Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for HB 1113
       
       
       
       
       
       
                                Ì6405847Î640584                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AE/2R         .           Floor: CA            
             04/30/2019 10:27 AM       .      05/03/2019 06:01 PM       
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       Senator Diaz moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (d) of subsection (3) of section
    6  110.123, Florida Statutes, is amended to read:
    7         110.123 State group insurance program.—
    8         (3) STATE GROUP INSURANCE PROGRAM.—
    9         (d)1. Notwithstanding chapter 287 and the authority of the
   10  department, for the purpose of protecting the health of, and
   11  providing medical services to, state employees participating in
   12  the state group insurance program, the department may contract
   13  to retain the services of professional administrators for the
   14  state group insurance program. The agency shall follow good
   15  purchasing practices of state procurement to the extent
   16  practicable under the circumstances.
   17         2. Each vendor in a major procurement, and any other vendor
   18  if the department deems it necessary to protect the state’s
   19  financial interests, shall, at the time of executing any
   20  contract with the department, post an appropriate bond with the
   21  department in an amount determined by the department to be
   22  adequate to protect the state’s interests but not higher than
   23  the full amount estimated to be paid annually to the vendor
   24  under the contract.
   25         3. Each major contract entered into by the department
   26  pursuant to this section shall contain a provision for payment
   27  of liquidated damages to the department for material
   28  noncompliance by a vendor with a contract provision. The
   29  department may require a liquidated damages provision in any
   30  contract if the department deems it necessary to protect the
   31  state’s financial interests.
   32         4. Section 120.57(3) applies to the department’s
   33  contracting process, except:
   34         a. A formal written protest of any decision, intended
   35  decision, or other action subject to protest shall be filed
   36  within 72 hours after receipt of notice of the decision,
   37  intended decision, or other action.
   38         b. As an alternative to any provision of s. 120.57(3), the
   39  department may proceed with the bid selection or contract award
   40  process if the director of the department sets forth, in
   41  writing, particular facts and circumstances that demonstrate the
   42  necessity of continuing the procurement process or the contract
   43  award process in order to avoid a substantial disruption to the
   44  provision of any scheduled insurance services.
   45         5. The department shall make arrangements as necessary to
   46  contribute claims data of the state group health insurance plan
   47  to the contracted vendor selected by the Agency for Health Care
   48  Administration pursuant to s. 408.05(3)(c).
   49         6. Each contracted vendor for the state group health
   50  insurance plan shall contribute Florida claims data to the
   51  contracted vendor selected by the Agency for Health Care
   52  Administration pursuant to s. 408.05(3)(c).
   53         7.Each contract for health care benefits or health care
   54  administrative services which is executed, renewed, or extended
   55  after July 1, 2021, must require the contractor to accommodate
   56  changes to the law which occur during the term of the contract.
   57  The parties may modify the contract to provide for an extension
   58  of time, term, or increase in compensation, based on changes in
   59  the law that materially cause an increase in the contracted
   60  services or the scope of work under the contract.
   61         Section 2. Section 110.12303, Florida Statutes, is amended
   62  to read:
   63         110.12303 State group insurance program; additional
   64  benefits; price transparency program; reporting.—Beginning with
   65  the 2018 plan year:
   66         (1) In addition to the comprehensive package of health
   67  insurance and other benefits required or authorized to be
   68  included in the state group insurance program, the package of
   69  benefits may also include products and services offered by:
   70         (a) Prepaid limited health service organizations authorized
   71  pursuant to part I of chapter 636.
   72         (b) Discount medical plan organizations authorized pursuant
   73  to part II of chapter 636.
   74         (c) Prepaid health clinics licensed under part II of
   75  chapter 641.
   76         (d) Licensed health care providers, including hospitals and
   77  other health care facilities, health care clinics, and health
   78  professionals, who sell service contracts and arrangements for a
   79  specified amount and type of health services.
   80         (e) Provider organizations, including service networks,
   81  group practices, professional associations, and other
   82  incorporated organizations of providers, who sell service
   83  contracts and arrangements for a specified amount and type of
   84  health services.
   85         (f) Entities that provide specific health services in
   86  accordance with applicable state law and sell service contracts
   87  and arrangements for a specified amount and type of health
   88  services.
   89         (g) Entities that provide health services or treatments
   90  through a bidding process.
