Florida Senate - 2015                             CS for SB 7044
       By the Committees on Appropriations; and Health Policy
       576-02879-15                                          20157044c1
    1                        A bill to be entitled                      
    2         An act relating to a health insurance affordability
    3         exchange; creating s. 409.720, F.S.; providing a short
    4         title; creating s. 409.721, F.S.; creating the Florida
    5         Health Insurance Affordability Exchange Program or
    6         FHIX in the Agency for Health Care Administration;
    7         providing program authority and principles; creating
    8         s. 409.722, F.S.; defining terms; creating s. 409.723,
    9         F.S.; providing eligibility and enrollment criteria;
   10         providing patient rights and responsibilities;
   11         providing premium levels; creating s. 409.724, F.S.;
   12         providing for premium credits and choice counseling;
   13         establishing an education campaign; providing for
   14         customer support and disenrollment; creating s.
   15         409.725, F.S.; providing for available products and
   16         services; creating s. 409.726, F.S.; providing for
   17         program accountability; creating s. 409.727, F.S.;
   18         providing an implementation schedule; creating s.
   19         409.728, F.S.; providing program operation and
   20         management duties; creating s. 409.729, F.S.;
   21         providing for the development of a long-term
   22         reorganization plan and the formation of the FHIX
   23         Workgroup; creating s. 409.730, F.S.; authorizing the
   24         agency to seek federal approval; creating s. 409.731,
   25         F.S.; providing for program expiration; repealing s.
   26         408.70, F.S., relating to legislative findings
   27         regarding access to affordable health care; amending
   28         s. 408.910, F.S.; revising legislative intent;
   29         redefining terms; revising the scope of the Florida
   30         Health Choices Program and the pricing of services
   31         under the program; providing requirements for
   32         operation of the marketplace; providing additional
   33         duties for the corporation to perform; requiring an
   34         annual report to the Governor and the Legislature;
   35         amending s. 409.904, F.S.; limiting eligible persons
   36         in the Medically Needy program to those under the age
   37         of 21 and pregnant women, and specifying an effective
   38         date; providing an expiration date for the program;
   39         amending s. 624.91, F.S.; revising eligibility
   40         requirements for state-funded assistance; revising the
   41         duties and powers of the Florida Healthy Kids
   42         Corporation; revising provisions for the appointment
   43         of members of the board of the Florida Healthy Kids
   44         Corporation; requiring transition plans; repealing s.
   45         624.915, F.S., relating to the operating fund of the
   46         Florida Healthy Kids Corporation; providing an
   47         effective date.
   49  Be It Enacted by the Legislature of the State of Florida:
   51         Section 1. The Division of Law Revision and Information is
   52  directed to rename part II of chapter 409, Florida Statutes, as
   53  “Insurance Affordability Programs” and to incorporate ss.
   54  409.720-409.731, Florida Statutes, under this part.
   55         Section 2. Section 409.720, Florida Statutes, is created to
   56  read:
   57         409.720 Short title.—Sections 409.720-409.731 may be cited
   58  as the “Florida Health Insurance Affordability Exchange Program”
   59  or “FHIX.”
   60         Section 3. Section 409.721, Florida Statutes, is created to
   61  read:
   62         409.721 Program authority.—The Florida Health Insurance
   63  Affordability Exchange Program, or FHIX, is created in the
   64  agency to assist Floridians in purchasing health benefits
   65  coverage and gaining access to health services. The products and
   66  services offered by FHIX are based on the following principles:
   67         (1) FAIR VALUE.—Financial assistance will be rationally
   68  allocated regardless of differences in categorical eligibility.
   69         (2) CONSUMER CHOICE.—Participants will be offered
   70  meaningful choices in the way they can redeem the value of the
   71  available assistance.
   72         (3) SIMPLICITY.—Obtaining assistance will be consumer
   73  friendly, and customer support will be available when needed.
   74         (4) PORTABILITY.—Participants can continue to access the
   75  services and products of FHIX despite changes in their
   76  circumstances.
   77         (5) PROMOTES EMPLOYMENT.—Assistance will be offered in a
   78  way that incentivizes employment.
   79         (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a
   80  manner that maximizes individual control over available
   81  resources.
   82         (7) RISK ADJUSTMENT.—The amount of assistance will reflect
   83  participants’ medical risk.
   84         Section 4. Section 409.722, Florida Statutes, is created to
   85  read:
   86         409.722 Definitions.—As used in ss. 409.720-409.731, the
   87  term:
   88         (1) “Agency” means the Agency for Health Care
   89  Administration.
   90         (2) “Applicant” means an individual who applies for
   91  determination of eligibility for health benefits coverage under
   92  this part.
   93         (3) “Corporation” means Florida Health Choices, Inc., as
   94  established under s. 408.910.
   95         (4) “Enrollee” means an individual who has been determined
   96  eligible for and is receiving health benefits coverage under
   97  this part.
   98         (5) “FHIX marketplace” or “marketplace” means the single,
   99  centralized market established under s. 408.910 which
  100  facilitates health benefits coverage.
  101         (6) “Florida Health Insurance Affordability Exchange
  102  Program” or “FHIX” means the program created under ss. 409.720
  103  409.731.
  104         (7) “Florida Healthy Kids Corporation” means the entity
  105  created under s. 624.91.
  106         (8) “Florida Kidcare program” or “Kidcare program” means
  107  the health benefits coverage administered through ss. 409.810
  108  409.821.
  109         (9) “Health benefits coverage” means the payment of
  110  benefits for covered health care services or the availability,
  111  directly or through arrangements with other persons, of covered
  112  health care services on a prepaid per capita basis or on a
  113  prepaid aggregate fixed-sum basis.
  114         (10) “Inactive status” means the enrollment status of a
  115  participant previously enrolled in health benefits coverage
  116  through the FHIX marketplace who lost coverage through the
  117  marketplace for non-payment, but maintains access to his or her
  118  balance in a health savings account or health reimbursement
  119  account.
  120         (11) “Medicaid” means the medical assistance program
  121  authorized by Title XIX of the Social Security Act, and
  122  regulations thereunder, and part III and part IV of this
  123  chapter, as administered in this state by the agency.
  124         (l2) “Modified adjusted gross income” means the
  125  individual’s or household’s annual adjusted gross income as
  126  defined in s. 36B(d)(2) of the Internal Revenue Code of 1986 and
  127  which is used to determine eligibility for FHIX.
  128         (13) “Patient Protection and Affordable Care Act” or
  129  “Affordable Care Act” means Pub. L. No. 111-148, as further
  130  amended by the Health Care and Education Reconciliation Act of
  131  2010, Pub. L. No. 111-152, and any amendments to, and
  132  regulations or guidance under, those acts.
  133         (14) “Premium credit” means the monthly amount paid by the
  134  agency per enrollee in the Florida Health Insurance
  135  Affordability Exchange Program toward health benefits coverage.
  136         (15) “Qualified alien” means an alien as defined in 8
  137  U.S.C. s. 1641(b) or (c).
  138         (16) “Resident” means a United States citizen or qualified
  139  alien who is domiciled in this state.
  140         Section 5. Section 409.723, Florida Statutes, is created to
  141  read:
  142         409.723Participation.—
  143         (1) ELIGIBILITY.—In order to participate in FHIX, an
  144  individual must be a resident and must meet the following
  145  requirements, as applicable:
  146         (a) Qualify as a newly eligible enrollee, who must be an
  147  individual as described in s. 1902(a)(10)(A)(i)(VIII) of the
  148  Social Security Act or s. 2001 of the Affordable Care Act and as
  149  may be further defined by federal regulation.
  150         (b) Meet and maintain the responsibilities under subsection
  151  (4).
  152         (c) Qualify as a participant in the Florida Healthy Kids
  153  program under s. 624.91, subject to the implementation of Phase
  154  Three under s. 409.727.
  155         (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit
  156  an application to the department for an eligibility
  157  determination.
  158         (a) Applications may be submitted by mail, fax, online, or
  159  any other method permitted by law or regulation.
  160         (b) The department is responsible for any eligibility
  161  correspondence and status updates to the participant and other
  162  agencies.
  163         (c) The department shall review a participant’s eligibility
  164  every 12 months.
  165         (d) An application or renewal is deemed complete when the
  166  participant has met all the requirements under subsection (4).
  167         (3) PARTICIPANT RIGHTS.—A participant has all of the
  168  following rights:
  169         (a)Access to the FHIX marketplace to select the scope,
  170  amount, and type of health care coverage and other services to
  171  purchase.
  172         (b) Continuity and portability of coverage to avoid
  173  disruption of coverage and other health care services when the
  174  participant’s economic circumstances change.
  175         (c) Retention of applicable unspent credits in the
  176  participant’s health savings or health reimbursement account
  177  following a change in the participant’s eligibility status.
