CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Scott moved the following substitute for amendment
12 (800576):
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14 Senate Amendment (with title amendment)
15 On page 6, line 1, delete that line
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17 and insert:
18 Section 2. Section 408.70, Florida Statutes, is
19 amended to read:
20 408.70 Health Alliance for Small Business Community
21 health purchasing; legislative findings and intent.--It is the
22 intent of the Legislature that a nonprofit corporation, to be
23 known as the "Health Alliance for Small Business," be
24 organized for the purpose of pooling by regions groups of
25 individuals employed by small employers and the dependents of
26 such employees into larger groups in order to facilitate the
27 purchase of affordable group health insurance coverage.
28 (1) The Legislature finds that the current health care
29 system in this state does not provide access to affordable
30 health care for all persons in this state. Almost one in five
31 persons is without health insurance. For many, entry into the
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 health care system is through a hospital emergency room rather
2 than a primary care setting. The availability of preventive
3 and primary care and managed, family-based care is limited.
4 Health insurance underwriting practices have led to the
5 avoidance, rather than to the sharing, of insurance risks,
6 limiting access to coverages for small-sized employer groups
7 and high-risk populations. Spiraling premium costs have
8 placed health insurance policies out of the reach of many
9 small-sized and medium-sized businesses and their employees.
10 Lack of outcome and cost information has forced individuals
11 and businesses to make critical health care decisions with
12 little guidance or leverage. Health care resources have not
13 been allocated efficiently, leading to excess and unevenly
14 distributed capacity. These factors have contributed to the
15 high cost of health care. Rural and other medically
16 underserved areas have too few health care resources.
17 Comprehensive, first-dollar coverages have allowed individuals
18 to seek care without regard to cost. Provider competition and
19 liability concerns have led to a medical technology arms race.
20 Rather than competing on the basis of price and patient
21 outcome, health care providers compete for patients on the
22 basis of service, equipping themselves with the latest and
23 best technologies. Managed-care and group-purchasing
24 mechanisms are not widely available to small group purchasers.
25 Health care regulation has placed undue burdens on health care
26 insurers and providers, driving up costs, limiting
27 competition, and preventing market-based solutions to cost and
28 quality problems. Health care costs have been increasing at
29 several times the rate of general inflation, eroding employer
30 profits and investments, increasing government revenue
31 requirements, reducing consumer coverages and purchasing
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 power, and limiting public investments in other vital
2 governmental services.
3 (2) It is the intent of the Legislature that a
4 structured health care competition model, known as "managed
5 competition," be implemented throughout the state to improve
6 the efficiency of the health care markets in this state. The
7 managed competition model will promote the pooling of
8 purchaser and consumer buying power; ensure informed
9 cost-conscious consumer choice of managed care plans; reward
10 providers for high-quality, economical care; increase access
11 to care for uninsured persons; and control the rate of
12 inflation in health care costs.
13 (3) The Legislature intends that state-chartered,
14 nonprofit private purchasing organizations, to be known as
15 "community health purchasing alliances," be established. The
16 community health purchasing alliances shall be responsible for
17 assisting alliance members in securing the highest quality of
18 health care, based on current standards, at the lowest
19 possible prices.
20 Section 3. Section 408.701, Florida Statutes, 1998
21 Supplement, is amended to read:
22 408.701 Health Alliance for Small Business Community
23 health purchasing; definitions.--As used in ss.
24 408.70-408.7045 ss. 408.70-408.706, the term:
25 (1) "Accountable health partnership" means an
26 organization that integrates health care providers and
27 facilities and assumes risk, in order to provide health care
28 services, as certified by the agency under s. 408.704.
29 (1)(2) "Agency" means the Agency for Health Care
30 Administration.
31 (2)(3) "Alliance" means the Health Alliance for Small
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 Business a community health purchasing alliance.
2 (3)(4) "Alliance member" means:
3 (a) a small employer as defined in s. 627.6699 who, or
4 (b) The state, for the purpose of providing health
5 benefits to state employees and their dependents through the
6 state group insurance program and to Medicaid recipients,
7 participants in the MedAccess program, and participants in the
8 Medicaid buy-in program,
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10 if such entities voluntarily elects choose to join an
11 alliance.
12 (5) "Antitrust laws" means federal and state laws
13 intended to protect commerce from unlawful restraints,
14 monopolies, and unfair business practices.
15 (6) "Associate alliance member" means any purchaser
16 who joins an alliance for the purposes of participating on the
17 alliance board and receiving data from the alliance at no
18 charge as a benefit of membership.
19 (7) "Benefit standard" means a specified set of health
20 services that are the minimum that must be covered under a
21 basic health benefit plan, as defined in s. 627.6699.
