Bill Text: FL S2508 | 2017 | Regular Session | Engrossed
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-Engrossed.html
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-Engrossed.html
SB 2508 First Engrossed 20172508e1 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 a contingency-based contract; requiring the 7 division to notify subscribers of dependent 8 eligibility rules by a certain date; requiring the 9 division to hold a subscriber harmless for past claims 10 of ineligible dependents for a specified timeframe; 11 providing for applicability; removing a requirement 12 that the Department of Management Services submit 13 budget amendments pursuant to ch. 216, F.S., regarding 14 vendor 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 authorizing foreign-born subscribers to submit an 26 affidavit in lieu of documentation under certain 27 circumstances; specifying that original or photocopied 28 documentation may be submitted; authorizing a 29 subscriber to redact unnecessary information before 30 submitting documentation; requiring the contractor to 31 retain documentation obtained for dependent 32 eligibility verification services for a specified 33 timeframe; requiring the department and the contractor 34 to destroy such documentation after a specified date; 35 amending s. 110.12315, F.S.; providing that retail, 36 mail order, and specialty pharmacies participating in 37 the state employees’ prescription drug program shall 38 be reimbursed as established by contract; revising 39 supply limitations under the program; requiring that 40 the pharmacy dispensing fee be negotiated by the 41 department; revising provisions governing the 42 reimbursement schedule for prescription drugs and 43 supplies dispensed under the program; requiring the 44 department to maintain certain lists; establishing 45 supply limitations for maintenance drugs and supplies; 46 specifying pricing of certain copayments by health 47 plan members; deleting a provision requiring the 48 department to implement additional cost-saving 49 measures and adjustments; revising copayment and 50 coinsurance amounts for the State Group Health 51 Insurance Standard Plan and the State Group Health 52 Insurance High Deductible Plan; providing an effective 53 date. 54 55 Be It Enacted by the Legislature of the State of Florida: 56 57 Section 1. Section 110.12301, Florida Statutes, is amended 58 to read: 59 110.12301 Competitive procurement of postpayment claims 60 review services and dependent eligibility verification 61 services.—The Division of State Group Insurance is directed to 62 competitively procure: 63 (1) Postpayment claims review services for the state group 64 health insurance plans established pursuant to s. 110.123. 65 Compensation under the contract shall be paid from amounts 66 identified as claim overpayments that are made by or on behalf 67 of the health plans and that are recovered by the vendor. The 68 vendor may retain that portion of the amount recovered as 69 provided in the contract. The contract must require the vendor 70 to maintain all necessary documentation supporting the amounts 71 recovered, retained, and remitted to the division; and 72 (2) Acontingency-basedcontract for dependent eligibility 73 verification services for the state group insurance program; 74 however, compensation under the contract may not exceed 75 historical claim costs for the prior 12 months for the dependent 76 populations disenrolled as a result of the contractor’svendor’s77 services. 78 (a)1. By September 1, 2017, the division shall notify all 79 subscribers regarding the eligibility rules for dependents. 80 Through November 30, 2017, the division mustmay establish a 381month grace period andhold subscribers harmless for past claims 82 of ineligible dependents if such dependents are removed from 83 plan membership before December 1, 2017. 84 2. Subparagraph 1. does not apply to any dependent 85 identified as ineligible before July 1, 2017, for which the 86 department has notified the state agency employing the 87 associated subscriberThe Department of Management Services88shall submit budget amendments pursuant to chapter 216 in order89to obtain budget authority necessary to expend funds from the90StateEmployees’ Group Health Self-Insurance Trust Fund for91payments to the vendor as provided in the contract. 92 (b) The contractor providing dependent eligibility 93 verification services may request the following information from 94 subscribers: 95 1. To prove a spouse’s eligibility: 96 a. If married less than 12 months and the subscriber and 97 his or her spouse have not filed a joint federal income tax 98 return, a government-issued marriage certificate; or 99 b. If married for 12 or more months, a transcript of the 100 most recently filed federal income tax return. 