Florida Senate - 2018                                    SB 1872
       By Senator Torres
       15-01229-18                                           20181872__
    1                        A bill to be entitled                      
    2         An act relating to health care coverage; creating part
    3         V of chapter 408, F.S., entitled the "Healthy Florida
    4         Act”; creating s. 408.95, F.S.; providing a short
    5         title; creating s. 408.951, F.S.; providing
    6         legislative findings and intent; creating s. 408.952,
    7         F.S.; defining terms; creating s. 408.953, F.S.;
    8         creating the Healthy Florida program, to be
    9         administered by the Healthy Florida Board; creating
   10         the Healthy Florida Board; declaring that the board is
   11         an independent public entity not affiliated with an
   12         agency or department; specifying the composition and
   13         governance of the board; specifying appointment
   14         procedures and requirements; specifying terms of board
   15         members; providing duties, qualifications, and
   16         prohibited acts of board members; specifying that
   17         board members may not receive compensation for service
   18         but may be reimbursed for certain per diem and travel
   19         expenses; defining the term “health care provider”;
   20         providing immunity from liability for certain acts
   21         performed or obligations entered into by the board or
   22         by board members, officers, or employees; requiring
   23         the board to hire an executive director who is exempt
   24         from civil service and who serves at the pleasure of
   25         the board; providing that the board’s meetings are
   26         subject to public meetings requirements; authorizing
   27         the board to adopt rules; creating s. 408.954, F.S.;
   28         requiring the State Surgeon General of the Department
   29         of Health to establish a public advisory committee to
   30         advise the board on policy matters; specifying the
   31         composition of the committee and the authority
   32         appointing each member; providing requirements for the
   33         Governor, President of the Senate, and Speaker of the
   34         House of Representatives in making appointments;
   35         specifying terms of appointments and reappointments;
   36         providing requirements for filling vacancies;
   37         specifying that committee members serve without
   38         compensation, except for reimbursement for per diem
   39         and travel expenses and a specified amount under
   40         certain circumstances; defining the term “full day of
   41         attending a meeting”; providing requirements for the
   42         minimum frequency and location of committee meetings;
   43         requiring such meetings to be open to the public;
   44         requiring the committee to elect a chair; specifying
   45         terms of the chair; providing qualifications and
   46         prohibited acts of committee members; creating s.
   47         408.955, F.S.; specifying powers and duties of the
   48         board in establishing and implementing comprehensive
   49         universal single-payer health care coverage and a
   50         health care cost control system for the benefit of
   51         state residents; prohibiting carriers from offering
   52         benefits or covering services for which coverage is
   53         offered to individuals under the Healthy Florida
   54         program; specifying benefits that may be offered by
   55         carriers; requiring, after a certain timeframe,
   56         certain board members to be program members; requiring
   57         the board to develop certain proposals within a
   58         specified timeframe; authorizing the board to contract
   59         with nonprofit organizations to provide certain
   60         assistance to consumers and health care providers;
   61         requiring the board to provide grants from certain
   62         sources to the Agency for Health Care Administration
   63         and the Department of Economic Opportunity for certain
   64         purposes; requiring the board to provide for the
   65         collection and availability of specified health care
   66         data; requiring the board to make such data publicly
   67         available in a specified manner; requiring the board
   68         to conduct programs to promote and protect public,
   69         environmental, and occupational health, using certain
   70         data; requiring the board to provide for the
   71         collection and availability of certain data within a
   72         certain timeframe; creating s. 408.956, F.S.;
   73         prohibiting law enforcement agencies from using
   74         Healthy Florida moneys, facilities, property,
   75         equipment, or personnel for certain purposes; creating
   76         s. 408.957, F.S.; providing that every resident of
   77         this state is eligible and entitled to enroll under
   78         the Healthy Florida program; specifying that members
   79         may not be required to pay any charge for enrollment
   80         or membership; specifying that members may not be
   81         required to pay any form of cost-sharing for a covered
   82         benefit; authorizing institutions of higher education
   83         to purchase coverage under the program for nonresident
   84         students and their dependents; creating s. 408.958,
   85         F.S.; specifying covered health care benefits for
   86         members; creating s. 408.96, F.S.; providing health
   87         care provider qualifications for participation in the
   88         program; requiring the board to establish and maintain
   89         certain procedures and standards for out-of-state
   90         health care providers providing services under certain
   91         circumstances; providing that members may choose to
   92         receive health care services from any participating
   93         provider, subject to certain conditions; providing
   94         requirements for retaining membership under, and
   95         procedures for withdrawing from, certain enrollments;
   96         creating s. 408.961, F.S.; providing requirements for
   97         care coordination provided by care coordinators;
   98         specifying qualifications for care coordinators;
   99         authorizing a health care provider to be reimbursed
  100         for a health care service only if the member is
  101         enrolled with a care coordinator at the time the
  102         service is provided; requiring the program to assist
  103         certain members in choosing a care coordinator;
  104         requiring that a member be enrolled with a care
  105         coordinator until the member enrolls with a different
  106         care coordinator or ceases to be a member; specifying
  107         a member’s right to change care coordinators;
  108         authorizing health care organizations to establish
  109         certain rules relating to care coordination; providing
  110         construction; requiring the board to develop by rule
  111         and implement certain procedures and standards;
  112         specifying requirements for a care coordinator to
  113         maintain approval under the program; creating s.
  114         408.962, F.S.; requiring the board to adopt rules
  115         relating to contracting and payment methodologies for
  116         covered health care services and care coordination;
  117         providing a requirement for payment rates; requiring
  118         certain health care services to be paid for on a fee
  119         for-service basis unless and until the board
  120         establishes another methodology; authorizing a certain
  121         payment methodology for certain entities; requiring
  122         that the program engage in good faith negotiations
  123         with health care providers’ representatives; requiring
  124         that negotiations for drugs be through a single entity
  125         on behalf of the entire program; providing
  126         construction; prohibiting participating providers from
  127         charging certain rates or soliciting or accepting
  128         certain payments; providing exceptions; authorizing
  129         the board to adopt rules for payment methodologies for
  130         the payment of certain capital-related expenses of
  131         certain health facilities; defining the term “health
  132         facility”; providing a prior approval requirement for
  133         the payment of such expenses; requiring that payment
  134         methodologies and payment rates include a
  135         reimbursement component for direct and indirect
  136         graduate medical education expenses; requiring the
  137         board to adopt rules for payment methodologies and
  138         procedures for services provided to members while out
  139         of the state; creating s. 408.963, F.S.; authorizing
  140         members to enroll with and receive certain services
  141         from a health care organization; specifying
  142         qualifications for a health care organization;
  143         requiring the board to develop and implement by rule
  144         certain procedures and standards for health care
  145         organizations; requiring the board, in developing and
  146         implementing such standards, to consult with the
  147         Substance Abuse and Mental Health Program Office
  148         within the Department of Children and Families;
  149         providing requirements for health care organizations
  150         to maintain approval under the program; authorizing
  151         the board to adopt certain rules relating to
  152         compliance; providing construction; prohibiting health
  153         care organizations from using health information
  154         technology or clinical practice guidelines for certain
  155         purposes; providing that physicians and registered
  156         nurses may override such technology and guidelines
  157         under certain circumstances; creating s. 408.964,
  158         F.S.; requiring the board to adopt rules establishing
  159         program requirements and standards for the program,
  160         health care organizations, care coordinators, and
  161         health care providers; specifying the objectives of
  162         such requirements and standards; requiring the board
  163         to adopt rules establishing requirements and standards
  164         for replacing and merging services provided by certain
  165         other programs; providing requirements for for-profit
  166         participating providers and care coordinators;
  167         requiring participating providers to furnish certain
  168         information for certain purposes; requiring the board
  169         to consult with certain entities in developing
  170         requirements and standards and making certain policy
  171         determinations; creating s. 408.97, F.S.; requiring
  172         the board to seek necessary federal waivers,
  173         approvals, and arrangements and submit necessary state
  174         plan amendments to operate the program; specifying
  175         requirements for the board in applying for such
  176         waivers and in making such arrangements; requiring the
  177         board to negotiate certain arrangements with the
  178         Federal Government; authorizing the board to require
  179         members or applicants to provide information for a
  180         certain purpose; prohibiting other uses of such
  181         information; authorizing the board to take additional
  182         actions necessary to effectively implement the
  183         program; providing requirements and authorizing
  184         certain acts with respect to the program’s
  185         administration of federally matched public health
  186         programs and Medicare; requiring the board to take
  187         certain actions, upon a finding approved by the Chief
  188         Financial Officer and the board, to reduce or
  189         eliminate certain individual obligations or increase
  190         an individual’s eligibility for certain financial
  191         support; providing applicability; authorizing the
  192         board to require members or applicants to provide
  193         certain information for certain purposes; requiring
  194         members eligible for Medicare benefits to enroll in
  195         Medicare to maintain eligibility in the program;
  196         requiring the program to provide premium assistance to
  197         members enrolling in a certain Medicare drug coverage
  198         plan; requiring a member to provide the program, and
  199         authorize the program to obtain, certain information
  200         relating to a subsidy under the Social Security Act
  201         for a certain purpose; requiring the board to attempt
  202         to obtain such information from records available to
  203         it; requiring the program to make a reasonable effort
  204         to notify members of certain obligations; providing
  205         procedures for notifying members and for the
  206         termination of coverage; prohibiting certain uses of
  207         member information by the board; providing that the
  208         board assumes responsibility for certain benefits and
  209         services; creating s. 408.972, F.S.; providing
  210         legislative intent regarding a revenue plan for the
  211         program; creating s. 408.98, F.S.; defining terms;
  212         specifying requirements for collective negotiation
  213         rights between health care providers and the program;
  214         requiring representatives of negotiating parties to
  215         pay a fee to the board; requiring the board to set
  216         certain fees by rule; prohibiting certain collective
  217         actions; providing construction; creating s. 408.99,
  218         F.S.; providing that the act does not become operative
  219         until the State Surgeon General of the Department of
  220         Health provides a specified notice to the Legislature;
  221         requiring the Department of Health to publish the
  222         notice on its website; creating s. 408.991, F.S.;
  223         providing for severability; providing an effective
  224         date.
