CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for CS for SB 1294
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Scott moved the following substitute for amendment
12 (820890):
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14 Senate Amendment (with title amendment)
15 On page 6, between lines 12 and 13,
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17 insert:
18 Section 2. Section 408.70, Florida Statutes, is
19 amended to read:
20 408.70 Health Alliance for Small Business Community
21 health purchasing; legislative findings and intent.--It is the
22 intent of the Legislature that a nonprofit corporation, to be
23 known as the "Health Alliance for Small Business," be
24 organized for the purpose of pooling groups of individuals
25 employed by small employers and the dependents of such
26 employees into larger groups in order to facilitate the
27 purchase of affordable group health insurance coverage.
28 (1) The Legislature finds that the current health care
29 system in this state does not provide access to affordable
30 health care for all persons in this state. Almost one in five
31 persons is without health insurance. For many, entry into the
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1 health care system is through a hospital emergency room rather
2 than a primary care setting. The availability of preventive
3 and primary care and managed, family-based care is limited.
4 Health insurance underwriting practices have led to the
5 avoidance, rather than to the sharing, of insurance risks,
6 limiting access to coverages for small-sized employer groups
7 and high-risk populations. Spiraling premium costs have
8 placed health insurance policies out of the reach of many
9 small-sized and medium-sized businesses and their employees.
10 Lack of outcome and cost information has forced individuals
11 and businesses to make critical health care decisions with
12 little guidance or leverage. Health care resources have not
13 been allocated efficiently, leading to excess and unevenly
14 distributed capacity. These factors have contributed to the
15 high cost of health care. Rural and other medically
16 underserved areas have too few health care resources.
17 Comprehensive, first-dollar coverages have allowed individuals
18 to seek care without regard to cost. Provider competition and
19 liability concerns have led to a medical technology arms race.
20 Rather than competing on the basis of price and patient
21 outcome, health care providers compete for patients on the
22 basis of service, equipping themselves with the latest and
23 best technologies. Managed-care and group-purchasing
24 mechanisms are not widely available to small group purchasers.
25 Health care regulation has placed undue burdens on health care
26 insurers and providers, driving up costs, limiting
27 competition, and preventing market-based solutions to cost and
28 quality problems. Health care costs have been increasing at
29 several times the rate of general inflation, eroding employer
30 profits and investments, increasing government revenue
31 requirements, reducing consumer coverages and purchasing
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1 power, and limiting public investments in other vital
2 governmental services.
3 (2) It is the intent of the Legislature that a
4 structured health care competition model, known as "managed
5 competition," be implemented throughout the state to improve
6 the efficiency of the health care markets in this state. The
7 managed competition model will promote the pooling of
8 purchaser and consumer buying power; ensure informed
9 cost-conscious consumer choice of managed care plans; reward
10 providers for high-quality, economical care; increase access
11 to care for uninsured persons; and control the rate of
12 inflation in health care costs.
13 (3) The Legislature intends that state-chartered,
14 nonprofit private purchasing organizations, to be known as
15 "community health purchasing alliances," be established. The
16 community health purchasing alliances shall be responsible for
17 assisting alliance members in securing the highest quality of
18 health care, based on current standards, at the lowest
19 possible prices.
20 Section 3. Section 408.701, Florida Statutes, 1998
21 Supplement, is amended to read:
22 408.701 Health Alliance for Small Business Community
23 health purchasing; definitions.--As used in ss.
24 408.70-408.7045 ss. 408.70-408.706, the term:
25 (1) "Accountable health partnership" means an
26 organization that integrates health care providers and
27 facilities and assumes risk, in order to provide health care
28 services, as certified by the agency under s. 408.704.
29 (1)(2) "Agency" means the Agency for Health Care
30 Administration.
31 (2)(3) "Alliance" means the Health Alliance for Small
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1 Business a community health purchasing alliance.
2 (3)(4) "Alliance member" means:
3 (a) a small employer as defined in s. 627.6699 who, or
4 (b) The state, for the purpose of providing health
5 benefits to state employees and their dependents through the
6 state group insurance program and to Medicaid recipients,
7 participants in the MedAccess program, and participants in the
8 Medicaid buy-in program,
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10 if such entities voluntarily elects choose to join an
11 alliance.
12 (5) "Antitrust laws" means federal and state laws
13 intended to protect commerce from unlawful restraints,
14 monopolies, and unfair business practices.
15 (6) "Associate alliance member" means any purchaser
16 who joins an alliance for the purposes of participating on the
17 alliance board and receiving data from the alliance at no
18 charge as a benefit of membership.
19 (7) "Benefit standard" means a specified set of health
20 services that are the minimum that must be covered under a
21 basic health benefit plan, as defined in s. 627.6699.
