Florida Senate - 2015                        COMMITTEE AMENDMENT
       Bill No. SPB 7044
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Comm: UNFAV           .                                
                  03/10/2015           .                                

       The Committee on Health Policy (Sobel) recommended the
    1         Senate Amendment 
    3         Delete lines 92 - 549
    4  and insert:
    5         (3) “Corporation” means the Florida Healthy Kids
    6  Corporation, as established under s. 624.91.
    7         (4) “Enrollee” means an individual who has been determined
    8  eligible for and is receiving health benefits coverage under
    9  this part.
   10         (5) “FHIX marketplace” or “marketplace” means the single,
   11  centralized market established under s. 408.910 which
   12  facilitates health benefits coverage.
   13         (6) “Florida Health Insurance Affordability Exchange
   14  Program” or “FHIX” means the program created under ss. 409.720
   15  409.731.
   16         (7) “Florida Healthy Kids Corporation” means the entity
   17  created under s. 624.91.
   18         (8) “Florida Kidcare program” or “Kidcare program” means
   19  the health benefits coverage administered through ss. 409.810
   20  409.821.
   21         (9) “Health benefits coverage” means the payment of
   22  benefits for covered health care services or the availability,
   23  directly or through arrangements with other persons, of covered
   24  health care services on a prepaid per capita basis or on a
   25  prepaid aggregate fixed-sum basis.
   26         (10) “Inactive status” means the enrollment status of a
   27  participant previously enrolled in health benefits coverage
   28  through the FIX marketplace who lost coverage through the
   29  marketplace for non-payment, but maintains access to his or her
   30  balance in a health savings account or health reimbursement
   31  account.
   32         (11) “Medicaid” means the medical assistance program
   33  authorized by Title XIX of the Social Security Act, and
   34  regulations thereunder, and part III and part IV of this
   35  chapter, as administered in this state by the agency.
   36         (l2) “Modified adjusted gross income” means the
   37  individual’s or household’s annual adjusted gross income as
   38  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986 and
   39  which is used to determine eligibility for FHIX.
   40         (13) “Patient Protection and Affordable Care Act” or
   41  “Affordable Care Act” means Pub. L. No. 111-148, as further
   42  amended by the Health Care and Education Reconciliation Act of
   43  2010, Pub. L. No. 111-152, and any amendments to, and
   44  regulations or guidance under, those acts.
   45         (14) “Premium credit” means the monthly amount paid by the
   46  agency per enrollee in the Florida Health Insurance
   47  Affordability Exchange Program toward health benefits coverage.
   48         (15) “Qualified alien” means an alien as defined in 8
   49  U.S.C. s. 1641(b) or (c).
   50         (16) “Resident” means a United States citizen or qualified
   51  alien who is domiciled in this state.
   52         Section 5. Section 409.723, Florida Statutes, is created to
   53  read:
   54         409.723Participation.—
   55         (1) ELIGIBILITY.—In order to participate in FHIX, an
   56  individual must be a resident and must meet the following
   57  requirements, as applicable:
   58         (a) Qualify as a newly eligible enrollee, who must be an
   59  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
   60  Social Security Act or s. 2001 of the Affordable Care Act and as
   61  may be further defined by federal regulation.
   62         (b) Meet and maintain the responsibilities under subsection
   63  (4).
   64         (c) Qualify as a participant in the Florida Healthy Kids
   65  program under s. 624.91, subject to the implementation of Phase
   66  Three under s. 409.727.
   67         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
   68  an application to the department for an eligibility
   69  determination.
   70         (a) Applications may be submitted by mail, fax, online, or
   71  any other method permitted by law or regulation.
   72         (b) The department is responsible for any eligibility
   73  correspondence and status updates to the participant and other
   74  agencies.
   75         (c) The department shall review a participant’s eligibility
   76  every 12 months.
   77         (d) An application or renewal is deemed complete when the
   78  participant has met all the requirements under subsection (4).
   79         (3) PARTICIPANT RIGHTS.—A participant has all of the
   80  following rights:
   81         (a)Access to the FHIX marketplace to select the scope,
   82  amount, and type of health care coverage and other services to
   83  purchase.
   84         (b) Continuity and portability of coverage to avoid
   85  disruption of coverage and other health care services when the
   86  participant’s economic circumstances change.
   87         (c) Retention of applicable unspent credits in the
   88  participant’s health savings or health reimbursement account
   89  following a change in the participant’s eligibility status.
   90  Credits are valid for an inactive status participant for up to 5
   91  years after the participant first enters an inactive status.