22 (8) "Business health coalition" means a group of
23 employers organized to share information about health services
24 and insurance coverage, to enable the employers to obtain more
25 cost-effective care for their employees.
26 (9) "Community health purchasing alliance" means a
27 state-chartered, nonprofit organization that provides
28 member-purchasing services and detailed information to its
29 members on comparative prices, usage, outcomes, quality, and
30 enrollee satisfaction with accountable health partnerships.
31 (10) "Consumer" means an individual user of health
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 care services.
2 (11) "Department" means the Department of Insurance.
3 (12) "Grievance procedure" means an established set of
4 rules that specify a process for appeal of an organizational
5 decision.
6 (4)(13) "Health care provider" or "provider" means a
7 state-licensed or state-authorized facility, a facility
8 principally supported by a local government or by funds from a
9 charitable organization that holds a current exemption from
10 federal income tax under s. 501(c)(3) of the Internal Revenue
11 Code, a licensed practitioner, a county health department
12 established under part I of chapter 154, a prescribed
13 pediatric extended care center defined in s. 400.902, a
14 federally supported primary care program such as a migrant
15 health center or a community health center authorized under s.
16 329 or s. 330 of the United States Public Health Services Act
17 that delivers health care services to individuals, or a
18 community facility that receives funds from the state under
19 the Community Alcohol, Drug Abuse, and Mental Health Services
20 Act and provides mental health services to individuals.
21 (5)(14) "Health insurer" or "insurer" means a health
22 insurer or health maintenance organization that is issued a
23 certificate of authority an organization licensed by the
24 Department of Insurance under part III of chapter 624 or part
25 I of chapter 641.
26 (6)(15) "Health plan" or "health insurance" means any
27 health insurance policy or health maintenance organization
28 contract issued by a health insurer hospital or medical policy
29 or contract or certificate, hospital or medical service plan
30 contract, or health maintenance organization contract as
31 defined in the insurance code or Health Maintenance
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 Organization Act. The term does not include accident-only,
2 specific disease, individual hospital indemnity, credit,
3 dental-only, vision-only, Medicare supplement, long-term care,
4 or disability income insurance; coverage issued as a
5 supplement to liability insurance; workers' compensation or
6 similar insurance; or automobile medical-payment insurance.
7 (7) "Regional board" means the board of directors of
8 each region of the alliance, as established under s.
9 408.702(1).
10 (8) "State board" or "board" means the board of
11 directors of the alliance, as established under s. 408.702(2).
12 (16) "Health status" means an assessment of an
13 individual's mental and physical condition.
14 (17) "Managed care" means systems or techniques
15 generally used by third-party payors or their agents to affect
16 access to and control payment for health care services.
17 Managed-care techniques most often include one or more of the
18 following: prior, concurrent, and retrospective review of the
19 medical necessity and appropriateness of services or site of
20 services; contracts with selected health care providers;
21 financial incentives or disincentives related to the use of
22 specific providers, services, or service sites; controlled
23 access to and coordination of services by a case manager; and
24 payor efforts to identify treatment alternatives and modify
25 benefit restrictions for high-cost patient care.
26 (18) "Managed competition" means a process by which
27 purchasers form alliances to obtain information on, and
28 purchase from, competing accountable health partnerships.
29 (19) "Medical outcome" means a change in an
30 individual's health status after the provision of health
31 services.
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 (20) "Provider network" means an affiliated group of
2 varied health care providers that is established to provide a
3 continuum of health care services to individuals.
4 (21) "Purchaser" means an individual, an organization,
5 or the state that makes health-benefit purchasing decisions on
6 behalf of a group of individuals.
7 (22) "Self-funded plan" means a group health insurance
8 plan in which the sponsoring organization assumes the
9 financial risk of paying for all covered services provided to
10 its enrollees.
11 (23) "Utilization management" means programs designed
12 to control the overutilization of health services by reviewing
13 their appropriateness relative to established standards or
14 norms.
15 (24) "24-hour coverage" means the consolidation of
16 such time-limited health care coverage as personal injury
17 protection under automobile insurance into a general health
18 insurance plan.
19 (25) "Agent" means a person who is licensed to sell
20 insurance in this state pursuant to chapter 626.
21 (26) "Primary care physician" means a physician
22 licensed under chapter 458 or chapter 459 who practices family
23 medicine, general internal medicine, general pediatrics, or
24 general obstetrics/ gynecology.
25 Section 4. Section 408.702, Florida Statutes, is
26 amended to read:
27 408.702 Health Alliance for Small Business Community
28 health purchasing alliance; establishment; state and regional
29 boards.--
30 (1) There is created the Health Alliance for Small
31 Business, which shall operate as a nonprofit corporation
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 organized under chapter 617. The alliance is not a state
2 agency. The alliance shall operate subject to the supervision
3 and approval of a board of directors composed of the chairman
4 of each of the regional boards of the alliance or, in lieu of
5 the chairman, a member of a regional board designated by the
6 chairman of that board.
