Florida Senate - 2015              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 7044
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to a health insurance affordability
    3         exchange; creating s. 409.720, F.S.; providing a short
    4         title; creating s. 409.721, F.S.; creating the Florida
    5         Health Insurance Affordability Exchange Program or
    6         FHIX in the Agency for Health Care Administration;
    7         providing program authority and principles; creating
    8         s. 409.722, F.S.; defining terms; creating s. 409.723,
    9         F.S.; providing eligibility and enrollment criteria;
   10         providing patient rights and responsibilities;
   11         providing premium levels; creating s. 409.724, F.S.;
   12         providing for premium credits and choice counseling;
   13         establishing an education campaign; providing for
   14         customer support and disenrollment; creating s.
   15         409.725, F.S.; providing for available products and
   16         services; creating s. 409.726, F.S.; providing for
   17         program accountability; creating s. 409.727, F.S.;
   18         providing an implementation schedule; creating s.
   19         409.728, F.S.; providing program operation and
   20         management duties; creating s. 409.729, F.S.;
   21         providing for the development of a long-term
   22         reorganization plan and the formation of the FHIX
   23         Workgroup; creating s. 409.730, F.S.; authorizing the
   24         agency to seek federal approval; creating s. 409.731,
   25         F.S.; providing for program expiration; repealing s.
   26         408.70, F.S., relating to legislative findings
   27         regarding access to affordable health care; amending
   28         s. 408.910, F.S.; revising legislative intent;
   29         redefining terms; revising the scope of the Florida
   30         Health Choices Program and the pricing of services
   31         under the program; providing requirements for
   32         operation of the marketplace; providing additional
   33         duties for the corporation to perform; requiring an
   34         annual report to the Governor and the Legislature;
   35         amending s. 409.904, F.S.; establishing a date when
   36         new enrollment in the Medically Needy program is
   37         suspended; providing an expiration date for the
   38         program; amending s. 624.91, F.S.; revising
   39         eligibility requirements for state-funded assistance;
   40         revising the duties and powers of the Florida Healthy
   41         Kids Corporation; revising provisions for the
   42         appointment of members of the board of the Florida
   43         Healthy Kids Corporation; requiring transition plans;
   44         repealing s. 624.915, F.S., relating to the operating
   45         fund of the Florida Healthy Kids Corporation;
   46         providing an effective date.
   48  Be It Enacted by the Legislature of the State of Florida:
   50         Section 1. The Division of Law Revision and Information is
   51  directed to rename part II of chapter 409, Florida Statutes, as
   52  “Insurance Affordability Programs” and to incorporate ss.
   53  409.720-409.731, Florida Statutes, under this part.
   54         Section 2. Section 409.720, Florida Statutes, is created to
   55  read:
   56         409.720 Short title.—Sections 409.720-409.731 may be cited
   57  as the “Florida Health Insurance Affordability Exchange Program”
   58  or “FHIX.”
   59         Section 3. Section 409.721, Florida Statutes, is created to
   60  read:
   61         409.721 Program authority.—The Florida Health Insurance
   62  Affordability Exchange Program, or FHIX, is created in the
   63  agency to assist Floridians in purchasing health benefits
   64  coverage and gaining access to health services. The products and
   65  services offered by FHIX are based on the following principles:
   66         (1) FAIR VALUE.—Financial assistance will be rationally
   67  allocated regardless of differences in categorical eligibility.
   68         (2) CONSUMER CHOICE.—Participants will be offered
   69  meaningful choices in the way they can redeem the value of the
   70  available assistance.
   71         (3) SIMPLICITY.—Obtaining assistance will be consumer
   72  friendly, and customer support will be available when needed.
   73         (4) PORTABILITY.—Participants can continue to access the
   74  services and products of FHIX despite changes in their
   75  circumstances.
   76         (5) PROMOTES EMPLOYMENT.—Assistance will be offered in a
   77  way that incentivizes employment.
   78         (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a
   79  manner that maximizes individual control over available
   80  resources.
   81         (7) RISK ADJUSTMENT.—The amount of assistance will reflect
   82  participants’ medical risk.
   83         Section 4. Section 409.722, Florida Statutes, is created to
   84  read:
   85         409.722 Definitions.—As used in ss. 409.720-409.731, the
   86  term:
   87         (1) “Agency” means the Agency for Health Care
   88  Administration.
   89         (2) “Applicant” means an individual who applies for
   90  determination of eligibility for health benefits coverage under
   91  this part.
   92         (3) “Corporation” means Florida Health Choices, Inc., as
   93  established under s. 408.910.
   94         (4) “Enrollee” means an individual who has been determined
   95  eligible for and is receiving health benefits coverage under
   96  this part.
   97         (5) “FHIX marketplace” or “marketplace” means the single,
   98  centralized market established under s. 408.910 which
   99  facilitates health benefits coverage.
  100         (6) “Florida Health Insurance Affordability Exchange
  101  Program” or “FHIX” means the program created under ss. 409.720
  102  409.731.
  103         (7) “Florida Healthy Kids Corporation” means the entity
  104  created under s. 624.91.
  105         (8) “Florida Kidcare program” or “Kidcare program” means
  106  the health benefits coverage administered through ss. 409.810
  107  409.821.
  108         (9) “Health benefits coverage” means the payment of
  109  benefits for covered health care services or the availability,
  110  directly or through arrangements with other persons, of covered
  111  health care services on a prepaid per capita basis or on a
  112  prepaid aggregate fixed-sum basis.
  113         (10) “Inactive status” means the enrollment status of a
  114  participant previously enrolled in health benefits coverage
  115  through the FHIX marketplace who lost coverage through the
  116  marketplace for non-payment, but maintains access to his or her
  117  balance in a health savings account or health reimbursement
  118  account.
  119         (11) “Medicaid” means the medical assistance program
  120  authorized by Title XIX of the Social Security Act, and
  121  regulations thereunder, and part III and part IV of this
  122  chapter, as administered in this state by the agency.
  123         (l2) “Modified adjusted gross income” means the
  124  individual’s or household’s annual adjusted gross income as
  125  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986 and
  126  which is used to determine eligibility for FHIX.
  127         (13) “Patient Protection and Affordable Care Act” or
  128  “Affordable Care Act” means Pub. L. No. 111-148, as further
  129  amended by the Health Care and Education Reconciliation Act of
  130  2010, Pub. L. No. 111-152, and any amendments to, and
  131  regulations or guidance under, those acts.
  132         (14) “Premium credit” means the monthly amount paid by the
  133  agency per enrollee in the Florida Health Insurance
  134  Affordability Exchange Program toward health benefits coverage.
  135         (15) “Qualified alien” means an alien as defined in 8
  136  U.S.C. s. 1641(b) or (c).
  137         (16) “Resident” means a United States citizen or qualified
  138  alien who is domiciled in this state.
  139         Section 5. Section 409.723, Florida Statutes, is created to
  140  read:
  141         409.723Participation.—
  142         (1) ELIGIBILITY.—In order to participate in FHIX, an
  143  individual must be a resident and must meet the following
  144  requirements, as applicable:
  145         (a) Qualify as a newly eligible enrollee, who must be an
  146  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
  147  Social Security Act or s. 2001 of the Affordable Care Act and as
  148  may be further defined by federal regulation.
  149         (b) Meet and maintain the responsibilities under subsection
  150  (4).
  151         (c) Qualify as a participant in the Florida Healthy Kids
  152  program under s. 624.91, subject to the implementation of Phase
  153  Three under s. 409.727.
  154         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
  155  an application to the department for an eligibility
  156  determination.
  157         (a) Applications may be submitted by mail, fax, online, or
  158  any other method permitted by law or regulation.
  159         (b) The department is responsible for any eligibility
  160  correspondence and status updates to the participant and other
  161  agencies.
  162         (c) The department shall review a participant’s eligibility
  163  every 12 months.
  164         (d) An application or renewal is deemed complete when the
  165  participant has met all the requirements under subsection (4).
  166         (3) PARTICIPANT RIGHTS.—A participant has all of the
  167  following rights:
  168         (a)Access to the FHIX marketplace to select the scope,
  169  amount, and type of health care coverage and other services to
  170  purchase.
  171         (b) Continuity and portability of coverage to avoid
  172  disruption of coverage and other health care services when the
  173  participant’s economic circumstances change.
  174         (c) Retention of applicable unspent credits in the
  175  participant’s health savings or health reimbursement account
  176  following a change in the participant’s eligibility status.
  177  Credits are valid for an inactive status participant for up to 5
  178  years after the participant first enters an inactive status.
  179         (d) Ability to select more than one product or plan on the
  180  FHIX marketplace.
  181         (e) Choice of at least two health benefits products that
  182  meet the requirements of the Affordable Care Act.