22 (8) "Business health coalition" means a group of
23 employers organized to share information about health services
24 and insurance coverage, to enable the employers to obtain more
25 cost-effective care for their employees.
26 (9) "Community health purchasing alliance" means a
27 state-chartered, nonprofit organization that provides
28 member-purchasing services and detailed information to its
29 members on comparative prices, usage, outcomes, quality, and
30 enrollee satisfaction with accountable health partnerships.
31 (10) "Consumer" means an individual user of health
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1 care services.
2 (11) "Department" means the Department of Insurance.
3 (12) "Grievance procedure" means an established set of
4 rules that specify a process for appeal of an organizational
5 decision.
6 (4)(13) "Health care provider" or "provider" means a
7 state-licensed or state-authorized facility, a facility
8 principally supported by a local government or by funds from a
9 charitable organization that holds a current exemption from
10 federal income tax under s. 501(c)(3) of the Internal Revenue
11 Code, a licensed practitioner, a county health department
12 established under part I of chapter 154, a prescribed
13 pediatric extended care center defined in s. 400.902, a
14 federally supported primary care program such as a migrant
15 health center or a community health center authorized under s.
16 329 or s. 330 of the United States Public Health Services Act
17 that delivers health care services to individuals, or a
18 community facility that receives funds from the state under
19 the Community Alcohol, Drug Abuse, and Mental Health Services
20 Act and provides mental health services to individuals.
21 (5)(14) "Health insurer" or "insurer" means a health
22 insurer or health maintenance organization that is issued a
23 certificate of authority an organization licensed by the
24 Department of Insurance under part III of chapter 624 or part
25 I of chapter 641.
26 (6)(15) "Health plan" or "health insurance" means any
27 health insurance policy or health maintenance organization
28 contract issued by a health insurer hospital or medical policy
29 or contract or certificate, hospital or medical service plan
30 contract, or health maintenance organization contract as
31 defined in the insurance code or Health Maintenance
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1 Organization Act. The term does not include accident-only,
2 specific disease, individual hospital indemnity, credit,
3 dental-only, vision-only, Medicare supplement, long-term care,
4 or disability income insurance; coverage issued as a
5 supplement to liability insurance; workers' compensation or
6 similar insurance; or automobile medical-payment insurance.
7 (7) "Regional board" means the board of directors of
8 each region of the alliance, as established under s.
9 408.702(1).
10 (8) "State board" or "board" means the board of
11 directors of the alliance, as established under s. 408.702(2).
12 (16) "Health status" means an assessment of an
13 individual's mental and physical condition.
14 (17) "Managed care" means systems or techniques
15 generally used by third-party payors or their agents to affect
16 access to and control payment for health care services.
17 Managed-care techniques most often include one or more of the
18 following: prior, concurrent, and retrospective review of the
19 medical necessity and appropriateness of services or site of
20 services; contracts with selected health care providers;
21 financial incentives or disincentives related to the use of
22 specific providers, services, or service sites; controlled
23 access to and coordination of services by a case manager; and
24 payor efforts to identify treatment alternatives and modify
25 benefit restrictions for high-cost patient care.
26 (18) "Managed competition" means a process by which
27 purchasers form alliances to obtain information on, and
28 purchase from, competing accountable health partnerships.
29 (19) "Medical outcome" means a change in an
30 individual's health status after the provision of health
31 services.
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1 (20) "Provider network" means an affiliated group of
2 varied health care providers that is established to provide a
3 continuum of health care services to individuals.
4 (21) "Purchaser" means an individual, an organization,
5 or the state that makes health-benefit purchasing decisions on
6 behalf of a group of individuals.
7 (22) "Self-funded plan" means a group health insurance
8 plan in which the sponsoring organization assumes the
9 financial risk of paying for all covered services provided to
10 its enrollees.
11 (23) "Utilization management" means programs designed
12 to control the overutilization of health services by reviewing
13 their appropriateness relative to established standards or
14 norms.
15 (24) "24-hour coverage" means the consolidation of
16 such time-limited health care coverage as personal injury
17 protection under automobile insurance into a general health
18 insurance plan.
19 (25) "Agent" means a person who is licensed to sell
20 insurance in this state pursuant to chapter 626.
21 (26) "Primary care physician" means a physician
22 licensed under chapter 458 or chapter 459 who practices family
23 medicine, general internal medicine, general pediatrics, or
24 general obstetrics/ gynecology.
25 Section 4. Section 408.702, Florida Statutes, is
26 amended to read:
27 408.702 Health Alliance for Small Business Community
28 health purchasing alliance; establishment; state and regional
29 boards.--
30 (1) There is created the Health Alliance for Small
31 Business, which shall operate as a nonprofit corporation
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1 organized under chapter 617. The alliance is not a state
2 agency. The alliance shall operate subject to the supervision
3 and approval of a board of directors composed of the chairman
4 of each of the regional boards of the alliance or, in lieu of
5 the chairman, a member of a regional board designated by the
6 chairman of that board.
