Florida Senate - 2015 COMMITTEE AMENDMENT
Bill No. SB 7044
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LEGISLATIVE ACTION
Senate . House
Comm: WD .
03/17/2015 .
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Appropriations Subcommittee on Health and Human Services (Sobel)
recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete lines 92 - 1410
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 FHIX marketplace who lost coverage through the
29 marketplace for nonpayment, 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:
54 409.723 Participation.—
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 III 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:
163 409.724 Available 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 and the corporation must
204 coordinate an ongoing enrollee education campaign beginning in
205 Phase I, as provided in s. 409.27, informing participants, at a
206 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 II, the
221 corporation shall provide customer support for FHIX, shall
222 address general program information, financial information, and
223 customer service issues, and shall provide status updates on
224 bill payments. Customer support must also provide a toll-free
225 number and maintain a website that is available in multiple
226 languages and that meets the needs of the enrollee population.
227 (5) INACTIVE PARTICIPANTS.—The corporation must inform the
228 inactive participant about other insurance affordability
229 programs and electronically refer the participant to the federal
230 exchange or other insurance affordability programs, as
231 appropriate.
232 Section 7. Section 409.725, Florida Statutes, is created to
233 read:
234 409.725 Available products and services.—The FHIX
235 marketplace shall offer the following products and services:
236 (1) Authorized products and services pursuant to s.
237 408.910.
238 (2) Medicaid managed care plans under part IV of this
239 chapter.
240 (3) Authorized products under the corporation pursuant to
241 s. 624.91.
242 (4) Employer-sponsored plans.
243 Section 8. Section 409.726, Florida Statutes, is created to
244 read:
245 409.726 Program accountability.—
246 (1) All managed care plans that participate in FHIX must
247 collect and maintain encounter level data in accordance with the
248 encounter data requirements under s. 409.967(2)(d) and are
249 subject to the accompanying penalties under s. 409.967(2)(h)2.
250 The agency is responsible for the collection and maintenance of
251 the encounter level data.
252 (2) The corporation, in consultation with the agency, shall
253 establish access and network standards for contracts on the FHIX
254 marketplace and shall ensure that contracted plans have
255 sufficient providers to meet enrollee needs. The corporation, in
256 consultation with the agency, shall develop quality of coverage
257 and provider standards specific to the adult population.
258 (3) The department shall develop accountability measures
259 and performance standards to be applied to applications and
260 renewal applications for FHIX which are submitted online, by
261 mail, by fax, or through referrals from a third party. The
262 minimum performance standards are:
263 (a) Application processing speed.—Ninety percent of all
264 applications, from all sources, must be processed within 45
265 days.
266 (b) Applications processing speed from online sources.
267 Ninety-five percent of all applications received from online
268 sources must be processed within 45 days.
269 (c) Renewal application processing speed.—Ninety percent of
270 all renewals, from all sources, must be processed within 45
271 days.
272 (d) Renewal application processing speed from online
273 sources.—Ninety-five percent of all applications received from
274 online sources must be processed within 45 days.
275 (4) The agency, the department, and the corporation must
276 meet the following standards for their respective roles in the
277 program:
278 (a) Eighty-five percent of calls must be answered in 20
279 seconds or less.
280 (b) One hundred percent of all contacts, which include, but
281 are not limited to, telephone calls, faxed documents and
282 requests, and e-mails, must be handled within 2 business days.
283 (c) Any self-service tools available to participants, such
284 as interactive voice response systems, must be operational 7
285 days a week, 24 hours a day, at least 98 percent of each month.
286 (5) The agency, the department, and the corporation must
287 conduct an annual satisfaction survey to address all measures
288 that require participant input specific to the FHIX marketplace
289 program. The parties may elect to incorporate these elements
290 into the annual report required under subsection (7).
291 (6) The agency and the corporation shall post online
292 monthly enrollment reports for FHIX.
293 (7) An annual report is due no later than July 1 to the
294 Governor, the President of the Senate, and the Speaker of the
295 House of Representatives. The annual report must be coordinated
296 by the agency and the corporation and must include, but is not
297 limited to:
298 (a) Enrollment and application trends and issues.
