HB 0295CS

CHAMBER ACTION



1The Governmental Operations Committee recommends the following:
2
3     Council/Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to the state group insurance program;
7amending s. 110.123, F.S.; revising and providing
8definitions; including the TRICARE supplemental insurance
9plan within the state group insurance program; requiring
10the Department of Management Services to purchase health
11care for employees under the TRICARE supplemental
12insurance plan; authorizing a surviving spouse to elect to
13continue coverage under the TRICARE supplemental insurance
14plan; providing that an enrollee in the TRICARE
15supplemental insurance plan may change to any other state
16health plan during open enrollment; providing an effective
17date.
18
19Be It Enacted by the Legislature of the State of Florida:
20
21     Section 1.  Subsections (2) and (3) of section 110.123,
22Florida Statutes, are amended to read:
23     110.123  State group insurance program.--
24     (2)  DEFINITIONS.--As used in this section, the term:
25     (a)  "Department" means the Department of Management
26Services.
27     (b)  "Enrollee" means all state officers and employees,
28retired state officers and employees, surviving spouses of
29deceased state officers and employees, and terminated employees
30or individuals with continuation coverage who are enrolled in an
31insurance plan offered by the state group insurance program.
32"Enrollee" includes all state university officers and employees,
33retired state university officers and employees, surviving
34spouses of deceased state university officers and employees, and
35terminated state university employees or individuals with
36continuation coverage who are enrolled in an insurance plan
37offered by the state group insurance program.
38     (c)  "Full-time state employees" includes all full-time
39employees of all branches or agencies of state government
40holding salaried positions and paid by state warrant or from
41agency funds, and employees paid from regular salary
42appropriations for 8 months' employment, including university
43personnel on academic contracts, but in no case shall "state
44employee" or "salaried position" include persons paid from
45other-personal-services (OPS) funds. "Full-time employees"
46includes all full-time employees of the state universities.
47     (d)  "Health maintenance organization" or "HMO" means an
48entity certified under part I of chapter 641.
49     (e)  "Health plan member" means any person participating in
50a state group health insurance plan, a TRICARE supplemental
51insurance plan, or in a health maintenance organization plan
52under the state group insurance program, including enrollees and
53covered dependents thereof.
54     (f)  "Part-time state employee" means any employee of any
55branch or agency of state government paid by state warrant from
56salary appropriations or from agency funds, and who is employed
57for less than the normal full-time workweek established by the
58department or, if on academic contract or seasonal or other type
59of employment which is less than year-round, is employed for
60less than 8 months during any 12-month period, but in no case
61shall "part-time" employee include a person paid from other-
62personal-services (OPS) funds. "Part-time state employee"
63includes any part-time employee of the state universities.
64     (g)  "Retired state officer or employee" or "retiree" means
65any state or state university officer or employee who retires
66under a state retirement system or a state optional annuity or
67retirement program or is placed on disability retirement, and
68who was insured under the state group insurance program at the
69time of retirement, and who begins receiving retirement benefits
70immediately after retirement from state or state university
71office or employment. In addition to these requirements, any
72state officer or state employee who retires under the Public
73Employee Optional Retirement Program established under part II
74of chapter 121 shall be considered a "retired state officer or
75employee" or "retiree" as used in this section if he or she:
76     1.  Meets the age and service requirements to qualify for
77normal retirement as set forth in s. 121.021(29); or
78     2.  Has attained the age specified by s. 72(t)(2)(A)(i) of
79the Internal Revenue Code and has 6 years of creditable service.
80     (h)  "State agency" or "agency" means any branch,
81department, or agency of state government. "State agency" or
82"agency" includes any state university for purposes of this
83section only.
84     (i)  "State group health insurance plan or plans" or "state
85plan or plans" mean the state self-insured health insurance plan
86or plans offered to state officers and employees, retired state
87officers and employees, and surviving spouses of deceased state
88officers and employees pursuant to this section.
89     (j)  "State-contracted HMO" means any health maintenance
90organization under contract with the department to participate
91in the state group insurance program.
92     (k)  "State group insurance program" or "programs" means
93the package of insurance plans offered to state officers and
94employees, retired state officers and employees, and surviving
95spouses of deceased state officers and employees pursuant to
96this section, including the state group health insurance plan or
97plans, health maintenance organization plans, TRICARE
98supplemental insurance plans, and other plans required or
99authorized by law.
100     (l)  "State officer" means any constitutional state
101officer, any elected state officer paid by state warrant, or any
102appointed state officer who is commissioned by the Governor and
103who is paid by state warrant.
