1 | Representative Ausley offered the following: |
2 |
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3 | Amendment (with title amendment) |
4 | Remove everything after the enacting clause and insert: |
5 | Section 1. Paragraph (d) of subsection (2) of section |
6 | 112.363, Florida Statutes, is amended to read: |
7 | 112.363 Retiree health insurance subsidy.-- |
8 | (2) ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.-- |
9 | (d) Payment of the retiree health insurance subsidy shall |
10 | be made only after coverage for health insurance for the retiree |
11 | or beneficiary has been certified in writing to the Department |
12 | of Management Services. Participation in a former employer's |
13 | group health insurance program is not a requirement for |
14 | eligibility under this section. Coverage issued pursuant to s. |
15 | 408.9091 is considered health insurance for the purposes of this |
16 | section. |
17 | Section 2. Subsections (5) and (10) of section 408.909, |
18 | Florida Statutes, are amended to read: |
19 | 408.909 Health flex plans.-- |
20 | (5) ELIGIBILITY.--Eligibility to enroll in an approved |
21 | health 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 |
24 | percent of the federal poverty level; |
25 | (c) Are eligible under a federally approved Medicaid |
26 | demonstration waiver and reside in Palm Beach County or Miami- |
27 | Dade County; |
28 | (c)(d) Are not covered by a private insurance policy and |
29 | are not eligible for coverage through a public health insurance |
30 | program, such as Medicare or Medicaid, unless specifically |
31 | authorized under paragraph (c), or another public health care |
32 | program, such as Kidcare, and have not been covered at any time |
33 | during the past 6 months; who are covered under an individual |
34 | contract issued by a health maintenance organization that is an |
35 | approved health flex plan on October 1, 2008, and are applying |
36 | for coverage in the same health flex plan without a lapse in |
37 | coverage and all other eligibility requirements under this |
38 | subsection are met; or who were covered under Medicaid or |
39 | Kidcare and lost eligibility for Medicaid or a Kidcare subsidy |
40 | due to income restrictions within 90 days before applying for |
41 | health care coverage through an approved health flex plan; and |
42 | (d)(e) Have applied for health care coverage through an |
43 | approved health flex plan and have agreed to make any payments |
44 | required for participation, including periodic payments or |
45 | payments 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 |
48 | to read: |
49 | 408.9091 Cover Florida Health Care Access Act.-- |
50 | (1) SHORT TITLE.--This section may be cited as the "Cover |
51 | Florida Health Access Program Act." |
52 | (2) INTENT.--The Legislature finds that a significant |
53 | proportion of state residents are unable to obtain affordable |
54 | health insurance coverage. The Legislature also finds that |
55 | existing "health flex" plan coverage has had limited |
56 | participation due in part to narrow eligibility restrictions as |
57 | well as minimal benefit options for catastrophic and emergency |
58 | care coverage. Therefore, it is the Legislature's intent to |
59 | expand the availability of health care options for uninsured |
60 | residents by developing an affordable health care product that |
61 | emphasizes coverage for basic and preventive health care |
62 | services; provides inpatient hospital, urgent, and emergency |
63 | care services; and is offered statewide by approved health |
64 | insurers, health maintenance organizations, health-care- |
65 | provider-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 |
68 | Administration. |
69 | (b) "Office" means the Office of Insurance Regulation of |
70 | the Financial Services Commission. |
71 | (c) "Enrollee" means an individual who has been determined |
72 | to be eligible for and is receiving health insurance coverage |
73 | under a Cover Florida plan. |
74 | (d) "Cover Florida plan" means a consumer choice benefit |
75 | plan approved under this section which guarantees payment or |
76 | coverage for specified benefits provided to an enrollee. |
77 | (e) "Cover Florida plan coverage" means health care |
78 | services that are covered as benefits under a Cover Florida |
79 | plan. |
80 | (f) "Cover Florida plan entity" means a health insurer, |