  178  Credits are valid for an inactive status participant for up to 5
  179  years after the participant first enters an inactive status.
  180         (d) Ability to select more than one product or plan on the
  181  FHIX marketplace.
  182         (e) Choice of at least two health benefits products that
  183  meet the requirements of the Affordable Care Act.
  184         (4) PARTICIPANT RESPONSIBILITIES.—A participant has all of
  185  the following responsibilities:
  186         (a) Complete an initial application for health benefits
  187  coverage and an annual renewal process;
  188         (b) Annually provide evidence of participation in one of
  189  the following activities at the levels required under paragraph
  190  (c):
  191         1. Proof of employment.
  192         2. On-the-job training or job placement activities.
  193         3. Pursuit of educational opportunities.
  194         (c) Engage in the activities required under paragraph (b)
  195  at the following minimum levels:
  196         1. For a parent of a child younger than 18 years of age, a
  197  minimum of 20 hours weekly.
  198         2. For a childless adult, a minimum of 30 hours weekly.
  200  A participant who is a disabled adult or a caregiver of a
  201  disabled child or adult may submit a request for an exception to
  202  these requirements to the corporation and, thereafter, shall
  203  annually submit to the department a request to renew the
  204  exception to the hourly level requirements.
  205         (d) Learn and remain informed about the choices available
  206  on the FHIX marketplace and the uses of credits in the
  207  individual accounts.
  208         (e) Execute a contract with the department to acknowledge
  209  that:
  210         1. FHIX is not an entitlement and state and federal funding
  211  may end at any time;
  212         2. Failure to pay required premiums or cost sharing will
  213  result in a transition to inactive status; and
  214         3. Noncompliance with work or educational requirements will
  215  result in a transition to inactive status.
  216         (f) Select plans and other products in a timely manner.
  217         (g) Comply with program rules and the prohibitions against
  218  fraud, as described in s. 414.39.
  219         (h) Timely make monthly premium and any other cost-sharing
  220  payments.
  221         (i) Meet minimum coverage requirements by selecting a high
  222  deductible health plan combined with a health savings or health
  223  reimbursement account if not selecting a plan offering more
  224  extensive coverage.
  225         (5) COST SHARING.—
  226         (a) Enrollees are assessed monthly premiums based on their
  227  modified adjusted gross income. The maximum monthly premium
  228  payments are set at the following income levels:
  229         1. At or below 22 percent of the federal poverty level: $3.
  230         2. Greater than 22 percent, but at or below 50 percent, of
  231  the federal poverty level: $8.
  232         3. Greater than 50 percent, but at or below 75 percent, of
  233  the federal poverty level: $15.
  234         4. Greater than 75 percent, but at or below 100 percent, of
  235  the federal poverty level: $20.
  236         5. Greater than 100 percent of the federal poverty level:
  237  $25.
  238         (b) Depending on the products and services selected by the
  239  enrollee, the enrollee may also incur additional cost-sharing,
  240  such as copayments, deductibles, or other out-of-pocket costs.
  241         (c) An enrollee may be subject to an inappropriate
  242  emergency room visit charge of up to $8 for the first visit and
  243  up to $25 for any subsequent visit, based on the enrollee’s
  244  benefit plan, to discourage inappropriate use of the emergency
  245  room.
  246         (d) Cumulative annual cost sharing per enrollee may not
  247  exceed 5 percent of an enrollee’s annual modified adjusted gross
  248  income.
  249         (e) If, after a 30-day grace period, a full premium payment
  250  has not been received, the enrollee shall be transitioned from
  251  coverage to inactive status and may not reenroll for a minimum
  252  of 6 months, unless a hardship exception has been granted.
  253  Enrollees may seek a hardship exception under the Medicaid Fair
  254  Hearing Process.
  255         Section 6. Section 409.724, Florida Statutes, is created to
  256  read:
  257         409.724Available assistance.—
  258         (1)PREMIUM CREDITS.—
  259         (a) Standard amount.—The standard monthly premium credit is
  260  equivalent to the applicable risk-adjusted capitation rate paid
  261  to Medicaid managed care plans under part IV of this chapter.
  262         (b) Supplemental funding.—Subject to federal approval,
  263  additional resources may be made available to enrollees and
  264  incorporated into FHIX.
  265         (c) Savings accounts.—In addition to the benefits provided
  266  under this section, the corporation must offer each enrollee
  267  access to an individual account that qualifies as a health
  268  reimbursement account or a health savings account. Eligible
  269  unexpended funds from the monthly premium credit must be
  270  deposited into each enrollee’s individual account in a timely
  271  manner. Enrollees may also be rewarded for healthy behaviors,
  272  adherence to wellness programs, and other activities established
  273  by the corporation which demonstrate compliance with prevention
  274  or disease management guidelines. Funds deposited into these
  275  accounts may be used to pay cost-sharing obligations or to
  276  purchase other health-related items to the extent permitted
  277  under federal law.
  278         (d) Enrollee contributions.—The enrollee may make deposits
  279  to his or her account at any time to supplement the premium
  280  credit, to purchase additional FHIX products, or to offset other
  281  cost-sharing obligations.
  282         (e) Third parties.—Third parties, including, but not
  283  limited to, an employer or relative, may also make deposits on
  284  behalf of the enrollee into the enrollee’s FHIX marketplace
  285  account. The enrollee may not withdraw any funds as a refund,
  286  except those funds the enrollee has deposited into his or her
  287  account.
  288         (2) CHOICE COUNSELING.—The agency and the corporation shall
  289  work together to develop a choice counseling program for FHIX.
  290  The choice counseling program must ensure that participants have
  291  information about the FHIX marketplace program, products, and
  292  services and that participants know where and whom to call for
  293  questions or to make their plan selections. The choice
  294  counseling program must provide culturally sensitive materials
  295  and must take into consideration the demographics of the
  296  projected population.
  297         (3)EDUCATION CAMPAIGN.—The agency, the corporation, and
  298  the Florida Healthy Kids Corporation must coordinate an ongoing
  299  enrollee education campaign beginning in Phase One, as provided
  300  in s. 409.27, informing participants, at a minimum:
  301         (a) How the transition process to the FHIX marketplace will
  302  occur and the timeline for the enrollee’s specific transition.
  303         (b) What plans are available and how to research
  304  information about available plans.
  305         (c) Information about other available insurance
  306  affordability programs for the individual and his or her family.
  307         (d) Information about health benefits coverage, provider
  308  networks, and cost sharing for available plans in each region.
  309         (e) Information on how to complete the required annual
  310  renewal process, including renewal dates and deadlines.
  311         (f) Information on how to update eligibility if the
  312  participant’s data have changed since his or her last renewal or
  313  application date.
  314         (4) CUSTOMER SUPPORT.—Beginning in Phase Two, the Florida
  315  Healthy Kids Corporation shall provide customer support for
  316  FHIX, shall address general program information, financial
  317  information, and customer service issues, and shall provide
  318  status updates on bill payments. Customer support must also
  319  provide a toll-free number and maintain a website that is
  320  available in multiple languages and that meets the needs of the
  321  enrollee population.
  322         (5) INACTIVE PARTICIPANTS.—The corporation must inform the
  323  inactive participant about other insurance affordability
  324  programs and electronically refer the participant to the federal
  325  exchange or other insurance affordability programs, as
  326  appropriate.
  327         Section 7. Section 409.725, Florida Statutes, is created to
  328  read:
  329         409.725Available products and services.—The FHIX
  330  marketplace shall offer the following products and services:
  331         (1) Authorized products and services pursuant to s.
  332  408.910.
  333         (2) Medicaid managed care plans under part IV of this
  334  chapter.
  335         (3) Authorized products under the Florida Healthy Kids
  336  Corporation pursuant to s. 624.91.
  337         (4) Employer-sponsored plans.
  338         Section 8. Section 409.726, Florida Statutes, is created to
  339  read:
  340         409.726Program accountability.—
  341         (1) All managed care plans that participate in FHIX must
  342  collect and maintain encounter level data in accordance with the
  343  encounter data requirements under s. 409.967(2)(d) and are
  344  subject to the accompanying penalties under s. 409.967(2)(h)2.
  345  The agency is responsible for the collection and maintenance of
  346  the encounter level data.
  347         (2)The corporation, in consultation with the agency, shall
  348  establish access and network standards for contracts on the FHIX
  349  marketplace and shall ensure that contracted plans have
  350  sufficient providers to meet enrollee needs. The corporation, in
  351  consultation with the agency, shall develop quality of coverage
  352  and provider standards specific to the adult population.
  353         (3)The department shall develop accountability measures
  354  and performance standards to be applied to applications and
  355  renewal applications for FHIX which are submitted online, by
  356  mail, by fax, or through referrals from a third party. The
  357  minimum performance standards are:
  358         (a) Application processing speed.—Ninety percent of all
  359  applications, from all sources, must be processed within 45
  360  days.