  226  Be It Enacted by the Legislature of the State of Florida:
  228         Section 1. The Division of Law Revision and Information is
  229  directed to create part V of chapter 408, Florida Statutes,
  230  consisting of ss. 408.95-408.991, Florida Statutes, to be
  231  entitled the “Healthy Florida Act.”
  232         Section 2. Section 408.95, Florida Statutes, is created to
  233  read:
  234         408.95 Short title.—This part may be cited as the “Healthy
  235  Florida Act.”
  236         Section 3. Section 408.951, Florida Statutes, is created to
  237  read:
  238         408.951 Legislative findings and intent.—
  239         (1)The Legislature finds and declares all of the
  240  following:
  241         (a)All residents of this state have the right to health
  242  care. While the federal Patient Protection and Affordable Care
  243  Act (PPACA) brought many improvements in health care and health
  244  care coverage, it still leaves many residents without coverage
  245  or with inadequate coverage.
  246         (b) Residents of this state, as individuals, employers, and
  247  taxpayers, have experienced increases in the cost of health care
  248  and health care coverage in recent years, including rising
  249  premiums, deductibles, and copays, as well as restricted
  250  provider networks and high out-of-network charges.
  251         (c)Businesses have also experienced increases in the costs
  252  of health care benefits for their employees and many employers
  253  are shifting a larger share of the coverage costs to their
  254  employees or dropping coverage entirely.
  255         (d)Individuals often find that they are deprived of
  256  affordable care and choice because of decisions by health
  257  benefit plans guided by the plan’s economic needs rather than by
  258  consumers’ health care needs.
  259         (e)To address the fiscal crisis facing the health care
  260  system and the state, and to ensure that residents of this state
  261  can exercise their right to health care, comprehensive health
  262  care coverage needs to be provided.
  263         (f)It is the intent of the Legislature to establish a
  264  comprehensive universal single-payer health care coverage
  265  program and a health care cost control system for the benefit of
  266  all residents of this state.
  267         (2)(a) It is further the intent of the Legislature to
  268  establish the Healthy Florida (HF) program to provide universal
  269  health coverage for every resident of this state based on his or
  270  her ability to pay and to be funded by broad-based revenue.
  271         (b)It is the intent of the Legislature for the state to
  272  work to obtain waivers and other approvals relating to Medicaid,
  273  the Children’s Health Insurance Program, Medicare, the PPACA,
  274  and any other federal programs so that any federal funds and
  275  other subsidies that would otherwise be paid to the state,
  276  residents of this state, and health care providers would be paid
  277  by the Federal Government to this state and deposited in the
  278  Healthy Florida Trust Fund.
  279         (c)Under such waivers and approvals, such funds would be
  280  used for health coverage that provides health benefits equal to
  281  or exceeding those federal programs as well as other program
  282  modifications, including elimination of cost-sharing and
  283  insurance premiums.
  284         (d)The Legislature intends for the programs in paragraph
  285  (b) to be replaced and merged into the HF program, which will
  286  operate as a true single-payer program.
  287         (e)If any necessary waivers or approvals are not obtained,
  288  it is the intent of the Legislature that the state use Medicaid
  289  state plan amendments and seek waivers and approvals to
  290  maximize, and make as seamless as possible, the use of federally
  291  matched public health programs and federal health programs in
  292  the HF program.
  293         (f)Thus, even if other programs such as Medicaid or
  294  Medicare may contribute to paying for care, it is the goal of
  295  this act that the coverage be delivered by the HF program, and,
  296  as much as possible, that the multiple sources of funding be
  297  pooled with other HF program funds and not be apparent to HF
  298  program members or participating providers.
  299         (3)This act does not create any employment benefit, nor
  300  does it require, prohibit, or limit the provision of any
  301  employment benefit.
  302         (4)(a) It is the intent of the Legislature not to change or
  303  impact in any way the role or authority of any licensing board
  304  or state agency that regulates the standards for or provision of
  305  health care and the standards for health care providers as
  306  established under current law, including, but not limited to,
  307  chapters 381 through 408; chapters 410, 411, 413, and 429;
  308  chapters 455 through 467; parts I through IV, X, and XIV of
  309  chapter 468; chapters 486, 490, and 491; and the Florida
  310  Insurance Code, as applicable.
  311         (b)This act does not authorize the Healthy Florida Board,
  312  the HF program, or the State Surgeon General of the Department
  313  of Health to establish or revise licensure standards for health
  314  care providers.
  315         (5)It is the intent of the Legislature that neither health
  316  information technology nor clinical practice guidelines limit
  317  the effective exercise of the professional judgment of
  318  physicians and registered nurses. Physicians and registered
  319  nurses are free to override health information technology and
  320  clinical practice guidelines, if, in their professional
  321  judgment, it is in the best interest of the patient and
  322  consistent with the patient’s wishes.
  323         (6)(a) It is the intent of the Legislature to provide an
  324  exemption from public records requirements for the personal
  325  identifying information of HF program members as set forth in s.
  326  408.985.
  327         (b)This act would also prohibit law enforcement agencies
  328  from using the HF program’s funds, facilities, property,
  329  equipment, or personnel to investigate, enforce, or assist in
  330  the investigation or enforcement of any criminal, civil, or
  331  administrative violation or warrant for a violation of any law
  332  that individuals register with the Federal Government or any
  333  federal agency based on religion, national origin, ethnicity, or
  334  immigration status.
  335         (7)It is the further intent of the Legislature to address
  336  the high cost of prescription drugs and ensure they are
  337  affordable for patients.
  338         Section 4. Section 408.952, Florida Statutes, is created to
  339  read:
  340         408.952Definitions.—As used in this part, the term:
  341         (1)“Affordable Care Act” or “PPACA” means the federal
  342  Patient Protection and Affordable Care Act, Pub. L. No. 111-148,
  343  as amended by the federal Health Care and Education
  344  Reconciliation Act of 2010, Pub. L. No. 111-152, and any
  345  amendments to, or regulations or guidance issued under, those
  346  acts.
  347         (2)“Allied health practitioner” means a group of health
  348  professionals who apply their expertise in all specialties to
  349  prevent disease transmission and diagnose, treat, and
  350  rehabilitate people of all ages. Together with a range of
  351  technical and support staff, they may deliver direct patient
  352  care, rehabilitation, treatment, diagnostics, and health
  353  improvement interventions to restore and maintain optimal
  354  physical, sensory, psychological, cognitive, and social
  355  functions. As used in this subsection, the term “health
  356  professional” includes, but is not limited to, an audiologist,
  357  an occupational therapist, a social worker, or a radiographer.
  358         (3)“Board” means the Healthy Florida Board created in s.
  359  408.953.
  360         (4)“Care coordination” means services provided by a care
  361  coordinator under s. 408.961.
  362         (5)“Care coordinator” means an individual or entity
  363  approved by the board to provide care coordination under s.
  364  408.961.
  365         (6)“Carrier” means a private health insurer holding a
  366  valid certificate of authority under chapter 624, or a health
  367  maintenance organization holding a valid certificate of
  368  authority under chapter 641, issued by the Office of Insurance
  369  Regulation.
  370         (7)“Committee” means the public advisory committee
  371  established under s. 408.954.
