Senate Bill 0402c1

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    Florida Senate - 2000                            CS for SB 402

    By the Committee on Banking and Insurance; and Senators
    Latvala, Geller and Horne




    311-1652-00

  1                      A bill to be entitled

  2         An act relating to health care; creating the

  3         Florida Health Endowment Association; providing

  4         for appointment of a board of directors;

  5         providing a limitation on the liability of

  6         members, employees of the association, and

  7         representatives of the Agency for Health Care

  8         Administration when performing responsibilities

  9         of the association; providing for open

10         meetings; prescribing duties of the board;

11         authorizing the board to administer the Florida

12         Health Endowment Trust Fund; providing for the

13         adoption of comprehensive health insurance

14         coverage for state residents; providing for the

15         establishment of a plan of operation by the

16         board that includes the assumption of all

17         assets and liabilities of the Florida

18         Comprehensive Health Association and for the

19         transfer of its remaining policyholders into

20         the association; providing rulemaking

21         authority; specifying mandatory and

22         discretionary powers of the board; requiring an

23         audit and report; providing definitions;

24         providing eligibility requirements for persons

25         who seek to join the new health endowment

26         insurance plan; specifying coverages and

27         limitations on coverages as a condition of a

28         person's eligibility; providing for the

29         selection of, term of service of, and duties of

30         the administrator for the association;

31         providing coverages, benefits, expenses,

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    Florida Senate - 2000                            CS for SB 402
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  1         premiums, and deductibles; authorizing the

  2         association to contract with insurers to

  3         provide disease-management services; providing

  4         conditions; repealing s. 627.648, F.S., which

  5         provides for the Florida Comprehensive Health

  6         Association Act; repealing s. 627.6482, F.S.,

  7         relating to definitions; repealing s. 627.6484,

  8         F.S., relating to termination of enrollment;

  9         repealing s. 627.6486, F.S., relating to

10         eligibility; repealing s. 627.6487, F.S.,

11         relating to availability of individual health

12         insurance coverage; repealing s. 627.64871,

13         F.S., relating to certification of coverage;

14         repealing s. 627.6488, F.S., relating to the

15         creation of the Florida Comprehensive Health

16         Association; repealing s. 627.6489, F.S.,

17         relating to the disease-management program;

18         repealing s. 627.649, F.S., relating to the

19         administrator of the program; repealing s.

20         627.6496, F.S., relating to issuance of

21         policies; repealing s. 627.6498, F.S., relating

22         to minimum benefits; repealing s. 627.6492,

23         F.S., relating to participation of insurers;

24         repealing s. 627.6494, F.S., relating to

25         assessments; providing that individuals having

26         coverage issued by the Florida Comprehensive

27         Health Association will be issued coverage by

28         the Florida Health Endowment Association;

29         requiring the Florida Health Endowment

30         Association to assume the assets and

31         liabilities of the Florida Comprehensive Health

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    Florida Senate - 2000                            CS for SB 402
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  1         Association; providing an appropriation to the

  2         Florida Health Endowment Association Trust

  3         Fund; providing an effective date.

  4

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

  6

  7         Section 1.  Florida Health Endowment Association.--

  8         (1)  There is created a nonprofit legal corporation to

  9  be known as the "Florida Health Endowment Association." The

10  association shall be considered a health insurer for purposes

11  of the Florida Insurance Code. The association is exempt from

12  the certificate-of-authority and financial requirements of the

13  Insurance Code.

14         (2)(a)  The association shall operate subject to the

15  supervision and approval of a five-member board of directors.

16  The board of directors shall consist of:

17         1.  The Director of the Agency for Health Care

18  Administration, or his or her designee, who shall serve as

19  chairperson of the board.

20         2.  The Insurance Commissioner, or his or her designee

21  from the Department of Insurance.

22         3.  Three members appointed by the Governor as follows:

23         a.  One representative of policyholders who is not

24  associated with the medical profession or a hospital.

