| 1 | The Governmental Operations Committee recommends the following: |
| 2 |
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| 3 | Council/Committee Substitute |
| 4 | Remove the entire bill and insert: |
| 5 | A bill to be entitled |
| 6 | An act relating to wellness programs for state employees; |
| 7 | amending s. 110.123, F.S.; defining the term "aged-based |
| 8 | and gender-based benefits" for purposes of the state group |
| 9 | insurance program; creating the Florida State Employee |
| 10 | Wellness Council within the Department of Management |
| 11 | Services; providing for membership; providing for |
| 12 | reimbursement of per diem and travel expenses; providing |
| 13 | purpose and duties of the council; providing an effective |
| 14 | date. |
| 15 |
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| 16 | Be It Enacted by the Legislature of the State of Florida: |
| 17 |
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| 18 | Section 1. Paragraph (h) of subsection (3) of section |
| 19 | 110.123, Florida Statutes, is amended, and subsection (13) is |
| 20 | added to that section, to read: |
| 21 | 110.123 State group insurance program.-- |
| 22 | (3) STATE GROUP INSURANCE PROGRAM.-- |
| 23 | (h)1. A person eligible to participate in the state group |
| 24 | insurance program may be authorized by rules adopted by the |
| 25 | department, in lieu of participating in the state group health |
| 26 | insurance plan, to exercise an option to elect membership in a |
| 27 | health maintenance organization plan which is under contract |
| 28 | with the state in accordance with criteria established by this |
| 29 | section and by said rules. The offer of optional membership in a |
| 30 | health maintenance organization plan permitted by this paragraph |
| 31 | may be limited or conditioned by rule as may be necessary to |
| 32 | meet the requirements of state and federal laws. |
| 33 | 2. The department shall contract with health maintenance |
| 34 | organizations seeking to participate in the state group |
| 35 | insurance program through a request for proposal or other |
| 36 | procurement process, as developed by the Department of |
| 37 | Management Services and determined to be appropriate. |
| 38 | a. The department shall establish a schedule of minimum |
| 39 | benefits for health maintenance organization coverage, and that |
| 40 | schedule shall include: physician services; inpatient and |
| 41 | outpatient hospital services; emergency medical services, |
| 42 | including out-of-area emergency coverage; diagnostic laboratory |
| 43 | and diagnostic and therapeutic radiologic services; mental |
| 44 | health, alcohol, and chemical dependency treatment services |
| 45 | meeting the minimum requirements of state and federal law; |
| 46 | skilled nursing facilities and services; prescription drugs; |
| 47 | age-based and gender-based wellness benefits; and other benefits |
| 48 | as may be required by the department. Additional services may be |
| 49 | provided subject to the contract between the department and the |
| 50 | HMO. As used in this paragraph, the term "age-based and gender- |
| 51 | based wellness benefits" includes aerobic exercise, education in |
| 52 | alcohol and substance abuse prevention, blood cholesterol |
| 53 | screening, health risk appraisals, blood pressure screening and |
| 54 | education, nutrition education, program planning, safety belt |
| 55 | education, smoking cessation, stress management, weight |
| 56 | management, and woman's health education. |
| 57 | b. The department may establish uniform deductibles, |
| 58 | copayments, coverage tiers, or coinsurance schedules for all |
| 59 | participating HMO plans. |
| 60 | c. The department may require detailed information from |
| 61 | each health maintenance organization participating in the |
| 62 | procurement process, including information pertaining to |
| 63 | organizational status, experience in providing prepaid health |
| 64 | benefits, accessibility of services, financial stability of the |
| 65 | plan, quality of management services, accreditation status, |
| 66 | quality of medical services, network access and adequacy, |
| 67 | performance measurement, ability to meet the department's |
| 68 | reporting requirements, and the actuarial basis of the proposed |
| 69 | rates and other data determined by the director to be necessary |
| 70 | for the evaluation and selection of health maintenance |
| 71 | organization plans and negotiation of appropriate rates for |
| 72 | these plans. Upon receipt of proposals by health maintenance |
| 73 | organization plans and the evaluation of those proposals, the |
| 74 | department may enter into negotiations with all of the plans or |
| 75 | a subset of the plans, as the department determines appropriate. |
| 76 | Nothing shall preclude the department from negotiating regional |
| 77 | or statewide contracts with health maintenance organization |
| 78 | plans when this is cost-effective and when the department |
| 79 | determines that the plan offers high value to enrollees. |
| 80 | d. The department may limit the number of HMOs that it |
| 81 | contracts with in each service area based on the nature of the |
| 82 | bids the department receives, the number of state employees in |
| 83 | the service area, or any unique geographical characteristics of |
| 84 | the service area. The department shall establish by rule service |
| 85 | areas throughout the state. |
| 86 | e. All persons participating in the state group insurance |
| 87 | program may be required to contribute towards a total state |