299 (b) Utilization and cost data.
300 (c) Customer satisfaction.
301 (d) Funding sources in health savings accounts or health
302 reimbursement accounts.
303 (e) Enrollee use of funds in health savings accounts or
304 health reimbursement accounts.
305 (f) Types of products and plans purchased.
306 (g) Movement of enrollees across different insurance
307 affordability programs.
308 (h) Recommendations for program improvement.
309 Section 9. Section 409.727, Florida Statutes, is created to
310 read:
311 409.727 Implementation schedule.—The agency, the
312 corporation, the department, and Florida Health Choices, Inc.,
313 shall begin implementation of FHIX by the effective date of this
314 act, with statewide implementation in all regions, as described
315 in s. 409.966(2), by January 1, 2016.
316 (1) READINESS REVIEW.—Before implementation of any phase
317 under this section, the agency shall conduct a readiness review
318 in consultation with the FHIX Workgroup described in s. 409.729.
319 The agency must determine that the region has satisfied, at a
320 minimum, the following readiness milestones:
321 (a) Functional readiness of the service delivery platform
322 for the phase.
323 (b) Plan availability and presence of plan choice.
324 (c) Provider network capacity and adequacy of the available
325 plans in the region.
326 (d) Availability of customer support.
327 (e) Other factors critical to the success of FHIX.
328 (2) PHASE I.—
329 (a) Phase I begins on July 1, 2015. The agency, the
330 corporation, and Florida Health Choices, Inc., shall coordinate
331 activities to ensure that enrollment begins by July 1, 2015.
332 (b) To be eligible during this phase, a participant must
333 meet the requirements under s. 409.723(1)(a).
334 (c) An enrollee is entitled to receive health benefits
335 coverage in the same manner as provided under and through the
336 selected managed care plans in the Medicaid managed care program
337 in part IV of this chapter.
338 (d) An enrollee shall have a choice of at least two managed
339 care plans in each region.
340 (e) Choice counseling and customer service must be provided
341 in accordance with s. 409.724(2).
342 (3) PHASE II.—
343 (a) Beginning no later than January 1, 2016, and contingent
344 upon federal approval, participants may enroll or transition to
345 health benefits coverage under the FHIX marketplace.
346 (b) To be eligible during this phase, a participant must
347 meet the requirements under s. 409.723(1)(a) and (b).
348 (c) An enrollee may select any benefit, service, or product
349 available.
350 (d) The corporation shall notify an enrollee of his or her
351 premium credit amount and how to access the FHIX marketplace
352 selection process.
353 (e) A Phase I enrollee must be transitioned to the FHIX
354 marketplace by April 1, 2016. An enrollee who does not select a
355 plan or service on the FHIX marketplace by that deadline shall
356 be moved to inactive status.
357 (f) An enrollee shall have a choice of at least two managed
358 care plans in each region which meet or exceed the Affordable
359 Care Act’s requirements and which qualify for a premium credit
360 on the FHIX marketplace.
361 (g) Choice counseling and customer service must be provided
362 in accordance with s. 409.724(2) and (4).
363 (4) PHASE III.—
364 (a) No later than July 1, 2016, the corporation and Florida
365 Health Choices, Inc., must begin the transition of enrollees
366 under s. 624.91 to the FHIX marketplace.
367 (b) Eligibility during this phase is based on meeting the
368 requirements of Phase II and s. 409.723(1)(c).
369 (c) An enrollee may select any benefit, service, or product
370 available under s. 409.725.
371 (d) A Florida Healthy Kids enrollee who selects a FHIX
372 marketplace plan must be provided a premium credit equivalent to
373 the average capitation rate paid in his or her county of
374 residence under Florida Healthy Kids as of June 30, 2016. The
375 enrollee is responsible for any difference in costs and may use
376 any remaining funds for supplemental benefits on the FHIX
377 marketplace.
378 (e) The corporation shall notify an enrollee of his or her
379 premium credit amount and how to access the FHIX marketplace
380 selection process.