7 (2)(a) The board of directors of each community health
8 purchasing alliance is redesignated as a regional board of the
9 Health Alliance for Small Business. Each regional board shall
10 operate as a nonprofit corporation organized under chapter
11 617. A regional board is not a state agency.
12 (b) The regional board replacing such community health
13 purchasing alliance shall assume the rights and obligations of
14 each former community health purchasing alliance as necessary
15 to fulfill the former alliance's contractual obligations
16 existing on the effective date of this act. Nothing in this
17 section shall impair or otherwise affect any such contract.
18 (3)(1) There is created a community health purchasing
19 alliance in each of the 11 health service planning districts
20 established under s. 408.032. Each alliance must be operated
21 as a state-chartered, nonprofit private organization organized
22 pursuant to chapter 617. There shall be no liability on the
23 part of, and no cause of action of any nature shall arise
24 against, any member of the board of directors of the a
25 community health purchasing alliance or of any regional board,
26 or their its employees or agents, for any action taken by a
27 the board in the performance of its powers and duties under
28 ss. 408.70-408.7045 ss. 408.70-408.706.
29 (4)(2) The number and geographical boundaries of
30 alliance districts may be revised by the state board Three or
31 fewer alliances located in contiguous districts that are not
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1 primarily urban may merge into a single alliance upon approval
2 of the agency based on upon a showing by the alliance board
3 members that the members of the each alliance would be better
4 served under a combined alliance. If the number or boundaries
5 of regional alliances are revised, the members of the new
6 regional boards for the affected regions must be
7 representative of the members of the former regional boards of
8 the affected regions in a method established by the state
9 board which reasonably provides for proportionate
10 representation of former board members. Board members of each
11 alliance shall serve as the board of the combined alliance.
12 (5)(3) The An alliance is the only entity that is
13 allowed to operate as an alliance in a particular district and
14 must operate for the benefit of its members who are: small
15 employers, as defined in s. 627.6699; the state on behalf of
16 its employees and the dependents of such employees; Medicaid
17 recipients; and associate alliance members. The An alliance
18 is the exclusive entity for the oversight and coordination of
19 alliance member purchases. Any health plan offered through the
20 an alliance must be offered by a health insurer an accountable
21 health partnership and the an alliance may not directly
22 provide insurance; directly contract, for purposes of
23 providing insurance, with a health care provider or provider
24 network; or bear any risk, or form self-insurance plans among
25 its members. An alliance may form a network with other
26 alliances in order to improve services provided to alliance
27 members. Nothing in ss. 408.70-408.7045 ss. 408.70-408.706
28 limits or authorizes the formation of business health
29 coalitions; however, a person or entity that pools together or
30 assists in purchasing health coverage for small employers, as
31 defined in s. 627.6699, state employees and their dependents,
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1 and Medicaid, Medicaid buy-in, and MedAccess recipients may
2 not discriminate in its activities based on the health status
3 or historical or projected claims experience of such employers
4 or recipients.
5 (4) Each alliance shall capitalize on the expertise of
6 existing business health coalitions.
7 (6)(5) Membership or associate membership in the an
8 alliance and participation by health insurers are is
9 voluntary.
10 (7) The state board of the alliance may:
11 (a) Negotiate with health insurers to offer health
12 plans to alliance members in one or more regions under terms
13 and conditions as agreed to between the board, as group
14 policyholder, and the health insurer. The board and the
15 insurer may negotiate and agree to health plan selection,
16 benefit design, premium rates, and other terms of coverage,
17 subject to the requirements of the Florida Insurance Code.
18 (b) Establish minimum requirements of alliance
19 membership, consistent with the definition of the term "small
20 employer" in s. 627.6699, including any documentation that an
21 applicant must submit to establish eligibility for membership.
22 (c) Establish administrative and accounting procedures
23 for its operation and for the operation of the regional
24 boards, and require regional boards to submit program reports
25 to the state board or the agency.
26 (d) Receive and accept grants, loans, advances, or
27 funds from any public or private agency, and receive and
28 accept, from any source, contributions of money, property,
29 labor, or any other thing of value.
30 (e) Hire employees or contract with qualified,
31 independent third parties for any service necessary to carry
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1 out the board's powers and duties, as authorized under ss.
2 408.70-408.7045. However, the board may not hire an insurance
3 agent who engages in activities on behalf of the alliance for
4 which an insurance agent's license is required by chapter 626.
5 (f) Perform any of the activities that may be
6 performed by a regional board under subsection (6), subject to
7 coordination with the regional boards to avoid duplication of
8 effort.
9 (8) Each regional board of the alliance may:
10 (a) Establish conditions of alliance membership
11 consistent with the minimum requirements established by the
12 state board.