  361         (b) Applications processing speed from online sources.
  362  Ninety-five percent of all applications received from online
  363  sources must be processed within 45 days.
  364         (c) Renewal application processing speed.—Ninety percent of
  365  all renewals, from all sources, must be processed within 45
  366  days.
  367         (d) Renewal application processing speed from online
  368  sources.—Ninety-five percent of all applications received from
  369  online sources must be processed within 45 days.
  370         (4) The agency, the department, and the Florida Healthy
  371  Kids Corporation must meet the following standards for their
  372  respective roles in the program:
  373         (a) Eighty-five percent of calls must be answered in 20
  374  seconds or less.
  375         (b) One hundred percent of all contacts, which include, but
  376  are not limited to, telephone calls, faxed documents and
  377  requests, and e-mails, must be handled within 2 business days.
  378         (c)Any self-service tools available to participants, such
  379  as interactive voice response systems, must be operational 7
  380  days a week, 24 hours a day, at least 98 percent of each month.
  381         (5) The agency, the department, and the Florida Healthy
  382  Kids Corporation must conduct an annual satisfaction survey to
  383  address all measures that require participant input specific to
  384  the FHIX marketplace program. The parties may elect to
  385  incorporate these elements into the annual report required under
  386  subsection (7).
  387         (6) The agency and the corporation shall post online
  388  monthly enrollment reports for FHIX.
  389         (7) An annual report is due no later than July 1 to the
  390  Governor, the President of the Senate, and the Speaker of the
  391  House of Representatives. The annual report must be coordinated
  392  by the agency and the corporation and must include, but is not
  393  limited to:
  394         (a) Enrollment and application trends and issues.
  395         (b) Utilization and cost data.
  396         (c) Customer satisfaction.
  397         (d) Funding sources in health savings accounts or health
  398  reimbursement accounts.
  399         (e) Enrollee use of funds in health savings accounts or
  400  health reimbursement accounts.
  401         (f) Types of products and plans purchased.
  402         (g) Movement of enrollees across different insurance
  403  affordability programs.
  404         (h) Recommendations for program improvement.
  405         Section 9. Section 409.727, Florida Statutes, is created to
  406  read:
  407         409.727Implementation schedule.—The agency, the
  408  corporation, the department, and the Florida Healthy Kids
  409  Corporation shall begin implementation of FHIX by the effective
  410  date of this act, with statewide implementation in all regions,
  411  as described in s. 409.966(2), by January 1, 2016.
  412         (1) READINESS REVIEW.—Before implementation of any phase
  413  under this section, the agency shall conduct a readiness review
  414  in consultation with the FHIX Workgroup described in s. 409.729.
  415  The agency must determine, at a minimum, the following readiness
  416  milestones:
  417         (a) Functional readiness of the service delivery platform
  418  for the phase.
  419         (b) Plan availability and presence of plan choice.
  420         (c) Provider network capacity and adequacy of the available
  421  plans in the region.
  422         (d) Availability of customer support.
  423         (e) Other factors critical to the success of FHIX.
  424         (2) PHASE ONE.—
  425         (a) Phase One begins on July 1, 2015. The agency, the
  426  corporation, the department, and the Florida Healthy Kids
  427  Corporation shall coordinate activities to ensure that
  428  enrollment begins by July 1, 2015.
  429         (b) To be eligible during this phase, a participant must
  430  meet the requirements under s. 409.723(1)(a).
  431         (c)An enrollee is entitled to receive health benefits
  432  coverage in the same manner as provided under and through the
  433  selected managed care plans in the Medicaid managed care program
  434  in part IV of this chapter.
  435         (d) An enrollee shall have a choice of at least two managed
  436  care plans in each region.
  437         (e) Choice counseling and customer service must be provided
  438  in accordance with s. 409.724(2).
  439         (3) PHASE TWO.—
  440         (a) Beginning no later than January 1, 2016, and contingent
  441  upon federal approval, participants may enroll or transition to
  442  health benefits coverage under the FHIX marketplace.
  443         (b)To be eligible during this phase, a participant must
  444  meet the requirements under s. 409.723(1)(a) and (b).
  445         (c) An enrollee may select any benefit, service, or product
  446  available.
  447         (d) The corporation shall notify an enrollee of his or her
  448  premium credit amount and how to access the FHIX marketplace
  449  selection process.
  450         (e) A Phase One enrollee must be transitioned to the FHIX
  451  marketplace by April 1, 2016. An enrollee who does not select a
  452  plan or service on the FHIX marketplace by that deadline shall
  453  be moved to inactive status.
  454         (f) An enrollee shall have a choice of at least two managed
  455  care plans in each region which meet or exceed the Affordable
  456  Care Act’s requirements and which qualify for a premium credit
  457  on the FHIX marketplace.
  458         (g) Choice counseling and customer service must be provided
  459  in accordance with s. 409.724(2) and (4).
  460         (4) PHASE THREE.—
  461         (a) No later than July 1, 2016, the corporation and the
  462  Florida Healthy Kids Corporation must begin the transition of
  463  enrollees under s. 624.91 to the FHIX marketplace.
  464         (b)Eligibility during this phase is based on meeting the
  465  requirements of Phase Two and s. 409.723(1)(c).
  466         (c) An enrollee may select any benefit, service, or product
  467  available under s. 409.725.
  468         (d) A Florida Healthy Kids enrollee who selects a FHIX
  469  marketplace plan must be provided a premium credit equivalent to
  470  the average capitation rate paid in his or her county of
  471  residence under Florida Healthy Kids as of June 30, 2016. The
  472  enrollee is responsible for any difference in costs and may use
  473  any remaining funds for supplemental benefits on the FHIX
  474  marketplace.
  475         (e) The corporation shall notify an enrollee of his or her
  476  premium credit amount and how to access the FHIX marketplace
  477  selection process.
  478         (f) Choice counseling and customer service must be provided
  479  in accordance with s. 409.724(2) and (4).
  480         (g) Enrollees under s. 624.91 must transition to the FHIX
  481  marketplace by September 30, 2016.
  482         Section 10. Section 409.728, Florida Statutes, is created
  483  to read:
  484         409.728Program operation and management.—In order to
  485  implement ss. 409.720-409.731:
  486         (1) The Agency for Health Care Administration shall do all
  487  of the following:
  488         (a) Contract with the corporation for the development,
  489  implementation, and administration of the Florida Health
  490  Insurance Affordability Exchange Program and for the release of
  491  any federal, state, or other funds appropriated to the
  492  corporation.
  493         (b) Administer Phase One of FHIX.
  494         (c) Provide administrative support to the FHIX Workgroup
  495  under s. 409.729.
  496         (d) Transition the FHIX enrollees to the FHIX marketplace
  497  beginning January 1, 2016, in accordance with the transition
  498  workplan. Stakeholders that serve low-income individuals and
  499  families must be consulted during the implementation and
  500  transition process through a public input process. All regions
  501  must complete the transition no later than April 1, 2016.
  502         (e) Timely transmit enrollee information to the
  503  corporation.
  504         (f) Beginning with Phase Two, determine annually the risk
  505  adjusted rate to be paid per month based on historical
  506  utilization and spending data for the medical and behavioral
  507  health of this population, projected forward, and adjusted to
  508  reflect the eligibility category, medical and dental trends,
  509  geographic areas, and the clinical risk profile of the
  510  enrollees.
  511         (g) Transfer to the corporation such funds as approved in
  512  the General Appropriations Act for the premium credits.
  513         (h) Encourage Medicaid managed care plans to apply as
  514  vendors to the marketplace to facilitate continuity of care and
  515  family care coordination.
  516         (2) The Department of Children and Families shall, in
  517  coordination with the corporation, the agency, and the Florida
  518  Healthy Kids Corporation, determine eligibility of applications
  519  and application renewals for FHIX in accordance with s. 409.902
  520  and shall transmit eligibility determination information on a
  521  timely basis to the agency and corporation.
  522         (3) The Florida Healthy Kids Corporation shall do all of
  523  the following:
  524         (a) Retain its duties and responsibilities under s. 624.91
  525  for Phase One and Phase Two of the program.
  526         (b) Provide customer service for the FHIX marketplace, in
  527  coordination with the agency and the corporation.
  528         (c) Transfer funds and provide financial support to the
  529  FHIX marketplace, including the collection of monthly cost
  530  sharing.
  531         (d) Conduct financial reporting related to such activities,
  532  in coordination with the corporation and the agency.
  533         (e) Coordinate activities for the program with the agency,
  534  the department, and the corporation.
  535         (4) Florida Health Choices, Inc., shall do all of the
  536  following:
  537         (a) Begin the development of FHIX during Phase One.
