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Senator Peaden moved the following Senate amendment to House

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amendment (364545):

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     Senate Amendment (with title amendment)

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     Delete line(s) 5-872

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and insert:

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     Section 1.  Paragraph (d) of subsection (2) of section

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112.363, Florida Statutes, is amended to read:

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     112.363  Retiree health insurance subsidy.--

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     (2)  ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.--

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     (d)  Payment of the retiree health insurance subsidy shall

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be made only after coverage for health insurance for the retiree

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or beneficiary has been certified in writing to the Department of

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Management Services. Participation in a former employer's group

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health insurance program is not a requirement for eligibility

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under this section. Coverage issued pursuant to s. 408.9091 is

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considered health insurance for the purposes of this section.

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     Section 2.  Subsections (5) and (10) of section 408.909,

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Florida Statutes, are amended to read:

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     408.909  Health flex plans.--

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     (5)  ELIGIBILITY.--Eligibility to enroll in an approved

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health flex plan is limited to residents of this state who:

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     (a)1. Are 64 years of age or younger;

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     2.(b) Have a family income equal to or less than 300 200

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percent of the federal poverty level;

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     (c) Are eligible under a federally approved Medicaid

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demonstration waiver and reside in Palm Beach County or Miami-

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Dade County;

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     3.(d) Are not covered by a private insurance policy and are

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not eligible for coverage through a public health insurance

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program, such as Medicare or Medicaid, unless specifically

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authorized under paragraph (c), or another public health care

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program, such as Kidcare, and have not been covered at any time

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during the past 6 months, except that:

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     a. A person who was covered under an individual health

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maintenance contract issued by a health maintenance organization

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licensed under part I of chapter 641 which was also an approved

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health flex plan on October 1, 2008, may apply for coverage in

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the same health maintenance organization's health flex plan

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without a lapse in coverage if all other eligibility requirements

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are met; or

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     b. A person who was covered under Medicaid or Kidcare and

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lost eligibility for the Medicaid or Kidcare subsidy due to

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income restrictions within 90 days prior to applying for health

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care coverage through an approved health flex plan may apply for

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coverage in a health flex plan without a lapse in coverage if all

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other eligibility requirements are met; and

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     4.(e) Have applied for health care coverage as an

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individual through an approved health flex plan and have agreed

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to make any payments required for participation, including

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periodic payments or payments due at the time health care

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services are provided; or

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     (b) Are part of an employer group of which at least 75

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percent of the employees have a family income equal to or less

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than 300 percent of the federal poverty level and the employer

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group is not covered by a private health insurance policy and has

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not been covered at any time during the past 6 months. If the

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health flex plan entity is a health insurer, health plan, or

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health maintenance organization licensed under Florida law, only

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50 percent of the employees must meet the income requirements for

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the purpose of this paragraph.

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     (10) EXPIRATION.--This section expires July 1, 2013 2008.

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     Section 3.  Section 408.9091, Florida Statutes, is created

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to read:

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     408.9091 Cover Florida Health Care Access Program.--

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     (1) SHORT TITLE.--This section may be cited as the "Cover

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Florida Health Care Access Program Act."

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     (2) LEGISLATIVE INTENT.--The Legislature finds that a

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significant number of state residents are unable to obtain

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affordable health insurance coverage. The Legislature also finds

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that existing health flex plan coverage has had limited

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participation due in part to narrow eligibility restrictions as

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well as minimal benefit options for catastrophic and emergency

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care coverage. Therefore, it is the intent of the Legislature to

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expand the availability of health care options for uninsured

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residents by developing an affordable health care product that

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emphasizes coverage for basic and preventive health care

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services; provides inpatient hospital, urgent, and emergency care

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services; and is offered statewide by approved health insurers,

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health maintenance organizations, health-care-provider-sponsored

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organizations, or health care districts.

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     (3) DEFINITIONS.--As used in this section, the term:

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     (a) "Agency" means the Agency for Health Care

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Administration.

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     (b) "Cover Florida plan" means a consumer choice benefit

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plan approved under this section which guarantees payment or

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coverage for specified benefits provided to an enrollee.

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     (c) "Cover Florida plan coverage" means health care

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services that are covered as benefits under a Cover Florida plan.

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     (d) "Cover Florida plan entity" means a health insurer,

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health maintenance organization, health-care-provider-sponsored

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organization, or health care district that develops and

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implements a Cover Florida plan and is responsible for

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administering the plan and paying all claims for Cover Florida

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plan coverage by enrollees.

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     (e) "Cover Florida Plus" means a supplemental insurance

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product, such as for additional catastrophic coverage or dental,

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vision, or cancer coverage, approved under this section and

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offered to all enrollees.

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     (f) "Enrollee" means an individual who has been determined

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to be eligible for and is receiving health insurance coverage

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under a Cover Florida plan.

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     (g) "Office" means the Office of Insurance Regulation of

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the Financial Services Commission.

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     (4) PROGRAM.--The agency and the office shall jointly

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establish and administer the Cover Florida Health Care Access

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Program.

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     (a) General Cover Florida plan components must require

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that:

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     1. Plans are offered on a guaranteed-issue basis to

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enrollees, subject to exclusions for preexisting conditions

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approved by the office and the agency.

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     2. Plans are portable such that the enrollee remains

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covered regardless of employment status or the cost-sharing of

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premiums.

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     3. Plans provide for cost containment through limits on the

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number of services, caps on benefit payments, and copayments for

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services.

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     4. A Cover Florida plan entity makes all benefit plan and

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marketing materials available in English and Spanish.

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     5. In order to provide for consumer choice, Cover Florida

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plan entities develop two alternative benefit option plans having

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different cost and benefit levels, including at least one plan

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that provides catastrophic coverage.

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     6. Plans without catastrophic coverage provide coverage

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options for services including, but not limited to:

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     a. Preventive health services, including immunizations,

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annual health assessments, well-woman and well-care services, and

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preventive screenings such as mammograms, cervical cancer

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screenings, and noninvasive colorectal or prostate screenings.

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     b. Incentives for routine preventive care.

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     c. Office visits for the diagnosis and treatment of illness

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or injury.

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     d. Office surgery, including anesthesia.

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     e. Behavioral health services.

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     f. Durable medical equipment and prosthetics.

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     g. Diabetic supplies.

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     7. Plans providing catastrophic coverage, at a minimum,

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provide coverage options for all of the services listed under

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subparagraph 6.; however, such plans may include, but are not

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limited to, coverage options for:

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     a. Inpatient hospital stays.