25         b.  One representative of the health insurance

26  industry.

27         c.  One member of the public.

28         (b)  The administrator for the association, or his or

29  her affiliate, may not be a member of the board. Any appointed

30  board member may be removed and replaced by his or her

31  appointor at any time without cause.

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    Florida Senate - 2000                            CS for SB 402
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  1         (c)  All appointed board members, including the

  2  chairperson, shall be appointed to staggered 3-year terms

  3  beginning on a date established in the plan of operation.

  4         (d)  The board of directors may employ persons to

  5  perform the administrative and financial transactions and

  6  responsibilities of the association and to perform other

  7  necessary functions not prohibited by law.

  8         (e)  The members of the board shall serve without

  9  compensation for such service, but are entitled to be

10  reimbursed for expenses incurred in carrying out their

11  responsibilities under this act, as provided in section

12  112.061, Florida Statutes.

13         (f)  There is no liability on the part of, and no cause

14  of action of any nature shall arise against, any employee of

15  the association, member of the board of directors of the

16  association, or representative of the Agency for Health Care

17  Administration for any act or omission taken by them in the

18  performance of their powers and duties under this act, unless

19  that act or omission is in intentional disregard of the rights

20  of the claimant.

21         (g)  Meetings of the board are subject to section

22  286.011, Florida Statutes.

23         (3)  The board of directors of the association shall:

24         (a)  Adopt a plan of operation pursuant to this act and

25  submit the plan of operation to the Agency for Health Care

26  Administration for approval. The plan of operation of the

27  Florida Comprehensive Health Association, and any amendments

28  thereto, shall remain in effect until the Agency for Health

29  Care Administration has approved the Florida Health Endowment

30  Association's plan of operation.

31

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    Florida Senate - 2000                            CS for SB 402
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  1         (b)  Administer the association in a manner that

  2  ensures that the financial resources of the association are

  3  adequate to meet the obligations of the program.

  4         (c)  Establish administrative and accounting procedures

  5  for the operation of the association and provide for an annual

  6  audit of the financial statements by an independent certified

  7  public accountant.

  8         (d)  Annually evaluate or cause to be evaluated the

  9  actuarial soundness of the association. The association shall

10  contract with an actuary to evaluate the pool of insureds in

11  the association and monitor the financial condition of the

12  Florida Health Endowment Trust Fund. The actuary shall

13  determine the feasibility of enrolling new members in the

14  association, which must be based on the projected revenues and

15  expenses of the association.

16         (e)  Establish eligibility requirements for individuals

17  participating in the association to ensure that the financial

18  resources of the association are adequate to meet the

19  obligations and are consistent with the actuarial

20  determination pursuant to paragraph (d) and with the

21  eligibility requirements of section 3.

22         (f)  Establish procedures under which members in the

23  association may have grievances reviewed internally by an

24  impartial body and reported to the association. Individuals

25  receiving care through the association under contract from a

26  health maintenance organization must follow the grievance

27  procedures established in sections 408.7056 and 641.31(5),

28  Florida Statutes.

29         (g)  Select an administrator.

30

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    Florida Senate - 2000                            CS for SB 402
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  1         (h)  Develop and implement a program to publicize the

  2  existence of the association, the eligibility requirements,

  3  and the procedures for enrollment.

  4         (i)  Design and employ cost-containment measures and

  5  requirements that shall include preadmission certification,

  6  any out-of-state health care, home health care, hospice care,

  7  negotiated purchase of medical and pharmaceutical supplies,

  8  and individual case management.

  9         (j)  Contract with authorized insurers, health

10  maintenance organizations, or health care providers.

11         (k)  Use a case manager or managers to supervise and

12  manage the medical care or coordinate the supervision and

13  management of the medical care of specified individuals. The

14  case manager, with the approval of the association, has final

15  approval over the case management for any specific individual.