  538         (b) Implement and administer Phase Two and Phase Three of
  539  the FHIX marketplace and the ongoing operations of the program.
  540         (c) Offer health benefits coverage packages on the FHIX
  541  marketplace, including plans compliant with the Affordable Care
  542  Act.
  543         (d) Offer FHIX enrollees a choice of at least two plans per
  544  county at each benefit level which meet the requirements under
  545  the Affordable Care Act.
  546         (e) Provide an opportunity for participation in Medicaid
  547  managed care plans if those plans meet the requirements of the
  548  FHIX marketplace.
  549         (f) Offer enhanced or customized benefits to FHIX
  550  marketplace enrollees.
  551         (g) Provide sufficient staff and resources to meet the
  552  program needs of enrollees.
  553         (h) Provide an opportunity for plans contracted with or
  554  previously contracted with the Florida Healthy Kids Corporation
  555  under s. 624.91 to participate with FHIX if those plans meet the
  556  requirements of the program.
  557         (i) Encourage insurance agents licensed under chapter 626
  558  to identify and assist enrollees. This act does not prohibit
  559  these agents from receiving usual and customary commissions from
  560  insurers and health maintenance organizations that offer plans
  561  in the FHIX marketplace.
  562         Section 11. Section 409.729, Florida Statutes, is created
  563  to read:
  564         409.729 Long-term reorganization.—The FHIX Workgroup is
  565  created to facilitate the implementation of FHIX and to plan for
  566  a multiyear reorganization of the state’s insurance
  567  affordability programs. The FHIX Workgroup consists of two
  568  representatives each from the agency, the department, the
  569  Florida Healthy Kids Corporation, and the corporation. An
  570  additional representative of the agency serves as chair. The
  571  FHIX Workgroup must hold its organizational meeting no later
  572  than 30 days after the effective date of this act and must meet
  573  at least bimonthly. The role of the FHIX Workgroup is to make
  574  recommendations to the agency. The responsibilities of the
  575  workgroup include, but are not limited to:
  576         (1) Recommend a Phase Two implementation plan no later than
  577  October 1, 2015.
  578         (2) Review network and access standards for plans and
  579  products.
  580         (3) Assess readiness and recommend actions needed to
  581  reorganize the state’s insurance affordability programs for each
  582  phase or region. If a phase or region receives a nonreadiness
  583  recommendation, the agency must notify the Legislature of that
  584  recommendation, the reasons for such a recommendation, and
  585  proposed plans for achieving readiness.
  586         (4) Recommend any proposed change to the Title XIX-funded
  587  or Title XXI-funded programs based on the continued availability
  588  and reauthorization of the Title XXI program and its federal
  589  funding.
  590         (5) Identify duplication of services among the corporation,
  591  the agency, and the Florida Healthy Kids Corporation currently
  592  and under FHIX’s proposed Phase Three program.
  593         (6) Evaluate any fiscal impacts based on the proposed
  594  transition plan under Phase Three.
  595         (7) Compile a schedule of impacted contracts, leases, and
  596  other assets.
  597         (8) Determine staff requirements for Phase Three.
  598         (9) Develop and present a final transition plan that
  599  incorporates all elements under this section no later than
  600  December 1, 2015, in a report to the Governor, the President of
  601  the Senate, and the Speaker of the House of Representatives.
  602         Section 12. Section 409.730, Florida Statutes, is created
  603  to read:
  604         409.730 Federal participation.—The agency may seek federal
  605  approval to implement FHIX.
  606         Section 13. Section 409.731, Florida Statutes, is created
  607  to read:
  608         409.731 Program expiration.The Florida Health Insurance
  609  Affordability Exchange Program expires at the end of Phase One
  610  if the state does not receive federal approval for Phase Two or
  611  at the end of the state fiscal year in which any of these
  612  conditions occurs:
  613         (1) The federal match contribution falls below 90 percent.
  614         (2) The federal match contribution falls below the
  615  increased Federal Medical Assistance Percentage for medical
  616  assistance for newly eligible mandatory individuals as specified
  617  in the Affordable Care Act.
  618         (3) The federal match for the FHIX program and the Medicaid
  619  program are blended under federal law or regulation in such a
  620  manner that causes the overall federal contribution to diminish
  621  when compared to separate, nonblended federal contributions.
  622         Section 14. Section 408.70, Florida Statutes, is repealed.
  623         Section 15. Section 408.910, Florida Statutes, is amended
  624  to read:
  625         408.910 Florida Health Choices Program.—
  626         (1) LEGISLATIVE INTENT.—The Legislature finds that a
  627  significant number of the residents of this state do not have
  628  adequate access to affordable, quality health care. The
  629  Legislature further finds that increasing access to affordable,
  630  quality health care can be best accomplished by establishing a
  631  competitive market for purchasing health insurance and health
  632  services. It is therefore the intent of the Legislature to
  633  create and expand the Florida Health Choices Program to:
  634         (a) Expand opportunities for Floridians to purchase
  635  affordable health insurance and health services.
  636         (b) Preserve the benefits of employment-sponsored insurance
  637  while easing the administrative burden for employers who offer
  638  these benefits.
  639         (c) Enable individual choice in both the manner and amount
  640  of health care purchased.
  641         (d) Provide for the purchase of individual, portable health
  642  care coverage.
  643         (e) Disseminate information to consumers on the price and
  644  quality of health services.
  645         (f) Sponsor a competitive market that stimulates product
  646  innovation, quality improvement, and efficiency in the
  647  production and delivery of health services.
  648         (2) DEFINITIONS.—As used in this section, the term:
  649         (a) “Corporation” means the Florida Health Choices, Inc.,
  650  established under this section.
  651         (b) “Corporation’s marketplace” means the single,
  652  centralized market established by the program that facilitates
  653  the purchase of products made available in the marketplace.
  654         (c) “Florida Health Insurance Affordability Exchange
  655  Program” or “FHIX” is the program created under ss. 409.720
  656  409.731 for low-income, uninsured residents of this state.
  657         (d)(c) “Health insurance agent” means an agent licensed
  658  under part IV of chapter 626.
  659         (e)(d) “Insurer” means an entity licensed under chapter 624
  660  which offers an individual health insurance policy or a group
  661  health insurance policy, a preferred provider organization as
  662  defined in s. 627.6471, an exclusive provider organization as
  663  defined in s. 627.6472, or a health maintenance organization
  664  licensed under part I of chapter 641, or a prepaid limited
  665  health service organization or discount medical plan
  666  organization licensed under chapter 636, or a managed care plan
  667  contracted with the Agency for Health Care Administration under
  668  the managed medical assistance program under part IV of chapter
  669  409.
  670         (f) “Patient Protection and Affordable Care Act” or
  671  “Affordable Care Act” means Pub. L. No. 111-148, as further
  672  amended by the Health Care and Education Reconciliation Act of
  673  2010, Pub. L. No. 111-152, and any amendments to or regulations
  674  or guidance under those acts.
  675         (g)(e) “Program” means the Florida Health Choices Program
  676  established by this section.
  677         (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health
  678  Choices Program is created as a single, centralized market for
  679  the sale and purchase of various products that enable
  680  individuals to pay for health care. These products include, but
  681  are not limited to, health insurance plans, health maintenance
  682  organization plans, prepaid services, service contracts, and
  683  flexible spending accounts. The components of the program
  684  include:
  685         (a) Enrollment of employers.
  686         (b) Administrative services for participating employers,
  687  including:
  688         1. Assistance in seeking federal approval of cafeteria
  689  plans.
  690         2. Collection of premiums and other payments.
  691         3. Management of individual benefit accounts.
  692         4. Distribution of premiums to insurers and payments to
  693  other eligible vendors.
  694         5. Assistance for participants in complying with reporting
  695  requirements.
  696         (c) Services to individual participants, including:
  697         1. Information about available products and participating
  698  vendors.
  699         2. Assistance with assessing the benefits and limits of
  700  each product, including information necessary to distinguish
  701  between policies offering creditable coverage and other products
  702  available through the program.
  703         3. Account information to assist individual participants
  704  with managing available resources.
  705         4. Services that promote healthy behaviors.
  706         5.Health benefits coverage information about health
  707  insurance plans compliant with the Affordable Care Act.
  708         6. Consumer assistance and enrollment services for the
  709  Florida Health Insurance Affordability Exchange Program, or
  710  FHIX.
  711         (d) Recruitment of vendors, including insurers, health
  712  maintenance organizations, prepaid clinic service providers,
  713  provider service networks, and other providers.
  714         (e) Certification of vendors to ensure capability,
  715  reliability, and validity of offerings.
  716         (f) Collection of data, monitoring, assessment, and
  717  reporting of vendor performance.
  718         (g) Information services for individuals and employers.
