Senate Bill sb1668
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
By Senator Lawson
6-1166-07
1 A bill to be entitled
2 An act relating to the state group insurance
3 program; amending s. 110.123, F.S.; requiring
4 that certain insurance providers be included in
5 the supplemental insurance benefit plan;
6 authorizing the Department of Management
7 Services to adopt rules establishing
8 performance standards for health care provided
9 to state employees under the program; providing
10 an effective date.
11
12 Be It Enacted by the Legislature of the State of Florida:
13
14 Section 1. Paragraph (h) of subsection (3) of section
15 110.123, Florida Statutes, is amended to read:
16 110.123 State group insurance program.--
17 (3) STATE GROUP INSURANCE PROGRAM.--
18 (h)1. A person eligible to participate in the state
19 group insurance program may be authorized by rules adopted by
20 the department, in lieu of participating in the state group
21 health insurance plan, to exercise an option to elect
22 membership in a health maintenance organization plan which is
23 under contract with the state in accordance with criteria
24 established by this section and by said rules. The offer of
25 optional membership in a health maintenance organization plan
26 permitted by this paragraph may be limited or conditioned by
27 rule as may be necessary to meet the requirements of state and
28 federal laws.
29 2. The department shall contract with health
30 maintenance organizations seeking to participate in the state
31 group insurance program through a request for proposal or
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 other procurement process, as developed by the Department of
2 Management Services and determined to be appropriate.
3 a. The department shall establish a schedule of
4 minimum benefits for health maintenance organization coverage,
5 and that schedule shall include: physician services; inpatient
6 and outpatient hospital services; emergency medical services,
7 including out-of-area emergency coverage; diagnostic
8 laboratory and diagnostic and therapeutic radiologic services;
9 mental health, alcohol, and chemical dependency treatment
10 services meeting the minimum requirements of state and federal
11 law; skilled nursing facilities and services; prescription
12 drugs; age-based and gender-based wellness benefits; and other
13 benefits as may be required by the department. Additional
14 services may be provided subject to the contract between the
15 department and the HMO. As used in this paragraph, the term
16 "age-based and gender-based wellness benefits" includes
17 aerobic exercise, education in alcohol and substance abuse
18 prevention, blood cholesterol screening, health risk
19 appraisals, blood pressure screening and education, nutrition
20 education, program planning, safety belt education, smoking
21 cessation, stress management, weight management, and women's
22 health education.
23 b. The department may establish uniform deductibles,
24 copayments, coverage tiers, or coinsurance schedules for all
25 participating HMO plans.
26 c. The department may require detailed information
27 from each health maintenance organization participating in the
28 procurement process, including information pertaining to
29 organizational status, experience in providing prepaid health
30 benefits, accessibility of services, financial stability of
31 the plan, quality of management services, accreditation
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 status, quality of medical services, network access and
2 adequacy, performance measurement, ability to meet the
3 department's reporting requirements, and the actuarial basis
4 of the proposed rates and other data determined by the
5 director to be necessary for the evaluation and selection of
6 health maintenance organization plans and negotiation of
7 appropriate rates for these plans. Upon receipt of proposals
8 by health maintenance organization plans and the evaluation of
9 those proposals, the department may enter into negotiations
10 with all of the plans or a subset of the plans, as the
11 department determines appropriate. Nothing shall preclude the
12 department from negotiating regional or statewide contracts
13 with health maintenance organization plans when this is
14 cost-effective and when the department determines that the
15 plan offers high value to enrollees.
16 d. The department may limit the number of HMOs that it
17 contracts with in each service area based on the nature of the
18 bids the department receives, the number of state employees in
19 the service area, or any unique geographical characteristics
20 of the service area. The department shall establish by rule
21 service areas throughout the state.
22 e. All persons participating in the state group
23 insurance program may be required to contribute towards a
24 total state group health premium that may vary depending upon
25 the plan and coverage tier selected by the enrollee and the
26 level of state contribution authorized by the Legislature.
27 3. The department is authorized to negotiate and to
28 contract with specialty psychiatric hospitals for mental
29 health benefits, on a regional basis, for alcohol, drug abuse,
30 and mental and nervous disorders. The department may
31 establish, subject to the approval of the Legislature pursuant
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 to subsection (5), any such regional plan upon completion of
2 an actuarial study to determine any impact on plan benefits
3 and premiums.
4 4. In addition to contracting pursuant to subparagraph
5 2., the department may enter into contract with any HMO to
6 participate in the state group insurance program which:
7 a. Serves greater than 5,000 recipients on a prepaid
8 basis under the Medicaid program;
9 b. Does not currently meet the 25-percent
10 non-Medicare/non-Medicaid enrollment composition requirement
11 established by the Department of Health excluding participants
12 enrolled in the state group insurance program;
13 c. Meets the minimum benefit package and copayments
14 and deductibles contained in sub-subparagraphs 2.a. and b.;
15 d. Is willing to participate in the state group
16 insurance program at a cost of premiums that is not greater
17 than 95 percent of the cost of HMO premiums accepted by the
18 department in each service area; and
19 e. Meets the minimum surplus requirements of s.
