Health Care Legislation Update, 4/16/2016

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Health Care Legislation Update, 4/16/2016

Pooled Purchasing: HB 1629 2

Creation of Health Plans for Uninsurable: HB 1629 2

Health Flex Pilot Program Expansion: HB 1629 3

Local Initiatives: HB 1843, SB 708 4

KidCare 5

Appropriate Use of Emergency Room Services: HB 1629 6

Protection of Safety-Net Providers: HB 1843, Appropriations Bill 7

Utilization of Electronic Health Care Information: HB 1629 8

Consumer Protection and Information, Promotion of Healthy Lifestyles: HB 1629 9

Evidence-based Medicine: HB 1629 11

Pooled Purchasing: HB 1629


Health Care Coverage

Summary of Legislation

  • Creates the “Small Employers Access Program”. Provides for pooled purchasing of health insurance options for employers with 25 or less employees.

  • Also permits municipalities, schools, hospitals, or nursing home employers in a rural community to participate.

  • Authorizes OIR to competitively bid for geographic regions similar to those used by Healthy Kids Corporation.

  • Provides for standard benefit packages and alternative benefit packages.

  • Limits participation to employers who have not offered health insurance benefits for at least six months.

  • Provides for an appropriation of $250,000 from the Insurance Regulatory Trust Fund for implementation of the Small Employers Access Program.

  • Provides for: “Mutually supported benefit plan means an optional alternative coverage plan developed within a defined geographic region, which may include, but is not limited to, a minimum level of primary care coverage in which the percentage of the premium is distributed among the employer, the employee, and community generated revenue either alone or in conjunction with federal matching funds.”


November 2004

  • RFI developed to solicit ideas and gauge participation by small group carriers. Eight RFI responses received – Aetna, BCBS of Florida, Neighborhood Health Plan, Florida Health Care Plans, Humana, Pacific Life and Annuity, Total Health Choice and United Healthcare.

  • J. Bracher and Associates contracted by OIR to assist in the design, evaluation and assessment of the program.

  • Follow-up meetings/conference calls held with FL Chamber of Commerce, Capital Health Plan, and BCBS of Florida. Additional calls scheduled.

May 2005

    • Final Project Report, Implementation of the Small Employers Access Program by J. Bracher & Associates completed February 2, 2005:

  • RFI was issued to carriers with responses of little interest due to past experience with pooled purchasing in Florida.

    • Recommendations:

  • OIR should issue RFP to all small employer insurers requesting proposals to provide coverage to potential participants in the Program;

  • This RFP should include a Question and Answer attachment responding, at a minimum, to the questions outlined in this report; and

  • OIR should convene a group of insurers and insurer trade associations to develop consensus on, and support for, legislative recommendations related to the program.

March 2006

  • (From OIR) A “Statement of Qualifications/Request for Quote—Small Employers Access Program” was issued on November 15, 2005, to obtain proposals from licensed health insurers to provide insurance coverage through the Small Employers Access Program as provide. Deadline for responses was January 15, 2006. No responses were received. A final report summarizing all activity, including the RFQ, is being prepared.

Creation of Health Plans for Uninsurable: HB 1629


Health Care Coverage

Summary of Legislation

  • Creates the Florida Health Insurance Plan for people with no other option for coverage.

  • Establishes the FHIP board and procedures.

  • Requires that the plan administrator be selected through competitive bidding; combines membership of the comprehensive health association.

  • Requires an actuarial study by December 1, 2004, regarding funding and impact on small employers. Includes $250,000 for the required actuarial study.

  • Premiums will be capped at 300% of standard risk rate, subject to a sliding surcharge based on insured’s income.

  • Requires an appropriation before action can be taken to implement the FHIP.

  • Following completion of the actuarial study and implementation of the Florida Health Insurance Plan, existing risk pool members enrolled in the Florida Comprehensive Health Care Association will be subsumed under FHIP.