   91         (h) Entities that provide health services or treatments
   92  through the bundling or aggregating of health services or
   93  treatments.
   94         (i) Entities that provide international prescription
   95  services.
   96         (j)Entities that provide optional participation in a
   97  Medicare Advantage Prescription Drug Plan.
   98         (k) Entities that provide other innovative and cost
   99  effective health service delivery methods.
  100         (2)(a) The department shall contract with at least one
  101  entity that provides comprehensive pricing and inclusive
  102  services for surgery and other medical procedures which may be
  103  accessed at the option of the enrollee. The contract shall
  104  require the entity to:
  105         1. Have procedures and evidence-based standards to ensure
  106  the inclusion of only high-quality health care providers.
  107         2. Provide assistance to the enrollee in accessing and
  108  coordinating care.
  109         3. Provide cost savings to the state group insurance
  110  program to be shared with both the state and the enrollee. Cost
  111  savings payable to an enrollee may be:
  112         a. Credited to the enrollee’s flexible spending account;
  113         b. Credited to the enrollee’s health savings account;
  114         c. Credited to the enrollee’s health reimbursement account;
  115  or
  116         d. Paid as additional health plan reimbursements not
  117  exceeding the amount of the enrollee’s out-of-pocket medical
  118  expenses.
  119         4. Provide an educational campaign for enrollees to learn
  120  about the services offered by the entity.
  121         (b) On or before January 15 of each year, the department
  122  shall report to the Governor, the President of the Senate, and
  123  the Speaker of the House of Representatives on the participation
  124  level and cost-savings to both the enrollee and the state
  125  resulting from the contract or contracts described in this
  126  subsection.
  127         (3) The department shall contract with an entity that
  128  provides enrollees with online information on the cost and
  129  quality of health care services and providers, allows an
  130  enrollee to shop for health care services and providers, and
  131  rewards the enrollee by sharing savings generated by the
  132  enrollee’s choice of services or providers. The contract shall
  133  require the entity to:
  134         (a) Establish an Internet-based, consumer-friendly platform
  135  that educates and informs enrollees about the price and quality
  136  of health care services and providers, including the average
  137  amount paid in each county for health care services and
  138  providers. The average amounts paid for such services and
  139  providers may be expressed for service bundles, which include
  140  all products and services associated with a particular treatment
  141  or episode of care, or for separate and distinct products and
  142  services.
  143         (b) Allow enrollees to shop for health care services and
  144  providers using the price and quality information provided on
  145  the Internet-based platform.
  146         (c) Permit a certified bargaining agent of state employees
  147  to provide educational materials and counseling to enrollees
  148  regarding the Internet-based platform.
  149         (d) Identify the savings realized to the enrollee and state
  150  if the enrollee chooses high-quality, lower-cost health care
  151  services or providers, and facilitate a shared savings payment
  152  to the enrollee. The amount of shared savings shall be
  153  determined by a methodology approved by the department and shall
  154  maximize value-based purchasing by enrollees. The amount payable
  155  to the enrollee may be:
  156         1. Credited to the enrollee’s flexible spending account;
  157         2. Credited to the enrollee’s health savings account;
  158         3. Credited to the enrollee’s health reimbursement account;
  159  or
  160         4. Paid as additional health plan reimbursements not
  161  exceeding the amount of the enrollee’s out-of-pocket medical
  162  expenses.
  163         (e) On or before January 1 of 2019, 2020, and 2021, the
  164  department shall report to the Governor, the President of the
  165  Senate, and the Speaker of the House of Representatives on the
  166  participation level, amount paid to enrollees, and cost-savings
  167  to both the enrollees and the state resulting from the
  168  implementation of this subsection.
