Bill Text: FL S0002 | 2015 | 1st Special Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health Insurance Affordability Exchange
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Engrossed - Dead) 2015-06-05 - CS failed to pass; YEAS 41 NAYS 72 [S0002 Detail]
Download: Florida-2015-S0002-Introduced.html
Bill Title: Health Insurance Affordability Exchange
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Engrossed - Dead) 2015-06-05 - CS failed to pass; YEAS 41 NAYS 72 [S0002 Detail]
Download: Florida-2015-S0002-Introduced.html
Florida Senate - 2015 SB 2-A By Senator Bean 4-00009A-15A 20152A__ 1 A bill to be entitled 2 An act relating to a health insurance affordability 3 exchange; creating s. 409.720, F.S.; providing a short 4 title; creating s. 409.721, F.S.; creating the Florida 5 Health Insurance Affordability Exchange Program or 6 FHIX in the Agency for Health Care Administration; 7 providing program authority and principles; creating 8 s. 409.722, F.S.; defining terms; creating s. 409.723, 9 F.S.; providing eligibility and enrollment criteria; 10 providing patient rights and responsibilities; 11 providing premium levels; creating s. 409.724, F.S.; 12 providing for premium credits and choice counseling; 13 establishing an education campaign; providing for 14 customer support and disenrollment; creating s. 15 409.725, F.S.; providing for available products and 16 services; creating s. 409.726, F.S.; providing for 17 program accountability; creating s. 409.727, F.S.; 18 providing an implementation schedule; creating s. 19 409.728, F.S.; providing program operation and 20 management duties; creating s. 409.729, F.S.; 21 providing for the development of a long-term 22 reorganization plan and the formation of the FHIX 23 Workgroup; creating s. 409.730, F.S.; authorizing the 24 agency to seek federal approval; creating s. 409.731, 25 F.S.; providing for program expiration; repealing s. 26 408.70, F.S., relating to legislative findings 27 regarding access to affordable health care; amending 28 s. 408.910, F.S.; revising legislative intent; 29 redefining terms; revising the scope of the Florida 30 Health Choices Program and the pricing of services 31 under the program; providing requirements for 32 operation of the marketplace; providing additional 33 duties for the corporation to perform; requiring an 34 annual report to the Governor and the Legislature; 35 amending s. 409.904, F.S.; limiting eligible persons 36 in the Medically Needy program to those under the age 37 of 21 and pregnant women, and specifying an effective 38 date; providing an expiration date for the program; 39 amending s. 624.91, F.S.; revising eligibility 40 requirements for state-funded assistance; revising the 41 duties and powers of the Florida Healthy Kids 42 Corporation; revising provisions for the appointment 43 of members of the board of the Florida Healthy Kids 44 Corporation; requiring transition plans; repealing s. 45 624.915, F.S., relating to the operating fund of the 46 Florida Healthy Kids Corporation; providing an 47 effective date. 48 49 Be It Enacted by the Legislature of the State of Florida: 50 51 Section 1. The Division of Law Revision and Information is 52 directed to rename part II of chapter 409, Florida Statutes, as 53 “Insurance Affordability Programs” and to incorporate ss. 54 409.720-409.731, Florida Statutes, under this part. 55 Section 2. Section 409.720, Florida Statutes, is created to 56 read: 57 409.720 Short title.—Sections 409.720-409.731 may be cited 58 as the “Florida Health Insurance Affordability Exchange Program” 59 or “FHIX.” 60 Section 3. Section 409.721, Florida Statutes, is created to 61 read: 62 409.721 Program authority.—The Florida Health Insurance 63 Affordability Exchange Program, or FHIX, is created in the 64 agency to assist Floridians in purchasing health benefits 65 coverage and gaining access to health services. The products and 66 services offered by FHIX are based on the following principles: 67 (1) FAIR VALUE.—Financial assistance will be rationally 68 allocated regardless of differences in categorical eligibility. 69 (2) CONSUMER CHOICE.—Participants will be offered 70 meaningful choices in the way they can redeem the value of the 71 available assistance. 72 (3) SIMPLICITY.—Obtaining assistance will be consumer 73 friendly, and customer support will be available when needed. 74 (4) PORTABILITY.—Participants can continue to access the 75 services and products of FHIX despite changes in their 76 circumstances. 77 (5) PROMOTES EMPLOYMENT.—Assistance will be offered in a 78 way that incentivizes employment. 79 (6) CONSUMER EMPOWERMENT.—Assistance will be offered in a 80 manner that maximizes individual control over available 81 resources. 82 (7) RISK ADJUSTMENT.—The amount of assistance will reflect 83 participants’ medical risk. 84 Section 4. Section 409.722, Florida Statutes, is created to 85 read: 86 409.722 Definitions.—As used in ss. 409.720-409.731, the 87 term: 88 (1) “Agency” means the Agency for Health Care 89 Administration. 90 (2) “Applicant” means an individual who applies for 91 determination of eligibility for health benefits coverage under 92 this part. 93 (3) “Corporation” means Florida Health Choices, Inc., as 94 established under s. 408.910. 95 (4) “Enrollee” means an individual who has been determined 96 eligible for and is receiving health benefits coverage under 97 this part. 98 (5) “FHIX marketplace” or “marketplace” means the single, 99 centralized market established under s. 408.910 which 100 facilitates health benefits coverage. 101 (6) “Florida Health Insurance Affordability Exchange 102 Program” or “FHIX” means the program created under ss. 409.720 103 409.731. 104 (7) “Florida Healthy Kids Corporation” means the entity 105 created under s. 624.91. 106 (8) “Florida Kidcare program” or “Kidcare program” means 107 the health benefits coverage administered through ss. 409.810 108 409.821. 109 (9) “Health benefits coverage” means the payment of 110 benefits for covered health care services or the availability, 111 directly or through arrangements with other persons, of covered 112 health care services on a prepaid per capita basis or on a 113 prepaid aggregate fixed-sum basis. 114 (10) “Inactive status” means the enrollment status of a 115 participant previously enrolled in health benefits coverage 116 through the FHIX marketplace who lost coverage through the 117 marketplace for non-payment, but maintains access to his or her 118 balance in a health savings account or health reimbursement 119 account. 120 (11) “Medicaid” means the medical assistance program 121 authorized by Title XIX of the Social Security Act, and 122 regulations thereunder, and part III and part IV of this 123 chapter, as administered in this state by the agency. 124 (l2) “Modified adjusted gross income” means the 125 individual’s or household’s annual adjusted gross income as 126 defined in s. 36B(d)(2) of the Internal Revenue Code of 1986 and 127 which is used to determine eligibility for FHIX. 128 (13) “Patient Protection and Affordable Care Act” or 129 “Affordable Care Act” means Pub. L. No. 111-148, as further 130 amended by the Health Care and Education Reconciliation Act of 131 2010, Pub. L. No. 111-152, and any amendments to, and 132 regulations or guidance under, those acts. 133 (14) “Premium credit” means the monthly amount paid by the 134 agency per enrollee in the Florida Health Insurance 135 Affordability Exchange Program toward health benefits coverage. 136 (15) “Qualified alien” means an alien as defined in 8 137 U.S.C. s. 1641(b) or (c). 138 (16) “Resident” means a United States citizen or qualified 139 alien who is domiciled in this state. 140 Section 5. Section 409.723, Florida Statutes, is created to 141 read: 142 409.723 Participation.— 143 (1) ELIGIBILITY.—In order to participate in FHIX, an 144 individual must be a resident and must meet the following 145 requirements, as applicable: 146 (a) Qualify as a newly eligible enrollee, who must be an 147 individual as described in s. 1902(a)(10)(A)(i)(VIII) of the 148 Social Security Act or s. 2001 of the Affordable Care Act and as 149 may be further defined by federal regulation. 150 (b) Meet and maintain the responsibilities under subsection 151 (4). 152 (c) Qualify as a participant in the Florida Healthy Kids 153 program under s. 624.91, subject to the implementation of Phase 154 Three under s. 409.727. 155 (2) ENROLLMENT.—To enroll in FHIX, an applicant must submit 156 an application to the department for an eligibility 157 determination. 158 (a) Applications may be submitted by mail, fax, online, or 159 any other method permitted by law or regulation. 160 (b) The department is responsible for any eligibility 161 correspondence and status updates to the participant and other 162 agencies. 163 (c) The department shall review a participant’s eligibility 164 every 12 months. 165 (d) An application or renewal is deemed complete when the 166 participant has met all the requirements under subsection (4). 167 (3) PARTICIPANT RIGHTS.—A participant has all of the 168 following rights: 169 (a) Access to the FHIX marketplace to select the scope, 170 amount, and type of health care coverage and other services to 171 purchase. 172 (b) Continuity and portability of coverage to avoid 173 disruption of coverage and other health care services when the 174 participant’s economic circumstances change. 175 (c) Retention of applicable unspent credits in the 176 participant’s health savings or health reimbursement account 177 following a change in the participant’s eligibility status. 178 Credits are valid for an inactive status participant for up to 5 179 years after the participant first enters an inactive status. 180 (d) Ability to select more than one product or plan on the 181 FHIX marketplace. 