381 (f) Choice counseling and customer service must be provided
382 in accordance with s. 409.724(2) and (4).
383 (g) Enrollees under s. 624.91 must transition to the FHIX
384 marketplace by September 30, 2016.
385 Section 10. Section 409.728, Florida Statutes, is created
386 to read:
387 409.728 Program operation and management.—In order to
388 implement ss. 409.720-409.731:
389 (1) The Agency for Health Care Administration shall do all
390 of the following:
391 (a) Contract with the corporation for the development,
392 implementation, and administration of the Florida Health
393 Insurance Affordability Exchange Program and for the release of
394 any federal, state, or other funds appropriated to the
395 corporation.
396 (b) Administer Phase One of FHIX.
397 (c) Provide administrative support to the FHIX Workgroup
398 under s. 409.729.
399 (d) Transition the FHIX enrollees to the FHIX marketplace
400 beginning January 1, 2016, in accordance with the transition
401 workplan. Stakeholders that serve low-income individuals and
402 families must be consulted during the implementation and
403 transition process through a public input process. All regions
404 must complete the transition no later than April 1, 2016.
405 (e) Timely transmit enrollee information to the
406 corporation.
407 (f) Beginning with Phase Two, determine annually the risk
408 adjusted rate to be paid per month based on historical
409 utilization and spending data for the medical and behavioral
410 health of this population, projected forward, and adjusted to
411 reflect the eligibility category, medical and dental trends,
412 geographic areas, and the clinical risk profile of the
413 enrollees.
414 (g) Transfer to the corporation such funds as approved in
415 the General Appropriations Act for the premium credits.
416 (h) Encourage Medicaid managed care plans to apply as
417 vendors to the marketplace to facilitate continuity of care and
418 family care coordination.
419 (2) The Department of Children and Families shall, in
420 coordination with the corporation, the agency, and Florida
421 Health Choices, Inc., determine eligibility of applications and
422 application renewals for FHIX in accordance with s. 409.902 and
423 shall transmit eligibility determination information on a timely
424 basis to the agency and corporation.
425 (3) The corporation shall do all of the following:
426 (a) Retain its duties and responsibilities under s. 624.91
427 for Phase One and Phase Two of the program.
428 (b) Provide customer service for the FHIX marketplace, in
429 coordination with the agency and the corporation.
430 (c) Transfer funds and provide financial support to the
431 FHIX marketplace, including the collection of monthly cost
432 sharing.
433 (d) Conduct financial reporting related to such activities,
434 in coordination with the corporation and the agency.
435 (e) Coordinate activities for the program with the agency,
436 the department, and the corporation.
437 (f) Begin the development of FHIX during Phase One.
438 (g) Implement and administer Phase Two and Phase Three of
439 the FHIX marketplace and the ongoing operations of the program.
440 (h) Offer health benefits coverage packages on the FHIX
441 marketplace, including plans compliant with the Affordable Care
442 Act.
443 (i) Offer FHIX enrollees a choice of at least two plans per
444 county at each benefit level which meet the requirements under
445 the Affordable Care Act.
446 (j) Provide an opportunity for participation in Medicaid
447 managed care plans if those plans meet the requirements of the
448 FHIX marketplace.
449 (k) Offer enhanced or customized benefits to FHIX
450 marketplace enrollees.
451 (l) Provide sufficient staff and resources to meet the
452 program needs of enrollees.
453 (m) Provide an opportunity for plans contracted with or
454 previously contracted with the corporation under s. 624.91 to
455 participate with FHIX if those plans meet the requirements of
456 the program.
457 Section 11. Section 409.729, Florida Statutes, is created
458 to read:
459 409.729 Long-term reorganization.—The FHIX Workgroup is
460 created to facilitate the implementation of FHIX and to plan for
461 a multiyear reorganization of the state’s insurance
462 affordability programs. The FHIX Workgroup consists of two
463 representatives each from the agency, the department, Florida
464 Health Choices, Inc., and the corporation. An additional
465 representative of the agency serves as chair. The FHIX Workgroup
466 must hold its organizational meeting no later than 30 days after
467 the effective date of this act and must meet at least bimonthly.