16  If cost-effective and available in the county where the

17  policyholder resides, the association, upon application or

18  renewal of a policy, may place an individual, as established

19  under section 5, with the case manager, who shall determine

20  the most cost-effective quality care system or health care

21  provider and shall place the individual in such system or with

22  such health care provider. Prior to and during the

23  implementation of case management, the case manager shall

24  obtain input from the policyholder, parent, guardian, and

25  health care providers.

26         (l)  Appoint an executive director to serve as the

27  chief administrative and operational officer of the

28  association and perform other duties assigned to him or her by

29  the board.

30

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  1         (m)  Establish in the plan of operation procedures for

  2  the transition of policyholders from the Florida Comprehensive

  3  Health Association to the association.

  4         1.  The plan of operation must include procedures for

  5  calculating, issuing, and collecting the final assessment for

  6  operating losses of the Florida Comprehensive Health

  7  Association as specified in section 627.6488(4)(d), Florida

  8  Statutes.

  9         2.  The plan of operation must ensure that remaining

10  Florida Comprehensive Health Association policyholders,

11  including those currently enrolled in Medicare, will not be

12  subjected to a new preexisting condition waiting period and

13  that any previous claims paid by the Florida Comprehensive

14  Health Care Association will apply towards the lifetime

15  maximum benefit available in the Florida Health Endowment

16  Association.

17         (n)  Contract with the State Board of Administration

18  for the investment of the funds held in the Florida Health

19  Endowment Trust Fund in accordance with a trust agreement

20  entered into by the association and the State Board of

21  Administration in accordance with sections 215.44-215.53,

22  Florida Statutes.

23         (o)    Submit a report to the Governor, the President

24  of the Senate, the Speaker of the House of Representatives,

25  and the Minority Leaders of the Senate and the House of

26  Representatives not later than October 1 of each year. The

27  report shall summarize the activities of the association for

28  the 12-month period ending December 31 of the previous year,

29  including then-current data and estimates as to premiums, the

30  expense of administration, the paid and incurred losses for

31  the year, and the financial status of the Florida Health

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  1  Endowment Trust Fund, and any recommendations by the actuary

  2  and actions by the association for the opening or closing of

  3  the association. The report shall also include analysis and

  4  recommendations for legislative changes regarding utilization

  5  review, quality assurance, an evaluation of the administrator

  6  of the association, access to cost-effective health care, and

  7  cost containment/case management policy and recommendations

  8  concerning new enrollment.

  9         (5)  The association may:

10         (a)  Sue or be sued.

11         (b)  Prepare or contract for an independent performance

12  audit of the administrator of the association.

13         (c)  Invest funds not required for immediate

14  disbursement.

15         (d)  Appear in its own behalf before boards,

16  commissions, or other governmental agencies.

17         (e)  Execute, hold, buy, and sell any instruments,

18  obligations, securities, and property determined appropriate

19  by the board.

20         (f)  Restrict the number of participants in the

21  association based on actuarial estimates. However, any person

22  denied participation solely on the basis of such restriction

23  must be granted priority on a first-come, first-served basis

24  for participation in the succeeding years in which the

25  association is reopened for participants.

26         (g)  Contract for necessary goods and services; employ

27  necessary personnel; and engage the services of private

28  consultants, actuaries, managers, legal counsel, and

29  independent certified public accountants for administrative or

30  technical assistance.

31

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    Florida Senate - 2000                            CS for SB 402
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  1         (h)  Solicit and accept gifts, grants, loans, and other

  2  aid from any source or participate in any other way in any

  3  government program to carry out the purposes of this act.

  4         (i)  Require and collect administrative fees and

  5  charges in connection with any transaction and impose

  6  reasonable penalties, including default, for delinquent

  7  payments or for entering into the association on a fraudulent

  8  basis.

  9         (j)  Procure insurance against any loss in connection

10  with the property, assets, and activities of the association

11  or the board.