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     b. Hospital emergency care services.

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     c. Urgent care services.

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     d. Outpatient facility services, outpatient surgery, and

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outpatient diagnostic services.

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     8. All plans offer prescription drug benefit coverage, use

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a prescription drug manager, or offer a discount drug card.

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     9. Plan enrollment materials provide information in plain

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language on policy benefit coverage, benefit limits, cost-sharing

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requirements, and exclusions and a clear representation of what

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is not covered in the plan. Such enrollment materials must

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include a standard disclosure form adopted by rule by the

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Financial Services Commission, to be reviewed and executed by all

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consumers purchasing Cover Florida plan coverage.

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     10. Plans offered through a qualified employer meet the

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requirements of s. 125 of the Internal Revenue Code.

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     (b) Guidelines shall be developed to ensure that Cover

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Florida plans meet minimum standards for quality of care and

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access to care. The agency shall ensure that the Cover Florida

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plans follow standardized grievance procedures.

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     (c) Changes in Cover Florida plan benefits, premiums, and

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policy forms are subject to regulatory oversight by the office

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and the agency as provided under rules adopted by the Financial

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Services Commission and the agency.

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     (d) The agency, the office, and the Executive Office of the

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Governor shall develop a public awareness program to be

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implemented throughout the state for the promotion of the Cover

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Florida Health Care Access Program.

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     (e) Public or private entities may design programs to

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encourage Floridians to participate in the Cover Florida Health

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Care Access Program or to encourage employers to cosponsor some

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share of Cover Florida plan premiums for employees.

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     (5) PLAN PROPOSALS.--The agency and the office shall

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announce, no later than July 1, 2008, an invitation to negotiate

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for Cover Florida plan entities to design a Cover Florida plan

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proposal in which benefits and premiums are specified.

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     (a) The invitation to negotiate shall include guidelines

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for the review of Cover Florida plan applications, policy forms,

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and all associated forms and provide regulatory oversight of

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Cover Florida plan advertisement and marketing procedures. A plan

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shall be disapproved or withdrawn if the plan:

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     1. Contains any ambiguous, inconsistent, or misleading

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provisions or any exceptions or conditions that deceptively

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affect or limit the benefits purported to be assumed in the

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general coverage provided by the plan;

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     2. Provides benefits that are unreasonable in relation to

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the premium charged or contains provisions that are unfair or

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inequitable, that are contrary to the public policy of this

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state, that encourage misrepresentation, or that result in unfair

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discrimination in sales practices;

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     3. Cannot demonstrate that the plan is financially sound

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and that the applicant is able to underwrite or finance the

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health care coverage provided;

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     4. Cannot demonstrate that the applicant and its management

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are in compliance with the standards required under s.

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624.404(3); or

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     5. Does not guarantee that enrollees may participate in the

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Cover Florida plan entity's comprehensive network of providers,

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as determined by the office, the agency, and the contract.

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     (b) The agency and the office may announce an invitation to

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negotiate for the design of Cover Florida Plus products to

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companies that offer supplemental insurance, discount medical

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plan organizations licensed under part II of chapter 636, or

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prepaid health clinics licensed under part II of chapter 641.

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     (c) The agency and office shall approve at least one Cover

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Florida plan entity having an existing statewide network of

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providers and may approve at least one regional network plan in

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each existing Medicaid area.

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     (6) LICENSE NOT REQUIRED.--

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     (a) The licensing requirements of the Florida Insurance

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Code and chapter 641 relating to health maintenance organizations

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do not apply to a Cover Florida plan approved under this section

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unless expressly made applicable. However, for the purpose of

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prohibiting unfair trade practices, Cover Florida plans are

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considered to be insurance subject to the applicable provisions

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of part IX of chapter 626 except as otherwise provided in this

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section.

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     (b) Cover Florida plans are not covered by the Florida Life

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and Health Insurance Guaranty Association under part III of

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chapter 631 or by the Health Maintenance Organization Consumer

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Assistance Plan under part IV of chapter 631.

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     (7) ELIGIBILITY.--Eligibility to enroll in a Cover Florida

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plan is limited to residents of this state who meet all of the

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following requirements:

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     (a) Are between 19 and 64 years of age, inclusive.

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     (b) Are not covered by a private insurance policy and are

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not eligible for coverage through a public health insurance

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program, such as Medicare, Medicaid, or Kidcare, unless

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eligibility for coverage lapses due to no longer meeting income

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or categorical requirements.

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     (c) Have not been covered by any health insurance program

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at any time during the past 6 months, unless coverage under a

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health insurance program was terminated within the previous 6

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months due to:

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     1. Loss of a job that provided an employer-sponsored health

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benefit plan;

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     2. Exhaustion of coverage that was continued under COBRA or

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continuation-of-coverage requirements under s. 627.6692;

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     3. Reaching the limiting age under the policy; or

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     4. Death of, or divorce from, a spouse who was provided an

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employer-sponsored health benefit plan.

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     (d) Have applied for health care coverage through a Cover

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Florida plan and have agreed to make any payments required for

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participation, including periodic payments or payments due at the

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time health care services are provided.

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     (8) RECORDS.--Each Cover Florida plan must maintain

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enrollment data and provide network data and reasonable records

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to enable the office and the agency to monitor plans and to

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determine the financial viability of the Cover Florida plan, as

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necessary.

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     (9) NONENTITLEMENT.--Coverage under a Cover Florida plan is

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not an entitlement, and a cause of action does not arise against

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the state, a local government entity, any other political

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subdivision of the state, or the agency or the office for failure

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to make coverage available to eligible persons under this

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section.

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     (10) PROGRAM EVALUATION.--The agency and the office shall:

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     (a) Evaluate the Cover Florida Health Care Access Program

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and its effect on the entities that seek approval as Cover

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Florida plans, on the number of enrollees, and on the scope of

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the health care coverage offered under a Cover Florida plan.

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     (b) Provide an assessment of the Cover Florida plans and

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their potential applicability in other settings.

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     (c) Use Cover Florida plans to gather more information to

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evaluate low-income, consumer-driven benefit packages.

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     (d) Jointly submit by March 1, 2009, and annually

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thereafter, a report to the Governor, the President of the

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Senate, and the Speaker of the House of Representatives which

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provides the information specified in paragraphs (a)-(c) and

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recommendations relating to the successful implementation and

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administration of the program.

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     (11) RULEMAKING AUTHORITY.--The agency and the Financial

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Services Commission may adopt rules pursuant to ss. 120.536(1)

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and 120.54 as needed to administer this section.

