The Florida Senate

408.702  Community health purchasing alliance; establishment.--

(1)  There is created a community health purchasing alliance in each of the 11 health service planning districts established under s. 408.032. Each alliance must be operated as a state-chartered, nonprofit private organization organized pursuant to chapter 617. There shall be no liability on the part of, and no cause of action of any nature shall arise against, any member of the board of directors of a community health purchasing alliance, or its employees or agents, for any action taken by the board in the performance of its powers and duties under ss. 408.70-408.706.

(2)  Three or fewer alliances located in contiguous districts that are not primarily urban may merge into a single alliance upon approval of the agency based upon a showing by the alliance board members that the members of each alliance would be better served under a combined alliance. Board members of each alliance shall serve as the board of the combined alliance.

(3)  An alliance is the only entity that is allowed to operate as an alliance in a particular district and must operate for the benefit of its members who are: small employers, as defined in s. 627.6699; the state on behalf of its employees and the dependents of such employees; Medicaid recipients; and associate alliance members. An alliance is the exclusive entity for the oversight and coordination of alliance member purchases. Any health plan offered through an alliance must be offered by an accountable health partnership and an alliance may not directly provide insurance; directly contract, for purposes of providing insurance, with a health care provider or provider network; or bear any risk, or form self-insurance plans among its members. An alliance may form a network with other alliances in order to improve services provided to alliance members. Nothing in ss. 408.70-408.706 limits or authorizes the formation of business health coalitions; however, a person or entity that pools together or assists in purchasing health coverage for small employers, as defined in s. 627.6699, state employees and their dependents, and Medicaid, Medicaid buy-in, and MedAccess recipients may not discriminate in its activities based on the health status or historical or projected claims experience of such employers or recipients.

(4)  Each alliance shall capitalize on the expertise of existing business health coalitions.

(5)  Membership or associate membership in an alliance is voluntary.

(6)  Each community health purchasing alliance has the following powers, duties, and responsibilities:

(a)  Establishing the conditions of alliance membership in accordance with ss. 408.70-408.706.

(b)  Providing to alliance members clear, standardized information on each accountable health partnership and each health plan offered by each accountable health partnership, including information on price, enrollee costs, quality, patient satisfaction, enrollment, and enrollee responsibilities and obligations; and providing accountable health partnership comparison sheets in accordance with agency rule to be used in providing members and their employees with information regarding standard, basic, and specialized coverage that may be obtained through the accountable health partnerships.

(c)  Annually offering to all alliance members all accountable health partnerships and health plans offered by the accountable health partnerships which meet the requirements of ss. 408.70-408.706, and which submit a responsive proposal as to information necessary for accountable health partnership comparison sheets, and providing assistance to alliance members in selecting and obtaining coverage through accountable health partnerships that meet those requirements.

(d)  Requesting proposals for the standard and basic health plans, as defined in s. 627.6699, from all accountable health partnerships in the district; providing, in the format required by the alliance in the request for proposals, the necessary information for accountable health partnership comparison sheets; and offering to its members health plans of accountable health partnerships which meet those requirements.

(e)  Requesting proposals from all accountable health partnerships in the district for specialized benefits approved by the alliance board based on input from alliance members, determining if the proposals submitted by the accountable health partnerships meet the requirements of the request for proposals, and offering them as options through riders to standard plans and basic plans. This paragraph does not limit an accountable health partnership's ability to offer other specialized benefits to alliance members.

(f)  Distributing to health care purchasers, placing special emphasis on the elderly, retail price data on prescription drugs and their generic equivalents, durable medical equipment, and disposable medical supplies which is provided by the agency pursuant to s. 408.063(3) and (4).

(g)  Establishing administrative and accounting procedures for the operation of the alliance and members' services, preparing an annual alliance budget, and preparing annual program and fiscal reports on alliance operations as required by the agency.

(h)  Developing and implementing a marketing plan to publicize the alliance to potential members and associate members and developing and implementing methods for informing the public about the alliance and its services.

(i)  Developing grievance procedures to be used in resolving disputes between members and the alliance and disputes between the accountable health partnerships and the alliance. Any member of, or accountable health partnership that serves, an alliance may appeal to the agency any grievance that is not resolved by the alliance.

(j)  Ensuring that accountable health partnerships have grievance procedures to be used in resolving disputes between members and an accountable health partnership. A member may appeal to the alliance any grievance that is not resolved by the accountable health partnership. An accountable health partnership that is a health maintenance organization must follow the grievance procedures established in ss. 408.7056 and 641.31(5).

(k)  Maintaining all records, reports, and other information required by the agency, ss. 408.70-408.706, or other state and local laws.

(l)  Receiving and accepting grants, loans, advances, or funds from any public or private agency; and receiving and accepting contributions, from any source, of money, property, labor, or any other thing of value.

(m)  Contracting, as authorized by alliance members, with a qualified, independent third party for any service necessary to carry out the powers and duties required by ss. 408.70-408.706.

(n)  Developing a plan to facilitate participation of providers in the district in an accountable health partnership, placing special emphasis on ensuring participation by minority physicians in accountable health partnerships if such physicians are available. The use of the term "minority" in ss. 408.70-408.706 is consistent with the definition of "minority person" provided in s. 288.703(3).

(o)  Ensuring that any health plan reasonably available within the jurisdiction of an alliance, through a preferred provider network, a point of service product, an exclusive provider organization, a health maintenance organization, or a pure indemnity product, is offered to members of the alliance. For the purposes of this paragraph, "pure indemnity product" means a health insurance policy or contract that does not provide different rates of reimbursement for a specified list of physicians and a "point of service product" means a preferred provider network or a health maintenance organization which allows members to select at a higher cost a provider outside of the network or the health maintenance organization.

(p)  Petitioning the agency for a determination as to the cost-effectiveness of collecting premiums on behalf of participating accountable health partnerships. If determined by the agency to be cost-effective, the alliance may establish procedures for collecting premiums from members and distribute them to the participating accountable health partnerships. This may include the remittance of the share of the group premium paid by both an employer and an enrollee. If an alliance assumes premium collection responsibility, it shall also assume liability for uncollected premium. This liability may be collected through a bad debt surcharge on alliance members to finance the cost of uncollected premiums. The alliance shall pay participating accountable health partnerships their contracting premium amounts on a prepaid monthly basis, or as otherwise mutually agreed upon.

(7)  Each alliance shall set reasonable fees for membership in the alliance which will finance all reasonable and necessary costs incurred in administering the alliance.

(8)  Each alliance shall annually report on the operations of the alliance, including program and financial operations, and shall provide for annual internal and independent audits.

(9)  A community health purchasing alliance may not engage in any activities for which an insurance agent's license is required.

(10)  The powers and responsibilities of a community health purchasing alliance with respect to purchasing services from accountable health partnerships do not extend beyond those enumerated in ss. 408.70-408.706.

History.--s. 68, ch. 93-129; s. 1, ch. 97-45; s. 10, ch. 97-270.