468 The role of the FHIX Workgroup is to make recommendations to the
469 agency. The responsibilities of the workgroup include, but are
470 not limited to:
471 (1) Recommend a Phase Two implementation plan no later than
472 October 1, 2015.
473 (2) Review network and access standards for plans and
474 products.
475 (3) Assess readiness and recommend actions needed to
476 reorganize the state’s insurance affordability programs for each
477 phase or region. If a phase or region receives a nonreadiness
478 recommendation, the agency must notify the Legislature of that
479 recommendation, the reasons for such a recommendation, and
480 proposed plans for achieving readiness.
481 (4) Recommend any proposed change to the Title XIX-funded
482 or Title XXI-funded programs based on the continued availability
483 and reauthorization of the Title XXI program and its federal
484 funding.
485 (5) Identify duplication of services among the corporation,
486 the agency, and Florida Health Choices, Inc., currently and
487 under FHIX’s proposed Phase Three program.
488 (6) Evaluate any fiscal impacts based on the proposed
489 transition plan under Phase Three.
490 (7) Compile a schedule of impacted contracts, leases, and
491 other assets.
492 (8) Determine staff requirements for Phase Three.
493 (9) Develop and present a final transition plan that
494 incorporates all elements under this section no later than
495 December 1, 2015, in a report to the Governor, the President of
496 the Senate, and the Speaker of the House of Representatives.
497 Section 12. Section 409.730, Florida Statutes, is created
498 to read:
499 409.730 Federal participation.—The agency may seek federal
500 approval to implement FHIX.
501 Section 13. Section 409.731, Florida Statutes, is created
502 to read:
503 409.731 Program expiration.—The Florida Health Insurance
504 Affordability Exchange Program expires at the end of Phase One
505 if the state does not receive federal approval for Phase Two or
506 at the end of the state fiscal year in which any of these
507 conditions occurs:
508 (1) The federal match contribution falls below 90 percent.
509 (2) The federal match contribution falls below the
510 increased Federal Medical Assistance Percentage for medical
511 assistance for newly eligible mandatory individuals as specified
512 in the Affordable Care Act.
513 (3) The federal match for the FHIX program and the Medicaid
514 program are blended under federal law or regulation in such a
515 manner that causes the overall federal contribution to diminish
516 when compared to separate, nonblended federal contributions.
517 Section 14. Section 408.70, Florida Statutes, is repealed.
518 Section 15. Subsection (2) of section 409.904, Florida
519 Statutes, is amended to read:
520 409.904 Optional payments for eligible persons.—The agency
521 may make payments for medical assistance and related services on
522 behalf of the following persons who are determined to be
523 eligible subject to the income, assets, and categorical
524 eligibility tests set forth in federal and state law. Payment on
525 behalf of these Medicaid eligible persons is subject to the
526 availability of moneys and any limitations established by the
527 General Appropriations Act or chapter 216.
528 (2) A family, a pregnant woman, a child under age 21, a
529 person age 65 or over, or a blind or disabled person, who would
530 be eligible under any group listed in s. 409.903(1), (2), or
531 (3), except that the income or assets of such family or person
532 exceed established limitations. For a family or person in one of
533 these coverage groups, medical expenses are deductible from
534 income in accordance with federal requirements in order to make
535 a determination of eligibility. A family or person eligible
536 under the coverage known as the “medically needy,” is eligible
537 to receive the same services as other Medicaid recipients, with
538 the exception of services in skilled nursing facilities and
539 intermediate care facilities for the developmentally disabled.
540 Section 16. Section 624.91, Florida Statutes, is amended to
541 read:
542 624.91 The Florida Healthy Kids Corporation Act.—
543 (1) SHORT TITLE.—This section may be cited as the “William
544 G. ‘Doc’ Myers Healthy Kids Corporation Act.”
545 (2) LEGISLATIVE INTENT.—
546 (a) The Legislature finds that increased access to health
547 care services could improve children’s health and the health of
548 adults and reduce the incidence and costs of childhood and adult
549 illness and disabilities among children in this state. Many
550 children and adults do not have comprehensive, affordable health
551 care services available. It is the intent of the Legislature
552 that the Florida Healthy Kids Corporation provide comprehensive
553 health insurance coverage to such children and adults. The
554 corporation is encouraged to cooperate with any existing health
555 service programs funded by the public or the private sector.
