Bill No. CS/HB 7081
Amendment No. 830641
Senate House

1Representative Ausley offered the following:
3     Amendment (with title amendment)
4     Remove everything after the enacting clause and insert:
5     Section 1.  Paragraph (d) of subsection (2) of section
6112.363, Florida Statutes, is amended to read:
7     112.363  Retiree health insurance subsidy.--
9     (d)  Payment of the retiree health insurance subsidy shall
10be made only after coverage for health insurance for the retiree
11or beneficiary has been certified in writing to the Department
12of Management Services. Participation in a former employer's
13group health insurance program is not a requirement for
14eligibility under this section. Coverage issued pursuant to s.
15408.9091 is considered health insurance for the purposes of this
17     Section 2.  Subsections (5) and (10) of section 408.909,
18Florida Statutes, are amended to read:
19     408.909  Health flex plans.--
20     (5)  ELIGIBILITY.--Eligibility to enroll in an approved
21health flex plan is limited to residents of this state who:
22     (a)  Are 64 years of age or younger;
23     (b)  Have a family income equal to or less than 300 200
24percent of the federal poverty level;
25     (c)  Are eligible under a federally approved Medicaid
26demonstration waiver and reside in Palm Beach County or Miami-
27Dade County;
28     (c)(d)  Are not covered by a private insurance policy and
29are not eligible for coverage through a public health insurance
30program, such as Medicare or Medicaid, unless specifically
31authorized under paragraph (c), or another public health care
32program, such as Kidcare, and have not been covered at any time
33during the past 6 months; who are covered under an individual
34contract issued by a health maintenance organization that is an
35approved health flex plan on October 1, 2008, and are applying
36for coverage in the same health flex plan without a lapse in
37coverage and all other eligibility requirements under this
38subsection are met; or who were covered under Medicaid or
39Kidcare and lost eligibility for Medicaid or a Kidcare subsidy
40due to income restrictions within 90 days before applying for
41health care coverage through an approved health flex plan; and
42     (d)(e)  Have applied for health care coverage through an
43approved health flex plan and have agreed to make any payments
44required for participation, including periodic payments or
45payments due at the time health care services are provided.
46     (10)  EXPIRATION.--This section expires July 1, 2013 2008.
47     Section 3.  Section 408.9091, Florida Statutes, is created
48to read:
49     408.9091  Cover Florida Health Care Access Act.--
50     (1)  SHORT TITLE.--This section may be cited as the "Cover
51Florida Health Access Program Act."
52     (2)  INTENT.--The Legislature finds that a significant
53proportion of state residents are unable to obtain affordable
54health insurance coverage. The Legislature also finds that
55existing "health flex" plan coverage has had limited
56participation due in part to narrow eligibility restrictions as
57well as minimal benefit options for catastrophic and emergency
58care coverage. Therefore, it is the Legislature's intent to
59expand the availability of health care options for uninsured
60residents by developing an affordable health care product that
61emphasizes coverage for basic and preventive health care
62services; provides inpatient hospital, urgent, and emergency
63care services; and is offered statewide by approved health
64insurers, health maintenance organizations, health-care-
65provider-sponsored organizations, or health care districts.
66     (3)  DEFINITIONS.--As used in this section, the term:
67     (a)  "Agency" means the Agency for Health Care
69     (b)  "Office" means the Office of Insurance Regulation of
70the Financial Services Commission.
71     (c)  "Enrollee" means an individual who has been determined
72to be eligible for and is receiving health insurance coverage
73under a Cover Florida plan.
74     (d)  "Cover Florida plan" means a consumer choice benefit
75plan approved under this section which guarantees payment or
76coverage for specified benefits provided to an enrollee.
77     (e)  "Cover Florida plan coverage" means health care
78services that are covered as benefits under a Cover Florida
80     (f)  "Cover Florida plan entity" means a health insurer,
81health maintenance organization, health-care-provider-sponsored
82organization, or health care district that develops and
83implements a Cover Florida plan and is responsible for
84administering the plan and paying all claims for Cover Florida
85plan coverage by enrollees.
