HOUSE AMENDMENT Bill No. HB 1881
1	CHAMBER ACTION
2	Senate House
3	.
4	.
5	.
6
7
8
9
10
11
12	Representative Hogan offered the following:
13
14	Amendment
15	Remove line(s) 77-284, and insert:
16
17	(f) Except as provided for in subparagraph (h)2., the
18	percentage ofstate contribution toward the cost of any plan in
19	the state group insurance program shall be uniform with respect
20	to all state employees in a state collective bargaining unit
21	units participating in the same coverage tier in the same plan
22	or any similar plan. Nothing contained within this section
23	prohibits the development of separate benefit plans for officers
24	and employees exempt from the career servicecollective
25	bargainingor the development of separate benefit plans for each
26	collective bargaining unit.
27	(g) Participation by individuals in the program shall be
28	available to all state officers, full-time state employees, and
29	part-time state employees; and such participation in the program
30	or any plan thereof shall be voluntary. Participation in the
31	program shall also be available to retired state officers and
32	employees, as defined in paragraph (2)(g), who elect at the time
33	of retirement to continue coverage under the program, but they
34	may elect to continue all or only part of the coverage they had
35	at the time of retirement. A surviving spouse may elect to
36	continue coverage only under athestate group health insurance
37	plan or a health maintenance organization plan.
38	(h)1. A person eligible to participate in the state group
39	insurance program may be authorized by rules adopted by the
40	department, in lieu of participating in athestate group health
41	insurance plan, to exercise an option to elect membership in a
42	health maintenance organization plan which is under contract
43	with the state in accordance with criteria established by this
44	section and by said rules. The offer of optional membership in a
45	health maintenance organization plan permitted by this paragraph
46	may be limited or conditioned by rule as may be necessary to
47	meet the requirements of state and federal laws.
48	2. The department shall contract with health maintenance
49	organizations seeking to participate in the state group
50	insurance program through a request for proposal or other
51	procurement process, as developed by the Department of
52	Management Services and determined to be appropriate.
53	a. The department shall establish a schedule of minimum
54	benefits for health maintenance organization coverage, and that
55	schedule shall include: physician services; inpatient and
56	outpatient hospital services; emergency medical services,
57	including out-of-area emergency coverage; diagnostic laboratory
58	and diagnostic and therapeutic radiologic services; mental
59	health, alcohol, and chemical dependency treatment services
60	meeting the minimum requirements of state and federal law;
61	skilled nursing facilities and services; prescription drugs;
62	age-based and gender-based wellness benefitsand other benefits
63	as may be required by the department. Additional services may be
64	provided subject to the contract between the department and the
65	HMO.
66	b. The department may establish uniform deductibles,
67	copayments, coverage tiers,or coinsurance schedules for all
68	participating HMO plans.
69	c. The department may require detailed information from
70	each health maintenance organization participating in the
71	procurement process, including information pertaining to
72	organizational status, experience in providing prepaid health
73	benefits, accessibility of services, financial stability of the
74	plan, quality of management services, accreditation status,
75	quality of medical services, network access and adequacy,
76	performance measurement, ability to meet the department's
77	reporting requirements, and the actuarial basis of the proposed
78	rates and other data determined by the director to be necessary
79	for the evaluation and selection of health maintenance
80	organization plans and negotiation of appropriate rates for
81	these plans. Upon receipt of proposals by health maintenance
82	organization plans and the evaluation of those proposals, the
83	department may enter into negotiations with all of the plans or
84	a subset of the plans, as the department determines appropriate.
85	Nothing shall preclude the department from negotiating regional
86	or statewide contracts with health maintenance organization
87	plans when this is cost-effective and when the department
88	determines that the plan offers high value to enrollees.
89	d. The department may limit the number of HMOs that it
90	contracts with in each service area based on the nature of the
91	bids the department receives, the number of state employees in
92	the service area, or any unique geographical characteristics of
93	the service area. The department shall establish by rule service
94	areas throughout the state.
95	e. All persons participating in the state group insurance
96	program may bewho arerequired to contribute towards a total
97	state group health premium that may vary depending upon the plan
98	and coverage tier selected by the enrollee and the level of
99	state contribution authorized by the Legislatureshall be
100	subject to the same dollar contribution regardless of whether
101	the enrollee enrolls in the state group health insurance plan or
102	in an HMO plan.
103	3. The department is authorized to negotiate and to
104	contract with specialty psychiatric hospitals for mental health
105	benefits, on a regional basis, for alcohol, drug abuse, and
106	mental and nervous disorders. The department may establish,
107	subject to the approval of the Legislature pursuant to
108	subsection (5), any such regional plan upon completion of an
109	actuarial study to determine any impact on plan benefits and
110	premiums.
111	4. In addition to contracting pursuant to subparagraph 2.,
112	the department mayshallenter into contract with any HMO to
113	participate in the state group insurance program which:
114	a. Serves greater than 5,000 recipients on a prepaid basis
115	under the Medicaid program;
116	b. Does not currently meet the 25-percent non-
117	Medicare/non-Medicaid enrollment composition requirement
118	established by the Department of Health excluding participants
119	enrolled in the state group insurance program;
120	c. Meets the minimum benefit package and copayments and
121	deductibles contained in sub-subparagraphs 2.a. and b.;
122	d. Is willing to participate in the state group insurance
123	program at a cost of premiums that is not greater than 95
124	percent of the cost of HMO premiums accepted by the department
125	in each service area; and
126	e. Meets the minimum surplus requirements of s. 641.225.
