The Florida Senate

408.006  The Florida Health Plan; goals; report.--The Legislature hereby establishes primary goals and strategies to guide the development of The Florida Health Plan. These goals and strategies include:

(1)  ACCESS TO HEALTH CARE SERVICES.--Access to health care is an increasing problem for many Floridians, especially for women and young children, part-time employees, employees of small businesses, and the unemployed. The failure of our health care system to be accessible to all residents is not only unacceptable to the Legislature for humanitarian reasons, but also because it results in inappropriate and far more costly use of health resources, a less productive workforce, and a less effective educational system. Therefore, the Legislature establishes the following health access goal for The Florida Health Plan: All Floridians shall be ensured access to a basic health care benefit package as determined by the Legislature, by December 31, 1994.

(a)  To ensure achievement of The Florida Health Plan's health access goal, the agency shall submit to the Legislature interim recommendations for the implementation of The Florida Health Plan health access goal on or before December 31, 1992, and final recommendations on or before December 31, 1993. At a minimum, recommendations shall include proposals for:

1.  Increasing health care coverage through the development of a basic health care benefit package that provides basic health services to all residents of the state, regardless of health condition, age, sex, race, geographic location, employment, or economic status.

2.  Ensuring that an appropriate number and distribution of health care facilities and health personnel are available throughout the state by January 1, 1996.

3.  Providing fair reimbursement to health care providers in a timely and uncomplicated manner.

(b)  In developing its recommendations, the agency shall consider the following:

1.  The role state and local government should assume in the provision of health services, including level of service, sources of funding, and delivery system models. By December 31, 1994, state and local governments, in cooperation with the private sector, shall ensure that all of the unemployed, low-income citizens of the state have access to the basic health benefit package.

2.  The role employers should assume, including whether employer mandates are needed to ensure access and the form such mandates should take. The plan shall ensure that, by December 31, 1994, employees and their dependents have, at a level acceptable to the Legislature, coverage of the basic health care benefit package or employers shall be mandated to provide such coverage. However, in no event shall the Legislature consider any system of employer-mandated coverage unless the Legislature finds that the cost containment goal has been met and mandated coverage is still necessary. The implementing legislation shall consider the potential impact on employment levels and shall provide a mechanism through appeal to the agency for an exemption to mandated coverage upon a showing of hardship.

3.  The role and responsibilities which each individual should assume in obtaining access to health care.

4.  Maximizing federal funding of publicly funded health insurance coverages.

5.  Ensuring coverage for persons who are unable to obtain or afford health insurance coverage because of chronic or acute illnesses.

6.  Ensuring accessible health care services in rural and other medically underserved areas.

(c)  At the time the recommendations are submitted to the Legislature, the agency shall provide the Legislature with a specific proposal to improve access to health care that should be implemented in the event that full access to basic health services has not been obtained for all residents of the state by December 31, 1994.

(2)  COST CONTAINMENT.--

(a)  Despite numerous efforts by the Legislature for at least the last decade to curb health spending, health care costs continue to increase at an unacceptable rate. The increase in health care costs is of concern to the Legislature, not only because increasing costs threaten the ability of the private sector and state and local governments to pay for health care, but also because rapid cost escalations threaten the ability of Florida business to compete in national and international markets. Therefore, the Legislature directs the agency to recommend to the Legislature a cost containment goal, and the means to achieve it, that is based upon an annual rate of increase in the basic health benefit package that will enable such package to remain affordable to businesses and their employees.

(b)  To reach The Florida Health Plan's cost containment goal, the agency shall submit to the Legislature interim recommendations for The Florida Health Plan cost containment goal on or before December 31, 1992, and final recommendations on or before December 31, 1993. The agency's recommendations shall consider the following principles and strategies:

1.  The state shall promote accessibility of primary and preventive care and control the proliferation of tertiary care.

2.  Because resources are limited, health care priorities shall be established. High priority shall be given to those programs that have best been shown to produce good outcomes, to include incentive structures which will respond to the needs of Floridians for good health care value, and to provide a healthy start for the state's youngest residents.

3.  Practice parameters which are scientifically sound should be adopted to ensure the appropriate utilization of services.

4.  Analytical techniques which address variations in health care delivery among providers and from region to region shall be used, which may include small area analysis and practice parameters.

5.  Resource utilization systems that are capable of taking into account resources consumed in the delivery of care for patients with similar diagnoses and outcomes produced in the treatment of like cases should be researched and refined for consideration.

6.  The state employee health insurance program shall ensure an appropriate distribution and utilization of affordable, efficient, and effective high-technology care.

7.  Consolidating the administration of state-funded, state-administered, or state-sponsored health insurance programs.

8.  Proposals for a public and private health insurance payor mechanism designed to simplify provider billing, reduce administrative overhead costs, and maximize government and third-party purchasing power.

9.  Recommending comprehensive changes in the system for handling medical negligence disputes that will ensure a more efficient and equitable method for determining damages and compensating injured parties.