182 (e) Choice of at least two health benefits products that 183 meet the requirements of the Affordable Care Act. 184 (4) PARTICIPANT RESPONSIBILITIES.—A participant has all of 185 the following responsibilities: 186 (a) Complete an initial application for health benefits 187 coverage and an annual renewal process; 188 (b) Annually provide evidence of participation in one of 189 the following activities at the levels required under paragraph 190 (c): 191 1. Proof of employment. 192 2. On-the-job training or job placement activities. 193 3. Pursuit of educational opportunities. 194 (c) Engage in the activities required under paragraph (b) 195 at the following minimum levels: 196 1. For a parent of a child younger than 18 years of age, a 197 minimum of 20 hours weekly. 198 2. For a childless adult, a minimum of 30 hours weekly. 199 200 A participant who is a disabled adult or a caregiver of a 201 disabled child or adult may submit a request for an exception to 202 these requirements to the corporation and, thereafter, shall 203 annually submit to the department a request to renew the 204 exception to the hourly level requirements. 205 (d) Learn and remain informed about the choices available 206 on the FHIX marketplace and the uses of credits in the 207 individual accounts. 208 (e) Execute a contract with the department to acknowledge 209 that: 210 1. FHIX is not an entitlement and state and federal funding 211 may end at any time; 212 2. Failure to pay required premiums or cost sharing will 213 result in a transition to inactive status; and 214 3. Noncompliance with work or educational requirements will 215 result in a transition to inactive status. 216 (f) Select plans and other products in a timely manner. 217 (g) Comply with program rules and the prohibitions against 218 fraud, as described in s. 414.39. 219 (h) Timely make monthly premium and any other cost-sharing 220 payments. 221 (i) Meet minimum coverage requirements by selecting a high 222 deductible health plan combined with a health savings or health 223 reimbursement account if not selecting a plan offering more 224 extensive coverage. 225 (5) COST SHARING.— 226 (a) Enrollees are assessed monthly premiums based on their 227 modified adjusted gross income. The maximum monthly premium 228 payments are set at the following income levels: 229 1. At or below 22 percent of the federal poverty level: $3. 230 2. Greater than 22 percent, but at or below 50 percent, of 231 the federal poverty level: $8. 232 3. Greater than 50 percent, but at or below 75 percent, of 233 the federal poverty level: $15. 234 4. Greater than 75 percent, but at or below 100 percent, of 235 the federal poverty level: $20. 236 5. Greater than 100 percent of the federal poverty level: 237 $25. 238 (b) Depending on the products and services selected by the 239 enrollee, the enrollee may also incur additional cost-sharing, 240 such as copayments, deductibles, or other out-of-pocket costs. 241 (c) An enrollee may be subject to an inappropriate 242 emergency room visit charge of up to $8 for the first visit and 243 up to $25 for any subsequent visit, based on the enrollee’s 244 benefit plan, to discourage inappropriate use of the emergency 245 room. 246 (d) Cumulative annual cost sharing per enrollee may not 247 exceed 5 percent of an enrollee’s annual modified adjusted gross 248 income. 249 (e) If, after a 30-day grace period, a full premium payment 250 has not been received, the enrollee shall be transitioned from 251 coverage to inactive status and may not reenroll for a minimum 252 of 6 months, unless a hardship exception has been granted. 253 Enrollees may seek a hardship exception under the Medicaid Fair 254 Hearing Process. 255 Section 6. Section 409.724, Florida Statutes, is created to 256 read: 257 409.724 Available assistance.— 258 (1) PREMIUM CREDITS.— 259 (a) Standard amount.—The standard monthly premium credit is 260 equivalent to the applicable risk-adjusted capitation rate paid 261 to Medicaid managed care plans under part IV of this chapter. 262 (b) Supplemental funding.—Subject to federal approval, 263 additional resources may be made available to enrollees and 264 incorporated into FHIX. 265 (c) Savings accounts.—In addition to the benefits provided 266 under this section, the corporation must offer each enrollee 267 access to an individual account that qualifies as a health 268 reimbursement account or a health savings account. Eligible 269 unexpended funds from the monthly premium credit must be 270 deposited into each enrollee’s individual account in a timely 271 manner. Enrollees may also be rewarded for healthy behaviors, 272 adherence to wellness programs, and other activities established 273 by the corporation which demonstrate compliance with prevention 274 or disease management guidelines. Funds deposited into these 275 accounts may be used to pay cost-sharing obligations or to 276 purchase other health-related items to the extent permitted 277 under federal law. 278 (d) Enrollee contributions.—The enrollee may make deposits 279 to his or her account at any time to supplement the premium 280 credit, to purchase additional FHIX products, or to offset other 281 cost-sharing obligations. 282 (e) Third parties.—Third parties, including, but not 283 limited to, an employer or relative, may also make deposits on 284 behalf of the enrollee into the enrollee’s FHIX marketplace 285 account. The enrollee may not withdraw any funds as a refund, 286 except those funds the enrollee has deposited into his or her 287 account. 288 (2) CHOICE COUNSELING.—The agency and the corporation shall 289 work together to develop a choice counseling program for FHIX. 290 The choice counseling program must ensure that participants have 291 information about the FHIX marketplace program, products, and 292 services and that participants know where and whom to call for 293 questions or to make their plan selections. The choice 294 counseling program must provide culturally sensitive materials 295 and must take into consideration the demographics of the 296 projected population. 297 (3) EDUCATION CAMPAIGN.—The agency, the corporation, and 298 the Florida Healthy Kids Corporation must coordinate an ongoing 299 enrollee education campaign beginning in Phase One, as provided 300 in s. 409.27, informing participants, at a minimum: 301 (a) How the transition process to the FHIX marketplace will 302 occur and the timeline for the enrollee’s specific transition. 303 (b) What plans are available and how to research 304 information about available plans. 305 (c) Information about other available insurance 306 affordability programs for the individual and his or her family. 307 (d) Information about health benefits coverage, provider 308 networks, and cost sharing for available plans in each region. 309 (e) Information on how to complete the required annual 310 renewal process, including renewal dates and deadlines. 311 (f) Information on how to update eligibility if the 312 participant’s data have changed since his or her last renewal or 313 application date. 314 (4) CUSTOMER SUPPORT.—Beginning in Phase Two, the Florida 315 Healthy Kids Corporation shall provide customer support for 316 FHIX, shall address general program information, financial 317 information, and customer service issues, and shall provide 318 status updates on bill payments. Customer support must also 319 provide a toll-free number and maintain a website that is 320 available in multiple languages and that meets the needs of the 321 enrollee population. 322 (5) INACTIVE PARTICIPANTS.—The corporation must inform the 323 inactive participant about other insurance affordability 324 programs and electronically refer the participant to the federal 325 exchange or other insurance affordability programs, as 326 appropriate. 327 Section 7. Section 409.725, Florida Statutes, is created to 328 read: 329 409.725 Available products and services.—The FHIX 330 marketplace shall offer the following products and services: 331 (1) Authorized products and services pursuant to s. 332 408.910. 333 (2) Medicaid managed care plans under part IV of this 334 chapter. 335 (3) Authorized products under the Florida Healthy Kids 336 Corporation pursuant to s. 624.91. 337 (4) Employer-sponsored plans. 338 Section 8. Section 409.726, Florida Statutes, is created to 339 read: 340 409.726 Program accountability.— 341 (1) All managed care plans that participate in FHIX must 342 collect and maintain encounter level data in accordance with the 343 encounter data requirements under s. 409.967(2)(d) and are 344 subject to the accompanying penalties under s. 409.967(2)(h)2. 345 The agency is responsible for the collection and maintenance of 346 the encounter level data. 347 (2) The corporation, in consultation with the agency, shall 348 establish access and network standards for contracts on the FHIX 349 marketplace and shall ensure that contracted plans have 350 sufficient providers to meet enrollee needs. The corporation, in 351 consultation with the agency, shall develop quality of coverage 352 and provider standards specific to the adult population. 353 (3) The department shall develop accountability measures 354 and performance standards to be applied to applications and 355 renewal applications for FHIX which are submitted online, by 356 mail, by fax, or through referrals from a third party. The 357 minimum performance standards are: 358 (a) Application processing speed.—Ninety percent of all 359 applications, from all sources, must be processed within 45 360 days. 361 (b) Applications processing speed from online sources. 362 Ninety-five percent of all applications received from online 363 sources must be processed within 45 days. 364 (c) Renewal application processing speed.