81 | health maintenance organization, health-care-provider-sponsored |
82 | organization, or health care district that develops and |
83 | implements a Cover Florida plan and is responsible for |
84 | administering the plan and paying all claims for Cover Florida |
85 | plan coverage by enrollees. |
86 | (g) "Cover Florida Plus" plan means a supplemental |
87 | insurance product, such as for additional catastrophic coverage |
88 | or dental, vision, or cancer coverage, approved under this |
89 | section and offered to all enrollees. |
90 | (4) PROGRAM.--The agency and the office shall jointly |
91 | establish and administer the Cover Florida Health Care Access |
92 | Program. |
93 | (a) General Cover Florida plan components must require |
94 | that: |
95 | 1. Plans are offered as guaranteed issue to enrollees, |
96 | subject to exclusions for preexisting conditions approved by the |
97 | office and the agency. |
98 | 2. Plans are portable, such that the enrollee remains |
99 | covered regardless of employment status or the cost-sharing of |
100 | premiums. |
101 | 3. Plans may provide for cost containment through limits |
102 | on the number of services, caps on benefit payments, and |
103 | copayments for services. |
104 | 4. A Cover Florida health plan entity makes all benefit |
105 | plan and marketing materials available in English and Spanish. |
106 | 5. In order to provide for consumer choice, Cover Florida |
107 | health plan entities develop two alternative benefit option |
108 | plans having different cost and benefit levels, including at |
109 | least one plan that provides catastrophic coverage. |
110 | 6. Plans without catastrophic coverage provide coverage |
111 | options for the following services, including, but not limited |
112 | to: |
113 | a. Preventive health services, including preventive |
114 | screenings, annual health assessments, and well-care and well- |
115 | woman services, including mammograms, screenings for cervical |
116 | cancer, noninvasive colorectal or prostate screenings, and |
117 | immunizations. |
118 | b. Incentives for routine, preventive care. |
119 | c. Office visits for the diagnosis and treatment of |
120 | illness 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, |
126 | provide coverage options for all of the services listed under |
127 | subparagraph 6., and in addition include, but are not limited |
128 | to, 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 |
133 | outpatient diagnostic services. |
134 | 8. Plans offer prescription drug benefit coverage on all |
135 | plans, or use a prescription drug manager, such as the Florida |
136 | Discount Drug Card Program. |
137 | 9. Plans provide, in enrollment materials, plain-language |
138 | information on policy benefit coverage, benefit limits, cost- |
139 | sharing requirements, and exclusions and a clear representation |
140 | of what is not covered in the plan. |
141 | 10. Plans offered through a qualified employer meet the |
142 | requirements of s. 125 of the Internal Revenue Code. |
143 | (b) Guidelines shall be developed to ensure that Cover |
144 | Florida plans meet minimum standards for quality of care and |
145 | access to care. The agency shall ensure that the Cover Florida |
146 | plans follow standardized grievance procedures. |
147 | (c) Changes in Cover Florida plan benefits, premiums, and |
148 | policy forms are subject to regulatory oversight by the office |
149 | and agency as provided by rules adopted by the Financial |
150 | Services Commission and the agency. |
151 | (d) The agency, the office, and the Executive Office of |
152 | the Governor shall develop a public awareness program to be |
153 | implemented throughout the state for the promotion of the Cover |
154 | Florida Health Access Program. |
155 | (e) Public or private entities may design programs to |
156 | encourage Floridians to participate in the Cover Florida Health |
157 | Access Program, or to encourage employers to cosponsor some |
158 | share of Cover Florida plan premiums for employees. |
159 | (5) PLAN PROPOSALS.--The agency and the office shall |
160 | announce, no later than July 1, 2008, an invitation to negotiate |
161 | for Cover Florida plan entities to design a Cover Florida plan |
162 | proposal in which benefits and premiums are specified. |
163 | (a) The invitation to negotiate shall include guidelines |
164 | for the review of Cover Florida plan applications, policy forms, |
165 | and all associated forms, and provide regulatory oversight of |