   92         (d) Ability to select more than one product or plan on the
   93  FHIX marketplace.
   94         (e) Choice of at least two health benefits products that
   95  meet the requirements of the Affordable Care Act.
   96         (4) PARTICIPANT RESPONSIBILITIES.—A participant has all of
   97  the following responsibilities:
   98         (a) Complete an initial application for health benefits
   99  coverage and an annual renewal process, which includes proof of
  100  employment, on-the-job training or placement activities, or
  101  pursuit of educational opportunities at the following hourly
  102  levels:
  103         1. For a parent of a child younger than 18 years of age, a
  104  minimum of 20 hours weekly.
  105         2. For a childless adult, a minimum of 30 hours weekly. A
  106  disabled adult or caregiver of a disabled child or adult may
  107  submit a request for an exception to these requirements to the
  108  corporation. A participant shall annually submit to the
  109  department such a request for an exception to the hourly level
  110  requirements.
  111         (b) Learn and remain informed about the choices available
  112  on the FHIX marketplace and the uses of credits in the
  113  individual accounts.
  114         (c) Execute a contract with the department to acknowledge
  115  that:
  116         1. FHIX is not an entitlement and state and federal funding
  117  may end at any time;
  118         2. Failure to pay required premiums or cost sharing will
  119  result in a transition to inactive status; and
  120         3. Noncompliance with work or educational requirements will
  121  result in a transition to inactive status.
  122         (d) Select plans and other products in a timely manner.
  123         (e) Comply with all program rules and the prohibitions
  124  against fraud, as described in s. 414.39.
  125         (f) Make monthly premium and any other cost-sharing
  126  payments by the deadline.
  127         (g) Meet minimum coverage requirements by selecting a high
  128  deductible health plan combined with a health savings or health
  129  reimbursement account if not selecting a plan with more
  130  extensive coverage.
  131         (5) COST SHARING.—
  132         (a) Enrollees are assessed monthly premiums based on their
  133  modified adjusted gross income. The maximum monthly premium
  134  payments are set at the following income levels:
  135         1. At or below 22 percent of the federal poverty level: $3.
  136         2. Greater than 22 percent, but at or below 50 percent, of
  137  the federal poverty level: $8.
  138         3. Greater than 50 percent, but at or below 75 percent, of
  139  the federal poverty level: $15.
  140         4. Greater than 75 percent, but at or below 100 percent, of
  141  the federal poverty level: $20.
  142         5. Greater than 100 percent of the federal poverty level:
  143  $25.
  144         (b) Depending on the products and services selected by the
  145  enrollee, the enrollee may also incur additional cost-sharing
  146  copayments, deductibles, or other out-of-pocket costs.
  147         (c) An enrollee may be subject to an inappropriate
  148  emergency room visit charge of up to $8 for the first visit and
  149  up to $25 for any subsequent visit, based on the enrollee’s
  150  benefit plan, to discourage inappropriate use of the emergency
  151  room.
  152         (d) Cumulative annual cost sharing per enrollee may not
  153  exceed 5 percent of an enrollee’s annual modified adjusted gross
  154  income.
  155         (e) If, after a 30-day grace period, a full premium payment
  156  has not been received, the enrollee shall be transitioned from
  157  coverage to inactive status and may not reenroll for a minimum
  158  of 6 months, unless a hardship exception has been granted.
  159  Enrollees may seek a hardship exception under the Medicaid Fair
  160  Hearing Process.
  161         Section 6. Section 409.724, Florida Statutes, is created to
  162  read:
  163         409.724Available assistance.—
  164         (1)PREMIUM CREDITS.—
  165         (a) Standard amount.—The standard monthly premium credit is
  166  equivalent to the applicable risk-adjusted capitation rate paid
  167  to Medicaid managed care plans under part IV of this chapter.
  168         (b) Supplemental funding.—Subject to federal approval,
  169  additional resources may be made available to enrollees and
  170  incorporated into FHIX.
  171         (c) Savings accounts.—In addition to the benefits provided
  172  under this section, the corporation must offer each enrollee
  173  access to an individual account that qualifies as a health
  174  reimbursement account or a health savings account. Eligible
  175  unexpended funds from the monthly premium credit must be
  176  deposited into each enrollee’s individual account in a timely
  177  manner. Enrollees may also be rewarded for healthy behaviors,
  178  adherence to wellness programs, and other activities established
  179  by the corporation which demonstrate compliance with prevention
  180  or disease management guidelines. Funds deposited into these
  181  accounts may be used to pay cost-sharing obligations or to
  182  purchase other health-related items to the extent permitted
  183  under federal law.