  719         (h) Program evaluation.
  720         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  721  program is voluntary and shall be available to employers,
  722  individuals, vendors, and health insurance agents as specified
  723  in this subsection.
  724         (a) Employers eligible to enroll in the program include
  725  those employers that meet criteria established by the
  726  corporation and elect to make their employees eligible through
  727  the program.
  728         (b) Individuals eligible to participate in the program
  729  include:
  730         1. Individual employees of enrolled employers.
  731         2. Other individuals that meet criteria established by the
  732  corporation.
  733         (c) Employers who choose to participate in the program may
  734  enroll by complying with the procedures established by the
  735  corporation. The procedures must include, but are not limited
  736  to:
  737         1. Submission of required information.
  738         2. Compliance with federal tax requirements for the
  739  establishment of a cafeteria plan, pursuant to s. 125 of the
  740  Internal Revenue Code, including designation of the employer’s
  741  plan as a premium payment plan, a salary reduction plan that has
  742  flexible spending arrangements, or a salary reduction plan that
  743  has a premium payment and flexible spending arrangements.
  744         3. Determination of the employer’s contribution, if any,
  745  per employee, provided that such contribution is equal for each
  746  eligible employee.
  747         4. Establishment of payroll deduction procedures, subject
  748  to the agreement of each individual employee who voluntarily
  749  participates in the program.
  750         5. Designation of the corporation as the third-party
  751  administrator for the employer’s health benefit plan.
  752         6. Identification of eligible employees.
  753         7. Arrangement for periodic payments.
  754         8. Employer notification to employees of the intent to
  755  transfer from an existing employee health plan to the program at
  756  least 90 days before the transition.
  757         (d) All eligible vendors who choose to participate and the
  758  products and services that the vendors are permitted to sell are
  759  as follows:
  760         1. Insurers licensed under chapter 624 may sell health
  761  insurance policies, limited benefit policies, other risk-bearing
  762  coverage, and other products or services.
  763         2. Health maintenance organizations licensed under part I
  764  of chapter 641 may sell health maintenance contracts, limited
  765  benefit policies, other risk-bearing products, and other
  766  products or services.
  767         3. Prepaid limited health service organizations may sell
  768  products and services as authorized under part I of chapter 636,
  769  and discount medical plan organizations may sell products and
  770  services as authorized under part II of chapter 636.
  771         4. Prepaid health clinic service providers licensed under
  772  part II of chapter 641 may sell prepaid service contracts and
  773  other arrangements for a specified amount and type of health
  774  services or treatments.
  775         5. Health care providers, including hospitals and other
  776  licensed health facilities, health care clinics, licensed health
  777  professionals, pharmacies, and other licensed health care
  778  providers, may sell service contracts and arrangements for a
  779  specified amount and type of health services or treatments.
  780         6. Provider organizations, including service networks,
  781  group practices, professional associations, and other
  782  incorporated organizations of providers, may sell service
  783  contracts and arrangements for a specified amount and type of
  784  health services or treatments.
  785         7. Corporate entities providing specific health services in
  786  accordance with applicable state law may sell service contracts
  787  and arrangements for a specified amount and type of health
  788  services or treatments.
  790  A vendor described in subparagraphs 3.-7. may not sell products
  791  that provide risk-bearing coverage unless that vendor is
  792  authorized under a certificate of authority issued by the Office
  793  of Insurance Regulation and is authorized to provide coverage in
  794  the relevant geographic area. Otherwise eligible vendors may be
  795  excluded from participating in the program for deceptive or
  796  predatory practices, financial insolvency, or failure to comply
  797  with the terms of the participation agreement or other standards
  798  set by the corporation.
  799         (e) Eligible individuals may participate in the program
  800  voluntarily. Individuals who join the program may participate by
  801  complying with the procedures established by the corporation.
  802  These procedures must include, but are not limited to:
  803         1. Submission of required information.
  804         2. Authorization for payroll deduction, if applicable.
  805         3. Compliance with federal tax requirements.
  806         4. Arrangements for payment.
  807         5. Selection of products and services.
  808         (f) Vendors who choose to participate in the program may
  809  enroll by complying with the procedures established by the
  810  corporation. These procedures may include, but are not limited
  811  to:
  812         1. Submission of required information, including a complete
  813  description of the coverage, services, provider network, payment
  814  restrictions, and other requirements of each product offered
  815  through the program.
  816         2. Execution of an agreement to comply with requirements
  817  established by the corporation.
  818         3. Execution of an agreement that prohibits refusal to sell
  819  any offered product or service to a participant who elects to
  820  buy it.
  821         4. Establishment of product prices based on applicable
  822  criteria.
  823         5. Arrangements for receiving payment for enrolled
  824  participants.
  825         6. Participation in ongoing reporting processes established
  826  by the corporation.
  827         7. Compliance with grievance procedures established by the
  828  corporation.
  829         (g) Health insurance agents licensed under part IV of
  830  chapter 626 are eligible to voluntarily participate as buyers’
  831  representatives. A buyer’s representative acts on behalf of an
  832  individual purchasing health insurance and health services
  833  through the program by providing information about products and
  834  services available through the program and assisting the
  835  individual with both the decision and the procedure of selecting
  836  specific products. Serving as a buyer’s representative does not
  837  constitute a conflict of interest with continuing
  838  responsibilities as a health insurance agent if the relationship
  839  between each agent and any participating vendor is disclosed
  840  before advising an individual participant about the products and
  841  services available through the program. In order to participate,
  842  a health insurance agent shall comply with the procedures
  843  established by the corporation, including:
  844         1. Completion of training requirements.
  845         2. Execution of a participation agreement specifying the
  846  terms and conditions of participation.
  847         3. Disclosure of any appointments to solicit insurance or
  848  procure applications for vendors participating in the program.
  849         4. Arrangements to receive payment from the corporation for
  850  services as a buyer’s representative.
  851         (5) PRODUCTS.—
  852         (a) The products that may be made available for purchase
  853  through the program include, but are not limited to:
  854         1. Health insurance policies.
  855         2. Health maintenance contracts.
  856         3. Limited benefit plans.
  857         4. Prepaid clinic services.
  858         5. Service contracts.
  859         6. Arrangements for purchase of specific amounts and types
  860  of health services and treatments.
  861         7. Flexible spending accounts.
  862         (b) Health insurance policies, health maintenance
  863  contracts, limited benefit plans, prepaid service contracts, and
  864  other contracts for services must ensure the availability of
  865  covered services.
  866         (c) Products may be offered for multiyear periods provided
  867  the price of the product is specified for the entire period or
  868  for each separately priced segment of the policy or contract.
  869         (d) The corporation shall provide a disclosure form for
  870  consumers to acknowledge their understanding of the nature of,
  871  and any limitations to, the benefits provided by the products
  872  and services being purchased by the consumer.
  873         (e) The corporation must determine that making the plan
  874  available through the program is in the interest of eligible
  875  individuals and eligible employers in the state.
  876         (6) PRICING.—Prices for the products and services sold
  877  through the program must be transparent to participants and
  878  established by the vendors. The corporation may shall annually
  879  assess a surcharge for each premium or price set by a
  880  participating vendor. Any The surcharge may not be more than 2.5
  881  percent of the price and shall be used to generate funding for
  882  administrative services provided by the corporation and payments
  883  to buyers’ representatives; however, a surcharge may not be
  884  assessed for products and services sold in the FHIX marketplace.
  885         (7) THE MARKETPLACE PROCESS.—The program shall provide a
  886  single, centralized market for purchase of health insurance,
  887  health maintenance contracts, and other health products and
  888  services. Purchases may be made by participating individuals
  889  over the Internet or through the services of a participating
  890  health insurance agent. Information about each product and
  891  service available through the program shall be made available
  892  through printed material and an interactive Internet website.
  893         (a)Marketplace purchasing.A participant needing personal
  894  assistance to select products and services shall be referred to
  895  a participating agent in his or her area.
  896         1.(a) Participation in the program may begin at any time
  897  during a year after the employer completes enrollment and meets
  898  the requirements specified by the corporation pursuant to
  899  paragraph (4)(c).
  900         2.(b) Initial selection of products and services must be
  901  made by an individual participant within the applicable open
  902  enrollment period.
  903         3.(c) Initial enrollment periods for each product selected
  904  by an individual participant must last at least 12 months,
  905  unless the individual participant specifically agrees to a
  906  different enrollment period.
  907         4.(d) If an individual has selected one or more products
  908  and enrolled in those products for at least 12 months or any
  909  other period specifically agreed to by the individual
  910  participant, changes in selected products and services may only
  911  be made during the annual enrollment period established by the
  912  corporation.