86     (g)  "Cover Florida Plus" plan means a supplemental
87insurance product, such as for additional catastrophic coverage
88or dental, vision, or cancer coverage, approved under this
89section and offered to all enrollees.
90     (4)  PROGRAM.--The agency and the office shall jointly
91establish and administer the Cover Florida Health Care Access
93     (a)  General Cover Florida plan components must require
95     1.  Plans are offered as guaranteed issue to enrollees,
96subject to exclusions for preexisting conditions approved by the
97office and the agency.
98     2.  Plans are portable, such that the enrollee remains
99covered regardless of employment status or the cost-sharing of
101     3.  Plans may provide for cost containment through limits
102on the number of services, caps on benefit payments, and
103copayments for services.
104     4.  A Cover Florida health plan entity makes all benefit
105plan and marketing materials available in English and Spanish.
106     5.  In order to provide for consumer choice, Cover Florida
107health plan entities develop two alternative benefit option
108plans having different cost and benefit levels, including at
109least one plan that provides catastrophic coverage.
110     6.  Plans without catastrophic coverage provide coverage
111options for the following services, including, but not limited
113     a.  Preventive health services, including preventive
114screenings, annual health assessments, and well-care and well-
115woman services, including mammograms, screenings for cervical
116cancer, noninvasive colorectal or prostate screenings, and
118     b.  Incentives for routine, preventive care.
119     c.  Office visits for the diagnosis and treatment of
120illness or injury.
121     d.  Office surgery, including anesthesia.
122     e.  Services related to behavioral health services.
123     f.  Durable medical equipment and prosthetics.
124     g.  Diabetic supplies.
125     7.  Plans providing catastrophic coverage, at a minimum,
126provide coverage options for all of the services listed under
127subparagraph 6., and in addition include, but are not limited
128to, coverage options for:
129     a.  Inpatient hospital stays.
130     b.  Hospital emergency care services.
131     c.  Urgent care services.
132     d.  Outpatient facility services, outpatient surgery, and
133outpatient diagnostic services.
134     8.  Plans offer prescription drug benefit coverage on all
135plans, or use a prescription drug manager, such as the Florida
136Discount Drug Card Program.
137     9.  Plans provide, in enrollment materials, plain-language
138information on policy benefit coverage, benefit limits, cost-
139sharing requirements, and exclusions and a clear representation
140of what is not covered in the plan.
141     10.  Plans offered through a qualified employer meet the
142requirements of s. 125 of the Internal Revenue Code.
143     (b)  Guidelines shall be developed to ensure that Cover
144Florida plans meet minimum standards for quality of care and
145access to care. The agency shall ensure that the Cover Florida
146plans follow standardized grievance procedures.
147     (c)  Changes in Cover Florida plan benefits, premiums, and
148policy forms are subject to regulatory oversight by the office
149and agency as provided by rules adopted by the Financial
150Services Commission and the agency.
151     (d)  The agency, the office, and the Executive Office of
152the Governor shall develop a public awareness program to be
153implemented throughout the state for the promotion of the Cover
154Florida Health Access Program.
155     (e)  Public or private entities may design programs to
156encourage Floridians to participate in the Cover Florida Health
157Access Program, or to encourage employers to cosponsor some
158share of Cover Florida plan premiums for employees.
159     (5)  PLAN PROPOSALS.--The agency and the office shall
160announce, no later than July 1, 2008, an invitation to negotiate
161for Cover Florida plan entities to design a Cover Florida plan
162proposal in which benefits and premiums are specified.