  183         (4) PARTICIPANT RESPONSIBILITIES.—A participant has all of
  184  the following responsibilities:
  185         (a) Complete an initial application for health benefits
  186  coverage and an annual renewal process;
  187         (b) Annually provide evidence of participation in one of
  188  the following activities at the levels required under paragraph
  189  (c):
  190         1. Proof of employment.
  191         2. On-the-job training or job placement activities.
  192         3. Pursuit of educational opportunities.
  193         (c) Engage in the activities required under paragraph (b)
  194  at the following minimum levels:
  195         1. For a parent of a child younger than 18 years of age, a
  196  minimum of 20 hours weekly.
  197         2. For a childless adult, a minimum of 30 hours weekly.
  199  A participant who is a disabled adult or a caregiver of a
  200  disabled child or adult may submit a request for an exception to
  201  these requirements to the corporation and, thereafter, shall
  202  annually submit to the department a request to renew the
  203  exception to the hourly level requirements.
  204         (d) Learn and remain informed about the choices available
  205  on the FHIX marketplace and the uses of credits in the
  206  individual accounts.
  207         (e) Execute a contract with the department to acknowledge
  208  that:
  209         1. FHIX is not an entitlement and state and federal funding
  210  may end at any time;
  211         2. Failure to pay required premiums or cost sharing will
  212  result in a transition to inactive status; and
  213         3. Noncompliance with work or educational requirements will
  214  result in a transition to inactive status.
  215         (f) Select plans and other products in a timely manner.
  216         (g) Comply with program rules and the prohibitions against
  217  fraud, as described in s. 414.39.
  218         (h) Timely make monthly premium and any other cost-sharing
  219  payments.
  220         (i) Meet minimum coverage requirements by selecting a high
  221  deductible health plan combined with a health savings or health
  222  reimbursement account if not selecting a plan offering more
  223  extensive coverage.
  224         (5) COST SHARING.—
  225         (a) Enrollees are assessed monthly premiums based on their
  226  modified adjusted gross income. The maximum monthly premium
  227  payments are set at the following income levels:
  228         1. At or below 22 percent of the federal poverty level: $3.
  229         2. Greater than 22 percent, but at or below 50 percent, of
  230  the federal poverty level: $8.
  231         3. Greater than 50 percent, but at or below 75 percent, of
  232  the federal poverty level: $15.
  233         4. Greater than 75 percent, but at or below 100 percent, of
  234  the federal poverty level: $20.
  235         5. Greater than 100 percent of the federal poverty level:
  236  $25.
  237         (b) Depending on the products and services selected by the
  238  enrollee, the enrollee may also incur additional cost-sharing,
  239  such as copayments, deductibles, or other out-of-pocket costs.
  240         (c) An enrollee may be subject to an inappropriate
  241  emergency room visit charge of up to $8 for the first visit and
  242  up to $25 for any subsequent visit, based on the enrollee’s
  243  benefit plan, to discourage inappropriate use of the emergency
  244  room.
  245         (d) Cumulative annual cost sharing per enrollee may not
  246  exceed 5 percent of an enrollee’s annual modified adjusted gross
  247  income.
  248         (e) If, after a 30-day grace period, a full premium payment
  249  has not been received, the enrollee shall be transitioned from
  250  coverage to inactive status and may not reenroll for a minimum
  251  of 6 months, unless a hardship exception has been granted.
  252  Enrollees may seek a hardship exception under the Medicaid Fair
  253  Hearing Process.
  254         Section 6. Section 409.724, Florida Statutes, is created to
  255  read:
  256         409.724Available assistance.—
  257         (1)PREMIUM CREDITS.—
  258         (a) Standard amount.—The standard monthly premium credit is
  259  equivalent to the applicable risk-adjusted capitation rate paid
  260  to Medicaid managed care plans under part IV of this chapter.
  261         (b) Supplemental funding.—Subject to federal approval,
  262  additional resources may be made available to enrollees and
  263  incorporated into FHIX.
  264         (c) Savings accounts.—In addition to the benefits provided
  265  under this section, the corporation must offer each enrollee
  266  access to an individual account that qualifies as a health
  267  reimbursement account or a health savings account. Eligible
  268  unexpended funds from the monthly premium credit must be
  269  deposited into each enrollee’s individual account in a timely
  270  manner. Enrollees may also be rewarded for healthy behaviors,
  271  adherence to wellness programs, and other activities established
  272  by the corporation which demonstrate compliance with prevention
  273  or disease management guidelines. Funds deposited into these
  274  accounts may be used to pay cost-sharing obligations or to
  275  purchase other health-related items to the extent permitted
  276  under federal law.
  277         (d) Enrollee contributions.—The enrollee may make deposits
  278  to his or her account at any time to supplement the premium
  279  credit, to purchase additional FHIX products, or to offset other
  280  cost-sharing obligations.
  281         (e) Third parties.—Third parties, including, but not
  282  limited to, an employer or relative, may also make deposits on
  283  behalf of the enrollee into the enrollee’s FHIX marketplace
  284  account. The enrollee may not withdraw any funds as a refund,
  285  except those funds the enrollee has deposited into his or her
  286  account.
  287         (2) CHOICE COUNSELING.—The agency and the corporation shall
  288  work together to develop a choice counseling program for FHIX.
  289  The choice counseling program must ensure that participants have
  290  information about the FHIX marketplace program, products, and
  291  services and that participants know where and whom to call for
  292  questions or to make their plan selections. The choice
  293  counseling program must provide culturally sensitive materials
  294  and must take into consideration the demographics of the
  295  projected population.
  296         (3)EDUCATION CAMPAIGN.—The agency, the corporation, and
  297  the Florida Healthy Kids Corporation must coordinate an ongoing
  298  enrollee education campaign beginning in Phase One, as provided
  299  in s. 409.27, informing participants, at a minimum:
  300         (a) How the transition process to the FHIX marketplace will
  301  occur and the timeline for the enrollee’s specific transition.
  302         (b) What plans are available and how to research
  303  information about available plans.
  304         (c) Information about other available insurance
  305  affordability programs for the individual and his or her family.
  306         (d) Information about health benefits coverage, provider
  307  networks, and cost sharing for available plans in each region.
  308         (e) Information on how to complete the required annual
  309  renewal process, including renewal dates and deadlines.
  310         (f) Information on how to update eligibility if the
  311  participant’s data have changed since his or her last renewal or
  312  application date.
  313         (4) CUSTOMER SUPPORT.—Beginning in Phase Two, the Florida
  314  Healthy Kids Corporation shall provide customer support for
  315  FHIX, shall address general program information, financial
  316  information, and customer service issues, and shall provide
  317  status updates on bill payments. Customer support must also
  318  provide a toll-free number and maintain a website that is
  319  available in multiple languages and that meets the needs of the
  320  enrollee population.
  321         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  322  inactive participant about other insurance affordability
  323  programs and electronically refer the participant to the federal
  324  exchange or other insurance affordability programs, as
  325  appropriate.
  326         Section 7. Section 409.725, Florida Statutes, is created to
  327  read:
  328         409.725Available products and services.—The FHIX
  329  marketplace shall offer the following products and services:
  330         (1) Authorized products and services pursuant to s.
  331  408.910.
  332         (2) Medicaid managed care plans under part IV of this
  333  chapter.
  334         (3) Authorized products under the Florida Healthy Kids
  335  Corporation pursuant to s. 624.91.
  336         (4) Employer-sponsored plans.
  337         Section 8. Section 409.726, Florida Statutes, is created to
  338  read:
  339         409.726Program accountability.—
  340         (1) All managed care plans that participate in FHIX must
  341  collect and maintain encounter level data in accordance with the
  342  encounter data requirements under s. 409.967(2)(d) and are
  343  subject to the accompanying penalties under s. 409.967(2)(h)2.
  344  The agency is responsible for the collection and maintenance of
  345  the encounter level data.
  346         (2)The corporation, in consultation with the agency, shall
  347  establish access and network standards for contracts on the FHIX
  348  marketplace and shall ensure that contracted plans have
  349  sufficient providers to meet enrollee needs. The corporation, in
  350  consultation with the agency, shall develop quality of coverage
  351  and provider standards specific to the adult population.
  352         (3)The department shall develop accountability measures
  353  and performance standards to be applied to applications and
  354  renewal applications for FHIX which are submitted online, by
  355  mail, by fax, or through referrals from a third party. The
  356  minimum performance standards are:
  357         (a) Application processing speed.—Ninety percent of all
  358  applications, from all sources, must be processed within 45
  359  days.
  360         (b) Applications processing speed from online sources.
  361  Ninety-five percent of all applications received from online
  362  sources must be processed within 45 days.