November 2004

  • DFS/OIR procured an actuarial study being completed by Mercer Oliver Wyman. OIR requested data from the active market to assist Mercer in its study. Data was received and modeling work began in mid-October. A report was issued November 11, 2004. Available online at:

  • OIR appointed staff resources to assist the Florida Health Insurance Plan Board. The FHIP board met August 26, September 2, and November 10, 2004.

  • New standard and basic plans, to cover current risk-pool enrollees, have been designed, approved by the board (8/26) and will be effective January 1, 2005. Notice of benefit changes and new premium rates were to be sent October 1, 2004.

May 2005

  • Both House and Senate had bills went to the floor but neither chamber could accept the other’s bill. As a result, the FCHA continues to operate but is closed to new members.

March 2006

  • An annual update to the actuarial report was submitted to the Governor on December 1, 2005.

Health Flex Pilot Program Expansion: HB 1629


Health Care Coverage

Summary of Legislation

  • Eliminates geographic restrictions to make Health Flex an option statewide.

  • Allows Health Flex plans to develop catastrophic coverage plans.

  • Requires Health Flex Plans to comply with standard grievance procedures similar to HMOs.

  • Requires regulatory oversight of plan advertisement and marketing procedure.

  • Requires completion of an evaluation of the Health Flex Plan benefit packages and a report by the AHCA on or before January 1, 2005.


November 2004

  • Current participation is:

  • JAXCare: 87

  • American Care: 82

  • Preferred Medical: 17

  • Jackson Memorial Health Plan: 1,300

  • Revisions to program application package completed including standards for plan marketing and advertising. Awaiting approval and transmittal to AHCA.

  • May 2005.

  • Same four plans, Palm Beach HCD expected to apply.

  • Interviews and focus groups recommend increasing eligibility for participants from 200% of FPL to 250 or 300% of FPL.

  • No change in 2005 Legislature.

  • JaxCare received appropriation of $101,929 to provide services to uninsured individuals.

March 2006

  • 2006 Annual Report on AHCA web:

  • Current participation

  • JaxCare: 319

  • American Care: 39

  • Preferred Medical Plan: 22

  • The Public Health Trust of Dade County: 828

  • New plan approved under the name of Vita Health, premiums on a sliding scale, sponsored and subsidized by the Health Care District of Palm Beach County, April 1, 2006.

  • Plans recommend: Increasing the income eligibility standard; funds for subsidizing premiums; and establishing eligible small business based on mean or median income of all employees.

Local Initiatives: HB 1843, SB 708


Health Care Coverage

Summary of Legislation

  • HB 1843: Supports local initiatives by providing for a review of the upper-payment-limit (UPL) funding option and how this option may be used to promote health care initiatives determined by the council to be state health care priorities.

  • SB 708: Provides for a pilot program in Monroe County to establish a self-insurance plan to be administered through a non-profit corporation.


November 2004

  • Some local programs are utilizing Health Flex as a vehicle to provide limited benefit health insurance products to low-income uninsured adults:

  • Jackson Health Plan has become a Health Flex provider enrolling 1,300 persons by November, 2004 with incomes below 200% FPL. This approach combines a local coverage initiative with Health Flex, enabling provision of a limited benefit package to otherwise uninsured persons and subsidizing the premium amount on a sliding scale with no premium required for persons with incomes below 100% FPL.

  • JaxCare is an approved Health Flex plan provider and has enrolled 87 persons.

  • The ability to subsidize the Health Flex Plan premium appears to make these limited benefit packages more attractive, since both local Health Flex plans have experienced faster enrollment than non-subsidized products. (See Health Flex section.)

  • Alachua County enacted a ¼ cent sales tax to support health services for uninsured residents (passed by 62% of voters). The tax will generate $7 million a year. The program (CHOICES) will offer primary care, pharmacy assistance, limited hospital services and basic adult dental services along with a disease management program for persons with diabetes, hypertension, asthma, and congestive heart failure.