7 (2)(a) The board of directors of each community health
8 purchasing alliance is redesignated as a regional board of the
9 Health Alliance for Small Business. Each regional board shall
10 operate as a nonprofit corporation organized under chapter
11 617. A regional board is not a state agency.
12 (b) The regional board replacing such community health
13 purchasing alliance shall assume the rights and obligations of
14 each former community health purchasing alliance as necessary
15 to fulfill the former alliance's contractual obligations
16 existing on the effective date of this act. Nothing in this
17 section shall impair or otherwise affect any such contract.
18 (3)(1) There is created a community health purchasing
19 alliance in each of the 11 health service planning districts
20 established under s. 408.032. Each alliance must be operated
21 as a state-chartered, nonprofit private organization organized
22 pursuant to chapter 617. There shall be no liability on the
23 part of, and no cause of action of any nature shall arise
24 against, any member of the board of directors of the a
25 community health purchasing alliance or of any regional board,
26 or their its employees or agents, for any action taken by a
27 the board in the performance of its powers and duties under
28 ss. 408.70-408.7045 ss. 408.70-408.706.
29 (4)(2) The number and geographical boundaries of
30 alliance districts may be revised by the state board Three or
31 fewer alliances located in contiguous districts that are not
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 primarily urban may merge into a single alliance upon approval
2 of the agency based on upon a showing by the alliance board
3 members that the members of the each alliance would be better
4 served under a combined alliance. If the number or boundaries
5 of regional alliances are revised, the members of the new
6 regional boards for the affected regions must be
7 representative of the members of the former regional boards of
8 the affected regions in a method established by the state
9 board which reasonably provides for proportionate
10 representation of former board members. Board members of each
11 alliance shall serve as the board of the combined alliance.
12 (5)(3) The An alliance is the only entity that is
13 allowed to operate as an alliance in a particular district and
14 must operate for the benefit of its members who are: small
15 employers, as defined in s. 627.6699; the state on behalf of
16 its employees and the dependents of such employees; Medicaid
17 recipients; and associate alliance members. The An alliance
18 is the exclusive entity for the oversight and coordination of
19 alliance member purchases. Any health plan offered through the
20 an alliance must be offered by a health insurer an accountable
21 health partnership and the an alliance may not directly
22 provide insurance; directly contract, for purposes of
23 providing insurance, with a health care provider or provider
24 network; or bear any risk, or form self-insurance plans among
25 its members. An alliance may form a network with other
26 alliances in order to improve services provided to alliance
27 members. Nothing in ss. 408.70-408.7045 ss. 408.70-408.706
28 limits or authorizes the formation of business health
29 coalitions; however, a person or entity that pools together or
30 assists in purchasing health coverage for small employers, as
31 defined in s. 627.6699, state employees and their dependents,
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 and Medicaid, Medicaid buy-in, and MedAccess recipients may
2 not discriminate in its activities based on the health status
3 or historical or projected claims experience of such employers
4 or recipients.
5 (4) Each alliance shall capitalize on the expertise of
6 existing business health coalitions.
7 (6)(5) Membership or associate membership in the an
8 alliance and participation by health insurers are is
9 voluntary.
10 (7) The state board of the alliance may:
11 (a) Establish minimum requirements of alliance
12 membership, consistent with the definition of the term "small
13 employer" in s. 627.6699, including any documentation that an
14 applicant must submit to establish eligibility for membership.
15 (b) Establish administrative and accounting procedures
16 for its operation and for the operation of the regional
17 boards, and require regional boards to submit program reports
18 to the state board or the agency.
19 (c) Receive and accept grants, loans, advances, or
20 funds from any public or private agency, and receive and
21 accept, from any source, contributions of money, property,
22 labor, or any other thing of value.
23 (d) Hire employees or contract with qualified,
24 independent third parties for any service necessary to carry
25 out the regional board's powers and duties, as authorized
26 under ss. 408.70-408.7045. However, the board may not hire an
27 insurance agent who engages in activities on behalf of the
28 alliance for which an insurance agent's license is required by
29 chapter 626.
30 (8) Each regional board of the alliance may:
31 (a) Negotiate with health insurers to offer health
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 plans to alliance members under terms and conditions as agreed
2 to between the regional board, as group policyholder, and the
3 health insurer. The regional board and the insurer may
4 negotiate and agree to health plan selection, benefit design,
5 premium rates, and other terms of coverage, subject to the
6 requirements of the Florida Insurance Code.
7 (b) Establish conditions of alliance membership
8 consistent with the minimum requirements established by the
9 state board.
10 (c) Provide to alliance members standardized
11 information for comparing health plans offered through the
12 alliance.
