Florida Senate - 2013 COMMITTEE AMENDMENT
Bill No. SB 1844
Senate . House
Comm: RCS .
Appropriations Subcommittee on Health and Human Services (Bean)
recommended the following:
1 Senate Amendment (with title amendment)
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Paragraphs (a), (b), (e), and (f) of subsection
6 (4) and paragraph (b) of subsection (7) of section 408.910,
7 Florida Statutes, are amended, and paragraph (c) is added to
8 subsection (10) of that section, to read
9 408.910 Florida Health Choices Program.—
10 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
11 program is voluntary and shall be available to employers,
12 individuals, vendors, and health insurance agents as specified
13 in this subsection.
14 (a) Employers eligible to enroll in the program include
15 those employers
16 1. Employers that meet criteria established by the
17 corporation and elect to make their employees eligible through
18 the program.
19 2. Fiscally constrained counties described in s. 218.67 .
20 3. Municipalities having populations of fewer than 50,000
22 4. School districts in fiscally constrained counties.
23 5. Statutory rural hospitals.
24 (b) Individuals eligible to participate in the program
26 1. Individual employees of enrolled employers.
27 2. Other individuals that meet criteria established by the
28 corporation State employees not eligible for state employee
29 health benefits.
30 3. State retirees.
31 4. Medicaid participants who opt out.
32 (e) Eligible individuals may participate in the program
33 voluntarily continue participation in the program regardless of
34 subsequent changes in job status or Medicaid eligibility.
35 Individuals who join the program may participate by complying
36 with the procedures established by the corporation. These
37 procedures must include, but are not limited to:
38 1. Submission of required information.
39 2. Authorization for payroll deduction.
40 3. Compliance with federal tax requirements.
41 4. Arrangements for payment in the event of job changes.
42 5. Selection of products and services.
43 (f) Vendors who choose to participate in the program may
44 enroll by complying with the procedures established by the
45 corporation. These procedures may include, but are not limited
47 1. Submission of required information, including a complete
48 description of the coverage, services, provider network, payment
49 restrictions, and other requirements of each product offered
50 through the program.
51 2. Execution of an agreement to comply with requirements
52 established by the corporation.
53 3. Execution of an agreement that prohibits refusal to sell
54 any offered non-risk-bearing product or service to a participant
55 who elects to buy it.
56 4. Establishment of product prices based on applicable
57 criteria age, gender, and location of the individual
58 participant, which may include medical underwriting.
59 5. Arrangements for receiving payment for enrolled
61 6. Participation in ongoing reporting processes established
62 by the corporation.
63 7. Compliance with grievance procedures established by the
65 (7) THE MARKETPLACE PROCESS.—The program shall provide a
66 single, centralized market for purchase of health insurance,
67 health maintenance contracts, and other health products and
68 services. Purchases may be made by participating individuals
69 over the Internet or through the services of a participating
70 health insurance agent. Information about each product and
71 service available through the program shall be made available
72 through printed material and an interactive Internet website. A
73 participant needing personal assistance to select products and
74 services shall be referred to a participating agent in his or
75 her area.
76 (b) Initial selection of products and services must be made
77 by an individual participant within the applicable open
78 enrollment period 60 days after the date the individual’s
79 employer qualified for participation. An individual who fails to
80 enroll in products and services by the end of this period is
81 limited to participation in flexible spending account services
82 until the next annual enrollment period .
83 (10) EXEMPTIONS.—
84 (c) Any standard forms, website design, or marketing
85 communication developed by the corporation and used by the
86 corporation, or any vendor that meets the requirements of s.
87 408.910(4)(f) is not subject to the Florida Insurance Code, as
88 established in s. 624.01.