166 | Cover Florida plan advertisement and marketing procedures. A |
167 | plan shall be disapproved or withdrawn if the plan: |
168 | 1. Contains any ambiguous, inconsistent, or misleading |
169 | provisions or any exceptions or conditions that deceptively |
170 | affect or limit the benefits purported to be assumed in the |
171 | general coverage provided by the plan; |
172 | 2. Provides benefits that are unreasonable in relation to |
173 | the premium charged or contains provisions that are unfair or |
174 | inequitable, that are contrary to the public policy of this |
175 | state, that encourage misrepresentation, or that result in |
176 | unfair discrimination in sales practices; |
177 | 3. Cannot demonstrate that the plan is financially sound |
178 | and that the applicant is able to underwrite or finance the |
179 | health care coverage provided; |
180 | 4. Cannot demonstrate that the applicant and its |
181 | management are in compliance with the standards required under |
182 | s. 624.404(3); or |
183 | 5. Does not guarantee that enrollees may participate in |
184 | the Cover Florida plan entity's comprehensive network of |
185 | providers, as determined by the office, the agency, and the |
186 | contract. |
187 | (b) The agency and the office may announce an invitation |
188 | to negotiate for the design of Cover Florida Plus products to |
189 | companies that offer supplemental insurance, discount medical |
190 | plan organizations licensed under part II of chapter 636, or |
191 | prepaid health clinics licensed under part II of chapter 641. |
192 | (c) The agency and office shall approve at least one Cover |
193 | Florida plan entity having an existing statewide network of |
194 | providers, and may approve at least one regional network plan in |
195 | each existing Medicaid area. |
196 | (6) LICENSE NOT REQUIRED.-- |
197 | (a) The licensing requirements of the Florida Insurance |
198 | Code and chapter 641, relating to health maintenance |
199 | organizations, do not apply to a Cover Florida plan approved |
200 | under this section unless expressly made applicable. However, |
201 | for the purpose of prohibiting unfair trade practices, Cover |
202 | Florida plans are considered to be insurance subject to the |
203 | applicable provisions of part IX of chapter 626, except as |
204 | otherwise provided in this section. |
205 | (b) Cover Florida plans are not covered by the Florida |
206 | Life and Health Insurance Guaranty Association under part III of |
207 | chapter 631 or by the Health Maintenance Organization Consumer |
208 | Assistance Plan under part IV of chapter 631. |
209 | (7) ELIGIBILITY.--Eligibility to enroll in a Cover Florida |
210 | plan is limited to residents of this state who meet all of the |
211 | following: |
212 | (a) Are 19 to 64 years of age. |
213 | (b) Are not covered by a private health insurance policy |
214 | and are not eligible for coverage through a public health |
215 | insurance program, such as Medicare, Medicaid, or Kidcare, |
216 | unless eligibility for coverage lapses due to no longer meeting |
217 | income or categorical requirements. |
218 | (c) Have not been covered by any health insurance program |
219 | at any time during the past 6 months, unless coverage under a |
220 | health insurance program was terminated within the previous 6 |
221 | months due to: |
222 | 1. Loss of a job that provided an employer-sponsored |
223 | health benefit plan; |
224 | 2. Exhaustion of coverage that was continued under COBRA |
225 | or 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 |
228 | employer-sponsored health benefit plan. |
229 | (d) Have applied for health care coverage through a Cover |
230 | Florida plan and have agreed to make any payments required for |
231 | participation, including periodic payments or payments due at |
232 | the time health care services are provided. |
233 | (8) RECORDS.--Each Cover Florida plan must maintain |
234 | enrollment data and provide network data and reasonable records |
235 | to enable the office and agency to monitor plans and to |
236 | determine the financial viability of the Cover Florida plan, as |
237 | necessary. |
238 | (9) NONENTITLEMENT.--Coverage under a Cover Florida plan |
239 | is not an entitlement, and a cause of action does not arise |
240 | against the state, a local government entity, any other |
241 | political subdivision of this state, or the agency or office for |