  169         (4)The department shall offer, as a voluntary supplemental
  170  benefit option, international prescription services that offer
  171  safe maintenance medications at a reduced cost to enrollees and
  172  that meet the standards of the United States Food and Drug
  173  Administration personal importation policy.
  174         Section 3. Subsections (9) and (10) are added to section
  175  110.12315, Florida Statutes, to read:
  176         110.12315 Prescription drug program.—The state employees’
  177  prescription drug program is established. This program shall be
  178  administered by the Department of Management Services, according
  179  to the terms and conditions of the plan as established by the
  180  relevant provisions of the annual General Appropriations Act and
  181  implementing legislation, subject to the following conditions:
  182         (9)(a)Beginning with the 2020 plan year, the department
  183  must implement formulary management for prescription drugs and
  184  supplies. Such management practices must require prescription
  185  drugs to be subject to formulary inclusion or exclusion but may
  186  not restrict access to the most clinically appropriate,
  187  clinically effective, and lowest net-cost prescription drugs and
  188  supplies. Drugs excluded from the formulary must be available
  189  for inclusion if a physician, advanced registered nurse
  190  practitioner, or physician assistant prescribing a
  191  pharmaceutical clearly states on the prescription that the
  192  excluded drug is medically necessary. Prescription drugs and
  193  supplies first made available in the marketplace after January
  194  1, 2020, may not be covered by the prescription drug program
  195  until specifically included in the list of covered prescription
  196  drugs and supplies.
  197         (b) Not later than October 1, 2019, and by each October 1
  198  thereafter, the department must submit to the Governor, the
  199  President of the Senate, and the Speaker of the House of
  200  Representatives the list of prescription drugs and supplies that
  201  will be excluded from program coverage for the next plan year.
  202  If the department proposes to exclude prescription drugs and
  203  supplies after the plan year has commenced, the department must
  204  provide notice to the Governor, the President of the Senate, and
  205  the Speaker of the House of Representatives of such exclusions
  206  at least 60 days before implementation of such exclusions.
  207         (10) In addition to the comprehensive package of health
  208  insurance and other benefits required or authorized to be
  209  included in the state group insurance program, the program must
  210  provide coverage for medically necessary prescription and
  211  nonprescription enteral formulas and amino-acid-based elemental
  212  formulas for home use, regardless of the method of delivery or
  213  intake, which are ordered or prescribed by a physician. As used
  214  in this subsection, the term “medically necessary” means the
  215  formula to be covered represents the only medically appropriate
  216  source of nutrition for a patient. Such coverage may not exceed
  217  an amount of $20,000 annually for any insured individual.
  218         Section 4. Effective December 31, 2019, section 8 of
  219  chapter 99-255, Laws of Florida, is repealed.
  220         Section 5. Effective January 1, 2020, section 627.6387,
  221  Florida Statutes, is created to read:
  222         627.6387Shared savings incentive program.—
  223         (1)This section and ss. 627.6648 and 641.31076 may be
  224  cited as the “Patient Savings Act.”
  225         (2)As used in this section, the term:
  226         (a)“Health care provider” means a hospital or facility
  227  licensed under chapter 395; an entity licensed under chapter
  228  400; a health care practitioner as defined in s. 456.001; a
  229  blood bank, plasma center, industrial clinic, or renal dialysis
  230  facility; or a professional association, partnership,
  231  corporation, joint venture, or other association for
  232  professional activity by health care providers. The term
  233  includes entities and professionals outside of this state with
  234  an active, unencumbered license for an equivalent facility or
  235  practitioner type issued by another state, the District of
  236  Columbia, or a possession or territory of the United States.
  237         (b)“Health insurer” means an authorized insurer offering
  238  health insurance as defined in s. 624.603.
  239         (c)“Shared savings incentive” means a voluntary and
  240  optional financial incentive that a health insurer may provide
  241  to an insured for choosing certain shoppable health care
  242  services under a shared savings incentive program and may
  243  include, but is not limited to, the incentives described in s.
  244  626.9541(4)(a).
  245         (d)“Shared savings incentive program” means a voluntary
  246  and optional incentive program established by a health insurer
  247  pursuant to this section.
  248         (e)“Shoppable health care service” means a lower-cost,
  249  high-quality nonemergency health care service for which a shared
  250  savings incentive is available for insureds under a health
  251  insurer’s shared savings incentive program. Shoppable health
  252  care services may be provided within or outside of this state
  253  and include, but are not limited to:
  254         1.Clinical laboratory services.
  255         2.Infusion therapy.
  256         3.Inpatient and outpatient surgical procedures.
  257         4.Obstetrical and gynecological services.
  258         5.Inpatient and outpatient nonsurgical diagnostic tests
  259  and procedures.
  260         6.Physical and occupational therapy services.
  261         7.Radiology and imaging services.
  262         8.Prescription drugs.
  263         9.Services provided through telehealth.
