House Bill 1631

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    Florida House of Representatives - 1999                HB 1631

        By Representatives Farkas, Morroni, Bense, Jones, L.
    Miller, Fasano, Cosgrove, Peaden and Wasserman Schultz





  1                      A bill to be entitled

  2         An act relating to health insurance; amending

  3         s. 408.70, F.S.; providing legislative intent

  4         for the organization of a nonprofit corporation

  5         for providing affordable group health

  6         insurance; amending s. 408.701, F.S.; revising

  7         definitions; amending s. 408.702, F.S.;

  8         creating the Health Alliance for Small

  9         Business; deleting authorization for community

10         health purchasing alliances; creating a board

11         of governors for the alliance; specifying

12         organizational requirements; specifying that

13         the alliance is not a state agency;

14         redesignating community health purchasing

15         alliances as regional boards of the alliance;

16         revising provisions related to liability of

17         board members, number and boundary of alliance

18         districts, eligibility for alliance membership,

19         and powers of the state board and regional

20         boards of the alliance; authorizing the Office

21         of the Auditor General to audit and inspect the

22         alliance; amending s. 408.703, F.S.; providing

23         eligibility requirements for small employer

24         members of the alliance; amending s. 408.704,

25         F.S.; providing responsibilities for the Agency

26         for Health Care Administration; amending s.

27         408.7041, F.S.; conforming provisions; amending

28         s. 408.7045, F.S.; revising marketing

29         requirements of the alliance; amending s.

30         627.6699, F.S.; revising restrictions related

31         to premium rates for small employer health

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  1         benefit plans; repealing ss. 408.7042,

  2         408.7055, 408.706, F.S., relating to purchasing

  3         coverage for state employees and Medicaid

  4         recipients through community health purchasing

  5         alliances, relating to the establishment of

  6         practitioner advisory groups by the Agency for

  7         Health Care Administration, and relating to

  8         requirements for accountable health

  9         partnerships; providing an effective date.

10

11  Be It Enacted by the Legislature of the State of Florida:

12

13         Section 1.  Section 408.70, Florida Statutes, is

14  amended to read:

15         408.70  Health Alliance for Small Business Community

16  health purchasing; legislative findings and intent.--It is the

17  intent of the Legislature that a nonprofit corporation, to be

18  known as the "Health Alliance for Small Business," be

19  organized for the purpose of pooling groups of individuals

20  employed by small employers and the dependents of such

21  employees into larger groups in order to facilitate the

22  purchase of affordable group health insurance coverage.

23         (1)  The Legislature finds that the current health care

24  system in this state does not provide access to affordable

25  health care for all persons in this state.  Almost one in five

26  persons is without health insurance.  For many, entry into the

27  health care system is through a hospital emergency room rather

28  than a primary care setting.  The availability of preventive

29  and primary care and managed, family-based care is limited.

30  Health insurance underwriting practices have led to the

31  avoidance, rather than to the sharing, of insurance risks,

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  1  limiting access to coverages for small-sized employer groups

  2  and high-risk populations.  Spiraling premium costs have

  3  placed health insurance policies out of the reach of many

  4  small-sized and medium-sized businesses and their employees.

  5  Lack of outcome and cost information has forced individuals

  6  and businesses to make critical health care decisions with

  7  little guidance or leverage. Health care resources have not

  8  been allocated efficiently, leading to excess and unevenly

  9  distributed capacity.  These factors have contributed to the

10  high cost of health care.  Rural and other medically

11  underserved areas have too few health care resources.

12  Comprehensive, first-dollar coverages have allowed individuals

13  to seek care without regard to cost.  Provider competition and

14  liability concerns have led to a medical technology arms race.

15  Rather than competing on the basis of price and patient

16  outcome, health care providers compete for patients on the

17  basis of service, equipping themselves with the latest and

18  best technologies.  Managed-care and group-purchasing

19  mechanisms are not widely available to small group purchasers.

20  Health care regulation has placed undue burdens on health care

21  insurers and providers, driving up costs, limiting

22  competition, and preventing market-based solutions to cost and

23  quality problems. Health care costs have been increasing at

24  several times the rate of general inflation, eroding employer

25  profits and investments, increasing government revenue

26  requirements, reducing consumer coverages and purchasing

27  power, and limiting public investments in other vital

28  governmental services.

29         (2)  It is the intent of the Legislature that a

30  structured health care competition model, known as "managed

31  competition," be implemented throughout the state to improve

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  1  the efficiency of the health care markets in this state.  The

  2  managed competition model will promote the pooling of

  3  purchaser and consumer buying power; ensure informed

  4  cost-conscious consumer choice of managed care plans; reward

  5  providers for high-quality, economical care; increase access

  6  to care for uninsured persons; and control the rate of

  7  inflation in health care costs.