556 (b) It is the intent of the Legislature that the Florida
557 Healthy Kids Corporation serve as one of several providers of
558 services to children and adults eligible for medical assistance
559 under Title XXI of the Social Security Act. Although the
560 corporation may serve other children and adults, the Legislature
561 intends the primary recipients of services provided through the
562 corporation be school-age children and adults with a family
563 income below 200 percent of the federal poverty level, who do
564 not qualify for Medicaid. It is also the intent of the
565 Legislature that state and local government Florida Healthy Kids
566 funds be used to continue coverage, subject to specific
567 appropriations in the General Appropriations Act, to children
568 and adults not eligible for federal matching funds under Title
569 XXI.
570 (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
571 of this state are eligible the following individuals are
572 eligible for state-funded assistance in paying Florida Healthy
573 Kids premiums pursuant to s. 409.814.:
574 (a) Residents of this state who are eligible for the
575 Florida Kidcare program pursuant to s. 409.814.
576 (b) Notwithstanding s. 409.814, legal aliens who are
577 enrolled in the Florida Healthy Kids program as of January 31,
578 2004, who do not qualify for Title XXI federal funds because
579 they are not qualified aliens as defined in s. 409.811.
580 (4) NONENTITLEMENT.—Nothing in this section shall be
581 construed as providing an individual with an entitlement to
582 health care services. No cause of action shall arise against the
583 state, the Florida Healthy Kids Corporation, or a unit of local
584 government for failure to make health services available under
585 this section.
586 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
587 (a) There is created the Florida Healthy Kids Corporation,
588 a not-for-profit corporation.
589 (b) The Florida Healthy Kids Corporation shall:
590 1. Arrange for the collection of any individual, family,
591 local contributions, or employer payment or premium, in an
592 amount to be determined by the board of directors, to provide
593 for payment of premiums for comprehensive insurance coverage and
594 for the actual or estimated administrative expenses.
595 2. Arrange for the collection of any voluntary
596 contributions to provide for payment of Florida Kidcare program
597 or Florida Health Insurance Affordability Exchange Program
598 premiums for children who are not eligible for medical
599 assistance under Title XIX or Title XXI of the Social Security
600 Act.
601 3. Subject to the provisions of s. 409.8134, accept
602 voluntary supplemental local match contributions that comply
603 with the requirements of Title XXI of the Social Security Act
604 for the purpose of providing additional Florida Kidcare coverage
605 in contributing counties under Title XXI.
606 4. Establish the administrative and accounting procedures
607 for the operation of the corporation.
608 4.5. Establish, with consultation from appropriate
609 professional organizations, standards for preventive health
610 services and providers and comprehensive insurance benefits
611 appropriate to children, provided that such standards for rural
612 areas shall not limit primary care providers to board-certified
613 pediatricians.
614 5.6. Determine eligibility for children and adults seeking
615 to participate in the Title XXI-funded components of the Florida
616 Kidcare program consistent with the requirements specified in s.
617 409.814, as well as the non-Title-XXI-eligible children as
618 provided in subsection (3).
619 6.7. Establish procedures under which providers of local
620 match to, applicants to and participants in the program may have
621 grievances reviewed by an impartial body and reported to the
622 board of directors of the corporation.
623 7.8. Establish participation criteria and, if appropriate,
624 contract with an authorized insurer, health maintenance
625 organization, or third-party administrator to provide
626 administrative services to the corporation.