242 | failure to make coverage available to eligible persons under |
243 | this section. |
244 | (10) PROGRAM EVALUATION.--The agency and the office shall: |
245 | (a) Evaluate the Cover Florida program and its effect on |
246 | the entities that seek approval as Cover Florida plans, on the |
247 | number of enrollees, and on the scope of the health care |
248 | coverage offered under a Cover Florida plan; |
249 | (b) Provide an assessment of the Cover Florida plans and |
250 | their potential applicability in other settings; |
251 | (c) Use Cover Florida plans to gather more information to |
252 | evaluate low-income, consumer-driven benefit packages; and |
253 | (d) Jointly submit by March 1, 2009, and annually |
254 | thereafter, a report to the Governor, the President of the |
255 | Senate, and the Speaker of the House of Representatives |
256 | providing the information specified in paragraphs (a)-(c) and |
257 | recommendations relating to the successful implementation and |
258 | administration of the program. |
259 | (11) RULEMAKING AUTHORITY.--The agency and the Financial |
260 | Services Commission may adopt rules as needed to administer this |
261 | section. |
262 | Section 4. Paragraph (b) of subsection (5) of section |
263 | 624.91, Florida Statutes, is amended to read: |
264 | 624.91 The Florida Healthy Kids Corporation Act.-- |
265 | (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.-- |
266 | (b) The Florida Healthy Kids Corporation shall: |
267 | 1. Arrange for the collection of any family, local |
268 | contributions, or employer payment or premium, in an amount to |
269 | be determined by the board of directors, to provide for payment |
270 | of premiums for comprehensive insurance coverage and for the |
271 | actual or estimated administrative expenses. |
272 | 2. Arrange for the collection of any voluntary |
273 | contributions to provide for payment of premiums for children |
274 | who are not eligible for medical assistance under Title XXI of |
275 | the Social Security Act. |
276 | 3. Subject to the provisions of s. 409.8134, accept |
277 | voluntary supplemental local match contributions that comply |
278 | with the requirements of Title XXI of the Social Security Act |
279 | for the purpose of providing additional coverage in contributing |
280 | counties under Title XXI. |
281 | 4. Establish the administrative and accounting procedures |
282 | for the operation of the corporation. |
283 | 5. Establish, with consultation from appropriate |
284 | professional organizations, standards for preventive health |
285 | services and providers and comprehensive insurance benefits |
286 | appropriate to children, provided that such standards for rural |
287 | areas shall not limit primary care providers to board-certified |
288 | pediatricians. |
289 | 6. Determine eligibility for children seeking to |
290 | participate in the Title XXI-funded components of the Florida |
291 | Kidcare program consistent with the requirements specified in s. |
292 | 409.814, as well as the non-Title-XXI-eligible children as |
293 | provided in subsection (3). |
294 | 7. Establish procedures under which providers of local |
295 | match to, applicants to and participants in the program may have |
296 | grievances reviewed by an impartial body and reported to the |
297 | board of directors of the corporation. |
298 | 8. Establish participation criteria and, if appropriate, |
299 | contract with an authorized insurer, health maintenance |
300 | organization, or third-party administrator to provide |
301 | administrative services to the corporation. |
302 | 9. Establish enrollment criteria which shall include |
303 | penalties or waiting periods of not fewer than 60 days for |
304 | reinstatement of coverage upon voluntary cancellation for |
305 | nonpayment of family premiums. |
306 | 10. Contract with authorized insurers or any provider of |
307 | health care services, meeting standards established by the |
308 | corporation, for the provision of comprehensive insurance |
309 | coverage to participants. Such standards shall include criteria |
310 | under which the corporation may contract with more than one |
311 | provider of health care services in program sites. Health plans |
312 | shall be selected through a competitive bid process. The Florida |
313 | Healthy Kids Corporation shall purchase goods and services in |
314 | the most cost-effective manner consistent with the delivery of |