13 (b) Provide to alliance members standardized
14 information for comparing health plans offered through the
15 alliance.
16 (c) Offer health plans to alliance members, subject to
17 the terms and conditions agreed to by the state board and
18 participating health insurers.
19 (d) Market and publicize the coverage and services
20 offered by the alliance.
21 (e) Collect premiums from alliance members on behalf
22 of participating health insurers.
23 (f) Assist members in resolving disputes between
24 health insurers and alliance members, consistent with
25 grievance procedures required by law.
26 (g) Set reasonable fees for alliance membership,
27 services offered by the alliance, and late payment of premiums
28 by alliance members for which the alliance is responsible.
29 (h) Receive and accept grants, loans, advances, or
30 funds from any public or private agency, and receive and
31 accept, from any source, contributions of money, property,
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1 labor, or any other thing of value.
2 (i) Hire employees or contract with qualified,
3 independent third parties for any service necessary to carry
4 out the regional board's powers and duties as authorized under
5 ss. 408.70-408.7045. However, a regional board may not hire an
6 insurance agent who engages in activities on behalf of the
7 alliance for which an insurance agent's license is required by
8 chapter 626.
9 (9) No state agency may expend or provide funds to the
10 Alliance that would subsidize the pricing of health insurance
11 policies for its members, unless the Legislature specifically
12 authorizes such expenditure.
13 (6) Each community health purchasing alliance has the
14 following powers, duties, and responsibilities:
15 (a) Establishing the conditions of alliance membership
16 in accordance with ss. 408.70-408.706.
17 (b) Providing to alliance members clear, standardized
18 information on each accountable health partnership and each
19 health plan offered by each accountable health partnership,
20 including information on price, enrollee costs, quality,
21 patient satisfaction, enrollment, and enrollee
22 responsibilities and obligations; and providing accountable
23 health partnership comparison sheets in accordance with agency
24 rule to be used in providing members and their employees with
25 information regarding standard, basic, and specialized
26 coverage that may be obtained through the accountable health
27 partnerships.
28 (c) Annually offering to all alliance members all
29 accountable health partnerships and health plans offered by
30 the accountable health partnerships which meet the
31 requirements of ss. 408.70-408.706, and which submit a
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1 responsive proposal as to information necessary for
2 accountable health partnership comparison sheets, and
3 providing assistance to alliance members in selecting and
4 obtaining coverage through accountable health partnerships
5 that meet those requirements.
6 (d) Requesting proposals for the standard and basic
7 health plans, as defined in s. 627.6699, from all accountable
8 health partnerships in the district; providing, in the format
9 required by the alliance in the request for proposals, the
10 necessary information for accountable health partnership
11 comparison sheets; and offering to its members health plans of
12 accountable health partnerships which meet those requirements.
13 (e) Requesting proposals from all accountable health
14 partnerships in the district for specialized benefits approved
15 by the alliance board based on input from alliance members,
16 determining if the proposals submitted by the accountable
17 health partnerships meet the requirements of the request for
18 proposals, and offering them as options through riders to
19 standard plans and basic plans. This paragraph does not limit
20 an accountable health partnership's ability to offer other
21 specialized benefits to alliance members.
22 (f) Distributing to health care purchasers, placing
23 special emphasis on the elderly, retail price data on
24 prescription drugs and their generic equivalents, durable
25 medical equipment, and disposable medical supplies which is
26 provided by the agency pursuant to s. 408.063(3) and (4).
27 (g) Establishing administrative and accounting
28 procedures for the operation of the alliance and members'
29 services, preparing an annual alliance budget, and preparing
30 annual program and fiscal reports on alliance operations as
31 required by the agency.
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1 (h) Developing and implementing a marketing plan to
2 publicize the alliance to potential members and associate
3 members and developing and implementing methods for informing
4 the public about the alliance and its services.
5 (i) Developing grievance procedures to be used in
6 resolving disputes between members and the alliance and
7 disputes between the accountable health partnerships and the
8 alliance. Any member of, or accountable health partnership
9 that serves, an alliance may appeal to the agency any
10 grievance that is not resolved by the alliance.
11 (j) Ensuring that accountable health partnerships have
12 grievance procedures to be used in resolving disputes between
13 members and an accountable health partnership. A member may
14 appeal to the alliance any grievance that is not resolved by
15 the accountable health partnership. An accountable health
16 partnership that is a health maintenance organization must
17 follow the grievance procedures established in ss. 408.7056
18 and 641.31(5).
19 (k) Maintaining all records, reports, and other
20 information required by the agency, ss. 408.70-408.706, or
21 other state and local laws.
22 (l) Receiving and accepting grants, loans, advances,
23 or funds from any public or private agency; and receiving and
24 accepting contributions, from any source, of money, property,
25 labor, or any other thing of value.
