Senate Bill sb0382

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2006                                   SB 382

    By Senator Margolis





    35-463-06

  1                      A bill to be entitled

  2         An act relating to wellness programs for state

  3         employees; amending s. 110.123, F.S.; defining

  4         the term "aged-based and gender-based benefits"

  5         for purposes of the state group insurance

  6         program; creating the Florida State Employees

  7         Wellness Council within the Department of

  8         Management Services; providing for membership;

  9         providing for reimbursement of per diem and

10         travel expenses; providing purpose and duties

11         of the council; providing an effective date.

12  

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

14  

15         Section 1.  Paragraph (h) of subsection (3) of section

16  110.123, Florida Statutes, is amended, and subsection (13) is

17  added to that section, to read:

18         110.123  State group insurance program.--

19         (3)  STATE GROUP INSURANCE PROGRAM.--

20         (h)1.  A person eligible to participate in the state

21  group insurance program may be authorized by rules adopted by

22  the department, in lieu of participating in the state group

23  health insurance plan, to exercise an option to elect

24  membership in a health maintenance organization plan which is

25  under contract with the state in accordance with criteria

26  established by this section and by said rules.  The offer of

27  optional membership in a health maintenance organization plan

28  permitted by this paragraph may be limited or conditioned by

29  rule as may be necessary to meet the requirements of state and

30  federal laws.

31  

                                  1

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1         2.  The department shall contract with health

 2  maintenance organizations seeking to participate in the state

 3  group insurance program through a request for proposal or

 4  other procurement process, as developed by the Department of

 5  Management Services and determined to be appropriate.

 6         a.  The department shall establish a schedule of

 7  minimum benefits for health maintenance organization coverage,

 8  and that schedule shall include: physician services; inpatient

 9  and outpatient hospital services; emergency medical services,

10  including out-of-area emergency coverage; diagnostic

11  laboratory and diagnostic and therapeutic radiologic services;

12  mental health, alcohol, and chemical dependency treatment

13  services meeting the minimum requirements of state and federal

14  law; skilled nursing facilities and services; prescription

15  drugs; age-based and gender-based wellness benefits; and other

16  benefits as may be required by the department. Additional

17  services may be provided subject to the contract between the

18  department and the HMO. As used in this paragraph, the term

19  "age-based and gender-based wellness benefits" includes

20  aerobic exercise, education in alcohol and substance abuse

21  prevention, blood cholesterol screening, health risk

22  appraisals, blood pressure screening and education, nutrition

23  education, program planning, safety belt education, smoking

24  cessation, stress management, weight loss, and woman's health

25  education.

26         b.  The department may establish uniform deductibles,

27  copayments, coverage tiers, or coinsurance schedules for all

28  participating HMO plans.

29         c.  The department may require detailed information

30  from each health maintenance organization participating in the

31  procurement process, including information pertaining to

                                  2

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1  organizational status, experience in providing prepaid health

 2  benefits, accessibility of services, financial stability of

 3  the plan, quality of management services, accreditation

 4  status, quality of medical services, network access and

 5  adequacy, performance measurement, ability to meet the

 6  department's reporting requirements, and the actuarial basis

 7  of the proposed rates and other data determined by the

 8  director to be necessary for the evaluation and selection of

 9  health maintenance organization plans and negotiation of

10  appropriate rates for these plans.  Upon receipt of proposals

11  by health maintenance organization plans and the evaluation of

12  those proposals, the department may enter into negotiations

13  with all of the plans or a subset of the plans, as the

14  department determines appropriate. Nothing shall preclude the

15  department from negotiating regional or statewide contracts

16  with health maintenance organization plans when this is

17  cost-effective and when the department determines that the

18  plan offers high value to enrollees.

19         d.  The department may limit the number of HMOs that it

20  contracts with in each service area based on the nature of the

21  bids the department receives, the number of state employees in

22  the service area, or any unique geographical characteristics

23  of the service area. The department shall establish by rule

24  service areas throughout the state.

25         e.  All persons participating in the state group

26  insurance program may be required to contribute towards a

27  total state group health premium that may vary depending upon

28  the plan and coverage tier selected by the enrollee and the

29  level of state contribution authorized by the Legislature.