627 8.9. Establish enrollment criteria that include penalties
628 or waiting periods of 30 days for reinstatement of coverage upon
629 voluntary cancellation for nonpayment of family or individual
630 premiums. Participation in the FHIX marketplace may begin at any
631 time during the year. Initial enrollment periods for certain
632 products selected by an individual enrollee which are
633 noncompliant with the Affordable Care Act may be required to
634 last at least 12 months, unless the individual participant
635 specifically agrees to a different enrollment period.
636 9.10. Contract with authorized insurers or any provider of
637 health care services, meeting standards established by the
638 corporation, for the provision of comprehensive insurance
639 coverage to participants. Such standards shall include criteria
640 under which the corporation may contract with more than one
641 provider of health care services in program sites.
642 a. Health plans shall be selected through a competitive bid
643 process. The Florida Healthy Kids Corporation shall purchase
644 goods and services in the most cost-effective manner consistent
645 with the delivery of quality medical care.
646 b. The maximum administrative cost for a Florida Healthy
647 Kids Corporation contract shall be 15 percent. For health and
648 dental care contracts, the minimum medical loss ratio for a
649 Florida Healthy Kids Corporation contract shall be 85 percent.
650 The calculations must use uniform financial data collected from
651 all plans in a format established by the corporation and shall
652 be computed for each plan on a statewide basis. Funds shall be
653 classified in a manner consistent with 45 C.F.R. part 158 For
654 dental contracts, the remaining compensation to be paid to the
655 authorized insurer or provider under a Florida Healthy Kids
656 Corporation contract shall be no less than an amount which is 85
657 percent of premium; to the extent any contract provision does
658 not provide for this minimum compensation, this section shall
659 prevail.
660 c. The health plan selection criteria and scoring system,
661 and the scoring results, shall be available upon request for
662 inspection after the bids have been awarded.
663 d. Effective July 1, 2016, health and dental services
664 contracts of the corporation must transition to the FHIX
665 marketplace under s. 409.722. Qualifying plans may enroll as
666 vendors with the FHIX marketplace to maintain continuity of care
667 for participants.
668 10.11. Establish disenrollment criteria in the event local
669 matching funds are insufficient to cover enrollments.
670 11.12. Develop and implement a plan to publicize the
671 Florida Kidcare program, the eligibility requirements of the
672 program, and the procedures for enrollment in the program and to
673 maintain public awareness of the corporation and the program.
674 12.13. Secure staff necessary to properly administer the
675 corporation. Staff costs shall be funded from state and local
676 matching funds and such other private or public funds as become
677 available. The board of directors shall determine the number of
678 staff members necessary to administer the corporation.
679 13.14. In consultation with the partner agencies, provide a
680 report on the Florida Kidcare program annually to the Governor,
681 the Chief Financial Officer, the Commissioner of Education, the
682 President of the Senate, the Speaker of the House of
683 Representatives, and the Minority Leaders of the Senate and the
684 House of Representatives.
685 14.15. Provide information on a quarterly basis online to
686 the Legislature and the Governor which compares the costs and
687 utilization of the full-pay enrolled population and the Title
688 XXI-subsidized enrolled population in the Florida Kidcare
689 program. The information, at a minimum, must include:
690 a. The monthly enrollment and expenditure for full-pay
691 enrollees in the Medikids and Florida Healthy Kids programs
692 compared to the Title XXI-subsidized enrolled population; and
693 b. The costs and utilization by service of the full-pay
694 enrollees in the Medikids and Florida Healthy Kids programs and
695 the Title XXI-subsidized enrolled population.
696 15.16. Establish benefit packages that conform to the
697 provisions of the Florida Kidcare program, as created in ss.
698 409.810-409.821.
699 16. Contract with other insurance affordability programs
700 and FHIX to provide customer service or other enrollment-focused
701 services.
702 17. Annually develop performance metrics for the following
703 focus areas:
704 a. Administrative functions.
705 b. Contracting with vendors.
706 c. Customer service.
707 d. Enrollee education.
708 e. Financial services.
709 f. Program integrity.
710 (c) Coverage under the corporation’s program is secondary
711 to any other available private coverage held by, or applicable
712 to, the participant child or family member. Insurers under
713 contract with the corporation are the payors of last resort and
714 must coordinate benefits with any other third-party payor that
715 may be liable for the participant’s medical care.
