Bill Text: FL S1844 | 2013 | Regular Session | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Florida Health Choices Program
Spectrum: Committee Bill
Status: (Passed) 2013-06-06 - Chapter No. 2013-110 [S1844 Detail]
Download: Florida-2013-S1844-Comm_Sub.html
Bill Title: Florida Health Choices Program
Spectrum: Committee Bill
Status: (Passed) 2013-06-06 - Chapter No. 2013-110 [S1844 Detail]
Download: Florida-2013-S1844-Comm_Sub.html
Florida Senate - 2013 CS for SB 1844 By the Committees on Appropriations; and Health Policy 576-04989-13 20131844c1 1 A bill to be entitled 2 An act relating to the Health Choice Plus Program; 3 amending s. 408.910, F.S.; conforming provisions to 4 changes made by the act; providing that the Florida 5 Insurance Code is not applicable in certain 6 circumstances; creating s. 408.9105, F.S.; creating 7 the Health Choice Plus Program; providing legislative 8 intent; providing requirements of the program; 9 providing definitions; providing eligibility 10 requirements; providing for enrollment in the program; 11 providing requirements and procedures for the deposit 12 and use of funds in a health benefits account; 13 providing that the marketplace is encouraged to use 14 existing community programs and partnerships to 15 deliver services and to include traditional safety net 16 providers for the delivery of services to enrollees; 17 requiring Florida Health Choices, Inc., to establish a 18 refund process; authorizing the corporation to accept 19 funds from various sources to deposit into health 20 benefits accounts, subsidize the costs of coverage, 21 and administer and support the program; requiring the 22 corporation to manage the health benefits accounts and 23 provide the marketplace of options which an enrollee 24 in the program may use; providing for payment for 25 achieving healthy living performance goals; requiring 26 the program to post on its website a list of optional 27 healthy living performance goals and to establish a 28 procedure for documentation, achievement, and payment 29 regarding the healthy living performance goals; 30 providing that coverage under the program is not an 31 entitlement; prohibiting a cause of action against 32 certain entities under certain circumstances; 33 requiring the corporation to submit to the Governor 34 and the Legislature information about the program in 35 its annual report and an evaluation of the 36 effectiveness of the program; providing for a program 37 review and repeal date; providing an appropriation; 38 providing an effective date. 39 40 Be It Enacted by the Legislature of the State of Florida: 41 42 Section 1. Paragraphs (a), (b), (e), and (f) of subsection 43 (4) and paragraph (b) of subsection (7) of section 408.910, 44 Florida Statutes, are amended, and paragraph (c) is added to 45 subsection (10) of that section, to read 46 408.910 Florida Health Choices Program.— 47 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the 48 program is voluntary and shall be available to employers, 49 individuals, vendors, and health insurance agents as specified 50 in this subsection. 51 (a) Employers eligible to enroll in the program include 52 those employers:531. Employersthat meet criteria established by the 54 corporation and elect to make their employees eligible through 55 the program. 562. Fiscally constrained counties described in s.218.67.573. Municipalities having populations of fewer than 50,00058residents.594. School districts in fiscally constrained counties.605. Statutory rural hospitals.61 (b) Individuals eligible to participate in the program 62 include: 63 1. Individual employees of enrolled employers. 64 2. Other individuals that meet criteria established by the 65 corporationState employees not eligible for state employee66health benefits. 673. State retirees.684. Medicaid participants who opt out.69 (e) Eligible individuals may participate in the program 70 voluntarilycontinue participation in the program regardless of71subsequent changes in job status or Medicaid eligibility. 72 Individuals who join the program may participate by complying 73 with the procedures established by the corporation. These 74 procedures must include, but are not limited to: 75 1. Submission of required information. 76 2. Authorization for payroll deduction. 77 3. Compliance with federal tax requirements. 78 4. Arrangements for paymentin the event of job changes. 79 5. Selection of products and services. 80 (f) Vendors who choose to participate in the program may 81 enroll by complying with the procedures established by the 82 corporation. These procedures may include, but are not limited 83 to: 84 1. Submission of required information, including a complete 85 description of the coverage, services, provider network, payment 86 restrictions, and other requirements of each product offered 87 through the program. 