13 (d) 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 (e) Market and publicize the coverage and services
17 offered by the alliance.
18 (f) Collect premiums from alliance members on behalf
19 of participating health insurers.
20 (g) Assist members in resolving disputes between
21 health insurers and alliance members, consistent with
22 grievance procedures required by law.
23 (h) 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 (i) 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 (j) Hire employees or contract with qualified,
31 independent third parties for any service necessary to carry
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 out the regional board's powers and duties as authorized under
2 ss. 408.70-408.7045. However, a regional board may not hire an
3 insurance agent who engages in activities on behalf of the
4 alliance for which an insurance agent's license is required by
5 chapter 626.
6 (9) No state agency may expend or provide funds to the
7 Alliance that would subsidize the pricing of health insurance
8 policies for its members or the cost of the alliance's
9 activities, unless the Legislature specifically authorizes
10 such expenditure.
11 (6) Each community health purchasing alliance has the
12 following powers, duties, and responsibilities:
13 (a) Establishing the conditions of alliance membership
14 in accordance with ss. 408.70-408.706.
15 (b) Providing to alliance members clear, standardized
16 information on each accountable health partnership and each
17 health plan offered by each accountable health partnership,
18 including information on price, enrollee costs, quality,
19 patient satisfaction, enrollment, and enrollee
20 responsibilities and obligations; and providing accountable
21 health partnership comparison sheets in accordance with agency
22 rule to be used in providing members and their employees with
23 information regarding standard, basic, and specialized
24 coverage that may be obtained through the accountable health
25 partnerships.
26 (c) Annually offering to all alliance members all
27 accountable health partnerships and health plans offered by
28 the accountable health partnerships which meet the
29 requirements of ss. 408.70-408.706, and which submit a
30 responsive proposal as to information necessary for
31 accountable health partnership comparison sheets, and
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 providing assistance to alliance members in selecting and
2 obtaining coverage through accountable health partnerships
3 that meet those requirements.
4 (d) Requesting proposals for the standard and basic
5 health plans, as defined in s. 627.6699, from all accountable
6 health partnerships in the district; providing, in the format
7 required by the alliance in the request for proposals, the
8 necessary information for accountable health partnership
9 comparison sheets; and offering to its members health plans of
10 accountable health partnerships which meet those requirements.
11 (e) Requesting proposals from all accountable health
12 partnerships in the district for specialized benefits approved
13 by the alliance board based on input from alliance members,
14 determining if the proposals submitted by the accountable
15 health partnerships meet the requirements of the request for
16 proposals, and offering them as options through riders to
17 standard plans and basic plans. This paragraph does not limit
18 an accountable health partnership's ability to offer other
19 specialized benefits to alliance members.
20 (f) Distributing to health care purchasers, placing
21 special emphasis on the elderly, retail price data on
22 prescription drugs and their generic equivalents, durable
23 medical equipment, and disposable medical supplies which is
24 provided by the agency pursuant to s. 408.063(3) and (4).
25 (g) Establishing administrative and accounting
26 procedures for the operation of the alliance and members'
27 services, preparing an annual alliance budget, and preparing
28 annual program and fiscal reports on alliance operations as
29 required by the agency.
30 (h) Developing and implementing a marketing plan to
31 publicize the alliance to potential members and associate
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 members and developing and implementing methods for informing
2 the public about the alliance and its services.
3 (i) Developing grievance procedures to be used in
4 resolving disputes between members and the alliance and
5 disputes between the accountable health partnerships and the
6 alliance. Any member of, or accountable health partnership
7 that serves, an alliance may appeal to the agency any
8 grievance that is not resolved by the alliance.
9 (j) Ensuring that accountable health partnerships have
10 grievance procedures to be used in resolving disputes between
11 members and an accountable health partnership. A member may
12 appeal to the alliance any grievance that is not resolved by
13 the accountable health partnership. An accountable health
14 partnership that is a health maintenance organization must
15 follow the grievance procedures established in ss. 408.7056
16 and 641.31(5).
17 (k) Maintaining all records, reports, and other
18 information required by the agency, ss. 408.70-408.706, or
19 other state and local laws.
20 (l) Receiving and accepting grants, loans, advances,
21 or funds from any public or private agency; and receiving and
22 accepting contributions, from any source, of money, property,
23 labor, or any other thing of value.
24 (m) Contracting, as authorized by alliance members,
25 with a qualified, independent third party for any service
26 necessary to carry out the powers and duties required by ss.
27 408.70-408.706.
28 (n) Developing a plan to facilitate participation of
29 providers in the district in an accountable health
30 partnership, placing special emphasis on ensuring
31 participation by minority physicians in accountable health
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 partnerships if such physicians are available. The use of the
2 term "minority" in ss. 408.70-408.706 is consistent with the
3 definition of "minority person" provided in s. 288.703(3).