  8         (3)  The Legislature intends that state-chartered,

  9  nonprofit private purchasing organizations, to be known as

10  "community health purchasing alliances," be established.  The

11  community health purchasing alliances shall be responsible for

12  assisting alliance members in securing the highest quality of

13  health care, based on current standards, at the lowest

14  possible prices.

15         Section 2.  Section 408.701, Florida Statutes, 1998

16  Supplement, is amended to read:

17         408.701  Health Alliance for Small Business Community

18  health purchasing; definitions.--As used in ss.

19  408.70-408.7045 ss. 408.70-408.706, the term:

20         (1)  "Accountable health partnership" means an

21  organization that integrates health care providers and

22  facilities and assumes risk, in order to provide health care

23  services, as certified by the agency under s. 408.704.

24         (1)(2)  "Agency" means the Agency for Health Care

25  Administration.

26         (2)(3)  "Alliance" means the Health Alliance for Small

27  Business a community health purchasing alliance.

28         (3)(4)  "Alliance member" means:

29         (a)  a small employer as defined in s. 627.6699 who, or

30         (b)  The state, for the purpose of providing health

31  benefits to state employees and their dependents through the

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  1  state group insurance program and to Medicaid recipients,

  2  participants in the MedAccess program, and participants in the

  3  Medicaid buy-in program,

  4

  5  if such entities voluntarily elects choose to join an

  6  alliance.

  7         (5)  "Antitrust laws" means federal and state laws

  8  intended to protect commerce from unlawful restraints,

  9  monopolies, and unfair business practices.

10         (6)  "Associate alliance member" means any purchaser

11  who joins an alliance for the purposes of participating on the

12  alliance board and receiving data from the alliance at no

13  charge as a benefit of membership.

14         (7)  "Benefit standard" means a specified set of health

15  services that are the minimum that must be covered under a

16  basic health benefit plan, as defined in s. 627.6699.

17         (8)  "Business health coalition" means a group of

18  employers organized to share information about health services

19  and insurance coverage, to enable the employers to obtain more

20  cost-effective care for their employees.

21         (9)  "Community health purchasing alliance" means a

22  state-chartered, nonprofit organization that provides

23  member-purchasing services and detailed information to its

24  members on comparative prices, usage, outcomes, quality, and

25  enrollee satisfaction with accountable health partnerships.

26         (10)  "Consumer" means an individual user of health

27  care services.

28         (11)  "Department" means the Department of Insurance.

29         (12)  "Grievance procedure" means an established set of

30  rules that specify a process for appeal of an organizational

31  decision.

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  1         (4)(13)  "Health care provider" or "provider" means a

  2  state-licensed or state-authorized facility, a facility

  3  principally supported by a local government or by funds from a

  4  charitable organization that holds a current exemption from

  5  federal income tax under s. 501(c)(3) of the Internal Revenue

  6  Code, a licensed practitioner, a county health department

  7  established under part I of chapter 154, a prescribed

  8  pediatric extended care center defined in s. 400.902, a

  9  federally supported primary care program such as a migrant

10  health center or a community health center authorized under s.

11  329 or s. 330 of the United States Public Health Services Act

12  that delivers health care services to individuals, or a

13  community facility that receives funds from the state under

14  the Community Alcohol, Drug Abuse, and Mental Health Services

15  Act and provides mental health services to individuals.

16         (5)(14)  "Health insurer" or "insurer" means a health

17  insurer or health maintenance organization that is issued a

18  certificate of authority an organization licensed by the

19  Department of Insurance under part III of chapter 624 or part

20  I of chapter 641.

21         (6)(15)  "Health plan" or "health insurance" means any

22  health insurance policy or health maintenance organization

23  contract issued by a health insurer hospital or medical policy

24  or contract or certificate, hospital or medical service plan

25  contract, or health maintenance organization contract as

26  defined in the insurance code or Health Maintenance

27  Organization Act.  The term does not include accident-only,

28  specific disease, individual hospital indemnity, credit,

29  dental-only, vision-only, Medicare supplement, long-term care,

30  or disability income insurance; coverage issued as a

31

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  1  supplement to liability insurance; workers' compensation or

  2  similar insurance; or automobile medical-payment insurance.

  3         (7)  "Regional board" means the board of directors of

  4  each region of the alliance, as established under s.

  5  408.702(1).

  6         (8)  "State board" or "board" means the board of

  7  directors of the alliance, as established under s. 408.702(2).

  8         (16)  "Health status" means an assessment of an

  9  individual's mental and physical condition.

10         (17)  "Managed care" means systems or techniques

11  generally used by third-party payors or their agents to affect

12  access to and control payment for health care services.