  184         (d) Enrollee contributions.—The enrollee may make deposits
  185  to his or her account at any time to supplement the premium
  186  credit, to purchase additional FHIX products, or to offset other
  187  cost-sharing obligations.
  188         (e) Third parties.—Third parties, including, but not
  189  limited to, an employer or relative, may also make deposits on
  190  behalf of the enrollee into the enrollee’s FHIX marketplace
  191  account. The enrollee may not withdraw any funds as a refund,
  192  except those funds the enrollee has deposited into his or her
  193  account.
  194         (2) CHOICE COUNSELING.—The agency and the corporation shall
  195  work together to develop a choice counseling program for FHIX.
  196  The choice counseling program must ensure that participants have
  197  information about the FHIX marketplace program, products, and
  198  services and that participants know where and whom to call for
  199  questions or to make their plan selections. The choice
  200  counseling program must provide culturally sensitive materials
  201  and must take into consideration the demographics of the
  202  projected population.
  203         (3)EDUCATION CAMPAIGN.—The agency, the corporation, and
  204  the Florida Healthy Kids Corporation must coordinate an ongoing
  205  enrollee education campaign beginning in Phase One, as provided
  206  in s. 409.27, informing participants, at a minimum:
  207         (a) How the transition process to the FHIX marketplace will
  208  occur and the timeline for the enrollee’s specific transition.
  209         (b) What plans are available and how to research
  210  information about available plans.
  211         (c) Information about other available insurance
  212  affordability programs for the individual and his or her family.
  213         (d) Information about health benefits coverage, provider
  214  networks, and cost sharing for available plans in each region.
  215         (e) Information on how to complete the required annual
  216  renewal process, including renewal dates and deadlines.
  217         (f) Information on how to update eligibility if the
  218  participant’s data have changed since his or her last renewal or
  219  application date.
  220         (4) CUSTOMER SUPPORT.—Beginning in Phase Two, the Florida
  221  Healthy Kids Corporation shall provide customer support for
  222  FHIX, shall address general program information, financial
  223  information, and customer service issues, and shall provide
  224  status updates on bill payments. Customer support must also
  225  provide a toll-free number and maintain a website that is
  226  available in multiple languages and that meets the needs of the
  227  enrollee population.
  228         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  229  inactive participant about other insurance affordability
  230  programs and electronically refer the participant to the federal
  231  exchange or other insurance affordability programs, as
  232  appropriate.
  233         Section 7. Section 409.725, Florida Statutes, is created to
  234  read:
  235         409.725Available products and services.—The FHIX
  236  marketplace shall offer the following products and services:
  237         (1) Authorized products and services pursuant to s.
  238  408.910.
  239         (2) Medicaid managed care plans under part IV of this
  240  chapter.
  241         (3) Authorized products under the Florida Healthy Kids
  242  Corporation pursuant to s. 624.91.
  243         (4) Employer-sponsored plans.
  244         Section 8. Section 409.726, Florida Statutes, is created to
  245  read:
  246         409.726Program accountability.—
  247         (1) All managed care plans that participate in FHIX must
  248  collect and maintain encounter level data in accordance with the
  249  encounter data requirements under s. 409.967(2)(d) and are
  250  subject to the accompanying penalties under s. 409.967(2)(h)2.
  251  The agency is responsible for the collection and maintenance of
  252  the encounter level data.
  253         (2)The corporation, in consultation with the agency, shall
  254  establish access and network standards for contracts on the FHIX
  255  marketplace and shall ensure that contracted plans have
  256  sufficient providers to meet enrollee needs. The corporation, in
  257  consultation with the agency, shall develop quality of coverage
  258  and provider standards specific to the adult population.
  259         (3)The department shall develop accountability measures
  260  and performance standards to be applied to applications and
  261  renewal applications for FHIX which are submitted online, by
  262  mail, by fax, or through referrals from a third party. The
  263  minimum performance standards are:
  264         (a) Application processing speed.—Ninety percent of all
  265  applications, from all sources, must be processed within 45
  266  days.
  267         (b) Applications processing speed from online sources.
  268  Ninety-five percent of all applications received from online
  269  sources must be processed within 45 days.
  270         (c) Renewal application processing speed.—Ninety percent of
  271  all renewals, from all sources, must be processed within 45
  272  days.
  273         (d) Renewal application processing speed from online
  274  sources.—Ninety-five percent of all applications received from
  275  online sources must be processed within 45 days.
  276         (4) The agency, the department, and the Florida Healthy
  277  Kids Corporation must meet the following standards for their
  278  respective roles in the program:
  279         (a) Eighty-five percent of calls must be answered in 20
  280  seconds or less.