20 641.225.
21
22 The department is authorized to contract with HMOs that meet
23 the requirements of sub-subparagraphs a.-d. prior to the open
24 enrollment period for state employees. The department is not
25 required to renew the contract with the HMOs as set forth in
26 this paragraph more than twice. Thereafter, the HMOs shall be
27 eligible to participate in the state group insurance program
28 only through the request for proposal or invitation to
29 negotiate process described in subparagraph 2.
30 5. All enrollees in a state group health insurance
31 plan, a TRICARE supplemental insurance plan, or any health
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 maintenance organization plan have the option of changing to
2 any other health plan that is offered by the state within any
3 open enrollment period designated by the department. Open
4 enrollment shall be held at least once each calendar year.
5 6. When a contract between a treating provider and the
6 state-contracted health maintenance organization is terminated
7 for any reason other than for cause, each party shall allow
8 any enrollee for whom treatment was active to continue
9 coverage and care when medically necessary, through completion
10 of treatment of a condition for which the enrollee was
11 receiving care at the time of the termination, until the
12 enrollee selects another treating provider, or until the next
13 open enrollment period offered, whichever is longer, but no
14 longer than 6 months after termination of the contract. Each
15 party to the terminated contract shall allow an enrollee who
16 has initiated a course of prenatal care, regardless of the
17 trimester in which care was initiated, to continue care and
18 coverage until completion of postpartum care. This does not
19 prevent a provider from refusing to continue to provide care
20 to an enrollee who is abusive, noncompliant, or in arrears in
21 payments for services provided. For care continued under this
22 subparagraph, the program and the provider shall continue to
23 be bound by the terms of the terminated contract. Changes made
24 within 30 days before termination of a contract are effective
25 only if agreed to by both parties.
26 7. Any HMO participating in the state group insurance
27 program shall submit health care utilization and cost data to
28 the department, in such form and in such manner as the
29 department shall require, as a condition of participating in
30 the program. The department shall enter into negotiations with
31 its contracting HMOs to determine the nature and scope of the
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 data submission and the final requirements, format, penalties
2 associated with noncompliance, and timetables for submission.
3 These determinations shall be adopted by rule.
4 8. The department may establish and direct, with
5 respect to collective bargaining issues, a comprehensive
6 package of insurance benefits that may include supplemental
7 health and life coverage, dental care, long-term care, vision
8 care, and other benefits it determines necessary to enable
9 state employees to select from among benefit options that best
10 suit their individual and family needs.
11 a. Based upon a desired benefit package, the
12 department shall issue a request for proposal or invitation to
13 negotiate for health insurance providers interested in
14 participating in the state group insurance program, and the
15 department shall issue a request for proposal or invitation to
16 negotiate for insurance providers interested in participating
17 in the non-health-related components of the state group
18 insurance program. Upon receipt of all proposals, the
19 department may enter into contract negotiations with insurance
20 providers submitting bids or negotiate a specially designed
21 benefit package. Insurance providers offering or providing
22 supplemental coverage as of May 30, 1991, which qualify for
23 pretax benefit treatment pursuant to s. 125 of the Internal
24 Revenue Code of 1986, with 5,500 or more state employees
25 currently enrolled shall may be included by the department in
26 the supplemental insurance benefit plan established by the
27 department without participating in a request for proposal,
28 submitting bids, negotiating contracts, or negotiating a
29 specially designed benefit package. These contracts shall
30 provide state employees with the most cost-effective and
31 comprehensive coverage available; however, no state or agency
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 funds shall be contributed toward the cost of any part of the
2 premium of such supplemental benefit plans. With respect to
3 dental coverage, the division shall include in any
4 solicitation or contract for any state group dental program
5 made after July 1, 2001, a comprehensive indemnity dental plan
6 option which offers enrollees a completely unrestricted choice
7 of dentists. If a dental plan is endorsed, or in some manner
8 recognized as the preferred product, such plan shall include a
9 comprehensive indemnity dental plan option which provides
10 enrollees with a completely unrestricted choice of dentists.
11 The department may establish by rule performance standards
12 regarding levels of service to state employees, which must
13 include written notice allowing a provider a right to cure a
14 deficiency in its performance of such standards.
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 Section 2. This act shall take effect July 1, 2007.
26
27
28
29
30
31
7
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2007 SB 1668
6-1166-07
1 *****************************************
2 SENATE SUMMARY
3 Requires insurance providers that meet specified criteria
to be included in the supplemental insurance benefit plan
4 established by the Department of Management Services
without submitting bids, participating in a request for
5 proposals, or negotiating a contract or benefit package.
Authorizes the department to establish performance
6 standards relating to levels of service provided to state
employees.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
8
CODING: Words stricken are deletions; words underlined are additions.