Florida Senate - 2013 (Proposed Committee Bill) SPB 7144
FOR CONSIDERATION By the Committee on Health Policy
588-03162A-13 20137144__
1 A bill to be entitled
2 An act relating to the Health Choice Plus Program;
3 amending s. 408.910, F.S.; conforming provisions to
4 changes made by the act; creating s. 408.9105, F.S.;
5 creating the Health Choice Plus Program; providing
6 legislative intent; providing definitions; providing
7 eligibility requirements; providing exceptions in
8 specific situations; providing for enrollment in the
9 program; providing for disenrollment in specific
10 situations; providing for reenrollment in specific
11 situations; providing requirements and procedures for
12 use of funds in a health benefits account; authorizing
13 the Florida Health Choices, Inc., to accept funds from
14 various sources to deposit into health benefits
15 accounts, subsidize the costs of coverage, and
16 administer and support the program; requiring the
17 corporation to manage the health benefits accounts and
18 provide the marketplace of options that an enrollee in
19 the program may use; specifying healthy living
20 performance goals; providing for payment for achieving
21 health living performance goals; providing that the
22 Florida Insurance Code is not applicable to the
23 program; providing that coverage under the program is
24 not an entitlement; prohibiting a cause of action
25 against certain entities under certain circumstances;
26 requiring the corporation to submit to the Governor
27 and the Legislature information about the program in
28 its annual report and an evaluation of the
29 effectiveness of the program; providing for a program
30 review and repeal date; providing an effective date.
31
32 Be It Enacted by the Legislature of the State of Florida:
33
34 Section 1. Subsection (1) of section 408.910, Florida
35 Statutes, is amended to read:
36 408.910 Florida Health Choices Program.—
37 (1) LEGISLATIVE INTENT.—The Legislature finds that a
38 significant number of the residents of this state do not have
39 adequate access to affordable, quality health care. The
40 Legislature further finds that increasing access to affordable,
41 quality health care can be best accomplished by establishing a
42 competitive markets market for purchasing health insurance and
43 health services. It is therefore the intent of the Legislature
44 to create the Florida Health Choices Program and the Health
45 Choice Plus Program to:
46 (a) Expand opportunities for Floridians to purchase
47 affordable health insurance and health services.
48 (b) Preserve the benefits of employment-sponsored insurance
49 while easing the administrative burden for employers who offer
50 these benefits.
51 (c) Enable individual choice in both the manner and amount
52 of health care purchased.
53 (d) Provide for the purchase of individual, portable health
54 care coverage.
55 (e) Disseminate information to consumers on the price and
56 quality of health services.
57 (f) Sponsor a competitive markets market that stimulate
58 stimulates product innovation, quality improvement, and
59 efficiency in the production and delivery of health services.
60 Section 2. Section 408.9105, Florida Statutes, is created
61 to read:
62 408.9105 Health Choice Plus Program.—
63 (1) LEGISLATIVE INTENT.—The Legislature recognizes that
64 there are more than 600,000 uninsured residents in this state
65 who have incomes at or below 100 percent of the federal poverty
66 level. Many insurance options are not affordable, and the
67 Legislature intends to provide a benefit program to those
68 individuals who seek assistance with coverage and who assume
69 individual responsibility for their own health care needs. It is
70 therefore the intent of the Legislature to expand the services
71 provided by the Florida Health Choices Program and begin the
72 phase-in of the Health Choice Plus Program starting July 1,
73 2013. The Health Choice Plus Program must:
74 (a) Use the existing Florida Health Choices Corporation’s
75 infrastructure and governance to manage the program described in
76 this section.
77 (b) Offer goods and services to individuals who are between
78 19 to 64 years of age, inclusive.
79 (c) Establish guidelines for financial participation in the
80 program which allows for enrollees and others to contribute
81 toward a health benefits account.
82 1. An enrollee shall contribute at least $20 per month
83 toward the health benefits account. This amount may be adjusted
84 annually in the General Appropriations Act.
85 2. The level of benefit paid into an enrollee’s account
86 using state funds is to be determined by the corporation based
87 upon the availability of state, local, and federal funding. The
88 amount may not exceed $10 per individual per month. This amount
89 may be adjusted annually in the General Appropriations Act.
90 (d) Implement an employer-based contribution option.
91 (e) Develop and maintain an education and public outreach
92 campaign for the Health Choice Plus Program.
93 (f) Provide a secure website to facilitate the purchase of
94 goods and services and to provide public information about the
95 program. The website must also provide information about the
96 availability of insurance affordability programs targeted at
97 this population.
98 (g) Establish an incentive program that rewards enrollees
99 for achievements in reaching healthy living goals.
100 (2) DEFINITIONS.—For the Health Choice Plus Program, the
101 following terms are applicable:
102 (a) “CHIP” means Children’s Health Insurance Program as
103 authorized under Title XXI of the Social Security Act.