4 (o) Ensuring that any health plan reasonably available
5 within the jurisdiction of an alliance, through a preferred
6 provider network, a point of service product, an exclusive
7 provider organization, a health maintenance organization, or a
8 pure indemnity product, is offered to members of the alliance.
9 For the purposes of this paragraph, "pure indemnity product"
10 means a health insurance policy or contract that does not
11 provide different rates of reimbursement for a specified list
12 of physicians and a "point of service product" means a
13 preferred provider network or a health maintenance
14 organization which allows members to select at a higher cost a
15 provider outside of the network or the health maintenance
16 organization.
17 (p) Petitioning the agency for a determination as to
18 the cost-effectiveness of collecting premiums on behalf of
19 participating accountable health partnerships. If determined
20 by the agency to be cost-effective, the alliance may establish
21 procedures for collecting premiums from members and distribute
22 them to the participating accountable health partnerships.
23 This may include the remittance of the share of the group
24 premium paid by both an employer and an enrollee. If an
25 alliance assumes premium collection responsibility, it shall
26 also assume liability for uncollected premium. This liability
27 may be collected through a bad debt surcharge on alliance
28 members to finance the cost of uncollected premiums. The
29 alliance shall pay participating accountable health
30 partnerships their contracting premium amounts on a prepaid
31 monthly basis, or as otherwise mutually agreed upon.
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 (7) Each alliance shall set reasonable fees for
2 membership in the alliance which will finance all reasonable
3 and necessary costs incurred in administering the alliance.
4 (9)(8) Each regional board alliance shall annually
5 report to the state board on the operations of the alliance in
6 that region, including program and financial operations, and
7 shall provide for annual internal and independent audits.
8 (10)(9) The alliance, the state board, and regional
9 boards A community health purchasing alliance may not engage
10 in any activities for which an insurance agent's license is
11 required by chapter 626. Any licensed health agent in good
12 standing with the Department of Insurance, who is otherwise
13 appointed to sell health insurance in this state, may place
14 alliance members coverage with an insurer selected to provide
15 such coverage by a regional board without being required to
16 secure an appointment with such insurer. An insurer shall not
17 be liable for the acts of an agent not appointed by it in
18 producing alliance business. This subsection does not prohibit
19 the alliance from requiring minimal training or education
20 related to activities of the alliance.
21 (11)(10) The powers and responsibilities of the a
22 community health purchasing alliance with respect to
23 purchasing health plans services from health insurers
24 accountable health partnerships do not extend beyond those
25 enumerated in ss. 408.70-408.7045 ss. 408.70-408.706.
26 (12) The Office of the Auditor General may audit and
27 inspect the operations and records of the alliance.
28 Section 5. Section 408.703, Florida Statutes, is
29 amended to read:
30 408.703 Small employer members of the alliance
31 community health purchasing alliances; eligibility
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 requirements.--
2 (1) The board agency shall establish conditions of
3 participation in the alliance for small employers, as defined
4 in s. 627.6699, which must include, but need not be limited
5 to:
6 (a) Assurance that the group is a valid small employer
7 and is not formed for the purpose of securing health benefit
8 coverage. This assurance must include requirements for sole
9 proprietors and self-employed individuals which must be based
10 on a specified requirement for the time that the sole
11 proprietor or self-employed individual has been in business,
12 required filings to verify employment status, and other
13 requirements to ensure that the individual is working.
14 (b) Assurance that the individuals in the small
15 employer group are employees and have not been added for the
16 purpose of securing health benefit coverage.
17 (2) The agency may not require a small employer to pay
18 any portion of premiums as a condition of participation in an
19 alliance.
20 (2)(3) The board agency may require a small employer
21 seeking membership to agree to participate in the alliance for
22 a specified minimum period of time, not to exceed 1 year.
23 (4) If a member small employer offers more than one
24 accountable health partnership or health plan and the employer
25 contributes to coverage of employees or dependents of the
26 employee, the alliance shall require that the employer
27 contribute the same dollar amount for each employee,
28 regardless of the accountable health partnership or benefit
29 plan chosen by the employee.
30 (5) An employer that employs 30 or fewer employees
31 must offer at least 2 accountable health partnerships or
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 health plans to its employees, and an employer that employs 31
2 or more employees must offer 3 or more accountable health
3 partnerships or health plans to its employees.
4 (3)(6) Notwithstanding any other law, if a small
5 employer member loses eligibility to purchase health care
6 through the a community health purchasing alliance solely
7 because the business of the small employer member expands to
8 more than 50 and less than 75 eligible employees, the small
9 employer member may, at its next renewal date, purchase
10 coverage through the alliance for not more than 1 additional
11 year.