716 (d) The Florida Healthy Kids Corporation shall be a private
717 corporation not for profit, organized pursuant to chapter 617,
718 and shall have all powers necessary to carry out the purposes of
719 this act, including, but not limited to, the power to receive
720 and accept grants, loans, or advances of funds from any public
721 or private agency and to receive and accept from any source
722 contributions of money, property, labor, or any other thing of
723 value, to be held, used, and applied for the purposes of this
724 act.
725 (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.—
726 (a) The Florida Healthy Kids Corporation shall operate
727 subject to the supervision and approval of a board of directors.
728 The board chair shall be an appointee designated by the
729 Governor, and the board shall be chaired by the Chief Financial
730 Officer or her or his designee, and composed of 12 other
731 members. The Senate shall confirm the designated chair and other
732 board appointees. The board members shall be appointed selected
733 for 3-year terms. of office as follows:
734 1. The Secretary of Health Care Administration, or his or
735 her designee.
736 2. One member appointed by the Commissioner of Education
737 from the Office of School Health Programs of the Florida
738 Department of Education.
739 3. One member appointed by the Chief Financial Officer from
740 among three members nominated by the Florida Pediatric Society.
741 4. One member, appointed by the Governor, who represents
742 the Children’s Medical Services Program.
743 5. One member appointed by the Chief Financial Officer from
744 among three members nominated by the Florida Hospital
745 Association.
746 6. One member, appointed by the Governor, who is an expert
747 on child health policy.
748 7. One member, appointed by the Chief Financial Officer,
749 from among three members nominated by the Florida Academy of
750 Family Physicians.
751 8. One member, appointed by the Governor, who represents
752 the state Medicaid program.
753 9. One member, appointed by the Chief Financial Officer,
754 from among three members nominated by the Florida Association of
755 Counties.
756 10. The State Health Officer or her or his designee.
757 11. The Secretary of Children and Families, or his or her
758 designee.
759 12. One member, appointed by the Governor, from among three
760 members nominated by the Florida Dental Association.
761 (b) A member of the board of directors serves at the
762 pleasure of the Governor may be removed by the official who
763 appointed that member. The board shall appoint an executive
764 director, who is responsible for other staff authorized by the
765 board.
766 (c) Board members are entitled to receive, from funds of
767 the corporation, reimbursement for per diem and travel expenses
768 as provided by s. 112.061.
769 (d) There shall be no liability on the part of, and no
770 cause of action shall arise against, any member of the board of
771 directors, or its employees or agents, for any action they take
772 in the performance of their powers and duties under this act.
773 (e) Board members who are serving as of the effective date
774 of this act may remain on the board until January 1, 2016.
775 (7) LICENSING NOT REQUIRED; FISCAL OPERATION.—
776 (a) The corporation shall not be deemed an insurer. The
777 officers, directors, and employees of the corporation shall not
778 be deemed to be agents of an insurer. Neither the corporation
779 nor any officer, director, or employee of the corporation is
780 subject to the licensing requirements of the insurance code or
781 the rules of the Department of Financial Services. However, any
782 marketing representative utilized and compensated by the
783 corporation must be appointed as a representative of the
784 insurers or health services providers with which the corporation
785 contracts.
786 (b) The board has complete fiscal control over the
787 corporation and is responsible for all corporate operations.
788 (c) The Department of Financial Services shall supervise
789 any liquidation or dissolution of the corporation and shall
790 have, with respect to such liquidation or dissolution, all power
791 granted to it pursuant to the insurance code.
792 (8) TRANSITION PLANS.—The corporation shall confer with the
793 Agency for Health Care Administration, the Department of
794 Children and Families, and Florida Health Choices, Inc., to
795 develop transition plans for the Florida Health Insurance
796 Affordability Exchange Program as created under ss. 409.720
797 409.731.
798
799 ================= T I T L E A M E N D M E N T ================
800 And the title is amended as follows:
801 Delete lines 27 - 34
802 and insert:
803 regarding access to affordable health care;