89 Section 2. Section 408.9105, Florida Statutes, is created
90 to read:
91 408.9105 Health Choice Plus Program.—
92 (1) LEGISLATIVE INTENT.—The Legislature recognizes that
93 there are more than 600,000 uninsured residents in this state
94 who have incomes at or below 100 percent of the federal poverty
95 level. Many insurance options are not affordable, and the
96 Legislature intends to provide a benefit program to those
97 individuals who seek assistance with coverage and who assume
98 individual responsibility for their own health care needs. It is
99 therefore the intent of the Legislature to expand the services
100 provided by the Florida Health Choices Program and begin the
101 phase-in of the Health Choice Plus Program starting July 1,
102 2013. The Health Choice Plus Program shall:
103 (a) Use the existing infrastructure and governance of
104 Florida Health Choices, Inc., to manage the program described in
105 this section.
106 (b) Offer goods and services to individuals who are between
107 19 to 64 years of age, inclusive.
108 (c) Establish guidelines for financial participation in the
109 program which allow for enrollees and others to contribute
110 toward a health benefits account.
111 1. An enrollee shall contribute at least $20 per month
112 toward the health benefits account. This contribution amount may
113 be adjusted annually in the General Appropriations Act.
114 2. The level of benefit paid into an enrollee’s account
115 using state funds is determined by the corporation based upon
116 the availability of state, local, and federal funds. The amount
117 may not exceed $10 per individual per month. This amount may be
118 adjusted annually in the General Appropriations Act.
119 (d) Implement an employer-based contribution option.
120 (e) Develop and maintain an education and public outreach
121 campaign for the Health Choice Plus Program.
122 (f) Provide a secure website to facilitate the purchase of
123 goods and services and to provide public information about the
124 program. The website must also provide information about the
125 availability of insurance affordability programs targeted at
126 this population.
127 (g) Establish an incentive program that rewards enrollees
128 for achievements in reaching healthy living goals.
129 (2) DEFINITIONS.—As used in this section, the term:
130 (a) “CHIP” means Children’s Health Insurance Program as
131 authorized under Title XXI of the Social Security Act.
132 (b) “Corporation” means Florida Health Choices, Inc., as
133 established under s. 408.910.
134 (c) “Corporation’s marketplace” means the single,
135 centralized market established by the corporation which
136 facilitates the purchase of products made available in the
138 (d) “Enrollee” means an individual who participates in or
139 receives benefits under the Health Choice Plus Program.
140 (e) “Goods and services” means the individual products
141 offered for sale to an enrollee on the corporation’s marketplace
142 or other health care-related items that may be purchased by an
143 enrollee in the private market. An enrollee may purchase these
144 products using funds accumulated in his or her health benefits
146 (f) “Health benefits account” means the account established
147 for an enrollee at the corporation into which funds may be
148 deposited by the state, the enrollee, other individuals, or
149 organizations for the purchase of health care goods and services
150 on the enrollee’s behalf.
151 (g) “Lawful permanent resident” means a non-United States
152 citizen who resides in the United States under legally
153 recognized and lawfully recorded permanent residence as an
154 immigrant. This individual may also be known as a permanent
155 resident alien.
156 (h) “Parent” or “caretaker relative” means an individual
157 who is a relative that has primary custody or legal guardianship
158 of a dependent child and provides the primary care and
159 supervision of that dependent child in the same household. A
160 caretaker relative must be related to the dependent child by
161 blood, marriage, or adoption within the fifth degree of kinship.
162 (i) “Patient Protection and Affordable Care Act” or “PPACA”
163 means the federal law enacted as Pub. L. No. 111-148, as further
164 amended by the federal Health Care and Education Reconciliation
165 Act of 2010, Pub. L. No. 111-152, and any amendments.
166 (j) “Program” means the Health Choice Plus Program
167 established under this section.
168 (k) “Vendor” means an entity that meets the requirements
169 under s. 408.910(4)(d) and is accepted by the corporation.
170 (3) ELIGIBILITY.—
171 (a) To be eligible for the Health Choice Plus Program, an
172 individual must be a resident of this state and meet all of the
173 following criteria:
174 1. Be between 19 and 64 years of age, inclusive.
175 2. Have a modified adjusted gross income that does not
176 exceed 100 percent of the federal poverty level based on the
177 individual’s most recent federal tax return, or if the
178 individual did not file a tax return, the individual’s most
179 recent monthly income.