104     (m)  "Surviving spouse" means the widow or widower of a
105deceased state officer, full-time state employee, part-time
106state employee, or retiree if such widow or widower was covered
107as a dependent under the state group health insurance plan, a
108TRICARE supplemental insurance plan, or a health maintenance
109organization plan established pursuant to this section at the
110time of the death of the deceased officer, employee, or retiree.
111"Surviving spouse" also means any widow or widower who is
112receiving or eligible to receive a monthly state warrant from a
113state retirement system as the beneficiary of a state officer,
114full-time state employee, or retiree who died prior to July 1,
1151979.  For the purposes of this section, any such widow or
116widower shall cease to be a surviving spouse upon his or her
117remarriage.
118     (n)  "TRICARE supplemental insurance plan" means the
119Department of Defense Health Insurance Program for eligible
120members of the uniformed services authorized by Title 10 U.S.C.
121s. 1097.
122     (3)  STATE GROUP INSURANCE PROGRAM.--
123     (a)  The Division of State Group Insurance is created
124within the Department of Management Services.
125     (b)  It is the intent of the Legislature to offer a
126comprehensive package of health insurance and retirement
127benefits and a personnel system for state employees which are
128provided in a cost-efficient and prudent manner, and to allow
129state employees the option to choose benefit plans which best
130suit their individual needs. Therefore, the state group
131insurance program is established which may include the state
132group health insurance plan or plans, health maintenance
133organization plans, group life insurance plans, TRICARE
134supplemental insurance plans, group accidental death and
135dismemberment plans, and group disability insurance plans.
136Furthermore, the department is additionally authorized to
137establish and provide as part of the state group insurance
138program any other group insurance plans or coverage choices that
139are consistent with the provisions of this section.
140     (c)  Notwithstanding any provision in this section to the
141contrary, it is the intent of the Legislature that the
142department shall be responsible for all aspects of the purchase
143of health care for state employees under the state group health
144insurance plan or plans, TRICARE supplemental insurance plans,
145and the health maintenance organization plans. Responsibilities
146shall include, but not be limited to, the development of
147requests for proposals or invitations to negotiate for state
148employee health services, the determination of health care
149benefits to be provided, and the negotiation of contracts for
150health care and health care administrative services.  Prior to
151the negotiation of contracts for health care services, the
152Legislature intends that the department shall develop, with
153respect to state collective bargaining issues, the health
154benefits and terms to be included in the state group health
155insurance program. The department shall adopt rules necessary to
156perform its responsibilities pursuant to this section.  It is
157the intent of the Legislature that the department shall be
158responsible for the contract management and day-to-day
159management of the state employee health insurance program,
160including, but not limited to, employee enrollment, premium
161collection, payment to health care providers, and other
162administrative functions related to the program.
163     (d)1.  Notwithstanding the provisions of chapter 287 and
164the authority of the department, for the purpose of protecting
165the health of, and providing medical services to, state
166employees participating in the state group insurance program,
167the department may contract to retain the services of
168professional administrators for the state group insurance
169program.  The agency shall follow good purchasing practices of
170state procurement to the extent practicable under the
171circumstances.
172     2.  Each vendor in a major procurement, and any other
173vendor if the department deems it necessary to protect the
174state's financial interests, shall, at the time of executing any
175contract with the department, post an appropriate bond with the
176department in an amount determined by the department to be
177adequate to protect the state's interests but not higher than
178the full amount estimated to be paid annually to the vendor
179under the contract.
180     3.  Each major contract entered into by the department
181pursuant to this section shall contain a provision for payment
182of liquidated damages to the department for material
183noncompliance by a vendor with a contract provision. The
184department may require a liquidated damages provision in any
185contract if the department deems it necessary to protect the
186state's financial interests.
187     4.  The provisions of s. 120.57(3) apply to the
188department's contracting process, except:
189     a.  A formal written protest of any decision, intended
190decision, or other action subject to protest shall be filed
191within 72 hours after receipt of notice of the decision,
192intended decision, or other action.
193     b.  As an alternative to any provision of s. 120.57(3), the
194department may proceed with the bid selection or contract award
195process if the director of the department sets forth, in
196writing, particular facts and circumstances which demonstrate
197the necessity of continuing the procurement process or the
198contract award process in order to avoid a substantial
199disruption to the provision of any scheduled insurance services.
200     (e)  The Department of Management Services and the Division
201of State Group Insurance may shall not prohibit or limit any
202properly licensed insurer, health maintenance organization,
203prepaid limited health services organization, or insurance agent
204from competing for any insurance product or plan purchased,
205provided, or endorsed by the department or the division on the
206basis of the compensation arrangement used by the insurer or
207organization for its agents.
208     (f)  Except as provided for in subparagraph (h)2., the
209state contribution toward the cost of any plan in the state
210group insurance program shall be uniform with respect to all
211state employees in a state collective bargaining unit
212participating in the same coverage tier in the same plan.