13  Managed-care techniques most often include one or more of the

14  following:  prior, concurrent, and retrospective review of the

15  medical necessity and appropriateness of services or site of

16  services; contracts with selected health care providers;

17  financial incentives or disincentives related to the use of

18  specific providers, services, or service sites; controlled

19  access to and coordination of services by a case manager; and

20  payor efforts to identify treatment alternatives and modify

21  benefit restrictions for high-cost patient care.

22         (18)  "Managed competition" means a process by which

23  purchasers form alliances to obtain information on, and

24  purchase from, competing accountable health partnerships.

25         (19)  "Medical outcome" means a change in an

26  individual's health status after the provision of health

27  services.

28         (20)  "Provider network" means an affiliated group of

29  varied health care providers that is established to provide a

30  continuum of health care services to individuals.

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  1         (21)  "Purchaser" means an individual, an organization,

  2  or the state that makes health-benefit purchasing decisions on

  3  behalf of a group of individuals.

  4         (22)  "Self-funded plan" means a group health insurance

  5  plan in which the sponsoring organization assumes the

  6  financial risk of paying for all covered services provided to

  7  its enrollees.

  8         (23)  "Utilization management" means programs designed

  9  to control the overutilization of health services by reviewing

10  their appropriateness relative to established standards or

11  norms.

12         (24)  "24-hour coverage" means the consolidation of

13  such time-limited health care coverage as personal injury

14  protection under automobile insurance into a general health

15  insurance plan.

16         (25)  "Agent" means a person who is licensed to sell

17  insurance in this state pursuant to chapter 626.

18         (26)  "Primary care physician" means a physician

19  licensed under chapter 458 or chapter 459 who practices family

20  medicine, general internal medicine, general pediatrics, or

21  general obstetrics/ gynecology.

22         Section 3.  Section 408.702, Florida Statutes, is

23  amended to read:

24         408.702  Health Alliance for Small Business Community

25  health purchasing alliance; establishment; state and regional

26  boards.--

27         (1)  There is created the Health Alliance for Small

28  Business, which shall operate as a nonprofit corporation

29  organized under chapter 617. The alliance is not a state

30  agency. The alliance shall operate subject to the supervision

31  and approval of a board of directors composed of the chairman

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  1  of each of the regional boards of the alliance or, in lieu of

  2  the chairman, a member of a regional board designated by the

  3  chairman of that board.

  4         (2)(a)  The board of directors of each community health

  5  purchasing alliance is redesignated as a regional board of the

  6  Health Alliance for Small Business. Each regional board shall

  7  operate as a nonprofit corporation organized under chapter

  8  617. A regional board is not a state agency.

  9         (b)  The regional board replacing such community health

10  purchasing alliance shall assume the rights and obligations of

11  each former community health purchasing alliance as necessary

12  to fulfill the former alliance's contractual obligations

13  existing on the effective date of this act. Nothing in this

14  section shall impair or otherwise affect any such contract.

15         (3)(1)  There is created a community health purchasing

16  alliance in each of the 11 health service planning districts

17  established under s. 408.032. Each alliance must be operated

18  as a state-chartered, nonprofit private organization organized

19  pursuant to chapter 617. There shall be no liability on the

20  part of, and no cause of action of any nature shall arise

21  against, any member of the board of directors of the a

22  community health purchasing alliance or of any regional board,

23  or their its employees or agents, for any action taken by a

24  the board in the performance of its powers and duties under

25  ss. 408.70-408.7045 ss. 408.70-408.706.

26         (4)(2)  The number and geographical boundaries of

27  alliance districts may be revised by the state board Three or

28  fewer alliances located in contiguous districts that are not

29  primarily urban may merge into a single alliance upon approval

30  of the agency based on upon a showing by the alliance board

31  members that the members of the each alliance would be better

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  1  served under a combined alliance. If the number or boundaries

  2  of regional alliances are revised, the members of the new

  3  regional boards for the affected regions must be

  4  representative of the members of the former regional boards of

  5  the affected regions in a method established by the state

  6  board which reasonably provides for proportionate

  7  representation of former board members. Board members of each

  8  alliance shall serve as the board of the combined alliance.

  9         (5)(3)  The An alliance is the only entity that is

10  allowed to operate as an alliance in a particular district and

11  must operate for the benefit of its members who are: small

12  employers, as defined in s. 627.6699; the state on behalf of

13  its employees and the dependents of such employees; Medicaid

14  recipients; and associate alliance members.  The An alliance

15  is the exclusive entity for the oversight and coordination of

16  alliance member purchases. Any health plan offered through the

17  an alliance must be offered by a health insurer an accountable

18  health partnership and the an alliance may not directly

19  provide insurance; directly contract, for purposes of

20  providing insurance, with a health care provider or provider

21  network; or bear any risk, or form self-insurance plans among

22  its members.  An alliance may form a network with other

23  alliances in order to improve services provided to alliance

24  members. Nothing in ss. 408.70-408.7045 ss. 408.70-408.706

25  limits or authorizes the formation of business health

26  coalitions; however, a person or entity that pools together or

27  assists in purchasing health coverage for small employers, as

28  defined in s. 627.6699, state employees and their dependents,

29  and Medicaid, Medicaid buy-in, and MedAccess recipients may

30  not discriminate in its activities based on the health status

31

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  1  or historical or projected claims experience of such employers

  2  or recipients.