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     Section 4.  Section 408.910, Florida Statutes, is created to

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read:

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     408.910 Florida Health Choices Program.--

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     (1) LEGISLATIVE INTENT.--The Legislature finds that a

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significant number of the residents of this state do not have

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adequate access to affordable, quality health care. The

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Legislature further finds that increasing access to affordable,

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quality health care can be best accomplished by establishing a

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competitive market for purchasing health insurance and health

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services. It is therefore the intent of the Legislature to create

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the Florida Health Choices Program to:

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     (a) Expand opportunities for Floridians to purchase

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affordable health insurance and health services.

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     (b) Preserve the benefits of employment-sponsored insurance

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while easing the administrative burden for employers who offer

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these benefits.

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     (c) Enable individual choice in both the manner and amount

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of health care purchased.

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     (d) Provide for the purchase of individual, portable health

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care coverage.

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     (e) Disseminate information to consumers on the price and

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quality of health services.

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     (f) Sponsor a competitive market that stimulates product

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innovation, quality improvement, and efficiency in the production

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and delivery of health services.

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     (2) DEFINITIONS.--As used in this section, the term:

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     (a) "Corporation" means the Florida Health Choices, Inc.,

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established under this section.

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     (b) "Health insurance agent" means an agent licensed under

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part IV of chapter 626.

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     (c) "Insurer" means an entity licensed under chapter 624

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which offers an individual health insurance policy or a group

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health insurance policy, a preferred provider organization as

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defined in s. 627.6471, or an exclusive provider organization as

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defined in s. 627.6472.

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     (d) "Program" means the Florida Health Choices Program

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established by this section.

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     (3) PROGRAM PURPOSE AND COMPONENTS.--The Florida Health

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Choices Program is created as a single, centralized market for

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the sale and purchase of various products that enable individuals

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to pay for health care. These products include, but are not

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limited to, health insurance plans, health maintenance

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organization plans, prepaid services, service contracts, and

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flexible spending accounts. The components of the program

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include:

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     (a) Enrollment of employers.

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     (b) Administrative services for participating employers,

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including:

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     1. Assistance in seeking federal approval of cafeteria

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plans.

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     2. Collection of premiums and other payments.

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     3. Management of individual benefit accounts.

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     4. Distribution of premiums to insurers and payments to

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other eligible vendors.

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     5. Assistance for participants in complying with reporting

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requirements.

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     (c) Services to individual participants, including:

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     1. Information about available products and participating

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vendors.

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     2. Assistance with assessing the benefits and limits of

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each product, including information necessary to distinguish

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between policies offering creditable coverage and other products

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available through the program.

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     3. Account information to assist individual participants

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with managing available resources.

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     4. Services that promote healthy behaviors.

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     (d) Recruitment of vendors, including insurers, health

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maintenance organizations, prepaid clinic service providers,

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provider service networks, and other providers.

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     (e) Certification of vendors to ensure capability,

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reliability, and validity of offerings.

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     (f) Collection of data, monitoring, assessment, and

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reporting of vendor performance.

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     (g) Information services for individuals and employers.

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     (h) Program evaluation.

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     (4) ELIGIBILITY AND PARTICIPATION.--Participation in the

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program is voluntary and shall be available to employers,

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individuals, vendors, and health insurance agents as specified in

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this subsection.

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     (a) Employers eligible to enroll in the program include:

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     1. Employers that have 1 to 50 employees.

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     2. Fiscally constrained counties described in s. 218.67.

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     3. Municipalities having populations of fewer than 50,000

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residents.

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     4. School districts in fiscally constrained counties.

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     (b) Individuals eligible to participate in the program

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include:

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     1. Individual employees of enrolled employers.

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     2. State employees not eligible for state employee health

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benefits.

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     3. State retirees.

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     4. Medicaid reform participants who select the opt-out

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provision of reform.

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     5. Statutory rural hospitals.

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     (c) Employers who choose to participate in the program may

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enroll by complying with the procedures established by the

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corporation. The procedures must include, but are not limited to:

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     1. Submission of required information.

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     2. Compliance with federal tax requirements for the

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establishment of a cafeteria plan, pursuant to s. 125 of the

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Internal Revenue Code, including designation of the employer's

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plan as a premium payment plan, a salary reduction plan that has

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flexible spending arrangements, or a salary reduction plan that

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has a premium payment and flexible spending arrangements.

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     3. Determination of the employer's contribution, if any,

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per employee, provided that such contribution is equal for each

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eligible employee.

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     4. Establishment of payroll deduction procedures, subject

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to the agreement of each individual employee who voluntarily

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participates in the program.

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     5. Designation of the corporation as the third-party

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administrator for the employer's health benefit plan.

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     6. Identification of eligible employees.

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     7. Arrangement for periodic payments.

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     8. Employer notification to employees of the intent to

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transfer from an existing employee health plan to the program at

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least 90 days before the transition.

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     (d) Eligible vendors and the products and services that the

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vendors are permitted to sell are as follows:

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     1. Insurers licensed under chapter 624 may sell health

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insurance policies, limited benefit policies, other risk-bearing

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coverage, and other products or services.

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     2. Health maintenance organizations licensed under part I

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of chapter 641 may sell health insurance policies, limited

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benefit policies, other risk-bearing products, and other products

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or services.

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     3. Prepaid health clinic service providers licensed under

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part II of chapter 641 may sell prepaid service contracts and

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other arrangements for a specified amount and type of health

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services or treatments.

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     4. Health care providers, including hospitals and other

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licensed health facilities, health care clinics, licensed health

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professionals, pharmacies, and other licensed health care

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providers, may sell service contracts and arrangements for a

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specified amount and type of health services or treatments.

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     5. Provider organizations, including service networks,

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group practices, professional associations, and other

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incorporated organizations of providers, may sell service

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contracts and arrangements for a specified amount and type of

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health services or treatments.

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     6. Corporate entities providing specific health services in

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accordance with applicable state law may sell service contracts

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and arrangements for a specified amount and type of health

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services or treatments.

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A vendor described in subparagraphs 3.-6. may not sell products

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that provide risk-bearing coverage unless that vendor is

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authorized under a certificate of authority issued by the Office

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of Insurance Regulation under the provisions of the Florida

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Insurance Code. Otherwise eligible vendors may be excluded from

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participating in the program for deceptive or predatory

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practices, financial insolvency, or failure to comply with the

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terms of the participation agreement or other standards set by

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the corporation.