—Ninety percent of 365 all renewals, from all sources, must be processed within 45 366 days. 367 (d) Renewal application processing speed from online 368 sources.—Ninety-five percent of all applications received from 369 online sources must be processed within 45 days. 370 (4) The agency, the department, and the Florida Healthy 371 Kids Corporation must meet the following standards for their 372 respective roles in the program: 373 (a) Eighty-five percent of calls must be answered in 20 374 seconds or less. 375 (b) One hundred percent of all contacts, which include, but 376 are not limited to, telephone calls, faxed documents and 377 requests, and e-mails, must be handled within 2 business days. 378 (c) Any self-service tools available to participants, such 379 as interactive voice response systems, must be operational 7 380 days a week, 24 hours a day, at least 98 percent of each month. 381 (5) The agency, the department, and the Florida Healthy 382 Kids Corporation must conduct an annual satisfaction survey to 383 address all measures that require participant input specific to 384 the FHIX marketplace program. The parties may elect to 385 incorporate these elements into the annual report required under 386 subsection (7). 387 (6) The agency and the corporation shall post online 388 monthly enrollment reports for FHIX. 389 (7) An annual report is due no later than July 1 to the 390 Governor, the President of the Senate, and the Speaker of the 391 House of Representatives. The annual report must be coordinated 392 by the agency and the corporation and must include, but is not 393 limited to: 394 (a) Enrollment and application trends and issues. 395 (b) Utilization and cost data. 396 (c) Customer satisfaction. 397 (d) Funding sources in health savings accounts or health 398 reimbursement accounts. 399 (e) Enrollee use of funds in health savings accounts or 400 health reimbursement accounts. 401 (f) Types of products and plans purchased. 402 (g) Movement of enrollees across different insurance 403 affordability programs. 404 (h) Recommendations for program improvement. 405 Section 9. Section 409.727, Florida Statutes, is created to 406 read: 407 409.727 Implementation schedule.—The agency, the 408 corporation, the department, and the Florida Healthy Kids 409 Corporation shall begin implementation of FHIX by the effective 410 date of this act, with statewide implementation in all regions, 411 as described in s. 409.966(2), by January 1, 2016. 412 (1) READINESS REVIEW.—Before implementation of any phase 413 under this section, the agency shall conduct a readiness review 414 in consultation with the FHIX Workgroup described in s. 409.729. 415 The agency must determine, at a minimum, the following readiness 416 milestones: 417 (a) Functional readiness of the service delivery platform 418 for the phase. 419 (b) Plan availability and presence of plan choice. 420 (c) Provider network capacity and adequacy of the available 421 plans in the region. 422 (d) Availability of customer support. 423 (e) Other factors critical to the success of FHIX. 424 (2) PHASE ONE.— 425 (a) Phase One begins on July 1, 2015. The agency, the 426 corporation, the department, and the Florida Healthy Kids 427 Corporation shall coordinate activities to ensure that 428 enrollment begins by July 1, 2015. 429 (b) To be eligible during this phase, a participant must 430 meet the requirements under s. 409.723(1)(a). 431 (c) An enrollee is entitled to receive health benefits 432 coverage in the same manner as provided under and through the 433 selected managed care plans in the Medicaid managed care program 434 in part IV of this chapter. 435 (d) An enrollee shall have a choice of at least two managed 436 care plans in each region. 437 (e) Choice counseling and customer service must be provided 438 in accordance with s. 409.724(2). 439 (3) PHASE TWO.— 440 (a) Beginning no later than January 1, 2016, and contingent 441 upon federal approval, participants may enroll or transition to 442 health benefits coverage under the FHIX marketplace. 443 (b) To be eligible during this phase, a participant must 444 meet the requirements under s. 409.723(1)(a) and (b). 445 (c) An enrollee may select any benefit, service, or product 446 available. 447 (d) The corporation shall notify an enrollee of his or her 448 premium credit amount and how to access the FHIX marketplace 449 selection process. 450 (e) A Phase One enrollee must be transitioned to the FHIX 451 marketplace by April 1, 2016. An enrollee who does not select a 452 plan or service on the FHIX marketplace by that deadline shall 453 be moved to inactive status. 454 (f) An enrollee shall have a choice of at least two managed 455 care plans in each region which meet or exceed the Affordable 456 Care Act’s requirements and which qualify for a premium credit 457 on the FHIX marketplace. 458 (g) Choice counseling and customer service must be provided 459 in accordance with s. 409.724(2) and (4). 460 (4) PHASE THREE.— 461 (a) No later than July 1, 2016, the corporation and the 462 Florida Healthy Kids Corporation must begin the transition of 463 enrollees under s. 624.91 to the FHIX marketplace. 464 (b) Eligibility during this phase is based on meeting the 465 requirements of Phase Two and s. 409.723(1)(c). 466 (c) An enrollee may select any benefit, service, or product 467 available under s. 409.725. 468 (d) A Florida Healthy Kids enrollee who selects a FHIX 469 marketplace plan must be provided a premium credit equivalent to 470 the average capitation rate paid in his or her county of 471 residence under Florida Healthy Kids as of June 30, 2016. The 472 enrollee is responsible for any difference in costs and may use 473 any remaining funds for supplemental benefits on the FHIX 474 marketplace. 475 (e) The corporation shall notify an enrollee of his or her 476 premium credit amount and how to access the FHIX marketplace 477 selection process. 478 (f) Choice counseling and customer service must be provided 479 in accordance with s. 409.724(2) and (4). 480 (g) Enrollees under s. 624.91 must transition to the FHIX 481 marketplace by September 30, 2016. 482 Section 10. Section 409.728, Florida Statutes, is created 483 to read: 484 409.728 Program operation and management.—In order to 485 implement ss. 409.720-409.731: 486 (1) The Agency for Health Care Administration shall do all 487 of the following: 488 (a) Contract with the corporation for the development, 489 implementation, and administration of the Florida Health 490 Insurance Affordability Exchange Program and for the release of 491 any federal, state, or other funds appropriated to the 492 corporation. 493 (b) Administer Phase One of FHIX. 494 (c) Provide administrative support to the FHIX Workgroup 495 under s. 409.729. 496 (d) Transition the FHIX enrollees to the FHIX marketplace 497 beginning January 1, 2016, in accordance with the transition 498 workplan. Stakeholders that serve low-income individuals and 499 families must be consulted during the implementation and 500 transition process through a public input process. All regions 501 must complete the transition no later than April 1, 2016. 502 (e) Timely transmit enrollee information to the 503 corporation. 504 (f) Beginning with Phase Two, determine annually the risk 505 adjusted rate to be paid per month based on historical 506 utilization and spending data for the medical and behavioral 507 health of this population, projected forward, and adjusted to 508 reflect the eligibility category, medical and dental trends, 509 geographic areas, and the clinical risk profile of the 510 enrollees. 511 (g) Transfer to the corporation such funds as approved in 512 the General Appropriations Act for the premium credits. 513 (h) Encourage Medicaid managed care plans to apply as 514 vendors to the marketplace to facilitate continuity of care and 515 family care coordination. 516 (2) The Department of Children and Families shall, in 517 coordination with the corporation, the agency, and the Florida 518 Healthy Kids Corporation, determine eligibility of applications 519 and application renewals for FHIX in accordance with s. 409.902 520 and shall transmit eligibility determination information on a 521 timely basis to the agency and corporation. 522 (3) The Florida Healthy Kids Corporation shall do all of 523 the following: 524 (a) Retain its duties and responsibilities under s. 624.91 525 for Phase One and Phase Two of the program. 526 (b) Provide customer service for the FHIX marketplace, in 527 coordination with the agency and the corporation. 528 (c) Transfer funds and provide financial support to the 529 FHIX marketplace, including the collection of monthly cost 530 sharing. 531 (d) Conduct financial reporting related to such activities, 532 in coordination with the corporation and the agency. 533 (e) Coordinate activities for the program with the agency, 534 the department, and the corporation. 535 (4) Florida Health Choices, Inc., shall do all of the 536 following: 537 (a) Begin the development of FHIX during Phase One. 538 (b) Implement and administer Phase Two and Phase Three of 539 the FHIX marketplace and the ongoing operations of the program. 540 (c) Offer health benefits coverage packages on the FHIX 541 marketplace, including plans compliant with the Affordable Care 542 Act. 543 (d) Offer FHIX enrollees a choice of at least two plans per 544 county at each benefit level which meet the requirements under 545 the Affordable Care Act. 546 (e) Provide an opportunity for participation in Medicaid 547 managed care plans if those plans meet the requirements of the 548 FHIX marketplace. 549 (f) Offer enhanced or customized benefits to FHIX 550 marketplace enrollees. 551 (g) Provide sufficient staff and resources to meet the 552 program needs of enrollees. 