  372         (8)“Essential community providers” means persons or
  373  entities acting as safety net clinics, safety net health care
  374  providers, or rural hospitals.
  375         (9)“Federally matched public health program” means the
  376  state’s Medicaid program under Title XIX of the Social Security
  377  Act, 42 U.S.C. ss. 1396 et seq., and the Florida Kidcare Act,
  378  the state’s Children’s Health Insurance Program under Title XXI
  379  of the Social Security Act, 42 U.S.C. ss. 1397aa et seq.
  380         (10)“Fund” means the Healthy Florida Trust Fund created
  381  under s. 408.971.
  382         (11)“Health care organization” means an entity that is
  383  approved by the board under s. 408.963 to provide health care
  384  services to members under the program.
  385         (12)“Health care service” means any health care service,
  386  including care coordination, which is included as a benefit
  387  under the program.
  388         (13) “Healthy Florida,” “HF, or “program” means the
  389  Healthy Florida program created in s. 408.953.
  390         (14)“Implementation period” means the period under s.
  391  408.955(6) during which the program is subject to special
  392  eligibility and financing provisions until it is fully
  393  implemented under that subsection.
  394         (15)“Integrated health care delivery system” means a
  395  provider organization that:
  396         (a)Is fully integrated, operationally and clinically, in
  397  order to provide a broad range of health care services,
  398  including preventive care, prenatal and well-baby care,
  399  immunizations, screening diagnostics, emergency services,
  400  hospital and medical services, surgical services, and ancillary
  401  services; and
  402         (b)Is compensated by Healthy Florida using capitation or
  403  facility budgets for the provision of health care services.
  404         (16)“Long-term care” means long-term care, treatment,
  405  maintenance, or services not covered under the Florida Kidcare
  406  Act, as appropriate, with the exception of short-term
  407  rehabilitation, and as defined by the board.
  408         (17)“Medicaid” or “medical assistance” means a program
  409  that is one of the following:
  410         (a)The state Medicaid program under Title XIX of the
  411  Social Security Act, 42 U.S.C. ss. 1396 et seq.
  412         (b)The Florida Kidcare Act, the state’s Children’s Health
  413  Insurance Program under Title XXI of the Social Security Act, 42
  414  U.S.C. ss. 1397aa et seq.
  415         (18)“Medicare” means Title XVIII of the Social Security
  416  Act, 42 U.S.C. ss. 1395 et seq., and the programs thereunder.
  417         (19)“Member” means an individual who is enrolled in the
  418  program.
  419         (20)“Out-of-state health care service” means a health care
  420  service provided in person to a member while he or she is
  421  physically located out of the state under either of the
  422  following circumstances:
  423         (a)It is medically necessary that the health care service
  424  be provided while the member is physically out of the state.
  425         (b)It is clinically appropriate and necessary, and cannot
  426  be provided in this state, because the health care service can
  427  only be provided by a particular health care provider physically
  428  located out of the state. However, any health care service
  429  provided to an HF member by a health care provider located
  430  outside the state and qualified under s. 408.96 is not
  431  considered an out-of-state service and must be covered as
  432  otherwise provided in this part.
  433         (21)“Participating provider” means any individual or
  434  entity that is a health care organization or that is a health
  435  care provider qualified under s. 408.96 which provides health
  436  care services to members under the program.
  437         (22)“Prescription drug” has the same meaning as provided
  438  in s. 499.003.
  439         (23)“Resident” means an individual whose primary place of
  440  abode is in this state, without regard to the individual’s
  441  immigration status.
  442         Section 5. Section 408.953, Florida Statutes, is created to
  443  read:
  444         408.953 The Healthy Florida program; the Healthy Florida
  445  Board; board appointments and governance.—
  446         (1) The Healthy Florida program is hereby created and is to
  447  be administered by the Healthy Florida Board created under this
  448  section.
  449         (2) The Healthy Florida Board is hereby created. The board
  450  shall be an independent public entity not affiliated with an
  451  agency or department. The board shall be governed by an
  452  executive board consisting of nine members who are residents of
  453  this state. Of the members of the executive board, four shall be
  454  appointed by the Governor, two shall be appointed by the
  455  President of the Senate, and two shall be appointed by the
  456  Speaker of the House of Representatives. The State Surgeon
  457  General of the Department of Health or his or her designee shall
  458  serve as a voting, ex officio member of the board.
  459         (3)Members of the board, other than an ex officio member,
  460  shall be appointed for a term of 4 years. Appointments by the
  461  Governor shall be subject to confirmation by the Senate. A
  462  member of the board may continue to serve until the appointment
  463  and qualification of his or her successor. Vacancies shall be
  464  filled by appointment for an unexpired term. The board shall
  465  elect a chair on an annual basis.
  466         (4)(a) Each person appointed to the board must have
  467  demonstrated and acknowledged expertise in health care.
  468         (b)Appointing authorities shall also consider the
  469  expertise of the other members of the board and attempt to make
  470  appointments so that the board’s composition reflects a
  471  diversity of expertise in the various aspects of health care.
  472         (c)Appointments to the board by the Governor, the
  473  President of the Senate, and the Speaker of the House of
  474  Representatives must consist of:
  475         1. At least one representative of a labor organization
  476  representing registered nurses.
  477         2. At least one representative of the general public.
  478         3. At least one representative of a labor organization.
  479         4. At least one representative of the medical provider
  480  community.
  481         (5) Each member of the board shall have the responsibility
  482  and duty to meet the requirements of this part, the Affordable
  483  Care Act, and all applicable state and federal laws and
  484  regulations, to serve the public interest of the individuals,
  485  employers, and taxpayers seeking health care coverage through
  486  the program, and to ensure the operational well-being and fiscal
  487  solvency of the program.
  488         (6)In making appointments to the board, the appointing
  489  authorities shall take into consideration the cultural, ethnic,
  490  and geographical diversity of the state so that the board’s
  491  composition reflects the communities of this state.
  492         (7)(a)A member of the board or of its staff may not be
  493  employed by, a consultant to, a member of the board of directors
  494  of, affiliated with, or otherwise be a representative of a
  495  health care provider, a health care facility, or a health clinic
  496  while serving on the board or on the board staff. A member of
  497  the board or of its staff may not be a member, a board member,
  498  or an employee of a trade association of health facilities,
  499  health clinics, or health care providers while serving on the
  500  board or on the staff of the board. A member of the board or of
  501  its staff may not be a health care provider unless he or she
  502  receives no compensation for rendering services as a health care
  503  provider and does not have an ownership interest in a health
  504  care practice.
  505         (b)A board member may not receive compensation for his or
  506  her service on the board, but may be reimbursed for per diem and
  507  travel expenses in accordance with s. 112.061 while engaged in
  508  the performance of official duties of the board.
  509         (c)For purposes of this subsection, the term “health care
  510  provider” means a health care professional licensed under
  511  chapter 458, chapter 459, chapter 460, chapter 461, chapter 463,
  512  chapter 464, chapter 465, chapter 466, part I, part III, part
  513  IV, part V, or part X of chapter 468, chapter 483, chapter 484,
  514  chapter 486, chapter 490, or chapter 491.
  515         (8)A member of the board may not make, participate in
  516  making, or in any way attempt to use his or her official
  517  position to influence the making of a decision that he or she
  518  knows, or has reason to know, will have a reasonably foreseeable
  519  material financial effect, distinguishable from its effect on
  520  the public generally, on him or her or a member of his or her
  521  immediate family, or on either of the following:
  522         (a)Any source of income aggregating $250 or more in value
  523  provided to, received by, or promised to the member within 12
  524  months before the time when the decision is made, other than
  525  gifts and other than loans by a commercial lending institution
  526  in the regular course of business on terms available to the
  527  public without regard to official status.
  528         (b)Any business entity in which the member is a director,
  529  officer, partner, trustee, or employee, or holds any position of
  530  management.
  531         (9)There may not be liability in a private capacity on the
  532  part of the board or a member of the board, or an officer or
  533  employee of the board, for or on account of an act performed or
  534  obligation entered into in an official capacity when done in
  535  good faith, without intent to defraud, and in connection with
  536  the administration, management, or conduct of this part or
  537  affairs related to this part.
  538         (10)The board shall hire an executive director to
  539  organize, administer, and manage the operations of the board.
  540  The executive director is exempt from civil service and shall
  541  serve at the pleasure of the board.
  542         (11)The board’s meetings are subject to s. 286.011.
  543         (12)The board may adopt rules necessary to implement and
  544  administer this part in accordance with chapter 120.