  3         (4)  Each alliance shall capitalize on the expertise of

  4  existing business health coalitions.

  5         (6)(5)  Membership or associate membership in the an

  6  alliance and participation by health insurers are is

  7  voluntary.

  8         (7)  The state board of the alliance may:

  9         (a)  Negotiate with health insurers to offer health

10  plans to alliance members in one or more regions under terms

11  and conditions as agreed to between the board, as group

12  policyholder, and the health insurer. The board and the

13  insurer may negotiate and agree to health plan selection,

14  benefit design, premium rates, and other terms of coverage,

15  subject to the requirements of the Florida Insurance Code.

16         (b)  Establish minimum requirements of alliance

17  membership, consistent with the definition of the term "small

18  employer" in s. 627.6699, including any documentation that an

19  applicant must submit to establish eligibility for membership.

20         (c)  Establish administrative and accounting procedures

21  for its operation and for the operation of the regional

22  boards, and require regional boards to submit program reports

23  to the state board or the agency.

24         (d)  Receive and accept grants, loans, advances, or

25  funds from any public or private agency, and receive and

26  accept, from any source, contributions of money, property,

27  labor, or any other thing of value.

28         (e)  Hire employees or contract with qualified,

29  independent third parties for any service necessary to carry

30  out the board's powers and duties, as authorized under ss.

31  408.70-408.7045.

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  1         (f)  Perform any of the activities that may be

  2  performed by a regional board under subsection (6), subject to

  3  coordination with the regional boards to avoid duplication of

  4  effort.

  5         (8)  Each regional board of the alliance may:

  6         (a)  Establish conditions of alliance membership

  7  consistent with the minimum requirements established by the

  8  state board.

  9         (b)  Provide to alliance members standardized

10  information for comparing health plans offered through the

11  alliance.

12         (c)  Offer health plans to alliance members, subject to

13  the terms and conditions agreed to by the state board and

14  participating health insurers.

15         (d)  Market and publicize the coverage and services

16  offered by the alliance.

17         (e)  Collect premiums from alliance members on behalf

18  of participating health insurers.

19         (f)  Assist members in resolving disputes between

20  health insurers and alliance members, consistent with

21  grievance procedures required by law.

22         (g)  Set reasonable fees for alliance membership,

23  services offered by the alliance, and late payment of premiums

24  by alliance members for which the alliance is responsible.

25         (h)  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         (i)  Hire employees or contract with qualified,

30  independent third parties for any service necessary to carry

31

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  1  out the regional board's powers and duties as authorized under

  2  ss. 408.70-408.7045.

  3         (6)  Each community health purchasing alliance has the

  4  following powers, duties, and responsibilities:

  5         (a)  Establishing the conditions of alliance membership

  6  in accordance with ss. 408.70-408.706.

  7         (b)  Providing to alliance members clear, standardized

  8  information on each accountable health partnership and each

  9  health plan offered by each accountable health partnership,

10  including information on price, enrollee costs, quality,

11  patient satisfaction, enrollment, and enrollee

12  responsibilities and obligations; and providing accountable

13  health partnership comparison sheets in accordance with agency

14  rule to be used in providing members and their employees with

15  information regarding standard, basic, and specialized

16  coverage that may be obtained through the accountable health

17  partnerships.

18         (c)  Annually offering to all alliance members all

19  accountable health partnerships and health plans offered by

20  the accountable health partnerships which meet the

21  requirements of ss. 408.70-408.706, and which submit a

22  responsive proposal as to information necessary for

23  accountable health partnership comparison sheets, and

24  providing assistance to alliance members in selecting and

25  obtaining coverage through accountable health partnerships

26  that meet those requirements.

27         (d)  Requesting proposals for the standard and basic

28  health plans, as defined in s. 627.6699, from all accountable

29  health partnerships in the district; providing, in the format

30  required by the alliance in the request for proposals, the

31  necessary information for accountable health partnership

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  1  comparison sheets; and offering to its members health plans of

  2  accountable health partnerships which meet those requirements.

  3         (e)  Requesting proposals from all accountable health

  4  partnerships in the district for specialized benefits approved

  5  by the alliance board based on input from alliance members,

  6  determining if the proposals submitted by the accountable

  7  health partnerships meet the requirements of the request for

  8  proposals, and offering them as options through riders to

  9  standard plans and basic plans.  This paragraph does not limit

10  an accountable health partnership's ability to offer other

11  specialized benefits to alliance members.