  913         5.(e) The limits established in subparagraphs 2., 3., and
  914  4. paragraphs (b)-(d) apply to any risk-bearing product that
  915  promises future payment or coverage for a variable amount of
  916  benefits or services. The limits do not apply to initiation of
  917  flexible spending plans if those plans are not associated with
  918  specific high-deductible insurance policies or the use of
  919  spending accounts for any products offering individual
  920  participants specific amounts and types of health services and
  921  treatments at a contracted price.
  922         (b) FHIX marketplace purchasing.
  923         1. Participation in the FHIX marketplace may begin at any
  924  time during the year.
  925         2. Initial enrollment periods for certain products selected
  926  by an individual enrollee which are noncompliant with the
  927  Affordable Care Act may be required to last at least 12 months,
  928  unless the individual participant specifically agrees to a
  929  different enrollment period.
  930         (8) CONSUMER INFORMATION.—The corporation shall:
  931         (a) Establish a secure website to facilitate the purchase
  932  of products and services by participating individuals. The
  933  website must provide information about each product or service
  934  available through the program.
  935         (b) Inform individuals about other public health care
  936  programs.
  937         (9) RISK POOLING.—The program may use methods for pooling
  938  the risk of individual participants and preventing selection
  939  bias. These methods may include, but are not limited to, a
  940  postenrollment risk adjustment of the premium payments to the
  941  vendors. The corporation may establish a methodology for
  942  assessing the risk of enrolled individual participants based on
  943  data reported annually by the vendors about their enrollees.
  944  Distribution of payments to the vendors may be adjusted based on
  945  the assessed relative risk profile of the enrollees in each
  946  risk-bearing product for the most recent period for which data
  947  is available.
  948         (10) EXEMPTIONS.—
  949         (a) Products, other than the products set forth in
  950  subparagraphs (4)(d)1.-4., sold as part of the program are not
  951  subject to the licensing requirements of the Florida Insurance
  952  Code, as defined in s. 624.01 or the mandated offerings or
  953  coverages established in part VI of chapter 627 and chapter 641.
  954         (b) The corporation may act as an administrator as defined
  955  in s. 626.88 but is not required to be certified pursuant to
  956  part VII of chapter 626. However, a third party administrator
  957  used by the corporation must be certified under part VII of
  958  chapter 626.
  959         (c) Any standard forms, website design, or marketing
  960  communication developed by the corporation and used by the
  961  corporation, or any vendor that meets the requirements of
  962  paragraph (4)(f) is not subject to the Florida Insurance Code,
  963  as established in s. 624.01.
  964         (11) CORPORATION.—There is created the Florida Health
  965  Choices, Inc., which shall be registered, incorporated,
  966  organized, and operated in compliance with part III of chapter
  967  112 and chapters 119, 286, and 617. The purpose of the
  968  corporation is to administer the program created in this section
  969  and to conduct such other business as may further the
  970  administration of the program.
  971         (a) The corporation shall be governed by a 15-member board
  972  of directors consisting of:
  973         1. Three ex officio, nonvoting members to include:
  974         a. The Secretary of Health Care Administration or a
  975  designee with expertise in health care services.
  976         b. The Secretary of Management Services or a designee with
  977  expertise in state employee benefits.
  978         c. The commissioner of the Office of Insurance Regulation
  979  or a designee with expertise in insurance regulation.
  980         2. Four members appointed by and serving at the pleasure of
  981  the Governor.
  982         3. Four members appointed by and serving at the pleasure of
  983  the President of the Senate.
  984         4. Four members appointed by and serving at the pleasure of
  985  the Speaker of the House of Representatives.
  986         5. Board members may not include insurers, health insurance
  987  agents or brokers, health care providers, health maintenance
  988  organizations, prepaid service providers, or any other entity,
  989  affiliate, or subsidiary of eligible vendors.
  990         (b) Members shall be appointed for terms of up to 3 years.
  991  Any member is eligible for reappointment. A vacancy on the board
  992  shall be filled for the unexpired portion of the term in the
  993  same manner as the original appointment.
  994         (c) The board shall select a chief executive officer for
  995  the corporation who shall be responsible for the selection of
  996  such other staff as may be authorized by the corporation’s
  997  operating budget as adopted by the board.
  998         (d) Board members are entitled to receive, from funds of
  999  the corporation, reimbursement for per diem and travel expenses
 1000  as provided by s. 112.061. No other compensation is authorized.
 1001         (e) There is no liability on the part of, and no cause of
 1002  action shall arise against, any member of the board or its
 1003  employees or agents for any action taken by them in the
 1004  performance of their powers and duties under this section.
 1005         (f) The board shall develop and adopt bylaws and other
 1006  corporate procedures as necessary for the operation of the
 1007  corporation and carrying out the purposes of this section. The
 1008  bylaws shall:
 1009         1. Specify procedures for selection of officers and
 1010  qualifications for reappointment, provided that no board member
 1011  shall serve more than 9 consecutive years.
 1012         2. Require an annual membership meeting that provides an
 1013  opportunity for input and interaction with individual
 1014  participants in the program.
 1015         3. Specify policies and procedures regarding conflicts of
 1016  interest, including the provisions of part III of chapter 112,
 1017  which prohibit a member from participating in any decision that
 1018  would inure to the benefit of the member or the organization
 1019  that employs the member. The policies and procedures shall also
 1020  require public disclosure of the interest that prevents the
 1021  member from participating in a decision on a particular matter.
 1022         (g) The corporation may exercise all powers granted to it
 1023  under chapter 617 necessary to carry out the purposes of this
 1024  section, including, but not limited to, the power to receive and
 1025  accept grants, loans, or advances of funds from any public or
 1026  private agency and to receive and accept from any source
 1027  contributions of money, property, labor, or any other thing of
 1028  value to be held, used, and applied for the purposes of this
 1029  section.
 1030         (h) The corporation may establish technical advisory panels
 1031  consisting of interested parties, including consumers, health
 1032  care providers, individuals with expertise in insurance
 1033  regulation, and insurers.
 1034         (i) The corporation shall:
 1035         1. Determine eligibility of employers, vendors,
 1036  individuals, and agents in accordance with subsection (4).
 1037         2. Establish procedures necessary for the operation of the
 1038  program, including, but not limited to, procedures for
 1039  application, enrollment, risk assessment, risk adjustment, plan
 1040  administration, performance monitoring, and consumer education.
 1041         3. Arrange for collection of contributions from
 1042  participating employers, third parties, governmental entities,
 1043  and individuals.
 1044         4. Arrange for payment of premiums and other appropriate
 1045  disbursements based on the selections of products and services
 1046  by the individual participants.
 1047         5. Establish criteria for disenrollment of participating
 1048  individuals based on failure to pay the individual’s share of
 1049  any contribution required to maintain enrollment in selected
 1050  products.
 1051         6. Establish criteria for exclusion of vendors pursuant to
 1052  paragraph (4)(d).
 1053         7. Develop and implement a plan for promoting public
 1054  awareness of and participation in the program.
 1055         8. Secure staff and consultant services necessary to the
 1056  operation of the program.
 1057         9. Establish policies and procedures regarding
 1058  participation in the program for individuals, vendors, health
 1059  insurance agents, and employers.
 1060         10. Provide for the operation of a toll-free hotline to
 1061  respond to requests for assistance.
 1062         11. Provide for initial, open, and special enrollment
 1063  periods.
 1064         12. Evaluate options for employer participation which may
 1065  conform to with common insurance practices.
 1066         13. Administer the Florida Health Insurance Affordability
 1067  Exchange Program in accordance with ss. 409.720-409.731.
 1068         14. Coordinate with the Agency for Health Care
 1069  Administration, the Department of Children and Families, and the
 1070  Florida Healthy Kids Corporation on the transition plan for FHIX
 1071  and any subsequent transition activities.
 1072         (12) REPORT.—The board of the corporation shall Beginning
 1073  in the 2009-2010 fiscal year, submit by February 1 an annual
 1074  report to the Governor, the President of the Senate, and the
 1075  Speaker of the House of Representatives documenting the
 1076  corporation’s activities in compliance with the duties
 1077  delineated in this section.
 1078         (13) PROGRAM INTEGRITY.—To ensure program integrity and to
 1079  safeguard the financial transactions made under the auspices of
 1080  the program, the corporation is authorized to establish
 1081  qualifying criteria and certification procedures for vendors,
 1082  require performance bonds or other guarantees of ability to
 1083  complete contractual obligations, monitor the performance of
 1084  vendors, and enforce the agreements of the program through
 1085  financial penalty or disqualification from the program.
 1087         (a) Definitions.—For purposes of this subsection, the term:
 1088         1. “Buyer’s representative” means a participating insurance
 1089  agent as described in paragraph (4)(g).
 1090         2. “Enrollee” means an employer who is eligible to enroll
 1091  in the program pursuant to paragraph (4)(a).