  545         Section 6. Section 408.954, Florida Statutes, is created to
  546  read:
  547         408.954 Public advisory committee; composition;
  548  appointments; duties.—
  549         (1)The State Surgeon General of the Department of Health
  550  shall establish a public advisory committee to advise the board
  551  on all matters of policy for the program.
  552         (2)The members of the committee must include all of the
  553  following:
  554         (a)Four physicians, all of whom must be board certified in
  555  their fields, and at least one of whom must be a psychiatrist.
  556  The President of the Senate and the Governor shall each appoint
  557  one member. The Speaker of the House of Representatives shall
  558  appoint two of these members, both of whom shall be primary care
  559  providers.
  560         (b)Two registered nurses, to be appointed by the President
  561  of the Senate.
  562         (c)One licensed allied health practitioner, to be
  563  appointed by the Speaker of the House of Representatives.
  564         (d)One mental health care provider, to be appointed by the
  565  President of the Senate.
  566         (e)One dentist, to be appointed by the Governor.
  567         (f)One representative of private hospitals, to be
  568  appointed by the Governor.
  569         (g)One representative of public hospitals, to be appointed
  570  by the Governor.
  571         (h)One representative of an integrated health care
  572  delivery system, to be appointed by the Governor.
  573         (i)Four consumers of health care. The Governor shall
  574  appoint two of these members, one of whom shall be a member of
  575  the disabled community. The President of the Senate shall
  576  appoint a member who is 65 years of age or older. The Speaker of
  577  the House of Representatives shall appoint the fourth member.
  578         (j)One representative of organized labor, to be appointed
  579  by the Speaker of the House of Representatives.
  580         (k)One member of organized labor, to be appointed by the
  581  President of the Senate.
  582         (l)One representative of essential community providers, to
  583  be appointed by the President of the Senate.
  584         (m)One representative of small business, which is a
  585  business that employs less than 25 people, to be appointed by
  586  the Governor.
  587         (n)One representative of large business, which is a
  588  business that employs more than 250 people, to be appointed by
  589  the Speaker of the House of Representatives.
  590         (o)One pharmacist, to be appointed by the Speaker of the
  591  House of Representatives.
  592         (3)In making appointments pursuant to this section, the
  593  Governor, the President of the Senate, and the Speaker of the
  594  House of Representatives shall make good faith efforts to ensure
  595  that their appointments, as a whole, reflect, to the greatest
  596  extent feasible, the social and geographic diversity of the
  597  state.
  598         (4)Any member appointed by the Governor, the President of
  599  the Senate, or the Speaker of the House of Representatives shall
  600  serve a 4-year term. These members may be reappointed for
  601  succeeding 4-year terms.
  602         (5)A vacancy that occurs must be filled within 30 days
  603  after it occurs and in the same manner in which the vacating
  604  member was initially selected or appointed. The State Surgeon
  605  General of the Department of Health shall notify the appropriate
  606  appointing authority of any expected vacancy on the public
  607  advisory committee.
  608         (6)Members of the committee shall serve without
  609  compensation, but shall be reimbursed for per diem and travel
  610  expenses in accordance with s. 112.061, and except that a member
  611  shall receive $100 for each full day of attending meetings of
  612  the committee. As used in this subsection, the term “full day of
  613  attending a meeting” means presence at, and participation in,
  614  not less than 75 percent of the total meeting time of the
  615  committee during any particular 24-hour period.
  616         (7)The public advisory committee shall meet at least 6
  617  times per year in a place convenient to the public. All meetings
  618  of the committee must be open to the public pursuant to s.
  619  286.011.
  620         (8)The public advisory committee shall elect a chair who
  621  shall serve for 2 years and who may be reelected for an
  622  additional 2 years.
  623         (9)Appointed committee members must have worked in the
  624  field they represent on the committee for a period of at least 2
  625  years before being appointed to the committee.
  626         (10)It is unlawful for the committee members or any of
  627  their assistants, clerks, or deputies to use for personal
  628  benefit any information that is filed with, or obtained by, the
  629  committee and that is not generally available to the public.
  630         Section 7. Section 408.955, Florida Statutes, is created to
  631  read:
  632         408.955 Board powers and duties.—
  633         (1)The board has all powers and duties necessary to
  634  establish and implement the Healthy Florida program under this
  635  part. The program must provide comprehensive universal single
  636  payer health care coverage and a health care cost control system
  637  for the benefit of all residents of this state.
  638         (2)The board shall, to the maximum extent possible,
  639  organize, administer, and market the program and services as a
  640  single-payer program under the name “HF,” “Healthy Florida,” or
  641  any other name as the board determines, regardless of the law or
  642  source where the definition of a benefit is found, including, on
  643  a voluntary basis, retiree health benefits. In implementing this
  644  part, the board shall avoid jeopardizing federal financial
  645  participation in the programs that are incorporated into Healthy
  646  Florida and shall take care to promote public understanding and
  647  awareness of available benefits and programs.
  648         (3)The board shall consider any matter necessary to carry
  649  out the provisions and purposes of this part. The board may have
  650  no executive, administrative, or appointive duties except as
  651  otherwise provided by law.
  652         (4)The board shall employ necessary staff and authorize
  653  reasonable expenditures, as necessary, from the Healthy Florida
  654  Trust Fund to pay program expenses and to administer the
  655  program.
  656         (5)The board may do all of the following:
  657         (a)Negotiate and enter into any necessary contracts,
  658  including, but not limited to, contracts with health care
  659  providers, integrated health care delivery systems, and care
  660  coordinators.
  661         (b) Sue and be sued.
  662         (c)Receive and accept gifts, grants, or donations of
  663  moneys from any agency of the Federal Government, any agency of
  664  the state, and any municipality, county, or other political
  665  subdivision of the state.
  666         (d)Receive and accept gifts, grants, or donations from
  667  individuals, associations, private foundations, and
  668  corporations, in compliance with the conflict of interest
  669  provisions to be adopted by the board by rule.
  670         (e)Share information with relevant state agencies,
  671  consistent with the confidentiality provisions in this part,
  672  which is necessary for the administration of the program.
  673         (6)The board shall determine when individuals may begin
  674  enrolling in the program. There must be an implementation period
  675  that begins on the date that individuals may begin enrolling in
  676  the program and ends on a date determined by the board.
  677         (7)A carrier may not offer benefits or cover any services
  678  for which coverage is offered to individuals under the program,
  679  but may, if otherwise authorized, offer benefits to cover health
  680  care services that are not offered to individuals under the
  681  program. However, this part does not prohibit a carrier from
  682  offering:
  683         (a)Any benefits to or for individuals, including their
  684  families, who are employed or self-employed in the state but who
  685  are not residents of the state; or
  686         (b)Any benefits during the implementation period to
  687  individuals who enrolled or may enroll as members of the
  688  program.
  689         (8)After the end of the implementation period, a person
  690  may not be a board member unless he or she is a member of the
  691  program, except the ex officio member.
  692         (9)No later than July 1, 2020, the board shall develop the
  693  following proposals:
  694         (a)A proposal, consistent with the principles of this
  695  part, for the program to provide long-term care coverage,
  696  including the development of a proposal, consistent with the
  697  principles of this part, for the program’s funding. In
  698  developing the proposal, the board shall consult with an
  699  advisory committee, appointed by the board chair, which includes
  700  representatives of consumers and potential consumers of long
  701  term care, providers of long-term care, members of organized
  702  labor, and other interested parties.
  703         (b)Proposals for:
  704         1. Accommodating employer retiree health benefits for
  705  people who have been members of HF but live as retirees out of
  706  this state; and
  707         2. Accommodating employer retiree health benefits for
  708  people who earned or accrued those benefits while residing in
  709  this state before the implementation of HF and live as retirees
  710  out of this state.
  711         (c)A proposal for HF coverage of health care services
  712  currently covered under the workers’ compensation system,
  713  including whether and how to continue funding for those services
  714  under that system and whether and how to incorporate an element
  715  of experience rating.
  716         (10) The board may contract with nonprofit organizations to
  717  provide:
  718         (a)Assistance to consumers with respect to selection of a
  719  care coordinator or health care organization, enrolling,
  720  obtaining health care services, disenrolling, and other matters
  721  relating to the program; and
  722         (b)Assistance to health care providers providing, seeking,
  723  or considering whether to provide health care services under the
  724  program, with respect to participating in a health care
  725  organization and interacting with a health care organization.
  726         (11) The board shall provide grants from funds in the
  727  Healthy Florida Trust Fund or from funds otherwise appropriated
  728  for this purpose to the Agency for Health Care Administration
  729  for its functions as the state health planning agency under s.
  730  408.034.