12         (f)  Distributing to health care purchasers, placing

13  special emphasis on the elderly, retail price data on

14  prescription drugs and their generic equivalents, durable

15  medical equipment, and disposable medical supplies which is

16  provided by the agency pursuant to s. 408.063(3) and (4).

17         (g)  Establishing administrative and accounting

18  procedures for the operation of the alliance and members'

19  services, preparing an annual alliance budget, and preparing

20  annual program and fiscal reports on alliance operations as

21  required by the agency.

22         (h)  Developing and implementing a marketing plan to

23  publicize the alliance to potential members and associate

24  members and developing and implementing methods for informing

25  the public about the alliance and its services.

26         (i)  Developing grievance procedures to be used in

27  resolving disputes between members and the alliance and

28  disputes between the accountable health partnerships and the

29  alliance.  Any member of, or accountable health partnership

30  that serves, an alliance may appeal to the agency any

31  grievance that is not resolved by the alliance.

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  1         (j)  Ensuring that accountable health partnerships have

  2  grievance procedures to be used in resolving disputes between

  3  members and an accountable health partnership.  A member may

  4  appeal to the alliance any grievance that is not resolved by

  5  the accountable health partnership.  An accountable health

  6  partnership that is a health maintenance organization must

  7  follow the grievance procedures established in ss. 408.7056

  8  and 641.31(5).

  9         (k)  Maintaining all records, reports, and other

10  information required by the agency, ss. 408.70-408.706, or

11  other state and local laws.

12         (l)  Receiving and accepting grants, loans, advances,

13  or funds from any public or private agency; and receiving and

14  accepting contributions, from any source, of money, property,

15  labor, or any other thing of value.

16         (m)  Contracting, as authorized by alliance members,

17  with a qualified, independent third party for any service

18  necessary to carry out the powers and duties required by ss.

19  408.70-408.706.

20         (n)  Developing a plan to facilitate participation of

21  providers in the district in an accountable health

22  partnership, placing special emphasis on ensuring

23  participation by minority physicians in accountable health

24  partnerships if such physicians are available.  The use of the

25  term "minority" in ss. 408.70-408.706 is consistent with the

26  definition of "minority person" provided in s. 288.703(3).

27         (o)  Ensuring that any health plan reasonably available

28  within the jurisdiction of an alliance, through a preferred

29  provider network, a point of service product, an exclusive

30  provider organization, a health maintenance organization, or a

31  pure indemnity product, is offered to members of the alliance.

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  1  For the purposes of this paragraph, "pure indemnity product"

  2  means a health insurance policy or contract that does not

  3  provide different rates of reimbursement for a specified list

  4  of physicians and a "point of service product" means a

  5  preferred provider network or a health maintenance

  6  organization which allows members to select at a higher cost a

  7  provider outside of the network or the health maintenance

  8  organization.

  9         (p)  Petitioning the agency for a determination as to

10  the cost-effectiveness of collecting premiums on behalf of

11  participating accountable health partnerships.  If determined

12  by the agency to be cost-effective, the alliance may establish

13  procedures for collecting premiums from members and distribute

14  them to the participating accountable health partnerships.

15  This may include the remittance of the share of the group

16  premium paid by both an employer and an enrollee.  If an

17  alliance assumes premium collection responsibility, it shall

18  also assume liability for uncollected premium.  This liability

19  may be collected through a bad debt surcharge on alliance

20  members to finance the cost of uncollected premiums. The

21  alliance shall pay participating accountable health

22  partnerships their contracting premium amounts on a prepaid

23  monthly basis, or as otherwise mutually agreed upon.

24         (7)  Each alliance shall set reasonable fees for

25  membership in the alliance which will finance all reasonable

26  and necessary costs incurred in administering the alliance.

27         (9)(8)  Each regional board alliance shall annually

28  report to the state board on the operations of the alliance in

29  that region, including program and financial operations, and

30  shall provide for annual internal and independent audits.

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  1         (10)(9)  The alliance, the state board, and regional

  2  boards A community health purchasing alliance may not engage

  3  in any activities for which an insurance agent's license is

  4  required by chapter 626.

  5         (11)(10)  The powers and responsibilities of the a

  6  community health purchasing alliance with respect to

  7  purchasing health plans services from health insurers

  8  accountable health partnerships do not extend beyond those

  9  enumerated in ss. 408.70-408.7045 ss. 408.70-408.706.

10         (12)  The Office of the Auditor General may audit and

11  inspect the operations and records of the alliance.