180 3. Be a United States citizen or a lawful permanent
182 4. Be ineligible for Medicaid.
183 5. Be ineligible for employer-sponsored insurance coverage.
184 If the enrollee is eligible for employer-sponsored coverage but
185 the cost of that coverage for the enrollee’s share for
186 individual coverage would exceed 5 percent of the enrollee’s
187 total modified adjusted gross household income or the enrollee’s
188 share of family coverage would exceed 5 percent of enrollee’s
189 total modified adjusted gross household income, the enrollee is
190 not considered eligible for employer-sponsored coverage for
191 purposes of this section.
192 6. Not be enrolled in other coverage that meets the
193 definition of essential benefits coverage under PPACA.
194 (b) In addition to the requirements in paragraph (a), an
195 enrollee must meet the following categorical requirements in
196 order to maintain enrollment in the program:
197 1. For an enrollee who is also a parent or a caretaker
198 relative, the enrollee must do all of the following:
199 a. Maintain enrollment in Medicaid or CHIP for any
200 dependent child in the household who is eligible for Medicaid or
201 CHIP and who must be enrolled in Medicaid or CHIP throughout the
202 enrollee’s participation in the Health Choice Plus Program.
203 b. Complete a health assessment within the first 3 months
204 after enrollment at a county health department, federally
205 qualified health center, or other approved health care provider.
206 c. Schedule and keep at least one preventive visit with a
207 primary care provider within 6 months after enrollment and
208 repeat the preventive visit at least once every 18 months
210 d. Provide proof of employment for at least 20 hours a week
211 or proof of efforts made to seek employment. In lieu of
212 employment, the enrollee may provide proof of volunteering for
213 at least 10 hours a month at a school or at a nonprofit
214 organization or enrollment as a full-time student at an
215 accredited educational institution. Exceptions to this
216 requirement may be made on a case-by-case basis for medical
217 conditions for an enrollee or if the enrollee is the primary
218 caretaker for a family member who has a chronic and severe
219 medical condition that requires a minimum of 40 hours a week of
221 2. For an enrollee who is also a childless adult, the
222 enrollee must do all of the following:
223 a. Provide proof of employment for at least 20 hours a week
224 or proof of efforts made to seek employment. In lieu of
225 employment, the enrollee may provide proof of volunteering for
226 at least 20 hours a month at a school or at a nonprofit
227 organization or enrollment as a full-time student at an
228 accredited educational institution. Exceptions to this
229 requirement may be made on a case-by-case basis for medical
230 conditions for the enrollee or if the enrollee is the primary
231 caretaker for a family member who has a chronic and severe
232 medical condition that requires a minimum of 40 hours a week of
234 b. Complete a health assessment within the first 3 months
235 after enrollment at a county health department, federally
236 qualified health center, or other approved health care provider.
237 c. Schedule and keep at least one preventive visit with a
238 primary care provider within the first 6 months after enrollment
239 and repeat the preventive visit at least once every 18 months
242 If the enrollee fails to meet the requirements specified in this
243 subsection, the enrollee is disenrolled from the program at the
244 end of the month in which the enrollee fails to meet the
245 requirements. The enrollee may receive one 30-day extension to
246 comply before cancellation of coverage. If an enrollee’s
247 coverage is canceled, the enrollee may not reapply for coverage
248 until the next open enrollment period or 90 days after
249 cancellation of coverage occurs, whichever occurs later. The
250 individual’s reenrollment is subject to available funding.
251 (4) ENROLLMENT.—
252 (a) Enrollment in the Health Choice Plus Program may occur
253 through the portal of the Florida Health Choices Program, a
254 referral process from the Department of Children and Families,
255 the Florida Healthy Kids Corporation, or the exchange as defined
256 by the federal Patient Protection and Affordable Care Act.
257 (b) Subject to available funding, the corporation shall
258 establish at least one open enrollment period each year. When
259 the program is full based on available funding, enrollment must
261 (c) Eligibility is determined by using electronic means to
262 the fullest extent practicable before requesting any written
263 documentation from an applicant.
