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