104 (b) “Corporation” means Florida Health Choices, Inc., as
105 established under s. 408.910.
106 (c) “Corporation’s marketplace” means the single,
107 centralized market established by the corporation which
108 facilitates the purchase of products made available in the
109 marketplace.
110 (d) “Enrollee” means an individual who participates in or
111 receives benefits under the Health Choice Plus Program.
112 (e) “Program” means the Health Choice Plus Program
113 established under this section.
114 (f) ”Vendor” means an entity that meets the requirements
115 under s. 408.910(4)(d) and is accepted by the corporation.
116 (g) “Health benefits account” means the account established
117 for an enrollee at the corporation into which funds may be
118 deposited by the state, the enrollee, other individuals, or
119 organizations for the purchase of health care goods and services
120 on the enrollee’s behalf.
121 (h) “Parent” or “caretaker relative” means an individual
122 who is a relative that has primary custody or legal guardianship
123 of a dependent child and provides the primary care and
124 supervision to that dependent child in the same household. A
125 caretaker relative must be related to the dependent child by
126 blood, marriage, or adoption within the fifth degree of kinship.
127 (i) ”Goods and services” means the individual products
128 offered for sale to an enrollee on the corporation’s marketplace
129 or other health care-related items that may be purchased by an
130 enrollee in the private market. An enrollee may purchase these
131 products using funds accumulated in his or her health benefits
132 account.
133 (j) “Lawful permanent resident” means a non-United States
134 citizen who resides in the United States under legally
135 recognized and lawfully recorded permanent residence as an
136 immigrant. This individual may also be known as a permanent
137 resident alien.
138 (k) “Patient Protection and Affordable Care Act” or “PPACA”
139 means the federal law enacted as Pub. L. No. 111-148, as further
140 amended by the federal Health Care and Education Reconciliation
141 Act of 2010, Pub. L. No. 111-152, and any amendments.
142 (3) ELIGIBILITY.—
143 (a) To be eligible for the Health Choice Plus Program, an
144 individual must be a resident of this state and meet all of the
145 following criteria:
146 1. Be between 19 and 64 years of age, inclusive.
147 2. Have a modified adjusted gross income that does not
148 exceed 100 percent of the federal poverty level based on the
149 individual’s most recent federal tax return, or if the
150 individual did not file a tax return, the individual’s most
151 recent monthly income.
152 3. Be a United States citizen or a lawful permanent
153 resident.
154 4. Not be eligible for Medicaid.
155 5. Not be eligible for employer-sponsored insurance
156 coverage. If the enrollee is eligible for employer-sponsored
157 coverage but the cost of that coverage for the enrollee’s share
158 for individual coverage would exceed 5 percent of the enrollee’s
159 total modified adjusted gross household income or the enrollee’s
160 share of family coverage would exceed 5 percent of enrollee’s
161 total modified adjusted gross household income, the enrollee is
162 not eligible for employer-sponsored coverage under this section.
163 6. Not be enrolled in other coverage that meets the
164 definition of essential benefits coverage under PPACA.
165 (b) In addition to the requirements in paragraph (a), an
166 enrollee must meet the following categorical requirements in
167 order to maintain enrollment in the program:
168 1. For an enrollee who is also a parent or a caretaker
169 relative, the enrollee must do all of the following:
170 a. Maintain enrollment in Medicaid or CHIP for any
171 dependent child in the household who is eligible for Medicaid or
172 CHIP and who must be enrolled in Medicaid or CHIP throughout the
173 enrollee’s participation in the Health Choice Plus program.
174 b. Complete a health assessment within the first 3 months
175 after enrollment at a county health department, federally
176 qualified health center, or other approved health care provider.
177 c. Schedule and keep at least one preventive visit with a
178 primary care provider within 6 months after enrollment and
179 repeat the preventive visit at least once every 18 months
180 thereafter.
181 d. Provide proof of employment for at least 20 hours a week
182 or of efforts made to seek employment. In lieu of employment,
183 the enrollee may provide proof of volunteering for at least 10
184 hours a month at a school or at a nonprofit organization or
185 enrollment as as full-time student at an accredited educational
186 institution. Exceptions to this requirement may be made on a
187 case-by-case basis for medical conditions for the enrollee or if
188 the enrollee is the primary caretaker for a family member who
189 has a chronic and severe medical condition that requires a
190 minimum of 40 hours a week of care.
191 e. Meet at least two of the healthy living performance
192 goals specified in subsection (7).