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     (e) Eligible individuals may voluntarily continue

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participation in the program regardless of subsequent changes in

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job status or Medicaid eligibility. Individuals who join the

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program may participate by complying with the procedures

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established by the corporation. These procedures must include,

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but are not limited to:

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     1. Submission of required information.

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     2. Authorization for payroll deduction.

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     3. Compliance with federal tax requirements.

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     4. Arrangements for payment in the event of job changes.

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     5. Selection of products and services.

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     (f) Vendors who choose to participate in the program may

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enroll by complying with the procedures established by the

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corporation. These procedures must include, but are not limited

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to:

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     1. Submission of required information, including a complete

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description of the coverage, services, provider network, payment

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restrictions, and other requirements of each product offered

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through the program.

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     2. Execution of an agreement to make all risk-bearing

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products offered through the program guaranteed-issue policies,

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subject to preexisting-condition exclusions established by the

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corporation.

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     3. Execution of an agreement that prohibits refusal to sell

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any offered non-risk-bearing product to a participant who elects

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to buy it.

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     4. Establishment of product prices based on age, gender,

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and location of the individual participant.

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     5. Arrangements for receiving payment for enrolled

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participants.

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     6. Participation in ongoing reporting processes established

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by the corporation.

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     7. Compliance with grievance procedures established by the

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corporation.

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     (g) Health insurance agents licensed under part IV of

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chapter 626 are eligible to voluntarily participate as buyers'

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representatives. A buyer's representative acts on behalf of an

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individual purchasing health insurance and health services

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through the program by providing information about products and

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services available through the program and assisting the

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individual with both the decision and the procedure of selecting

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specific products. Serving as a buyer's representative does not

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constitute a conflict of interest with continuing

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responsibilities as a health insurance agent if the relationship

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between each agent and any participating vendor is disclosed

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before advising an individual participant about the products and

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services available through the program. In order to participate,

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a health insurance agent shall comply with the procedures

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established by the corporation, including:

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     1. Completion of training requirements.

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     2. Execution of a participation agreement specifying the

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terms and conditions of participation.

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     3. Disclosure of any appointments to solicit insurance or

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procure applications for vendors participating in the program.

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     4. Arrangements to receive payment from the corporation for

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services as a buyer's representative.

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     (5) PRODUCTS.--

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     (a) The products that may be made available for purchase

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through the program include, but are not limited to:

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     1. Health insurance policies.

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     2. Limited benefit plans.

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     3. Prepaid clinic services.

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     4. Service contracts.

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     5. Arrangements for purchase of specific amounts and types

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of health services and treatments.

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     6. Flexible spending accounts.

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     (b) Health insurance policies, limited benefit plans,

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prepaid service contracts, and other contracts for services must

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ensure the availability of covered services and benefits to

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participating individuals for at least 1 full enrollment year.

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     (c) Products may be offered for multiyear periods provided

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the price of the product is specified for the entire period or

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for each separately priced segment of the policy or contract.

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     (d) The corporation shall provide a disclosure form for

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consumers to acknowledge their understanding of the nature of,

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and any limitations to, the benefits provided by the products and

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services being purchased by the consumer.

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     (6) PRICING.--Prices for the products sold through the

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program must be transparent to participants and established by

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the vendors based on age, gender, and location of participants.

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The corporation shall develop a methodology for evaluating the

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actuarial soundness of products offered through the program. The

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methodology shall be reviewed by the Office of Insurance

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Regulation prior to use by the corporation. Before making the

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product available to individual participants, the corporation

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shall use the methodology to compare the expected health care

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costs for the covered services and benefits to the vendor's price

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for that coverage. The results shall be reported to individuals

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participating in the program. Once established, the price set by

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the vendor must remain in force for at least 1 year and may only

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be redetermined by the vendor at the next annual enrollment

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period. The corporation shall annually assess a surcharge for

522

each premium or price set by a participating vendor. The

523

surcharge may not be more than 2.5 percent of the price and shall

524

be used to generate funding for administrative services provided

525

by the corporation and payments to buyers' representatives.

526

     (7) EXCHANGE PROCESS.--The program shall provide a single,

527

centralized market for purchase of health insurance and health

528

services. Purchases may be made by participating individuals over

529

the Internet or through the services of a participating health

530

insurance agent. Information about each product and service

531

available through the program shall be made available through

532

printed material and an interactive Internet website. A

533

participant needing personal assistance to select products and

534

services shall be referred to a participating agent in his or her

535

area.

536

     (a) Participation in the program may begin at any time

537

during a year after the employer completes enrollment and meets

538

the requirements specified by the corporation pursuant to

539

paragraph (4)(c).

540

     (b) Initial selection of products and services must be made

541

by an individual participant within 60 days after the date the

542

individual's employer qualified for participation. An individual

543

who fails to enroll in products and services by the end of this

544

period is limited to participation in flexible spending account

545

services until the next annual enrollment period.

546

     (c) Initial enrollment periods for each product selected by

547

an individual participant must last at least 12 months, unless

548

the individual participant specifically agrees to a different

549

enrollment period.

550

     (d) If an individual has selected one or more products and

551

enrolled in those products for at least 12 months or any other

552

period specifically agreed to by the individual participant,

553

changes in selected products and services may only be made during

554

the annual enrollment period established by the corporation.

555

     (e) The limits established in paragraphs (b)-(d) apply to

556

any risk-bearing product that promises future payment or coverage

557

for a variable amount of benefits or services. The limits do not

558

apply to initiation of flexible spending plans if those plans are

559

not associated with specific high-deductible insurance policies

560

or the use of spending accounts for any products offering

561

individual participants specific amounts and types of health

562

services and treatments at a contracted price.

563

     (8) CONSUMER INFORMATION.--The corporation shall establish

564

a secure website to facilitate the purchase of products and

565

services by participating individuals. The website must provide

566

information about each product or service available through the

567

program.

568

     (a) Prior to making a risk-bearing product available

569

through the program, the corporation shall provide information

570

regarding the product to the Office of Insurance Regulation. The

571

office shall review the product information and provide consumer

572

information and a recommendation on the risk-bearing product to

573

the corporation within 30 days after receiving the product

574

information.

575

     1. Upon receiving a recommendation that a risk-bearing

576

product should be made available in the marketplace, the

577

corporation may include the product on its website. If the

578

consumer information and recommendation is not received within 30

579

days, the corporation may make the risk-bearing product available

580

on the website without consumer information from the office.

581

     2. Upon receiving a recommendation that a risk-bearing

582

product should not be made available in the marketplace, the

583

risk-bearing product may be included as an eligible product in

584

the marketplace and on its website only if a majority of the

585

board of directors vote to include the product.

