SENATE AMENDMENT

    Bill No. CS for SB 2280

    Amendment No.    

                            CHAMBER ACTION
              Senate                               House
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11  Senator Campbell moved the following amendment:

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13         Senate Amendment 

14         On page 17, line 20 through

15            page 19, line 11,  delete those lines

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17  and insert:

18         2.  The department division shall contract with health

19  maintenance organizations seeking to participate in the state

20  group insurance program through a request for proposal or

21  other procurement process, as developed by the Department of

22  Management Services and determined to be appropriate. based

23  upon a premium and a minimum benefit package as follows:

24         a.  The department shall establish a schedule of

25  minimum benefits for health maintenance organization coverage,

26  and that schedule A minimum benefit package to be provided by

27  a participating HMO shall include: physician services;

28  inpatient and outpatient hospital services; emergency medical

29  services, including out-of-area emergency coverage; diagnostic

30  laboratory and diagnostic and therapeutic radiologic services;

31  mental health, alcohol, and chemical dependency treatment

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2280

    Amendment No.    





 1  services meeting the minimum requirements of state and federal

 2  law; skilled nursing facilities and services; prescription

 3  drugs; and other benefits as may be required by the department

 4  division.  Additional services may be provided subject to the

 5  contract between the department division and the HMO.

 6         b.  The department may establish a uniform schedule for

 7  deductibles, and copayments, or coinsurance schedules may be

 8  established for all participating HMO plans HMOs.

 9         c.  The department may require detailed information

10  from each health maintenance organization participating in the

11  procurement process, including information pertaining to

12  organizational status, experience in providing pre-paid health

13  benefits, accessibility of services, financial stability of

14  the plan, quality of management services, accreditation

15  status, quality of medical services, network access and

16  adequacy, performance measurement, ability to meet the

17  department's reporting requirements, and the actuarial basis

18  of the proposed rates and other data determined by the

19  director to be necessary for the evaluation and selection of

20  health maintenance organization plans and negotiation of

21  appropriate rates for these plans. Upon receipt of proposals

22  by health maintenance organization plans and the evaluation of

23  those proposals, the department may enter into negotiations

24  with all of the plans or a subset of the plans, as the

25  department determines appropriate. Based upon the minimum

26  benefit package and copayments and deductibles contained in

27  sub-subparagraphs a. and b., the division shall issue a

28  request for proposal for all HMOs which are interested in

29  participating in the state group insurance program.  Upon

30  receipt of all proposals, the division may, as it deems

31  appropriate, enter into contract negotiations with HMOs

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2280

    Amendment No.    





 1  submitting bids. As part of the request for proposal process,

 2  the division may require detailed financial data from each HMO

 3  which participates in the bidding process for the purpose of

 4  determining the financial stability of the HMO.

 5         d.  In determining which HMOs to contract with, the

 6  division shall, at a minimum, consider:  each proposed

 7  contractor's previous experience and expertise in providing

 8  prepaid health benefits; each proposed contractor's historical

 9  experience in enrolling and providing health care services to

10  participants in the state group insurance program; the cost of

11  the premiums; the plan's ability to adequately provide service

12  coverage and administrative support services as determined by

13  the division; plan benefits in addition to the minimum benefit

14  package; accessibility to providers; and the financial

15  solvency of the plan. Nothing shall preclude the department

16  division from negotiating regional or statewide contracts with

17  health maintenance organization plans when this is

18  cost-effective and when the department division determines

19  that the plan offers high value to enrollees has the best

20  overall benefit package for the service areas involved.

21  However, no HMO shall be eligible for a contract if the HMO's

22  retiree Medicare premium exceeds the retiree rate as set by

23  the division for the state group health insurance plan.

24         e.  The department division may limit the number of

25  HMOs that it contracts with in each service area based on the

26  nature of the bids the department division receives, the

27  number of state employees in the service area, or and any

28  unique geographical characteristics of the service area. The

29  department division shall establish by rule service areas

30  throughout the state.

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