CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Posey and Boyd offered the following:
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13 Amendment (with title amendment)
14 On page 17, line 16,
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16 insert:
17 Section 11. Paragraph (g) of subsection (3) of section
18 110.123, Florida Statutes, is amended to read:
19 110.123 State group insurance program.--
20 (3) STATE GROUP INSURANCE PROGRAM.--
21 (g)1. A person eligible to participate in the state
22 group insurance program may be authorized by rules adopted by
23 the department, in lieu of participating in the state group
24 health insurance plan, to exercise an option to elect
25 membership in a health maintenance organization plan which is
26 under contract with the state in accordance with criteria
27 established by this section and by said rules. The offer of
28 optional membership in a health maintenance organization plan
29 permitted by this paragraph may be limited or conditioned by
30 rule as may be necessary to meet the requirements of state and
31 federal laws.
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HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
1 2. The department shall contract with health
2 maintenance organizations seeking to participate in the state
3 group insurance program through a request for proposal or
4 other procurement process, as developed by the Department of
5 Management Services and determined to be appropriate.
6 a. The department shall establish a schedule of
7 minimum benefits for health maintenance organization coverage,
8 and that schedule shall include: physician services; inpatient
9 and outpatient hospital services; emergency medical services,
10 including out-of-area emergency coverage; diagnostic
11 laboratory and diagnostic and therapeutic radiologic services;
12 mental health, alcohol, and chemical dependency treatment
13 services meeting the minimum requirements of state and federal
14 law; skilled nursing facilities and services; prescription
15 drugs; and other benefits as may be required by the
16 department. Additional services may be provided subject to
17 the contract between the department and the HMO.
18 b. The department may establish uniform deductibles,
19 copayments, or coinsurance schedules for all participating HMO
20 plans.
21 c. The department may require detailed information
22 from each health maintenance organization participating in the
23 procurement process, including information pertaining to
24 organizational status, experience in providing prepaid health
25 benefits, accessibility of services, financial stability of
26 the plan, quality of management services, accreditation
27 status, quality of medical services, network access and
28 adequacy, performance measurement, ability to meet the
29 department's reporting requirements, and the actuarial basis
30 of the proposed rates and other data determined by the
31 director to be necessary for the evaluation and selection of
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HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
1 health maintenance organization plans and negotiation of
2 appropriate rates for these plans. Upon receipt of proposals
3 by health maintenance organization plans and the evaluation of
4 those proposals, the department may enter into negotiations
5 with all of the plans or a subset of the plans, as the
6 department determines appropriate. Nothing shall preclude the
7 department from negotiating regional or statewide contracts
8 with health maintenance organization plans when this is
9 cost-effective and when the department determines that the
10 plan offers high value to enrollees.
11 d. The department may limit the number of HMOs that it
12 contracts with in each service area based on the nature of the
13 bids the department receives, the number of state employees in
14 the service area, or any unique geographical characteristics
15 of the service area. The department shall establish by rule
16 service areas throughout the state.
17 e. All persons participating in the state group
18 insurance program who are required to contribute towards a
19 total state group health premium shall be subject to the same
20 dollar contribution regardless of whether the enrollee enrolls
21 in the state group health insurance plan or in an HMO plan.
22 3. The division is authorized to negotiate and to
23 contract with specialty psychiatric hospitals for mental
24 health benefits, on a regional basis, for alcohol, drug abuse,
25 and mental and nervous disorders. The division may establish,
26 subject to the approval of the Legislature pursuant to
27 subsection (5), any such regional plan upon completion of an
28 actuarial study to determine any impact on plan benefits and
29 premiums.
30 4. In addition to contracting pursuant to subparagraph
31 2., the department shall enter into contract with any HMO to
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HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
1 participate in the state group insurance program which:
2 a. Serves greater than 5,000 recipients on a prepaid
3 basis under the Medicaid program;
4 b. Does not currently meet the 25 percent
5 non-Medicare/non-Medicaid enrollment composition requirement
6 established by the Department of Health excluding participants
7 enrolled in the state group insurance program;
8 c. Meets the minimum benefit package and copayments
9 and deductibles contained in sub-subparagraphs 2.a. and b.;
10 d. Is willing to participate in the state group
11 insurance program at a cost of premiums that is not greater
12 than 95 percent of the cost of HMO premiums accepted by the
13 department in each service area; and
14 e. Meets the minimum surplus requirements of s.
15 641.225.
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17 The department is authorized to contract with HMOs that meet
18 the requirements of sub-subparagraphs a. through d. prior to
19 the open enrollment period for state employees. The
20 department is not required to renew the contract with the HMOs
21 as set forth in this paragraph more than twice. Thereafter,
22 the HMOs shall be eligible to participate in the state group
23 insurance program only through the request for proposal
24 process described in subparagraph 2.