163     (a)  The invitation to negotiate shall include guidelines
164for the review of Cover Florida plan applications, policy forms,
165and all associated forms, and provide regulatory oversight of
166Cover Florida plan advertisement and marketing procedures. A
167plan shall be disapproved or withdrawn if the plan:
168     1.  Contains any ambiguous, inconsistent, or misleading
169provisions or any exceptions or conditions that deceptively
170affect or limit the benefits purported to be assumed in the
171general coverage provided by the plan;
172     2.  Provides benefits that are unreasonable in relation to
173the premium charged or contains provisions that are unfair or
174inequitable, that are contrary to the public policy of this
175state, that encourage misrepresentation, or that result in
176unfair discrimination in sales practices;
177     3.  Cannot demonstrate that the plan is financially sound
178and that the applicant is able to underwrite or finance the
179health care coverage provided;
180     4.  Cannot demonstrate that the applicant and its
181management are in compliance with the standards required under
182s. 624.404(3); or
183     5.  Does not guarantee that enrollees may participate in
184the Cover Florida plan entity's comprehensive network of
185providers, as determined by the office, the agency, and the
187     (b)  The agency and the office may announce an invitation
188to negotiate for the design of Cover Florida Plus products to
189companies that offer supplemental insurance, discount medical
190plan organizations licensed under part II of chapter 636, or
191prepaid health clinics licensed under part II of chapter 641.
192     (c)  The agency and office shall approve at least one Cover
193Florida plan entity having an existing statewide network of
194providers, and may approve at least one regional network plan in
195each existing Medicaid area.
196     (6)  LICENSE NOT REQUIRED.--
197     (a)  The licensing requirements of the Florida Insurance
198Code and chapter 641, relating to health maintenance
199organizations, do not apply to a Cover Florida plan approved
200under this section unless expressly made applicable. However,
201for the purpose of prohibiting unfair trade practices, Cover
202Florida plans are considered to be insurance subject to the
203applicable provisions of part IX of chapter 626, except as
204otherwise provided in this section.
205     (b)  Cover Florida plans are not covered by the Florida
206Life and Health Insurance Guaranty Association under part III of
207chapter 631 or by the Health Maintenance Organization Consumer
208Assistance Plan under part IV of chapter 631.
209     (7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
210plan is limited to residents of this state who meet all of the
212     (a)  Are 19 to 64 years of age.
213     (b)  Are not covered by a private health insurance policy
214and are not eligible for coverage through a public health
215insurance program, such as Medicare, Medicaid, or Kidcare,
216unless eligibility for coverage lapses due to no longer meeting
217income or categorical requirements.
218     (c)  Have not been covered by any health insurance program
219at any time during the past 6 months, unless coverage under a
220health insurance program was terminated within the previous 6
221months due to:
222     1.  Loss of a job that provided an employer-sponsored
223health benefit plan;
224     2.  Exhaustion of coverage that was continued under COBRA
225or continuation-of-coverage requirements under s. 627.6692;
226     3.  Reaching the limiting age under the policy; or
227     4.  Death of, or divorce from, a spouse who was provided
228employer-sponsored health benefit plan.
229     (d)  Have applied for health care coverage through a Cover
230Florida plan and have agreed to make any payments required for
231participation, including periodic payments or payments due at
232the time health care services are provided.
233     (8)  RECORDS.--Each Cover Florida plan must maintain
234enrollment data and provide network data and reasonable records
235to enable the office and agency to monitor plans and to
236determine the financial viability of the Cover Florida plan, as
238     (9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
239is not an entitlement, and a cause of action does not arise
240against the state, a local government entity, any other
241political subdivision of this state, or the agency or office for
242failure to make coverage available to eligible persons under
243this section.
244     (10)  PROGRAM EVALUATION.--The agency and the office shall:
245     (a)  Evaluate the Cover Florida program and its effect on
246the entities that seek approval as Cover Florida plans, on the
247number of enrollees, and on the scope of the health care
248coverage offered under a Cover Florida plan;
249     (b)  Provide an assessment of the Cover Florida plans and
250their potential applicability in other settings;
251     (c)  Use Cover Florida plans to gather more information to
252evaluate low-income, consumer-driven benefit packages; and
253     (d)  Jointly submit by March 1, 2009, and annually
254thereafter, a report to the Governor, the President of the
255Senate, and the Speaker of the House of Representatives
256providing the information specified in paragraphs (a)-(c) and
257recommendations relating to the successful implementation and
258administration of the program.