101 2. To prove a biological child’s or a newborn grandchild’s 102 eligibility, a government-issued birth certificate. 103 3. To prove an adopted child’s eligibility: 104 a. An adoption certificate; or 105 b. An adoption placement agreement and a petition for 106 adoption. 107 4. To prove a stepchild’s eligibility: 108 a. A government-issued birth certificate for the stepchild; 109 and 110 b. The transcript of the subscriber’s most recently filed 111 federal income tax return. 112 5. Any other information necessary to verify the 113 dependent’s eligibility for enrollment in the state group 114 insurance program. 115 (c) If a document requested from a subscriber is not 116 confidential or exempt from public records requirements, the 117 division and the contractor shall disclose to all subscribers 118 that such information submitted to verify the eligibility of 119 dependents may be subject to disclosure and inspection under 120 chapter 119. 121 (d) A government-issued marriage license or marriage 122 certificate submitted for dependent eligibility verification 123 must include the date of the marriage between the subscriber and 124 the spouse. 125 (e) A government-issued birth certificate submitted for 126 dependent eligibility verification must list the parents’ names. 127 (f) Foreign-born subscribers unable to obtain the necessary 128 documentation within the specified time period of producing 129 verification documentation may execute a signed affidavit 130 attesting to eligibility requirements. 131 (g) Documentation submitted to verify eligibility may be an 132 original or a photocopy of an original document. Before 133 submitting a document, the subscriber may redact any information 134 on a document which is not necessary to verify the eligibility 135 of the dependent. 136 (h) All documentation obtained by the contractor to conduct 137 the dependent eligibility verification services must be retained 138 until June 30, 2019. The department or the contractor is not 139 required to retain such documentation after June 30, 2019, and 140 shall destroy such documentation as soon as practicable after 141 such date. 142 Section 2. Upon the expiration and reversion of the 143 amendments made to section 110.12315, Florida Statutes, pursuant 144 to section 123 of chapter 2016-62, Laws of Florida, section 145 110.12315, Florida Statutes, is amended to read: 146 110.12315 Prescription drug program.—The state employees’ 147 prescription drug program is established. This program shall be 148 administered by the Department of Management Services, according 149 to the terms and conditions of the plan as established by the 150 relevant provisions of the annual General Appropriations Act and 151 implementing legislation, subject to the following conditions: 152 (1) The department shall allow prescriptions written by 153 health care providers under the plan to be filled by any 154 licensed pharmacy and reimbursed pursuant to subsection (2) 155contractual claims-processing provisions.Nothing inThis 156 section may not be construed as prohibiting a mail order 157 prescription drug program distinct from the service provided by 158 retail pharmacies. 159 (2) In providing for reimbursement of pharmacies for 160 prescription drugs and suppliesmedicinesdispensed to members 161 of the state group health insurance plan and their dependents 162 under the state employees’ prescription drug program: 163 (a) Retail, mail order, and specialty pharmacies 164 participating in the program must be reimbursed as established 165 by contract andat a uniform rate and subject to uniform166conditions,according to the terms and conditions of the plan. 167 (b) There isshall bea 30-day supply limit for retail 168 pharmacy fills, a 90-day supply limit for mail order fills, and 169 a 90-day supply limit for maintenance drug fills by retail 170 pharmaciesprescription card purchases and 90-day supply limit171for mail order or mail order prescription drug purchases. This 172 paragraph may not be construed to prohibit fills at any amount 173 less than the applicable supply limit. 174 (c) Thecurrentpharmacy dispensing fee shall be negotiated 175 by the departmentremains in effect. 176 (d)(3)The departmentof Management Servicesshall 177 establish the reimbursement schedule for prescription drugs and 178 suppliespharmaceuticalsdispensed under the program. 