30         3.  The department is authorized to negotiate and to

31  contract with specialty psychiatric hospitals for mental

                                  3

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1  health benefits, on a regional basis, for alcohol, drug abuse,

 2  and mental and nervous disorders. The department may

 3  establish, subject to the approval of the Legislature pursuant

 4  to subsection (5), any such regional plan upon completion of

 5  an actuarial study to determine any impact on plan benefits

 6  and premiums.

 7         4.  In addition to contracting pursuant to subparagraph

 8  2., the department may enter into contract with any HMO to

 9  participate in the state group insurance program which:

10         a.  Serves greater than 5,000 recipients on a prepaid

11  basis under the Medicaid program;

12         b.  Does not currently meet the 25-percent

13  non-Medicare/non-Medicaid enrollment composition requirement

14  established by the Department of Health excluding participants

15  enrolled in the state group insurance program;

16         c.  Meets the minimum benefit package and copayments

17  and deductibles contained in sub-subparagraphs 2.a. and b.;

18         d.  Is willing to participate in the state group

19  insurance program at a cost of premiums that is not greater

20  than 95 percent of the cost of HMO premiums accepted by the

21  department in each service area; and

22         e.  Meets the minimum surplus requirements of s.

23  641.225.

24  

25  The department is authorized to contract with HMOs that meet

26  the requirements of sub-subparagraphs a.-d. prior to the open

27  enrollment period for state employees.  The department is not

28  required to renew the contract with the HMOs as set forth in

29  this paragraph more than twice. Thereafter, the HMOs shall be

30  eligible to participate in the state group insurance program

31  

                                  4

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1  only through the request for proposal or invitation to

 2  negotiate process described in subparagraph 2.

 3         5.  All enrollees in a state group health insurance

 4  plan, a TRICARE supplemental insurance plan, or any health

 5  maintenance organization plan have the option of changing to

 6  any other health plan that is offered by the state within any

 7  open enrollment period designated by the department. Open

 8  enrollment shall be held at least once each calendar year.

 9         6.  When a contract between a treating provider and the

10  state-contracted health maintenance organization is terminated

11  for any reason other than for cause, each party shall allow

12  any enrollee for whom treatment was active to continue

13  coverage and care when medically necessary, through completion

14  of treatment of a condition for which the enrollee was

15  receiving care at the time of the termination, until the

16  enrollee selects another treating provider, or until the next

17  open enrollment period offered, whichever is longer, but no

18  longer than 6 months after termination of the contract. Each

19  party to the terminated contract shall allow an enrollee who

20  has initiated a course of prenatal care, regardless of the

21  trimester in which care was initiated, to continue care and

22  coverage until completion of postpartum care. This does not

23  prevent a provider from refusing to continue to provide care

24  to an enrollee who is abusive, noncompliant, or in arrears in

25  payments for services provided. For care continued under this

26  subparagraph, the program and the provider shall continue to

27  be bound by the terms of the terminated contract. Changes made

28  within 30 days before termination of a contract are effective

29  only if agreed to by both parties.

30         7.  Any HMO participating in the state group insurance

31  program shall submit health care utilization and cost data to

                                  5

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1  the department, in such form and in such manner as the

 2  department shall require, as a condition of participating in

 3  the program.  The department shall enter into negotiations

 4  with its contracting HMOs to determine the nature and scope of

 5  the data submission and the final requirements, format,

 6  penalties associated with noncompliance, and timetables for

 7  submission.  These determinations shall be adopted by rule.

 8         8.  The department may establish and direct, with

 9  respect to collective bargaining issues, a comprehensive

10  package of insurance benefits that may include supplemental

11  health and life coverage, dental care, long-term care, vision

12  care, and other benefits it determines necessary to enable

13  state employees to select from among benefit options that best

14  suit their individual and family needs.

15         a.  Based upon a desired benefit package, the

16  department shall issue a request for proposal or invitation to

17  negotiate for health insurance providers interested in

18  participating in the state group insurance program, and the

19  department shall issue a request for proposal or invitation to

20  negotiate for insurance providers interested in participating

21  in the non-health-related components of the state group

22  insurance program. Upon receipt of all proposals, the

23  department may enter into contract negotiations with insurance

24  providers submitting bids or negotiate a specially designed

25  benefit package. Insurance providers offering or providing

26  supplemental coverage as of May 30, 1991, which qualify for

27  pretax benefit treatment pursuant to s. 125 of the Internal

28  Revenue Code of 1986, with 5,500 or more state employees

29  currently enrolled may be included by the department in the

30  supplemental insurance benefit plan established by the

31  department without participating in a request for proposal,

                                  6

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1  submitting bids, negotiating contracts, or negotiating a