12         Section 4.  Section 408.703, Florida Statutes, is

13  amended to read:

14         408.703  Small employer members of the alliance

15  community health purchasing alliances; eligibility

16  requirements.--

17         (1)  The board agency shall establish conditions of

18  participation in the alliance for small employers, as defined

19  in s. 627.6699, which must include, but need not be limited

20  to:

21         (a)  Assurance that the group is a valid small employer

22  and is not formed for the purpose of securing health benefit

23  coverage. This assurance must include requirements for sole

24  proprietors and self-employed individuals which must be based

25  on a specified requirement for the time that the sole

26  proprietor or self-employed individual has been in business,

27  required filings to verify employment status, and other

28  requirements to ensure that the individual is working.

29         (b)  Assurance that the individuals in the small

30  employer group are employees and have not been added for the

31  purpose of securing health benefit coverage.

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  1         (2)  The agency may not require a small employer to pay

  2  any portion of premiums as a condition of participation in an

  3  alliance.

  4         (2)(3)  The board agency may require a small employer

  5  seeking membership to agree to participate in the alliance for

  6  a specified minimum period of time, not to exceed 1 year.

  7         (4)  If a member small employer offers more than one

  8  accountable health partnership or health plan and the employer

  9  contributes to coverage of employees or dependents of the

10  employee, the alliance shall require that the employer

11  contribute the same dollar amount for each employee,

12  regardless of the accountable health partnership or benefit

13  plan chosen by the employee.

14         (5)  An employer that employs 30 or fewer employees

15  must offer at least 2 accountable health partnerships or

16  health plans to its employees, and an employer that employs 31

17  or more employees must offer 3 or more accountable health

18  partnerships or health plans to its employees.

19         (3)(6)  Notwithstanding any other law, if a small

20  employer member loses eligibility to purchase health care

21  through the a community health purchasing alliance solely

22  because the business of the small employer member expands to

23  more than 50 and less than 75 eligible employees, the small

24  employer member may, at its next renewal date, purchase

25  coverage through the alliance for not more than 1 additional

26  year.

27         Section 5.  Section 408.704, Florida Statutes, 1998

28  Supplement, is amended to read:

29         408.704  Agency duties and responsibilities related to

30  community health purchasing alliances.--

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  1         (1)  The agency shall assist the alliance in purchasing

  2  health insurance for its members and supervise its operation.

  3  in developing a statewide system of community health

  4  purchasing alliances.  To this end, the agency is responsible

  5  for:

  6         (1)  Initially and thereafter annually certifying that

  7  each community health purchasing alliance complies with ss.

  8  408.70-408.706 and rules adopted pursuant to ss.

  9  408.70-408.706. The agency may decertify any community health

10  purchasing alliance if the alliance fails to comply with ss.

11  408.70-408.706 and rules adopted by the agency.

12         (2)  The agency shall conduct Providing administrative

13  startup funds.  Each contract for startup funds is limited to

14  $275,000.

15         (3)  Conducting an annual review of the performance of

16  the each alliance to ensure that the alliance is in compliance

17  with ss. 408.70-408.706. To assist the agency in its review,

18  the each alliance shall submit, quarterly, data to the agency,

19  including, but not limited to, employer enrollment by employer

20  size, industry sector, previous insurance status, and count;

21  number of total eligible employers in the alliance district

22  participating in the alliance; number of insured lives by

23  county and insured category, including employees, dependents,

24  and other insured categories, represented by alliance members;

25  profiles of potential employer membership by county; premium

26  ranges for each health insurer accountable health partnership

27  for alliance member categories; type and resolution of member

28  grievances; membership fees; and alliance financial

29  statements.  A summary of this annual review shall be provided

30  to the Legislature and to each alliance.

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  1         (3)  The agency shall assist the alliance in

  2  developing, collecting, and analyzing market information that

  3  would support the purchasing decisions of the alliance.

  4         (4)  Developing accountable health partnership

  5  comparison sheets to be used in providing members and their

  6  employees with information regarding the accountable health

  7  partnership.

  8         (5)  Establishing a data system for accountable health

  9  partnerships.

10         (a)  The agency shall establish an advisory data

11  committee comprised of the following representatives of

12  employers, medical providers, hospitals, health maintenance

13  organizations, and insurers:

14         1.  Two representatives appointed by each of the

15  following organizations:  Associated Industries of Florida,

16  the Florida Chamber of Commerce, the National Federation of

17  Independent Businesses, and the Florida Retail Federation;

18         2.  One representative of each of the following

19  organizations:  the Florida League of Hospitals, the

20  Association of Voluntary Hospitals of Florida, the Florida

21  Hospital Association, the Florida Medical Association, the

22  Florida Osteopathic Medical Association, the Florida

23  Chiropractic Association, the Florida Chapter of the National

24  Medical Association, the Association of Managed Care

25  Physicians, the Florida Insurance Council, the Florida

26  Association of Domestic Insurers, the Florida Association of

27  Health Maintenance Organizations; and

28         3.  One representative of governmental health care

29  purchasers and three consumer representatives, to be appointed

30  by the agency.