25 5. All enrollees in the state group health insurance
26 plan or any health maintenance organization plan shall have
27 the option of changing to any other health plan which is
28 offered by the state within any open enrollment period
29 designated by the department. Open enrollment shall be held at
30 least once each calendar year.
31 6. When a contract between a treating provider and the
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HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
1 state-contracted health maintenance organization is terminated
2 for any reason other than for cause, each party shall allow
3 any enrollee for whom treatment was active to continue
4 coverage and care when medically necessary, through completion
5 of treatment of a condition for which the enrollee was
6 receiving care at the time of the termination, until the
7 enrollee selects another treating provider, or until the next
8 open enrollment period offered, whichever is longer, but no
9 longer than 6 months after termination of the contract. Each
10 party to the terminated contract shall allow an enrollee who
11 has initiated a course of prenatal care, regardless of the
12 trimester in which care was initiated, to continue care and
13 coverage until completion of postpartum care. This does not
14 prevent a provider from refusing to continue to provide care
15 to an enrollee who is abusive, noncompliant, or in arrears in
16 payments for services provided. For care continued under this
17 subparagraph, the program and the provider shall continue to
18 be bound by the terms of the terminated contract. Changes made
19 within 30 days before termination of a contract are effective
20 only if agreed to by both parties.
21 7. Any HMO participating in the state group insurance
22 program shall submit health care utilization and cost data to
23 the department, in such form and in such manner as the
24 division shall require, as a condition of participating in the
25 program. The department shall enter into negotiations with
26 its contracting HMOs to determine the nature and scope of the
27 data submission and the final requirements, format, penalties
28 associated with noncompliance, and timetables for submission.
29 These determinations shall be adopted by rule.
30 8. The department may establish and direct, with
31 respect to collective bargaining issues, a comprehensive
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HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
1 package of insurance benefits that may include supplemental
2 health and life coverage, dental care, long-term care, vision
3 care, and other benefits it determines necessary to enable
4 state employees to select from among benefit options that best
5 suit their individual and family needs.
6 a. Based upon a desired benefit package, the
7 department shall issue a request for proposal for health
8 insurance providers interested in participating in the state
9 group insurance program, and the division shall issue a
10 request for proposal for insurance providers interested in
11 participating in the non-health-related components of the
12 state group insurance program. Upon receipt of all proposals,
13 the department may enter into contract negotiations with
14 insurance providers submitting bids or negotiate a specially
15 designed benefit package. Insurance providers offering or
16 providing supplemental coverage as of May 30, 1991, which
17 qualify for pretax benefit treatment pursuant to s. 125 of the
18 Internal Revenue Code of 1986, with 5,500 or more state
19 employees currently enrolled may be included by the department
20 in the supplemental insurance benefit plan established by the
21 department without participating in a request for proposal,
22 submitting bids, negotiating contracts, or negotiating a
23 specially designed benefit package. These contracts shall
24 provide state employees with the most cost-effective and
25 comprehensive coverage available; however, no state or agency
26 funds shall be contributed toward the cost of any part of the
27 premium of such supplemental benefit plans. With respect to
28 dental coverage, the division shall include in any
29 solicitation or contract for any state group dental program
30 made after July 1, 2001, a comprehensive indemnity dental plan
31 option which offers enrollees a completely unrestricted choice
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HOUSE AMENDMENT
Bill No. HB 2167
Amendment No. (for drafter's use only)
1 of dentists. If a dental plan is endorsed, or in some manner
2 recognized as the preferred product, such plan shall include a
3 comprehensive indemnity dental plan option which provides
4 enrollees with a completely unrestricted choice of dentists.
5 b. Pursuant to the applicable provisions of s.
6 110.161, and s. 125 of the Internal Revenue Code of 1986, the
7 department shall enroll in the pretax benefit program those
8 state employees who voluntarily elect coverage in any of the
9 supplemental insurance benefit plans as provided by
10 sub-subparagraph a.
11 c. Nothing herein contained shall be construed to
12 prohibit insurance providers from continuing to provide or
13 offer supplemental benefit coverage to state employees as
14 provided under existing agency plans.
15 Section 12. This act shall take effect July 1, 2001.
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19 And the title is amended as follows:
20 On page 2, line 15, after the semicolon
21 remove from the title of the bill:
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23 and insert in lieu thereof:
24 amending s. 110.123, F.S.; requiring
25 solicitations or contracts or a state group
26 dental program to include a comprehensive
27 indemnity dental plan option providing
28 enrollees an unrestricted access to dentists;
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