586

     (b) If a risk-bearing product is made available on the

587

website, the corporation shall make the consumer information and

588

office recommendation available on the website and in print

589

format. The corporation shall make late-submitted and ongoing

590

updates to consumer information available on the website and in

591

print format.

592

     (9) RISK POOLING.--The program shall utilize methods for

593

pooling the risk of individual participants and preventing

594

selection bias. These methods shall include, but are not limited

595

to, a postenrollment risk adjustment of the premium payments to

596

the vendors. The corporation shall establish a methodology for

597

assessing the risk of enrolled individual participants based on

598

data reported by the vendors about their enrollees. Monthly

599

distributions of payments to the vendors shall be adjusted based

600

on the assessed relative risk profile of the enrollees in each

601

risk-bearing product for the most recent period for which data is

602

available.

603

     (10) EXEMPTIONS.--

604

     (a) Policies sold as part of the program are not subject to

605

the licensing requirements of the Florida Insurance Code, chapter

606

641, or the mandated offerings or coverages established in part

607

VI of chapter 627 and chapter 641.

608

     (b) The corporation may act as an administrator as defined

609

in s. 626.88 but is not required to be certified pursuant to part

610

VII of chapter 626. However, a third party administrator used by

611

the corporation must be certified under part VII of chapter 626.

612

     (11) CORPORATION.--There is created the Florida Health

613

Choices, Inc., which shall be registered, incorporated,

614

organized, and operated in compliance with part III of chapter

615

112, chapter 119, chapter 286 and chapter 617. The purpose of the

616

corporation is to administer the program created in this section

617

and to conduct such other business as may further the

618

administration of the program.

619

     (a) The corporation shall be governed by a 15-member board

620

of directors consisting of:

621

     1. Three ex officio, nonvoting members to include:

622

     a. The Secretary of Health Care Administration or a

623

designee with expertise in health care services.

624

     b. The Secretary of Management Services or a designee with

625

expertise in state employee benefits.

626

     c. The Commissioner of the Office of Insurance Regulation

627

or a designee with expertise in insurance regulation.

628

     2. Four members appointed by and serving at the pleasure of

629

the Governor.

630

     3. Four members appointed by and serving at the pleasure of

631

the President of the Senate.

632

     4. Four members appointed by and serving at the pleasure of

633

the Speaker of the House of Representatives.

634

     5. Board members may not include insurers, health insurance

635

agents or brokers, health care providers, health maintenance

636

organizations, prepaid service providers, or any other entity,

637

affiliate or subsidiary of eligible vendors.

638

     (b) Members shall be appointed for terms of up to 3 years.

639

Any member is eligible for reappointment. A vacancy on the board

640

shall be filled for the unexpired portion of the term in the same

641

manner as the original appointment.

642

     (c) The board shall select a chief executive officer for

643

the corporation who shall be responsible for the selection of

644

such other staff as may be authorized by the corporation's

645

operating budget as adopted by the board.

646

     (d) Board members are entitled to receive, from funds of

647

the corporation, reimbursement for per diem and travel expenses

648

as provided by s. 112.061. No other compensation is authorized.

649

     (e) There is no liability on the part of, and no cause of

650

action shall arise against, any member of the board or its

651

employees or agents for any action taken by them in the

652

performance of their powers and duties under this section.

653

     (f) The board shall develop and adopt bylaws and other

654

corporate procedures as necessary for the operation of the

655

corporation and carrying out the purposes of this section. The

656

bylaws shall:

657

     1. Specify procedures for selection of officers and

658

qualifications for reappointment, provided that no board member

659

shall serve more than 9 consecutive years.

660

     2. Require an annual membership meeting that provides an

661

opportunity for input and interaction with individual

662

participants in the program.

663

     3. Specify policies and procedures regarding conflicts of

664

interest, including the provisions of part III of chapter 112,

665

which prohibit a member from participating in any decision that

666

would inure to the benefit of the member or the organization that

667

employs the member. The policies and procedures shall also

668

require public disclosure of the interest that prevents the

669

member from participating in a decision on a particular matter.

670

     (g) The corporation may exercise all powers granted to it

671

under chapter 617 necessary to carry out the purposes of this

672

section, including, but not limited to, the power to receive and

673

accept grants, loans, or advances of funds from any public or

674

private agency and to receive and accept from any source

675

contributions of money, property, labor, or any other thing of

676

value to be held, used, and applied for the purposes of this

677

section.

678

     (h) The corporation may establish technical advisory panels

679

consisting of interested parties, including consumers, health

680

care providers, individuals with expertise in insurance

681

regulation, and insurers.

682

     (i) The corporation shall:

683

     1. Determine eligibility of employers, vendors,

684

individuals, and agents in accordance with subsection (4).

685

     2. Establish procedures necessary for the operation of the

686

program, including, but not limited to, procedures for

687

application, enrollment, risk assessment, risk adjustment, plan

688

administration, performance monitoring, and consumer education.

689

     3. Arrange for collection of contributions from

690

participating employers and individuals.

691

     4. Arrange for payment of premiums and other appropriate

692

disbursements based on the selections of products and services by

693

the individual participants.

694

     5. Establish criteria for disenrollment of participating

695

individuals based on failure to pay the individual's share of any

696

contribution required to maintain enrollment in selected

697

products.

698

     6. Establish criteria for exclusion of vendors pursuant to

699

paragraph (4)(d).

700

     7. Develop and implement a plan for promoting public

701

awareness of and participation in the program.

702

     8. Secure staff and consultant services necessary to the

703

operation of the program.

704

     9. Establish policies and procedures regarding

705

participation in the program for individuals, vendors, health

706

insurance agents, and employers.

707

     10. Develop a plan, in coordination with the Department of

708

Revenue, to establish tax credits or refunds for employers that

709

participate in the program. The corporation shall submit the plan

710

to the Governor, the President of the Senate, and the Speaker of

711

the House of Representatives by January 1, 2009.

712

     (12) REPORT.--Beginning in the 2009-2010 fiscal year,

713

submit by February 1 an annual report to the Governor, the

714

President of the Senate, and the Speaker of the House of

715

Representatives documenting the corporation's activities in

716

compliance with the duties delineated in this section.

717

     (13) PROGRAM INTEGRITY.--To ensure program integrity and to

718

safeguard the financial transactions made under the auspices of

719

the program, the corporation is authorized to establish

720

qualifying criteria and certification procedures for vendors,

721

require performance bonds or other guarantees of ability to

722

complete contractual obligations, monitor the performance of

723

vendors, and enforce the agreements of the program through

724

financial penalty or disqualification from the program.