553 (h) Provide an opportunity for plans contracted with or 554 previously contracted with the Florida Healthy Kids Corporation 555 under s. 624.91 to participate with FHIX if those plans meet the 556 requirements of the program. 557 (i) Encourage insurance agents licensed under chapter 626 558 to identify and assist enrollees. This act does not prohibit 559 these agents from receiving usual and customary commissions from 560 insurers and health maintenance organizations that offer plans 561 in the FHIX marketplace. 562 Section 11. Section 409.729, Florida Statutes, is created 563 to read: 564 409.729 Long-term reorganization.—The FHIX Workgroup is 565 created to facilitate the implementation of FHIX and to plan for 566 a multiyear reorganization of the state’s insurance 567 affordability programs. The FHIX Workgroup consists of two 568 representatives each from the agency, the department, the 569 Florida Healthy Kids Corporation, and the corporation. An 570 additional representative of the agency serves as chair. The 571 FHIX Workgroup must hold its organizational meeting no later 572 than 30 days after the effective date of this act and must meet 573 at least bimonthly. The role of the FHIX Workgroup is to make 574 recommendations to the agency. The responsibilities of the 575 workgroup include, but are not limited to: 576 (1) Recommend a Phase Two implementation plan no later than 577 October 1, 2015. 578 (2) Review network and access standards for plans and 579 products. 580 (3) Assess readiness and recommend actions needed to 581 reorganize the state’s insurance affordability programs for each 582 phase or region. If a phase or region receives a nonreadiness 583 recommendation, the agency must notify the Legislature of that 584 recommendation, the reasons for such a recommendation, and 585 proposed plans for achieving readiness. 586 (4) Recommend any proposed change to the Title XIX-funded 587 or Title XXI-funded programs based on the continued availability 588 and reauthorization of the Title XXI program and its federal 589 funding. 590 (5) Identify duplication of services among the corporation, 591 the agency, and the Florida Healthy Kids Corporation currently 592 and under FHIX’s proposed Phase Three program. 593 (6) Evaluate any fiscal impacts based on the proposed 594 transition plan under Phase Three. 595 (7) Compile a schedule of impacted contracts, leases, and 596 other assets. 597 (8) Determine staff requirements for Phase Three. 598 (9) Develop and present a final transition plan that 599 incorporates all elements under this section no later than 600 December 1, 2015, in a report to the Governor, the President of 601 the Senate, and the Speaker of the House of Representatives. 602 Section 12. Section 409.730, Florida Statutes, is created 603 to read: 604 409.730 Federal participation.—The agency may seek federal 605 approval to implement FHIX. 606 Section 13. Section 409.731, Florida Statutes, is created 607 to read: 608 409.731 Program expiration.—The Florida Health Insurance 609 Affordability Exchange Program expires at the end of Phase One 610 if the state does not receive federal approval for Phase Two or 611 at the end of the state fiscal year in which any of these 612 conditions occurs: 613 (1) The federal match contribution falls below 90 percent. 614 (2) The federal match contribution falls below the 615 increased Federal Medical Assistance Percentage for medical 616 assistance for newly eligible mandatory individuals as specified 617 in the Affordable Care Act. 618 (3) The federal match for the FHIX program and the Medicaid 619 program are blended under federal law or regulation in such a 620 manner that causes the overall federal contribution to diminish 621 when compared to separate, nonblended federal contributions. 622 Section 14. Section 408.70, Florida Statutes, is repealed. 623 Section 15. Section 408.910, Florida Statutes, is amended 624 to read: 625 408.910 Florida Health Choices Program.— 626 (1) LEGISLATIVE INTENT.—The Legislature finds that a 627 significant number of the residents of this state do not have 628 adequate access to affordable, quality health care. The 629 Legislature further finds that increasing access to affordable, 630 quality health care can be best accomplished by establishing a 631 competitive market for purchasing health insurance and health 632 services. It is therefore the intent of the Legislature to 633 create and expand the Florida Health Choices Program to: 634 (a) Expand opportunities for Floridians to purchase 635 affordable health insurance and health services. 636 (b) Preserve the benefits of employment-sponsored insurance 637 while easing the administrative burden for employers who offer 638 these benefits. 639 (c) Enable individual choice in both the manner and amount 640 of health care purchased. 641 (d) Provide for the purchase of individual, portable health 642 care coverage. 643 (e) Disseminate information to consumers on the price and 644 quality of health services. 645 (f) Sponsor a competitive market that stimulates product 646 innovation, quality improvement, and efficiency in the 647 production and delivery of health services. 648 (2) DEFINITIONS.—As used in this section, the term: 649 (a) “Corporation” means the Florida Health Choices, Inc., 650 established under this section. 651 (b) “Corporation’s marketplace” means the single, 652 centralized market established by the program that facilitates 653 the purchase of products made available in the marketplace. 654 (c) “Florida Health Insurance Affordability Exchange 655 Program” or “FHIX” is the program created under ss. 409.720 656 409.731 for low-income, uninsured residents of this state. 657 (d)(c)“Health insurance agent” means an agent licensed 658 under part IV of chapter 626. 659 (e)(d)“Insurer” means an entity licensed under chapter 624 660 which offers an individual health insurance policy or a group 661 health insurance policy, a preferred provider organization as 662 defined in s. 627.6471, an exclusive provider organization as 663 defined in s. 627.6472,ora health maintenance organization 664 licensed under part I of chapter 641,ora prepaid limited 665 health service organization or discount medical plan 666 organization licensed under chapter 636, or a managed care plan 667 contracted with the Agency for Health Care Administration under 668 the managed medical assistance program under part IV of chapter 669 409. 670 (f) “Patient Protection and Affordable Care Act” or 671 “Affordable Care Act” means Pub. L. No. 111-148, as further 672 amended by the Health Care and Education Reconciliation Act of 673 2010, Pub. L. No. 111-152, and any amendments to or regulations 674 or guidance under those acts. 675 (g)(e)“Program” means the Florida Health Choices Program 676 established by this section. 677 (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Health 678 Choices Program is created as a single, centralized market for 679 the sale and purchase of various products that enable 680 individuals to pay for health care. These products include, but 681 are not limited to, health insurance plans, health maintenance 682 organization plans, prepaid services, service contracts, and 683 flexible spending accounts. The components of the program 684 include: 685 (a) Enrollment of employers. 686 (b) Administrative services for participating employers, 687 including: 688 1. Assistance in seeking federal approval of cafeteria 689 plans. 690 2. Collection of premiums and other payments. 691 3. Management of individual benefit accounts. 692 4. Distribution of premiums to insurers and payments to 693 other eligible vendors. 694 5. Assistance for participants in complying with reporting 695 requirements. 696 (c) Services to individual participants, including: 697 1. Information about available products and participating 698 vendors. 699 2. Assistance with assessing the benefits and limits of 700 each product, including information necessary to distinguish 701 between policies offering creditable coverage and other products 702 available through the program. 703 3. Account information to assist individual participants 704 with managing available resources. 705 4. Services that promote healthy behaviors. 706 5. Health benefits coverage information about health 707 insurance plans compliant with the Affordable Care Act. 708 6. Consumer assistance and enrollment services for the 709 Florida Health Insurance Affordability Exchange Program, or 710 FHIX. 711 (d) Recruitment of vendors, including insurers, health 712 maintenance organizations, prepaid clinic service providers, 713 provider service networks, and other providers. 714 (e) Certification of vendors to ensure capability, 715 reliability, and validity of offerings. 716 (f) Collection of data, monitoring, assessment, and 717 reporting of vendor performance. 718 (g) Information services for individuals and employers. 719 (h) Program evaluation. 720 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the 721 program is voluntary and shall be available to employers, 722 individuals, vendors, and health insurance agents as specified 723 in this subsection. 724 (a) Employers eligible to enroll in the program include 725 those employers that meet criteria established by the 726 corporation and elect to make their employees eligible through 727 the program. 728 (b) Individuals eligible to participate in the program 729 include: 730 1. Individual employees of enrolled employers. 731 2. Other individuals that meet criteria established by the 732 corporation. 733 (c) Employers who choose to participate in the program may 734 enroll by complying with the procedures established by the 735 corporation. The procedures must include, but are not limited 736 to: 737 1. Submission of required information. 