315 | quality medical care. The maximum administrative cost for a |
316 | Florida Healthy Kids Corporation contract shall be 15 percent. |
317 | For health care contracts, the minimum medical loss ratio for a |
318 | Florida Healthy Kids Corporation contract shall be 85 percent. |
319 | For dental contracts, the remaining compensation to be paid to |
320 | the authorized insurer or provider under a Florida Healthy Kids |
321 | Corporation contract shall be no less than an amount which is 85 |
322 | percent of premium; to the extent any contract provision does |
323 | not provide for this minimum compensation, this section shall |
324 | prevail. The health plan selection criteria and scoring system, |
325 | and the scoring results, shall be available upon request for |
326 | inspection after the bids have been awarded. |
327 | 11. Establish disenrollment criteria in the event local |
328 | matching funds are insufficient to cover enrollments. |
329 | 12. Develop and implement a plan to publicize the Florida |
330 | Healthy Kids Corporation, the eligibility requirements of the |
331 | program, and the procedures for enrollment in the program and to |
332 | maintain public awareness of the corporation and the program. |
333 | 13. Secure staff necessary to properly administer the |
334 | corporation. Staff costs shall be funded from state and local |
335 | matching funds and such other private or public funds as become |
336 | available. The board of directors shall determine the number of |
337 | staff members necessary to administer the corporation. |
338 | 14. Provide a report annually to the Governor, Chief |
339 | Financial Officer, Commissioner of Education, Senate President, |
340 | Speaker of the House of Representatives, and Minority Leaders of |
341 | the Senate and the House of Representatives. |
342 | 15. Provide information on a quarterly basis to the |
343 | Legislature and the Governor which compares the costs and |
344 | utilization of the full-pay enrolled population and the Title |
345 | XXI-subsidized enrolled population in the KidCare program. The |
346 | information, at a minimum, must include: |
347 | a. The monthly enrollment and expenditure for full-pay |
348 | enrollees in the Medikids and Florida Healthy Kids programs |
349 | compared to the Title XXI-subsidized enrolled population; and |
350 | b. The costs and utilization by service of the full-pay |
351 | enrollees in the Medikids and Florida Healthy Kids programs and |
352 | the Title XXI-subsidized enrolled population. |
353 | |
354 | By February 1, 2009, the Florida Healthy Kids Corporation shall |
355 | provide a study to the Legislature and the Governor on premium |
356 | impacts to the subsidized portion of the program from the |
357 | inclusion of the full-pay program, which shall include |
358 | recommendations on how to eliminate or mitigate possible impacts |
359 | to the subsidized premiums. |
360 | 16.15. Establish benefit packages which conform to the |
361 | provisions of the Florida Kidcare program, as created in ss. |
362 | 409.810-409.820. |
363 | Section 5. Subsection (5) of section 409.814, Florida |
364 | Statutes, is amended to read: |
365 | 409.814 Eligibility.--A child who has not reached 19 years |
366 | of age whose family income is equal to or below 200 percent of |
367 | the federal poverty level is eligible for the Florida Kidcare |
368 | program as provided in this section. For enrollment in the |
369 | Children's Medical Services Network, a complete application |
370 | includes the medical or behavioral health screening. If, |
371 | subsequently, an individual is determined to be ineligible for |
372 | coverage, he or she must immediately be disenrolled from the |
373 | respective Florida Kidcare program component. |
374 | (5) A child whose family income is above 200 percent of |
375 | the federal poverty level or a child who is excluded under the |
376 | provisions of subsection (4) may participate in the Medikids |
377 | program as provided in s. 409.8132 or, if the child is |
378 | ineligible for Medikids by reason of age, in the Florida Healthy |
379 | Kids program, subject to the following provisions: |
380 | (a) The family is not eligible for premium assistance |
381 | payments and must pay the full cost of the premium, including |
382 | any administrative costs. |
383 | (b) The agency is authorized to place limits on enrollment |
384 | in Medikids by these children in order to avoid adverse |