 1092         3. “Participant” means an individual who is eligible to
 1093  participate in the program pursuant to paragraph (4)(b).
 1094         4. “Proprietary confidential business information” means
 1095  information, regardless of form or characteristics, that is
 1096  owned or controlled by a vendor requesting confidentiality under
 1097  this section; that is intended to be and is treated by the
 1098  vendor as private in that the disclosure of the information
 1099  would cause harm to the business operations of the vendor; that
 1100  has not been disclosed unless disclosed pursuant to a statutory
 1101  provision, an order of a court or administrative body, or a
 1102  private agreement providing that the information may be released
 1103  to the public; and that is information concerning:
 1104         a. Business plans.
 1105         b. Internal auditing controls and reports of internal
 1106  auditors.
 1107         c. Reports of external auditors for privately held
 1108  companies.
 1109         d. Client and customer lists.
 1110         e. Potentially patentable material.
 1111         f. A trade secret as defined in s. 688.002.
 1112         5. “Vendor” means a participating insurer or other provider
 1113  of services as described in paragraph (4)(d).
 1114         (b) Public record exemptions.—
 1115         1. Personal identifying information of an enrollee or
 1116  participant who has applied for or participates in the Florida
 1117  Health Choices Program is confidential and exempt from s.
 1118  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1119         2. Client and customer lists of a buyer’s representative
 1120  held by the corporation are confidential and exempt from s.
 1121  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1122         3. Proprietary confidential business information held by
 1123  the corporation is confidential and exempt from s. 119.07(1) and
 1124  s. 24(a), Art. I of the State Constitution.
 1125         (c) Retroactive application.—The public record exemptions
 1126  provided for in paragraph (b) apply to information held by the
 1127  corporation before, on, or after the effective date of this
 1128  exemption.
 1129         (d) Authorized release.—
 1130         1. Upon request, information made confidential and exempt
 1131  pursuant to this subsection shall be disclosed to:
 1132         a. Another governmental entity in the performance of its
 1133  official duties and responsibilities.
 1134         b. Any person who has the written consent of the program
 1135  applicant.
 1136         c. The Florida Kidcare program for the purpose of
 1137  administering the program authorized in ss. 409.810-409.821.
 1138         2. Paragraph (b) does not prohibit a participant’s legal
 1139  guardian from obtaining confirmation of coverage, dates of
 1140  coverage, the name of the participant’s health plan, and the
 1141  amount of premium being paid.
 1142         (e) Penalty.—A person who knowingly and willfully violates
 1143  this subsection commits a misdemeanor of the second degree,
 1144  punishable as provided in s. 775.082 or s. 775.083.
 1145         (f) Review and repeal.—This subsection is subject to the
 1146  Open Government Sunset Review Act in accordance with s. 119.15,
 1147  and shall stand repealed on October 2, 2016, unless reviewed and
 1148  saved from repeal through reenactment by the Legislature.
 1149         Section 16. Subsection (2) of section 409.904, Florida
 1150  Statutes, is amended to read:
 1151         409.904 Optional payments for eligible persons.—The agency
 1152  may make payments for medical assistance and related services on
 1153  behalf of the following persons who are determined to be
 1154  eligible subject to the income, assets, and categorical
 1155  eligibility tests set forth in federal and state law. Payment on
 1156  behalf of these Medicaid eligible persons is subject to the
 1157  availability of moneys and any limitations established by the
 1158  General Appropriations Act or chapter 216.
 1159         (2) A family, a pregnant woman, a child under age 21, a
 1160  person age 65 or over, or a blind or disabled person, who would
 1161  be eligible under any group listed in s. 409.903(1), (2), or
 1162  (3), except that the income or assets of such family or person
 1163  exceed established limitations. For a family or person in one of
 1164  these coverage groups, medical expenses are deductible from
 1165  income in accordance with federal requirements in order to make
 1166  a determination of eligibility. A family or person eligible
 1167  under the coverage known as the “medically needy,” is eligible
 1168  to receive the same services as other Medicaid recipients, with
 1169  the exception of services in skilled nursing facilities and
 1170  intermediate care facilities for the developmentally disabled.
 1171  Effective October 1, 2015, persons eligible under “medically
 1172  needy” shall be limited to children under the age of 21 and
 1173  pregnant women. This subsection expires October 1, 2019.
 1174         Section 17. Section 624.91, Florida Statutes, is amended to
 1175  read:
 1176         624.91 The Florida Healthy Kids Corporation Act.—
 1177         (1) SHORT TITLE.—This section may be cited as the “William
 1178  G. ‘Doc’ Myers Healthy Kids Corporation Act.”
 1179         (2) LEGISLATIVE INTENT.—
 1180         (a) The Legislature finds that increased access to health
 1181  care services could improve children’s health and reduce the
 1182  incidence and costs of childhood illness and disabilities among
 1183  children in this state. Many children do not have comprehensive,
 1184  affordable health care services available. It is the intent of
 1185  the Legislature that the Florida Healthy Kids Corporation
 1186  provide comprehensive health insurance coverage to such
 1187  children. The corporation is encouraged to cooperate with any
 1188  existing health service programs funded by the public or the
 1189  private sector.
 1190         (b) It is the intent of the Legislature that the Florida
 1191  Healthy Kids Corporation serve as one of several providers of
 1192  services to children eligible for medical assistance under Title
 1193  XXI of the Social Security Act. Although the corporation may
 1194  serve other children, the Legislature intends the primary
 1195  recipients of services provided through the corporation be
 1196  school-age children with a family income below 200 percent of
 1197  the federal poverty level, who do not qualify for Medicaid. It
 1198  is also the intent of the Legislature that state and local
 1199  government Florida Healthy Kids funds be used to continue
 1200  coverage, subject to specific appropriations in the General
 1201  Appropriations Act, to children not eligible for federal
 1202  matching funds under Title XXI.
 1203         (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents
 1204  of this state are eligible the following individuals are
 1205  eligible for state-funded assistance in paying Florida Healthy
 1206  Kids premiums pursuant to s. 409.814.:
 1207         (a) Residents of this state who are eligible for the
 1208  Florida Kidcare program pursuant to s. 409.814.
 1209         (b) Notwithstanding s. 409.814, legal aliens who are
 1210  enrolled in the Florida Healthy Kids program as of January 31,
 1211  2004, who do not qualify for Title XXI federal funds because
 1212  they are not qualified aliens as defined in s. 409.811.
 1213         (4) NONENTITLEMENT.—Nothing in this section shall be
 1214  construed as providing an individual with an entitlement to
 1215  health care services. No cause of action shall arise against the
 1216  state, the Florida Healthy Kids Corporation, or a unit of local
 1217  government for failure to make health services available under
 1218  this section.
 1220         (a) There is created the Florida Healthy Kids Corporation,
 1221  a not-for-profit corporation.
 1222         (b) The Florida Healthy Kids Corporation shall:
 1223         1. Arrange for the collection of any individual, family,
 1224  local contributions, or employer payment or premium, in an
 1225  amount to be determined by the board of directors, to provide
 1226  for payment of premiums for comprehensive insurance coverage and
 1227  for the actual or estimated administrative expenses.
 1228         2. Arrange for the collection of any voluntary
 1229  contributions to provide for payment of Florida Kidcare program
 1230  or Florida Health Insurance Affordability Exchange Program
 1231  premiums for children who are not eligible for medical
 1232  assistance under Title XIX or Title XXI of the Social Security
 1233  Act.
 1234         3. Subject to the provisions of s. 409.8134, accept
 1235  voluntary supplemental local match contributions that comply
 1236  with the requirements of Title XXI of the Social Security Act
 1237  for the purpose of providing additional Florida Kidcare coverage
 1238  in contributing counties under Title XXI.
 1239         4. Establish the administrative and accounting procedures
 1240  for the operation of the corporation.
 1241         4.5. Establish, with consultation from appropriate
 1242  professional organizations, standards for preventive health
 1243  services and providers and comprehensive insurance benefits
 1244  appropriate to children, provided that such standards for rural
 1245  areas shall not limit primary care providers to board-certified
 1246  pediatricians.
 1247         5.6. Determine eligibility for children seeking to
 1248  participate in the Title XXI-funded components of the Florida
 1249  Kidcare program consistent with the requirements specified in s.
 1250  409.814, as well as the non-Title-XXI-eligible children as
 1251  provided in subsection (3).
 1252         6.7. Establish procedures under which providers of local
 1253  match to, applicants to and participants in the program may have
 1254  grievances reviewed by an impartial body and reported to the
 1255  board of directors of the corporation.
 1256         7.8. Establish participation criteria and, if appropriate,
 1257  contract with an authorized insurer, health maintenance
 1258  organization, or third-party administrator to provide
 1259  administrative services to the corporation.
