The Florida Senate

408.7042  Purchasing health care for state employees and Medicaid recipients through community health purchasing alliances.--

(1)  Pursuant to legislative approval as provided in s. 110.123, and prior to the purchase of health care for state employees and their dependents through community health purchasing alliances, the Agency for Health Care Administration shall consult with collective bargaining organizations that represent state employees, the Department of Management Services, and the administrator of the state group insurance program. Legislative approval for such purchase of health care is not required, however, if the employee benefit package remains unchanged, or is enhanced, the quality of care is increased, and there is no additional cost to the state or its employees. The purchase of health care for state employees and their dependents through a community health purchasing alliance will be determined by the ability of the alliance to meet or exceed the benefit standard that has been collectively bargained. When purchasing health care for state employees and the dependents of such employees through community health purchasing alliances, the Department of Management Services shall annually offer to all employees the opportunity to select from health plans offered by all accountable health partnerships in the district in which the employee lives. The Department of Management Services shall make available to state employees accountable health partnerships that offer health plans through health maintenance organizations, exclusive provider organizations, preferred provider organizations, and managed-care pure indemnity plans. An accountable health partnership is not required to provide all four types of health plans, but all four types of plans must be made available through multiple accountable health partnerships to state employees, if the Department of Management Services elects to purchase health care for state employees through community health purchasing alliances. The Department of Management Services shall offer a minimum of five health maintenance organizations and five preferred provider organizations, where available to state employees. The agency shall select the accountable health partnerships based upon appropriate objective criteria, including premium price, access to quality care, and member satisfaction.

(2)  When purchasing health care for Medicaid, MedAccess, and Medicaid buy-in recipients through community health purchasing alliances, the agency shall ensure that the claims experiences, rates, and charges for such recipients are not commingled with those of other alliance members. However, the claims experiences, rates, and charges for Medicaid recipients, participants in the MedAccess program, and participants in the Medicaid buy-in program shall not be commingled with those of other alliance members. Prior to providing medical benefits to Medicaid recipients through a community health purchasing alliance, the agency shall seek consultation with the Legislature pursuant to the provisions of s. 216.177(2). The state shall offer to all Medicaid, MedAccess, and Medicaid buy-in recipients the opportunity to select health plans from all accountable health partnerships, including providers that have a Medicaid managed-care contract or MediPass, that has been approved by the United States Health Care Financing Administration, or from physicians and facilities that participate in MediPass, in the district in which the recipient lives. For purposes of the purchase of health care for such recipients, current ¹Medicard providers, including providers participating in the MediPass program and entities with Medicaid managed-care contracts are accountable health partnerships. An entity that provides managed-care for Medicaid recipients pursuant to a contract must obtain a certificate of authority from the agency. Purchase of health care for Medicaid, MedAccess, and Medicaid buy-in recipients by the agency through community health purchasing alliances may not result in a reduction of benefits or any increased costs for such recipients without prior legislative approval.

History.--s. 72, ch. 93-129.

¹Note.--The reference to "Medicard providers" may be intended to refer to Medicaid providers.