259     (11)  RULEMAKING AUTHORITY.--The agency and the Financial
260Services Commission may adopt rules as needed to administer this
262     Section 4.  Paragraph (b) of subsection (5) of section
263624.91, Florida Statutes, is amended to read:
264     624.91  The Florida Healthy Kids Corporation Act.--
266     (b)  The Florida Healthy Kids Corporation shall:
267     1.  Arrange for the collection of any family, local
268contributions, or employer payment or premium, in an amount to
269be determined by the board of directors, to provide for payment
270of premiums for comprehensive insurance coverage and for the
271actual or estimated administrative expenses.
272     2.  Arrange for the collection of any voluntary
273contributions to provide for payment of premiums for children
274who are not eligible for medical assistance under Title XXI of
275the Social Security Act.
276     3.  Subject to the provisions of s. 409.8134, accept
277voluntary supplemental local match contributions that comply
278with the requirements of Title XXI of the Social Security Act
279for the purpose of providing additional coverage in contributing
280counties under Title XXI.
281     4.  Establish the administrative and accounting procedures
282for the operation of the corporation.
283     5.  Establish, with consultation from appropriate
284professional organizations, standards for preventive health
285services and providers and comprehensive insurance benefits
286appropriate to children, provided that such standards for rural
287areas shall not limit primary care providers to board-certified
289     6.  Determine eligibility for children seeking to
290participate in the Title XXI-funded components of the Florida
291Kidcare program consistent with the requirements specified in s.
292409.814, as well as the non-Title-XXI-eligible children as
293provided in subsection (3).
294     7.  Establish procedures under which providers of local
295match to, applicants to and participants in the program may have
296grievances reviewed by an impartial body and reported to the
297board of directors of the corporation.
298     8.  Establish participation criteria and, if appropriate,
299contract with an authorized insurer, health maintenance
300organization, or third-party administrator to provide
301administrative services to the corporation.
302     9.  Establish enrollment criteria which shall include
303penalties or waiting periods of not fewer than 60 days for
304reinstatement of coverage upon voluntary cancellation for
305nonpayment of family premiums.
306     10.  Contract with authorized insurers or any provider of
307health care services, meeting standards established by the
308corporation, for the provision of comprehensive insurance
309coverage to participants. Such standards shall include criteria
310under which the corporation may contract with more than one
311provider of health care services in program sites. Health plans
312shall be selected through a competitive bid process. The Florida
313Healthy Kids Corporation shall purchase goods and services in
314the most cost-effective manner consistent with the delivery of
315quality medical care. The maximum administrative cost for a
316Florida Healthy Kids Corporation contract shall be 15 percent.
317For health care contracts, the minimum medical loss ratio for a
318Florida Healthy Kids Corporation contract shall be 85 percent.
319For dental contracts, the remaining compensation to be paid to
320the authorized insurer or provider under a Florida Healthy Kids
321Corporation contract shall be no less than an amount which is 85
322percent of premium; to the extent any contract provision does
323not provide for this minimum compensation, this section shall
324prevail. The health plan selection criteria and scoring system,
325and the scoring results, shall be available upon request for
326inspection after the bids have been awarded.
327     11.  Establish disenrollment criteria in the event local
328matching funds are insufficient to cover enrollments.
329     12.  Develop and implement a plan to publicize the Florida
330Healthy Kids Corporation, the eligibility requirements of the
331program, and the procedures for enrollment in the program and to
332maintain public awareness of the corporation and the program.
333     13.  Secure staff necessary to properly administer the
334corporation. Staff costs shall be funded from state and local
335matching funds and such other private or public funds as become
336available. The board of directors shall determine the number of
337staff members necessary to administer the corporation.
338     14.  Provide a report annually to the Governor, Chief
339Financial Officer, Commissioner of Education, Senate President,
340Speaker of the House of Representatives, and Minority Leaders of
341the Senate and the House of Representatives.
342     15.  Provide information on a quarterly basis to the
343Legislature and the Governor which compares the costs and
344utilization of the full-pay enrolled population and the Title
345XXI-subsidized enrolled population in the KidCare program. The
346information, at a minimum, must include:
347     a.  The monthly enrollment and expenditure for full-pay
348enrollees in the Medikids and Florida Healthy Kids programs
349compared to the Title XXI-subsidized enrolled population; and
350     b.  The costs and utilization by service of the full-pay
351enrollees in the Medikids and Florida Healthy Kids programs and
352the Title XXI-subsidized enrolled population.