  264         (3)A health insurer may offer a shared savings incentive
  265  program to provide incentives to an insured when the insured
  266  obtains a shoppable health care service from the health
  267  insurer’s shared savings list. An insured may not be required to
  268  participate in a shared savings incentive program. A health
  269  insurer that offers a shared savings incentive program must:
  270         (a)Establish the program as a component part of the policy
  271  or certificate of insurance provided by the health insurer and
  272  notify the insureds and the office at least 30 days before
  273  program termination.
  274         (b)File a description of the program on a form prescribed
  275  by commission rule. The office must review the filing and
  276  determine whether the shared savings incentive program complies
  277  with this section.
  278         (c)Notify an insured annually and at the time of renewal,
  279  and an applicant for insurance at the time of enrollment, of the
  280  availability of the shared savings incentive program and the
  281  procedure to participate in the program.
  282         (d)Publish on a webpage easily accessible to insureds and
  283  to applicants for insurance a list of shoppable health care
  284  services and health care providers and the shared savings
  285  incentive amount applicable for each service. A shared savings
  286  incentive may not be less than 25 percent of the savings
  287  generated by the insured’s participation in any shared savings
  288  incentive offered by the health insurer. The baseline for the
  289  savings calculation is the average in-network amount paid for
  290  that service in the most recent 12-month period or some other
  291  methodology established by the health insurer and approved by
  292  the office.
  293         (e)At least quarterly, credit or deposit the shared
  294  savings incentive amount to the insured’s account as a return or
  295  reduction in premium, or credit the shared savings incentive
  296  amount to the insured’s flexible spending account, health
  297  savings account, or health reimbursement account, such that the
  298  amount does not constitute income to the insured.
  299         (f)Submit an annual report to the office within 90
  300  business days after the close of each plan year. At a minimum,
  301  the report must include the following information:
  302         1.The number of insureds who participated in the program
  303  during the plan year and the number of instances of
  304  participation.
  305         2.The total cost of services provided as a part of the
  306  program.
  307         3.The total value of the shared savings incentive payments
  308  made to insureds participating in the program and the values
  309  distributed as premium reductions, credits to flexible spending
  310  accounts, credits to health savings accounts, or credits to
  311  health reimbursement accounts.
  312         4.An inventory of the shoppable health care services
  313  offered by the health insurer.
  314         (4)(a)A shared savings incentive offered by a health
  315  insurer in accordance with this section:
  316         1.Is not an administrative expense for rate development or
  317  rate filing purposes.
  318         2.Does not constitute an unfair method of competition or
  319  an unfair or deceptive act or practice under s. 626.9541 and is
  320  presumed to be appropriate unless credible data clearly
  321  demonstrates otherwise.
  322         (b)A shared saving incentive amount provided as a return
  323  or reduction in premium reduces the health insurer’s direct
  324  written premium by the shared saving incentive dollar amount for
  325  the purposes of the taxes in ss. 624.509 and 624.5091.
  326         (5)The commission may adopt rules necessary to implement
  327  and enforce this section.
  328         Section 6. Effective January 1, 2020, section 627.6648,
  329  Florida Statutes, is created to read:
  330         627.6648 Shared savings incentive program.—
  331         (1)This section and ss. 627.6387 and 641.31076 may be
  332  cited as the “Patient Savings Act.”
  333         (2)As used in this section, the term:
  334         (a)“Health care provider” means a hospital or facility
  335  licensed under chapter 395; an entity licensed under chapter
  336  400; a health care practitioner as defined in s. 456.001; a
  337  blood bank, plasma center, industrial clinic, or renal dialysis
  338  facility; or a professional association, partnership,
  339  corporation, joint venture, or other association for
  340  professional activity by health care providers. The term
  341  includes entities and professionals outside of this state with
  342  an active, unencumbered license for an equivalent facility or
  343  practitioner type issued by another state, the District of
  344  Columbia, or a possession or territory of the United States.
  345         (b)“Health insurer” means an authorized insurer offering
  346  health insurance as defined in s. 624.603. The term does not
  347  include the state group health insurance program provided under
  348  s. 110.123.
  349         (c)“Shared savings incentive” means a voluntary and
  350  optional financial incentive that a health insurer may provide
  351  to an insured for choosing certain shoppable health care
  352  services under a shared savings incentive program and may
  353  include, but is not limited to, the incentives described in s.