Health Care Coverage

Summary of Legislation

  • Conference Report on HB 1835: Permits use of additional local and family funds to serve additional children.

  • Conference Report on HB 1837, SB 2000:

  • Establishes open enrollment periods for Florida KidCare program.

  • First enrollment period is January 1, 2005 to January 30, 2005.

  • People on waiting list as of March 12, 2004 are eligible to enroll upon becoming law.

  • Conference Amendment to HB 1843, SB 2000:

  • Requires that children be enrolled on a first come, first served basis (rather than maintenance of a waiting list and enrollment from this list).

  • Excludes enrollment of children whose parents have access to employer-sponsored insurance (unless the cost of the child’s insurance is more than 5% of the family income or the child has a pre-existing condition that precludes access to ESI).

  • Requires proof of family income supported by copies of any federal income tax return for the prior year, any wages and earnings statements (W-2 forms), and any other appropriate document.


November 2004

  • The legislature funded the waiting list and increased funding for 2004-2005.

  • January 2005 – open enrollment will begin and September and January open enrollment thereafter, if the Florida KidCare administrators unanimously recommend this and the Social Services Estimating Conference determines there is sufficient funding to continue through FFY 2007.

  • Transfers between program components will be allowed outside of open enrollment periods (MediKids, Kid Care, etc.).

  • Income verification now required using most recent pay stub or wage statement and tax return and W-2 and documentation of unearned income.

  • If parents have access to ESI and ESI is “affordable” (costs 5% or less of annual income) child ineligible. If ESI is unavailable due to a pre-existing condition, child is eligible for KidCare. Voluntary cancellation of ESI within 6 months prior to application disqualifies child.

  • If the program goes over budget, children will be disenrolled – last in, first out.

  • Non-payment of premium results in ineligibility for 60 days (and this requirement was waived through November 1 following several hurricanes).

May 2005

  • 2005 Legislature, HB 569, reversed the changes made to limited enrolment periods enacted in 2004. Enrollment had dropped from 336,689 to 226,016 in the past year. An open, year around, enrollment, process is now in effect.

Appropriate Use of Emergency Room Services: HB 1629


Health Care Cost Drivers

Summary of Legislation

  • Establishes an Emergency Room Diversion Program: Permits hospitals to develop emergency room diversion programs, including:

    • An "Emergency Hotline", which allows patients to help determine if emergency department services are appropriate or if other health care settings may be more appropriate for care;

    • A "Fast Track" program allowing non-emergency patients to be treated at an alternative site; and

    • Provisions for follow-up care and case management.

      • Other health care settings include:

  • Health care programs funded with local tax revenue;

  • Federally funded community health centers;

  • County health departments; or

  • Other non-hospital providers of health care services.


    • There is discussion regarding a possible pilot project in Palm Beach County that would develop community-wide call schedules for certain physician specialties.

May 2005

    • Appropriations bill funds $250,000 for pilot emergency room diversion project in Naples.

    • CS for CS for SB 838. Where feasible, safe, and cost effective, the agency shall encourage hospitals, emergency medical services providers, and other public and private health care providers to work together in their local communities to enter into agreements and arrangements to ensure access to alternatives to emergency services and care for those Medicaid recipients who need non emergent care. The agency shall coordinate with hospitals, emergency medical services providers, private health plans, capitated managed care networks as established in s. 409.91211, and other public and private health care providers to implement the provisions of ss. 395.1041 (7), 409.91255(3) (g), 627.6405, and 641.31097 to develop and implement emergency department diversion programs for Medic aid recipients.

Protection of Safety-Net Providers: HB 1843, Appropriations Bill


Health Care Coverage

Summary of Legislation

  • HB 1843: Provides for reallocation of DSH funds not otherwise allocated to hospitals to non-state government owned hospitals (e.g. county hospitals) that have greater than 3,300 Medicaid days.