  363         (c) Renewal application processing speed.—Ninety percent of
  364  all renewals, from all sources, must be processed within 45
  365  days.
  366         (d) Renewal application processing speed from online
  367  sources.—Ninety-five percent of all applications received from
  368  online sources must be processed within 45 days.
  369         (4) The agency, the department, and the Florida Healthy
  370  Kids Corporation must meet the following standards for their
  371  respective roles in the program:
  372         (a) Eighty-five percent of calls must be answered in 20
  373  seconds or less.
  374         (b) One hundred percent of all contacts, which include, but
  375  are not limited to, telephone calls, faxed documents and
  376  requests, and e-mails, must be handled within 2 business days.
  377         (c)Any self-service tools available to participants, such
  378  as interactive voice response systems, must be operational 7
  379  days a week, 24 hours a day, at least 98 percent of each month.
  380         (5) The agency, the department, and the Florida Healthy
  381  Kids Corporation must conduct an annual satisfaction survey to
  382  address all measures that require participant input specific to
  383  the FHIX marketplace program. The parties may elect to
  384  incorporate these elements into the annual report required under
  385  subsection (7).
  386         (6) The agency and the corporation shall post online
  387  monthly enrollment reports for FHIX.
  388         (7) An annual report is due no later than July 1 to the
  389  Governor, the President of the Senate, and the Speaker of the
  390  House of Representatives. The annual report must be coordinated
  391  by the agency and the corporation and must include, but is not
  392  limited to:
  393         (a) Enrollment and application trends and issues.
  394         (b) Utilization and cost data.
  395         (c) Customer satisfaction.
  396         (d) Funding sources in health savings accounts or health
  397  reimbursement accounts.
  398         (e) Enrollee use of funds in health savings accounts or
  399  health reimbursement accounts.
  400         (f) Types of products and plans purchased.
  401         (g) Movement of enrollees across different insurance
  402  affordability programs.
  403         (h) Recommendations for program improvement.
  404         Section 9. Section 409.727, Florida Statutes, is created to
  405  read:
  406         409.727Implementation schedule.—The agency, the
  407  corporation, the department, and the Florida Healthy Kids
  408  Corporation shall begin implementation of FHIX by the effective
  409  date of this act, with statewide implementation in all regions,
  410  as described in s. 409.966(2), by January 1, 2016.
  411         (1) READINESS REVIEW.—Before implementation of any phase
  412  under this section, the agency shall conduct a readiness review
  413  in consultation with the FHIX Workgroup described in s. 409.729.
  414  The agency must determine, at a minimum, the following readiness
  415  milestones:
  416         (a) Functional readiness of the service delivery platform
  417  for the phase.
  418         (b) Plan availability and presence of plan choice.
  419         (c) Provider network capacity and adequacy of the available
  420  plans in the region.
  421         (d) Availability of customer support.
  422         (e) Other factors critical to the success of FHIX.
  423         (2) PHASE ONE.—
  424         (a) Phase One begins on July 1, 2015. The agency, the
  425  corporation, the department, and the Florida Healthy Kids
  426  Corporation shall coordinate activities to ensure that
  427  enrollment begins by July 1, 2015.
  428         (b) To be eligible during this phase, a participant must
  429  meet the requirements under s. 409.723(1)(a).
  430         (c)An enrollee is entitled to receive health benefits
  431  coverage in the same manner as provided under and through the
  432  selected managed care plans in the Medicaid managed care program
  433  in part IV of this chapter.
  434         (d) An enrollee shall have a choice of at least two managed
  435  care plans in each region.
  436         (e) Choice counseling and customer service must be provided
  437  in accordance with s. 409.724(2).
  438         (3) PHASE TWO.—
  439         (a) Beginning no later than January 1, 2016, and contingent
  440  upon federal approval, participants may enroll or transition to
  441  health benefits coverage under the FHIX marketplace.
  442         (b)To be eligible during this phase, a participant must
  443  meet the requirements under s. 409.723(1)(a) and (b).
  444         (c) An enrollee may select any benefit, service, or product
  445  available.
  446         (d) The corporation shall notify an enrollee of his or her
  447  premium credit amount and how to access the FHIX marketplace
  448  selection process.
  449         (e) A Phase One enrollee must be transitioned to the FHIX
  450  marketplace by April 1, 2016. An enrollee who does not select a
  451  plan or service on the FHIX marketplace by that deadline shall
  452  be moved to inactive status.
  453         (f) An enrollee shall have a choice of at least two managed
  454  care plans in each region which meet or exceed the Affordable
  455  Care Act’s requirements and which qualify for a premium credit
  456  on the FHIX marketplace.
  457         (g) Choice counseling and customer service must be provided
  458  in accordance with s. 409.724(2) and (4).
  459         (4) PHASE THREE.—
  460         (a) No later than July 1, 2016, the corporation and the
  461  Florida Healthy Kids Corporation must begin the transition of
  462  enrollees under s. 624.91 to the FHIX marketplace.
  463         (b)Eligibility during this phase is based on meeting the
  464  requirements of Phase Two and s. 409.723(1)(c).
  465         (c) An enrollee may select any benefit, service, or product
  466  available under s. 409.725.
  467         (d) A Florida Healthy Kids enrollee who selects a FHIX
  468  marketplace plan must be provided a premium credit equivalent to
  469  the average capitation rate paid in his or her county of
  470  residence under Florida Healthy Kids as of June 30, 2016. The
  471  enrollee is responsible for any difference in costs and may use
  472  any remaining funds for supplemental benefits on the FHIX
  473  marketplace.
  474         (e) The corporation shall notify an enrollee of his or her
  475  premium credit amount and how to access the FHIX marketplace
  476  selection process.
  477         (f) Choice counseling and customer service must be provided
  478  in accordance with s. 409.724(2) and (4).
  479         (g) Enrollees under s. 624.91 must transition to the FHIX
  480  marketplace by September 30, 2016.
  481         Section 10. Section 409.728, Florida Statutes, is created
  482  to read:
  483         409.728Program operation and management.—In order to
  484  implement ss. 409.720-409.731:
  485         (1) The Agency for Health Care Administration shall do all
  486  of the following:
  487         (a) Contract with the corporation for the development,
  488  implementation, and administration of the Florida Health
  489  Insurance Affordability Exchange Program and for the release of
  490  any federal, state, or other funds appropriated to the
  491  corporation.
  492         (b) Administer Phase One of FHIX.
  493         (c) Provide administrative support to the FHIX Workgroup
  494  under s. 409.729.
  495         (d) Transition the FHIX enrollees to the FHIX marketplace
  496  beginning January 1, 2016, in accordance with the transition
  497  workplan. Stakeholders that serve low-income individuals and
  498  families must be consulted during the implementation and
  499  transition process through a public input process. All regions
  500  must complete the transition no later than April 1, 2016.
  501         (e) Timely transmit enrollee information to the
  502  corporation.
  503         (f) Beginning with Phase Two, determine annually the risk
  504  adjusted rate to be paid per month based on historical
  505  utilization and spending data for the medical and behavioral
  506  health of this population, projected forward, and adjusted to
  507  reflect the eligibility category, medical and dental trends,
  508  geographic areas, and the clinical risk profile of the
  509  enrollees.
  510         (g) Transfer to the corporation such funds as approved in
  511  the General Appropriations Act for the premium credits.
  512         (h) Encourage Medicaid managed care plans to apply as
  513  vendors to the marketplace to facilitate continuity of care and
  514  family care coordination.
  515         (2) The Department of Children and Families shall, in
  516  coordination with the corporation, the agency, and the Florida
  517  Healthy Kids Corporation, determine eligibility of applications
  518  and application renewals for FHIX in accordance with s. 409.902
  519  and shall transmit eligibility determination information on a
  520  timely basis to the agency and corporation.
  521         (3) The Florida Healthy Kids Corporation shall do all of
  522  the following:
  523         (a) Retain its duties and responsibilities under s. 624.91
  524  for Phase One and Phase Two of the program.
  525         (b) Provide customer service for the FHIX marketplace, in
  526  coordination with the agency and the corporation.
  527         (c) Transfer funds and provide financial support to the
  528  FHIX marketplace, including the collection of monthly cost
  529  sharing.
  530         (d) Conduct financial reporting related to such activities,
  531  in coordination with the corporation and the agency.
  532         (e) Coordinate activities for the program with the agency,
  533  the department, and the corporation.
  534         (4) Florida Health Choices, Inc., shall do all of the
  535  following:
  536         (a) Begin the development of FHIX during Phase One.
  537         (b) Implement and administer Phase Two and Phase Three of
  538  the FHIX marketplace and the ongoing operations of the program.