12         (k)  Establish other policies, procedures, and criteria

13  to implement and administer this section.

14         (l)  Adopt procedures to govern contract dispute

15  proceedings between the association and its vendors.

16         (6)  The Auditor General shall conduct an operational

17  audit and an actuarial study of the Florida Health Endowment

18  Association. The actuarial study shall determine the projected

19  revenues and expenses associated with providing continuing

20  coverage to the current members of the Florida Comprehensive

21  Health Association and the feasibility of enrolling new

22  members. The reports shall be submitted to the President of

23  the Senate and Speaker of the House of Representatives on or

24  before January 1, 2002.

25         Section 2.  Definitions.--As used in sections 1-8 of

26  this act, the term:

27         (1)  "Administrator" means an authorized insurer or a

28  licensed third-party administrator licensed under chapter 626,

29  Florida Statutes.

30         (2)  "Association" means the Florida Health Endowment

31  Association.

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    Florida Senate - 2000                            CS for SB 402
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  1         (3)  "Board" means the board of directors of the

  2  association.

  3         (4)  "Case management" means the specific supervision

  4  and management of the medical care provided or prescribed for

  5  a specific individual or a specific episode of care, which may

  6  include the use of health care providers designated by the

  7  case manager.

  8         (5)  "Agency" means the Agency for Health Care

  9  Administration.

10         (6)  "Medicaid" means the medical assistance program

11  authorized by Title XIX of the Social Security Act, 42 U.S.C.

12  s. 1396 et seq., and regulations thereunder, as administered

13  in this state by the agency.

14         (7)  "Medicare" means coverage under both parts A and B

15  of Title XVII of the Social Security Act, 42 U.S.C. s. 1395 et

16  seq., as amended.

17         (8)  "Case manager" means the person or persons used by

18  the association to supervise and manage or coordinate with the

19  administrator the supervision and management of the medical

20  care provided or prescribed for a specific individual.

21         (9)  "Plan of operation" means the articles, bylaws,

22  and operating rules and procedures adopted by the association.

23         (10)  "Resident" means a person who is legally

24  domiciled in this state.

25         Section 3.  Eligibility.--

26         (1)  Except as provided in subsection (2), any person

27  who has been a resident for the previous year and continues to

28  be a resident of the state is eligible for coverage if such

29  person provides evidence of a notice of rejection or refusal

30  to issue substantially similar insurance for health reasons by

31  an insurer licensed to do business in this state.

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  1         (2)  The association or administrator shall require

  2  verification of residency for the preceding 12 months and

  3  shall require any additional information or documentation or

  4  statements under oath when necessary to determine residency

  5  upon initial application and for the entire term of the

  6  policy. A person may demonstrate his or her residency by

  7  maintaining his or her residence in this state for the

  8  preceding year, purchasing a home which is occupied by him or

  9  her as his or her primary residence for the past 12 months, or

10  establishing a domicile in this state pursuant to section

11  222.17, Florida Statutes, for the previous 12 months.

12         (3)  A person is ineligible for coverage under the

13  association if:

14         (a)  The person has or obtains health insurance

15  coverage substantially similar to or more comprehensive than

16  the association's policy, or would be eligible to have

17  coverage if the person elected to obtain it.

18         (b)  The person is an inmate or resident of a public

19  institution or correction facility.

20         (c)  The person's premiums are paid for or reimbursed

21  under any government-sponsored program or by any government

22  agency or health care provider, except as an agency or health

23  care provider.

24         (d)  The person has received the lifetime maximum

25  benefit under coverage issued by the association.

26         (e)  The person is eligible, on the date of issue of

27  coverage under the association, for substantially similar

28  coverage under another contract or policy.

