Bill Text: FL S2508 | 2017 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Division of State Group Insurance

Spectrum: Committee Bill

Status: (Passed) 2017-06-19 - Chapter No. 2017-127, companion bill(s) passed, see SB 2510 (Ch. 2017-128), SB 2500 (Ch. 2017-70) [S2508 Detail]

Download: Florida-2017-S2508-Introduced.html
       Florida Senate - 2017                                    SB 2508
       
       
        
       By the Committee on Appropriations
       
       
       
       
       
       576-03486-17                                          20172508__
    1                        A bill to be entitled                      
    2         An act relating to the Division of State Group
    3         Insurance; amending s. 110.12301, F.S.; removing a
    4         requirement that a contract for dependent eligibility
    5         verification services for the state group insurance
    6         program be contingency-based; requiring the division
    7         to notify subscribers of dependent eligibility rules
    8         by a certain date; requiring the division to hold a
    9         subscriber harmless for past claims of ineligible
   10         dependents for a specified timeframe; providing for
   11         applicability; removing a requirement that the
   12         Department of Management Services submit budget
   13         amendments pursuant to ch. 216, F.S., regarding vendor
   14         payments for dependent eligibility verification
   15         services; authorizing the contractor providing
   16         dependent eligibility verification services to request
   17         certain information from subscribers; requiring the
   18         division and the contractor to disclose to subscribers
   19         that dependent eligibility verification information
   20         may be subject to disclosure and inspection under
   21         public records requirements under certain
   22         circumstances; specifying requirements for marriage
   23         licenses or certificates or birth certificates
   24         submitted for dependent eligibility verification;
   25         requiring the contractor to retain documentation
   26         obtained for dependent eligibility verification
   27         services for a specified timeframe; requiring the
   28         department and the contractor to destroy such
   29         documentation after a specified date; amending s.
   30         110.12315, F.S.; providing that retail, mail order,
   31         and specialty pharmacies participating in the state
   32         employees’ prescription drug program shall be
   33         reimbursed as established by contract; revising supply
   34         limitations under the program; providing that the
   35         pharmacy dispensing fee be negotiated by the
   36         department; revising provisions governing the
   37         reimbursement schedule for prescription drugs and
   38         supplies dispensed under the program; requiring the
   39         department to maintain certain lists; establishing
   40         supply limitations for maintenance drugs and supplies;
   41         specifying pricing of certain copayments by health
   42         plan members; deleting a provision requiring the
   43         department to implement additional cost-saving
   44         measures and adjustments; revising copayment and
   45         coinsurance amounts for the State Group Health
   46         Insurance Standard Plan and the State Group Health
   47         Insurance High Deductible Plan; requiring the
   48         department to implement formulary management for
   49         prescription drugs and supplies by a specified date;
   50         requiring that certain prescription drugs and supplies
   51         remain available unless specifically excluded from the
   52         list of approved prescription drugs and supplies;
   53         providing that prescription drugs and supplies first
   54         made available after a specified date may not be
   55         covered by the prescription drug program unless
   56         otherwise approved; requiring the department to submit
   57         the list of excluded prescription drugs and supplies
   58         to the Executive Office of the Governor by a specified
   59         date; requiring the list of excluded prescription
   60         drugs and supplies approved by the Executive Office of
   61         the Governor to be submitted to the Legislature by a
   62         specified date; authorizing the department to
   63         implement the exclusions if no objection is submitted
   64         by the Legislature by a certain date; authorizing the
   65         department to propose additional exclusions from
   66         coverage, make modifications to the formulary, and
   67         move drugs and supplies between copayment tiers;
   68         prescribing procedures and requirements with respect
   69         to the proposal of additional exclusions or
   70         modifications; requiring the department to submit
   71         certain information regarding the initial formulary
   72         and any subsequent modifications to the Executive
   73         Office of the Governor and the Legislature; repealing
   74         s. 8 of chapter 99-255, Laws of Florida; repealing a
   75         provision prohibiting the department from implementing
   76         a prior authorization program or a restricted
   77         formulary program that meets certain criteria;
   78         providing an effective date.