725

     Section 5.  Subsection (5) of section 409.814, Florida

726

Statutes, is amended to read:

727

     409.814  Eligibility.--A child who has not reached 19 years

728

of age whose family income is equal to or below 200 percent of

729

the federal poverty level is eligible for the Florida Kidcare

730

program as provided in this section. For enrollment in the

731

Children's Medical Services Network, a complete application

732

includes the medical or behavioral health screening. If,

733

subsequently, an individual is determined to be ineligible for

734

coverage, he or she must immediately be disenrolled from the

735

respective Florida Kidcare program component.

736

     (5)  A child whose family income is above 200 percent of the

737

federal poverty level or a child who is excluded under the

738

provisions of subsection (4) may participate in the Medikids

739

program as provided in s. 409.8132 or, if the child is ineligible

740

for Medikids by reason of age, in the Florida Healthy Kids

741

program, subject to the following provisions:

742

     (a)  The family is not eligible for premium assistance

743

payments and must pay the full cost of the premium, including any

744

administrative costs.

745

     (b) The agency is authorized to place limits on enrollment

746

in Medikids by these children in order to avoid adverse

747

selection. The number of children participating in Medikids whose

748

family income exceeds 200 percent of the federal poverty level

749

must not exceed 10 percent of total enrollees in the Medikids

750

program.

751

     (b)(c) The board of directors of the Florida Healthy Kids

752

Corporation may is authorized to place limits on enrollment of

753

these children in order to avoid adverse selection. In addition,

754

the board is authorized to offer a reduced benefit package to

755

these children in order to limit program costs for such families.

756

The number of children participating in the Florida Healthy Kids

757

program whose family income exceeds 200 percent of the federal

758

poverty level must not exceed 10 percent of total enrollees in

759

the Florida Healthy Kids program.

760

     Section 6.  Section 624.1265, Florida Statutes, is created

761

to read:

762

     624.1265 Nonprofit religious organization exemption;

763

authority; notice.--

764

     (1) A nonprofit religious organization is not subject to

765

the requirements of the Florida Insurance Code if the nonprofit

766

religious organization qualifies under Title 26, s. 501 of the

767

Internal Revenue Code of 1986, as amended; limits its

768

participants to members of the same religion; acts as an

769

organizational clearinghouse for information between participants

770

who have financial, physical, or medical needs and participants

771

who have the ability to pay for the benefit of those participants

772

who have financial, physical, or medical needs; provides for the

773

financial or medical needs of a participant through payments

774

directly from one participant to another participant; and

775

suggests amounts that participants may voluntarily give with no

776

assumption of risk or promise to pay among the participants or

777

between the participants.

778

     (2) This section does not prevent the organization

779

described in subsection (1) from establishing qualifications of

780

participation relating to the health of a prospective

781

participant, does not prevent a participant from limiting the

782

financial or medical needs that may be eligible for payment, and

783

does not prevent the organization from canceling the membership

784

of a participant when such participant indicates his or her

785

unwillingness to participate by failing to make a payment to

786

another participant for a period in excess of 60 days.

787

     (3) The religious organization described in subsection (1)

788

shall provide each prospective participant in the organizational

789

clearinghouse written notice that the organization is not an

790

insurance company, that membership is not offered through an

791

insurance company, and that the organization is not subject to

792

the regulatory requirements or consumer protections of the

793

Florida Insurance Code.

794

     Section 7.  Paragraph (b) of subsection (5) of section

795

624.91, Florida Statutes, is amended to read:

796

     624.91  The Florida Healthy Kids Corporation Act.--

797

     (5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--

798

     (b)  The Florida Healthy Kids Corporation shall:

799

     1.  Arrange for the collection of any family, local

800

contributions, or employer payment or premium, in an amount to be

801

determined by the board of directors, to provide for payment of

802

premiums for comprehensive insurance coverage and for the actual

803

or estimated administrative expenses.

804

     2.  Arrange for the collection of any voluntary

805

contributions to provide for payment of premiums for children who

806

are not eligible for medical assistance under Title XXI of the

807

Social Security Act.

808

     3.  Subject to the provisions of s. 409.8134, accept

809

voluntary supplemental local match contributions that comply with

810

the requirements of Title XXI of the Social Security Act for the

811

purpose of providing additional coverage in contributing counties

812

under Title XXI.

813

     4.  Establish the administrative and accounting procedures

814

for the operation of the corporation.

815

     5.  Establish, with consultation from appropriate

816

professional organizations, standards for preventive health

817

services and providers and comprehensive insurance benefits

818

appropriate to children, provided that such standards for rural

819

areas shall not limit primary care providers to board-certified

820

pediatricians.

821

     6.  Determine eligibility for children seeking to

822

participate in the Title XXI-funded components of the Florida

823

Kidcare program consistent with the requirements specified in s.

824

409.814, as well as the non-Title-XXI-eligible children as

825

provided in subsection (3).

826

     7.  Establish procedures under which providers of local

827

match to, applicants to and participants in the program may have

828

grievances reviewed by an impartial body and reported to the

829

board of directors of the corporation.

830

     8.  Establish participation criteria and, if appropriate,

831

contract with an authorized insurer, health maintenance

832

organization, or third-party administrator to provide

833

administrative services to the corporation.

834

     9.  Establish enrollment criteria which shall include

835

penalties or waiting periods of not fewer than 60 days for

836

reinstatement of coverage upon voluntary cancellation for

837

nonpayment of family premiums.

838

     10.  Contract with authorized insurers or any provider of

839

health care services, meeting standards established by the

840

corporation, for the provision of comprehensive insurance

841

coverage to participants. Such standards shall include criteria

842

under which the corporation may contract with more than one

843

provider of health care services in program sites. Health plans

844

shall be selected through a competitive bid process. The Florida

845

Healthy Kids Corporation shall purchase goods and services in the

846

most cost-effective manner consistent with the delivery of

847

quality medical care. The maximum administrative cost for a

848

Florida Healthy Kids Corporation contract shall be 15 percent.

849

For health care contracts, the minimum medical loss ratio for a

850

Florida Healthy Kids Corporation contract shall be 85 percent.