29         (f)  The person is currently enrolled for health care

30  benefits under the Medicare programs, except for those persons

31

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  1  currently insured by the Florida Comprehensive Health

  2  Association and currently enrolled under Medicare.

  3         (4)  Coverage ceases:

  4         (a)  On the date a person is no longer a resident of

  5  this state;

  6         (b)  On the date a person requests coverage to end;

  7         (c)  Upon the date of death of the covered person;

  8         (d)  On the date state law requires cancellation of the

  9  policy; or

10         (e)  Sixty days after the person receives notice from

11  the association making any inquiry concerning the person's

12  eligibility or place of residence to which the person does not

13  reply.

14         (5)  All eligible persons must, upon application or

15  renewal, agree to be placed in a case-management system when

16  it is determined by the association and the case manager that

17  such system will be cost-effective and provide quality care to

18  the individual.

19         (6)  The coverage of any person who ceases to meet the

20  eligibility requirements shall be terminated immediately. If

21  such person again becomes eligible for subsequent coverage,

22  any previous claims payments must be applied towards the

23  lifetime maximum benefit, and any limitation relating to

24  preexisting conditions in effect at the time such person again

25  becomes eligible applies to such person.

26         Section 4.  Administrator.--

27         (1)  The association shall select an administrator,

28  through a competitive bidding process, to administer the

29  coverage offered through the association. The association

30  shall evaluate bids based on criteria established by the

31  board, which must include:

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  1         (a)  The administrator's proven ability to handle

  2  individual accident and health insurance.

  3         (b)  The extent to which the administrator has

  4  developed a network of health care providers for providing

  5  managed health care on a statewide basis.

  6         (c)  The efficiency of the administrator's

  7  claims-paying procedures.

  8         (d)  An estimate of total charges for administering the

  9  coverage for the association.

10         (2)  The administrator serves for a period of 3 years

11  unless otherwise determined by the board. At least one year

12  prior to the expiration of each 3-year period of service by an

13  administrator, the association shall invite all insurers or

14  third party administrators, including the current

15  administering insurer, to submit bids to serve as the

16  administrator for the succeeding 3-year period. The selection

17  of the administrator for the succeeding period must be made at

18  least 6 months prior to the end of the current 3-year period.

19         (3)  The administration may:

20         (a)  Perform all eligibility and administrative

21  claims-payment functions relating to the association, as

22  prescribed by the association.

23         (b)  Pay an agent's referral fee as established by the

24  association to each insurance agent who refers an applicant to

25  the association, if the applicant's application is accepted.

26  The selling or marketing of coverage is not limited to the

27  administrator or its agents. However, any agent must be

28  licensed by the Department of Insurance to sell health

29  insurance in this state. The referral fees must be paid by the

30  administrator from moneys received as premiums for the

31  coverage.

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  1         (c)  Establish a premium-billing procedure for

  2  collecting premiums from insured persons. Billings must be

  3  made periodically as determined by the association.

  4         (d)  Perform all necessary functions to assure timely

  5  payment of benefits, including:

  6         1.  Making available information relating to the proper

  7  manner of submitting a claim for benefits and distributing

  8  forms upon which submissions are made.

  9         2.  Evaluating the eligibility of each claim for

10  payment.

11         3.  Notifying each claimant, within the time limits

12  prescribed by law as to insurers and third-party

13  administrators, after receiving a properly completed and

14  executed proof of loss whether the claim is accepted,

15  rejected, or compromised.

16         (e)  Submit regular reports to the association. The

17  frequency, content, and form of the reports must be determined

18  by the association.

19         (f)  Following the close of each calendar year,

20  determine net premiums, reinsurance premiums less

21  administrative expense allowance, and the expense of

22  administration pertaining to the reinsurance operations of the

23  association.

24         (g)  Pay claims expenses from the premium payments

25  received from or on behalf of covered persons.

26         Section 5.  Minimum benefits coverage; exclusions;

27  premiums; deductibles.--

28         (1)  COVERAGE OFFERED.--

29         (a)  The association must offer in an annually

30  renewable policy the coverage specified in this section for

31  each eligible individual.