193 2. For an enrollee who is also a childless adult, the
194 enrollee must do all of the following:
195 a. Provide proof of employment for at least 20 hours a week
196 or of efforts made to seek employment. In lieu of employment,
197 the enrollee may provide proof of volunteering for at least 20
198 hours a month at a school or at a nonprofit organization or
199 enrollment as a full-time student at an accredited educational
200 institution. Exceptions to this requirement may be made on a
201 case-by-case basis for medical conditions for the enrollee or if
202 the enrollee is the primary caretaker for a family member who
203 has a chronic and severe medical condition that requires a
204 minimum of 40 hours a week of care.
205 b. Complete a health assessment within the first 3 months
206 after enrollment at a county health department, federally
207 qualified health center, or other approved health care provider;
208 c. Schedule and keep at least one preventive visit with a
209 primary care provider within the first 6 months after enrollment
210 and repeat the preventive visit at least once every 18 months
211 thereafter.
212 d. Meet at least two of the healthy living performance
213 goals specified in subsection (7).
214
215 If the enrollee fails to meet the requirements specified in this
216 subsection, the enrollee is disenrolled from the program at the
217 end of the month in which the enrollee has not met the
218 requirements. The enrollee may receive one 30-day extension to
219 comply before cancellation of coverage. If an enrollee’s
220 coverage is canceled, the enrollee may not reapply for coverage
221 until the next open enrollment period or 90 days after
222 cancellation of coverage occurs, whichever occurs later. The
223 individual’s reenrollment is subject to available funding.
224 (4) ENROLLMENT.—
225 (a) Enrollment in the Health Choice Plus Program may occur
226 through the portal of the Florida Health Choices Program, a
227 referral process from the Department of Children and Families,
228 the Florida Healthy Kids Corporation, or the exchange as defined
229 by the federal Patient Protection and Affordable Care Act.
230 (b) Subject to available funding, the corporation shall
231 establish at least one open enrollment period each year. When
232 the program is full based on available funding, enrollment must
233 cease.
234 (c) Eligibility is determined by using electronic means to
235 the fullest extent practicable before requesting any written
236 documentation from an applicant.
237 (5) HEALTH BENEFITS ACCOUNT.—
238 (a) A health benefits account is established for each
239 enrollee upon confirmation of eligibility in the program. The
240 corporation shall determine the deposit amount and frequency of
241 deposits based on the availability of funds, the number of
242 enrollees, and other factors.
243 (b) An enrollee shall make a financial contribution toward
244 his or her own health benefits account in order to maintain
245 enrollment in accordance with paragraph (1)(c).
246 1. The corporation shall establish disenrollment criteria
247 for failure to pay the required minimum contribution.
248 2. The disenrollment criteria must include waiting periods
249 of not more than 1 month before reinstatement to the program if
250 the enrollee is still eligible and has paid all required
251 financial obligations.
252 (c) Subject to appropriations available for this specific
253 purpose, the corporation shall establish a procedure for the
254 deposit of supplemental or bonus funds into an enrollee’s health
255 benefits account if certain healthy living performance goals are
256 achieved. These goals must be established no later than July 1
257 in each fiscal year and distributed to all enrollees, published
258 on the corporation’s website, and distributed to new enrollees
259 within 30 calendar days after enrollment. For calendar year
260 2014, the goals must be established no later than October 1,
261 2013.
262 1. An enrollee may use funds deposited in a health benefits
263 account to offset other health care costs or to purchase other
264 products and services offered by the marketplace, subject to
265 guidelines established by the corporation and in accordance with
266 federal law.
267 2. Bonus funds may accumulate in the enrollee’s health
268 benefits account for the duration of the program and must
269 automatically expire and return to the corporation upon the
270 termination of the program.
271 (d) The marketplace is encouraged to use existing community
272 programs and partnerships to deliver services and to include
273 traditional safety net providers for the delivery of services to
274 enrollees, including, but not limited to, rural health clinics,
275 federally qualified health centers, county health departments,
276 emergency room diversion programs, and community mental health
277 centers. A health care entity that receives state funding must
278 participate in the Health Choice Plus Program and offer services
279 or products through the marketplace or to enrollees, as
280 appropriate. An enrollee may be required to make nominal
281 copayments to providers for any nonpreventive services. The
282 corporation may establish the amount of the copayments when
283 applicable.
284 (e) Except for supplemental funds described under paragraph
285 (c), funds deposited in a health benefits account belong to the
286 enrollee when deposited and are available for health-care
287 related expenditures, including, but not limited to, physician’s
288 fees, hospital costs, prescriptions, insurance premium payments,
289 copayments, and coinsurance. The corporation shall establish a
290 process or contract with another entity for the management of
291 the funds. The process must ensure the timely distribution and
292 the appropriate expenditure of the state’s contributions.
293 (f) The corporation shall establish a refund process for an
294 enrollee who requests the closure of a health benefits account
295 and the return of any unspent individual contributions. The
296 enrollee may be refunded only those funds that the enrollee or
297 employer has contributed to his or her health benefits account.
