation that would require all state revenues from the 1357 program to be deposited in an account within the Healthy Florida 1358 Trust Fund to be established and known as the Healthy Florida 1359 Trust Fund Account. 1360 Section 18. Section 408.98, Florida Statutes, is created to 1361 read: 1362 408.98 Collective negotiation by health care providers with 1363 Healthy Florida; definitions; requirements and prohibited acts.— 1364 (1) DEFINITIONS.—As used in this section, the term: 1365 (a)“Health care provider” means a health care professional 1366 licensed under chapter 458, chapter 459, chapter 460, chapter 1367 461, chapter 463, chapter 464, chapter 465, chapter 466, part I, 1368 part III, part IV, part V, or part X of chapter 468, chapter 1369 483, chapter 484, chapter 486, chapter 490, or chapter 491, and 1370 who is any of the following: 1371 1. An individual who practices his or her profession as a 1372 health care provider or as an independent contractor. 1373 2. An owner, officer, shareholder, or proprietor of a 1374 health care provider. 1375 3. An entity that employs or uses health care providers to 1376 provide health care services, including, but not limited to, a 1377 facility authorized by law to provide services under chapter 1378 393, chapter 394, chapter 395, chapter 400, chapter 429, or 1379 chapter 651. 1380 1381 A health care provider who practices as an employee of a health 1382 care provider is not a health care provider for the purposes of 1383 this section. 1384 (b) “Health care providers’ representative” means a third 1385 party that is authorized by a group of health care providers to 1386 negotiate on the group’s behalf with Healthy Florida concerning 1387 terms and conditions affecting the health care providers. 1388 (2) COLLECTIVE NEGOTIATION REQUIREMENTS.— 1389 (a) Collective negotiation rights granted by this section 1390 must meet all of the following requirements: 1391 1. Health care providers may communicate with other health 1392 care providers regarding the terms and conditions to be 1393 negotiated with HF. 1394 2. Health care providers may communicate with health care 1395 providers’ representatives. 1396 3. A health care providers’ representative is the only 1397 party authorized to negotiate with HF on behalf of the health 1398 care providers as a group. 1399 4. A health care provider may be bound by the terms and 1400 conditions negotiated by the health care providers’ 1401 representatives. 1402 5. In communicating or negotiating with the health care 1403 providers’ representative, HF is entitled to offer and provide 1404 different terms and conditions to individual competing health 1405 care providers. 1406 (b) Before engaging in collective negotiations with HF on 1407 behalf of health care providers, a health care providers’ 1408 representative must file with the board, in the manner 1409 prescribed by the board, information identifying the 1410 representative, the representative’s plan of operation, and the 1411 representative’s procedures to ensure compliance with this 1412 chapter. 1413 (c) Each person who acts as the representative of 1414 negotiating parties under this chapter shall pay a fee to the 1415 board to act as a representative. The board shall set by rule 1416 fees in amounts deemed reasonable and necessary to cover the 1417 costs the board incurs in administering this chapter. 1418 (3) PROHIBITED COLLECTIVE ACTION.— 1419 (a) This section does not authorize competing health care 1420 providers to act in concert in response to a health care 1421 providers’ representative’s discussions or negotiations with HF, 1422 except as authorized by other law. 1423 (b) A health care providers’ representative may not 1424 negotiate any agreement that excludes, limits the participation 1425 or reimbursement of, or otherwise limits the scope of services 1426 to be provided by any health care provider or group of health 1427 care providers with respect to the performance of services that 1428 are within the health care provider’s scope of practice, 1429 license, registration, or certificate. 1430 (4) CONSTRUCTION.— 1431 (a) This section does not affect or limit the right of a 1432 health care provider or group of health care providers to 1433 collectively petition a governmental entity for a change in a 1434 law, rule, or regulation. 1435 (b) This section does not affect or limit collective action 1436 or collective bargaining on the part of a health care provider 1437 with his or her employer or any other lawful collective action 1438 or collective bargaining. 1439 Section 19. Section 408.99, Florida Statutes, is created to 1440 read: 1441 408.99 Effective date of operation.— 1442 (1) Notwithstanding any other law, this part may not become 1443 operative until the date the State Surgeon General of the 1444 Department of Health notifies the President of the Senate and 1445 the Speaker of the House of Representatives in writing that he 1446 or she has determined that the Healthy Florida Trust Fund has 1447 the revenues to fund the costs of implementing this part. 1448 (2) The Department of Health shall publish on its website a 1449 copy of the notice described in subsection (1). 1450 Section 20. Section 408.991, Florida Statutes, is created 1451 to read: 1452 408.991 Severability.—The provisions of this part are 1453 severable. If any provision of this part or its application is 1454 held invalid, that invalidity may not affect other provisions or 1455 applications that can be given effect without the invalid 1456 provision or application. 1457 Section 21. This act shall take effect July 1, 2018.