213Nothing contained within This section does not prohibit
214prohibits the development of separate benefit plans for officers
215and employees exempt from the career service or the development
216of separate benefit plans for each collective bargaining unit.
217     (g)  Participation by individuals in the program is shall
218be available to all state officers, full-time state employees,
219and part-time state employees; and such participation in the
220program or any plan is thereof shall be voluntary. Participation
221in the program is shall also be available to retired state
222officers and employees, as defined in paragraph (2)(g), who
223elect at the time of retirement to continue coverage under the
224program, but they may elect to continue all or only part of the
225coverage they had at the time of retirement. A surviving spouse
226may elect to continue coverage only under a state group health
227insurance plan, a TRICARE supplemental insurance plan, or a
228health maintenance organization plan.
229     (h)1.  A person eligible to participate in the state group
230insurance program may be authorized by rules adopted by the
231department, in lieu of participating in the state group health
232insurance plan, to exercise an option to elect membership in a
233health maintenance organization plan which is under contract
234with the state in accordance with criteria established by this
235section and by said rules.  The offer of optional membership in
236a health maintenance organization plan permitted by this
237paragraph may be limited or conditioned by rule as may be
238necessary to meet the requirements of state and federal laws.
239     2.  The department shall contract with health maintenance
240organizations seeking to participate in the state group
241insurance program through a request for proposal or other
242procurement process, as developed by the Department of
243Management Services and determined to be appropriate.
244     a.  The department shall establish a schedule of minimum
245benefits for health maintenance organization coverage, and that
246schedule shall include: physician services; inpatient and
247outpatient hospital services; emergency medical services,
248including out-of-area emergency coverage; diagnostic laboratory
249and diagnostic and therapeutic radiologic services; mental
250health, alcohol, and chemical dependency treatment services
251meeting the minimum requirements of state and federal law;
252skilled nursing facilities and services; prescription drugs;
253age-based and gender-based wellness benefits; and other benefits
254as may be required by the department. Additional services may be
255provided subject to the contract between the department and the
256HMO.
257     b.  The department may establish uniform deductibles,
258copayments, coverage tiers, or coinsurance schedules for all
259participating HMO plans.
260     c.  The department may require detailed information from
261each health maintenance organization participating in the
262procurement process, including information pertaining to
263organizational status, experience in providing prepaid health
264benefits, accessibility of services, financial stability of the
265plan, quality of management services, accreditation status,
266quality of medical services, network access and adequacy,
267performance measurement, ability to meet the department's
268reporting requirements, and the actuarial basis of the proposed
269rates and other data determined by the director to be necessary
270for the evaluation and selection of health maintenance
271organization plans and negotiation of appropriate rates for
272these plans.  Upon receipt of proposals by health maintenance
273organization plans and the evaluation of those proposals, the
274department may enter into negotiations with all of the plans or
275a subset of the plans, as the department determines appropriate.
276Nothing shall preclude the department from negotiating regional
277or statewide contracts with health maintenance organization
278plans when this is cost-effective and when the department
279determines that the plan offers high value to enrollees.
280     d.  The department may limit the number of HMOs that it
281contracts with in each service area based on the nature of the
282bids the department receives, the number of state employees in
283the service area, or any unique geographical characteristics of
284the service area. The department shall establish by rule service
285areas throughout the state.
286     e.  All persons participating in the state group insurance
287program may be required to contribute towards a total state
288group health premium that may vary depending upon the plan and
289coverage tier selected by the enrollee and the level of state
290contribution authorized by the Legislature.
291     3.  The department is authorized to negotiate and to
292contract with specialty psychiatric hospitals for mental health
293benefits, on a regional basis, for alcohol, drug abuse, and
294mental and nervous disorders. The department may establish,
295subject to the approval of the Legislature pursuant to
296subsection (5), any such regional plan upon completion of an
297actuarial study to determine any impact on plan benefits and
298premiums.
299     4.  In addition to contracting pursuant to subparagraph 2.,
300the department may enter into contract with any HMO to
301participate in the state group insurance program which:
302     a.  Serves greater than 5,000 recipients on a prepaid basis
303under the Medicaid program;
304     b.  Does not currently meet the 25-percent non-
305Medicare/non-Medicaid enrollment composition requirement
306established by the Department of Health excluding participants
307enrolled in the state group insurance program;
308     c.  Meets the minimum benefit package and copayments and
309deductibles contained in sub-subparagraphs 2.a. and b.;
310     d.  Is willing to participate in the state group insurance
311program at a cost of premiums that is not greater than 95
312percent of the cost of HMO premiums accepted by the department
313in each service area; and
314     e.  Meets the minimum surplus requirements of s. 641.225.