   79          
   80  Be It Enacted by the Legislature of the State of Florida:
   81  
   82         Section 1. Section 110.12301, Florida Statutes, is amended
   83  to read:
   84         110.12301 Competitive procurement of postpayment claims
   85  review services.—The Division of State Group Insurance is
   86  directed to competitively procure:
   87         (1) Postpayment claims review services for the state group
   88  health insurance plans established pursuant to s. 110.123.
   89  Compensation under the contract shall be paid from amounts
   90  identified as claim overpayments that are made by or on behalf
   91  of the health plans and that are recovered by the vendor. The
   92  vendor may retain that portion of the amount recovered as
   93  provided in the contract. The contract must require the vendor
   94  to maintain all necessary documentation supporting the amounts
   95  recovered, retained, and remitted to the division; and
   96         (2) A contingency-based contract for dependent eligibility
   97  verification services for the state group insurance program;
   98  however, compensation under the contract may not exceed
   99  historical claim costs for the prior 12 months for the dependent
  100  populations disenrolled as a result of the contractor’s vendor’s
  101  services.
  102         (a)1. By September 1, 2017, the division shall notify all
  103  subscribers regarding the eligibility rules for dependents.
  104  Through November 30, 2017, the division must may establish a 3
  105  month grace period and hold subscribers harmless for past claims
  106  of ineligible dependents if such dependents are removed from
  107  plan membership before December 1, 2017.
  108         2. Subparagraph 1. does not apply to any dependent
  109  identified as ineligible before July 1, 2017, for which the
  110  department has notified the state agency employing the
  111  associated subscriber The Department of Management Services
  112  shall submit budget amendments pursuant to chapter 216 in order
  113  to obtain budget authority necessary to expend funds from the
  114  State Employees’ Group Health Self-Insurance Trust Fund for
  115  payments to the vendor as provided in the contract.
  116         (b) The contractor providing dependent eligibility
  117  verification services may request the following information from
  118  subscribers:
  119         1. To prove a spouse’s eligibility:
  120         a. If married less than 12 months and the subscriber and
  121  his or her spouse have not filed a joint federal income tax
  122  return, a government-issued marriage certificate; or
  123         b. If married for 12 or more months, a transcript of the
  124  most recently filed federal income tax return.
  125         2. To prove a biological child’s or a newborn grandchild’s
  126  eligibility, a government-issued birth certificate.
  127         3. To prove an adopted child’s eligibility:
  128         a. An adoption certificate; or
  129         b. An adoption placement agreement and a petition for
  130  adoption.
  131         4. To prove a stepchild’s eligibility:
  132         a. A government-issued birth certificate for the stepchild;
  133  and
  134         b. The transcript of the subscriber’s most recently filed
  135  federal income tax return.
  136         5. Any other information necessary to verify the
  137  dependent’s eligibility for enrollment in the state group
  138  insurance program.
  139         (c) If a document requested from a subscriber is not
  140  confidential or exempt from public records requirements, the
  141  division and the contractor shall disclose to all subscribers
  142  that such information submitted to verify the eligibility of
  143  dependents may be subject to disclosure and inspection under
  144  chapter 119.
  145         (d) A government-issued marriage license or marriage
  146  certificate submitted for dependent eligibility verification
  147  must include the date of the marriage between the subscriber and
  148  the spouse.
  149         (e) A government-issued birth certificate submitted for
  150  dependent eligibility verification must list the parents’ names.
  151         (f) All documentation obtained by the contractor to conduct
  152  the dependent eligibility verification services must be retained
  153  until June 30, 2019. The department or the contractor are not
  154  required to retain such documentation after June 30, 2019, and
  155  shall destroy such documentation as soon as practicable after
  156  such date.
  157         Section 2. Upon the expiration and reversion of the
  158  amendments made to section 110.12315, Florida Statutes, pursuant
  159  to section 123 of chapter 2016-62, Laws of Florida, section
  160  110.12315, Florida Statutes, is amended to read:
  161         110.12315 Prescription drug program.—The state employees’
  162  prescription drug program is established. This program shall be
  163  administered by the Department of Management Services, according
  164  to the terms and conditions of the plan as established by the
  165  relevant provisions of the annual General Appropriations Act and
  166  implementing legislation, subject to the following conditions:
  167         (1) The department shall allow prescriptions written by
  168  health care providers under the plan to be filled by any
  169  licensed pharmacy and reimbursed pursuant to subsection (2)
  170  contractual claims-processing provisions. Nothing in This
  171  section may not be construed as prohibiting a mail order