851

For dental contracts, the remaining compensation to be paid to

852

the authorized insurer or provider under a Florida Healthy Kids

853

Corporation contract shall be no less than an amount which is 85

854

percent of premium; to the extent any contract provision does not

855

provide for this minimum compensation, this section shall

856

prevail. The health plan selection criteria and scoring system,

857

and the scoring results, shall be available upon request for

858

inspection after the bids have been awarded.

859

     11.  Establish disenrollment criteria in the event local

860

matching funds are insufficient to cover enrollments.

861

     12.  Develop and implement a plan to publicize the Florida

862

Healthy Kids Corporation, the eligibility requirements of the

863

program, and the procedures for enrollment in the program and to

864

maintain public awareness of the corporation and the program.

865

     13.  Secure staff necessary to properly administer the

866

corporation. Staff costs shall be funded from state and local

867

matching funds and such other private or public funds as become

868

available. The board of directors shall determine the number of

869

staff members necessary to administer the corporation.

870

     14.  Provide a report annually to the Governor, Chief

871

Financial Officer, Commissioner of Education, Senate President,

872

Speaker of the House of Representatives, and Minority Leaders of

873

the Senate and the House of Representatives.

874

     15. Provide information on a quarterly basis to the

875

Legislature and the Governor which compares the costs and

876

utilization of the full-pay enrolled population and the Title

877

XXI-subsidized enrolled population in the Florida Kidcare

878

program. The information, at a minimum, must include:

879

     a. The monthly enrollment and expenditure for full-pay

880

enrollees in the Medikids and Florida Healthy Kids programs

881

compared to the Title XXI-subsidized enrolled population; and

882

     b. The costs and utilization by service of the full-pay

883

enrollees in the Medikids and Florida Healthy Kids programs and

884

the Title XXI-subsidized enrolled population.

885

886

By February 1, 2009, the Florida Healthy Kids Corporation shall

887

provide a study to the Legislature and the Governor on premium

888

impacts to the subsidized portion of the program from the

889

inclusion of the full-pay program, which shall include

890

recommendations on how to eliminate or mitigate possible impacts

891

to the subsidized premiums.

892

     16.15. Establish benefit packages which conform to the

893

provisions of the Florida Kidcare program, as created in ss.

894

409.810-409.820.

895

     Section 8.  Effective upon this act becoming a law and

896

applicable to policies issued or renewed on or after October 1,

897

2008, paragraph (c) of subsection (1) of section 627.602, Florida

898

Statutes, is amended to read:

899

     627.602  Scope, format of policy.--

900

     (1)  Each health insurance policy delivered or issued for

901

delivery to any person in this state must comply with all

902

applicable provisions of this code and all of the following

903

requirements:

904

     (c)  The policy may purport to insure only one person,

905

except that upon the application of an adult member of a family,

906

who is deemed to be the policyholder, a policy may insure, either

907

originally or by subsequent amendment, any eligible members of

908

that family, including husband, wife, any children or any person

909

dependent upon the policyholder. If an insurer offers coverage

910

for dependent children of the policyholder, such policy must

911

comply with the provisions of s. 627.6562.

912

     Section 9.  Effective upon this act becoming a law and

913

applicable to policies issued or renewed on or after October 1,

914

2008, section 627.6562, Florida Statutes, is amended to read:

915

     627.6562  Dependent coverage.--

916

     (1) If an insurer offers coverage under a group, blanket,

917

or franchise health insurance policy that insures dependent

918

children of the policyholder or certificateholder, the policy

919

must insure a dependent child of the policyholder or

920

certificateholder at least until the end of the calendar year in

921

which the child reaches the age of 25, if the child meets all of

922

the following:

923

     (a)  The child is dependent upon the policyholder or

924

certificateholder for support.

925

     (b)  The child is living in the household of the

926

policyholder or certificateholder, or the child is a full-time or

927

part-time student.

928

     (2) A policy that is subject to the requirements of

929

subsection (1) must also offer the policyholder or

930

certificateholder the option to insure a child of the

931

policyholder or certificateholder at least until the end of the

932

calendar year in which the child reaches the age of 30, if the

933

child:

934

     (a) Is unmarried and does not have a dependent of his or

935

her own;

936

     (b) Is a resident of this state or a full-time or part-time

937

student; and

938

     (c) Is not provided coverage as a named subscriber,

939

insured, enrollee, or covered person under any other group,

940

blanket, or franchise health insurance policy or individual

941

health benefits plan, or is not entitled to benefits under Title

942

XVIII of the Social Security Act.

943

     (3) If, pursuant to subsection (2), a child is provided

944

coverage under the parent's policy after the end of the calendar

945

year in which the child reaches age 25 and coverage for the child

946

is subsequently terminated, the child is not eligible to be

947

covered under the parent's policy unless the child was

948

continuously covered by other creditable coverage without a gap

949

in coverage of more than 63 days. For the purposes of this

950

subsection, the term "creditable coverage" has the same meaning

951

as provided in s. 627.6561(5).

952

     (4)(2) Nothing in This section does not:

953

     (a) Affect or preempt affects or preempts an insurer's

954

right to medically underwrite or charge the appropriate premium;

955

     (b) Require coverage for services provided to a dependent

956

before October 1, 2008;

957

     (c) Require an employer to pay all or part of the cost of

958

coverage provided for a dependent under this section; or

959

     (d) Prohibit an insurer or health maintenance organization

960

from increasing the limiting age for dependent coverage to age 30

961

in policies or contracts issued or renewed prior to the effective

962

date of this act.

963

     (5)(a) Until April 1, 2009, the parent of a child who

964

qualifies for coverage under subsection (2) but whose coverage as

965

a dependent child under the parent's plan terminated under the

966

terms of the plan before October 1, 2008, may make a written

967

election to reinstate coverage, without proof of insurability,

968

under that plan as a dependent child pursuant to this section.

969

     (b) The covered person's plan may require the payment of a

970

premium by the covered person or dependent child, as appropriate,

971

subject to the approval of the Office of Insurance Regulation,

972

for any period of coverage relating to a dependent's written

973

election for coverage pursuant to paragraph (a).

974

     (c) Notice regarding the reinstatement of coverage for a

975

dependent child as provided under this subsection must be

976

provided to a covered person in the certificate of coverage

977

prepared for covered persons by the insurer or by the covered

978

person's employer. Such notice may be given through the group

979

policyholder.

980

     (6) This section does not apply to accident only, specified

981

disease, disability income, Medicare supplement, or long-term

982

care insurance policies.