127
128	The department is authorized to contract with HMOs that meet the
129	requirements of sub-subparagraphs a.-d. prior to the open
130	enrollment period for state employees. The department is not
131	required to renew the contract with the HMOs as set forth in
132	this paragraph more than twice. Thereafter, the HMOs shall be
133	eligible to participate in the state group insurance program
134	only through the request for proposal or invitation to negotiate
135	process described in subparagraph 2.
136	5. All enrollees in anythestate group health insurance
137	plan or any health maintenance organization plan shall have the
138	option of changing to any other health plan which is offered by
139	the state within any open enrollment period designated by the
140	department. Open enrollment shall be held at least once each
141	calendar year.
142	6. When a contract between a treating provider and the
143	state-contracted health maintenance organization is terminated
144	for any reason other than for cause, each party shall allow any
145	enrollee for whom treatment was active to continue coverage and
146	care when medically necessary, through completion of treatment
147	of a condition for which the enrollee was receiving care at the
148	time of the termination, until the enrollee selects another
149	treating provider, or until the next open enrollment period
150	offered, whichever is longer, but no longer than 6 months after
151	termination of the contract. Each party to the terminated
152	contract shall allow an enrollee who has initiated a course of
153	prenatal care, regardless of the trimester in which care was
154	initiated, to continue care and coverage until completion of
155	postpartum care. This does not prevent a provider from refusing
156	to continue to provide care to an enrollee who is abusive,
157	noncompliant, or in arrears in payments for services provided.
158	For care continued under this subparagraph, the program and the
159	provider shall continue to be bound by the terms of the
160	terminated contract. Changes made within 30 days before
161	termination of a contract are effective only if agreed to by
162	both parties.
163	7. Any HMO participating in the state group insurance
164	program shall submit health care utilization and cost data to
165	the department, in such form and in such manner as the
166	department shall require, as a condition of participating in the
167	program. The department shall enter into negotiations with its
168	contracting HMOs to determine the nature and scope of the data
169	submission and the final requirements, format, penalties
170	associated with noncompliance, and timetables for submission.
171	These determinations shall be adopted by rule.
172	8. The department may establish and direct, with respect
173	to collective bargaining issues, a comprehensive package of
174	insurance benefits that may include supplemental health and life
175	coverage, dental care, long-term care, vision care, and other
176	benefits it determines necessary to enable state employees to
177	select from among benefit options that best suit their
178	individual and family needs.
179	a. Based upon a desired benefit package, the department
180	shall issue a request for proposal or invitation to negotiate
181	for health insurance providers interested in participating in
182	the state group insurance program, and the department shall
183	issue a request for proposal or invitation to negotiatefor
184	insurance providers interested in participating in the non-
185	health-related components of the state group insurance program.
186	Upon receipt of all proposals, the department may enter into
187	contract negotiations with insurance providers submitting bids
188	or negotiate a specially designed benefit package. Insurance
189	providers offering or providing supplemental coverage as of May
190	30, 1991, which qualify for pretax benefit treatment pursuant to
191	s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
192	state employees currently enrolled may be included by the
193	department in the supplemental insurance benefit plan
194	established by the department without participating in a request
195	for proposal, submitting bids, negotiating contracts, or
196	negotiating a specially designed benefit package. These
197	contracts shall provide state employees with the most cost-
198	effective and comprehensive coverage available; however, no
199	state or agency funds shall be contributed toward the cost of
200	any part of the premium of such supplemental benefit plans. With
201	respect to dental coverage, the division shall include in any
202	solicitation or contract for any state group dental program made
203	after July 1, 2001, a comprehensive indemnity dental plan option
204	which offers enrollees a completely unrestricted choice of
205	dentists. If a dental plan is endorsed, or in some manner
206	recognized as the preferred product, such plan shall include a
207	comprehensive indemnity dental plan option which provides
208	enrollees with a completely unrestricted choice of dentists.
209	b. Pursuant to the applicable provisions of s. 110.161,
210	and s. 125 of the Internal Revenue Code of 1986, the department
211	shall enroll in the pretax benefit program those state employees
212	who voluntarily elect coverage in any of the supplemental
213	insurance benefit plans as provided by sub-subparagraph a.
214	c. Nothing herein contained shall be construed to prohibit
215	insurance providers from continuing to provide or offer
216	supplemental benefit coverage to state employees as provided
217	under existing agency plans.
218	(4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION
219	ON ACTIONS TO PAY AND COLLECT PREMIUMS.--
220	(c) During each policy or budget year, no state agency
221	shall contribute a greater dollar amountpercentageof the
222	premium cost for its officers or employees for any plan option
223	type of coverageunder the state group insurance program than
224	any other agency for similar officers and employees, nor shall
225	any greater dollar amountpercentage contributionof premium
226	cost be made for employees in one state collective bargaining
227	unit than for those in any other state collective bargaining
228	unit. Nothing in this section prohibits the use of different
229	levels of state contributions for positions exempt from career
230	service.
231