HB 1881, Engrossed 1 2003
1	A bill to be entitled
2	An act relating to state employee health insurance;
3	providing a popular name; amending s. 110.123, F.S.;
4	revising the terms of coverage and payment for officers
5	and employees participating in state employee group health
6	insurance; amending s. 110.161, F.S., specifying that
7	employees of state universities are state employees
8	eligible participating in the state pretax benefits
9	programs; amending s. 1001.74, F.S., adding a cross
10	reference to specify that state university system
11	employees are eligible to participate in the state pretax
12	benefits program; providing an effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1. Paragraphs (e), (i), and (k) of subsection (2),
17	paragraphs (b), (c), (f), (g), and (h) of subsection (3),
18	paragraphs (c), (d), and (e) of subsection (4), paragraph (d) of
19	subsection (5), and paragraph (b) of subsection (8) of section
20	110.123, Florida Statutes, are amended to read:
21	110.123 State group insurance program.--
22	(2) DEFINITIONS.--As used in this section, the term:
23	(e) "Health plan member" means any person participating in
24	athestate group health insurance plan or in a health
25	maintenance organization plan under the state group insurance
26	program, including enrollees and covered dependents thereof.
27	(i) "State group health insurance plan" or "state plan"
28	means anythestate self-insured health insurance plan offered
29	to state officers and employees, retired state officers and
30	employees, and surviving spouses of deceased state officers and
31	employees as provided by lawpursuant to this section.
32	(k) "State group insurance program" or "programs" means
33	the package of insurance plans offered to state officers and
34	employees, retired state officers and employees, and surviving
35	spouses of deceased state officers and employees pursuant to
36	this section, including the state group health insurance plan,
37	health maintenance organization plans, and other plans required
38	or authorized by lawthis section.
39	(3) STATE GROUP INSURANCE PROGRAM.--
40	(b) It is the intent of the Legislature to offer a
41	comprehensive package of health insurance and retirement
42	benefits and a personnel system for state employees which are
43	provided in a cost-efficient and prudent manner, and to allow
44	state employees the option to choose benefit plans which best
45	suit their individual needs. Therefore, the state group
46	insurance program is established which may include anythestate
47	group health insurance plan, health maintenance organization
48	plans, group life insurance plans, group accidental death and
49	dismemberment plans, and group disability insurance plans.
50	Furthermore, the department is additionally authorized to
51	establish and provide as part of the state group insurance
52	program any other group insurance plans or coverage choices
53	which are consistent with benefit plans offered in the open
54	marketthe provisions of this section.
55	(c) Notwithstanding any provision in this section to the
56	contrary, it is the intent of the Legislature that the
57	department shall be responsible for all aspects of the purchase
58	of health care for state employees under the state group health
59	insurance plan and the health maintenance organization plans.
60	Responsibilities shall include, but not be limited to, the
61	development of requests for proposals or invitations to
62	negotiatefor state employee health services, the determination
63	of health care benefits to be provided, and the negotiation of
64	contracts for health care and health care administrative
65	services. Prior to the negotiation of contracts for health care
66	services, the Legislature intends that the department shall
67	develop, with respect to state collective bargaining issues, the
68	health benefits and terms to be included in the state group
69	health insurance program. The department shall adopt rules
70	necessary to perform its responsibilities pursuant to this
71	section. It is the intent of the Legislature that the department
72	shall be responsible for the contract management and day-to-day
73	management of the state employee health insurance program,
74	including, but not limited to, employee enrollment, premium
75	collection, payment to health care providers, and other
76	administrative functions related to the program.
77	(f) Except as provided for in subparagraph (h)2., the
78	percentage ofstate contribution toward the cost of any plan in
79	the state group insurance program shall be uniform with respect
80	to all state employees in a state collective bargaining unit
81	units participating in the same coverage tier in the same plan
82	or any similar plan. Nothing contained within this section
83	prohibits the development of separate benefit plans for officers
84	and employees exempt from the career servicecollective
85	bargainingor the development of separate benefit plans for each
86	collective bargaining unit.
87	(g) Participation by individuals in the program shall be
88	available to all state officers, full-time state employees, and
89	part-time state employees; and such participation in the program
90	or any plan thereof shall be voluntary. Participation in the
91	program shall also be available to retired state officers and
92	employees, as defined in paragraph (2)(g), who elect at the time
93	of retirement to continue coverage under the program, but they
94	may elect to continue all or only part of the coverage they had
95	at the time of retirement. A surviving spouse may elect to
96	continue coverage only under athestate group health insurance
97	plan or a health maintenance organization plan.