354By February 1, 2009, the Florida Healthy Kids Corporation shall
355provide a study to the Legislature and the Governor on premium
356impacts to the subsidized portion of the program from the
357inclusion of the full-pay program, which shall include
358recommendations on how to eliminate or mitigate possible impacts
359to the subsidized premiums.
360     16.15.  Establish benefit packages which conform to the
361provisions of the Florida Kidcare program, as created in ss.
363     Section 5.  Subsection (5) of section 409.814, Florida
364Statutes, is amended to read:
365     409.814  Eligibility.--A child who has not reached 19 years
366of age whose family income is equal to or below 200 percent of
367the federal poverty level is eligible for the Florida Kidcare
368program as provided in this section. For enrollment in the
369Children's Medical Services Network, a complete application
370includes the medical or behavioral health screening. If,
371subsequently, an individual is determined to be ineligible for
372coverage, he or she must immediately be disenrolled from the
373respective Florida Kidcare program component.
374     (5)  A child whose family income is above 200 percent of
375the federal poverty level or a child who is excluded under the
376provisions of subsection (4) may participate in the Medikids
377program as provided in s. 409.8132 or, if the child is
378ineligible for Medikids by reason of age, in the Florida Healthy
379Kids program, subject to the following provisions:
380     (a)  The family is not eligible for premium assistance
381payments and must pay the full cost of the premium, including
382any administrative costs.
383     (b)  The agency is authorized to place limits on enrollment
384in Medikids by these children in order to avoid adverse
385selection. The number of children participating in Medikids
386whose family income exceeds 200 percent of the federal poverty
387level must not exceed 10 percent of total enrollees in the
388Medikids program.
389     (b)(c)  The board of directors of the Florida Healthy Kids
390Corporation may is authorized to place limits on enrollment of
391these children in order to avoid adverse selection. In addition,
392the board is authorized to offer a reduced benefit package to
393these children in order to limit program costs for such
394families. The number of children participating in the Florida
395Healthy Kids program whose family income exceeds 200 percent of
396the federal poverty level must not exceed 10 percent of total
397enrollees in the Florida Healthy Kids program.
398     Section 6.  Effective upon this act becoming law and
399applicable to policies issued or renewed on or after October 1,
4002008, section 627.6562, Florida Statutes, is amended to read:
401     627.6562  Dependent coverage.--
402     (1)  If an insurer offers coverage that insures dependent
403children of the policyholder or certificateholder, the policy
404must insure a dependent child of the policyholder or
405certificateholder at least until the end of the calendar year in
406which the child reaches the age of 25, if the child meets all of
407the following:
408     (a)  The child is dependent upon the policyholder or
409certificateholder for support.
410     (b)  The child is living in the household of the
411policyholder or certificateholder, or the child is a full-time
412or part-time student.
413     (2)  A policy that is subject to the requirements of
414subsection (1) must also offer the policyholder or
415certificateholder the option to insure a child of the
416policyholder or certificateholder at least until the end of the
417calendar year in which the child reaches the age of 30, if the
419     (a)  Is unmarried and does not have a dependent of his or
420her own;
421     (b)  Is a resident of this state or a full-time or part-
422time student; and
423     (c)  Is not provided coverage as a named subscriber,
424insured, enrollee, or covered person under any other group,
425blanket, or franchise health insurance policy or individual
426health benefits plan, or entitled to benefits under Title XVIII
427of the Social Security Act.
428     (3)  If, pursuant to subsection (2), a child is provided
429coverage under the parent's policy after the end of the calendar
430year in which the child reaches age 25, and coverage for the
431child is subsequently terminated, the child is not eligible to
432be covered under the parent's policy unless the child was
433continuously covered by other creditable coverage without a gap
434in coverage of more than 63 days. For the purposes of this
435subsection, the term "creditable coverage" has the same meaning
436as defined in s. 627.6561(5).
437     (4)(2)  Nothing in This section does not affect or preempt
438affects or preempts an insurer's right to medically underwrite
439or charge the appropriate premium.