385 | selection. The number of children participating in Medikids |
386 | whose family income exceeds 200 percent of the federal poverty |
387 | level must not exceed 10 percent of total enrollees in the |
388 | Medikids program. |
389 | (b)(c) The board of directors of the Florida Healthy Kids |
390 | Corporation may is authorized to place limits on enrollment of |
391 | these children in order to avoid adverse selection. In addition, |
392 | the board is authorized to offer a reduced benefit package to |
393 | these children in order to limit program costs for such |
394 | families. The number of children participating in the Florida |
395 | Healthy Kids program whose family income exceeds 200 percent of |
396 | the federal poverty level must not exceed 10 percent of total |
397 | enrollees in the Florida Healthy Kids program. |
398 | Section 6. Effective upon this act becoming law and |
399 | applicable to policies issued or renewed on or after October 1, |
400 | 2008, section 627.6562, Florida Statutes, is amended to read: |
401 | 627.6562 Dependent coverage.-- |
402 | (1) If an insurer offers coverage that insures dependent |
403 | children of the policyholder or certificateholder, the policy |
404 | must insure a dependent child of the policyholder or |
405 | certificateholder at least until the end of the calendar year in |
406 | which the child reaches the age of 25, if the child meets all of |
407 | the following: |
408 | (a) The child is dependent upon the policyholder or |
409 | certificateholder for support. |
410 | (b) The child is living in the household of the |
411 | policyholder or certificateholder, or the child is a full-time |
412 | or part-time student. |
413 | (2) A policy that is subject to the requirements of |
414 | subsection (1) must also offer the policyholder or |
415 | certificateholder the option to insure a child of the |
416 | policyholder or certificateholder at least until the end of the |
417 | calendar year in which the child reaches the age of 30, if the |
418 | child: |
419 | (a) Is unmarried and does not have a dependent of his or |
420 | her own; |
421 | (b) Is a resident of this state or a full-time or part- |
422 | time student; and |
423 | (c) Is not provided coverage as a named subscriber, |
424 | insured, enrollee, or covered person under any other group, |
425 | blanket, or franchise health insurance policy or individual |
426 | health benefits plan, or entitled to benefits under Title XVIII |
427 | of the Social Security Act. |
428 | (3) If, pursuant to subsection (2), a child is provided |
429 | coverage under the parent's policy after the end of the calendar |
430 | year in which the child reaches age 25, and coverage for the |
431 | child is subsequently terminated, the child is not eligible to |
432 | be covered under the parent's policy unless the child was |
433 | continuously covered by other creditable coverage without a gap |
434 | in coverage of more than 63 days. For the purposes of this |
435 | subsection, the term "creditable coverage" has the same meaning |
436 | as defined in s. 627.6561(5). |
437 | (4)(2) Nothing in This section does not affect or preempt |
438 | affects or preempts an insurer's right to medically underwrite |
439 | or charge the appropriate premium. |
440 | Section 7. Effective upon this act becoming a law and |
441 | applicable to policies issued or renewed on or after that date, |
442 | paragraph (v) of subsection (3) of section 627.6699, Florida |
443 | Statutes, 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 |
447 | benefit plan with respect to a calendar year and a plan year, |
448 | any person, sole proprietor, self-employed individual, |
449 | independent contractor, firm, corporation, partnership, or |
450 | association that is actively engaged in business, has its |
451 | principal place of business in this state, employed an average |
452 | of at least 1 but not more than 50 eligible employees on |
453 | business days during the preceding calendar year, the majority |
454 | of whom were employed within this state, and employs at least 1 |
455 | employee on the first day of the plan year, and is not formed |
456 | primarily for the purpose of purchasing health insurance. In |
457 | determining the number of eligible employees, companies that are |
458 | an affiliated group as defined in s. 1504(a) of the Internal |
459 | Revenue Code shall be considered one employer. For purposes of |