88 2. Execution of an agreement to comply with requirements 89 established by the corporation. 90 3. Execution of an agreement that prohibits refusal to sell 91 any offerednon-risk-bearingproduct or service to a participant 92 who elects to buy it. 93 4. Establishment of product prices based on applicable 94 criteriaage, gender, and location of the individual95participant, which may include medical underwriting. 96 5. Arrangements for receiving payment for enrolled 97 participants. 98 6. Participation in ongoing reporting processes established 99 by the corporation. 100 7. Compliance with grievance procedures established by the 101 corporation. 102 (7) THE MARKETPLACE PROCESS.—The program shall provide a 103 single, centralized market for purchase of health insurance, 104 health maintenance contracts, and other health products and 105 services. Purchases may be made by participating individuals 106 over the Internet or through the services of a participating 107 health insurance agent. Information about each product and 108 service available through the program shall be made available 109 through printed material and an interactive Internet website. A 110 participant needing personal assistance to select products and 111 services shall be referred to a participating agent in his or 112 her area. 113 (b) Initial selection of products and services must be made 114 by an individual participant within the applicable open 115 enrollment period60 days after the date the individual’s116employer qualified for participation.An individual who fails to117enroll in products and services by the end of this period is118limited to participation in flexible spending account services119until the next annual enrollment period.120 (10) EXEMPTIONS.— 121 (c) Any standard forms, website design, or marketing 122 communication developed by the corporation and used by the 123 corporation, or any vendor that meets the requirements of s. 124 408.910(4)(f) is not subject to the Florida Insurance Code, as 125 established in s. 624.01. 126 Section 2. Section 408.9105, Florida Statutes, is created 127 to read: 128 408.9105 Health Choice Plus Program.— 129 (1) LEGISLATIVE INTENT.—The Legislature recognizes that 130 there are more than 600,000 uninsured residents in this state 131 who have incomes at or below 100 percent of the federal poverty 132 level. Many insurance options are not affordable, and the 133 Legislature intends to provide a benefit program to those 134 individuals who seek assistance with coverage and who assume 135 individual responsibility for their own health care needs. It is 136 therefore the intent of the Legislature to expand the services 137 provided by the Florida Health Choices Program and begin the 138 phase-in of the Health Choice Plus Program starting July 1, 139 2013. The Health Choice Plus Program shall: 140 (a) Use the existing infrastructure and governance of 141 Florida Health Choices, Inc., to manage the program described in 142 this section. 143 (b) Offer goods and services to individuals who are between 144 19 to 64 years of age, inclusive. 145 (c) Establish guidelines for financial participation in the 146 program which allow for enrollees and others to contribute 147 toward a health benefits account. 148 1. An enrollee shall contribute at least $20 per month 149 toward the health benefits account. This contribution amount may 150 be adjusted annually in the General Appropriations Act. 151 2. The level of benefit paid into an enrollee’s account 152 using state funds is determined by the corporation based upon 153 the availability of state, local, and federal funds. The amount 154 may not exceed $10 per individual per month. This amount may be 155 adjusted annually in the General Appropriations Act. 156 (d) Implement an employer-based contribution option. 157 (e) Develop and maintain an education and public outreach 158 campaign for the Health Choice Plus Program. 159 (f) Provide a secure website to facilitate the purchase of 160 goods and services and to provide public information about the 161 program. The website must also provide information about the 162 availability of insurance affordability programs targeted at 163 this population. 164 (g) Establish an incentive program that rewards enrollees 165 for achievements in reaching healthy living goals. 166 (2) DEFINITIONS.—As used in this section, the term: 167 (a) “CHIP” means Children’s Health Insurance Program as 168 authorized under Title XXI of the Social Security Act. 169 (b) “Corporation” means Florida Health Choices, Inc., as 170 established under s. 408.910. 171 (c) “Corporation’s marketplace” means the single, 172 centralized market established by the corporation which 173 facilitates the purchase of products made available in the 174 marketplace. 175 (d) “Enrollee” means an individual who participates in or 176 receives benefits under the Health Choice Plus Program. 