  539         (c) Offer health benefits coverage packages on the FHIX
  540  marketplace, including plans compliant with the Affordable Care
  541  Act.
  542         (d) Offer FHIX enrollees a choice of at least two plans per
  543  county at each benefit level which meet the requirements under
  544  the Affordable Care Act.
  545         (e) Provide an opportunity for participation in Medicaid
  546  managed care plans if those plans meet the requirements of the
  547  FHIX marketplace.
  548         (f) Offer enhanced or customized benefits to FHIX
  549  marketplace enrollees.
  550         (g) Provide sufficient staff and resources to meet the
  551  program needs of enrollees.
  552         (h) Provide an opportunity for plans contracted with or
  553  previously contracted with the Florida Healthy Kids Corporation
  554  under s. 624.91 to participate with FHIX if those plans meet the
  555  requirements of the program.
  556         (i) Encourage insurance agents licensed under chapter 626
  557  to identify and assist enrollees. This act does not prohibit
  558  these agents from receiving usual and customary commissions from
  559  insurers and health maintenance organizations that offer plans
  560  in the FHIX marketplace.
  561         Section 11. Section 409.729, Florida Statutes, is created
  562  to read:
  563         409.729 Long-term reorganization.—The FHIX Workgroup is
  564  created to facilitate the implementation of FHIX and to plan for
  565  a multiyear reorganization of the state’s insurance
  566  affordability programs. The FHIX Workgroup consists of two
  567  representatives each from the agency, the department, the
  568  Florida Healthy Kids Corporation, and the corporation. An
  569  additional representative of the agency serves as chair. The
  570  FHIX Workgroup must hold its organizational meeting no later
  571  than 30 days after the effective date of this act and must meet
  572  at least bimonthly. The role of the FHIX Workgroup is to make
  573  recommendations to the agency. The responsibilities of the
  574  workgroup include, but are not limited to:
  575         (1) Recommend a Phase Two implementation plan no later than
  576  October 1, 2015.
  577         (2) Review network and access standards for plans and
  578  products.
  579         (3) Assess readiness and recommend actions needed to
  580  reorganize the state’s insurance affordability programs for each
  581  phase or region. If a phase or region receives a nonreadiness
  582  recommendation, the agency must notify the Legislature of that
  583  recommendation, the reasons for such a recommendation, and
  584  proposed plans for achieving readiness.
  585         (4) Recommend any proposed change to the Title XIX-funded
  586  or Title XXI-funded programs based on the continued availability
  587  and reauthorization of the Title XXI program and its federal
  588  funding.
  589         (5) Identify duplication of services among the corporation,
  590  the agency, and the Florida Healthy Kids Corporation currently
  591  and under FHIX’s proposed Phase Three program.
  592         (6) Evaluate any fiscal impacts based on the proposed
  593  transition plan under Phase Three.
  594         (7) Compile a schedule of impacted contracts, leases, and
  595  other assets.
  596         (8) Determine staff requirements for Phase Three.
  597         (9) Develop and present a final transition plan that
  598  incorporates all elements under this section no later than
  599  December 1, 2015, in a report to the Governor, the President of
  600  the Senate, and the Speaker of the House of Representatives.
  601         Section 12. Section 409.730, Florida Statutes, is created
  602  to read:
  603         409.730 Federal participation.—The agency may seek federal
  604  approval to implement FHIX.
  605         Section 13. Section 409.731, Florida Statutes, is created
  606  to read:
  607         409.731 Program expiration.The Florida Health Insurance
  608  Affordability Exchange Program expires at the end of Phase One
  609  if the state does not receive federal approval for Phase Two or
  610  at the end of the state fiscal year in which any of these
  611  conditions occurs:
  612         (1) The federal match contribution falls below 90 percent.
  613         (2) The federal match contribution falls below the
  614  increased Federal Medical Assistance Percentage for medical
  615  assistance for newly eligible mandatory individuals as specified
  616  in the Affordable Care Act.
  617         (3) The federal match for the FHIX program and the Medicaid
  618  program are blended under federal law or regulation in such a
  619  manner that causes the overall federal contribution to diminish
  620  when compared to separate, nonblended federal contributions.
  621         Section 14. Section 408.70, Florida Statutes, is repealed.
  622         Section 15. Section 408.910, Florida Statutes, is amended
  623  to read:
  624         408.910 Florida Health Choices Program.—
  625         (1) LEGISLATIVE INTENT.—The Legislature finds that a
  626  significant number of the residents of this state do not have
  627  adequate access to affordable, quality health care. The
  628  Legislature further finds that increasing access to affordable,
  629  quality health care can be best accomplished by establishing a
  630  competitive market for purchasing health insurance and health
  631  services. It is therefore the intent of the Legislature to
  632  create and expand the Florida Health Choices Program to:
  633         (a) Expand opportunities for Floridians to purchase
  634  affordable health insurance and health services.
  635         (b) Preserve the benefits of employment-sponsored insurance
  636  while easing the administrative burden for employers who offer
  637  these benefits.
  638         (c) Enable individual choice in both the manner and amount
  639  of health care purchased.
  640         (d) Provide for the purchase of individual, portable health
  641  care coverage.
  642         (e) Disseminate information to consumers on the price and
  643  quality of health services.
  644         (f) Sponsor a competitive market that stimulates product
  645  innovation, quality improvement, and efficiency in the
  646  production and delivery of health services.
  647         (2) DEFINITIONS.—As used in this section, the term:
  648         (a) “Corporation” means the Florida Health Choices, Inc.,
  649  established under this section.
  650         (b) “Corporation’s marketplace” means the single,
  651  centralized market established by the program that facilitates
  652  the purchase of products made available in the marketplace.
  653         (c) “Florida Health Insurance Affordability Exchange
  654  Program” or “FHIX” is the program created under ss. 409.720
  655  409.731 for low-income, uninsured residents of this state.
  656         (d)(c) “Health insurance agent” means an agent licensed
  657  under part IV of chapter 626.
  658         (e)(d) “Insurer” means an entity licensed under chapter 624
  659  which offers an individual health insurance policy or a group
  660  health insurance policy, a preferred provider organization as
  661  defined in s. 627.6471, an exclusive provider organization as
  662  defined in s. 627.6472, or a health maintenance organization
  663  licensed under part I of chapter 641, or a prepaid limited
  664  health service organization or discount medical plan
  665  organization licensed under chapter 636, or a managed care plan
  666  contracted with the Agency for Health Care Administration under
  667  the managed medical assistance program under part IV of chapter
  668  409.
  669         (f) “Patient Protection and Affordable Care Act” or
  670  “Affordable Care Act” means Pub. L. No. 111-148, as further
  671  amended by the Health Care and Education Reconciliation Act of
  672  2010, Pub. L. No. 111-152, and any amendments to or regulations
  673  or guidance under those acts.
  674         (g)(e) “Program” means the Florida Health Choices Program
  675  established by this section.
  676         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
  677  Choices Program is created as a single, centralized market for
  678  the sale and purchase of various products that enable
  679  individuals to pay for health care. These products include, but
  680  are not limited to, health insurance plans, health maintenance
  681  organization plans, prepaid services, service contracts, and
  682  flexible spending accounts. The components of the program
  683  include:
  684         (a) Enrollment of employers.
  685         (b) Administrative services for participating employers,
  686  including:
  687         1. Assistance in seeking federal approval of cafeteria
  688  plans.
  689         2. Collection of premiums and other payments.
  690         3. Management of individual benefit accounts.
  691         4. Distribution of premiums to insurers and payments to
  692  other eligible vendors.
  693         5. Assistance for participants in complying with reporting
  694  requirements.
  695         (c) Services to individual participants, including:
  696         1. Information about available products and participating
  697  vendors.
  698         2. Assistance with assessing the benefits and limits of
  699  each product, including information necessary to distinguish
  700  between policies offering creditable coverage and other products
  701  available through the program.
  702         3. Account information to assist individual participants
  703  with managing available resources.
  704         4. Services that promote healthy behaviors.
  705         5.Health benefits coverage information about health
  706  insurance plans compliant with the Affordable Care Act.
  707         6. Consumer assistance and enrollment services for the
  708  Florida Health Insurance Affordability Exchange Program, or
  709  FHIX.
  710         (d) Recruitment of vendors, including insurers, health
  711  maintenance organizations, prepaid clinic service providers,
  712  provider service networks, and other providers.
  713         (e) Certification of vendors to ensure capability,
  714  reliability, and validity of offerings.
  715         (f) Collection of data, monitoring, assessment, and
  716  reporting of vendor performance.
  717         (g) Information services for individuals and employers.
  718         (h) Program evaluation.