26 (m) Contracting, as authorized by alliance members,
27 with a qualified, independent third party for any service
28 necessary to carry out the powers and duties required by ss.
29 408.70-408.706.
30 (n) Developing a plan to facilitate participation of
31 providers in the district in an accountable health
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1 partnership, placing special emphasis on ensuring
2 participation by minority physicians in accountable health
3 partnerships if such physicians are available. The use of the
4 term "minority" in ss. 408.70-408.706 is consistent with the
5 definition of "minority person" provided in s. 288.703(3).
6 (o) Ensuring that any health plan reasonably available
7 within the jurisdiction of an alliance, through a preferred
8 provider network, a point of service product, an exclusive
9 provider organization, a health maintenance organization, or a
10 pure indemnity product, is offered to members of the alliance.
11 For the purposes of this paragraph, "pure indemnity product"
12 means a health insurance policy or contract that does not
13 provide different rates of reimbursement for a specified list
14 of physicians and a "point of service product" means a
15 preferred provider network or a health maintenance
16 organization which allows members to select at a higher cost a
17 provider outside of the network or the health maintenance
18 organization.
19 (p) Petitioning the agency for a determination as to
20 the cost-effectiveness of collecting premiums on behalf of
21 participating accountable health partnerships. If determined
22 by the agency to be cost-effective, the alliance may establish
23 procedures for collecting premiums from members and distribute
24 them to the participating accountable health partnerships.
25 This may include the remittance of the share of the group
26 premium paid by both an employer and an enrollee. If an
27 alliance assumes premium collection responsibility, it shall
28 also assume liability for uncollected premium. This liability
29 may be collected through a bad debt surcharge on alliance
30 members to finance the cost of uncollected premiums. The
31 alliance shall pay participating accountable health
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1 partnerships their contracting premium amounts on a prepaid
2 monthly basis, or as otherwise mutually agreed upon.
3 (7) Each alliance shall set reasonable fees for
4 membership in the alliance which will finance all reasonable
5 and necessary costs incurred in administering the alliance.
6 (9)(8) Each regional board alliance shall annually
7 report to the state board on the operations of the alliance in
8 that region, including program and financial operations, and
9 shall provide for annual internal and independent audits.
10 (10)(9) The alliance, the state board, and regional
11 boards A community health purchasing alliance may not engage
12 in any activities for which an insurance agent's license is
13 required by chapter 626.
14 (11)(10) The powers and responsibilities of the a
15 community health purchasing alliance with respect to
16 purchasing health plans services from health insurers
17 accountable health partnerships do not extend beyond those
18 enumerated in ss. 408.70-408.7045 ss. 408.70-408.706.
19 (12) The Office of the Auditor General may audit and
20 inspect the operations and records of the alliance.
21 Section 5. Section 408.703, Florida Statutes, is
22 amended to read:
23 408.703 Small employer members of the alliance
24 community health purchasing alliances; eligibility
25 requirements.--
26 (1) The board agency shall establish conditions of
27 participation in the alliance for small employers, as defined
28 in s. 627.6699, which must include, but need not be limited
29 to:
30 (a) Assurance that the group is a valid small employer
31 and is not formed for the purpose of securing health benefit
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1 coverage. This assurance must include requirements for sole
2 proprietors and self-employed individuals which must be based
3 on a specified requirement for the time that the sole
4 proprietor or self-employed individual has been in business,
5 required filings to verify employment status, and other
6 requirements to ensure that the individual is working.
7 (b) Assurance that the individuals in the small
8 employer group are employees and have not been added for the
9 purpose of securing health benefit coverage.
10 (2) The agency may not require a small employer to pay
11 any portion of premiums as a condition of participation in an
12 alliance.
13 (2)(3) The board agency may require a small employer
14 seeking membership to agree to participate in the alliance for
15 a specified minimum period of time, not to exceed 1 year.
16 (4) If a member small employer offers more than one
17 accountable health partnership or health plan and the employer
18 contributes to coverage of employees or dependents of the
19 employee, the alliance shall require that the employer
20 contribute the same dollar amount for each employee,
21 regardless of the accountable health partnership or benefit
22 plan chosen by the employee.
23 (5) An employer that employs 30 or fewer employees
24 must offer at least 2 accountable health partnerships or
25 health plans to its employees, and an employer that employs 31
26 or more employees must offer 3 or more accountable health
27 partnerships or health plans to its employees.
28 (3)(6) Notwithstanding any other law, if a small
29 employer member loses eligibility to purchase health care
30 through the a community health purchasing alliance solely
31 because the business of the small employer member expands to
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1 more than 50 and less than 75 eligible employees, the small
2 employer member may, at its next renewal date, purchase
3 coverage through the alliance for not more than 1 additional
4 year.