  731         (12) The board shall provide funds from the Healthy Florida
  732  Trust Fund or funds otherwise appropriated for this purpose to
  733  the Department of Economic Opportunity for a program for
  734  retraining and assisting with job transition for individuals
  735  employed or previously employed in the fields of health
  736  insurance, for health care service plans, and for other third
  737  party payments for health care or those individuals providing
  738  services to health care providers to deal with third-party
  739  payers for health care and whose jobs may be or have been ended
  740  as a result of the implementation of the program, consistent
  741  with otherwise applicable law.
  742         (13)(a) The board shall provide for the collection and
  743  availability of all of the following data to promote
  744  transparency, assess adherence to patient care standards,
  745  compare patient outcomes, and review utilization of health care
  746  services paid for by the program:
  747         1. Inpatient discharge data, including acuity and risk of
  748  mortality.
  749         2. Emergency department and ambulatory surgery data,
  750  including charge data, length of stay, and patients’ unit of
  751  observation.
  752         3. Hospital annual financial data, including all of the
  753  following:
  754         a. Community benefits by hospital in dollar value.
  755         b. Number of employees and classification by hospital unit.
  756         c. Number of hours worked by hospital unit.
  757         d. Employee wage information by job title and hospital
  758  unit.
  759         e. Number of registered nurses per staffed bed by hospital
  760  unit.
  761         f. Type and value of healthy information technology.
  762         g. Annual spending on health information technology,
  763  including purchases, upgrades, and maintenance.
  764         (b)The board shall make all disclosed data collected under
  765  paragraph (a) publicly available and searchable through a
  766  website and through the Department of Health’s public data sets.
  767         (c)The board shall, directly and through grants to
  768  nonprofit entities, conduct programs using data collected
  769  through the Healthy Florida program to promote and protect
  770  public, environmental, and occupational health, including
  771  cooperation with other data collection and research programs of
  772  the Department of Health, consistent with this part and
  773  otherwise applicable law.
  774         (d) Before full implementation of the program, the board
  775  shall provide for the collection and availability of data on the
  776  number of patients served by hospitals and the dollar value of
  777  the care provided, at cost, for all of the following categories
  778  of Department of Health data items:
  779         1. Patients receiving charity care.
  780         2. Contractual adjustments of county and indigent programs,
  781  including traditional and managed care.
  782         3. Bad debts.
  783         Section 8. Section 408.956, Florida Statutes, is created to
  784  read:
  785         408.956 Law enforcement agencies; prohibited acts relating
  786  to Healthy Florida.—Notwithstanding any other law, a law
  787  enforcement agency may not use Healthy Florida moneys,
  788  facilities, property, equipment, or personnel to investigate,
  789  enforce, or assist in the investigation or enforcement of any
  790  criminal, civil, or administrative violation or warrant for a
  791  violation of any requirement that individuals register with the
  792  Federal Government or any federal agency based on religion,
  793  national origin, ethnicity, or immigration status.
  794         Section 9. Section 408.957, Florida Statutes, is created to
  795  read:
  796         408.957 Eligibility and enrollment.—
  797         (1)Every resident of this state is eligible and entitled
  798  to enroll as a member under the program.
  799         (2)(a) A member may not be required to pay any fee,
  800  payment, or other charge for enrolling in or being a member
  801  under the program.
  802         (b)A member may not be required to pay any premium,
  803  copayment, coinsurance, deductible, or any other form of cost
  804  sharing for all covered benefits.
  805         (3)A college, university, or other institution of higher
  806  education in this state may purchase coverage under the program
  807  for a student, or a student’s dependent, who is not a resident
  808  of the state.
  809         Section 10. Section 408.958, Florida Statutes, is created
  810  to read:
  811         408.958 Benefits.—
  812         (1)Covered health care benefits under the program include
  813  all medical care determined to be medically appropriate by the
  814  member’s health care provider.
  815         (2)Covered health care benefits for members must include,
  816  but are not limited to, all of the following:
  817         (a)Licensed inpatient and licensed outpatient medical and
  818  health facility services.
  819         (b)Inpatient and outpatient professional health care
  820  provider medical services.
  821         (c)Diagnostic imaging, laboratory services, and other
  822  diagnostic and evaluative services.
  823         (d)Medical equipment, appliances, and assistive
  824  technology, including prosthetics, eyeglasses, and hearing aids
  825  and the repair, technical support, and customization needed for
  826  individual use.
  827         (e)Inpatient and outpatient rehabilitative care.
  828         (f) Emergency care services.
  829         (g) Emergency transportation.
  830         (h)Necessary transportation for health care services for
  831  persons with disabilities or who may qualify as low income.
  832         (i)Child and adult immunizations and preventive care.
  833         (j) Health and wellness education.
  834         (k) Hospice care.
  835         (l)Care in a skilled nursing facility.
  836         (m)Home health care, including health care provided in an
  837  assisted living facility.
  838         (n) Mental health services.
  839         (o) Substance abuse treatment.
  840         (p) Dental care.
  841         (q) Vision care.
  842         (r) Prescription drugs.
  843         (s) Pediatric care.
  844         (t)Prenatal and postnatal care.
  845         (u) Podiatric care.
  846         (v) Chiropractic care.
  847         (w) Acupuncture.
  848         (x)Therapies that are shown by the National Center for
  849  Complementary and Integrative Health, National Institutes of
  850  Health, to be safe and effective.
  851         (y) Blood and blood products.
  852         (z) Dialysis.
  853         (aa) Adult day care.
  854         (bb)Rehabilitative services.
  855         (cc)Ancillary health care or social services previously
  856  covered by county primary care programs under part I of chapter
  857  154.
  858         (dd)Ancillary health care or social services for persons
  859  with developmental disabilities which were previously
  860  administered by the Developmental Disabilities Council under
  861  chapter 393.
  862         (ee)Case management and care coordination.
  863         (ff)Language interpretation and translation for health
  864  care services, including sign language and Braille or other
  865  services needed for individuals to overcome communication
  866  barriers.
  867         (gg)Health care and long-term supportive services
  868  currently covered under Medicaid or the Florida Kidcare Act.
  869         (3)Covered benefits for members must also include all
  870  health care services required to be covered under any of the
  871  following provisions, without regard to whether the member would
  872  otherwise be eligible for or covered by the program or source
  873  referred to:
  874         (a)The Florida Kidcare Act.
  875         (b)The state Medicaid program.
  876         (c)The Medicare program pursuant to Title XVIII of the
  877  Social Security Act, 42 U.S.C. ss. 1395 et seq.
  878         (d)Chapter 641.
  879         (e)Parts II, VI, and VII of chapter 627, relating to
  880  health insurers.
  881         (f)Any additional health care services authorized to be
  882  added to the program’s benefits by the program.
  883         (g)All essential health benefits mandated by the
  884  Affordable Care Act as of July 1, 2018.
  885         Section 11. Section 408.96, Florida Statutes, is created to
  886  read:
  887         408.96Delivery of care; health care providers.—
  888         (1)(a)Any health care provider who is licensed to practice
  889  in this state and is otherwise in good standing is qualified to
  890  participate in the program as long as the health care provider’s
  891  services are performed within this state.
  892         (b)The board shall establish and maintain procedures and
  893  standards for recognizing health care providers located out of
  894  this state for purposes of providing coverage under the program
  895  for a member who requires out-of-state health care services
  896  while he or she is temporarily located out of this state.
  897         (2)Any health care provider qualified to participate under
  898  this section may provide covered health care services under the
  899  program as long as the health care provider is legally
  900  authorized to perform the health care service for the individual
  901  and under the circumstances involved.
  902         (3)A member may choose to receive health care services
  903  under the program from any participating provider, consistent
  904  with this part and the willingness or availability of the
  905  provider, subject to provisions of this part relating to
  906  discrimination and the appropriate clinically relevant
  907  circumstances.
  908         (4)A person who chooses to enroll with an integrated
  909  health care delivery system, group medical practice, or
  910  essential community provider that offers comprehensive services
  911  shall retain membership for at least 1 year after an initial 3
  912  month evaluation period, during which time the person may
  913  withdraw for any reason.
  914         (a)The 3-month period must commence on the date when a
  915  member first sees a primary care provider.
  916         (b)A person who wishes to withdraw after the initial 3
  917  month period shall request a withdrawal pursuant to the dispute
  918  resolution procedures established by the board and may request
  919  assistance from the patient advocate, which must be provided for
  920  in the dispute resolution procedures, in resolving the dispute.
  921  The dispute must be resolved in a timely fashion and may not
  922  have an adverse effect on the care a patient receives.