12 Section 6. Section 408.704, Florida Statutes, 1998
13 Supplement, is amended to read:
14 408.704 Agency duties and responsibilities related to
15 the alliance community health purchasing alliances.--
16 (1) The agency shall supervise the operation of the
17 alliance. assist in developing a statewide system of community
18 health purchasing alliances. To this end, the agency is
19 responsible for:
20 (1) Initially and thereafter annually certifying that
21 each community health purchasing alliance complies with ss.
22 408.70-408.706 and rules adopted pursuant to ss.
23 408.70-408.706. The agency may decertify any community health
24 purchasing alliance if the alliance fails to comply with ss.
25 408.70-408.706 and rules adopted by the agency.
26 (2) The agency shall conduct Providing administrative
27 startup funds. Each contract for startup funds is limited to
28 $275,000.
29 (3) Conducting an annual review of the performance of
30 the each alliance to ensure that the alliance is in compliance
31 with ss. 408.70-408.7045 ss. 408.70-408.706. To assist the
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 agency in its review, the each alliance shall submit,
2 quarterly, data to the agency, including, but not limited to,
3 employer enrollment by employer size, industry sector,
4 previous insurance status, and count; number of total eligible
5 employers in the alliance district participating in the
6 alliance; number of insured lives by county and insured
7 category, including employees, dependents, and other insured
8 categories, represented by alliance members; profiles of
9 potential employer membership by county; premium ranges for
10 each health insurer accountable health partnership for
11 alliance member categories; type and resolution of member
12 grievances; membership fees; and alliance financial
13 statements. A summary of this annual review shall be provided
14 to the Legislature and to each alliance.
15 (4) Developing accountable health partnership
16 comparison sheets to be used in providing members and their
17 employees with information regarding the accountable health
18 partnership.
19 (5) Establishing a data system for accountable health
20 partnerships.
21 (a) The agency shall establish an advisory data
22 committee comprised of the following representatives of
23 employers, medical providers, hospitals, health maintenance
24 organizations, and insurers:
25 1. Two representatives appointed by each of the
26 following organizations: Associated Industries of Florida,
27 the Florida Chamber of Commerce, the National Federation of
28 Independent Businesses, and the Florida Retail Federation;
29 2. One representative of each of the following
30 organizations: the Florida League of Hospitals, the
31 Association of Voluntary Hospitals of Florida, the Florida
19
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 Hospital Association, the Florida Medical Association, the
2 Florida Osteopathic Medical Association, the Florida
3 Chiropractic Association, the Florida Chapter of the National
4 Medical Association, the Association of Managed Care
5 Physicians, the Florida Insurance Council, the Florida
6 Association of Domestic Insurers, the Florida Association of
7 Health Maintenance Organizations; and
8 3. One representative of governmental health care
9 purchasers and three consumer representatives, to be appointed
10 by the agency.
11 (b) The advisory data committee shall issue a report
12 and recommendations on each of the following subjects as each
13 is completed. A final report covering all subjects must be
14 included in the final Florida Health Plan to be submitted to
15 the Legislature on December 31, 1993. The report shall
16 include recommendations regarding:
17 1. Types of data to be collected. Careful
18 consideration shall be given to other data collection projects
19 and standards for electronic data interchanges already in
20 process in this state and nationally, to evaluating and
21 recommending the feasibility and cost-effectiveness of various
22 data collection activities, and to ensuring that data
23 reporting is necessary to support the evaluation of providers
24 with respect to cost containment, access, quality, control of
25 expensive technologies, and customer satisfaction analysis.
26 Data elements to be collected from providers include prices,
27 utilization, patient outcomes, quality, and patient
28 satisfaction. The completion of this task is the first
29 priority of the advisory data committee. The agency shall
30 begin implementing these data collection activities
31 immediately upon receipt of the recommendations, but no later
20
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 than January 1, 1994. The data shall be submitted by
2 hospitals, other licensed health care facilities, pharmacists,
3 and group practices as defined in s. 455.654(3)(f).
4 2. A standard data set, a standard cost-effective
5 format for collecting the data, and a standard methodology for
6 reporting the data to the agency, or its designee, and to the
7 alliances. The reporting mechanisms must be designed to
8 minimize the administrative burden and cost to health care
9 providers and carriers. A methodology shall be developed for
10 aggregating data in a standardized format for making
11 comparisons between accountable health partnerships which
12 takes advantage of national models and activities.
13 3. Methods by which the agency should collect,
14 process, analyze, and distribute the data.
15 4. Standards for data interpretation. The advisory
16 data committee shall actively solicit broad input from the
17 provider community, carriers, the business community, and the
18 general public.
