Florida Senate - 2015                        COMMITTEE AMENDMENT
       Bill No. SB 7044
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  03/17/2015           .                                

       Appropriations Subcommittee on Health and Human Services (Sobel)
       recommended the following:
    1         Senate Amendment (with title amendment)
    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         409.723Participation.—
   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  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         409.724Available 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 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         409.725Available 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         409.726Program 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         409.727Implementation 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         409.728Program 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.
  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.
  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.
  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.
  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;