  923         Section 12. Section 408.961, Florida Statutes, is created
  924  to read:
  925         408.961 Care coordination.—
  926         (1)Care coordination must be provided to the member by his
  927  or her care coordinator. A care coordinator may employ or use
  928  the services of other individuals or entities to assist in
  929  providing care coordination for the member, consistent with
  930  regulations of the board and with the statutory requirements and
  931  regulations of the care coordinator’s licensure.
  932         (2)Care coordination includes administrative tracking and
  933  medical recordkeeping services for members, except as otherwise
  934  specified for integrated health care delivery systems.
  935         (3)Care coordination administrative tracking and medical
  936  recordkeeping services for members are not required in order to
  937  use a certified electronic health record, meet any other
  938  requirements of the federal Health Information Technology for
  939  Economic and Clinical Health Act enacted under the federal
  940  American Recovery and Reinvestment Act of 2009, Pub. L. 111-5,
  941  or meet certification requirements of the federal Centers for
  942  Medicare and Medicaid Services’ Electronic Health Records
  943  Incentive Programs, including meaningful use requirements.
  944         (4)The care coordinator shall comply with all state and
  945  federal privacy laws, including, but not limited to, s. 381.004,
  946  s. 395.3025, s. 456.057, and the Health Insurance Portability
  947  and Accountability Act, 42 U.S.C. ss. 1320d et seq., and its
  948  implementing regulations.
  949         (5)Referrals from a care coordinator are not required for
  950  a member to see any eligible provider.
  951         (6)A care coordinator may be an individual or entity that
  952  is approved under the program and that is any of the following:
  953         (a)A health care practitioner that is any of the
  954  following:
  955         1. The member’s primary care provider.
  956         2. The member’s provider of primary gynecological care.
  957         3. At the option of a member who has a chronic condition
  958  that requires specialty care, a specialist health care
  959  practitioner who regularly and continually provides treatment to
  960  the member for that condition.
  961         (b)An entity authorized by law to provide:
  962         1. Hospital services in accordance with chapter 395;
  963         2. Nursing home care services in accordance with chapter
  964  400;
  965         3. Life care services in accordance with chapter 651;
  966         4. Services for the developmentally disabled under chapter
  967  393;
  968         5. Services for the mentally ill under chapter 394;
  969         6. Assisted living services in accordance with chapter 429;
  970  or
  971         7. Hospice services in accordance with chapter 400.
  972         (c) A health care organization.
  973         (d)A Taft-Hartley health and welfare fund, with respect to
  974  its members and their family members. This paragraph does not
  975  preclude a Taft-Hartley health and welfare fund from becoming a
  976  care coordinator under paragraph (e) or a health care
  977  organization under s. 408.963.
  978         (e)Any nonprofit or governmental entity approved under the
  979  program.
  980         (7)(a)A health care provider may be reimbursed for a
  981  health care service only if the member is enrolled with a care
  982  coordinator at the time the service is provided.
  983         (b)Every member is encouraged to enroll with a care
  984  coordinator that agrees to provide care coordination before the
  985  member receives health care services to be paid for under the
  986  program. If a member receives health care services before
  987  choosing a care coordinator, the program shall assist the
  988  member, when appropriate, with choosing a care coordinator.
  989         (c)The member must remain enrolled with his or her care
  990  coordinator until the member enrolls with a different care
  991  coordinator or ceases to be a member. A member has the right to
  992  change his or her care coordinators on terms at least as
  993  permissive as provided in part III or part IV of chapter 409.
  994         (8)A health care organization may establish rules relating
  995  to care coordination for members in the health care organization
  996  which are different from this section but otherwise consistent
  997  with this part and other applicable laws.
  998         (9)This section does not authorize any individual to
  999  engage in any act in violation of the applicable chapter under
 1000  which he or she is licensed to practice.
 1001         (10)An individual or entity may not be a care coordinator
 1002  unless the services included in care coordination are within the
 1003  individual’s professional scope of practice or the entity’s
 1004  legal authority.
 1005         (11)(a) The board shall develop by rule and implement
 1006  procedures and standards for an individual or entity to be
 1007  approved as a care coordinator in the program, including, but
 1008  not limited to, procedures and standards relating to the
 1009  revocation, suspension, or limitation of approval on a
 1010  determination that the individual or entity is incompetent to be
 1011  a care coordinator or has exhibited conduct that is inconsistent
 1012  with program standards and regulations, or that exhibits an
 1013  unwillingness to meet those standards and regulations, or is a
 1014  potential threat to the public health or safety.
 1015         (b)The procedures and standards the board adopts must be
 1016  consistent with established professional practice, licensure
 1017  standards, and regulations for health care practitioners and
 1018  providers.
 1019         (c)In developing and implementing standards of approval of
 1020  care coordinators for individuals receiving chronic mental
 1021  health care services, the board shall consult with the Substance
 1022  Abuse and Mental Health Program Office within the Department of
 1023  Children and Families.
 1024         (12)To maintain approval under the program, a care
 1025  coordinator must do all of the following:
 1026         (a)Renew the approval every 3 years pursuant to rules the
 1027  board adopts.
 1028         (b)Provide to the program any data required by the
 1029  Department of Health which would enable the board to evaluate
 1030  the impact of care coordinators on quality, outcomes, and cost
 1031  of health care.
 1032         Section 13. Section 408.962, Florida Statutes, is created
 1033  to read:
 1034         408.962 Payment for health care services and care
 1035  coordination.—
 1036         (1)The board shall adopt rules regarding contracting for,
 1037  and establishing payment methodologies for, covered health care
 1038  services and care coordination provided to members under the
 1039  program by participating providers, care coordinators, and
 1040  health care organizations. There may be a variety of different
 1041  payment methodologies, including those established on a
 1042  demonstration basis. All payment rates under the program must be
 1043  reasonable and reasonably related to the cost of efficiently
 1044  providing the health care service and ensuring an adequate and
 1045  accessible supply of health care services.
 1046         (2)Health care services provided to members under the
 1047  program, except for care coordination, must be paid for on a
 1048  fee-for-service basis unless and until another payment
 1049  methodology is established by the board.
 1050         (3)Notwithstanding subsection (2), integrated health care
 1051  delivery systems, essential community providers, and group
 1052  medical practices that provide comprehensive, coordinated
 1053  services may choose to be reimbursed on the basis of a capitated
 1054  system operating budget or a noncapitated system operating
 1055  budget that covers all costs of providing health care services.
 1056         (4)The program shall engage in good faith negotiations
 1057  with health care providers’ representatives under s. 408.98,
 1058  including, but not limited to, in relation to rates of payment
 1059  for health care services, rates of payment for prescription and
 1060  nonprescription drugs, and payment methodologies. For
 1061  prescription and nonprescription drugs, the negotiations must be
 1062  conducted through a single entity on behalf of the entire
 1063  program.
 1064         (5)(a) Payments for health care services established under
 1065  this part are considered payment in full.
 1066         (b)A participating provider may not charge any rate in
 1067  excess of the payment established under this part for any health
 1068  care service provided to a member under the program and may not
 1069  solicit or accept payment from any member or third party for any
 1070  health care service, except as provided under a federal program.
 1071         (c)However, this section does not preclude the program
 1072  from acting as a primary or secondary payer in conjunction with
 1073  another third-party payer when permitted by a federal program.
 1074         (6)The board may adopt by rule payment methodologies for
 1075  the payment of capital-related expenses for specifically
 1076  identified capital expenditures incurred by a nonprofit or
 1077  governmental entity that is a health facility. As used in this
 1078  subsection, the term “health facility” has the same meaning as
 1079  provided in s. 154.205(8). Any capital-related expense generated
 1080  by a capital expenditure that requires prior approval must have
 1081  received that approval in order to be paid by the program. That
 1082  approval must be based on achievement of the program standards
 1083  described in s. 408.964.
 1084         (7)Payment methodologies and payment rates must include a
 1085  distinct component for reimbursement of direct and indirect
 1086  graduate medical education expenses.
 1087         (8)The board shall adopt by rule payment methodologies and
 1088  procedures for paying for health care services provided to a
 1089  member while he or she is located out of the state.
 1090         Section 14. Section 408.963, Florida Statutes, is created
 1091  to read:
 1092         408.963 Health care organizations.—
 1093         (1)A member may choose to enroll with and receive program
 1094  care coordination and ancillary health care services from a
 1095  health care organization.
 1096         (2)A health care organization must be a nonprofit or
 1097  governmental entity that is approved by the board and that is
 1098  either of the following:
 1099         (a)The county health department delivery system
 1100  established by the Department of Health under s. 154.01.
 1101         (b)A facility licensed by the Agency for Persons for
 1102  Disabilities which provides developmental disabilities services
 1103  under chapter 393.