179 Reimbursement rates for a prescription drug or supply 180pharmaceuticalmust be based on the cost of the generic 181 equivalent drug or supply if a generic equivalent exists, unless 182 the physician, advanced registered nurse practitioner, or 183 physician assistant prescribing the drug or supply 184pharmaceuticalclearly states on the prescription that the brand 185 name drug or supply is medically necessary or that the drug or 186 supplyproductis included on the formulary of drugs and 187 suppliesdrug productsthat may not be interchanged as provided 188 in chapter 465, in which case reimbursement must be based on the 189 cost of the brand name drug or supply as specified in the 190 reimbursement schedule adopted by the departmentof Management191Services. 192 (3) The department shall maintain the generic, preferred 193 brand name, and the nonpreferred brand name lists of drugs and 194 supplies to be used in the administration of the state 195 employees’ prescription drug program. 196 (4) The department shall maintain a list of maintenance 197 drugs and supplies. 198 (a) Preferred provider organization health plan members may 199 have prescriptions for maintenance drugs and supplies filled up 200 to three times as a supply for up to 30 days through a retail 201 pharmacy; thereafter, prescriptions for the same maintenance 202 drug or supply must be filled for up to 90 days either through 203 the department’s contracted mail order pharmacy or through a 204 retail pharmacy. 205 (b) Health maintenance organization health plan members may 206 have prescriptions for maintenance drugs and supplies filled for 207 up to 90 days either through a mail order pharmacy or through a 208 retail pharmacy. 209 (5) Copayments made by health plan members for a supply for 210 up to 90 days through a retail pharmacy shall be the same as 211 copayments made for a similar supply through the department’s 212 contracted mail order pharmacy. 213 (6)(4)The departmentof Management Servicesshall conduct 214 a prescription utilization review program. In order to 215 participate in the state employees’ prescription drug program, 216 retail pharmacies dispensing prescription drugs and supplies 217medicinesto members of the state group health insurance plan or 218 their covered dependents, or to subscribers or covered 219 dependents of a health maintenance organization plan under the 220 state group insurance program, shall make their records 221 available for this review. 222(5) The Department of Management Services shall implement223such additional cost-saving measures and adjustments as may be224required to balance program funding within appropriations225provided, including a trial or starter dose program and226dispensing of long-term-maintenance medication in lieu of acute227therapy medication.228 (7)(6)Participating pharmacies must use a point-of-sale 229 device or an online computer system to verify a participant’s 230 eligibility for coverage. The state is not liable for 231 reimbursement of a participating pharmacy for dispensing 232 prescription drugs and supplies to any person whose current 233 eligibility for coverage has not been verified by the state’s 234 contracted administrator or by the departmentof Management235Services. 236(7) Under the state employees’ prescription drug program237copayments must be made as follows:238 (8)(a) Effective July 1, 2017January 1, 2006, for the 239 State Group Health Insurance Standard Plan, copayments must be 240 made as follows: 241 1. For a supply for up to 30 days from a retail pharmacy: 242 a. For generic drugwith card.....................$7$10. 243 b.2.For preferred brand name drugwith card.....$30$25. 244 c.3.For nonpreferred brand name drugwith card..$50$40. 245 2. For a supply for up to 90 days from a mail order 246 pharmacy or a retail pharmacy: 247 a.4.For genericmail orderdrug.................$14$20. 248 b.5.For preferred brand namemail orderdrug....$60$50. 249 c.6.For nonpreferred brand namemail orderdrug$100$80. 250 (b) Effective July 1, 2017January 1, 2006, for the State 251 Group Health Insurance High Deductible Plan, coinsurance must be 252 paid as follows: 253 1. For a supply for up to 30 days from a retail pharmacy: 254 a.Retail coinsuranceFor generic drugwith card.....30%. 255 b.2.Retail coinsuranceFor preferred brand name drugwith256card........................................................30%. 257 c.3.Retail coinsuranceFor nonpreferred brand name drug 258with card...................................................50%. 259 2. For a supply for up to 90 days from a mail order 260 pharmacy or a retail pharmacy: 261 a.4. Mail order coinsuranceFor generic drug.........30%. 262 b.5. Mail order coinsuranceFor preferred brand name 263 drug........................................................30%. 264 c.6. Mail order coinsuranceFor nonpreferred brand name 265 drug........................................................50%. 266(c) The Department of Management Services shall create a267preferred brand name drug list to be used in the administration268of the state employees’ prescription drug program.269 Section 3. This act shall take effect July 1, 2017.