177 (e) “Goods and services” means the individual products 178 offered for sale to an enrollee on the corporation’s marketplace 179 or other health care-related items that may be purchased by an 180 enrollee in the private market. An enrollee may purchase these 181 products using funds accumulated in his or her health benefits 182 account. 183 (f) “Health benefits account” means the account established 184 for an enrollee at the corporation into which funds may be 185 deposited by the state, the enrollee, other individuals, or 186 organizations for the purchase of health care goods and services 187 on the enrollee’s behalf. 188 (g) “Lawful permanent resident” means a non-United States 189 citizen who resides in the United States under legally 190 recognized and lawfully recorded permanent residence as an 191 immigrant. This individual may also be known as a permanent 192 resident alien. 193 (h) “Parent” or “caretaker relative” means an individual 194 who is a relative that has primary custody or legal guardianship 195 of a dependent child and provides the primary care and 196 supervision of that dependent child in the same household. A 197 caretaker relative must be related to the dependent child by 198 blood, marriage, or adoption within the fifth degree of kinship. 199 (i) “Patient Protection and Affordable Care Act” or “PPACA” 200 means the federal law enacted as Pub. L. No. 111-148, as further 201 amended by the federal Health Care and Education Reconciliation 202 Act of 2010, Pub. L. No. 111-152, and any amendments. 203 (j) “Program” means the Health Choice Plus Program 204 established under this section. 205 (k) “Vendor” means an entity that meets the requirements 206 under s. 408.910(4)(d) and is accepted by the corporation. 207 (3) ELIGIBILITY.— 208 (a) To be eligible for the Health Choice Plus Program, an 209 individual must be a resident of this state and meet all of the 210 following criteria: 211 1. Be between 19 and 64 years of age, inclusive. 212 2. Have a modified adjusted gross income that does not 213 exceed 100 percent of the federal poverty level based on the 214 individual’s most recent federal tax return, or if the 215 individual did not file a tax return, the individual’s most 216 recent monthly income. 217 3. Be a United States citizen or a lawful permanent 218 resident. 219 4. Be ineligible for Medicaid. 220 5. Be ineligible for employer-sponsored insurance coverage. 221 If the enrollee is eligible for employer-sponsored coverage but 222 the cost of that coverage for the enrollee’s share for 223 individual coverage would exceed 5 percent of the enrollee’s 224 total modified adjusted gross household income or the enrollee’s 225 share of family coverage would exceed 5 percent of enrollee’s 226 total modified adjusted gross household income, the enrollee is 227 not considered eligible for employer-sponsored coverage for 228 purposes of this section. 229 6. Not be enrolled in other coverage that meets the 230 definition of essential benefits coverage under PPACA. 231 (b) In addition to the requirements in paragraph (a), an 232 enrollee must meet the following categorical requirements in 233 order to maintain enrollment in the program: 234 1. For an enrollee who is also a parent or a caretaker 235 relative, the enrollee must do all of the following: 236 a. Maintain enrollment in Medicaid or CHIP for any 237 dependent child in the household who is eligible for Medicaid or 238 CHIP and who must be enrolled in Medicaid or CHIP throughout the 239 enrollee’s participation in the Health Choice Plus Program. 240 b. Complete a health assessment within the first 3 months 241 after enrollment at a county health department, federally 242 qualified health center, or other approved health care provider. 243 c. Schedule and keep at least one preventive visit with a 244 primary care provider within 6 months after enrollment and 245 repeat the preventive visit at least once every 18 months 246 thereafter. 247 d. Provide proof of employment for at least 20 hours a week 248 or proof of efforts made to seek employment. In lieu of 249 employment, the enrollee may provide proof of volunteering for 250 at least 10 hours a month at a school or at a nonprofit 251 organization or enrollment as a full-time student at an 252 accredited educational institution. Exceptions to this 253 requirement may be made on a case-by-case basis for medical 254 conditions for an enrollee or if the enrollee is the primary 255 caretaker for a family member who has a chronic and severe 256 medical condition that requires a minimum of 40 hours a week of 257 care. 258 2. For an enrollee who is also a childless adult, the 259 enrollee must do all of the following: 260 a. Provide proof of employment for at least 20 hours a week 261 or proof of efforts made to seek employment. In lieu of 262 employment, the enrollee may provide proof of volunteering for 263 at least 20 hours a month at a school or at a nonprofit 264 organization or enrollment as a full-time student at an 265 accredited educational institution. Exceptions to this 266 requirement may be made on a case-by-case basis for medical 267 conditions for the enrollee or if the enrollee is the primary 268 caretaker for a family member who has a chronic and severe 269 medical condition that requires a minimum of 40 hours a week of 270 care. 271 b. Complete a health assessment within the first 3 months 272 after enrollment at a county health department, federally 273 qualified health center, or other approved health care provider. 