19 5. Structuring the data collection process to:
20 a. Incorporate safeguards to ensure that the health
21 care services utilization data collected is reviewed by
22 experienced, practicing physicians licensed to practice
23 medicine in this state;
24 b. Require that carrier customer satisfaction data
25 conclusions are validated by the agency;
26 c. Protect the confidentiality of medical information
27 to protect the patient's identity and to protect the privacy
28 of individual physicians and patients. Proprietary data
29 submitted by insurers, providers, and purchasers are
30 confidential pursuant to s. 408.061; and
31 d. Afford all interested professional medical and
21
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 hospital associations and carriers a minimum of 60 days to
2 review and comment before data is released to the public.
3 6. Developing a data collection implementation
4 schedule, based on the data collection capabilities of
5 carriers and providers.
6 (c) In developing data recommendations, the advisory
7 data committee shall assess the cost-effectiveness of
8 collecting data from individual physician providers. The
9 initial emphasis must be placed on collecting data from those
10 providers with whom the highest percentages of the health care
11 dollars are spent: hospitals, large physician group practices,
12 outpatient facilities, and pharmacies.
13 (d) The agency shall, to the maximum extent possible,
14 adopt and implement the recommendations of the advisory data
15 committee. The agency shall report all recommendations of the
16 advisory data committee to the Legislature and submit an
17 implementation plan.
18 (e) The travel expenses of the participants of the
19 advisory data committee must be paid by the participant or by
20 the organization that nominated the participant.
21 (6) Collecting, compiling, and analyzing data on
22 accountable health partnerships and providing statistical
23 information to alliances.
24 (7) Receiving appeals by members of an alliance and
25 accountable health partnerships whose grievances were not
26 resolved by the alliance. The agency shall review these
27 appeals pursuant to chapter 120. Records or reports submitted
28 as a part of a grievance proceeding conducted as provided for
29 under this subsection are confidential and exempt from the
30 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
31 Constitution. Records or reports of patient care quality
22
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 assurance proceedings obtained or made by any member of a
2 community health purchasing alliance or any member of an
3 accountable health partnership and received by the agency as a
4 part of a proceeding conducted pursuant to this subsection are
5 confidential and exempt from s. 119.07(1) and s. 24(a), Art. I
6 of the State Constitution. Portions of meetings held pursuant
7 to the provisions of this subsection during which records held
8 confidential pursuant to the provisions of this subsection are
9 discussed are exempt from the provisions of s. 286.011 and s.
10 24(b), Art. I of the State Constitution. All portions of any
11 meeting closed to the public shall be recorded by a certified
12 court reporter. For any portion of a meeting that is closed,
13 the reporter shall record the times of commencement and
14 termination of the meeting, all discussion and proceedings,
15 the names of all persons present at any time, and the names of
16 all persons speaking. No portion of the closed meeting shall
17 be off the record. The court reporter's notes shall be fully
18 transcribed and given to the appropriate records custodian
19 within a reasonable time after the meeting. A copy of the
20 original transcript, with information otherwise confidential
21 or exempt from public disclosure redacted, shall be made
22 available for public inspection and copying 3 years after the
23 date of the closed meeting.
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.
31 (2) The Each alliance shall make available to members
23
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 marketing materials that accurately summarize the benefit
2 plans that are offered by its health insurer accountable
3 health partnerships and the rates, costs, and accreditation
4 information relating to those plans.
5 (3) Annually, the alliance shall offer each member
6 small employer all accountable health partnerships available
7 in the alliance and provide them with the appropriate
8 materials relating to those plans. The member small employer
9 may choose which health benefit plans shall be offered to
10 eligible employees and may change the selection each year.
11 The employee may be given options with regard to health plans
12 and the type of managed care system under which his or her
13 benefits will be provided.
14 (4) An alliance may notify the agency of any marketing
15 practices or materials that it finds are contrary to the fair
16 and affirmative marketing requirements of the program. Upon
17 the request of an alliance, the agency shall request the
18 Department of Insurance to investigate the practices and the
19 Department of Insurance may take any action authorized for a
20 violation of the insurance code or the Health Maintenance
21 Organization Act.
22 Section 8. Paragraph (b) of subsection (6) of section
23 627.6699, Florida Statutes, 1998 Supplement, is amended to
24 read:
25 627.6699 Employee Health Care Access Act.--
26 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
27 (b) For all small employer health benefit plans that
28 are subject to this section and are issued by small employer
29 carriers on or after January 1, 1994, premium rates for health
30 benefit plans subject to this section are subject to the
31 following:
24
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 1. Small employer carriers must use a modified
2 community rating methodology in which the premium for each
3 small employer must be determined solely on the basis of the
4 eligible employee's and eligible dependent's gender, age,
5 family composition, tobacco use, or geographic area as
6 determined under paragraph (5)(j) (5)(k).