264 (5) HEALTH BENEFITS ACCOUNT.—
265 (a) A health benefits account is established for each
266 enrollee upon confirmation of eligibility in the program. The
267 corporation shall determine the deposit amount and frequency of
268 deposits based on the availability of funds, the number of
269 enrollees, and other factors.
270 (b) An enrollee shall make a financial contribution toward
271 his or her own health benefits account in order to maintain
272 enrollment in accordance with paragraph (1)(c).
273 1. The corporation shall establish disenrollment criteria
274 for failure to pay the required minimum contribution.
275 2. The disenrollment criteria must include waiting periods
276 of not more than 1 month before reinstatement to the program if
277 the enrollee is still eligible and has paid all required
278 financial obligations.
279 3. The enrollee’s employer may contribute toward an
280 employee’s health benefits account under the program, including
281 making the enrollee’s required contribution, in whole or in
282 part, to the enrollee’s health benefits account at any time.
283 (c) Subject to appropriations available for this specific
284 purpose, the corporation shall establish a procedure for the
285 deposit of supplemental or bonus funds into an enrollee’s health
286 benefits account if certain healthy living performance goals are
287 achieved. These goals must be established no later than July 1
288 in each fiscal year and distributed to all enrollees, published
289 on the corporation’s website, and distributed to new enrollees
290 within 30 calendar days after enrollment. For the 2014 calendar
291 year, the goals must be established no later than October 1,
293 1. An enrollee may use funds deposited in a health benefits
294 account to offset other health care costs or to purchase other
295 products and services offered by the marketplace, subject to
296 guidelines established by the corporation and in accordance with
297 federal law.
298 2. Bonus funds may accumulate in the enrollee’s health
299 benefits account for the duration of the program and must
300 automatically expire and return to the corporation upon the
301 termination of the program.
302 (d) The marketplace is encouraged to use existing community
303 programs and partnerships to deliver services and to include
304 traditional safety net providers for the delivery of services to
305 enrollees, including, but not limited to, rural health clinics,
306 federally qualified health centers, county health departments,
307 emergency room diversion programs, and community mental health
308 centers. A health care entity that receives state funding must
309 participate in the Health Choice Plus Program and offer services
310 or products through the marketplace or to enrollees, as
311 appropriate. An enrollee may be required to make nominal
312 copayments to providers for nonpreventive services. The
313 corporation may establish the amount of the copayments when
315 (e) Except for supplemental funds described under paragraph
316 (c), funds deposited in a health benefits account belong to the
317 enrollee when deposited and are available for health-care
318 related expenditures, including, but not limited to, physician’s
319 fees, hospital costs, prescriptions, insurance premium payments,
320 copayments, and coinsurance. The corporation shall establish a
321 process or contract with another entity for the management of
322 the funds. The process must ensure the timely distribution and
323 the appropriate expenditure of the state’s contributions.
324 (f) The corporation shall establish a refund process for an
325 enrollee who requests the closure of a health benefits account
326 and the return of any unspent individual contributions. The
327 enrollee may be refunded only those funds that the enrollee or
328 employer has contributed to his or her health benefits account.
329 All other state funds in the enrollee’s health benefits account
330 revert to the corporation.
331 (6) FUNDING.—
332 (a) The corporation may accept funds from an employer to
333 deposit into an enrollee’s health benefits account to supplement
334 funds if such a deposit is not in conflict with other provisions
335 of this section.
336 (b) The corporation may accept state and federal funds to
337 further subsidize the costs of coverage and to administer the
339 (c) The corporation shall seek other grants and donations
340 to support the program.
341 (d) An assessment on vendors that participate in the
342 marketplace may be used to fund the administration of the
344 (7) SERVICES.—The corporation shall manage the health
345 benefits accounts and provide a marketplace of options from
346 which an enrollee may also use his or her health benefits
347 account to purchase individual services and products, including,
348 but not limited to, discount medical plans, limited benefit
349 plans, health flex plans, individual health insurance plans,
350 prepaid health clinic plans, bundled services, or other prepaid
351 health care coverage.
