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
a42 competitive markets marketfor 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 acompetitive markets marketthat stimulate 58 stimulatesproduct 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.