274 c. Schedule and keep at least one preventive visit with a 275 primary care provider within the first 6 months after enrollment 276 and repeat the preventive visit at least once every 18 months 277 thereafter. 278 279 If the enrollee fails to meet the requirements specified in this 280 subsection, the enrollee is disenrolled from the program at the 281 end of the month in which the enrollee fails to meet the 282 requirements. The enrollee may receive one 30-day extension to 283 comply before cancellation of coverage. If an enrollee’s 284 coverage is canceled, the enrollee may not reapply for coverage 285 until the next open enrollment period or 90 days after 286 cancellation of coverage occurs, whichever occurs later. The 287 individual’s reenrollment is subject to available funding. 288 (4) ENROLLMENT.— 289 (a) Enrollment in the Health Choice Plus Program may occur 290 through the portal of the Florida Health Choices Program, a 291 referral process from the Department of Children and Families, 292 the Florida Healthy Kids Corporation, or the exchange as defined 293 by the federal Patient Protection and Affordable Care Act. 294 (b) Subject to available funding, the corporation shall 295 establish at least one open enrollment period each year. When 296 the program is full based on available funding, enrollment must 297 cease. 298 (c) Eligibility is determined by using electronic means to 299 the fullest extent practicable before requesting any written 300 documentation from an applicant. 301 (5) HEALTH BENEFITS ACCOUNT.— 302 (a) A health benefits account is established for each 303 enrollee upon confirmation of eligibility in the program. The 304 corporation shall determine the deposit amount and frequency of 305 deposits based on the availability of funds, the number of 306 enrollees, and other factors. 307 (b) An enrollee shall make a financial contribution toward 308 his or her own health benefits account in order to maintain 309 enrollment in accordance with paragraph (1)(c). 310 1. The corporation shall establish disenrollment criteria 311 for failure to pay the required minimum contribution. 312 2. The disenrollment criteria must include waiting periods 313 of not more than 1 month before reinstatement to the program if 314 the enrollee is still eligible and has paid all required 315 financial obligations. 316 3. The enrollee’s employer may contribute toward an 317 employee’s health benefits account under the program, including 318 making the enrollee’s required contribution, in whole or in 319 part, to the enrollee’s health benefits account at any time. 320 (c) Subject to appropriations available for this specific 321 purpose, the corporation shall establish a procedure for the 322 deposit of supplemental or bonus funds into an enrollee’s health 323 benefits account if certain healthy living performance goals are 324 achieved. These goals must be established no later than July 1 325 in each fiscal year and distributed to all enrollees, published 326 on the corporation’s website, and distributed to new enrollees 327 within 30 calendar days after enrollment. For the 2014 calendar 328 year, the goals must be established no later than October 1, 329 2013. 330 1. An enrollee may use funds deposited in a health benefits 331 account to offset other health care costs or to purchase other 332 products and services offered by the marketplace, subject to 333 guidelines established by the corporation and in accordance with 334 federal law. 335 2. Bonus funds may accumulate in the enrollee’s health 336 benefits account for the duration of the program and must 337 automatically expire and return to the corporation upon the 338 termination of the program. 339 (d) The marketplace is encouraged to use existing community 340 programs and partnerships to deliver services and to include 341 traditional safety net providers for the delivery of services to 342 enrollees, including, but not limited to, rural health clinics, 343 federally qualified health centers, county health departments, 344 emergency room diversion programs, and community mental health 345 centers. A health care entity that receives state funding must 346 participate in the Health Choice Plus Program and offer services 347 or products through the marketplace or to enrollees, as 348 appropriate. An enrollee may be required to make nominal 349 copayments to providers for nonpreventive services. The 350 corporation may establish the amount of the copayments when 351 applicable. 