 1104         (3)(a) The board shall by rule develop and implement
 1105  procedures and standards for an entity to be approved as a
 1106  health care organization in the program, including, but not
 1107  limited to, procedures and standards relating to the revocation,
 1108  suspension, or limitation of approval on a determination that
 1109  the entity is incompetent to be a health care organization or
 1110  has exhibited a course of conduct that is inconsistent with
 1111  program standards and regulations, or that exhibits an
 1112  unwillingness to meet those standards and regulations, or is a
 1113  potential threat to the public health or safety.
 1114         (b)The procedures and standards adopted by the board must
 1115  be consistent with established professional practice, licensure
 1116  standards, and regulations for health care practitioners and
 1117  providers.
 1118         (c)In developing and implementing standards of approval of
 1119  health care organizations, the board shall consult with the
 1120  Substance Abuse and Mental Health Program Office within the
 1121  Department of Children and Families.
 1122         (4)To maintain approval under the program, a health care
 1123  organization must:
 1124         (a)Renew its approval at a frequency determined by the
 1125  board; and
 1126         (b)Provide data to the Department of Health, as required
 1127  by the board, to enable the board to evaluate the health care
 1128  organization in relation to the quality of health care services
 1129  provided, health care outcomes, and cost.
 1130         (5)The board may adopt rules relating specifically to
 1131  health care organizations for the sole and specific purpose of
 1132  ensuring compliance with this part.
 1133         (6)This part may not be construed to alter in any way the
 1134  professional practice of health care providers or their
 1135  licensure standards.
 1136         (7)Health care organizations may not use health
 1137  information technology or clinical practice guidelines that
 1138  limit the effective exercise of the professional judgment of
 1139  physicians and registered nurses. Physicians and registered
 1140  nurses are free to override health information technology and
 1141  clinical practice guidelines if, in their professional judgment,
 1142  it is in the best interest of the patient and consistent with
 1143  the patient’s wishes.
 1144         Section 15. Section 408.964, Florida Statutes, is created
 1145  to read:
 1146         408.964 Program standards.—The Healthy Florida Board shall
 1147  establish a single standard of safe, therapeutic care for all
 1148  residents of the state by the following means:
 1149         (1)The board shall establish by rule requirements and
 1150  standards for the program and for health care organizations,
 1151  care coordinators, and health care providers consistent with
 1152  this part and consistent with the applicable professional
 1153  practice and licensure standards of health care providers and
 1154  health care professionals, including requirements and standards
 1155  for, as applicable:
 1156         (a)The scope, quality, and accessibility of health care
 1157  services.
 1158         (b)Relations between health care organizations or health
 1159  care providers and members.
 1160         (c)Relations between health care organizations and health
 1161  care providers, including credentialing and participation in the
 1162  health care organization, and terms, methods, and rates of
 1163  payment.
 1164         (2)The board shall establish by rule requirements and
 1165  standards under the program which include, but are not limited
 1166  to, provisions to promote all of the following:
 1167         (a)Simplification of, transparency in, uniformity in, and
 1168  fairness in health care provider credentialing and participation
 1169  in health care organization networks, referrals, payment
 1170  procedures and rates, claims processing, and approval of health
 1171  care services, as applicable.
 1172         (b)In-person primary and preventive care, care
 1173  coordination, efficient and effective health care services,
 1174  quality assurance, and promotion of public, environmental, and
 1175  occupational health.
 1176         (c)Elimination of health care disparities.
 1177         (d)Nondiscrimination with respect to members and health
 1178  care providers on the basis of race, color, ancestry, national
 1179  origin, religion, citizenship, immigration status, primary
 1180  language, mental or physical disability, age, sex, gender,
 1181  sexual orientation, gender identity or expression, medical
 1182  condition, genetic information, marital status, familial status,
 1183  military or veteran status, or source of income; however, health
 1184  care services provided under the program must be appropriate to
 1185  the patient’s clinically relevant circumstances.
 1186         (e)Accessibility of care coordination, health care
 1187  organization services, and health care services, including
 1188  accessibility for people with disabilities and people with
 1189  limited ability to speak or understand English.
 1190         (f)Providing care coordination, health care organization
 1191  services, and health care services in a culturally competent
 1192  manner.
 1193         (3)The board shall establish by rule requirements and
 1194  standards, to the extent authorized by federal law, for
 1195  replacing and merging with the Healthy Florida program health
 1196  care services and ancillary services currently provided by other
 1197  programs, including, but not limited to, Medicare, the
 1198  Affordable Care Act, and federally matched public health
 1199  programs.
 1200         (4)Any participating provider or care coordinator that is
 1201  organized as a for-profit entity shall be required to meet the
 1202  same requirements and standards as entities organized as
 1203  nonprofits, and payments under the program paid to those
 1204  entities may not be calculated to accommodate the generation of
 1205  profit, revenue for dividends, or other return on investment or
 1206  the payment of taxes that would not be paid by a nonprofit
 1207  entity.
 1208         (5)Every participating provider shall furnish information
 1209  as required by the Department of Health and allow the
 1210  examination of that information by the program as may be
 1211  reasonably required for purposes of reviewing accessibility and
 1212  utilization of health care services, quality assurance, cost
 1213  containment, the making of payments, and statistical or other
 1214  studies of the operation of the program or for protection and
 1215  promotion of public, environmental, and occupational health.
 1216         (6)In developing requirements and standards and making
 1217  other policy determinations under this section, the board shall
 1218  consult with representatives of members, health care providers,
 1219  care coordinators, health care organizations, labor
 1220  organizations representing health care employees, and other
 1221  interested parties.
 1222         Section 16. Section 408.97, Florida Statutes, is created to
 1223  read:
 1224         408.97 Federal health programs and funding.—
 1225         (1)The board shall seek all federal waivers and other
 1226  federal approvals and arrangements and submit state plan
 1227  amendments as necessary to operate the Healthy Florida program
 1228  consistent with this part.
 1229         (2)(a) The board shall apply to the United States Secretary
 1230  of Health and Human Services or other appropriate federal
 1231  official for all waivers of requirements, and make other
 1232  arrangements necessary, under Medicare, any federally matched
 1233  public health program, the Affordable Care Act, and any other
 1234  federal program that provides federal funds for payment of
 1235  health care services, to enable all Healthy Florida members to
 1236  receive all benefits under the program, to enable the state to
 1237  implement this part, and to allow the state to receive and
 1238  deposit all federal payments under those programs, including
 1239  funds that may be provided in lieu of premium tax credits, cost
 1240  sharing subsidies, and small business tax credits, in the State
 1241  Treasury to the credit of the Healthy Florida Trust Fund,
 1242  created under s. 408.971, and to use those funds for the program
 1243  and other provisions under this part.
 1244         (b)To the fullest extent possible, the board shall
 1245  negotiate arrangements with the Federal Government to ensure
 1246  that federal payments are paid to Healthy Florida in place of
 1247  federal funding of, or tax benefits for, federally matched
 1248  public health programs or federal health programs.
 1249         (c)The board may require members or applicants to provide
 1250  information necessary for the program to comply with any waiver
 1251  or arrangement under this part. Information provided by members
 1252  to the board for the purposes of this paragraph may not be used
 1253  for any other purpose.
 1254         (d)The board may take any additional actions necessary to
 1255  effectively implement Healthy Florida to the maximum extent
 1256  possible as a single-payer program consistent with this part.
 1257         (3)The board may take actions consistent with this part to
 1258  enable the program to administer Medicare in this state. The
 1259  program must be a provider of supplemental insurance coverage
 1260  under Medicare Part B and must provide premium assistance for
 1261  drug coverage under Medicare Part D for eligible members of the
 1262  program.
 1263         (4)The board may waive or modify the applicability of any
 1264  provision of this section relating to any federally matched
 1265  public health program or Medicare, as necessary, to implement
 1266  any waiver or arrangement under this section or to maximize the
 1267  federal benefits to the program under this section, provided
 1268  that the board, in consultation with the Chief Financial
 1269  Officer, determines that the waiver or modification is in the
 1270  best interest of the state and members affected by the action.
 1271         (5)The board may apply for coverage for, and enroll, any
 1272  eligible member under any federally matched public health
 1273  program or Medicare. Enrollment in a federally matched public
 1274  health program or Medicare may not cause any member to lose any
 1275  health care service provided by the program or diminish any
 1276  right the member would otherwise have.