983

     Section 10.  Effective upon this act becoming a law and

984

applicable to contracts issued or renewed on or after October 1,

985

2008, subsection (41) is added to section 641.31, Florida

986

Statutes, to read:

987

     641.31  Health maintenance contracts.--

988

     (41) All health maintenance contracts providing coverage

989

for a member of the subscriber's family must comply with the

990

provisions of s. 627.6562.

991

     Section 11. For the 2008-2009 fiscal year, the following is

992

appropriated from the General Revenue Fund to the Agency for

993

Health Care Administration to fund the Florida Health Choices

994

Program:

995

     (1) The sum of $325,000 in nonrecurring funds for the

996

salaries and benefits of the chief executive office and staff of

997

Florida Health Choices, Inc., for the 2008-2009 fiscal year.

998

     (2) The sum of $825,000 in nonrecurring funds for costs

999

related to the general administration, marketing, consulting, and

1000

other duties of the Florida Health Choices, Inc., for the 2008-

1001

2009 fiscal year.

1002

     (3) The sum of $350,000 in nonrecurring funds for the

1003

third-party administrator functions of Florida Health Choices

1004

Inc., during the 2008-2009 fiscal year.

1005

     Section 12.  This act shall take effect upon becoming a law.

1006

1007

================ T I T L E  A M E N D M E N T ================

1008

And the title is amended as follows:

1009

     Delete line(s) 881-981

1010

and insert:

1011

An act relating to health insurance; amending s. 112.363,

1012

F.S.; specifying that coverage provided through the Cover

1013

Florida Health Care Access Program is considered health

1014

insurance coverage for the purposes of determining

1015

eligibility for the state retiree health insurance

1016

subsidy; amending s. 408.909, F.S.; revising eligibility

1017

for enrollment in a health flex plan; revising the

1018

expiration date of the health flex plan program; creating

1019

s. 408.9091, F.S.; creating the Cover Florida Health Care

1020

Access Program; providing a short title; providing

1021

legislative intent; providing definitions; requiring the

1022

Agency for Health Care Administration and the Office of

1023

Insurance Regulation of the Financial Services Commission

1024

within the Department of Financial Services to jointly  

1025

administer the program; providing program requirements;

1026

requiring the development of guidelines to meet minimum

1027

standards for quality of care and access to care;

1028

requiring the agency to ensure that the Cover Florida

1029

plans follow standardized grievance procedures; requiring

1030

the Executive Office of the Governor, the agency, and the

1031

office to develop a public awareness program; authorizing

1032

public and private entities to design or extend incentives

1033

for participation in the Cover Florida Access Program;

1034

requiring the agency and the office to announce an

1035

invitation to negotiate for Cover Florida plan entities to

1036

design a coverage proposal; requiring the agency and the

1037

office to approve one plan entity; authorizing the agency

1038

and the office to approve one regional network plan in

1039

each existing Medicaid area; requiring the invitation to

1040

negotiate to include certain guidelines; providing certain

1041

conditions in which plans are disapproved or withdrawn;

1042

authorizing the agency and the office to announce an

1043

invitation to negotiate for companies that offer

1044

supplemental insurance or discount medical plans;

1045

providing that certain licensing requirements or ch. 641,

1046

F.S., are not applicable to a Cover Florida plan;

1047

providing that Cover Florida plans are considered

1048

insurance under certain conditions; excluding Cover

1049

Florida plans from the Florida Life and Health Insurance

1050

Guaranty Association and the Health Maintenance

1051

Organization Consumer Assistance Plan; providing

1052

requirements for eligibility in a Cover Florida plan;

1053

requiring each Cover Florida plan to maintain and provide

1054

certain records; providing that coverage under a Cover

1055

Florida plan is not an entitlement and does not give rise

1056

to a cause of action; requiring the agency and the office

1057

to evaluate the Cover Florida program and submit an annual

1058

report to the Governor and the Legislature; requiring the

1059

agency and the Financial Services Commission to adopt

1060

rules; creating s. 408.910, F.S.; establishing the Florida

1061

Health Choices Program; providing legislative intent;

1062

providing definitions; providing program purpose and

1063

components; providing employer eligibility criteria;

1064

providing individual eligibility criteria; providing

1065

employer enrollment criteria; providing vendor, product,

1066

and service eligibility criteria; providing for individual

1067

participation regardless of subsequent job status or

1068

Medicaid eligibility; providing vendor enrollment

1069

criteria; providing for participation by health insurance

1070

agents; providing criteria for products available for

1071

purchase; providing criteria for product pricing;

1072

providing for an administrative surcharge; providing for

1073

an exchange process; providing for enrollment periods and

1074

changes in selected products; requiring the corporation to

1075

establish a website to provide information about products

1076

and services; providing methods for the pooling of risk;

1077

providing for exemptions from certain statutory

1078

provisions, mandated offerings and coverages, and

1079

licensing requirements; providing for administrators;

1080

creating the Florida Health Choices, Inc.; requiring the

1081

department to supervise any liquidation or dissolution of

1082

the corporation; providing for corporate governance and

1083

board membership and terms; providing for reimbursement

1084

for per diem and travel expenses; providing for powers and

1085

duties of the corporation; requiring the corporation to

1086

coordinate with the Department of Revenue to develop a

1087

plan by January 1, 2009, for creating tax exemptions or

1088

refunds for participating in the program; requiring the

1089

corporation to submit an annual report to the Governor and

1090

Legislature; authorizing the corporation to establish and

1091

enforce certain program integrity measures; amending s.

1092

409.814, F.S.; revising the eligibility requirements for

1093

participation in the Medikids program or the Florida

1094

Healthy Kids program; deleting certain limitations;

1095

creating s. 624.1265, F.S.; exempting certain nonprofit

1096

religious organizations from requirements of the Florida

1097

Insurance Code; preserving certain authority of such

1098

organizations; requiring such organizations to provide

1099

certain notice to prospective participants; providing

1100

notice requirements; amending s. 624.91, F.S.; revising

1101

the duties of the Florida Healthy Kids Corporation;

1102

amending s. 627.602, F.S.; requiring that individual

1103

health insurance policies insuring dependent children of a

1104

policyholder comply with certain provisions of state law;

1105

amending s. 627.6562, F.S.; requiring group health

1106

insurance policies that provide dependent coverage to

1107

provide the policyholder with the option of insuring a

1108

child until the age of 30 under certain circumstances;

1109

amending s. 641.31, F.S.; requiring that health

1110

maintenance organization contracts providing coverage for

1111

a member of the subscriber's family to comply with certain

1112

provisions of state law; providing an appropriation;

1113

providing an effective date.

5/1/2008  5:32:00 PM     2-09449-08