738 2. Compliance with federal tax requirements for the 739 establishment of a cafeteria plan, pursuant to s. 125 of the 740 Internal Revenue Code, including designation of the employer’s 741 plan as a premium payment plan, a salary reduction plan that has 742 flexible spending arrangements, or a salary reduction plan that 743 has a premium payment and flexible spending arrangements. 744 3. Determination of the employer’s contribution, if any, 745 per employee, provided that such contribution is equal for each 746 eligible employee. 747 4. Establishment of payroll deduction procedures, subject 748 to the agreement of each individual employee who voluntarily 749 participates in the program. 750 5. Designation of the corporation as the third-party 751 administrator for the employer’s health benefit plan. 752 6. Identification of eligible employees. 753 7. Arrangement for periodic payments. 754 8. Employer notification to employees of the intent to 755 transfer from an existing employee health plan to the program at 756 least 90 days before the transition. 757 (d) All eligible vendors who choose to participate and the 758 products and services that the vendors are permitted to sell are 759 as follows: 760 1. Insurers licensed under chapter 624 may sell health 761 insurance policies, limited benefit policies, other risk-bearing 762 coverage, and other products or services. 763 2. Health maintenance organizations licensed under part I 764 of chapter 641 may sell health maintenance contracts, limited 765 benefit policies, other risk-bearing products, and other 766 products or services. 767 3. Prepaid limited health service organizations may sell 768 products and services as authorized under part I of chapter 636, 769 and discount medical plan organizations may sell products and 770 services as authorized under part II of chapter 636. 771 4. Prepaid health clinic service providers licensed under 772 part II of chapter 641 may sell prepaid service contracts and 773 other arrangements for a specified amount and type of health 774 services or treatments. 775 5. Health care providers, including hospitals and other 776 licensed health facilities, health care clinics, licensed health 777 professionals, pharmacies, and other licensed health care 778 providers, may sell service contracts and arrangements for a 779 specified amount and type of health services or treatments. 780 6. Provider organizations, including service networks, 781 group practices, professional associations, and other 782 incorporated organizations of providers, may sell service 783 contracts and arrangements for a specified amount and type of 784 health services or treatments. 785 7. Corporate entities providing specific health services in 786 accordance with applicable state law may sell service contracts 787 and arrangements for a specified amount and type of health 788 services or treatments. 789 790 A vendor described in subparagraphs 3.-7. may not sell products 791 that provide risk-bearing coverage unless that vendor is 792 authorized under a certificate of authority issued by the Office 793 of Insurance Regulation and is authorized to provide coverage in 794 the relevant geographic area. Otherwise eligible vendors may be 795 excluded from participating in the program for deceptive or 796 predatory practices, financial insolvency, or failure to comply 797 with the terms of the participation agreement or other standards 798 set by the corporation. 799 (e) Eligible individuals may participate in the program 800 voluntarily. Individuals who join the program may participate by 801 complying with the procedures established by the corporation. 802 These procedures must include, but are not limited to: 803 1. Submission of required information. 804 2. Authorization for payroll deduction, if applicable. 805 3. Compliance with federal tax requirements. 806 4. Arrangements for payment. 807 5. Selection of products and services. 808 (f) Vendors who choose to participate in the program may 809 enroll by complying with the procedures established by the 810 corporation. These procedures may include, but are not limited 811 to: 812 1. Submission of required information, including a complete 813 description of the coverage, services, provider network, payment 814 restrictions, and other requirements of each product offered 815 through the program. 816 2. Execution of an agreement to comply with requirements 817 established by the corporation. 818 3. Execution of an agreement that prohibits refusal to sell 819 any offered product or service to a participant who elects to 820 buy it. 821 4. Establishment of product prices based on applicable 822 criteria. 823 5. Arrangements for receiving payment for enrolled 824 participants. 825 6. Participation in ongoing reporting processes established 826 by the corporation. 827 7. Compliance with grievance procedures established by the 828 corporation. 829 (g) Health insurance agents licensed under part IV of 830 chapter 626 are eligible to voluntarily participate as buyers’ 831 representatives. A buyer’s representative acts on behalf of an 832 individual purchasing health insurance and health services 833 through the program by providing information about products and 834 services available through the program and assisting the 835 individual with both the decision and the procedure of selecting 836 specific products. Serving as a buyer’s representative does not 837 constitute a conflict of interest with continuing 838 responsibilities as a health insurance agent if the relationship 839 between each agent and any participating vendor is disclosed 840 before advising an individual participant about the products and 841 services available through the program. In order to participate, 842 a health insurance agent shall comply with the procedures 843 established by the corporation, including: 844 1. Completion of training requirements. 845 2. Execution of a participation agreement specifying the 846 terms and conditions of participation. 847 3. Disclosure of any appointments to solicit insurance or 848 procure applications for vendors participating in the program. 849 4. Arrangements to receive payment from the corporation for 850 services as a buyer’s representative. 851 (5) PRODUCTS.— 852 (a) The products that may be made available for purchase 853 through the program include, but are not limited to: 854 1. Health insurance policies. 855 2. Health maintenance contracts. 856 3. Limited benefit plans. 857 4. Prepaid clinic services. 858 5. Service contracts. 859 6. Arrangements for purchase of specific amounts and types 860 of health services and treatments. 861 7. Flexible spending accounts. 862 (b) Health insurance policies, health maintenance 863 contracts, limited benefit plans, prepaid service contracts, and 864 other contracts for services must ensure the availability of 865 covered services. 866 (c) Products may be offered for multiyear periods provided 867 the price of the product is specified for the entire period or 868 for each separately priced segment of the policy or contract. 869 (d) The corporation shall provide a disclosure form for 870 consumers to acknowledge their understanding of the nature of, 871 and any limitations to, the benefits provided by the products 872 and services being purchased by the consumer. 873 (e) The corporation must determine that making the plan 874 available through the program is in the interest of eligible 875 individuals and eligible employers in the state. 876 (6) PRICING.—Prices for the products and services sold 877 through the program must be transparent to participants and 878 established by the vendors. The corporation mayshallannually 879 assess a surcharge for each premium or price set by a 880 participating vendor. AnyThesurcharge may not be more than 2.5 881 percent of the price and shall be used to generate funding for 882 administrative services provided by the corporation and payments 883 to buyers’ representatives; however, a surcharge may not be 884 assessed for products and services sold in the FHIX marketplace. 885 (7) THE MARKETPLACE PROCESS.—The program shall provide a 886 single, centralized market for purchase of health insurance, 887 health maintenance contracts, and other health products and 888 services. Purchases may be made by participating individuals 889 over the Internet or through the services of a participating 890 health insurance agent. Information about each product and 891 service available through the program shall be made available 892 through printed material and an interactive Internet website. 893 (a) Marketplace purchasing.—A participant needing personal 894 assistance to select products and services shall be referred to 895 a participating agent in his or her area. 896 1.(a)Participation in the program may begin at any time 897 during a year after the employer completes enrollment and meets 898 the requirements specified by the corporation pursuant to 899 paragraph (4)(c). 900 2.(b)Initial selection of products and services must be 901 made by an individual participant within the applicable open 902 enrollment period. 903 3.(c)Initial enrollment periods for each product selected 904 by an individual participant must last at least 12 months, 905 unless the individual participant specifically agrees to a 906 different enrollment period. 907 4.(d)If an individual has selected one or more products 908 and enrolled in those products for at least 12 months or any 909 other period specifically agreed to by the individual 910 participant, changes in selected products and services may only 911 be made during the annual enrollment period established by the 912 corporation. 913 5.