 1277         (6)(a) Notwithstanding any other law, the board shall
 1278  increase by rule the income eligibility level, increase or
 1279  eliminate the resource test for eligibility, simplify any
 1280  procedural or documentation requirement for enrollment, and
 1281  increase the benefits for any federally matched public health
 1282  program and for any program in order to reduce or eliminate an
 1283  individual’s coinsurance, cost-sharing, or premium obligations
 1284  or increase an individual’s eligibility for any federal
 1285  financial support related to Medicare or the Affordable Care
 1286  Act.
 1287         (b)The board may act under this subsection upon a finding
 1288  approved by the Chief Financial Officer and the board that the
 1289  action:
 1290         1. Will help to increase the number of members who are
 1291  eligible for and enrolled in federally matched public health
 1292  programs; or, for any program, to reduce or eliminate an
 1293  individual’s coinsurance, cost-sharing, or premium obligations;
 1294  or increase an individual’s eligibility for any federal
 1295  financial support related to Medicare or the Affordable Care
 1296  Act;
 1297         2. Will not diminish any individual’s access to any health
 1298  care service or any right the individual would otherwise have;
 1299         3. Is in the interest of the program; and
 1300         4. Has received any necessary federal waivers or approvals
 1301  to ensure federal financial participation, or does not require
 1302  any such waiver or approval.
 1303         (c)Actions under this subsection do not apply to
 1304  eligibility for payment for long-term care.
 1305         (7)To enable the board to apply for coverage for, and
 1306  enroll, any eligible member under any federally matched public
 1307  health program or Medicare, the board may require that every
 1308  member or applicant provide the information necessary to enable
 1309  the board to determine whether the applicant is eligible for a
 1310  federally matched public health program or for Medicare, or any
 1311  program or benefit under Medicare.
 1312         (8)As a condition of continued eligibility for health care
 1313  services under the program, a member who is eligible for
 1314  benefits under Medicare must enroll in Medicare, including Parts
 1315  A, B, and D.
 1316         (9)The program shall provide premium assistance for all
 1317  members enrolling in a Medicare Part D drug coverage plan under
 1318  s. 1860D of Title XVIII of the Social Security Act, 42 U.S.C.
 1319  ss. 1395w-101 et seq., limited to the low-income benchmark
 1320  premium amount established by the federal Centers for Medicare
 1321  and Medicaid Services and any other amount the federal agency
 1322  establishes under its de minimis premium policy, except that
 1323  those payments made on behalf of members enrolled in a Medicare
 1324  advantage plan may exceed the low-income benchmark premium
 1325  amount if determined to be cost effective to the program.
 1326         (10)If the board has reasonable grounds to believe that a
 1327  member may be eligible for an income-related subsidy under s.
 1328  1860D-14 of Title XVIII of the Social Security Act, 42 U.S.C. s.
 1329  1395w-114, the member must provide, and authorize the program to
 1330  obtain, any information or documentation required to establish
 1331  the member’s eligibility for that subsidy; however, the board
 1332  shall attempt to obtain as much of the information and
 1333  documentation as possible from records that are available to it.
 1334         (11)The program shall make a reasonable effort to notify
 1335  members of their obligations under this section. After a
 1336  reasonable effort has been made to contact the member, the
 1337  member must be notified in writing that he or she has 60 days to
 1338  provide the required information. If the required information is
 1339  not provided within the 60-day period, the member’s coverage
 1340  under the program may be terminated. Information members provide
 1341  to the board for the purposes of this section may not be used
 1342  for any other purpose.
 1343         (12)The board shall assume responsibility for all benefits
 1344  and services paid for by the Federal Government with federal
 1345  funds.
 1346         Section 17. Section 408.972, Florida Statutes, is created
 1347  to read:
 1348         408.972 Healthy Florida financing.—
 1349         (1)It is the intent of the Legislature to enact
 1350  legislation that would develop a revenue plan, taking into
 1351  consideration anticipated federal revenue available for the
 1352  Healthy Florida program. In developing the revenue plan, it is
 1353  the intent of the Legislature to consult with appropriate
 1354  officials and stakeholders.
 1355         (2)It is the intent of the Legislature to enact
 1356  legislation that would require all state revenues from the
 1357  program to be deposited in an account within the Healthy Florida
 1358  Trust Fund to be established and known as the Healthy Florida
 1359  Trust Fund Account.
 1360         Section 18. Section 408.98, Florida Statutes, is created to
 1361  read:
 1362         408.98 Collective negotiation by health care providers with
 1363  Healthy Florida; definitions; requirements and prohibited acts.
 1364         (1) DEFINITIONS.—As used in this section, the term:
 1365         (a)“Health care provider” means a health care professional
 1366  licensed under chapter 458, chapter 459, chapter 460, chapter
 1367  461, chapter 463, chapter 464, chapter 465, chapter 466, part I,
 1368  part III, part IV, part V, or part X of chapter 468, chapter
 1369  483, chapter 484, chapter 486, chapter 490, or chapter 491, and
 1370  who is any of the following:
 1371         1. An individual who practices his or her profession as a
 1372  health care provider or as an independent contractor.
 1373         2. An owner, officer, shareholder, or proprietor of a
 1374  health care provider.
 1375         3. An entity that employs or uses health care providers to
 1376  provide health care services, including, but not limited to, a
 1377  facility authorized by law to provide services under chapter
 1378  393, chapter 394, chapter 395, chapter 400, chapter 429, or
 1379  chapter 651.
 1381  A health care provider who practices as an employee of a health
 1382  care provider is not a health care provider for the purposes of
 1383  this section.
 1384         (b)“Health care providers’ representative” means a third
 1385  party that is authorized by a group of health care providers to
 1386  negotiate on the group’s behalf with Healthy Florida concerning
 1387  terms and conditions affecting the health care providers.
 1389         (a)Collective negotiation rights granted by this section
 1390  must meet all of the following requirements:
 1391         1. Health care providers may communicate with other health
 1392  care providers regarding the terms and conditions to be
 1393  negotiated with HF.
 1394         2. Health care providers may communicate with health care
 1395  providers’ representatives.
 1396         3. A health care providers’ representative is the only
 1397  party authorized to negotiate with HF on behalf of the health
 1398  care providers as a group.
 1399         4. A health care provider may be bound by the terms and
 1400  conditions negotiated by the health care providers’
 1401  representatives.
 1402         5. In communicating or negotiating with the health care
 1403  providers’ representative, HF is entitled to offer and provide
 1404  different terms and conditions to individual competing health
 1405  care providers.
 1406         (b) Before engaging in collective negotiations with HF on
 1407  behalf of health care providers, a health care providers’
 1408  representative must file with the board, in the manner
 1409  prescribed by the board, information identifying the
 1410  representative, the representative’s plan of operation, and the
 1411  representative’s procedures to ensure compliance with this
 1412  chapter.
 1413         (c) Each person who acts as the representative of
 1414  negotiating parties under this chapter shall pay a fee to the
 1415  board to act as a representative. The board shall set by rule
 1416  fees in amounts deemed reasonable and necessary to cover the
 1417  costs the board incurs in administering this chapter.
 1419         (a)This section does not authorize competing health care
 1420  providers to act in concert in response to a health care
 1421  providers’ representative’s discussions or negotiations with HF,
 1422  except as authorized by other law.
 1423         (b)A health care providers’ representative may not
 1424  negotiate any agreement that excludes, limits the participation
 1425  or reimbursement of, or otherwise limits the scope of services
 1426  to be provided by any health care provider or group of health
 1427  care providers with respect to the performance of services that
 1428  are within the health care provider’s scope of practice,
 1429  license, registration, or certificate.
 1430         (4) CONSTRUCTION.—
 1431         (a) This section does not affect or limit the right of a
 1432  health care provider or group of health care providers to
 1433  collectively petition a governmental entity for a change in a
 1434  law, rule, or regulation.
 1435         (b) This section does not affect or limit collective action
 1436  or collective bargaining on the part of a health care provider
 1437  with his or her employer or any other lawful collective action
 1438  or collective bargaining.
 1439         Section 19. Section 408.99, Florida Statutes, is created to
 1440  read:
 1441         408.99 Effective date of operation.—
 1442         (1)Notwithstanding any other law, this part may not become
 1443  operative until the date the State Surgeon General of the
 1444  Department of Health notifies the President of the Senate and
 1445  the Speaker of the House of Representatives in writing that he
 1446  or she has determined that the Healthy Florida Trust Fund has
 1447  the revenues to fund the costs of implementing this part.
 1448         (2)The Department of Health shall publish on its website a
 1449  copy of the notice described in subsection (1).
 1450         Section 20. Section 408.991, Florida Statutes, is created
 1451  to read:
 1452         408.991 Severability.—The provisions of this part are
 1453  severable. If any provision of this part or its application is
 1454  held invalid, that invalidity may not affect other provisions or
 1455  applications that can be given effect without the invalid
 1456  provision or application.
 1457         Section 21. This act shall take effect July 1, 2018.