  172  prescription drug program distinct from the service provided by
  173  retail pharmacies.
  174         (2) In providing for reimbursement of pharmacies for
  175  prescription drugs and supplies medicines dispensed to members
  176  of the state group health insurance plan and their dependents
  177  under the state employees’ prescription drug program:
  178         (a) Retail, mail order, and specialty pharmacies
  179  participating in the program must be reimbursed as established
  180  by contract and at a uniform rate and subject to uniform
  181  conditions, according to the terms and conditions of the plan.
  182         (b) There is shall be a 30-day supply limit for retail
  183  pharmacy fills, a 90-day supply limit for mail order fills, and
  184  a 90-day supply limit for fills by retail pharmacies
  185  participating in a 90-day supply network prescription card
  186  purchases and 90-day supply limit for mail order or mail order
  187  prescription drug purchases. This paragraph may not be construed
  188  to prohibit fills at any amount less than the applicable supply
  189  limit.
  190         (c) The current pharmacy dispensing fee shall be negotiated
  191  by the department remains in effect.
  192         (d)(3) The department of Management Services shall
  193  establish the reimbursement schedule for prescription drugs and
  194  supplies pharmaceuticals dispensed under the program.
  195  Reimbursement rates for a prescription drug or supply
  196  pharmaceutical must be based on the cost of the generic
  197  equivalent drug or supply if a generic equivalent exists, unless
  198  the physician, advanced registered nurse practitioner, or
  199  physician assistant prescribing the drug or supply
  200  pharmaceutical clearly states on the prescription that the brand
  201  name drug or supply is medically necessary or that the drug or
  202  supply product is included on the formulary of drugs and
  203  supplies drug products that may not be interchanged as provided
  204  in chapter 465, in which case reimbursement must be based on the
  205  cost of the brand name drug or supply as specified in the
  206  reimbursement schedule adopted by the department of Management
  207  Services.
  208         (3) The department shall maintain the generic, preferred
  209  brand name, and the nonpreferred brand name lists of drugs and
  210  supplies to be used in the administration of the state
  211  employees’ prescription drug program.
  212         (4) The department shall maintain a list of maintenance
  213  drugs and supplies.
  214         (a) Preferred provider organization health plan members may
  215  have prescriptions for maintenance drugs and supplies filled up
  216  to 3 times as a supply for up to 30 days through a retail
  217  pharmacy; thereafter, prescriptions for the same maintenance
  218  drug or supply must be filled for up to 90 days either through
  219  the department’s contracted mail order pharmacy or through a
  220  retail pharmacy participating in a 90-day supply network.
  221         (b) Health maintenance organization health plan members may
  222  have prescriptions for maintenance drugs and supplies filled for
  223  up to 90 days either through a mail order pharmacy or through a
  224  retail pharmacy participating in a 90-day supply network.
  225         (5) Copayments made by health plan members for a supply for
  226  up to 90 days through a retail pharmacy participating in a 90
  227  day supply network shall be the same as copayments made for a
  228  similar supply through the department’s contracted mail order
  229  pharmacy.
  230         (6)(4) The department of Management Services shall conduct
  231  a prescription utilization review program. In order to
  232  participate in the state employees’ prescription drug program,
  233  retail pharmacies dispensing prescription drugs and supplies
  234  medicines to members of the state group health insurance plan or
  235  their covered dependents, or to subscribers or covered
  236  dependents of a health maintenance organization plan under the
  237  state group insurance program, shall make their records
  238  available for this review.
  239         (5) The Department of Management Services shall implement
  240  such additional cost-saving measures and adjustments as may be
  241  required to balance program funding within appropriations
  242  provided, including a trial or starter dose program and
  243  dispensing of long-term-maintenance medication in lieu of acute
  244  therapy medication.
  245         (7)(6) Participating pharmacies must use a point-of-sale
  246  device or an online computer system to verify a participant’s
  247  eligibility for coverage. The state is not liable for
  248  reimbursement of a participating pharmacy for dispensing
  249  prescription drugs and supplies to any person whose current
  250  eligibility for coverage has not been verified by the state’s
  251  contracted administrator or by the department of Management
  252  Services.
  253         (7) Under the state employees’ prescription drug program
  254  copayments must be made as follows:
  255         (8)(a) Effective July 1, 2017 January 1, 2006, for the
  256  State Group Health Insurance Standard Plan, copayments must be
  257  made as follows:
  258         1. For a supply for up to 30 days from a retail pharmacy:
  259         a. For generic drug with card.....................$7 $10.
  260         b.2. For preferred brand name drug with card.....$30 $25.