 1260         8.9. Establish enrollment criteria that include penalties
 1261  or waiting periods of 30 days for reinstatement of coverage upon
 1262  voluntary cancellation for nonpayment of family or individual
 1263  premiums.
 1264         9.10. Contract with authorized insurers or any provider of
 1265  health care services, meeting standards established by the
 1266  corporation, for the provision of comprehensive insurance
 1267  coverage to participants. Such standards shall include criteria
 1268  under which the corporation may contract with more than one
 1269  provider of health care services in program sites.
 1270         a. Health plans shall be selected through a competitive bid
 1271  process. The Florida Healthy Kids Corporation shall purchase
 1272  goods and services in the most cost-effective manner consistent
 1273  with the delivery of quality medical care.
 1274         b. The maximum administrative cost for a Florida Healthy
 1275  Kids Corporation contract shall be 15 percent. For health and
 1276  dental care contracts, the minimum medical loss ratio for a
 1277  Florida Healthy Kids Corporation contract shall be 85 percent.
 1278  The calculations must use uniform financial data collected from
 1279  all plans in a format established by the corporation and shall
 1280  be computed for each plan on a statewide basis. Funds shall be
 1281  classified in a manner consistent with 45 C.F.R. part 158 For
 1282  dental contracts, the remaining compensation to be paid to the
 1283  authorized insurer or provider under a Florida Healthy Kids
 1284  Corporation contract shall be no less than an amount which is 85
 1285  percent of premium; to the extent any contract provision does
 1286  not provide for this minimum compensation, this section shall
 1287  prevail.
 1288         c. The health plan selection criteria and scoring system,
 1289  and the scoring results, shall be available upon request for
 1290  inspection after the bids have been awarded.
 1291         d. Effective July 1, 2016, health and dental services
 1292  contracts of the corporation must transition to the FHIX
 1293  marketplace under s. 409.722. Qualifying plans may enroll as
 1294  vendors with the FHIX marketplace to maintain continuity of care
 1295  for participants.
 1296         10.11. Establish disenrollment criteria in the event local
 1297  matching funds are insufficient to cover enrollments.
 1298         11.12. Develop and implement a plan to publicize the
 1299  Florida Kidcare program, the eligibility requirements of the
 1300  program, and the procedures for enrollment in the program and to
 1301  maintain public awareness of the corporation and the program.
 1302         12.13. Secure staff necessary to properly administer the
 1303  corporation. Staff costs shall be funded from state and local
 1304  matching funds and such other private or public funds as become
 1305  available. The board of directors shall determine the number of
 1306  staff members necessary to administer the corporation.
 1307         13.14. In consultation with the partner agencies, provide a
 1308  report on the Florida Kidcare program annually to the Governor,
 1309  the Chief Financial Officer, the Commissioner of Education, the
 1310  President of the Senate, the Speaker of the House of
 1311  Representatives, and the Minority Leaders of the Senate and the
 1312  House of Representatives.
 1313         14.15. Provide information on a quarterly basis online to
 1314  the Legislature and the Governor which compares the costs and
 1315  utilization of the full-pay enrolled population and the Title
 1316  XXI-subsidized enrolled population in the Florida Kidcare
 1317  program. The information, at a minimum, must include:
 1318         a. The monthly enrollment and expenditure for full-pay
 1319  enrollees in the Medikids and Florida Healthy Kids programs
 1320  compared to the Title XXI-subsidized enrolled population; and
 1321         b. The costs and utilization by service of the full-pay
 1322  enrollees in the Medikids and Florida Healthy Kids programs and
 1323  the Title XXI-subsidized enrolled population.
 1324         15.16. Establish benefit packages that conform to the
 1325  provisions of the Florida Kidcare program, as created in ss.
 1326  409.810-409.821.
 1327         16. Contract with other insurance affordability programs
 1328  and FHIX to provide customer service or other enrollment-focused
 1329  services.
 1330         17. Annually develop performance metrics for the following
 1331  focus areas:
 1332         a. Administrative functions.
 1333         b. Contracting with vendors.
 1334         c. Customer service.
 1335         d. Enrollee education.
 1336         e. Financial services.
 1337         f. Program integrity.
 1338         (c) Coverage under the corporation’s program is secondary
 1339  to any other available private coverage held by, or applicable
 1340  to, the participant child or family member. Insurers under
 1341  contract with the corporation are the payors of last resort and
 1342  must coordinate benefits with any other third-party payor that
 1343  may be liable for the participant’s medical care.
 1344         (d) The Florida Healthy Kids Corporation shall be a private
 1345  corporation not for profit, organized pursuant to chapter 617,
 1346  and shall have all powers necessary to carry out the purposes of
 1347  this act, including, but not limited to, the power to receive
 1348  and accept grants, loans, or advances of funds from any public
 1349  or private agency and to receive and accept from any source
 1350  contributions of money, property, labor, or any other thing of
 1351  value, to be held, used, and applied for the purposes of this
 1352  act.
 1354         (a) The Florida Healthy Kids Corporation shall operate
 1355  subject to the supervision and approval of a board of directors.
 1356  The board chair shall be an appointee designated by the
 1357  Governor, and the board shall be chaired by the Chief Financial
 1358  Officer or her or his designee, and composed of 12 other
 1359  members. The Senate shall confirm the designated chair and other
 1360  board appointees. The board members shall be appointed selected
 1361  for 3-year terms. of office as follows:
 1362         1. The Secretary of Health Care Administration, or his or
 1363  her designee.
 1364         2. One member appointed by the Commissioner of Education
 1365  from the Office of School Health Programs of the Florida
 1366  Department of Education.
 1367         3. One member appointed by the Chief Financial Officer from
 1368  among three members nominated by the Florida Pediatric Society.
 1369         4. One member, appointed by the Governor, who represents
 1370  the Children’s Medical Services Program.
 1371         5. One member appointed by the Chief Financial Officer from
 1372  among three members nominated by the Florida Hospital
 1373  Association.
 1374         6. One member, appointed by the Governor, who is an expert
 1375  on child health policy.
 1376         7. One member, appointed by the Chief Financial Officer,
 1377  from among three members nominated by the Florida Academy of
 1378  Family Physicians.
 1379         8. One member, appointed by the Governor, who represents
 1380  the state Medicaid program.
 1381         9. One member, appointed by the Chief Financial Officer,
 1382  from among three members nominated by the Florida Association of
 1383  Counties.
 1384         10. The State Health Officer or her or his designee.
 1385         11. The Secretary of Children and Families, or his or her
 1386  designee.
 1387         12. One member, appointed by the Governor, from among three
 1388  members nominated by the Florida Dental Association.
 1389         (b) A member of the board of directors serves at the
 1390  pleasure of the Governor may be removed by the official who
 1391  appointed that member. The board shall appoint an executive
 1392  director, who is responsible for other staff authorized by the
 1393  board.
 1394         (c) Board members are entitled to receive, from funds of
 1395  the corporation, reimbursement for per diem and travel expenses
 1396  as provided by s. 112.061.
 1397         (d) There shall be no liability on the part of, and no
 1398  cause of action shall arise against, any member of the board of
 1399  directors, or its employees or agents, for any action they take
 1400  in the performance of their powers and duties under this act.
 1401         (e) Board members who are serving as of the effective date
 1402  of this act may remain on the board until January 1, 2016.
 1404         (a) The corporation shall not be deemed an insurer. The
 1405  officers, directors, and employees of the corporation shall not
 1406  be deemed to be agents of an insurer. Neither the corporation
 1407  nor any officer, director, or employee of the corporation is
 1408  subject to the licensing requirements of the insurance code or
 1409  the rules of the Department of Financial Services. However, any
 1410  marketing representative utilized and compensated by the
 1411  corporation must be appointed as a representative of the
 1412  insurers or health services providers with which the corporation
 1413  contracts.
 1414         (b) The board has complete fiscal control over the
 1415  corporation and is responsible for all corporate operations.
 1416         (c) The Department of Financial Services shall supervise
 1417  any liquidation or dissolution of the corporation and shall
 1418  have, with respect to such liquidation or dissolution, all power
 1419  granted to it pursuant to the insurance code.
 1420         (8) TRANSITION PLANS.—The corporation shall confer with the
 1421  Agency for Health Care Administration, the Department of
 1422  Children and Families, and Florida Health Choices, Inc., to
 1423  develop transition plans for the Florida Health Insurance
 1424  Affordability Exchange Program as created under ss. 409.720
 1425  409.731.
 1426         Section 18. Section 624.915, Florida Statutes, is repealed.
 1427         Section 19. The Division of Law Revision and Information is
 1428  directed to replace the phrase “the effective date of this act”
 1429  wherever it occurs in this act with the date the act becomes a
 1430  law.
 1431         Section 20. This act shall take effect upon becoming a law.