(e)The limits established in subparagraphs 2., 3., and 914 4.paragraphs(b)-(d)apply to any risk-bearing product that 915 promises future payment or coverage for a variable amount of 916 benefits or services. The limits do not apply to initiation of 917 flexible spending plans if those plans are not associated with 918 specific high-deductible insurance policies or the use of 919 spending accounts for any products offering individual 920 participants specific amounts and types of health services and 921 treatments at a contracted price. 922 (b) FHIX marketplace purchasing.— 923 1. Participation in the FHIX marketplace may begin at any 924 time during the year. 925 2. Initial enrollment periods for certain products selected 926 by an individual enrollee which are noncompliant with the 927 Affordable Care Act may be required to last at least 12 months, 928 unless the individual participant specifically agrees to a 929 different enrollment period. 930 (8) CONSUMER INFORMATION.—The corporation shall: 931 (a) Establish a secure website to facilitate the purchase 932 of products and services by participating individuals. The 933 website must provide information about each product or service 934 available through the program. 935 (b) Inform individuals about other public health care 936 programs. 937 (9) RISK POOLING.—The program may use methods for pooling 938 the risk of individual participants and preventing selection 939 bias. These methods may include, but are not limited to, a 940 postenrollment risk adjustment of the premium payments to the 941 vendors. The corporation may establish a methodology for 942 assessing the risk of enrolled individual participants based on 943 data reported annually by the vendors about their enrollees. 944 Distribution of payments to the vendors may be adjusted based on 945 the assessed relative risk profile of the enrollees in each 946 risk-bearing product for the most recent period for which data 947 is available. 948 (10) EXEMPTIONS.— 949 (a) Products, other than the products set forth in 950 subparagraphs (4)(d)1.-4., sold as part of the program are not 951 subject to the licensing requirements of the Florida Insurance 952 Code, as defined in s. 624.01 or the mandated offerings or 953 coverages established in part VI of chapter 627 and chapter 641. 954 (b) The corporation may act as an administrator as defined 955 in s. 626.88 but is not required to be certified pursuant to 956 part VII of chapter 626. However, a third party administrator 957 used by the corporation must be certified under part VII of 958 chapter 626. 959 (c) Any standard forms, website design, or marketing 960 communication developed by the corporation and used by the 961 corporation, or any vendor that meets the requirements of 962 paragraph (4)(f) is not subject to the Florida Insurance Code, 963 as established in s. 624.01. 964 (11) CORPORATION.—There is created the Florida Health 965 Choices, Inc., which shall be registered, incorporated, 966 organized, and operated in compliance with part III of chapter 967 112 and chapters 119, 286, and 617. The purpose of the 968 corporation is to administer the program created in this section 969 and to conduct such other business as may further the 970 administration of the program. 971 (a) The corporation shall be governed by a 15-member board 972 of directors consisting of: 973 1. Three ex officio, nonvoting members to include: 974 a. The Secretary of Health Care Administration or a 975 designee with expertise in health care services. 976 b. The Secretary of Management Services or a designee with 977 expertise in state employee benefits. 978 c. The commissioner of the Office of Insurance Regulation 979 or a designee with expertise in insurance regulation. 980 2. Four members appointed by and serving at the pleasure of 981 the Governor. 982 3. Four members appointed by and serving at the pleasure of 983 the President of the Senate. 984 4. Four members appointed by and serving at the pleasure of 985 the Speaker of the House of Representatives. 986 5. Board members may not include insurers, health insurance 987 agents or brokers, health care providers, health maintenance 988 organizations, prepaid service providers, or any other entity, 989 affiliate, or subsidiary of eligible vendors. 990 (b) Members shall be appointed for terms of up to 3 years. 991 Any member is eligible for reappointment. A vacancy on the board 992 shall be filled for the unexpired portion of the term in the 993 same manner as the original appointment. 994 (c) The board shall select a chief executive officer for 995 the corporation who shall be responsible for the selection of 996 such other staff as may be authorized by the corporation’s 997 operating budget as adopted by the board. 998 (d) Board members are entitled to receive, from funds of 999 the corporation, reimbursement for per diem and travel expenses 1000 as provided by s. 112.061. No other compensation is authorized. 1001 (e) There is no liability on the part of, and no cause of 1002 action shall arise against, any member of the board or its 1003 employees or agents for any action taken by them in the 1004 performance of their powers and duties under this section. 1005 (f) The board shall develop and adopt bylaws and other 1006 corporate procedures as necessary for the operation of the 1007 corporation and carrying out the purposes of this section. The 1008 bylaws shall: 1009 1. Specify procedures for selection of officers and 1010 qualifications for reappointment, provided that no board member 1011 shall serve more than 9 consecutive years. 1012 2. Require an annual membership meeting that provides an 1013 opportunity for input and interaction with individual 1014 participants in the program. 1015 3. Specify policies and procedures regarding conflicts of 1016 interest, including the provisions of part III of chapter 112, 1017 which prohibit a member from participating in any decision that 1018 would inure to the benefit of the member or the organization 1019 that employs the member. The policies and procedures shall also 1020 require public disclosure of the interest that prevents the 1021 member from participating in a decision on a particular matter. 1022 (g) The corporation may exercise all powers granted to it 1023 under chapter 617 necessary to carry out the purposes of this 1024 section, including, but not limited to, the power to receive and 1025 accept grants, loans, or advances of funds from any public or 1026 private agency and to receive and accept from any source 1027 contributions of money, property, labor, or any other thing of 1028 value to be held, used, and applied for the purposes of this 1029 section. 1030 (h) The corporation may establish technical advisory panels 1031 consisting of interested parties, including consumers, health 1032 care providers, individuals with expertise in insurance 1033 regulation, and insurers. 1034 (i) The corporation shall: 1035 1. Determine eligibility of employers, vendors, 1036 individuals, and agents in accordance with subsection (4). 1037 2. Establish procedures necessary for the operation of the 1038 program, including, but not limited to, procedures for 1039 application, enrollment, risk assessment, risk adjustment, plan 1040 administration, performance monitoring, and consumer education. 1041 3. Arrange for collection of contributions from 1042 participating employers, third parties, governmental entities, 1043 and individuals. 1044 4. Arrange for payment of premiums and other appropriate 1045 disbursements based on the selections of products and services 1046 by the individual participants. 1047 5. Establish criteria for disenrollment of participating 1048 individuals based on failure to pay the individual’s share of 1049 any contribution required to maintain enrollment in selected 1050 products. 1051 6. Establish criteria for exclusion of vendors pursuant to 1052 paragraph (4)(d). 1053 7. Develop and implement a plan for promoting public 1054 awareness of and participation in the program. 1055 8. Secure staff and consultant services necessary to the 1056 operation of the program. 1057 9. Establish policies and procedures regarding 1058 participation in the program for individuals, vendors, health 1059 insurance agents, and employers. 1060 10. Provide for the operation of a toll-free hotline to 1061 respond to requests for assistance. 1062 11. Provide for initial, open, and special enrollment 1063 periods. 1064 12. Evaluate options for employer participation which may 1065 conform towithcommon insurance practices. 1066 13. Administer the Florida Health Insurance Affordability 1067 Exchange Program in accordance with ss. 409.720-409.731. 1068 14. Coordinate with the Agency for Health Care 1069 Administration, the Department of Children and Families, and the 1070 Florida Healthy Kids Corporation on the transition plan for FHIX 1071 and any subsequent transition activities. 1072 (12) REPORT.—The board of the corporation shallBeginning1073in the 2009-2010 fiscal year,submit by February 1 an annual 1074 report to the Governor, the President of the Senate, and the 1075 Speaker of the House of Representatives documenting the 1076 corporation’s activities in compliance with the duties 1077 delineated in this section. 1078 (13) PROGRAM INTEGRITY.—To ensure program integrity and to 1079 safeguard the financial transactions made under the auspices of 1080 the program, the corporation is authorized to establish 1081 qualifying criteria and certification procedures for vendors, 1082 require performance bonds or other guarantees of ability to 1083 complete contractual obligations, monitor the performance of 1084 vendors, and enforce the agreements of the program through 1085 financial penalty or disqualification from the program. 1086 (14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS.— 1087 (a) Definitions.—For purposes of this subsection, the term: 1088 1. “Buyer’s representative” means a participating insurance 1089 agent as described in paragraph (4)(g). 