December 13, 2019
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                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

  5                                           ORIGINAL STAMP BELOW

  6

  7

  8

  9

10  ______________________________________________________________

11  Representative(s) Alexander offered the following:

12

13         Amendment (with title amendment) 

14         On page 832 of the bill, between lines 12 and 13,

15

16  insert:

17         Section 893.  Effective upon this act becoming a law,

18  paragraph (h) of subsection (3) of section 110.123, Florida

19  Statutes, is amended to read:

20         110.123  State group insurance program.--

21         (3)  STATE GROUP INSURANCE PROGRAM.--

22         (h)1.  A person eligible to participate in the state

23  group insurance program may be authorized by rules adopted by

24  the department, in lieu of participating in the state group

25  health insurance plan, to exercise an option to elect

26  membership in a health maintenance organization plan which is

27  under contract with the state in accordance with criteria

28  established by this section and by said rules.  The offer of

29  optional membership in a health maintenance organization plan

30  permitted by this paragraph may be limited or conditioned by

31  rule as may be necessary to meet the requirements of state and

                                  1

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869




                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)





  1  federal laws.

  2         2.  The department shall contract with health

  3  maintenance organizations seeking to participate in the state

  4  group insurance program through a request for proposal or

  5  other procurement process, as developed by the Department of

  6  Management Services and determined to be appropriate.

  7         a.  The department shall establish a schedule of

  8  minimum benefits for health maintenance organization coverage,

  9  and that schedule shall include: physician services; inpatient

10  and outpatient hospital services; emergency medical services,

11  including out-of-area emergency coverage; diagnostic

12  laboratory and diagnostic and therapeutic radiologic services;

13  mental health, alcohol, and chemical dependency treatment

14  services meeting the minimum requirements of state and federal

15  law; skilled nursing facilities and services; prescription

16  drugs; and other benefits as may be required by the

17  department.  Additional services may be provided subject to

18  the contract between the department and the HMO.

19         b.  The department may establish uniform deductibles,

20  copayments, or coinsurance schedules for all participating HMO

21  plans.

22         c.  The department may require detailed information

23  from each health maintenance organization participating in the

24  procurement process, including information pertaining to

25  organizational status, experience in providing prepaid health

26  benefits, accessibility of services, financial stability of

27  the plan, quality of management services, accreditation

28  status, quality of medical services, network access and

29  adequacy, performance measurement, ability to meet the

30  department's reporting requirements, and the actuarial basis

31  of the proposed rates and other data determined by the

                                  2

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869




                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)





  1  director to be necessary for the evaluation and selection of

  2  health maintenance organization plans and negotiation of

  3  appropriate rates for these plans.  Upon receipt of proposals

  4  by health maintenance organization plans and the evaluation of

  5  those proposals, the department may enter into negotiations

  6  with all of the plans or a subset of the plans, as the

  7  department determines appropriate. Nothing shall preclude the

  8  department from negotiating regional or statewide contracts

  9  with health maintenance organization plans when this is

10  cost-effective and when the department determines that the

11  plan offers high value to enrollees.

12         d.  The department may limit the number of HMOs that it

13  contracts with in each service area based on the nature of the

14  bids the department receives, the number of state employees in

15  the service area, or any unique geographical characteristics

16  of the service area. The department shall establish by rule

17  service areas throughout the state.

18         e.  All persons participating in the state group

19  insurance program who are required to contribute towards a

20  total state group health premium shall be subject to the same

21  dollar contribution regardless of whether the enrollee enrolls

22  in the state group health insurance plan or in an HMO plan.

23         3.  The department is authorized to negotiate and to

24  contract with specialty psychiatric hospitals for mental

25  health benefits, on a regional basis, for alcohol, drug abuse,

26  and mental and nervous disorders. The department may

27  establish, subject to the approval of the Legislature pursuant

28  to subsection (5), any such regional plan upon completion of

29  an actuarial study to determine any impact on plan benefits

30  and premiums.

31         4.  In addition to contracting pursuant to subparagraph

                                  3

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869




                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)





  1  2., the department shall enter into contract with any HMO to

  2  participate in the state group insurance program which:

  3         a.  Serves greater than 5,000 recipients on a prepaid

  4  basis under the Medicaid program;

  5         b.  Does not currently meet the 25-percent

  6  non-Medicare/non-Medicaid enrollment composition requirement

  7  established by the Department of Health excluding participants

  8  enrolled in the state group insurance program;

  9         c.  Meets the minimum benefit package and copayments

10  and deductibles contained in sub-subparagraphs 2.a. and b.;

11         d.  Is willing to participate in the state group

12  insurance program at a cost of premiums that is not greater

13  than 95 percent of the cost of HMO premiums accepted by the

14  department in each service area; and

15         e.  Meets the minimum surplus requirements of s.

16  641.225.