5 Section 6. Section 408.704, Florida Statutes, 1998
6 Supplement, is amended to read:
7 408.704 Agency duties and responsibilities related to
8 the alliance community health purchasing alliances.--
9 (1) The agency shall supervise the operation of the
10 alliance. assist in developing a statewide system of community
11 health purchasing alliances. To this end, the agency is
12 responsible for:
13 (1) Initially and thereafter annually certifying that
14 each community health purchasing alliance complies with ss.
15 408.70-408.706 and rules adopted pursuant to ss.
16 408.70-408.706. The agency may decertify any community health
17 purchasing alliance if the alliance fails to comply with ss.
18 408.70-408.706 and rules adopted by the agency.
19 (2) The agency shall conduct Providing administrative
20 startup funds. Each contract for startup funds is limited to
21 $275,000.
22 (3) Conducting an annual review of the performance of
23 the each alliance to ensure that the alliance is in compliance
24 with ss. 408.70-408.7045 ss. 408.70-408.706. To assist the
25 agency in its review, the each alliance shall submit,
26 quarterly, data to the agency, including, but not limited to,
27 employer enrollment by employer size, industry sector,
28 previous insurance status, and count; number of total eligible
29 employers in the alliance district participating in the
30 alliance; number of insured lives by county and insured
31 category, including employees, dependents, and other insured
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1 categories, represented by alliance members; profiles of
2 potential employer membership by county; premium ranges for
3 each health insurer accountable health partnership for
4 alliance member categories; type and resolution of member
5 grievances; membership fees; and alliance financial
6 statements. A summary of this annual review shall be provided
7 to the Legislature and to each alliance.
8 (4) Developing accountable health partnership
9 comparison sheets to be used in providing members and their
10 employees with information regarding the accountable health
11 partnership.
12 (5) Establishing a data system for accountable health
13 partnerships.
14 (a) The agency shall establish an advisory data
15 committee comprised of the following representatives of
16 employers, medical providers, hospitals, health maintenance
17 organizations, and insurers:
18 1. Two representatives appointed by each of the
19 following organizations: Associated Industries of Florida,
20 the Florida Chamber of Commerce, the National Federation of
21 Independent Businesses, and the Florida Retail Federation;
22 2. One representative of each of the following
23 organizations: the Florida League of Hospitals, the
24 Association of Voluntary Hospitals of Florida, the Florida
25 Hospital Association, the Florida Medical Association, the
26 Florida Osteopathic Medical Association, the Florida
27 Chiropractic Association, the Florida Chapter of the National
28 Medical Association, the Association of Managed Care
29 Physicians, the Florida Insurance Council, the Florida
30 Association of Domestic Insurers, the Florida Association of
31 Health Maintenance Organizations; and
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1 3. One representative of governmental health care
2 purchasers and three consumer representatives, to be appointed
3 by the agency.
4 (b) The advisory data committee shall issue a report
5 and recommendations on each of the following subjects as each
6 is completed. A final report covering all subjects must be
7 included in the final Florida Health Plan to be submitted to
8 the Legislature on December 31, 1993. The report shall
9 include recommendations regarding:
10 1. Types of data to be collected. Careful
11 consideration shall be given to other data collection projects
12 and standards for electronic data interchanges already in
13 process in this state and nationally, to evaluating and
14 recommending the feasibility and cost-effectiveness of various
15 data collection activities, and to ensuring that data
16 reporting is necessary to support the evaluation of providers
17 with respect to cost containment, access, quality, control of
18 expensive technologies, and customer satisfaction analysis.
19 Data elements to be collected from providers include prices,
20 utilization, patient outcomes, quality, and patient
21 satisfaction. The completion of this task is the first
22 priority of the advisory data committee. The agency shall
23 begin implementing these data collection activities
24 immediately upon receipt of the recommendations, but no later
25 than January 1, 1994. The data shall be submitted by
26 hospitals, other licensed health care facilities, pharmacists,
27 and group practices as defined in s. 455.654(3)(f).
28 2. A standard data set, a standard cost-effective
29 format for collecting the data, and a standard methodology for
30 reporting the data to the agency, or its designee, and to the
31 alliances. The reporting mechanisms must be designed to
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1 minimize the administrative burden and cost to health care
2 providers and carriers. A methodology shall be developed for
3 aggregating data in a standardized format for making
4 comparisons between accountable health partnerships which
5 takes advantage of national models and activities.
6 3. Methods by which the agency should collect,
7 process, analyze, and distribute the data.
8 4. Standards for data interpretation. The advisory
9 data committee shall actively solicit broad input from the
10 provider community, carriers, the business community, and the
11 general public.