  719         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  720  program is voluntary and shall be available to employers,
  721  individuals, vendors, and health insurance agents as specified
  722  in this subsection.
  723         (a) Employers eligible to enroll in the program include
  724  those employers that meet criteria established by the
  725  corporation and elect to make their employees eligible through
  726  the program.
  727         (b) Individuals eligible to participate in the program
  728  include:
  729         1. Individual employees of enrolled employers.
  730         2. Other individuals that meet criteria established by the
  731  corporation.
  732         (c) Employers who choose to participate in the program may
  733  enroll by complying with the procedures established by the
  734  corporation. The procedures must include, but are not limited
  735  to:
  736         1. Submission of required information.
  737         2. Compliance with federal tax requirements for the
  738  establishment of a cafeteria plan, pursuant to s. 125 of the
  739  Internal Revenue Code, including designation of the employer’s
  740  plan as a premium payment plan, a salary reduction plan that has
  741  flexible spending arrangements, or a salary reduction plan that
  742  has a premium payment and flexible spending arrangements.
  743         3. Determination of the employer’s contribution, if any,
  744  per employee, provided that such contribution is equal for each
  745  eligible employee.
  746         4. Establishment of payroll deduction procedures, subject
  747  to the agreement of each individual employee who voluntarily
  748  participates in the program.
  749         5. Designation of the corporation as the third-party
  750  administrator for the employer’s health benefit plan.
  751         6. Identification of eligible employees.
  752         7. Arrangement for periodic payments.
  753         8. Employer notification to employees of the intent to
  754  transfer from an existing employee health plan to the program at
  755  least 90 days before the transition.
  756         (d) All eligible vendors who choose to participate and the
  757  products and services that the vendors are permitted to sell are
  758  as follows:
  759         1. Insurers licensed under chapter 624 may sell health
  760  insurance policies, limited benefit policies, other risk-bearing
  761  coverage, and other products or services.
  762         2. Health maintenance organizations licensed under part I
  763  of chapter 641 may sell health maintenance contracts, limited
  764  benefit policies, other risk-bearing products, and other
  765  products or services.
  766         3. Prepaid limited health service organizations may sell
  767  products and services as authorized under part I of chapter 636,
  768  and discount medical plan organizations may sell products and
  769  services as authorized under part II of chapter 636.
  770         4. Prepaid health clinic service providers licensed under
  771  part II of chapter 641 may sell prepaid service contracts and
  772  other arrangements for a specified amount and type of health
  773  services or treatments.
  774         5. Health care providers, including hospitals and other
  775  licensed health facilities, health care clinics, licensed health
  776  professionals, pharmacies, and other licensed health care
  777  providers, may sell service contracts and arrangements for a
  778  specified amount and type of health services or treatments.
  779         6. Provider organizations, including service networks,
  780  group practices, professional associations, and other
  781  incorporated organizations of providers, may sell service
  782  contracts and arrangements for a specified amount and type of
  783  health services or treatments.
  784         7. Corporate entities providing specific health services in
  785  accordance with applicable state law may sell service contracts
  786  and arrangements for a specified amount and type of health
  787  services or treatments.
  789  A vendor described in subparagraphs 3.-7. may not sell products
  790  that provide risk-bearing coverage unless that vendor is
  791  authorized under a certificate of authority issued by the Office
  792  of Insurance Regulation and is authorized to provide coverage in
  793  the relevant geographic area. Otherwise eligible vendors may be
  794  excluded from participating in the program for deceptive or
  795  predatory practices, financial insolvency, or failure to comply
  796  with the terms of the participation agreement or other standards
  797  set by the corporation.
  798         (e) Eligible individuals may participate in the program
  799  voluntarily. Individuals who join the program may participate by
  800  complying with the procedures established by the corporation.
  801  These procedures must include, but are not limited to:
  802         1. Submission of required information.
  803         2. Authorization for payroll deduction, if applicable.
  804         3. Compliance with federal tax requirements.
  805         4. Arrangements for payment.
  806         5. Selection of products and services.
  807         (f) Vendors who choose to participate in the program may
  808  enroll by complying with the procedures established by the
  809  corporation. These procedures may include, but are not limited
  810  to:
  811         1. Submission of required information, including a complete
  812  description of the coverage, services, provider network, payment
  813  restrictions, and other requirements of each product offered
  814  through the program.
  815         2. Execution of an agreement to comply with requirements
  816  established by the corporation.
  817         3. Execution of an agreement that prohibits refusal to sell
  818  any offered product or service to a participant who elects to
  819  buy it.
  820         4. Establishment of product prices based on applicable
  821  criteria.
  822         5. Arrangements for receiving payment for enrolled
  823  participants.
  824         6. Participation in ongoing reporting processes established
  825  by the corporation.
  826         7. Compliance with grievance procedures established by the
  827  corporation.
  828         (g) Health insurance agents licensed under part IV of
  829  chapter 626 are eligible to voluntarily participate as buyers’
  830  representatives. A buyer’s representative acts on behalf of an
  831  individual purchasing health insurance and health services
  832  through the program by providing information about products and
  833  services available through the program and assisting the
  834  individual with both the decision and the procedure of selecting
  835  specific products. Serving as a buyer’s representative does not
  836  constitute a conflict of interest with continuing
  837  responsibilities as a health insurance agent if the relationship
  838  between each agent and any participating vendor is disclosed
  839  before advising an individual participant about the products and
  840  services available through the program. In order to participate,
  841  a health insurance agent shall comply with the procedures
  842  established by the corporation, including:
  843         1. Completion of training requirements.
  844         2. Execution of a participation agreement specifying the
  845  terms and conditions of participation.
  846         3. Disclosure of any appointments to solicit insurance or
  847  procure applications for vendors participating in the program.
  848         4. Arrangements to receive payment from the corporation for
  849  services as a buyer’s representative.
  850         (5) PRODUCTS.—
  851         (a) The products that may be made available for purchase
  852  through the program include, but are not limited to:
  853         1. Health insurance policies.
  854         2. Health maintenance contracts.
  855         3. Limited benefit plans.
  856         4. Prepaid clinic services.
  857         5. Service contracts.
  858         6. Arrangements for purchase of specific amounts and types
  859  of health services and treatments.
  860         7. Flexible spending accounts.
  861         (b) Health insurance policies, health maintenance
  862  contracts, limited benefit plans, prepaid service contracts, and
  863  other contracts for services must ensure the availability of
  864  covered services.
  865         (c) Products may be offered for multiyear periods provided
  866  the price of the product is specified for the entire period or
  867  for each separately priced segment of the policy or contract.
  868         (d) The corporation shall provide a disclosure form for
  869  consumers to acknowledge their understanding of the nature of,
  870  and any limitations to, the benefits provided by the products
  871  and services being purchased by the consumer.
  872         (e) The corporation must determine that making the plan
  873  available through the program is in the interest of eligible
  874  individuals and eligible employers in the state.
  875         (6) PRICING.—Prices for the products and services sold
  876  through the program must be transparent to participants and
  877  established by the vendors. The corporation may shall annually
  878  assess a surcharge for each premium or price set by a
  879  participating vendor. Any The surcharge may not be more than 2.5
  880  percent of the price and shall be used to generate funding for
  881  administrative services provided by the corporation and payments
  882  to buyers’ representatives; however, a surcharge may not be
  883  assessed for products and services sold in the FHIX marketplace.
  884         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  885  single, centralized market for purchase of health insurance,
  886  health maintenance contracts, and other health products and
  887  services. Purchases may be made by participating individuals
  888  over the Internet or through the services of a participating
  889  health insurance agent. Information about each product and
  890  service available through the program shall be made available
  891  through printed material and an interactive Internet website.
  892         (a)Marketplace purchasing.A participant needing personal
  893  assistance to select products and services shall be referred to
  894  a participating agent in his or her area.
  895         1.(a) Participation in the program may begin at any time
  896  during a year after the employer completes enrollment and meets
  897  the requirements specified by the corporation pursuant to
  898  paragraph (4)(c).
  899         2.(b) Initial selection of products and services must be
  900  made by an individual participant within the applicable open
  901  enrollment period.
  902         3.(c) Initial enrollment periods for each product selected
  903  by an individual participant must last at least 12 months,
  904  unless the individual participant specifically agrees to a
  905  different enrollment period.
  906         4.(d) If an individual has selected one or more products
  907  and enrolled in those products for at least 12 months or any
  908  other period specifically agreed to by the individual
  909  participant, changes in selected products and services may only
  910  be made during the annual enrollment period established by the
  911  corporation.