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  1         (b)  The advisory data committee shall issue a report

  2  and recommendations on each of the following subjects as each

  3  is completed.  A final report covering all subjects must be

  4  included in the final Florida Health Plan to be submitted to

  5  the Legislature on December 31, 1993.  The report shall

  6  include recommendations regarding:

  7         1.  Types of data to be collected.  Careful

  8  consideration shall be given to other data collection projects

  9  and standards for electronic data interchanges already in

10  process in this state and nationally, to evaluating and

11  recommending the feasibility and cost-effectiveness of various

12  data collection activities, and to ensuring that data

13  reporting is necessary to support the evaluation of providers

14  with respect to cost containment, access, quality, control of

15  expensive technologies, and customer satisfaction analysis.

16  Data elements to be collected from providers include prices,

17  utilization, patient outcomes, quality, and patient

18  satisfaction.  The completion of this task is the first

19  priority of the advisory data committee. The agency shall

20  begin implementing these data collection activities

21  immediately upon receipt of the recommendations, but no later

22  than January 1, 1994.  The data shall be submitted by

23  hospitals, other licensed health care facilities, pharmacists,

24  and group practices as defined in s. 455.654(3)(f).

25         2.  A standard data set, a standard cost-effective

26  format for collecting the data, and a standard methodology for

27  reporting the data to the agency, or its designee, and to the

28  alliances.  The reporting mechanisms must be designed to

29  minimize the administrative burden and cost to health care

30  providers and carriers.  A methodology shall be developed for

31  aggregating data in a standardized format for making

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  1  comparisons between accountable health partnerships which

  2  takes advantage of national models and activities.

  3         3.  Methods by which the agency should collect,

  4  process, analyze, and distribute the data.

  5         4.  Standards for data interpretation.  The advisory

  6  data committee shall actively solicit broad input from the

  7  provider community, carriers, the business community, and the

  8  general public.

  9         5.  Structuring the data collection process to:

10         a.  Incorporate safeguards to ensure that the health

11  care services utilization data collected is reviewed by

12  experienced, practicing physicians licensed to practice

13  medicine in this state;

14         b.  Require that carrier customer satisfaction data

15  conclusions are validated by the agency;

16         c.  Protect the confidentiality of medical information

17  to protect the patient's identity and to protect the privacy

18  of individual physicians and patients.  Proprietary data

19  submitted by insurers, providers, and purchasers are

20  confidential pursuant to s. 408.061; and

21         d.  Afford all interested professional medical and

22  hospital associations and carriers a minimum of 60 days to

23  review and comment before data is released to the public.

24         6.  Developing a data collection implementation

25  schedule, based on the data collection capabilities of

26  carriers and providers.

27         (c)  In developing data recommendations, the advisory

28  data committee shall assess the cost-effectiveness of

29  collecting data from individual physician providers.  The

30  initial emphasis must be placed on collecting data from those

31  providers with whom the highest percentages of the health care

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  1  dollars are spent: hospitals, large physician group practices,

  2  outpatient facilities, and pharmacies.

  3         (d)  The agency shall, to the maximum extent possible,

  4  adopt and implement the recommendations of the advisory data

  5  committee.  The agency shall report all recommendations of the

  6  advisory data committee to the Legislature and submit an

  7  implementation plan.

  8         (e)  The travel expenses of the participants of the

  9  advisory data committee must be paid by the participant or by

10  the organization that nominated the participant.

11         (6)  Collecting, compiling, and analyzing data on

12  accountable health partnerships and providing statistical

13  information to alliances.

14         (7)  Receiving appeals by members of an alliance and

15  accountable health partnerships whose grievances were not

16  resolved by the alliance.  The agency shall review these

17  appeals pursuant to chapter 120.  Records or reports submitted

18  as a part of a grievance proceeding conducted as provided for

19  under this subsection are confidential and exempt from the

20  provisions of s. 119.07(1) and s. 24(a), Art. I of the State

21  Constitution. Records or reports of patient care quality

22  assurance proceedings obtained or made by any member of a

23  community health purchasing alliance or any member of an

24  accountable health partnership and received by the agency as a

25  part of a proceeding conducted pursuant to this subsection are

26  confidential and exempt from s. 119.07(1) and s. 24(a), Art. I

27  of the State Constitution. Portions of meetings held pursuant

28  to the provisions of this subsection during which records held

29  confidential pursuant to the provisions of this subsection are

30  discussed are exempt from the provisions of s. 286.011 and s.