315
316The department is authorized to contract with HMOs that meet the
317requirements of sub-subparagraphs a.-d. prior to the open
318enrollment period for state employees.  The department is not
319required to renew the contract with the HMOs as set forth in
320this paragraph more than twice. Thereafter, the HMOs shall be
321eligible to participate in the state group insurance program
322only through the request for proposal or invitation to negotiate
323process described in subparagraph 2.
324     5.  All enrollees in a state group health insurance plan, a
325TRICARE supplemental insurance plan, or any health maintenance
326organization plan shall have the option of changing to any other
327health plan that which is offered by the state within any open
328enrollment period designated by the department. Open enrollment
329shall be held at least once each calendar year.
330     6.  When a contract between a treating provider and the
331state-contracted health maintenance organization is terminated
332for any reason other than for cause, each party shall allow any
333enrollee for whom treatment was active to continue coverage and
334care when medically necessary, through completion of treatment
335of a condition for which the enrollee was receiving care at the
336time of the termination, until the enrollee selects another
337treating provider, or until the next open enrollment period
338offered, whichever is longer, but no longer than 6 months after
339termination of the contract. Each party to the terminated
340contract shall allow an enrollee who has initiated a course of
341prenatal care, regardless of the trimester in which care was
342initiated, to continue care and coverage until completion of
343postpartum care. This does not prevent a provider from refusing
344to continue to provide care to an enrollee who is abusive,
345noncompliant, or in arrears in payments for services provided.
346For care continued under this subparagraph, the program and the
347provider shall continue to be bound by the terms of the
348terminated contract. Changes made within 30 days before
349termination of a contract are effective only if agreed to by
350both parties.
351     7.  Any HMO participating in the state group insurance
352program shall submit health care utilization and cost data to
353the department, in such form and in such manner as the
354department shall require, as a condition of participating in the
355program.  The department shall enter into negotiations with its
356contracting HMOs to determine the nature and scope of the data
357submission and the final requirements, format, penalties
358associated with noncompliance, and timetables for submission.  
359These determinations shall be adopted by rule.
360     8.  The department may establish and direct, with respect
361to collective bargaining issues, a comprehensive package of
362insurance benefits that may include supplemental health and life
363coverage, dental care, long-term care, vision care, and other
364benefits it determines necessary to enable state employees to
365select from among benefit options that best suit their
366individual and family needs.
367     a.  Based upon a desired benefit package, the department
368shall issue a request for proposal or invitation to negotiate
369for health insurance providers interested in participating in
370the state group insurance program, and the department shall
371issue a request for proposal or invitation to negotiate for
372insurance providers interested in participating in the non-
373health-related components of the state group insurance program.
374Upon receipt of all proposals, the department may enter into
375contract negotiations with insurance providers submitting bids
376or negotiate a specially designed benefit package. Insurance
377providers offering or providing supplemental coverage as of May
37830, 1991, which qualify for pretax benefit treatment pursuant to
379s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
380state employees currently enrolled may be included by the
381department in the supplemental insurance benefit plan
382established by the department without participating in a request
383for proposal, submitting bids, negotiating contracts, or
384negotiating a specially designed benefit package. These
385contracts shall provide state employees with the most cost-
386effective and comprehensive coverage available; however, no
387state or agency funds shall be contributed toward the cost of
388any part of the premium of such supplemental benefit plans. With
389respect to dental coverage, the division shall include in any
390solicitation or contract for any state group dental program made
391after July 1, 2001, a comprehensive indemnity dental plan option
392which offers enrollees a completely unrestricted choice of
393dentists. If a dental plan is endorsed, or in some manner
394recognized as the preferred product, such plan shall include a
395comprehensive indemnity dental plan option which provides
396enrollees with a completely unrestricted choice of dentists.
397     b.  Pursuant to the applicable provisions of s. 110.161,
398and s. 125 of the Internal Revenue Code of 1986, the department
399shall enroll in the pretax benefit program those state employees
400who voluntarily elect coverage in any of the supplemental
401insurance benefit plans as provided by sub-subparagraph a.
402     c.  Nothing herein contained shall be construed to prohibit
403insurance providers from continuing to provide or offer
404supplemental benefit coverage to state employees as provided
405under existing agency plans.
406     (i)  The benefits of the insurance authorized by this
407section shall not be in lieu of any benefits payable under
408chapter 440, the Workers' Compensation Law. The insurance
409authorized by this law shall not be deemed to constitute
410insurance to secure workers' compensation benefits as required
411by chapter 440.
412     Section 2.  This act shall take effect upon becoming a law.


CODING: Words stricken are deletions; words underlined are additions.