440     Section 7.  Effective upon this act becoming a law and
441applicable to policies issued or renewed on or after that date,
442paragraph (v) of subsection (3) of section 627.6699, Florida
443Statutes, is amended to read:
444     627.6699  Employee Health Care Access Act.--
445     (3)  DEFINITIONS.--As used in this section, the term:
446     (v)  "Small employer" means, in connection with a health
447benefit plan with respect to a calendar year and a plan year,
448any person, sole proprietor, self-employed individual,
449independent contractor, firm, corporation, partnership, or
450association that is actively engaged in business, has its
451principal place of business in this state, employed an average
452of at least 1 but not more than 50 eligible employees on
453business days during the preceding calendar year, the majority
454of whom were employed within this state, and employs at least 1
455employee on the first day of the plan year, and is not formed
456primarily for the purpose of purchasing health insurance. In
457determining the number of eligible employees, companies that are
458an affiliated group as defined in s. 1504(a) of the Internal
459Revenue Code shall be considered one employer. For purposes of
460this section, a sole proprietor, an independent contractor, or a
461self-employed individual is considered a small employer only if
462all of the conditions and criteria established in this section
463are met.
464     Section 8.  This act shall take effect upon becoming a law.
T I T L E  A M E N D M E N T
471     Remove the entire title and insert:
A bill to be entitled
473An act relating to health insurance; amending s. 112.363, F.S.;
474specifying that coverage provided through the Cover Florida
475Health Care Access Program is considered health insurance
476coverage for the purposes of determining eligibility for the
477state retiree health insurance subsidy; amending s. 408.909,
478F.S.; revising eligibility for enrollment in a health flex plan;
479revising the expiration date of the health flex plan program;
480creating s. 408.9091, F.S.; creating the Cover Florida Health
481Care Access Program; providing a short title; providing
482legislative intent; providing definitions; requiring the Agency
483for Health Care Administration and the Office of Insurance
484Regulation of the Financial Services Commission within the
485Department of Financial Services to jointly  administer the
486program; providing program requirements; requiring the
487development of guidelines to meet minimum standards for quality
488care and access to care; requiring the agency to ensure that the
489Cover Florida plans follow standardized grievance procedures;
490requiring the Executive Office of the Governor, the agency, and
491the office to develop a public awareness program; authorizing
492public and private entities to design or extend incentives for
493participation in the Cover Florida Access Program; requiring the
494agency and the office to announce an invitation to negotiate for
495Cover Florida plan entities to design a coverage proposal;
496requiring the agency and the office to approve one plan entity;
497authorizing the agency and the office to approve one regional
498network plan in each existing Medicaid area; requiring the
499invitation to negotiate to include certain guidelines; providing
500certain conditions in which plans are disapproved or withdrawn;
501authorizing the agency and the office to announce an invitation
502to negotiate for companies that offer supplemental insurance or
503discount medical plans; providing that certain licensing
504requirements or ch. 641, F.S., are not applicable to a Cover
505Florida plan; providing that Cover Florida plans are considered
506insurance under certain conditions; excluding Cover Florida
507plans from the Florida Life and Health Insurance Guaranty
508Association and the Health Maintenance Organization Consumer
509Assistance Plan; providing requirements for eligibility in a
510Cover Florida plan; requiring each Cover Florida plan to
511maintain and provide certain records; providing that coverage
512under a Cover Florida plan is not an entitlement and does not
513give rise to a cause of action; requiring the agency and the
514office to evaluate the Cover Florida program and submit an
515annual report to the Governor and the Legislature; requiring the
516agency and the Financial Services Commission to adopt rules;
517amending s. 624.91, F.S.; revising the duties of the Florida
518Healthy Kids Corporation; amending s. 409.814, F.S.; revising
519the eligibility requirements for participation in the Medikids
520program or the Florida Healthy Kids program; deleting certain
521limitations; amending s. 627.6562, F.S.; requiring insurance
522policies that provide dependent coverage to provide the
523policyholder with the option of insuring a child until the age
524of 30 under certain circumstances; amending s. 627.6699, F.S.;
525redefining the term "small employer" for purposes of the
526Employee Health Care Access Act; providing an effective date.

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