| 88 | group health premium that may vary depending upon the plan and |
| 89 | coverage tier selected by the enrollee and the level of state |
| 90 | contribution authorized by the Legislature. |
| 91 | 3. The department is authorized to negotiate and to |
| 92 | contract with specialty psychiatric hospitals for mental health |
| 93 | benefits, on a regional basis, for alcohol, drug abuse, and |
| 94 | mental and nervous disorders. The department may establish, |
| 95 | subject to the approval of the Legislature pursuant to |
| 96 | subsection (5), any such regional plan upon completion of an |
| 97 | actuarial study to determine any impact on plan benefits and |
| 98 | premiums. |
| 99 | 4. In addition to contracting pursuant to subparagraph 2., |
| 100 | the department may enter into contract with any HMO to |
| 101 | participate in the state group insurance program which: |
| 102 | a. Serves greater than 5,000 recipients on a prepaid basis |
| 103 | under the Medicaid program; |
| 104 | b. Does not currently meet the 25-percent non- |
| 105 | Medicare/non-Medicaid enrollment composition requirement |
| 106 | established by the Department of Health excluding participants |
| 107 | enrolled in the state group insurance program; |
| 108 | c. Meets the minimum benefit package and copayments and |
| 109 | deductibles contained in sub-subparagraphs 2.a. and b.; |
| 110 | d. Is willing to participate in the state group insurance |
| 111 | program at a cost of premiums that is not greater than 95 |
| 112 | percent of the cost of HMO premiums accepted by the department |
| 113 | in each service area; and |
| 114 | e. Meets the minimum surplus requirements of s. 641.225. |
| 115 |
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| 116 | The department is authorized to contract with HMOs that meet the |
| 117 | requirements of sub-subparagraphs a.-d. prior to the open |
| 118 | enrollment period for state employees. The department is not |
| 119 | required to renew the contract with the HMOs as set forth in |
| 120 | this paragraph more than twice. Thereafter, the HMOs shall be |
| 121 | eligible to participate in the state group insurance program |
| 122 | only through the request for proposal or invitation to negotiate |
| 123 | process described in subparagraph 2. |
| 124 | 5. All enrollees in a state group health insurance plan, a |
| 125 | TRICARE supplemental insurance plan, or any health maintenance |
| 126 | organization plan have the option of changing to any other |
| 127 | health plan that is offered by the state within any open |
| 128 | enrollment period designated by the department. Open enrollment |
| 129 | shall be held at least once each calendar year. |
| 130 | 6. When a contract between a treating provider and the |
| 131 | state-contracted health maintenance organization is terminated |
| 132 | for any reason other than for cause, each party shall allow any |
| 133 | enrollee for whom treatment was active to continue coverage and |
| 134 | care when medically necessary, through completion of treatment |
| 135 | of a condition for which the enrollee was receiving care at the |
| 136 | time of the termination, until the enrollee selects another |
| 137 | treating provider, or until the next open enrollment period |
| 138 | offered, whichever is longer, but no longer than 6 months after |
| 139 | termination of the contract. Each party to the terminated |
| 140 | contract shall allow an enrollee who has initiated a course of |
| 141 | prenatal care, regardless of the trimester in which care was |
| 142 | initiated, to continue care and coverage until completion of |
| 143 | postpartum care. This does not prevent a provider from refusing |
| 144 | to continue to provide care to an enrollee who is abusive, |
| 145 | noncompliant, or in arrears in payments for services provided. |
| 146 | For care continued under this subparagraph, the program and the |
| 147 | provider shall continue to be bound by the terms of the |
| 148 | terminated contract. Changes made within 30 days before |
| 149 | termination of a contract are effective only if agreed to by |
| 150 | both parties. |
| 151 | 7. Any HMO participating in the state group insurance |
| 152 | program shall submit health care utilization and cost data to |
| 153 | the department, in such form and in such manner as the |
| 154 | department shall require, as a condition of participating in the |
| 155 | program. The department shall enter into negotiations with its |
| 156 | contracting HMOs to determine the nature and scope of the data |
| 157 | submission and the final requirements, format, penalties |
| 158 | associated with noncompliance, and timetables for submission. |
| 159 | These determinations shall be adopted by rule. |
| 160 | 8. The department may establish and direct, with respect |
| 161 | to collective bargaining issues, a comprehensive package of |
| 162 | insurance benefits that may include supplemental health and life |
| 163 | coverage, dental care, long-term care, vision care, and other |
| 164 | benefits it determines necessary to enable state employees to |
| 165 | select from among benefit options that best suit their |
| 166 | individual and family needs. |
| 167 | a. Based upon a desired benefit package, the department |
| 168 | shall issue a request for proposal or invitation to negotiate |
| 169 | for health insurance providers interested in participating in |
| 170 | the state group insurance program, and the department shall |
| 171 | issue a request for proposal or invitation to negotiate for |
| 172 | insurance providers interested in participating in the non- |