12 5. Structuring the data collection process to:
13 a. Incorporate safeguards to ensure that the health
14 care services utilization data collected is reviewed by
15 experienced, practicing physicians licensed to practice
16 medicine in this state;
17 b. Require that carrier customer satisfaction data
18 conclusions are validated by the agency;
19 c. Protect the confidentiality of medical information
20 to protect the patient's identity and to protect the privacy
21 of individual physicians and patients. Proprietary data
22 submitted by insurers, providers, and purchasers are
23 confidential pursuant to s. 408.061; and
24 d. Afford all interested professional medical and
25 hospital associations and carriers a minimum of 60 days to
26 review and comment before data is released to the public.
27 6. Developing a data collection implementation
28 schedule, based on the data collection capabilities of
29 carriers and providers.
30 (c) In developing data recommendations, the advisory
31 data committee shall assess the cost-effectiveness of
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1 collecting data from individual physician providers. The
2 initial emphasis must be placed on collecting data from those
3 providers with whom the highest percentages of the health care
4 dollars are spent: hospitals, large physician group practices,
5 outpatient facilities, and pharmacies.
6 (d) The agency shall, to the maximum extent possible,
7 adopt and implement the recommendations of the advisory data
8 committee. The agency shall report all recommendations of the
9 advisory data committee to the Legislature and submit an
10 implementation plan.
11 (e) The travel expenses of the participants of the
12 advisory data committee must be paid by the participant or by
13 the organization that nominated the participant.
14 (6) Collecting, compiling, and analyzing data on
15 accountable health partnerships and providing statistical
16 information to alliances.
17 (7) Receiving appeals by members of an alliance and
18 accountable health partnerships whose grievances were not
19 resolved by the alliance. The agency shall review these
20 appeals pursuant to chapter 120. Records or reports submitted
21 as a part of a grievance proceeding conducted as provided for
22 under this subsection are confidential and exempt from the
23 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
24 Constitution. Records or reports of patient care quality
25 assurance proceedings obtained or made by any member of a
26 community health purchasing alliance or any member of an
27 accountable health partnership and received by the agency as a
28 part of a proceeding conducted pursuant to this subsection are
29 confidential and exempt from s. 119.07(1) and s. 24(a), Art. I
30 of the State Constitution. Portions of meetings held pursuant
31 to the provisions of this subsection during which records held
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1 confidential pursuant to the provisions of this subsection are
2 discussed are exempt from the provisions of s. 286.011 and s.
3 24(b), Art. I of the State Constitution. All portions of any
4 meeting closed to the public shall be recorded by a certified
5 court reporter. For any portion of a meeting that is closed,
6 the reporter shall record the times of commencement and
7 termination of the meeting, all discussion and proceedings,
8 the names of all persons present at any time, and the names of
9 all persons speaking. No portion of the closed meeting shall
10 be off the record. The court reporter's notes shall be fully
11 transcribed and given to the appropriate records custodian
12 within a reasonable time after the meeting. A copy of the
13 original transcript, with information otherwise confidential
14 or exempt from public disclosure redacted, shall be made
15 available for public inspection and copying 3 years after the
16 date of the closed meeting.
17 Section 7. Section 408.7045, Florida Statutes, is
18 amended to read:
19 408.7045 Community health purchasing Alliance
20 marketing requirements.--
21 (1) The Each alliance shall use appropriate,
22 efficient, and standardized means to notify members of the
23 availability of sponsored health coverage from the alliance.
24 (2) The Each alliance shall make available to members
25 marketing materials that accurately summarize the benefit
26 plans that are offered by its health insurer accountable
27 health partnerships and the rates, costs, and accreditation
28 information relating to those plans.
29 (3) Annually, the alliance shall offer each member
30 small employer all accountable health partnerships available
31 in the alliance and provide them with the appropriate
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1 materials relating to those plans. The member small employer
2 may choose which health benefit plans shall be offered to
3 eligible employees and may change the selection each year.
4 The employee may be given options with regard to health plans
5 and the type of managed care system under which his or her
6 benefits will be provided.
7 (4) An alliance may notify the agency of any marketing
8 practices or materials that it finds are contrary to the fair
9 and affirmative marketing requirements of the program. Upon
10 the request of an alliance, the agency shall request the
11 Department of Insurance to investigate the practices and the
12 Department of Insurance may take any action authorized for a
13 violation of the insurance code or the Health Maintenance
14 Organization Act.
15 Section 8. Paragraph (b) of subsection (6) of section
16 627.6699, Florida Statutes, 1998 Supplement, is amended to
17 read:
18 627.6699 Employee Health Care Access Act.--
19 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
20 (b) For all small employer health benefit plans that
21 are subject to this section and are issued by small employer
22 carriers on or after January 1, 1994, premium rates for health
23 benefit plans subject to this section are subject to the
24 following:
25 1. Small employer carriers must use a modified
26 community rating methodology in which the premium for each
27 small employer must be determined solely on the basis of the
28 eligible employee's and eligible dependent's gender, age,
29 family composition, tobacco use, or geographic area as
30 determined under paragraph (5)(j) (5)(k).