460 | this section, a sole proprietor, an independent contractor, or a |
461 | self-employed individual is considered a small employer only if |
462 | all of the conditions and criteria established in this section |
463 | are met. |
464 | Section 8. This act shall take effect upon becoming a law. |
465 |
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466 |
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469 | ----------------------------------------------------- |
470 | T I T L E A M E N D M E N T |
471 | Remove the entire title and insert: |
472 | A bill to be entitled |
473 | An act relating to health insurance; amending s. 112.363, F.S.; |
474 | specifying that coverage provided through the Cover Florida |
475 | Health Care Access Program is considered health insurance |
476 | coverage for the purposes of determining eligibility for the |
477 | state retiree health insurance subsidy; amending s. 408.909, |
478 | F.S.; revising eligibility for enrollment in a health flex plan; |
479 | revising the expiration date of the health flex plan program; |
480 | creating s. 408.9091, F.S.; creating the Cover Florida Health |
481 | Care Access Program; providing a short title; providing |
482 | legislative intent; providing definitions; requiring the Agency |
483 | for Health Care Administration and the Office of Insurance |
484 | Regulation of the Financial Services Commission within the |
485 | Department of Financial Services to jointly administer the |
486 | program; providing program requirements; requiring the |
487 | development of guidelines to meet minimum standards for quality |
488 | care and access to care; requiring the agency to ensure that the |
489 | Cover Florida plans follow standardized grievance procedures; |
490 | requiring the Executive Office of the Governor, the agency, and |
491 | the office to develop a public awareness program; authorizing |
492 | public and private entities to design or extend incentives for |
493 | participation in the Cover Florida Access Program; requiring the |
494 | agency and the office to announce an invitation to negotiate for |
495 | Cover Florida plan entities to design a coverage proposal; |
496 | requiring the agency and the office to approve one plan entity; |
497 | authorizing the agency and the office to approve one regional |
498 | network plan in each existing Medicaid area; requiring the |
499 | invitation to negotiate to include certain guidelines; providing |
500 | certain conditions in which plans are disapproved or withdrawn; |
501 | authorizing the agency and the office to announce an invitation |
502 | to negotiate for companies that offer supplemental insurance or |
503 | discount medical plans; providing that certain licensing |
504 | requirements or ch. 641, F.S., are not applicable to a Cover |
505 | Florida plan; providing that Cover Florida plans are considered |
506 | insurance under certain conditions; excluding Cover Florida |
507 | plans from the Florida Life and Health Insurance Guaranty |
508 | Association and the Health Maintenance Organization Consumer |
509 | Assistance Plan; providing requirements for eligibility in a |
510 | Cover Florida plan; requiring each Cover Florida plan to |
511 | maintain and provide certain records; providing that coverage |
512 | under a Cover Florida plan is not an entitlement and does not |
513 | give rise to a cause of action; requiring the agency and the |
514 | office to evaluate the Cover Florida program and submit an |
515 | annual report to the Governor and the Legislature; requiring the |
516 | agency and the Financial Services Commission to adopt rules; |
517 | amending s. 624.91, F.S.; revising the duties of the Florida |
518 | Healthy Kids Corporation; amending s. 409.814, F.S.; revising |
519 | the eligibility requirements for participation in the Medikids |
520 | program or the Florida Healthy Kids program; deleting certain |
521 | limitations; amending s. 627.6562, F.S.; requiring insurance |
522 | policies that provide dependent coverage to provide the |
523 | policyholder with the option of insuring a child until the age |
524 | of 30 under certain circumstances; amending s. 627.6699, F.S.; |
525 | redefining the term "small employer" for purposes of the |
526 | Employee Health Care Access Act; providing an effective date. |
527 |
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528 |
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