  281         (b) One hundred percent of all contacts, which include, but
  282  are not limited to, telephone calls, faxed documents and
  283  requests, and e-mails, must be handled within 2 business days.
  284         (c)Any self-service tools available to participants, such
  285  as interactive voice response systems, must be operational 7
  286  days a week, 24 hours a day, at least 98 percent of each month.
  287         (5) The agency, the department, and the Florida Healthy
  288  Kids Corporation must conduct an annual satisfaction survey to
  289  address all measures that require participant input specific to
  290  the FHIX marketplace program. The parties may elect to
  291  incorporate these elements into the annual report required under
  292  subsection (7).
  293         (6) The agency and the corporation shall post online
  294  monthly enrollment reports for FHIX.
  295         (7) An annual report is due no later than July 1 to the
  296  Governor, the President of the Senate, and the Speaker of the
  297  House of Representatives. The annual report must be coordinated
  298  by the agency and the corporation and must include, but is not
  299  limited to:
  300         (a) Enrollment and application trends and issues.
  301         (b) Utilization and cost data.
  302         (c) Customer satisfaction.
  303         (d) Funding sources in health savings accounts or health
  304  reimbursement accounts.
  305         (e) Enrollee use of funds in health savings accounts or
  306  health reimbursement accounts.
  307         (f) Types of products and plans purchased.
  308         (g) Movement of enrollees across different insurance
  309  affordability programs.
  310         (h) Recommendations for program improvement.
  311         Section 9. Section 409.727, Florida Statutes, is created to
  312  read:
  313         409.727Implementation schedule.—The agency, the
  314  corporation, the department, and the Florida Healthy Kids
  315  Corporation shall begin implementation of FHIX by the effective
  316  date of this act, with statewide implementation in all regions,
  317  as described in s. 409.966(2), by January 1, 2016.
  318         (1) READINESS REVIEW.—Before implementation of any phase
  319  under this section, the agency shall conduct a readiness review
  320  in consultation with the FHIX Workgroup described in s. 409.729.
  321  The agency must determine that the region has satisfied, at a
  322  minimum, the following readiness milestones:
  323         (a) Functional readiness of the service delivery platform
  324  for the phase.
  325         (b) Plan availability and presence of plan choice.
  326         (c) Provider network capacity and adequacy of the available
  327  plans in the region.
  328         (d) Availability of customer support.
  329         (e) Other factors critical to the success of FHIX.
  330         (2) PHASE ONE.—
  331         (a) Phase One begins on July 1, 2015. The agency, the
  332  corporation, and the Florida Healthy Kids Corporation shall
  333  coordinate activities to ensure that enrollment begins by July
  334  1, 2015.
  335         (b) To be eligible during this phase, a participant must
  336  meet the requirements under s. 409.723(1)(a).
  337         (c)An enrollee is entitled to receive health benefits
  338  coverage in the same manner as provided under and through the
  339  selected managed care plans in the Medicaid managed care program
  340  in part IV of this chapter.
  341         (d) An enrollee shall have a choice of at least two managed
  342  care plans in each region.
  343         (e) Choice counseling and customer service must be provided
  344  in accordance with s. 409.724(2).
  345         (3) PHASE TWO.—
  346         (a) Beginning no later than January 1, 2016, and contingent
  347  upon federal approval, participants may enroll or transition to
  348  health benefits coverage under the FHIX marketplace.
  349         (b)To be eligible during this phase, a participant must
  350  meet the requirements under s. 409.723(1)(a) and (b).
  351         (c) An enrollee may select any benefit, service, or product
  352  available.
  353         (d) The corporation shall notify an enrollee of his or her
  354  premium credit amount and how to access the FHIX marketplace
  355  selection process.
  356         (e) A Phase One enrollee must be transitioned to the FHIX
  357  marketplace by April 1, 2016. An enrollee who does not select a
  358  plan or service on the FHIX marketplace by that deadline shall
  359  be moved to inactive status.
  360         (f) An enrollee shall have a choice of at least two managed
  361  care plans in each region which meet or exceed the Affordable
  362  Care Act’s requirements and which qualify for a premium credit
  363  on the FHIX marketplace.
  364         (g) Choice counseling and customer service must be provided
  365  in accordance with s. 409.724(2) and (4).
  366         (4) PHASE THREE.—
  367         (a) No later than July 1, 2016, the corporation and the
  368  Florida Healthy Kids Corporation must begin the transition of
  369  enrollees under s. 624.91 to the FHIX marketplace.