  354  626.9541(4)(a).
  355         (d)“Shared savings incentive program” means a voluntary
  356  and optional incentive program established by a health insurer
  357  pursuant to this section.
  358         (e)“Shoppable health care service” means a lower-cost,
  359  high-quality nonemergency health care service for which a shared
  360  savings incentive is available for insureds under a health
  361  insurer’s shared savings incentive program. Shoppable health
  362  care services may be provided within or outside of this state
  363  and include, but are not limited to:
  364         1.Clinical laboratory services.
  365         2.Infusion therapy.
  366         3.Inpatient and outpatient surgical procedures.
  367         4.Obstetrical and gynecological services.
  368         5.Inpatient and outpatient nonsurgical diagnostic tests
  369  and procedures.
  370         6.Physical and occupational therapy services.
  371         7.Radiology and imaging services.
  372         8.Prescription drugs.
  373         9.Services provided through telehealth.
  374         (3)A health insurer may offer a shared savings incentive
  375  program to provide incentives to an insured when the insured
  376  obtains a shoppable health care service from the health
  377  insurer’s shared savings list. An insured may not be required to
  378  participate in a shared savings incentive program. A health
  379  insurer that offers a shared savings incentive program must:
  380         (a)Establish the program as a component part of the policy
  381  or certificate of insurance provided by the health insurer and
  382  notify the insureds and the office at least 30 days before
  383  program termination.
  384         (b)File a description of the program on a form prescribed
  385  by commission rule. The office must review the filing and
  386  determine whether the shared savings incentive program complies
  387  with this section.
  388         (c)Notify an insured annually and at the time of renewal,
  389  and an applicant for insurance at the time of enrollment, of the
  390  availability of the shared savings incentive program and the
  391  procedure to participate in the program.
  392         (d)Publish on a webpage easily accessible to insureds and
  393  to applicants for insurance a list of shoppable health care
  394  services and health care providers and the shared savings
  395  incentive amount applicable for each service. A shared savings
  396  incentive may not be less than 25 percent of the savings
  397  generated by the insured’s participation in any shared savings
  398  incentive offered by the health insurer. The baseline for the
  399  savings calculation is the average in-network amount paid for
  400  that service in the most recent 12-month period or some other
  401  methodology established by the health insurer and approved by
  402  the office.
  403         (e)At least quarterly, credit or deposit the shared
  404  savings incentive amount to the insured’s account as a return or
  405  reduction in premium, or credit the shared savings incentive
  406  amount to the insured’s flexible spending account, health
  407  savings account, or health reimbursement account, such that the
  408  amount does not constitute income to the insured.
  409         (f)Submit an annual report to the office within 90
  410  business days after the close of each plan year. At a minimum,
  411  the report must include the following information:
  412         1.The number of insureds who participated in the program
  413  during the plan year and the number of instances of
  414  participation.
  415         2.The total cost of services provided as a part of the
  416  program.
  417         3.The total value of the shared savings incentive payments
  418  made to insureds participating in the program and the values
  419  distributed as premium reductions, credits to flexible spending
  420  accounts, credits to health savings accounts, or credits to
  421  health reimbursement accounts.
  422         4.An inventory of the shoppable health care services
  423  offered by the health insurer.
  424         (4)(a)A shared savings incentive offered by a health
  425  insurer in accordance with this section:
  426         1.Is not an administrative expense for rate development or
  427  rate filing purposes.
  428         2.Does not constitute an unfair method of competition or
  429  an unfair or deceptive act or practice under s. 626.9541 and is
  430  presumed to be appropriate unless credible data clearly
  431  demonstrates otherwise.
  432         (b)A shared saving incentive amount provided as a return
  433  or reduction in premium reduces the health insurer’s direct
  434  written premium by the shared saving incentive dollar amount for
  435  the purposes of the taxes in ss. 624.509 and 624.5091.
  436         (5)The commission may adopt rules necessary to implement
  437  and enforce this section.
  438         Section 7. Effective January 1, 2020, section 641.31076,
  439  Florida Statutes, is created to read:
  440         641.31076 Shared savings incentive program.—
  441         (1)This section and ss. 627.6387 and 627.6648 may be cited
  442  as the “Patient Savings Act.”