  912         5.(e) The limits established in subparagraphs 2., 3., and
  913  4. paragraphs (b)-(d) apply to any risk-bearing product that
  914  promises future payment or coverage for a variable amount of
  915  benefits or services. The limits do not apply to initiation of
  916  flexible spending plans if those plans are not associated with
  917  specific high-deductible insurance policies or the use of
  918  spending accounts for any products offering individual
  919  participants specific amounts and types of health services and
  920  treatments at a contracted price.
  921         (b) FHIX marketplace purchasing.
  922         1. Participation in the FHIX marketplace may begin at any
  923  time during the year.
  924         2. Initial enrollment periods for certain products selected
  925  by an individual enrollee which are noncompliant with the
  926  Affordable Care Act may be required to last at least 12 months,
  927  unless the individual participant specifically agrees to a
  928  different enrollment period.
  929         (8) CONSUMER INFORMATION.—The corporation shall:
  930         (a) Establish a secure website to facilitate the purchase
  931  of products and services by participating individuals. The
  932  website must provide information about each product or service
  933  available through the program.
  934         (b) Inform individuals about other public health care
  935  programs.
  936         (9) RISK POOLING.—The program may use methods for pooling
  937  the risk of individual participants and preventing selection
  938  bias. These methods may include, but are not limited to, a
  939  postenrollment risk adjustment of the premium payments to the
  940  vendors. The corporation may establish a methodology for
  941  assessing the risk of enrolled individual participants based on
  942  data reported annually by the vendors about their enrollees.
  943  Distribution of payments to the vendors may be adjusted based on
  944  the assessed relative risk profile of the enrollees in each
  945  risk-bearing product for the most recent period for which data
  946  is available.
  947         (10) EXEMPTIONS.—
  948         (a) Products, other than the products set forth in
  949  subparagraphs (4)(d)1.-4., sold as part of the program are not
  950  subject to the licensing requirements of the Florida Insurance
  951  Code, as defined in s. 624.01 or the mandated offerings or
  952  coverages established in part VI of chapter 627 and chapter 641.
  953         (b) The corporation may act as an administrator as defined
  954  in s. 626.88 but is not required to be certified pursuant to
  955  part VII of chapter 626. However, a third party administrator
  956  used by the corporation must be certified under part VII of
  957  chapter 626.
  958         (c) Any standard forms, website design, or marketing
  959  communication developed by the corporation and used by the
  960  corporation, or any vendor that meets the requirements of
  961  paragraph (4)(f) is not subject to the Florida Insurance Code,
  962  as established in s. 624.01.
  963         (11) CORPORATION.—There is created the Florida Health
  964  Choices, Inc., which shall be registered, incorporated,
  965  organized, and operated in compliance with part III of chapter
  966  112 and chapters 119, 286, and 617. The purpose of the
  967  corporation is to administer the program created in this section
  968  and to conduct such other business as may further the
  969  administration of the program.
  970         (a) The corporation shall be governed by a 15-member board
  971  of directors consisting of:
  972         1. Three ex officio, nonvoting members to include:
  973         a. The Secretary of Health Care Administration or a
  974  designee with expertise in health care services.
  975         b. The Secretary of Management Services or a designee with
  976  expertise in state employee benefits.
  977         c. The commissioner of the Office of Insurance Regulation
  978  or a designee with expertise in insurance regulation.
  979         2. Four members appointed by and serving at the pleasure of
  980  the Governor.
  981         3. Four members appointed by and serving at the pleasure of
  982  the President of the Senate.
  983         4. Four members appointed by and serving at the pleasure of
  984  the Speaker of the House of Representatives.
  985         5. Board members may not include insurers, health insurance
  986  agents or brokers, health care providers, health maintenance
  987  organizations, prepaid service providers, or any other entity,
  988  affiliate, or subsidiary of eligible vendors.
  989         (b) Members shall be appointed for terms of up to 3 years.
  990  Any member is eligible for reappointment. A vacancy on the board
  991  shall be filled for the unexpired portion of the term in the
  992  same manner as the original appointment.
  993         (c) The board shall select a chief executive officer for
  994  the corporation who shall be responsible for the selection of
  995  such other staff as may be authorized by the corporation’s
  996  operating budget as adopted by the board.
  997         (d) Board members are entitled to receive, from funds of
  998  the corporation, reimbursement for per diem and travel expenses
  999  as provided by s. 112.061. No other compensation is authorized.
 1000         (e) There is no liability on the part of, and no cause of
 1001  action shall arise against, any member of the board or its
 1002  employees or agents for any action taken by them in the
 1003  performance of their powers and duties under this section.
 1004         (f) The board shall develop and adopt bylaws and other
 1005  corporate procedures as necessary for the operation of the
 1006  corporation and carrying out the purposes of this section. The
 1007  bylaws shall:
 1008         1. Specify procedures for selection of officers and
 1009  qualifications for reappointment, provided that no board member
 1010  shall serve more than 9 consecutive years.
 1011         2. Require an annual membership meeting that provides an
 1012  opportunity for input and interaction with individual
 1013  participants in the program.
 1014         3. Specify policies and procedures regarding conflicts of
 1015  interest, including the provisions of part III of chapter 112,
 1016  which prohibit a member from participating in any decision that
 1017  would inure to the benefit of the member or the organization
 1018  that employs the member. The policies and procedures shall also
 1019  require public disclosure of the interest that prevents the
 1020  member from participating in a decision on a particular matter.
 1021         (g) The corporation may exercise all powers granted to it
 1022  under chapter 617 necessary to carry out the purposes of this
 1023  section, including, but not limited to, the power to receive and
 1024  accept grants, loans, or advances of funds from any public or
 1025  private agency and to receive and accept from any source
 1026  contributions of money, property, labor, or any other thing of
 1027  value to be held, used, and applied for the purposes of this
 1028  section.
 1029         (h) The corporation may establish technical advisory panels
 1030  consisting of interested parties, including consumers, health
 1031  care providers, individuals with expertise in insurance
 1032  regulation, and insurers.
 1033         (i) The corporation shall:
 1034         1. Determine eligibility of employers, vendors,
 1035  individuals, and agents in accordance with subsection (4).
 1036         2. Establish procedures necessary for the operation of the
 1037  program, including, but not limited to, procedures for
 1038  application, enrollment, risk assessment, risk adjustment, plan
 1039  administration, performance monitoring, and consumer education.
 1040         3. Arrange for collection of contributions from
 1041  participating employers, third parties, governmental entities,
 1042  and individuals.
 1043         4. Arrange for payment of premiums and other appropriate
 1044  disbursements based on the selections of products and services
 1045  by the individual participants.
 1046         5. Establish criteria for disenrollment of participating
 1047  individuals based on failure to pay the individual’s share of
 1048  any contribution required to maintain enrollment in selected
 1049  products.
 1050         6. Establish criteria for exclusion of vendors pursuant to
 1051  paragraph (4)(d).
 1052         7. Develop and implement a plan for promoting public
 1053  awareness of and participation in the program.
 1054         8. Secure staff and consultant services necessary to the
 1055  operation of the program.
 1056         9. Establish policies and procedures regarding
 1057  participation in the program for individuals, vendors, health
 1058  insurance agents, and employers.
 1059         10. Provide for the operation of a toll-free hotline to
 1060  respond to requests for assistance.
 1061         11. Provide for initial, open, and special enrollment
 1062  periods.
 1063         12. Evaluate options for employer participation which may
 1064  conform to with common insurance practices.
 1065         13. Administer the Florida Health Insurance Affordability
 1066  Exchange Program in accordance with ss. 409.720-409.731.
 1067         14. Coordinate with the Agency for Health Care
 1068  Administration, the Department of Children and Families, and the
 1069  Florida Healthy Kids Corporation on the transition plan for FHIX
 1070  and any subsequent transition activities.
 1071         (12) REPORT.—The board of the corporation shall Beginning
 1072  in the 2009-2010 fiscal year, submit by February 1 an annual
 1073  report to the Governor, the President of the Senate, and the
 1074  Speaker of the House of Representatives documenting the
 1075  corporation’s activities in compliance with the duties
 1076  delineated in this section.
 1077         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1078  safeguard the financial transactions made under the auspices of
 1079  the program, the corporation is authorized to establish
 1080  qualifying criteria and certification procedures for vendors,
 1081  require performance bonds or other guarantees of ability to
 1082  complete contractual obligations, monitor the performance of
 1083  vendors, and enforce the agreements of the program through
 1084  financial penalty or disqualification from the program.
 1086         (a) Definitions.—For purposes of this subsection, the term:
 1087         1. “Buyer’s representative” means a participating insurance
 1088  agent as described in paragraph (4)(g).
 1089         2. “Enrollee” means an employer who is eligible to enroll
 1090  in the program pursuant to paragraph (4)(a).
 1091         3. “Participant” means an individual who is eligible to
 1092  participate in the program pursuant to paragraph (4)(b).