1090 2. “Enrollee” means an employer who is eligible to enroll 1091 in the program pursuant to paragraph (4)(a). 1092 3. “Participant” means an individual who is eligible to 1093 participate in the program pursuant to paragraph (4)(b). 1094 4. “Proprietary confidential business information” means 1095 information, regardless of form or characteristics, that is 1096 owned or controlled by a vendor requesting confidentiality under 1097 this section; that is intended to be and is treated by the 1098 vendor as private in that the disclosure of the information 1099 would cause harm to the business operations of the vendor; that 1100 has not been disclosed unless disclosed pursuant to a statutory 1101 provision, an order of a court or administrative body, or a 1102 private agreement providing that the information may be released 1103 to the public; and that is information concerning: 1104 a. Business plans. 1105 b. Internal auditing controls and reports of internal 1106 auditors. 1107 c. Reports of external auditors for privately held 1108 companies. 1109 d. Client and customer lists. 1110 e. Potentially patentable material. 1111 f. A trade secret as defined in s. 688.002. 1112 5. “Vendor” means a participating insurer or other provider 1113 of services as described in paragraph (4)(d). 1114 (b) Public record exemptions.— 1115 1. Personal identifying information of an enrollee or 1116 participant who has applied for or participates in the Florida 1117 Health Choices Program is confidential and exempt from s. 1118 119.07(1) and s. 24(a), Art. I of the State Constitution. 1119 2. Client and customer lists of a buyer’s representative 1120 held by the corporation are confidential and exempt from s. 1121 119.07(1) and s. 24(a), Art. I of the State Constitution. 1122 3. Proprietary confidential business information held by 1123 the corporation is confidential and exempt from s. 119.07(1) and 1124 s. 24(a), Art. I of the State Constitution. 1125 (c) Retroactive application.—The public record exemptions 1126 provided for in paragraph (b) apply to information held by the 1127 corporation before, on, or after the effective date of this 1128 exemption. 1129 (d) Authorized release.— 1130 1. Upon request, information made confidential and exempt 1131 pursuant to this subsection shall be disclosed to: 1132 a. Another governmental entity in the performance of its 1133 official duties and responsibilities. 1134 b. Any person who has the written consent of the program 1135 applicant. 1136 c. The Florida Kidcare program for the purpose of 1137 administering the program authorized in ss. 409.810-409.821. 1138 2. Paragraph (b) does not prohibit a participant’s legal 1139 guardian from obtaining confirmation of coverage, dates of 1140 coverage, the name of the participant’s health plan, and the 1141 amount of premium being paid. 1142 (e) Penalty.—A person who knowingly and willfully violates 1143 this subsection commits a misdemeanor of the second degree, 1144 punishable as provided in s. 775.082 or s. 775.083. 1145 (f) Review and repeal.—This subsection is subject to the 1146 Open Government Sunset Review Act in accordance with s. 119.15, 1147 and shall stand repealed on October 2, 2016, unless reviewed and 1148 saved from repeal through reenactment by the Legislature. 1149 Section 16. Subsection (2) of section 409.904, Florida 1150 Statutes, is amended to read: 1151 409.904 Optional payments for eligible persons.—The agency 1152 may make payments for medical assistance and related services on 1153 behalf of the following persons who are determined to be 1154 eligible subject to the income, assets, and categorical 1155 eligibility tests set forth in federal and state law. Payment on 1156 behalf of these Medicaid eligible persons is subject to the 1157 availability of moneys and any limitations established by the 1158 General Appropriations Act or chapter 216. 1159 (2) A family, a pregnant woman, a child under age 21, a 1160 person age 65 or over, or a blind or disabled person, who would 1161 be eligible under any group listed in s. 409.903(1), (2), or 1162 (3), except that the income or assets of such family or person 1163 exceed established limitations. For a family or person in one of 1164 these coverage groups, medical expenses are deductible from 1165 income in accordance with federal requirements in order to make 1166 a determination of eligibility. A family or person eligible 1167 under the coverage known as the “medically needy,” is eligible 1168 to receive the same services as other Medicaid recipients, with 1169 the exception of services in skilled nursing facilities and 1170 intermediate care facilities for the developmentally disabled. 1171 Effective October 1, 2015, persons eligible under “medically 1172 needy” shall be limited to children under the age of 21 and 1173 pregnant women. This subsection expires October 1, 2019. 1174 Section 17. Section 624.91, Florida Statutes, is amended to 1175 read: 1176 624.91 The Florida Healthy Kids Corporation Act.— 1177 (1) SHORT TITLE.—This section may be cited as the “William 1178 G. ‘Doc’ Myers Healthy Kids Corporation Act.” 1179 (2) LEGISLATIVE INTENT.— 1180 (a) The Legislature finds that increased access to health 1181 care services could improve children’s health and reduce the 1182 incidence and costs of childhood illness and disabilities among 1183 children in this state. Many children do not have comprehensive, 1184 affordable health care services available. It is the intent of 1185 the Legislature that the Florida Healthy Kids Corporation 1186 provide comprehensive health insurance coverage to such 1187 children. The corporation is encouraged to cooperate with any 1188 existing health service programs funded by the public or the 1189 private sector. 1190 (b) It is the intent of the Legislature that the Florida 1191 Healthy Kids Corporation serve as one of several providers of 1192 services to children eligible for medical assistance under Title 1193 XXI of the Social Security Act. Although the corporation may 1194 serve other children, the Legislature intends the primary 1195 recipients of services provided through the corporation be 1196 school-age children with a family income below 200 percent of 1197 the federal poverty level, who do not qualify for Medicaid. It 1198 is also the intent of the Legislature that state and local 1199 government Florida Healthy Kids funds be used to continue 1200 coverage, subject to specific appropriations in the General 1201 Appropriations Act, to children not eligible for federal 1202 matching funds under Title XXI. 1203 (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only residents 1204 of this state are eligiblethe following individuals are1205eligiblefor state-funded assistance in paying Florida Healthy 1206 Kids premiums pursuant to s. 409.814.:1207(a) Residents of this state who are eligible for the1208Florida Kidcare program pursuant to s. 409.814.1209(b) Notwithstanding s. 409.814, legal aliens who are1210enrolled in the Florida Healthy Kids program as of January 31,12112004, who do not qualify for Title XXI federal funds because1212they are not qualified aliens as defined in s. 409.811.1213 (4) NONENTITLEMENT.—Nothing in this section shall be 1214 construed as providing an individual with an entitlement to 1215 health care services. No cause of action shall arise against the 1216 state, the Florida Healthy Kids Corporation, or a unit of local 1217 government for failure to make health services available under 1218 this section. 1219 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.— 1220 (a) There is created the Florida Healthy Kids Corporation, 1221 a not-for-profit corporation. 1222 (b) The Florida Healthy Kids Corporation shall: 1223 1. Arrange for the collection of any individual, family, 1224local contributions,or employer payment or premium, in an 1225 amount to be determined by the board of directors, to provide 1226 for payment of premiums for comprehensive insurance coverage and 1227 for the actual or estimated administrative expenses. 1228 2. Arrange for the collection of any voluntary 1229 contributions to provide for payment of Florida Kidcare program 1230 or Florida Health Insurance Affordability Exchange Program 1231 premiumsfor children who are not eligible for medical1232assistance under Title XIX or Title XXI of the Social Security1233Act. 1234 3.Subject to the provisions of s. 409.8134, accept1235voluntary supplemental local match contributions that comply1236with the requirements of Title XXI of the Social Security Act1237for the purpose of providing additional Florida Kidcare coverage1238in contributing counties under Title XXI.12394.Establish the administrative and accounting procedures 1240 for the operation of the corporation. 1241 4.5.Establish, with consultation from appropriate 1242 professional organizations, standards for preventive health 1243 services and providers and comprehensive insurance benefits 1244 appropriate to children, provided that such standards for rural 1245 areas shall not limit primary care providers to board-certified 1246 pediatricians. 1247 5.6.Determine eligibility for children seeking to 1248 participate in the Title XXI-funded components of the Florida 1249 Kidcare program consistent with the requirements specified in s. 1250 409.814, as well as the non-Title-XXI-eligible children as1251provided in subsection (3). 1252 6.7.Establish procedures under whichproviders of local1253match to,applicants to and participants in the program may have 1254 grievances reviewed by an impartial body and reported to the 1255 board of directors of the corporation. 1256 7.8.Establish participation criteria and, if appropriate, 1257 contract with an authorized insurer, health maintenance 1258 organization, or third-party administrator to provide 1259 administrative services to the corporation. 