352 (e) Except for supplemental funds described under paragraph 353 (c), funds deposited in a health benefits account belong to the 354 enrollee when deposited and are available for health-care 355 related expenditures, including, but not limited to, physician’s 356 fees, hospital costs, prescriptions, insurance premium payments, 357 copayments, and coinsurance. The corporation shall establish a 358 process or contract with another entity for the management of 359 the funds. The process must ensure the timely distribution and 360 the appropriate expenditure of the state’s contributions. 361 (f) The corporation shall establish a refund process for an 362 enrollee who requests the closure of a health benefits account 363 and the return of any unspent individual contributions. The 364 enrollee may be refunded only those funds that the enrollee or 365 employer has contributed to his or her health benefits account. 366 All other state funds in the enrollee’s health benefits account 367 revert to the corporation. 368 (6) FUNDING.— 369 (a) The corporation may accept funds from an employer to 370 deposit into an enrollee’s health benefits account to supplement 371 funds if such a deposit is not in conflict with other provisions 372 of this section. 373 (b) The corporation may accept state and federal funds to 374 further subsidize the costs of coverage and to administer the 375 program. 376 (c) The corporation shall seek other grants and donations 377 to support the program. 378 (d) An assessment on vendors that participate in the 379 marketplace may be used to fund the administration of the 380 program. 381 (7) SERVICES.—The corporation shall manage the health 382 benefits accounts and provide a marketplace of options from 383 which an enrollee may also use his or her health benefits 384 account to purchase individual services and products, including, 385 but not limited to, discount medical plans, limited benefit 386 plans, health flex plans, individual health insurance plans, 387 prepaid health clinic plans, bundled services, or other prepaid 388 health care coverage. 389 (8) HEALTHY LIVING PERFORMANCE GOALS AND PAYMENT.— 390 (a) To the extent that funds are made available for this 391 purpose, an enrollee is rewarded for achieving a healthy 392 lifestyle and using preventive health care services 393 appropriately. 394 (b) The program shall post on its website, by July 1 of 395 each fiscal year, a list of optional healthy living performance 396 goals and the proposed incentives for achievement of each goal. 397 The corporation shall establish a procedure for the 398 documentation of such goals, timeframes for achievement of the 399 optional goals, and the payment of supplemental amounts into an 400 enrollee’s health benefits account, subject to available 401 funding. 402 (c) Bonus payments for achieving a healthy living 403 performance goal shall be paid into an enrollee’s health 404 benefits account at the end of the quarter in which the goal is 405 achieved. The amount of the payment is based upon the schedule 406 posted by the program on July 1 of that fiscal year. 407 (9) LIABILITY.—Coverage under the Health Choice Plus 408 Program is not an entitlement, and a cause of action does not 409 arise against the state, a local governmental entity, any other 410 political subdivision of the state, or the corporation or its 411 board of directors for failure to make coverage under this 412 section available to an eligible person or for discontinuation 413 of any coverage. 414 (10) PROGRAM EVALUATION.—The corporation shall include 415 information about the Health Choice Plus Program in its annual 416 report under s. 408.910. The corporation shall complete and 417 submit by January 1, 2016, a separate independent evaluation of 418 the effectiveness of the Health Choice Plus Program to the 419 Governor, the President of the Senate, and the Speaker of the 420 House of Representatives. 421 (11) PROGRAM REVIEW.—The Health Choice Plus Program is 422 subject to repeal on July 1, 2016, unless reviewed and saved 423 from repeal through reenactment by the Legislature. 424 Section 3. The sum of $15,275,000 from the General Revenue 425 Fund is appropriated to the Agency for Health Care 426 Administration beginning in the 2013-2014 fiscal year to provide 427 funding for the Health Choice Plus Program within Florida Health 428 Choices, Inc., and to fund the corporation’s administrative 429 costs necessary for implementing and operating the program. 430 Section 4. This act shall take effect July 1, 2013.