HB 809

1	A bill to be entitled
2	An act relating to the State Group Insurance Program;
3	amending s. 110.123, F.S.; requiring the Department of
4	Management Services to include certain insurance providers
5	in the supplemental insurance benefit plan established by
6	the department; authorizing the department to establish
7	performance standards relating to levels of service to
8	state employees; providing a notice requirement; providing
9	an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Paragraph (h) of subsection (3) of section
14	110.123, Florida Statutes, is amended to read:
15	110.123  State group insurance program.--
16	(3)  STATE GROUP INSURANCE PROGRAM.--
17	(h)1.  A person eligible to participate in the state group
18	insurance program may be authorized by rules adopted by the
19	department, in lieu of participating in the state group health
20	insurance plan, to exercise an option to elect membership in a
21	health maintenance organization plan which is under contract
22	with the state in accordance with criteria established by this
23	section and by said rules. The offer of optional membership in a
24	health maintenance organization plan permitted by this paragraph
25	may be limited or conditioned by rule as may be necessary to
26	meet the requirements of state and federal laws.
27	2.  The department shall contract with health maintenance
28	organizations seeking to participate in the state group
29	insurance program through a request for proposal or other
30	procurement process, as developed by the Department of
31	Management Services and determined to be appropriate.
32	a.  The department shall establish a schedule of minimum
33	benefits for health maintenance organization coverage, and that
34	schedule shall include: physician services; inpatient and
35	outpatient hospital services; emergency medical services,
36	including out-of-area emergency coverage; diagnostic laboratory
37	and diagnostic and therapeutic radiologic services; mental
38	health, alcohol, and chemical dependency treatment services
39	meeting the minimum requirements of state and federal law;
40	skilled nursing facilities and services; prescription drugs;
41	age-based and gender-based wellness benefits; and other benefits
42	as may be required by the department. Additional services may be
43	provided subject to the contract between the department and the
44	HMO. As used in this paragraph, the term "age-based and gender-
45	based wellness benefits" includes aerobic exercise, education in
46	alcohol and substance abuse prevention, blood cholesterol
47	screening, health risk appraisals, blood pressure screening and
48	education, nutrition education, program planning, safety belt
49	education, smoking cessation, stress management, weight
50	management, and women's health education.
51	b.  The department may establish uniform deductibles,
52	copayments, coverage tiers, or coinsurance schedules for all
53	participating HMO plans.
54	c.  The department may require detailed information from
55	each health maintenance organization participating in the
56	procurement process, including information pertaining to
57	organizational status, experience in providing prepaid health
58	benefits, accessibility of services, financial stability of the
59	plan, quality of management services, accreditation status,
60	quality of medical services, network access and adequacy,
61	performance measurement, ability to meet the department's
62	reporting requirements, and the actuarial basis of the proposed
63	rates and other data determined by the director to be necessary
64	for the evaluation and selection of health maintenance
65	organization plans and negotiation of appropriate rates for
66	these plans. Upon receipt of proposals by health maintenance
67	organization plans and the evaluation of those proposals, the
68	department may enter into negotiations with all of the plans or
69	a subset of the plans, as the department determines appropriate.
70	Nothing shall preclude the department from negotiating regional
71	or statewide contracts with health maintenance organization
72	plans when this is cost-effective and when the department
73	determines that the plan offers high value to enrollees.
74	d.  The department may limit the number of HMOs that it
75	contracts with in each service area based on the nature of the
76	bids the department receives, the number of state employees in
77	the service area, or any unique geographical characteristics of
78	the service area. The department shall establish by rule service
79	areas throughout the state.
80	e.  All persons participating in the state group insurance
81	program may be required to contribute towards a total state
82	group health premium that may vary depending upon the plan and
83	coverage tier selected by the enrollee and the level of state
84	contribution authorized by the Legislature.
85	3.  The department is authorized to negotiate and to
86	contract with specialty psychiatric hospitals for mental health
87	benefits, on a regional basis, for alcohol, drug abuse, and
88	mental and nervous disorders. The department may establish,
89	subject to the approval of the Legislature pursuant to
90	subsection (5), any such regional plan upon completion of an
91	actuarial study to determine any impact on plan benefits and
92	premiums.
93	4.  In addition to contracting pursuant to subparagraph 2.,
94	the department may enter into contract with any HMO to
95	participate in the state group insurance program which:
96	a.  Serves greater than 5,000 recipients on a prepaid basis
97	under the Medicaid program;
98	b.  Does not currently meet the 25-percent non-
99	Medicare/non-Medicaid enrollment composition requirement
100	established by the Department of Health excluding participants
101	enrolled in the state group insurance program;
102	c.  Meets the minimum benefit package and copayments and
103	deductibles contained in sub-subparagraphs 2.a. and b.;
104	d.  Is willing to participate in the state group insurance
105	program at a cost of premiums that is not greater than 95
106	percent of the cost of HMO premiums accepted by the department
107	in each service area; and
108	e.  Meets the minimum surplus requirements of s. 641.225.