| 173 | health-related components of the state group insurance program. |
| 174 | Upon receipt of all proposals, the department may enter into |
| 175 | contract negotiations with insurance providers submitting bids |
| 176 | or negotiate a specially designed benefit package. Insurance |
| 177 | providers offering or providing supplemental coverage as of May |
| 178 | 30, 1991, which qualify for pretax benefit treatment pursuant to |
| 179 | s. 125 of the Internal Revenue Code of 1986, with 5,500 or more |
| 180 | state employees currently enrolled may be included by the |
| 181 | department in the supplemental insurance benefit plan |
| 182 | established by the department without participating in a request |
| 183 | for proposal, submitting bids, negotiating contracts, or |
| 184 | negotiating a specially designed benefit package. These |
| 185 | contracts shall provide state employees with the most cost- |
| 186 | effective and comprehensive coverage available; however, no |
| 187 | state or agency funds shall be contributed toward the cost of |
| 188 | any part of the premium of such supplemental benefit plans. With |
| 189 | respect to dental coverage, the division shall include in any |
| 190 | solicitation or contract for any state group dental program made |
| 191 | after July 1, 2001, a comprehensive indemnity dental plan option |
| 192 | which offers enrollees a completely unrestricted choice of |
| 193 | dentists. If a dental plan is endorsed, or in some manner |
| 194 | recognized as the preferred product, such plan shall include a |
| 195 | comprehensive indemnity dental plan option which provides |
| 196 | enrollees with a completely unrestricted choice of dentists. |
| 197 | b. Pursuant to the applicable provisions of s. 110.161, |
| 198 | and s. 125 of the Internal Revenue Code of 1986, the department |
| 199 | shall enroll in the pretax benefit program those state employees |
| 200 | who voluntarily elect coverage in any of the supplemental |
| 201 | insurance benefit plans as provided by sub-subparagraph a. |
| 202 | c. Nothing herein contained shall be construed to prohibit |
| 203 | insurance providers from continuing to provide or offer |
| 204 | supplemental benefit coverage to state employees as provided |
| 205 | under existing agency plans. |
| 206 | (13) FLORIDA STATE EMPLOYEE WELLNESS COUNCIL.-- |
| 207 | (a) There is created within the department the Florida |
| 208 | State Employee Wellness Council. |
| 209 | (b) The council shall be an advisory body to the |
| 210 | department to provide health education information to employees |
| 211 | and to assist the department in developing minimum benefits for |
| 212 | all health care providers when providing age-based and gender- |
| 213 | based wellness benefits. |
| 214 | (c) The council shall be composed of nine members |
| 215 | appointed by the Governor. When making appointments to the |
| 216 | council, the Governor shall appoint persons who are residents of |
| 217 | the state and who are highly knowledgeable concerning, active |
| 218 | in, and recognized leaders in the health and medical field, at |
| 219 | least one of whom must be an employee of the state. Council |
| 220 | members shall equitably represent the broadest spectrum of the |
| 221 | health industry and the geographic areas of the state. Not more |
| 222 | than one member of the council may be from any one company, |
| 223 | organization, or association. |
| 224 | (d)1. Council members shall be appointed to 4-year terms, |
| 225 | except that the initial terms shall be staggered. The Governor |
| 226 | shall appoint three members to 2-year terms, three members to 3- |
| 227 | year terms, and three members to 4-year terms. |
| 228 | 2. A member's absence from three consecutive meetings |
| 229 | shall result in his or her automatic removal from the council. A |
| 230 | vacancy on the council shall be filled for the remainder of the |
| 231 | unexpired term. |
| 232 | (e) The council shall annually elect from its membership |
| 233 | one member to serve as chair of the council and one member to |
| 234 | serve as vice chair. |
| 235 | (f) The first meeting of the council shall be called by |
| 236 | the chair not more than 60 days after the council members are |
| 237 | appointed by the Governor. The council shall thereafter meet at |
| 238 | least once quarterly and may meet more often as necessary. The |
| 239 | department shall provide staff assistance to the council which |
| 240 | shall include, but not be limited to, keeping records of the |
| 241 | proceedings of the council and serving as custodian of all |
| 242 | books, documents, and papers filed with the council. |
| 243 | (g) A majority of the members of the council constitutes a |
| 244 | quorum. |
| 245 | (h) Members of the council shall serve without |
| 246 | compensation, but are entitled to reimbursement for per diem and |
| 247 | travel expenses as provided in s. 112.061 while performing their |
| 248 | duties. |
| 249 | (i) The council shall: |
| 250 | 1. Work to encourage participation in wellness programs by |
| 251 | state employees. The council may prepare informational programs |
| 252 | and brochures for state agencies and employees. |
| 253 | 2. In consultation with the department, develop standards |
| 254 | and criteria for age-based and gender-based wellness programs. |
| 255 | 3. In consultation with the department, recommend a |
| 256 | "healthy food and beverage" menu for cafeterias and other food- |
| 257 | service establishments located in buildings owned, operated, or |
| 258 | leased by the state. |
| 259 | Section 2. This act shall take effect July 1, 2006. |