98	(h)1. A person eligible to participate in the state group
99	insurance program may be authorized by rules adopted by the
100	department, in lieu of participating in athestate group health
101	insurance plan, to exercise an option to elect membership in a
102	health maintenance organization plan which is under contract
103	with the state in accordance with criteria established by this
104	section and by said rules. The offer of optional membership in a
105	health maintenance organization plan permitted by this paragraph
106	may be limited or conditioned by rule as may be necessary to
107	meet the requirements of state and federal laws.
108	2. The department shall contract with health maintenance
109	organizations seeking to participate in the state group
110	insurance program through a request for proposal or other
111	procurement process, as developed by the Department of
112	Management Services and determined to be appropriate.
113	a. The department shall establish a schedule of minimum
114	benefits for health maintenance organization coverage, and that
115	schedule shall include: physician services; inpatient and
116	outpatient hospital services; emergency medical services,
117	including out-of-area emergency coverage; diagnostic laboratory
118	and diagnostic and therapeutic radiologic services; mental
119	health, alcohol, and chemical dependency treatment services
120	meeting the minimum requirements of state and federal law;
121	skilled nursing facilities and services; prescription drugs;
122	age-based and gender-based wellness benefitsand other benefits
123	as may be required by the department. Additional services may be
124	provided subject to the contract between the department and the
125	HMO.
126	b. The department may establish uniform deductibles,
127	copayments, coverage tiers,or coinsurance schedules for all
128	participating HMO plans.
129	c. The department may require detailed information from
130	each health maintenance organization participating in the
131	procurement process, including information pertaining to
132	organizational status, experience in providing prepaid health
133	benefits, accessibility of services, financial stability of the
134	plan, quality of management services, accreditation status,
135	quality of medical services, network access and adequacy,
136	performance measurement, ability to meet the department's
137	reporting requirements, and the actuarial basis of the proposed
138	rates and other data determined by the director to be necessary
139	for the evaluation and selection of health maintenance
140	organization plans and negotiation of appropriate rates for
141	these plans. Upon receipt of proposals by health maintenance
142	organization plans and the evaluation of those proposals, the
143	department may enter into negotiations with all of the plans or
144	a subset of the plans, as the department determines appropriate.
145	Nothing shall preclude the department from negotiating regional
146	or statewide contracts with health maintenance organization
147	plans when this is cost-effective and when the department
148	determines that the plan offers high value to enrollees.
149	d. The department may limit the number of HMOs that it
150	contracts with in each service area based on the nature of the
151	bids the department receives, the number of state employees in
152	the service area, or any unique geographical characteristics of
153	the service area. The department shall establish by rule service
154	areas throughout the state.
155	e. All persons participating in the state group insurance
156	program may bewho arerequired to contribute towards a total
157	state group health premium that may vary depending upon the plan
158	and coverage tier selected by the enrollee and the level of
159	state contribution authorized by the Legislatureshall be
160	subject to the same dollar contribution regardless of whether
161	the enrollee enrolls in the state group health insurance plan or
162	in an HMO plan.
163	3. The department is authorized to negotiate and to
164	contract with specialty psychiatric hospitals for mental health
165	benefits, on a regional basis, for alcohol, drug abuse, and
166	mental and nervous disorders. The department may establish,
167	subject to the approval of the Legislature pursuant to
168	subsection (5), any such regional plan upon completion of an
169	actuarial study to determine any impact on plan benefits and
170	premiums.
171	4. In addition to contracting pursuant to subparagraph 2.,
172	the department mayshallenter into contract with any HMO to
173	participate in the state group insurance program which:
174	a. Serves greater than 5,000 recipients on a prepaid basis
175	under the Medicaid program;
176	b. Does not currently meet the 25-percent non-
177	Medicare/non-Medicaid enrollment composition requirement
178	established by the Department of Health excluding participants
179	enrolled in the state group insurance program;
180	c. Meets the minimum benefit package and copayments and
181	deductibles contained in sub-subparagraphs 2.a. and b.;
182	d. Is willing to participate in the state group insurance
183	program at a cost of premiums that is not greater than 95
184	percent of the cost of HMO premiums accepted by the department
185	in each service area; and
186	e. Meets the minimum surplus requirements of s. 641.225.