298 All other state funds in the enrollee’s health benefits account
299 revert to the corporation.
300 (6) FUNDING.—
301 (a) The corporation may accept funds from an employer to
302 deposit in an enrollee’s health benefits account to supplement
303 funds if such a deposit is not in conflict with other provisions
304 of this section.
305 (b) The corporation may accept state and federal funds to
306 further subsidize the costs of coverage and to administer the
307 program.
308 (c) The corporation shall seek other grants and donations
309 to support the program.
310 (d) An assessment on vendors that participate in the
311 marketplace may be used to fund the administration of the
312 program.
313 (7) SERVICES.—The corporation shall manage the health
314 benefits accounts and provide a marketplace of options from
315 which an enrollee may also use his or her health benefits
316 account to purchase individual services and products, including,
317 but not limited to, discount medical plans, limited benefit
318 plans, health flex plans, individual health insurance plans,
319 bundled services, or other prepaid health care coverage.
320 (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.—
321 (a) To the extent that funds are made available for this
322 purpose, an enrollee is rewarded for achieving a healthy
323 lifestyle and using preventive health care services
324 appropriately.
325 (b) Healthy living performance goals for the program
326 include, but are not limited to:
327 1. Visiting a primary care provider for preventive care,
328 including well-woman exams.
329 2. Receiving dental preventive exams and cleanings.
330 3. Maintaining a Body Mass Index (BMI) of less than 25, or
331 if the enrollee’s BMI is more than 25 on July 1 of the previous
332 year, reducing the BMI by 5 percent as measured on July 1 of the
333 following year.
334 4. Maintaining an HDL cholesterol level of no less than 40
335 mg/dL for men or 50 mg/dL for women, or if an enrollee’s HDL
336 cholesterol level is less than these levels, increasing the HDL
337 cholesterol level by at least 5 points.
338 5. Maintaining an LDL cholesterol level at no more than 130
339 mg/dL, or if an enrollee’s LDL is higher than this level,
340 reducing the LDL cholesterol level by at least 5 points.
341 6. Maintaining a triglyceride level at no more than 150
342 mg/dL, or if an enrollee’s triglyceride level is higher than
343 this level, reducing the triglyceride level by at least 5
344 points.
345 7. For women, obtaining a mammogram, as appropriate. For
346 men, obtaining a prostate exam, as appropriate, based on
347 standards of the United States Preventive Services Task Force.
348 8. Maintaining blood pressure no higher than 140(systolic)
349 and 90 (diastolic). Both numbers must be achieved to receive
350 credit for the goal.
351 9. Obtaining an annual flu shot.
352 10. Being up to date on adult vaccinations.
353 11. Ceasing to smoke or showing evidence of participating
354 in a formal smoking cessation program.
355 12. Demonstrating evidence of an exercise regimen,
356 including an exercise program or other formal training program.
357 13. Participating and achieving any other goals established
358 by the program.
359
360 The program shall post on its website, by July 1 of each fiscal
361 year in which a goal is deemed eligible or ineligible, any other
362 goal that an enrollee is eligible for payment or the elimination
363 of a goal. The corporation shall establish a procedure for the
364 documentation of such goals, timeframes for achievement of the
365 goals if not otherwise provided in this paragraph, and payments
366 of supplemental amounts into an enrollee’s health benefits
367 account.
368 (c) Bonus payments for achieving a healthy living
369 performance goal shall be paid into an enrollee’s health
370 benefits account at the end of the quarter in which the goal is
371 achieved. The amount of the payment is based upon the schedule
372 posted by the program on July 1 of that fiscal year.
373 (9) APPLICABILITY OF INSURANCE CODE.—Coverage offered under
374 this program is not insurance. Any standard forms, website
375 design, or marketing communication developed by the corporation
376 and used by the corporation or any vendor that meets the
377 requirements of s. 408.910(4)(f) is not subject to the Florida
378 Insurance Code.
379 (10) LIABILITY.—Coverage under the Health Choice Plus
380 Program is not an entitlement, and a cause of action does not
381 arise against the state, a local governmental entity, any other
382 political subdivision of the state, or the corporation or its
383 board of directors for failure to make coverage under this
384 section available to an eligible person or for discontinuation
385 of any coverage.
386 (11) PROGRAM EVALUATION.—The corporation shall include
387 information about the Health Choice Plus Program in its annual
388 report under s. 408.910. The corporation shall complete and
389 submit by January 1, 2016, a separate independent evaluation of
390 the effectiveness of the Health Choice Plus Program to the
391 Governor, the President of the Senate, and the Speaker of the
392 House of Representatives.
393 (12) PROGRAM REVIEW.—The Health Choice Plus Program is
394 subject to repeal on July 1, 2016, unless reviewed and saved
395 from repeal through reenactment by the Legislature.
396 Section 3. This act shall take effect July 1, 2013.