17

18  The department is authorized to contract with HMOs that meet

19  the requirements of sub-subparagraphs a.-d. prior to the open

20  enrollment period for state employees.  The department is not

21  required to renew the contract with the HMOs as set forth in

22  this paragraph more than twice. Thereafter, the HMOs shall be

23  eligible to participate in the state group insurance program

24  only through the request for proposal process described in

25  subparagraph 2.

26         5.  All enrollees in the state group health insurance

27  plan or any health maintenance organization plan shall have

28  the option of changing to any other health plan which is

29  offered by the state within any open enrollment period

30  designated by the department. Open enrollment shall be held at

31  least once each calendar year.

                                  4

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869




                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)





  1         6.  When a contract between a treating provider and the

  2  state-contracted health maintenance organization is terminated

  3  for any reason other than for cause, each party shall allow

  4  any enrollee for whom treatment was active to continue

  5  coverage and care when medically necessary, through completion

  6  of treatment of a condition for which the enrollee was

  7  receiving care at the time of the termination, until the

  8  enrollee selects another treating provider, or until the next

  9  open enrollment period offered, whichever is longer, but no

10  longer than 6 months after termination of the contract. Each

11  party to the terminated contract shall allow an enrollee who

12  has initiated a course of prenatal care, regardless of the

13  trimester in which care was initiated, to continue care and

14  coverage until completion of postpartum care. This does not

15  prevent a provider from refusing to continue to provide care

16  to an enrollee who is abusive, noncompliant, or in arrears in

17  payments for services provided. For care continued under this

18  subparagraph, the program and the provider shall continue to

19  be bound by the terms of the terminated contract. Changes made

20  within 30 days before termination of a contract are effective

21  only if agreed to by both parties.

22         7.  Any HMO participating in the state group insurance

23  program shall submit health care utilization and cost data to

24  the department, in such form and in such manner as the

25  department shall require, as a condition of participating in

26  the program.  The department shall enter into negotiations

27  with its contracting HMOs to determine the nature and scope of

28  the data submission and the final requirements, format,

29  penalties associated with noncompliance, and timetables for

30  submission.  These determinations shall be adopted by rule.

31         8.  The department may establish and direct, with

                                  5

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869




                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)





  1  respect to collective bargaining issues, a comprehensive

  2  package of insurance benefits that may include supplemental

  3  health and life coverage, dental care, long-term care, vision

  4  care, and other benefits it determines necessary to enable

  5  state employees to select from among benefit options that best

  6  suit their individual and family needs.

  7         a.  Based upon a desired benefit package, the

  8  department shall issue a request for proposal for health

  9  insurance providers interested in participating in the state

10  group insurance program, and the department shall issue a

11  request for proposal for insurance providers interested in

12  participating in the non-health-related components of the

13  state group insurance program. Upon receipt of all proposals,

14  the department may enter into contract negotiations with

15  insurance providers submitting bids or negotiate a specially

16  designed benefit package. Insurance providers offering or

17  providing supplemental coverage as of May 30, 2002 1991, which

18  qualify for pretax benefit treatment pursuant to s. 125 of the

19  Internal Revenue Code of 1986, with 5,500 or more state

20  employees currently enrolled shall may be included by the

21  department in the supplemental insurance benefit plan

22  established by the department without participating in a

23  request for proposal, submitting bids, negotiating contracts,

24  or negotiating a specially designed benefit package. These

25  contracts shall provide state employees with the most

26  cost-effective and comprehensive coverage available; however,

27  no state or agency funds shall be contributed toward the cost

28  of any part of the premium of such supplemental benefit plans.

29  With respect to dental coverage, the division shall include in

30  any solicitation or contract for any state group dental

31  program made after July 1, 2001, a comprehensive indemnity

                                  6

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869




                                                   HOUSE AMENDMENT

                   Bill No. CS for CS for SB's 662 & 232, 2nd Eng.

    Amendment No. ___ (for drafter's use only)





  1  dental plan option which offers enrollees a completely

  2  unrestricted choice of dentists. If a dental plan is endorsed,

  3  or in some manner recognized as the preferred product, such

  4  plan shall include a comprehensive indemnity dental plan

  5  option which provides enrollees with a completely unrestricted

  6  choice of dentists.

  7         b.  Pursuant to the applicable provisions of s.

  8  110.161, and s. 125 of the Internal Revenue Code of 1986, the

  9  department shall enroll in the pretax benefit program those

10  state employees who voluntarily elect coverage in any of the

11  supplemental insurance benefit plans as provided by

12  sub-subparagraph a.

13         c.  Nothing herein contained shall be construed to

14  prohibit insurance providers from continuing to provide or

15  offer supplemental benefit coverage to state employees as

16  provided under existing agency plans.

17

18

19  ================ T I T L E   A M E N D M E N T ===============

20  And the title is amended as follows:

21         On page 8, line 20 after the semicolon,

22

23  insert:

24         amending s. 110.123, F.S.; requiring inclusion

25         of certain supplemental coverage within a

26         supplemental insurance benefit plan;

27

28

29

30

31

                                  7

    File original & 9 copies    03/22/02
    hag0009                     09:52 am         00662-0066-024869

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