352 (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.—
353 (a) To the extent that funds are made available for this
354 purpose, an enrollee is rewarded for achieving a healthy
355 lifestyle and using preventive health care services
357 (b) The program shall post on its website, by July 1 of
358 each fiscal year, a list of optional healthy living performance
359 goals and the proposed incentives for achievement of each goal.
360 The corporation shall establish a procedure for the
361 documentation of such goals, timeframes for achievement of the
362 optional goals, and the payment of supplemental amounts into an
363 enrollee’s health benefits account, subject to available
365 (c) Bonus payments for achieving a healthy living
366 performance goal shall be paid into an enrollee’s health
367 benefits account at the end of the quarter in which the goal is
368 achieved. The amount of the payment is based upon the schedule
369 posted by the program on July 1 of that fiscal year.
370 (9) LIABILITY.—Coverage under the Health Choice Plus
371 Program is not an entitlement, and a cause of action does not
372 arise against the state, a local governmental entity, any other
373 political subdivision of the state, or the corporation or its
374 board of directors for failure to make coverage under this
375 section available to an eligible person or for discontinuation
376 of any coverage.
377 (10) PROGRAM EVALUATION.—The corporation shall include
378 information about the Health Choice Plus Program in its annual
379 report under s. 408.910. The corporation shall complete and
380 submit by January 1, 2016, a separate independent evaluation of
381 the effectiveness of the Health Choice Plus Program to the
382 Governor, the President of the Senate, and the Speaker of the
383 House of Representatives.
384 (11) PROGRAM REVIEW.—The Health Choice Plus Program is
385 subject to repeal on July 1, 2016, unless reviewed and saved
386 from repeal through reenactment by the Legislature.
387 Section 3. The sum of $15,275,000 from the General Revenue
388 Fund is appropriated to the Agency for Health Care
389 Administration beginning in the 2013-2014 fiscal year to provide
390 funding for the Health Choice Plus Program within Florida Health
391 Choices, Inc., and to fund the corporation’s administrative
392 costs necessary for implementing and operating the program.
393 Section 4. This act shall take effect July 1, 2013.
395 ================= T I T L E A M E N D M E N T ================
396 And the title is amended as follows:
397 Delete everything before the enacting clause
398 and insert:
399 A bill to be entitled
400 An act relating to the Health Choice Plus Program;
401 amending s. 408.910, F.S.; conforming provisions to
402 changes made by the act; providing that the Florida
403 Insurance Code is not applicable in certain
404 circumstances; creating s. 408.9105, F.S.; creating
405 the Health Choice Plus Program; providing legislative
406 intent; providing requirements of the program;
407 providing definitions; providing eligibility
408 requirements; providing for enrollment in the program;
409 providing requirements and procedures for the deposit
410 and use of funds in a health benefits account;
411 providing that the marketplace is encouraged to use
412 existing community programs and partnerships to
413 deliver services and to include traditional safety net
414 providers for the delivery of services to enrollees;
415 requiring Florida Health Choices, Inc., to establish a
416 refund process; authorizing the corporation to accept
417 funds from various sources to deposit into health
418 benefits accounts, subsidize the costs of coverage,
419 and administer and support the program; requiring the
420 corporation to manage the health benefits accounts and
421 provide the marketplace of options which an enrollee
422 in the program may use; providing for payment for
423 achieving healthy living performance goals; requiring
424 the program to post on its website a list of optional
425 healthy living performance goals and to establish a
426 procedure for documentation, achievement, and payment
427 regarding the healthy living performance goals;
428 providing that coverage under the program is not an
429 entitlement; prohibiting a cause of action against
430 certain entities under certain circumstances;
431 requiring the corporation to submit to the Governor
432 and the Legislature information about the program in
433 its annual report and an evaluation of the
434 effectiveness of the program; providing for a program
435 review and repeal date; providing an appropriation;
436 providing an effective date.