31  24(b), Art. I of the State Constitution.  All portions of any

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  1  meeting closed to the public shall be recorded by a certified

  2  court reporter.  For any portion of a meeting that is closed,

  3  the reporter shall record the times of commencement and

  4  termination of the meeting, all discussion and proceedings,

  5  the names of all persons present at any time, and the names of

  6  all persons speaking.  No portion of the closed meeting shall

  7  be off the record.  The court reporter's notes shall be fully

  8  transcribed and given to the appropriate records custodian

  9  within a reasonable time after the meeting.  A copy of the

10  original transcript, with information otherwise confidential

11  or exempt from public disclosure redacted, shall be made

12  available for public inspection and copying 3 years after the

13  date of the closed meeting.

14         Section 6.  Section 408.7041, Florida Statutes, is

15  amended to read:

16         408.7041  Antitrust protection.--In addition to the

17  duties described in s. 408.704, the agency shall actively

18  supervise the alliance community health purchasing alliances

19  to ensure that actions that affect market competition are not

20  for private interests, but accomplish the legislative intent

21  found in s. 408.70, so as to provide state and federal

22  antitrust protection of the alliance and state and regional

23  alliances and their board members.

24         Section 7.  Section 408.7045, Florida Statutes, is

25  amended to read:

26         408.7045  Community health purchasing Alliance

27  marketing requirements.--

28         (1)  The Each alliance shall use appropriate,

29  efficient, and standardized means to notify members of the

30  availability of sponsored health coverage from the alliance.

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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 8.  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

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  1  benefit plans subject to this section are subject to the

  2  following:

  3         1.  Small employer carriers must use a modified

  4  community rating methodology in which the premium for each

  5  small employer must be determined solely on the basis of the

  6  eligible employee's and eligible dependent's gender, age,

  7  family composition, tobacco use, or geographic area as

  8  determined under paragraph (5)(j) (5)(k).

  9         2.  Rating factors related to age, gender, family

10  composition, tobacco use, or geographic location may be

11  developed by each carrier to reflect the carrier's experience.

12  The factors used by carriers are subject to department review

13  and approval.

14         3.  Small employer carriers may not modify the rate for

15  a small employer for 12 months from the initial issue date or

16  renewal date, unless the composition of the group changes or

17  benefits are changed. However, a small employer carrier may

18  modify the rate one time prior to 12 months after the initial

19  issue date for a small employer who enrolls under a previously

20  issued group policy that has a common anniversary date for all

21  employers covered under the policy, if the carrier discloses

22  to the employer in a clear and conspicuous manner the date of

23  the first renewal and the fact that the premium may increase

24  on or after that date and if the insurer demonstrates to the

25  department that efficiencies in administration are achieved

26  and reflected in the rates charged to small employers covered

27  under the policy.

28         4.  A small employer carrier may issue a policy to a

29  group association with rates that reflect a premium credit for

30  expense savings attributable to administrative activities

31  being performed by the group association, if these expense

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  1  savings are specifically documented in the carrier's rate

  2  filing and are approved by the department. Any such credit may

  3  not be based on different morbidity assumptions or on any

  4  other factor related to the health status or claims experience

  5  of the group or its members. Carriers participating in the

  6  alliance program, in accordance with ss. 408.700-408.707, may

  7  apply a different community rate to business written in that

  8  program.

  9         (c)  For all small employer health benefit plans that

10  are subject to this section, that are issued by small employer

11  carriers before January 1, 1994, and that are renewed on or

12  after January 1, 1995, renewal rates must be based on the same

13  modified community rating standard applied to new business.

14         (d)  Notwithstanding s. 627.401(2), this section and

15  ss. 627.410 and 627.411 apply to any health benefit plan

16  provided by a small employer carrier that provides coverage to

17  one or more employees of a small employer regardless of where

18  the policy, certificate, or contract is issued or delivered,

19  if the health benefit plan covers employees or their covered

20  dependents who are residents of this state.

21         Section 9.  Sections 408.7042, 408.7055, and 408.706,

22  Florida Statutes, are repealed.

23         Section 10.  This act shall take effect upon becoming a

24  law.

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  1            *****************************************

  2                          SENATE SUMMARY

  3    Creates the Health Alliance for Small Business, replacing
      community health purchasing alliances, for the purpose of
  4    providing affordable group health insurance to employees
      of small employers. Specifies organizational
  5    requirements. Authorizes the Office of Auditor General to
      audit and inspect the alliance. Provides eligibility
  6    requirements for small employer members. Prescribes
      responsibilities for the Agency for Health Care
  7    Administration. Revises marketing requirements of the
      alliance. Revises restrictions relating to premium rates
  8    for small employer health benefit plans. Repeals ss.
      408.7042, 408.7055, and 408.706, F.S., deleting
  9    provisions related to purchasing coverage for state
      employees and Medicaid recipients through community
10    health purchasing alliances. Deletes provisions related
      to establishment of practitioner advisory groups by the
11    Agency for Health Care Administration. Deletes
      requirements for accountable health partnerships.
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