7 2. Rating factors related to age, gender, family
8 composition, tobacco use, or geographic location may be
9 developed by each carrier to reflect the carrier's experience.
10 The factors used by carriers are subject to department review
11 and approval.
12 3. Small employer carriers may not modify the rate for
13 a small employer for 12 months from the initial issue date or
14 renewal date, unless the composition of the group changes or
15 benefits are changed. However, a small employer carrier may
16 modify the rate one time prior to 12 months after the initial
17 issue date for a small employer who enrolls under a previously
18 issued group policy that has a common anniversary date for all
19 employers covered under the policy, if the carrier discloses
20 to the employer in a clear and conspicuous manner the date of
21 the first renewal and the fact that the premium may increase
22 on or after that date and if the insurer demonstrates to the
23 department that efficiencies in administration are achieved
24 and reflected in the rates charged to small employers covered
25 under the policy.
26 4. A small employer carrier may issue a policy to a
27 group association with rates that reflect a premium credit for
28 expense savings attributable to administrative activities
29 being performed by the group association, if these expense
30 savings are specifically documented in the carrier's rate
31 filing and are approved by the department. Any such credit may
25
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 not be based on different morbidity assumptions or on any
2 other factor related to the health status or claims experience
3 of the group or its members. Carriers participating in the
4 alliance program, in accordance with ss. 408.700-408.707, may
5 apply a different community rate to business written in that
6 program.
7 (c) For all small employer health benefit plans that
8 are subject to this section, that are issued by small employer
9 carriers before January 1, 1994, and that are renewed on or
10 after January 1, 1995, renewal rates must be based on the same
11 modified community rating standard applied to new business.
12 (d) Notwithstanding s. 627.401(2), this section and
13 ss. 627.410 and 627.411 apply to any health benefit plan
14 provided by a small employer carrier that provides coverage to
15 one or more employees of a small employer regardless of where
16 the policy, certificate, or contract is issued or delivered,
17 if the health benefit plan covers employees or their covered
18 dependents who are residents of this state.
19 Section 9. Sections 408.7041, 408.7042, 408.7055, and
20 408.706, Florida Statutes, are repealed.
21 Section 10. This act shall take effect July 1, 1999.
22
23
24 ================ T I T L E A M E N D M E N T ===============
25 And the title is amended as follows:
26 On page 1, lines 2-9, delete those lines
27
28 and insert:
29 An act relating to health insurance for small
30 employers; amending s. 627.6699, F.S.;
31 modifying definitions; requiring small employer
26
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 carriers to begin to offer and issue all small
2 employer benefit plans on a specified date;
3 deleting the requirement that basic and
4 standard small employer health benefit plans be
5 issued; providing additional requirements for
6 determining premium rates for benefit plans;
7 providing for applicability of the act to plans
8 provided by small employer carriers that are
9 insurers or health maintenance organizations
10 notwithstanding the provisions of certain other
11 specified statutes under specified conditions;
12 amending s. 408.70, F.S.; providing legislative
13 intent for the organization of a nonprofit
14 corporation for providing affordable group
15 health insurance; amending s. 408.701, F.S.;
16 revising definitions; amending s. 408.702,
17 F.S.; creating the Health Alliance for Small
18 Business; deleting authorization for community
19 health purchasing alliances; creating a board
20 of governors for the alliance; specifying
21 organizational requirements; specifying that
22 the alliance is not a state agency;
23 redesignating community health purchasing
24 alliances as regional boards of the alliance;
25 revising provisions related to liability of
26 board members, number and boundary of alliance
27 districts, eligibility for alliance membership,
28 and powers of the state board and regional
29 boards of the alliance; authorizing the Office
30 of the Auditor General to audit and inspect the
31 alliance; prohibiting state agencies from
27
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SENATE AMENDMENT
Bill No. CS/HB 903, 1st Eng.
Amendment No.
1 providing certain funds to the alliance without
2 specific legislative approval; amending s.
3 408.703, F.S.; providing eligibility
4 requirements for small employer members of the
5 alliance; amending s. 408.704, F.S.; providing
6 responsibilities for the Agency for Health Care
7 Administration; amending s. 408.7045, F.S.;
8 revising marketing requirements of the
9 alliance; amending s. 627.6699, F.S.; revising
10 restrictions related to premium rates for small
11 employer health benefit plans; repealing ss.
12 408.7041, 408.7042, 408.7055, 408.706, F.S.,
13 relating to anti-trust protection, relating to
14 purchasing coverage for state employees and
15 Medicaid recipients through community health
16 purchasing alliances, relating to the
17 establishment of practitioner advisory groups
18 by the Agency for Health Care Administration,
19 and relating to requirements for accountable
20 health partnerships; providing an effective
21 date.
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23
24
25
26
27
28
29
30
31
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