187
188	The department is authorized to contract with HMOs that meet the
189	requirements of sub-subparagraphs a.-d. prior to the open
190	enrollment period for state employees. The department is not
191	required to renew the contract with the HMOs as set forth in
192	this paragraph more than twice. Thereafter, the HMOs shall be
193	eligible to participate in the state group insurance program
194	only through the request for proposal or invitation to negotiate
195	process described in subparagraph 2.
196	5. All enrollees in anythestate group health insurance
197	plan or any health maintenance organization plan shall have the
198	option of changing to any other health plan which is offered by
199	the state within any open enrollment period designated by the
200	department. Open enrollment shall be held at least once each
201	calendar year.
202	6. When a contract between a treating provider and the
203	state-contracted health maintenance organization is terminated
204	for any reason other than for cause, each party shall allow any
205	enrollee for whom treatment was active to continue coverage and
206	care when medically necessary, through completion of treatment
207	of a condition for which the enrollee was receiving care at the
208	time of the termination, until the enrollee selects another
209	treating provider, or until the next open enrollment period
210	offered, whichever is longer, but no longer than 6 months after
211	termination of the contract. Each party to the terminated
212	contract shall allow an enrollee who has initiated a course of
213	prenatal care, regardless of the trimester in which care was
214	initiated, to continue care and coverage until completion of
215	postpartum care. This does not prevent a provider from refusing
216	to continue to provide care to an enrollee who is abusive,
217	noncompliant, or in arrears in payments for services provided.
218	For care continued under this subparagraph, the program and the
219	provider shall continue to be bound by the terms of the
220	terminated contract. Changes made within 30 days before
221	termination of a contract are effective only if agreed to by
222	both parties.
223	7. Any HMO participating in the state group insurance
224	program shall submit health care utilization and cost data to
225	the department, in such form and in such manner as the
226	department shall require, as a condition of participating in the
227	program. The department shall enter into negotiations with its
228	contracting HMOs to determine the nature and scope of the data
229	submission and the final requirements, format, penalties
230	associated with noncompliance, and timetables for submission.
231	These determinations shall be adopted by rule.
232	8. The department may establish and direct, with respect
233	to collective bargaining issues, a comprehensive package of
234	insurance benefits that may include supplemental health and life
235	coverage, dental care, long-term care, vision care, and other
236	benefits it determines necessary to enable state employees to
237	select from among benefit options that best suit their
238	individual and family needs.
239	a. Based upon a desired benefit package, the department
240	shall issue a request for proposal or invitation to negotiate
241	for health insurance providers interested in participating in
242	the state group insurance program, and the department shall
243	issue a request for proposal or invitation to negotiatefor
244	insurance providers interested in participating in the non-
245	health-related components of the state group insurance program.
246	Upon receipt of all proposals, the department may enter into
247	contract negotiations with insurance providers submitting bids
248	or negotiate a specially designed benefit package. Insurance
249	providers offering or providing supplemental coverage as of May
250	30, 1991, which qualify for pretax benefit treatment pursuant to
251	s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
252	state employees currently enrolled may be included by the
253	department in the supplemental insurance benefit plan
254	established by the department without participating in a request
255	for proposal, submitting bids, negotiating contracts, or
256	negotiating a specially designed benefit package. These
257	contracts shall provide state employees with the most cost-
258	effective and comprehensive coverage available; however, no
259	state or agency funds shall be contributed toward the cost of
260	any part of the premium of such supplemental benefit plans. With
261	respect to dental coverage, the division shall include in any
262	solicitation or contract for any state group dental program made
263	after July 1, 2001, a comprehensive indemnity dental plan option
264	which offers enrollees a completely unrestricted choice of
265	dentists. If a dental plan is endorsed, or in some manner
266	recognized as the preferred product, such plan shall include a
267	comprehensive indemnity dental plan option which provides
268	enrollees with a completely unrestricted choice of dentists.
269	b. Pursuant to the applicable provisions of s. 110.161,
270	and s. 125 of the Internal Revenue Code of 1986, the department
271	shall enroll in the pretax benefit program those state employees
272	who voluntarily elect coverage in any of the supplemental
273	insurance benefit plans as provided by sub-subparagraph a.
274	c. Nothing herein contained shall be construed to prohibit
275	insurance providers from continuing to provide or offer
276	supplemental benefit coverage to state employees as provided
277	under existing agency plans.