109
110	The department is authorized to contract with HMOs that meet the
111	requirements of sub-subparagraphs a.-d. prior to the open
112	enrollment period for state employees. The department is not
113	required to renew the contract with the HMOs as set forth in
114	this paragraph more than twice. Thereafter, the HMOs shall be
115	eligible to participate in the state group insurance program
116	only through the request for proposal or invitation to negotiate
117	process described in subparagraph 2.
118	5.  All enrollees in a state group health insurance plan, a
119	TRICARE supplemental insurance plan, or any health maintenance
120	organization plan have the option of changing to any other
121	health plan that is offered by the state within any open
122	enrollment period designated by the department. Open enrollment
123	shall be held at least once each calendar year.
124	6.  When a contract between a treating provider and the
125	state-contracted health maintenance organization is terminated
126	for any reason other than for cause, each party shall allow any
127	enrollee for whom treatment was active to continue coverage and
128	care when medically necessary, through completion of treatment
129	of a condition for which the enrollee was receiving care at the
130	time of the termination, until the enrollee selects another
131	treating provider, or until the next open enrollment period
132	offered, whichever is longer, but no longer than 6 months after
133	termination of the contract. Each party to the terminated
134	contract shall allow an enrollee who has initiated a course of
135	prenatal care, regardless of the trimester in which care was
136	initiated, to continue care and coverage until completion of
137	postpartum care. This does not prevent a provider from refusing
138	to continue to provide care to an enrollee who is abusive,
139	noncompliant, or in arrears in payments for services provided.
140	For care continued under this subparagraph, the program and the
141	provider shall continue to be bound by the terms of the
142	terminated contract. Changes made within 30 days before
143	termination of a contract are effective only if agreed to by
144	both parties.
145	7.  Any HMO participating in the state group insurance
146	program shall submit health care utilization and cost data to
147	the department, in such form and in such manner as the
148	department shall require, as a condition of participating in the
149	program. The department shall enter into negotiations with its
150	contracting HMOs to determine the nature and scope of the data
151	submission and the final requirements, format, penalties
152	associated with noncompliance, and timetables for submission.
153	These determinations shall be adopted by rule.
154	8.  The department may establish and direct, with respect
155	to collective bargaining issues, a comprehensive package of
156	insurance benefits that may include supplemental health and life
157	coverage, dental care, long-term care, vision care, and other
158	benefits it determines necessary to enable state employees to
159	select from among benefit options that best suit their
160	individual and family needs.
161	a.  Based upon a desired benefit package, the department
162	shall issue a request for proposal or invitation to negotiate
163	for health insurance providers interested in participating in
164	the state group insurance program, and the department shall
165	issue a request for proposal or invitation to negotiate for
166	insurance providers interested in participating in the non-
167	health-related components of the state group insurance program.
168	Upon receipt of all proposals, the department may enter into
169	contract negotiations with insurance providers submitting bids
170	or negotiate a specially designed benefit package. Insurance
171	providers offering or providing supplemental coverage as of May
172	30, 1991, which qualify for pretax benefit treatment pursuant to
173	s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
174	state employees currently enrolled shall may be included by the
175	department in the supplemental insurance benefit plan
176	established by the department without participating in a request
177	for proposal, submitting bids, negotiating contracts, or
178	negotiating a specially designed benefit package. These
179	contracts shall provide state employees with the most cost-
180	effective and comprehensive coverage available; however, no
181	state or agency funds shall be contributed toward the cost of
182	any part of the premium of such supplemental benefit plans. With
183	respect to dental coverage, the division shall include in any
184	solicitation or contract for any state group dental program made
185	after July 1, 2001, a comprehensive indemnity dental plan option
186	which offers enrollees a completely unrestricted choice of
187	dentists. If a dental plan is endorsed, or in some manner
188	recognized as the preferred product, such plan shall include a
189	comprehensive indemnity dental plan option which provides
190	enrollees with a completely unrestricted choice of dentists. The
191	department may establish by rule performance standards relating
192	to levels of service to state employees, which shall include
193	written notice allowing a provider a right to cure a deficiency
194	in its performance of such standards.
195	b.  Pursuant to the applicable provisions of s. 110.161,
196	and s. 125 of the Internal Revenue Code of 1986, the department
197	shall enroll in the pretax benefit program those state employees
198	who voluntarily elect coverage in any of the supplemental
199	insurance benefit plans as provided by sub-subparagraph a.
200	c.  Nothing herein contained shall be construed to prohibit
201	insurance providers from continuing to provide or offer
202	supplemental benefit coverage to state employees as provided
203	under existing agency plans.
204	Section 2.  This act shall take effect July 1, 2007.

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