 1093         4. “Proprietary confidential business information” means
 1094  information, regardless of form or characteristics, that is
 1095  owned or controlled by a vendor requesting confidentiality under
 1096  this section; that is intended to be and is treated by the
 1097  vendor as private in that the disclosure of the information
 1098  would cause harm to the business operations of the vendor; that
 1099  has not been disclosed unless disclosed pursuant to a statutory
 1100  provision, an order of a court or administrative body, or a
 1101  private agreement providing that the information may be released
 1102  to the public; and that is information concerning:
 1103         a. Business plans.
 1104         b. Internal auditing controls and reports of internal
 1105  auditors.
 1106         c. Reports of external auditors for privately held
 1107  companies.
 1108         d. Client and customer lists.
 1109         e. Potentially patentable material.
 1110         f. A trade secret as defined in s. 688.002.
 1111         5. “Vendor” means a participating insurer or other provider
 1112  of services as described in paragraph (4)(d).
 1113         (b) Public record exemptions.—
 1114         1. Personal identifying information of an enrollee or
 1115  participant who has applied for or participates in the Florida
 1116  Health Choices Program is confidential and exempt from s.
 1117  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1118         2. Client and customer lists of a buyer’s representative
 1119  held by the corporation are confidential and exempt from s.
 1120  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1121         3. Proprietary confidential business information held by
 1122  the corporation is confidential and exempt from s. 119.07(1) and
 1123  s. 24(a), Art. I of the State Constitution.
 1124         (c) Retroactive application.—The public record exemptions
 1125  provided for in paragraph (b) apply to information held by the
 1126  corporation before, on, or after the effective date of this
 1127  exemption.
 1128         (d) Authorized release.—
 1129         1. Upon request, information made confidential and exempt
 1130  pursuant to this subsection shall be disclosed to:
 1131         a. Another governmental entity in the performance of its
 1132  official duties and responsibilities.
 1133         b. Any person who has the written consent of the program
 1134  applicant.
 1135         c. The Florida Kidcare program for the purpose of
 1136  administering the program authorized in ss. 409.810-409.821.
 1137         2. Paragraph (b) does not prohibit a participant’s legal
 1138  guardian from obtaining confirmation of coverage, dates of
 1139  coverage, the name of the participant’s health plan, and the
 1140  amount of premium being paid.
 1141         (e) Penalty.—A person who knowingly and willfully violates
 1142  this subsection commits a misdemeanor of the second degree,
 1143  punishable as provided in s. 775.082 or s. 775.083.
 1144         (f) Review and repeal.—This subsection is subject to the
 1145  Open Government Sunset Review Act in accordance with s. 119.15,
 1146  and shall stand repealed on October 2, 2016, unless reviewed and
 1147  saved from repeal through reenactment by the Legislature.
 1148         Section 16. Subsection (2) of section 409.904, Florida
 1149  Statutes, is amended to read:
 1150         409.904 Optional payments for eligible persons.—The agency
 1151  may make payments for medical assistance and related services on
 1152  behalf of the following persons who are determined to be
 1153  eligible subject to the income, assets, and categorical
 1154  eligibility tests set forth in federal and state law. Payment on
 1155  behalf of these Medicaid eligible persons is subject to the
 1156  availability of moneys and any limitations established by the
 1157  General Appropriations Act or chapter 216.
 1158         (2) A family, a pregnant woman, a child under age 21, a
 1159  person age 65 or over, or a blind or disabled person, who would
 1160  be eligible under any group listed in s. 409.903(1), (2), or
 1161  (3), except that the income or assets of such family or person
 1162  exceed established limitations. For a family or person in one of
 1163  these coverage groups, medical expenses are deductible from
 1164  income in accordance with federal requirements in order to make
 1165  a determination of eligibility. A family or person eligible
 1166  under the coverage known as the “medically needy,” is eligible
 1167  to receive the same services as other Medicaid recipients, with
 1168  the exception of services in skilled nursing facilities and
 1169  intermediate care facilities for the developmentally disabled.
 1171  Effective October 1, 2015, no new enrollees over the age of 20
 1172  may be enrolled under this subsection. This subsection expires
 1173  September 30, 2019.
 1174         Section 17. Section 624.91, Florida Statutes, is amended to
 1175  read:
 1176         624.91 The Florida Healthy Kids Corporation Act.—
 1177         (1) SHORT TITLE.—This section may be cited as the “William
 1178  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1179         (2) LEGISLATIVE INTENT.—
 1180         (a) The Legislature finds that increased access to health
 1181  care services could improve children’s health and reduce the
 1182  incidence and costs of childhood illness and disabilities among
 1183  children in this state. Many children do not have comprehensive,
 1184  affordable health care services available. It is the intent of
 1185  the Legislature that the Florida Healthy Kids Corporation
 1186  provide comprehensive health insurance coverage to such
 1187  children. The corporation is encouraged to cooperate with any
 1188  existing health service programs funded by the public or the
 1189  private sector.
 1190         (b) It is the intent of the Legislature that the Florida
 1191  Healthy Kids Corporation serve as one of several providers of
 1192  services to children eligible for medical assistance under Title
 1193  XXI of the Social Security Act. Although the corporation may
 1194  serve other children, the Legislature intends the primary
 1195  recipients of services provided through the corporation be
 1196  school-age children with a family income below 200 percent of
 1197  the federal poverty level, who do not qualify for Medicaid. It
 1198  is also the intent of the Legislature that state and local
 1199  government Florida Healthy Kids funds be used to continue
 1200  coverage, subject to specific appropriations in the General
 1201  Appropriations Act, to children not eligible for federal
 1202  matching funds under Title XXI.
 1203         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1204  of this state are eligible the following individuals are
 1205  eligible for state-funded assistance in paying Florida Healthy
 1206  Kids premiums pursuant to s. 409.814.:
 1207         (a) Residents of this state who are eligible for the
 1208  Florida Kidcare program pursuant to s. 409.814.
 1209         (b) Notwithstanding s. 409.814, legal aliens who are
 1210  enrolled in the Florida Healthy Kids program as of January 31,
 1211  2004, who do not qualify for Title XXI federal funds because
 1212  they are not qualified aliens as defined in s. 409.811.
 1213         (4) NONENTITLEMENT.—Nothing in this section shall be
 1214  construed as providing an individual with an entitlement to
 1215  health care services. No cause of action shall arise against the
 1216  state, the Florida Healthy Kids Corporation, or a unit of local
 1217  government for failure to make health services available under
 1218  this section.
 1220         (a) There is created the Florida Healthy Kids Corporation,
 1221  a not-for-profit corporation.
 1222         (b) The Florida Healthy Kids Corporation shall:
 1223         1. Arrange for the collection of any individual, family,
 1224  local contributions, or employer payment or premium, in an
 1225  amount to be determined by the board of directors, to provide
 1226  for payment of premiums for comprehensive insurance coverage and
 1227  for the actual or estimated administrative expenses.
 1228         2. Arrange for the collection of any voluntary
 1229  contributions to provide for payment of Florida Kidcare program
 1230  or Florida Health Insurance Affordability Exchange Program
 1231  premiums for children who are not eligible for medical
 1232  assistance under Title XIX or Title XXI of the Social Security
 1233  Act.
 1234         3. Subject to the provisions of s. 409.8134, accept
 1235  voluntary supplemental local match contributions that comply
 1236  with the requirements of Title XXI of the Social Security Act
 1237  for the purpose of providing additional Florida Kidcare coverage
 1238  in contributing counties under Title XXI.
 1239         4. Establish the administrative and accounting procedures
 1240  for the operation of the corporation.
 1241         4.5. Establish, with consultation from appropriate
 1242  professional organizations, standards for preventive health
 1243  services and providers and comprehensive insurance benefits
 1244  appropriate to children, provided that such standards for rural
 1245  areas shall not limit primary care providers to board-certified
 1246  pediatricians.
 1247         5.6. Determine eligibility for children seeking to
 1248  participate in the Title XXI-funded components of the Florida
 1249  Kidcare program consistent with the requirements specified in s.
 1250  409.814, as well as the non-Title-XXI-eligible children as
 1251  provided in subsection (3).
 1252         6.7. Establish procedures under which providers of local
 1253  match to, applicants to and participants in the program may have
 1254  grievances reviewed by an impartial body and reported to the
 1255  board of directors of the corporation.
 1256         7.8. Establish participation criteria and, if appropriate,
 1257  contract with an authorized insurer, health maintenance
 1258  organization, or third-party administrator to provide
 1259  administrative services to the corporation.