  443         (2)As used in this section, the term:
  444         (a)“Health care provider” means a hospital or facility
  445  licensed under chapter 395; an entity licensed under chapter
  446  400; a health care practitioner as defined in s. 456.001; a
  447  blood bank, plasma center, industrial clinic, or renal dialysis
  448  facility; or a professional association, partnership,
  449  corporation, joint venture, or other association for
  450  professional activity by health care providers. The term
  451  includes entities and professionals outside of this state with
  452  an active, unencumbered license for an equivalent facility or
  453  practitioner type issued by another state, the District of
  454  Columbia, or a possession or territory of the United States.
  455         (b)“Health maintenance organization” has the same meaning
  456  as provided in s. 641.19. The term does not include the state
  457  group health insurance program provided under s. 110.123.
  458         (c)“Shared savings incentive” means a voluntary and
  459  optional financial incentive that a health maintenance
  460  organization may provide to a subscriber for choosing certain
  461  shoppable health care services under a shared savings incentive
  462  program and may include, but is not limited to, the incentives
  463  described in s. 641.3903(15).
  464         (d)“Shared savings incentive program” means a voluntary
  465  and optional incentive program established by a health
  466  maintenance organization pursuant to this section.
  467         (e)“Shoppable health care service” means a lower-cost,
  468  high-quality nonemergency health care service for which a shared
  469  savings incentive is available for subscribers under a health
  470  maintenance organization’s shared savings incentive program.
  471  Shoppable health care services may be provided within or outside
  472  of this state and include, but are not limited to:
  473         1.Clinical laboratory services.
  474         2.Infusion therapy.
  475         3.Inpatient and outpatient surgical procedures.
  476         4.Obstetrical and gynecological services.
  477         5.Inpatient and outpatient nonsurgical diagnostic tests
  478  and procedures.
  479         6.Physical and occupational therapy services.
  480         7.Radiology and imaging services.
  481         8.Prescription drugs.
  482         9.Services provided through telehealth.
  483         (3)A health maintenance organization may offer a shared
  484  savings incentive program to provide incentives to a subscriber
  485  when the subscriber obtains a shoppable health care service from
  486  the health maintenance organization’s shared savings list. A
  487  subscriber may not be required to participate in a shared
  488  savings incentive program. A health maintenance organization
  489  that offers a shared savings incentive program must:
  490         (a)Establish the program as a component part of the
  491  contract of coverage provided by the health maintenance
  492  organization and notify the subscribers and the office at least
  493  30 days before program termination.
  494         (b)File a description of the program on a form prescribed
  495  by commission rule. The office must review the filing and
  496  determine whether the shared savings incentive program complies
  497  with this section.
  498         (c)Notify a subscriber annually and at the time of
  499  renewal, and an applicant for coverage at the time of
  500  enrollment, of the availability of the shared savings incentive
  501  program and the procedure to participate in the program.
  502         (d)Publish on a webpage easily accessible to subscribers
  503  and to applicants for coverage a list of shoppable health care
  504  services and health care providers and the shared savings
  505  incentive amount applicable for each service. A shared savings
  506  incentive may not be less than 25 percent of the savings
  507  generated by the subscriber’s participation in any shared
  508  savings incentive offered by the health maintenance
  509  organization. The baseline for the savings calculation is the
  510  average in-network amount paid for that service in the most
  511  recent 12-month period or some other methodology established by
  512  the health maintenance organization and approved by the office.
  513         (e)At least quarterly, credit or deposit the shared
  514  savings incentive amount to the subscriber’s account as a return
  515  or reduction in premium, or credit the shared savings incentive
  516  amount to the subscriber’s flexible spending account, health
  517  savings account, or health reimbursement account, such that the
  518  amount does not constitute income to the subscriber.
  519         (f)Submit an annual report to the office within 90
  520  business days after the close of each plan year. At a minimum,
  521  the report must include the following information:
  522         1.The number of subscribers who participated in the
  523  program during the plan year and the number of instances of
  524  participation.
  525         2.The total cost of services provided as a part of the
  526  program.
  527         3.The total value of the shared savings incentive payments
  528  made to subscribers participating in the program and the values
  529  distributed as premium reductions, credits to flexible spending
  530  accounts, credits to health savings accounts, or credits to
  531  health reimbursement accounts.