278	(4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION
279	ON ACTIONS TO PAY AND COLLECT PREMIUMS.--
280	(c) During each policy or budget year, no state agency
281	shall contribute a greater dollar amountpercentageof the
282	premium cost for its officers or employees for any plan option
283	type of coverageunder the state group insurance program than
284	any other agency for similar officers and employees, nor shall
285	any greater dollar amountpercentage contributionof premium
286	cost be made for employees in one state collective bargaining
287	unit than for those in any other state collective bargaining
288	unit. Nothing in this section prohibits the use of different
289	levels of state contributions for positions exempt from career
290	service.
291	(d) The state contribution for a part-time permanent state
292	employee who elects to participate in the program shall be
293	prorated so that the amountpercentageof the cost contributed
294	for the part-time permanent employee bears that relation to the
295	amountpercentageof cost contributed for a similar full-time
296	employee that the part-time employee's normal workday bears to a
297	full-time employee's normal workday.
298	(e) No state contribution for the cost of any part of the
299	premium shall be made for retirees or surviving spouses for any
300	type of coverage under the state group insurance program.
301	However, any state agency that employs a full-time law
302	enforcement officer, correctional officer, or correctional
303	probation officer who is killed or suffers catastrophic injury
304	in the line of duty as provided in s. 112.19, or a full-time
305	firefighter who is killed or suffers catastrophic injury in the
306	line of duty as provided in s. 112.191, shall pay the entire
307	premium of the state group health insurance plan selectedfor
308	the employee's surviving spouse until remarried, and for each
309	dependent child of the employee, subject to the conditions and
310	limitations set forth in s. 112.19 or s. 112.191, as applicable.
311	(5) DEPARTMENT POWERS AND DUTIES.--The department is
312	responsible for the administration of the state group insurance
313	program. The department shall initiate and supervise the program
314	as established by this section and shall adopt such rules as are
315	necessary to perform its responsibilities. To implement this
316	program, the department shall, with prior approval by the
317	Legislature:
318	(d) With respect to anythestate group health insurance
319	plan, be authorized to require copayments with respect to all
320	providers under the plan.
321
322	Final decisions concerning enrollment, the existence of
323	coverage, or covered benefits under the state group insurance
324	program shall not be delegated or deemed to have been delegated
325	by the department.
326	(8) COVERAGE FOR LEGISLATIVE MEMBERS AND EMPLOYEES.--
327	(b) Effective July 1, 1999, any legislative member who
328	terminates his or her elected service after July 1, 1999, after
329	having vested in the state retirement system, may purchase
330	coverage in athestate group health insurance plan at the same
331	premium cost as that for retirees and surviving spouses. Such
332	legislators may also elect to continue coverage under the group
333	term life insurance program prevailing for current members at
334	the premium cost in effect for that plan.
335	Section 2. Subsection (2) of section 110.161, Florida
336	Statutes, is amended to read:
337	110.161 State employees; pretax benefits program.--
338	(2) As used in this section, "employee" means any
339	individual filling an authorized and established position in the
340	executive, legislative, or judicial branch of the state,
341	including the employees of the State Board of Administration and
342	the state universities.
343	Section 3. Subsection (19) of section 1001.74, Florida
344	Statutes, is amended to read:
345	1001.74 Powers and duties of university boards of
346	trustees.--
347	(19) Each board of trustees shall establish the personnel
348	program for all employees of the university, including the
349	president, pursuant to the provisions of chapter 1012 and, in
350	accordance with rules and guidelines of the State Board of
351	Education, including: compensation and other conditions of
352	employment, recruitment and selection, nonreappointment,
353	standards for performance and conduct, evaluation, benefits and
354	hours of work, leave policies, recognition and awards,
355	inventions and works, travel, learning opportunities, exchange
356	programs, academic freedom and responsibility, promotion,
357	assignment, demotion, transfer, tenure and permanent status,
358	ethical obligations and conflicts of interest, restrictive
359	covenants, disciplinary actions, complaints, appeals and
360	grievance procedures, and separation and termination from
361	employment. The Department of Management Services shall retain
362	authority over state university employees for programs
363	established in ss. 110.123, 110.1232, 110.1234, and 110.1238,
364	and 110.161and in chapters 121, 122, and 238.
365	Section 4. This act shall take effect July 1, 2003.