 1260         8.9. Establish enrollment criteria that include penalties
 1261  or waiting periods of 30 days for reinstatement of coverage upon
 1262  voluntary cancellation for nonpayment of family or individual
 1263  premiums.
 1264         9.10. Contract with authorized insurers or any provider of
 1265  health care services, meeting standards established by the
 1266  corporation, for the provision of comprehensive insurance
 1267  coverage to participants. Such standards shall include criteria
 1268  under which the corporation may contract with more than one
 1269  provider of health care services in program sites.
 1270         a. Health plans shall be selected through a competitive bid
 1271  process. The Florida Healthy Kids Corporation shall purchase
 1272  goods and services in the most cost-effective manner consistent
 1273  with the delivery of quality medical care.
 1274         b. The maximum administrative cost for a Florida Healthy
 1275  Kids Corporation contract shall be 15 percent. For health and
 1276  dental care contracts, the minimum medical loss ratio for a
 1277  Florida Healthy Kids Corporation contract shall be 85 percent.
 1278  The calculations must use uniform financial data collected from
 1279  all plans in a format established by the corporation and shall
 1280  be computed for each plan on a statewide basis. Funds shall be
 1281  classified in a manner consistent with 45 C.F.R. part 158 For
 1282  dental contracts, the remaining compensation to be paid to the
 1283  authorized insurer or provider under a Florida Healthy Kids
 1284  Corporation contract shall be no less than an amount which is 85
 1285  percent of premium; to the extent any contract provision does
 1286  not provide for this minimum compensation, this section shall
 1287  prevail.
 1288         c. The health plan selection criteria and scoring system,
 1289  and the scoring results, shall be available upon request for
 1290  inspection after the bids have been awarded.
 1291         d. Effective July 1, 2016, health and dental services
 1292  contracts of the corporation must transition to the FHIX
 1293  marketplace under s. 409.722. Qualifying plans may enroll as
 1294  vendors with the FHIX marketplace to maintain continuity of care
 1295  for participants.
 1296         10.11. Establish disenrollment criteria in the event local
 1297  matching funds are insufficient to cover enrollments.
 1298         11.12. Develop and implement a plan to publicize the
 1299  Florida Kidcare program, the eligibility requirements of the
 1300  program, and the procedures for enrollment in the program and to
 1301  maintain public awareness of the corporation and the program.
 1302         12.13. Secure staff necessary to properly administer the
 1303  corporation. Staff costs shall be funded from state and local
 1304  matching funds and such other private or public funds as become
 1305  available. The board of directors shall determine the number of
 1306  staff members necessary to administer the corporation.
 1307         13.14. In consultation with the partner agencies, provide a
 1308  report on the Florida Kidcare program annually to the Governor,
 1309  the Chief Financial Officer, the Commissioner of Education, the
 1310  President of the Senate, the Speaker of the House of
 1311  Representatives, and the Minority Leaders of the Senate and the
 1312  House of Representatives.
 1313         14.15. Provide information on a quarterly basis online to
 1314  the Legislature and the Governor which compares the costs and
 1315  utilization of the full-pay enrolled population and the Title
 1316  XXI-subsidized enrolled population in the Florida Kidcare
 1317  program. The information, at a minimum, must include:
 1318         a. The monthly enrollment and expenditure for full-pay
 1319  enrollees in the Medikids and Florida Healthy Kids programs
 1320  compared to the Title XXI-subsidized enrolled population; and
 1321         b. The costs and utilization by service of the full-pay
 1322  enrollees in the Medikids and Florida Healthy Kids programs and
 1323  the Title XXI-subsidized enrolled population.
 1324         15.16. Establish benefit packages that conform to the
 1325  provisions of the Florida Kidcare program, as created in ss.
 1326  409.810-409.821.
 1327         16. Contract with other insurance affordability programs
 1328  and FHIX to provide customer service or other enrollment-focused
 1329  services.
 1330         17. Annually develop performance metrics for the following
 1331  focus areas:
 1332         a. Administrative functions.
 1333         b. Contracting with vendors.
 1334         c. Customer service.
 1335         d. Enrollee education.
 1336         e. Financial services.
 1337         f. Program integrity.
 1338         (c) Coverage under the corporation’s program is secondary
 1339  to any other available private coverage held by, or applicable
 1340  to, the participant child or family member. Insurers under
 1341  contract with the corporation are the payors of last resort and
 1342  must coordinate benefits with any other third-party payor that
 1343  may be liable for the participant’s medical care.
 1344         (d) The Florida Healthy Kids Corporation shall be a private
 1345  corporation not for profit, organized pursuant to chapter 617,
 1346  and shall have all powers necessary to carry out the purposes of
 1347  this act, including, but not limited to, the power to receive
 1348  and accept grants, loans, or advances of funds from any public
 1349  or private agency and to receive and accept from any source
 1350  contributions of money, property, labor, or any other thing of
 1351  value, to be held, used, and applied for the purposes of this
 1352  act.
 1354         (a) The Florida Healthy Kids Corporation shall operate
 1355  subject to the supervision and approval of a board of directors.
 1356  The board chair shall be an appointee designated by the
 1357  Governor, and the board shall be chaired by the Chief Financial
 1358  Officer or her or his designee, and composed of 12 other
 1359  members. The Senate shall confirm the designated chair and other
 1360  board appointees. The board members shall be appointed selected
 1361  for 3-year terms. of office as follows:
 1362         1. The Secretary of Health Care Administration, or his or
 1363  her designee.
 1364         2. One member appointed by the Commissioner of Education
 1365  from the Office of School Health Programs of the Florida
 1366  Department of Education.
 1367         3. One member appointed by the Chief Financial Officer from
 1368  among three members nominated by the Florida Pediatric Society.
 1369         4. One member, appointed by the Governor, who represents
 1370  the Children’s Medical Services Program.
 1371         5. One member appointed by the Chief Financial Officer from
 1372  among three members nominated by the Florida Hospital
 1373  Association.
 1374         6. One member, appointed by the Governor, who is an expert
 1375  on child health policy.
 1376         7. One member, appointed by the Chief Financial Officer,
 1377  from among three members nominated by the Florida Academy of
 1378  Family Physicians.
 1379         8. One member, appointed by the Governor, who represents
 1380  the state Medicaid program.
 1381         9. One member, appointed by the Chief Financial Officer,
 1382  from among three members nominated by the Florida Association of
 1383  Counties.
 1384         10. The State Health Officer or her or his designee.
 1385         11. The Secretary of Children and Families, or his or her
 1386  designee.
 1387         12. One member, appointed by the Governor, from among three
 1388  members nominated by the Florida Dental Association.
 1389         (b) A member of the board of directors serves at the
 1390  pleasure of the Governor may be removed by the official who
 1391  appointed that member. The board shall appoint an executive
 1392  director, who is responsible for other staff authorized by the
 1393  board.
 1394         (c) Board members are entitled to receive, from funds of
 1395  the corporation, reimbursement for per diem and travel expenses
 1396  as provided by s. 112.061.
 1397         (d) There shall be no liability on the part of, and no
 1398  cause of action shall arise against, any member of the board of
 1399  directors, or its employees or agents, for any action they take
 1400  in the performance of their powers and duties under this act.
 1401         (e) Board members who are serving as of the effective date
 1402  of this act may remain on the board until January 1, 2016.
 1404         (a) The corporation shall not be deemed an insurer. The
 1405  officers, directors, and employees of the corporation shall not
 1406  be deemed to be agents of an insurer. Neither the corporation
 1407  nor any officer, director, or employee of the corporation is
 1408  subject to the licensing requirements of the insurance code or
 1409  the rules of the Department of Financial Services. However, any
 1410  marketing representative utilized and compensated by the
 1411  corporation must be appointed as a representative of the
 1412  insurers or health services providers with which the corporation
 1413  contracts.
 1414         (b) The board has complete fiscal control over the
 1415  corporation and is responsible for all corporate operations.
 1416         (c) The Department of Financial Services shall supervise
 1417  any liquidation or dissolution of the corporation and shall
 1418  have, with respect to such liquidation or dissolution, all power
 1419  granted to it pursuant to the insurance code.
 1420         (8) TRANSITION PLANS.—The corporation shall confer with the
 1421  Agency for Health Care Administration, the Department of
 1422  Children and Families, and Florida Health Choices, Inc., to
 1423  develop transition plans for the Florida Health Insurance
 1424  Affordability Exchange Program as created under ss. 409.720
 1425  409.731.
 1426         Section 18. Section 624.915, Florida Statutes, is repealed.
 1427         Section 19. The Division of Law Revision and Information is
 1428  directed to replace the phrase “the effective date of this act”
 1429  wherever it occurs in this act with the date the act becomes a
 1430  law.
 1431         Section 20. This act shall take effect upon becoming a law.