  532         4.An inventory of the shoppable health care services
  533  offered by the health maintenance organization.
  534         (4)A shared savings incentive offered by a health
  535  maintenance organization in accordance with this section:
  536         (a)Is not an administrative expense for rate development
  537  or rate filing purposes.
  538         (b)Does not constitute an unfair method of competition or
  539  an unfair or deceptive act or practice under s. 641.3903 and is
  540  presumed to be appropriate unless credible data clearly
  541  demonstrates otherwise.
  542         (5)The commission may adopt rules necessary to implement
  543  and enforce this section.
  544         Section 8. The Division of State Group Insurance within the
  545  Department of Management Services is directed to analyze the
  546  efficiency and effectiveness of providing health coverage by
  547  health maintenance organizations to enrollees participating in
  548  the state group insurance program on a county basis, on a
  549  regional basis, and on a statewide basis. Not later than January
  550  1, 2020, the division shall recommend to the Governor, the
  551  President of the Senate, and the Speaker of the House of
  552  Representatives the service areas the division determines to be
  553  the most efficient and effective to provide health insurance
  554  coverage for the 2023 plan year.
  555         Section 9. Except as otherwise expressly provided in this
  556  act, this act shall take effect July 1, 2019.
  557  
  558  ================= T I T L E  A M E N D M E N T ================
  559  And the title is amended as follows:
  560         Delete everything before the enacting clause
  561  and insert:
  562                        A bill to be entitled                      
  563         An act relating to health insurance; amending s.
  564         110.123, F.S.; requiring that certain contracts under
  565         the state group insurance program which are executed,
  566         renewed, or extended after a certain date require the
  567         contractor to accommodate changes to the law that
  568         occur during the term of the contract; authorizing the
  569         parties to the contract to make certain modifications
  570         to the contract; amending s. 110.12303, F.S.; removing
  571         an obsolete date; adding products and services offered
  572         by certain entities to a list of products and services
  573         that may be included in the package of health
  574         insurance and other benefits under the state group
  575         insurance program; requiring the Department of
  576         Management Services to offer, as a voluntary
  577         supplemental benefit option, certain international
  578         prescription services; amending s. 110.12315, F.S.;
  579         requiring the department to implement formulary
  580         management cost-saving measures beginning with the
  581         2020 plan year; specifying requirements for such
  582         measures; providing that certain prescription drugs
  583         and supplies may not be covered until specifically
  584         included in the formulary; requiring the department to
  585         report to the Governor and the Legislature regarding
  586         formulary exclusions by a specified date and annually
  587         thereafter; requiring the coverage of certain
  588         medically necessary enteral formulas and elemental
  589         formulas; defining the term “medically necessary”;
  590         specifying an annual coverage limit; repealing s. 8 of
  591         ch. 99-255, Laws of Florida, relating to a restriction
  592         prohibiting the department from implementing prior
  593         authorization or restricted formulary programs within
  594         the state employees’ prescription drug program;
  595         creating ss. 627.6387, 627.6648, and 641.31076, F.S.;
  596         providing a short title; defining terms; authorizing
  597         individual and group health insurers and health
  598         maintenance organizations, respectively, to offer
  599         shared savings incentive programs to insureds and
  600         subscribers; providing that insureds and subscribers
  601         are not required to participate in such programs;
  602         specifying requirements for health insurers and health
  603         maintenance organizations offering such programs;
  604         requiring the Office of Insurance Regulation to review
  605         filed descriptions of programs and make a certain
  606         determination; providing notification and account
  607         credit or deposit requirements for insurers and health
  608         maintenance organizations; specifying the minimum
  609         shared savings incentive and the basis for calculating
  610         savings; specifying requirements for annual reports
  611         submitted by health insurers and health maintenance
  612         organizations to the office; providing construction;
  613         providing that certain shared saving incentive amounts
  614         reduce a health insurer’s direct written premium for
  615         purposes of the insurance premium tax and the
  616         retaliatory tax; authorizing the Financial Services
  617         Commission to adopt rules; requiring the Division of
  618         State Group Insurance within the department to analyze
  619         the efficiency and effectiveness of providing health
  620         coverage by health maintenance organizations by
  621         specified bases to state group insurance program
  622         enrollees; requiring the division to make a certain
  623         recommendation to the Governor and the Legislature by
  624         a certain date; providing effective dates.