(3)  INSURANCE REFORMS.--The Legislature finds that almost half of the uninsured are at or near poverty, requiring insurance reforms that significantly lower costs. Almost three-quarters of the uninsured are employed or are dependents of employees, and half of these uninsured workers are employed by small businesses. These findings make the expansion of employer-based health care coverage options a priority. Therefore, the Legislature establishes the following insurance reform goal for The Florida Health Plan: On or before July 1, 1994, the state shall institute reforms in private health insurance that shall ensure that employed and unemployed residents have access to basic health insurance coverage.

(a)  To ensure the achievement of The Florida Health Plan's insurance reform goal, the agency shall submit to the Legislature interim recommendations for the implementation of The Florida Health Plan insurance goal on or before December 31, 1992, and final recommendations on or before December 31, 1993.

(b)  In developing recommendations for insurance reforms, the agency shall consider strategies that:

1.  Maximize the number of employed persons and their dependents who are enrolled in employer-sponsored health insurance plans. Coverage should be made available to entire employer groups and not exclude individuals who present high medical risks.

2.  Rely on private providers for the delivery of health services.

3.  Ensure that health insurance coverage for a state resident continues regardless of changes in employers.

4.  Provide that employer groups and individuals are not canceled at renewal time because of high claims costs.

5.  Require insurers to accept all health risks with appropriate protection for extraordinary risks.

6.  Ensure that all residents participate in a public or private health insurance plan.

7.  Ensure that all residents contribute, based on their ability to pay, to the financing of their health insurance coverage.

8.  Provide basic health insurance benefits that promote healthier lifestyles, require persons to assume greater responsibility for their health, and provide early diagnosis and treatment to avoid later and more costly medical interventions.

9.  Provide for uniform billing, payment, and service documentation requirements.

10.  Require employers receiving government contracts and grants to offer health care coverage to all employees.

11.  Implement managed care in public and private health insurance plans.

12.  Reform private health insurance practices to ensure coverage for employees and their dependents, regardless of their health status and employer size, such as proposals for adopting community ratings for employers of all sizes, prohibiting the exclusion of preexisting conditions, and guaranteeing acceptance and continuation of employee groups.

(4)  HEALTH REGULATION.--

(a)  The Legislature finds that a competitive marketplace is lacking in some areas of health care, and, therefore, an appropriate level of regulation is necessary in order to ensure the quality, affordability, and availability of health care services. Further, the Legislature finds that existing health regulatory programs are not well-coordinated, lack clear goals and objectives, contain many archaic administrative rules, are too administratively complex, and require redesign in order to meet the needs of a rapidly evolving health care system. By placing all health regulatory programs into a single state agency, the Legislature intends to begin the process of streamlining and making more cost-effective the regulatory process. In order to complete the task, the Legislature establishes the following health regulation goal: By December 31, 1994, health regulatory programs shall be redesigned and modernized, with an emphasis on efficiency, administrative simplicity, coordination, and protection of the public.

(b)  To ensure the achievement of The Florida Health Plan's health regulation goal, the agency shall submit to the Legislature interim recommendations for achieving the goal on or before December 31, 1992, and final recommendations on or before December 31, 1993. Included in the recommendations shall be proposals to:

1.  Create a consistent theme for all regulatory programs, including the establishment of clear goals and objectives for each regulatory program.

2.  Review all existing administrative rules for the purpose of eliminating archaic or excessively costly rules.

3.  Simplify regulatory programs to ensure that administrative complexity is the minimum necessary to guarantee due process.

4.  Eliminate laws and rules which serve to protect economic interests of health professionals or health providers, at the expense of the public.

5.  Provide for a uniform health regulatory program through the elimination of loopholes and exemptions created for special interest groups.

6.  Redesign market entry controls to provide for uniformity across all health care providers, to limit regulation only to those areas which require regulation due to limited market needs and high capitalization costs, and provide review standards for other services and technologies which do not restrict market entry but, rather, create incentives for high-quality providers to offer these services in ways which meet community needs while discouraging inappropriate utilization and development.

7.  Provide an appropriate level of regulation in areas where market forces have been unsuccessful in constraining rapidly escalating costs.

(5)  DATA COLLECTION, RESEARCH, AND ANALYSIS.--

(a)  The Legislature finds that it is difficult to evaluate the effectiveness of access, cost containment, regulation, and insurance reform strategies without Florida-specific empirical evidence. The collection and analysis of data improves the state's ability to identify major health care issues and to develop a comprehensive health policy for the state. Therefore, the Legislature establishes the following goal for data collection and analysis for The Florida Health Plan: By July 1, 1994, there shall be established an integrated data collection and analysis system that includes data from all health care providers, facilities, and insurers and that will permit assessments of cost-effectiveness, quality of care, and variations in practice parameters.

(b)  To ensure the achievement of The Florida Health Plan's goal for data collection, the agency shall submit to the Legislature interim recommendations for the implementation of The Florida Health Plan's data collection goal on or before December 31, 1992, and final recommendations on or before December 31, 1993. Recommendations shall give consideration to:

1.  Establishing a comprehensive, integrated system of data from health care providers, facilities, and insurers.

2.  Cataloging existing health care data maintained by local, state, and federal agencies, universities, and private organizations.

3.  Publishing an annual state health expenditure report to the Legislature.

History.--s. 7, ch. 92-33; s. 6, ch. 95-144; s. 34, ch. 97-103.