  370         (b)Eligibility during this phase is based on meeting the
  371  requirements of Phase II and s. 409.723(1)(c).
  372         (c) An enrollee may select any benefit, service, or product
  373  available under s. 409.725.
  374         (d) A Florida Healthy Kids enrollee who selects a FHIX
  375  marketplace plan must be provided a premium credit equivalent to
  376  the average capitation rate paid in his or her county of
  377  residence under Florida Healthy Kids as of June 30, 2016. The
  378  enrollee is responsible for any difference in costs and may use
  379  any remaining funds for supplemental benefits on the FHIX
  380  marketplace.
  381         (e) The corporation shall notify an enrollee of his or her
  382  premium credit amount and how to access the FHIX marketplace
  383  selection process.
  384         (f) Choice counseling and customer service must be provided
  385  in accordance with s. 409.724(2) and (4).
  386         (g) Enrollees under s. 624.91 must transition to the FHIX
  387  marketplace by September 30, 2016.
  388         Section 10. Section 409.728, Florida Statutes, is created
  389  to read:
  390         409.728Program operation and management.—In order to
  391  implement ss. 409.720-409.731:
  392         (1) The Agency for Health Care Administration shall do all
  393  of the following:
  394         (a) Contract with the corporation for the development,
  395  implementation, and administration of the Florida Health
  396  Insurance Affordability Exchange Program and for the release of
  397  any federal, state, or other funds appropriated to the
  398  corporation.
  399         (b) Administer Phase One of FHIX.
  400         (c) Provide administrative support to the FHIX Workgroup
  401  under s. 409.729.
  402         (d) Transition the FHIX enrollees to the FHIX marketplace
  403  beginning January 1, 2016, in accordance with the transition
  404  workplan. Stakeholders that serve low-income individuals and
  405  families must be consulted during the implementation and
  406  transition process through a public input process. All regions
  407  must complete the transition no later than April 1, 2016.
  408         (e) Timely transmit enrollee information to the
  409  corporation.
  410         (f) Beginning with Phase Two, determine annually the risk
  411  adjusted rate to be paid per month based on historical
  412  utilization and spending data for the medical and behavioral
  413  health of this population, projected forward, and adjusted to
  414  reflect the eligibility category, medical and dental trends,
  415  geographic areas, and the clinical risk profile of the
  416  enrollees.
  417         (g) Transfer to the corporation such funds as approved in
  418  the General Appropriations Act for the premium credits.
  419         (h) Encourage Medicaid managed care plans to apply as
  420  vendors to the marketplace to facilitate continuity of care and
  421  family care coordination.
  422         (2) The Department of Children and Families shall, in
  423  coordination with the corporation, the agency, and the Florida
  424  Healthy Kids Corporation, determine eligibility of applications
  425  and application renewals for FHIX in accordance with s. 409.902
  426  and shall transmit eligibility determination information on a
  427  timely basis to the agency and corporation.
  428         (3) The Florida Healthy Kids Corporation shall do all of
  429  the following:
  430         (a) Retain its duties and responsibilities under s. 624.91
  431  for Phase One and Phase Two of the program.
  432         (b) Provide customer service for the FHIX marketplace, in
  433  coordination with the agency and the corporation.
  434         (c) Transfer funds and provide financial support to the
  435  FHIX marketplace, including the collection of monthly cost
  436  sharing.
  437         (d) Conduct financial reporting related to such activities,
  438  in coordination with the corporation and the agency.
  439         (e) Coordinate activities for the program with the agency,
  440  the department, and the corporation.
  441         (f) Begin the development of FHIX during Phase One.
  442         (g) Implement and administer Phase Two and Phase Three of
  443  the FHIX marketplace and the ongoing operations of the program.
  444         (h) Offer health benefits coverage packages on the FHIX
  445  marketplace, including plans compliant with the Affordable Care
  446  Act.
  447         (i) Offer FHIX enrollees a choice of at least two plans per
  448  county at each benefit level which meet the requirements under
  449  the Affordable Care Act.
  450         (j) Provide an opportunity for participation in Medicaid
  451  managed care plans if those plans meet the requirements of the
  452  FHIX marketplace.
  453         (k) Offer enhanced or customized benefits to FHIX
  454  marketplace enrollees.
  455         (l) Provide sufficient staff and resources to meet the
  456  program needs of enrollees.
  457         (m) Provide an opportunity for plans contracted with or
  458  previously contracted with the Florida Healthy Kids Corporation
  459  under s. 624.91 to participate with FHIX if those plans meet the
  460  requirements of the program.