1260 8.9.Establish enrollment criteria that include penalties 1261 or waiting periods of 30 days for reinstatement of coverage upon 1262 voluntary cancellation for nonpayment of family or individual 1263 premiums. 1264 9.10.Contract with authorized insurers or any provider of 1265 health care services, meeting standards established by the 1266 corporation, for the provision of comprehensive insurance 1267 coverage to participants. Such standards shall include criteria 1268 under which the corporation may contract with more than one 1269 provider of health care services in program sites. 1270 a. Health plans shall be selected through a competitive bid 1271 process. The Florida Healthy Kids Corporation shall purchase 1272 goods and services in the most cost-effective manner consistent 1273 with the delivery of quality medical care. 1274 b. The maximum administrative cost for a Florida Healthy 1275 Kids Corporation contract shall be 15 percent. For health and 1276 dental care contracts, the minimum medical loss ratio for a 1277 Florida Healthy Kids Corporation contract shall be 85 percent. 1278 The calculations must use uniform financial data collected from 1279 all plans in a format established by the corporation and shall 1280 be computed for each plan on a statewide basis. Funds shall be 1281 classified in a manner consistent with 45 C.F.R. part 158For1282dental contracts, the remaining compensation to be paid to the1283authorized insurer or provider under a Florida Healthy Kids1284Corporation contract shall be no less than an amount which is 851285percent of premium; to the extent any contract provision does1286not provide for this minimum compensation, this section shall1287prevail. 1288 c. The health plan selection criteria and scoring system, 1289 and the scoring results, shall be available upon request for 1290 inspection after the bids have been awarded. 1291 d. Effective July 1, 2016, health and dental services 1292 contracts of the corporation must transition to the FHIX 1293 marketplace under s. 409.722. Qualifying plans may enroll as 1294 vendors with the FHIX marketplace to maintain continuity of care 1295 for participants. 1296 10.11.Establish disenrollment criteria in the eventlocal1297matchingfunds are insufficient to cover enrollments. 1298 11.12.Develop and implement a plan to publicize the 1299 Florida Kidcare program, the eligibility requirements of the 1300 program, and the procedures for enrollment in the program and to 1301 maintain public awareness of the corporation and the program. 1302 12.13.Secure staff necessary to properly administer the 1303 corporation. Staff costs shall be funded from stateand local1304matching fundsand such other private or public funds as become 1305 available. The board of directors shall determine the number of 1306 staff members necessary to administer the corporation. 1307 13.14.In consultation with the partner agencies, provide a 1308 report on the Florida Kidcare program annually to the Governor, 1309 the Chief Financial Officer, the Commissioner of Education, the 1310 President of the Senate, the Speaker of the House of 1311 Representatives, and the Minority Leaders of the Senate and the 1312 House of Representatives. 1313 14.15.Provide information on a quarterly basis online to 1314 the Legislature and the Governor which compares the costs and 1315 utilization of the full-pay enrolled population and the Title 1316 XXI-subsidized enrolled population in the Florida Kidcare 1317 program. The information, at a minimum, must include: 1318 a. The monthly enrollment and expenditure for full-pay 1319 enrollees in the Medikids and Florida Healthy Kids programs 1320 compared to the Title XXI-subsidized enrolled population; and 1321 b. The costs and utilization by service of the full-pay 1322 enrollees in the Medikids and Florida Healthy Kids programs and 1323 the Title XXI-subsidized enrolled population. 1324 15.16.Establish benefit packages that conform to the 1325 provisions of the Florida Kidcare program, as created in ss. 1326 409.810-409.821. 1327 16. Contract with other insurance affordability programs 1328 and FHIX to provide customer service or other enrollment-focused 1329 services. 1330 17. Annually develop performance metrics for the following 1331 focus areas: 1332 a. Administrative functions. 1333 b. Contracting with vendors. 1334 c. Customer service. 1335 d. Enrollee education. 1336 e. Financial services. 1337 f. Program integrity. 1338 (c) Coverage under the corporation’s program is secondary 1339 to any other available private coverage held by, or applicable 1340 to, the participant child or family member. Insurers under 1341 contract with the corporation are the payors of last resort and 1342 must coordinate benefits with any other third-party payor that 1343 may be liable for the participant’s medical care. 1344 (d) The Florida Healthy Kids Corporation shall be a private 1345 corporation not for profit, organized pursuant to chapter 617, 1346 and shall have all powers necessary to carry out the purposes of 1347 this act, including, but not limited to, the power to receive 1348 and accept grants, loans, or advances of funds from any public 1349 or private agency and to receive and accept from any source 1350 contributions of money, property, labor, or any other thing of 1351 value, to be held, used, and applied for the purposes of this 1352 act. 1353 (6) BOARD OF DIRECTORS AND MANAGEMENT SUPERVISION.— 1354 (a) The Florida Healthy Kids Corporation shall operate 1355 subject to the supervision and approval of a board of directors. 1356 The board chair shall be an appointee designated by the 1357 Governor, and the board shall bechaired bytheChief Financial1358Officer or her or his designee,andcomposed of 12 other 1359 members. The Senate shall confirm the designated chair and other 1360 board appointees. The board members shall be appointedselected1361 for 3-year terms.of office as follows:13621. The Secretary of Health Care Administration, or his or1363her designee.13642. One member appointed by the Commissioner of Education1365from the Office of School Health Programs of the Florida1366Department of Education.13673. One member appointed by the Chief Financial Officer from1368among three members nominated by the Florida Pediatric Society.13694. One member, appointed by the Governor, who represents1370the Children’s Medical Services Program.13715. One member appointed by the Chief Financial Officer from1372among three members nominated by the Florida Hospital1373Association.13746. One member, appointed by the Governor, who is an expert1375on child health policy.13767. One member, appointed by the Chief Financial Officer,1377from among three members nominated by the Florida Academy of1378Family Physicians.13798. One member, appointed by the Governor, who represents1380the state Medicaid program.13819. One member, appointed by the Chief Financial Officer,1382from among three members nominated by the Florida Association of1383Counties.138410. The State Health Officer or her or his designee.138511. The Secretary of Children and Families, or his or her1386designee.138712. One member, appointed by the Governor, from among three1388members nominated by the Florida Dental Association.1389 (b) A member of the board of directors serves at the 1390 pleasure of the Governormay be removed by the official who1391appointed that member. The board shall appoint an executive 1392 director, who is responsible for other staff authorized by the 1393 board. 1394 (c) Board members are entitled to receive, from funds of 1395 the corporation, reimbursement for per diem and travel expenses 1396 as provided by s. 112.061. 1397 (d) There shall be no liability on the part of, and no 1398 cause of action shall arise against, any member of the board of 1399 directors, or its employees or agents, for any action they take 1400 in the performance of their powers and duties under this act. 1401 (e) Board members who are serving as of the effective date 1402 of this act may remain on the board until January 1, 2016. 1403 (7) LICENSING NOT REQUIRED; FISCAL OPERATION.— 1404 (a) The corporation shall not be deemed an insurer. The 1405 officers, directors, and employees of the corporation shall not 1406 be deemed to be agents of an insurer. Neither the corporation 1407 nor any officer, director, or employee of the corporation is 1408 subject to the licensing requirements of the insurance code or 1409 the rules of the Department of Financial Services. However, any 1410 marketing representative utilized and compensated by the 1411 corporation must be appointed as a representative of the 1412 insurers or health services providers with which the corporation 1413 contracts. 1414 (b) The board has complete fiscal control over the 1415 corporation and is responsible for all corporate operations. 1416 (c) The Department of Financial Services shall supervise 1417 any liquidation or dissolution of the corporation and shall 1418 have, with respect to such liquidation or dissolution, all power 1419 granted to it pursuant to the insurance code. 1420 (8) TRANSITION PLANS.—The corporation shall confer with the 1421 Agency for Health Care Administration, the Department of 1422 Children and Families, and Florida Health Choices, Inc., to 1423 develop transition plans for the Florida Health Insurance 1424 Affordability Exchange Program as created under ss. 409.720 1425 409.731. 1426 Section 18. Section 624.915, Florida Statutes, is repealed. 1427 Section 19. The Division of Law Revision and Information is 1428 directed to replace the phrase “the effective date of this act” 1429 wherever it occurs in this act with the date the act becomes a 1430 law. 1431 Section 20. This act shall take effect upon becoming a law.