 2  specially designed benefit package. These contracts shall

 3  provide state employees with the most cost-effective and

 4  comprehensive coverage available; however, no state or agency

 5  funds shall be contributed toward the cost of any part of the

 6  premium of such supplemental benefit plans. With respect to

 7  dental coverage, the division shall include in any

 8  solicitation or contract for any state group dental program

 9  made after July 1, 2001, a comprehensive indemnity dental plan

10  option which offers enrollees a completely unrestricted choice

11  of dentists. If a dental plan is endorsed, or in some manner

12  recognized as the preferred product, such plan shall include a

13  comprehensive indemnity dental plan option which provides

14  enrollees with a completely unrestricted choice of dentists.

15         b.  Pursuant to the applicable provisions of s.

16  110.161, and s. 125 of the Internal Revenue Code of 1986, the

17  department shall enroll in the pretax benefit program those

18  state employees who voluntarily elect coverage in any of the

19  supplemental insurance benefit plans as provided by

20  sub-subparagraph a.

21         c.  Nothing herein contained shall be construed to

22  prohibit insurance providers from continuing to provide or

23  offer supplemental benefit coverage to state employees as

24  provided under existing agency plans.

25         (13)  WELLNESS COUNCIL.--

26         (a)  There is created within the department the Florida

27  State Employee Wellness Council.

28         (b)  The council shall be an advisory body to the

29  department to provide health education information to

30  employees and to assist the department in developing minimum

31  

                                  7

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1  benefits for health maintenance organizations when providing

 2  age-based and gender-based wellness benefits.

 3         (c)  The council shall be composed of nine members

 4  appointed by the Governor. When making appointments to the

 5  council, the Governor shall appoint persons who are residents

 6  of the state and who are highly knowledgeable concerning,

 7  active in, and recognized leaders in the health and medical

 8  field. Council members shall equitably represent the broadest

 9  spectrum of the health industry and the geographic areas of

10  the state. Not more than one member of the council may be from

11  any one company, organization, or association.

12         (d)1.  Council members shall be appointed to 4-year

13  terms, except that the initial terms shall be staggered. The

14  Governor shall appoint three members to 2-year terms, three

15  members to 3-year terms, and three members to 4-year terms.

16         2.  A member's absence from three consecutive meetings

17  shall result in his or her automatic removal from the council.

18  A vacancy on the council shall be filled for the remainder of

19  the unexpired term.

20         (e)  The council shall annually elect from its

21  membership one member to serve as chair of the council and one

22  member to serve as vice chair.

23         (f)  The first meeting of the council shall be called

24  by the chairperson not more than 60 days after the council

25  members are appointed by the Governor. The council shall

26  thereafter meet at least once quarterly and may meet more

27  often as necessary. The department shall provide staff

28  assistance to the council which shall include, but not be

29  limited to, keeping records of the proceedings of the council

30  and serving as custodian of all books, documents, and papers

31  filed with the council.

                                  8

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






    Florida Senate - 2006                                   SB 382
    35-463-06




 1         (g)  A majority of the members of the council

 2  constitutes a quorum.

 3         (h)  Members of the council shall serve without

 4  compensation, but are entitled to reimbursement for per diem

 5  and travel expenses as provided in s. 112.061 while performing

 6  their duties.

 7         (i)  The council shall:

 8         1.  Work to encourage participation in wellness

 9  programs by state employees. The council may prepare

10  informational programs and brochures for state agencies and

11  employees.

12         2.  In consultation with the department, develop

13  standards and criteria for age-based and gender-based wellness

14  programs.

15         3.  In consultation with the department, recommend a

16  "healthy food and beverage" menu for cafeterias and other

17  food-service establishments located in buildings owned,

18  operated, or leased by the state.

19         Section 2.  This act shall take effect July 1, 2006.

20  

21            *****************************************

22                          SENATE SUMMARY

23    Defines the term "aged-based and gender-based benefits"
      for purposes of the state group insurance program.
24    Creates the Florida State Employees Wellness Council
      within the Department of Management Services. Provides
25    for membership on the council. Provides the purpose and
      duties of the council.
26  

27  

28  

29  

30  

31  

                                  9

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