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  1         (b)  Coverage provided to a person who is eligible for

  2  Medicare benefits may not be issued as a Medicare supplement

  3  policy as defined in section 627.672, Florida Statutes.

  4         (2)  BENEFITS.--The association must offer coverage to

  5  every eligible person, subject to limitations set by the

  6  association. The coverage offered must pay an eligible

  7  person's covered expenses, subject to limits on the deductible

  8  and coinsurance payments authorized under subsection (4), up

  9  to a lifetime limit of $1 million per covered individual. The

10  maximum limit under this subsection may not be altered by the

11  association, and no actuarially equivalent benefit may be

12  substituted by the association.

13         (3)  COVERED EXPENSES.--The coverage issued by the

14  association must, at a minimum, be patterned after the

15  standard health benefit as defined in section 627.6699,

16  Florida Statutes.

17         (4)  PREMIUMS, DEDUCTIBLES, AND COINSURANCE.--

18         (a)  The association may provide for annual deductibles

19  for coverage in the amount of $1,000 or any higher amounts

20  proposed by the board and approved by the Department of

21  Insurance. The schedules of premiums and deductibles must be

22  established by the association.

23         1.  Separate schedules of premium rates based on age,

24  gender, and geography may apply for individual risks.

25         2.  Rates are subject to approval by the Department of

26  Insurance.

27         3.  Standard risk rates for coverage issued by the

28  association must be established by the Department of

29  Insurance, pursuant to section 627.6675(3), Florida Statutes.

30         4.  An association policy may contain provisions under

31  which coverage is excluded during a period of 12 months

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  1  following the effective date of coverage with respect to a

  2  given covered individual for any preexisting condition, as

  3  long as:

  4         (a)  The condition manifested itself within a period of

  5  6 months before the effective date of coverage; or

  6         (b)  Medical advice or treatment was recommended or

  7  received within a period of 6 months before the effective date

  8  of coverage.

  9         5.  The board shall establish premium schedules and

10  shall revise premium schedules pursuant to this section each

11  12-month policy period, and the rate will be 200 percent of

12  the standard risk rate as established by the Department of

13  Insurance.

14         (a)  If the covered costs incurred by the eligible

15  person exceed the deductible for coverage selected by the

16  person in a policy year, the association shall pay in the

17  following manner:

18         1.  For individuals placed under case management, the

19  association shall pay 90 percent of the additional covered

20  costs incurred by the person during the policy year for the

21  first $10,000, after which the association shall pay 100

22  percent of the covered cost incurred by the person during the

23  policy year.

24         2.  For individuals using the preferred provider

25  network, the association shall pay 80 percent of the

26  additional covered costs incurred by the person during the

27  policy year for the first $10,000, after which the association

28  shall pay 90 percent of covered costs incurred by the person

29  during the policy year.

30         3.  If the person does not use either the case

31  management system or the preferred provider network, the

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  1  association shall pay 60 percent of the additional covered

  2  costs incurred by the person for the first $10,000, after

  3  which the association shall pay 70 percent of the additional

  4  covered costs incurred by the person during the policy year.

  5         (b)  All premiums paid to the association must be

  6  deposited with the Florida Health Endowment Association.

  7         (c)  Notwithstanding the provisions of section 624.509,

  8  Florida Statutes, premiums for coverage are, as to the

  9  association and participating insurers, exempt from premium

10  taxation.

11         (6)  OTHER SOURCES PRIMARY.--

12         (a)  Any amounts paid or payable by Medicare or any

13  other governmental program or any other insurance, or

14  self-insurance maintained in lieu of otherwise statutorily

15  required insurance, may not be made or recognized as claims

16  under such policy or be recognized as or towards satisfaction

17  of applicable deductibles or out-of-pocket maximums or to

18  reduce the limits of benefits available.