  261         c.3. For nonpreferred brand name drug with card..$50 $40.
  262         2. For a supply for up to 90 days from a mail order
  263  pharmacy or a retail pharmacy participating in a 90-day supply
  264  network:
  265         a.4. For generic mail order drug.................$14 $20.
  266         b.5. For preferred brand name mail order drug....$60 $50.
  267         c.6. For nonpreferred brand name mail order drug$100 $80.
  268         (b) Effective July 1, 2017 January 1, 2006, for the State
  269  Group Health Insurance High Deductible Plan, coinsurance must be
  270  paid as follows:
  271         1. For a supply for up to 30 days from a retail pharmacy:
  272         a.Retail coinsurance For generic drug with card.....30%.
  273         b.2.Retail coinsurance For preferred brand name drug with
  274  card........................................................30%.
  275         c.3.Retail coinsurance For nonpreferred brand name drug
  276  with card...................................................50%.
  277         2. For a supply for up to 90 days from a mail order
  278  pharmacy or a retail pharmacy participating in a 90-day supply
  279  network:
  280         a.4. Mail order coinsurance For generic drug.........30%.
  281         b.5. Mail order coinsurance For preferred brand name
  282  drug........................................................30%.
  283         c.6. Mail order coinsurance For nonpreferred brand name
  284  drug........................................................50%.
  285         (9)(a) Beginning January 1, 2018, the department shall
  286  implement formulary management for prescription drugs and
  287  supplies but may not restrict access to the most clinically
  288  appropriate, clinically effective, and lowest net cost
  289  prescription drugs and supplies. Prescription drugs and supplies
  290  available for coverage through the prescription drug program as
  291  of July 1, 2017, must remain available unless specifically
  292  excluded from coverage in accordance with the list developed
  293  pursuant to this subsection. Prescription drugs and supplies
  294  first made available after July 1, 2017, may not be covered by
  295  the prescription drug program unless specifically included in
  296  the list of approved prescription drugs and supplies.
  297         (b) The department must submit the list of excluded
  298  prescription drugs and supplies to the Executive Office of the
  299  Governor for review and approval by July 21, 2017. The approved
  300  formulary must be submitted to the Legislature for review by
  301  August 18, 2017. The implementation of the initial list of
  302  excluded prescription drugs and supplies shall be treated as an
  303  action subject to the notice, review, and objection procedures
  304  under s. 216.177. If no objection is submitted in writing by
  305  September 15, 2017, the department may implement the exclusions,
  306  as approved by the Executive Office of the Governor, beginning
  307  January 1, 2018.
  308         (c) The department may propose additional exclusions from
  309  coverage under the prescription drug program once each plan
  310  year, for implementation on January 1 of the next plan year or
  311  as otherwise directed by the Legislature. The department must
  312  submit its proposed exclusions to the Executive Office of the
  313  Governor for review and approval at least 30 days before the
  314  date the Governor’s recommended budget is required to be
  315  submitted to the Legislature. Any recommendations by the
  316  Governor to exclude drugs or supplies from coverage under the
  317  prescription drug program must be submitted to the Legislature
  318  with the Governor’s recommended budget.
  319         (d) The department may propose modifications to the
  320  formulary to include prescription drugs or supplies not covered
  321  under the program or to move the drugs or supplies between
  322  copayment tiers. Such modifications may be implemented on
  323  January 1, April 1, July 1, or October 1 of the plan year.
  324         (e) With each proposed change to the status of prescription
  325  drugs and supplies under the program, the department shall
  326  submit the following information to the Executive Office of the
  327  Governor and the Legislature:
  328         1. The drugs and supplies excluded or proposed for a change
  329  in copayment tier;
  330         2. The drugs that remain available under the program as a
  331  substitute for the excluded drug;
  332         3. The number of prescriptions written for the affected
  333  drug or supply during the prior plan year and the current plan
  334  year and the number of plan members affected by the change;
  335         4. The expected financial impact to the prescription drug
  336  program, including the impact by drug on plan payments and
  337  rebates to the plan; and
  338         5. The expected financial impact to the plan members,
  339  including the impact on member copayments and coinsurance, and
  340  the cost of the drug to the plan members if the drug is
  341  excluded.
  342         (c) The Department of Management Services shall create a
  343  preferred brand name drug list to be used in the administration
  344  of the state employees’ prescription drug program.
  345         Section 3. Section 8 of ch. 99-255, Laws of Florida, is
  346  repealed.
  347         Section 4. This act shall take effect July 1, 2017.

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