31 2. Rating factors related to age, gender, family
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1 composition, tobacco use, or geographic location may be
2 developed by each carrier to reflect the carrier's experience.
3 The factors used by carriers are subject to department review
4 and approval.
5 3. Small employer carriers may not modify the rate for
6 a small employer for 12 months from the initial issue date or
7 renewal date, unless the composition of the group changes or
8 benefits are changed. However, a small employer carrier may
9 modify the rate one time prior to 12 months after the initial
10 issue date for a small employer who enrolls under a previously
11 issued group policy that has a common anniversary date for all
12 employers covered under the policy, if the carrier discloses
13 to the employer in a clear and conspicuous manner the date of
14 the first renewal and the fact that the premium may increase
15 on or after that date and if the insurer demonstrates to the
16 department that efficiencies in administration are achieved
17 and reflected in the rates charged to small employers covered
18 under the policy.
19 4. A small employer carrier may issue a policy to a
20 group association with rates that reflect a premium credit for
21 expense savings attributable to administrative activities
22 being performed by the group association, if these expense
23 savings are specifically documented in the carrier's rate
24 filing and are approved by the department. Any such credit may
25 not be based on different morbidity assumptions or on any
26 other factor related to the health status or claims experience
27 of the group or its members. Carriers participating in the
28 alliance program, in accordance with ss. 408.700-408.707, may
29 apply a different community rate to business written in that
30 program.
31 (c) For all small employer health benefit plans that
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1 are subject to this section, that are issued by small employer
2 carriers before January 1, 1994, and that are renewed on or
3 after January 1, 1995, renewal rates must be based on the same
4 modified community rating standard applied to new business.
5 (d) Notwithstanding s. 627.401(2), this section and
6 ss. 627.410 and 627.411 apply to any health benefit plan
7 provided by a small employer carrier that provides coverage to
8 one or more employees of a small employer regardless of where
9 the policy, certificate, or contract is issued or delivered,
10 if the health benefit plan covers employees or their covered
11 dependents who are residents of this state.
12 Section 9. Sections 408.7041, 408.7042, 408.7055, and
13 408.706, Florida Statutes, are repealed.
14
15 (Redesignate subsequent sections.)
16
17
18 ================ T I T L E A M E N D M E N T ===============
19 And the title is amended as follows:
20 On page 1, lines 2-16, delete those lines
21
22 and insert:
23 An act relating to health insurance; amending
24 s. 627.6699, F.S.; modifying definitions;
25 requiring small employer carriers to begin to
26 offer and issue all small employer benefit
27 plans on a specified date; deleting the
28 requirement that basic and standard small
29 employer health benefit plans be issued;
30 providing additional requirements for
31 determining premium rates for benefit plans;
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1 providing for applicability of the act to plans
2 provided by small employer carriers that are
3 insurers or health maintenance organizations
4 notwithstanding the provisions of certain other
5 specified statutes under specified conditions;
6 amending s. 408.70, F.S.; providing legislative
7 intent for the organization of a nonprofit
8 corporation for providing affordable group
9 health insurance; amending s. 408.701, F.S.;
10 revising definitions; amending s. 408.702,
11 F.S.; creating the Health Alliance for Small
12 Business; deleting authorization for community
13 health purchasing alliances; creating a board
14 of governors for the alliance; specifying
15 organizational requirements; specifying that
16 the alliance is not a state agency;
17 redesignating community health purchasing
18 alliances as regional boards of the alliance;
19 revising provisions related to liability of
20 board members, number and boundary of alliance
21 districts, eligibility for alliance membership,
22 and powers of the state board and regional
23 boards of the alliance; authorizing the Office
24 of the Auditor General to audit and inspect the
25 alliance; prohibiting state agencies from
26 providing certain funds to the alliance without
27 specific legislative approval; amending s.
28 408.703, F.S.; providing eligibility
29 requirements for small employer members of the
30 alliance; amending s. 408.704, F.S.; providing
31 responsibilities for the Agency for Health Care
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1 Administration; amending s. 408.7045, F.S.;
2 revising marketing requirements of the
3 alliance; amending s. 627.6699, F.S.; revising
4 restrictions related to premium rates for small
5 employer health benefit plans; repealing ss.
6 408.7041, 408.7042, 408.7055, 408.706, F.S.,
7 relating to anti-trust protection, relating to
8 purchasing coverage for state employees and
9 Medicaid recipients through community health
10 purchasing alliances, relating to the
11 establishment of practitioner advisory groups
12 by the Agency for Health Care Administration,
13 and relating to requirements for accountable
14 health partnerships; providing an effective
15 date.
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