19         (b)  The association has a cause of action against a

20  participant for any benefits paid to the participant which

21  should not have been claimed or recognized as claims because

22  of the provisions of this subsection or because the condition

23  is not covered.

24         (7)  NONENTITLEMENT.--This section does not provide an

25  individual with an entitlement to health care services or

26  health insurance. A cause of action does not arise against the

27  state or the board for failure to make health services for

28  health insurance available under this section.

29         Section 6.  Disease management services.--

30

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    Florida Senate - 2000                            CS for SB 402
    311-1652-00




  1         (1)  The association may contract with insurers to

  2  provide disease management services for insurers that elect to

  3  participate in the association's disease management program.

  4         (2)  An insurer that elects to contract for such

  5  services must provide the association with all medical records

  6  and claims information necessary for the association to

  7  effectively manage the services.

  8         (3)  Moneys collected by the association for providing

  9  disease management services must be used by the association to

10  pay administrative expenses associated with the disease

11  management program, and any remaining moneys must be deposited

12  in the Florida Health Endowment Trust Fund.

13         Section 7.  Sections 627.648, 627.6482, 627.6484,

14  627.6486, 627.6488, 627.6489, 627.649, 627.6496 and 627.6498,

15  Florida Statutes, are repealed effective upon the opening of

16  the association. Sections 627.6492 and 627.6494, Florida

17  Statutes, are repealed January 1, 2001.

18         Section 8.  Effective upon the date of the opening of

19  the association, all individuals who have insurance coverage

20  issued by the Florida Comprehensive Health Association on that

21  date must be issued insurance coverage under the Florida

22  Health Endowment Association. The Florida Health Endowment

23  Association shall assume all assets and liabilities of the

24  Florida Comprehensive Health Association. The articles,

25  bylaws, and operational rules of the Florida Comprehensive

26  Health Association, and any amendments thereto, shall remain

27  in effect until the Agency for Health Care Administration has

28  approved the Florida Health Endowment Association plan of

29  operation, articles, bylaws, and operating rules.

30         Section 9.  The sum of $50 million is appropriated from

31  the General Revenue Fund to the Florida Health Endowment Trust

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    Florida Senate - 2000                            CS for SB 402
    311-1652-00




  1  Fund to carry out the provisions of this act during fiscal

  2  year 2000-2001.

  3         Section 10.  This act shall take effect July 1, 2000.

  4

  5          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
  6                         Senate Bill 402

  7

  8  The committee substitute provides the following changes:

  9  1.    Moves oversight responsibility of the Florida Health
          Endowment Association from the Department of Health to
10        the Agency for Health Care Administration. The director
          of the agency shall serve as the chairperson of the
11        board of directors. The Department is no longer
          represented on the board.
12
    2.    Eliminates the requirement that the premiums be based
13        upon participants' income and requires that the
          association establish premium schedules at the rate of
14        200 percent of the standard risk rate, as developed by
          the Department of Insurance.
15
    3.    Specifies that the association shall be considered a
16        health insurer for purposes of the Florida Insurance
          Code. The association is exempt from the
17        certificate-of-authority and financial requirements of
          the Insurance Code.
18
    4.    Tightens the eligibility requirements for the
19        association by no longer allowing individuals to be
          eligible if coverage in the private sector was more
20        expensive than coverage offered through the association,
          and requiring an individual to provide evidence of a
21        notice of rejection or refusal to issue substantially
          similar coverage for health reasons only.
22
    5.    Eliminates the vested tax credit against insurance
23        premium tax liability to insurers who contribute to the
          Florida Health Endowment Association.
24
    6.    Eliminates the provision that the effective date of the
25        bill is contingent upon $50 million being appropriated
          to the Florida Health Endowment Association and,
26        instead, the bill provides for a July 1, 2000, effective
          date.
27
    7.    Provides other changes related to the powers and
28        responsibilities of the board of directors.

29

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