  • Appropriations Bill (Page 48): Provides for funds in Specific Appropriation 202, $870,028 from the Grants and Donations Trust Fund and $1,246,829 from the Medical Care Trust Fund to be used for special Medicaid payments to hospitals providing low-income individuals access to primary care clinics.

  • Hospitals that participated in the Primary Care DSH program in State Fiscal Year 2003-04 and are currently receiving special Medicaid payments for primary care are not eligible to receive funds under this section.

  • AHCA is required to establish criteria for hospitals to receive funds under this section and a methodology for distributing the funds no later than November 1, 2005.

  • At a minimum, a hospital qualifying to receive funds must provide financial support to a freestanding clinic in the hospital’s local community that provides primary care to individuals free of charge and/or on a sliding fee schedule.


    • The AHCA has been awarded a grant from HRSA to assess the capacity of Florida’s ambulatory “safety-net”. The grant will also include development of a state-wide strategic plan for the safety-net and funding will be sought from HRSA to develop and assist safety-net providers with implementations of plans designed to strengthen their capacity.

May 2005

    • Safety-net providers recognized in Medicaid Reform legislation. Hospital safety-net is to be protected by waiver for UPL special payments with growth rate, disproportionate share funds; new managed care entities to include FQHCs, Rural Health Clinics, County Health Departments, etc.

March 2006

    • The Florida Medicaid Reform Waiver secured an amount of $1billion per year for the hospital and ambulatory safety-net providers. On July 1, 2006, or upon implementation of the waiver, Florida will administer a Low-Income Pool program. The former special payments to hospitals under the Upper Payment Limit provisions will cease. CMS Terms and Conditions and Legislative Direction have been provided. AHCA must submit plan for the program to CMS.

Utilization of Electronic Health Care Information: HB 1629


Health Care Cost Drivers

Summary of Legislation

  • Requires AHCA to develop and implement a strategy for the adoption and use of electronic health records.

  • Provides for a $2 million appropriation to AHCA for implementation of the electronic medical records provision.


November 2004

  • Florida’s Health Information Infrastructure Advisory Board was created by Executive Order. Its mission is to promote the adoption of electronic health records and the networking of information needed for patient care and public health.

  • The Board began meeting in July and has received public input from stakeholders including physicians, hospitals, pharmacists and other health care providers and stakeholders concerning the use of EMRs.

  • During a two-day workshop and meeting, the Advisory Board recommended Florida be a lead state in establishing community pilot initiatives to transition to an electronic records system. The Advisory Board will develop and recommend criteria for selection of communities and will also recommend a 24-month timetable for implementation and measurement of the pilot programs. For more information see the AHCA website, Florida’s Health Information Infrastructure icon at:

May 2005

  • CS for CS for SB 838. “By April 1, 2006, the agency shall contract with an entity to design a database of clinical utilization information or electronic medical records for Medicaid providers. This system must be web-based and allow providers to review on a real-time basis the utilization of Medicaid services, including but not limited to, physician office visits, inpatient and outpatient hospitalizations, laboratory and pathology services, radiological and other imaging services, dental care, and patterns of dispensing prescription drugs in order to coordinate care and identify potential fraud and abuse.”

March 2006

    • On January 6, Florida Health Information Network (FHIN) grants were awarded to facilitate the adoption and use of privacy-protected health records in Florida. $1.5 million awarded.

  • Planning Grants:

  • Access Escambia, Inc., $150,000

  • Central Florida Health are Coalition, $108,864

  • Health First, Inc. Brevard County, $44,789

  • Health Foundation of South Florida, $127,924

  • Pinellas County Health Department, $110,985

  • Implementation Grant:

  • Big Bend Regional Healthcare Information Organization, $246,850

  • Health Care District of Palm Beach County, $250,000

  • Tampa Bay Partnership Regional Research and Education Foundation, $467,000

  • Training and Technical Assistance Grant:

  • Florida Academy of Family Physicians, $25,316

Consumer Protection and Information, Promotion of Healthy Lifestyles: HB 1629


Consumer Protection

Summary of Legislation

  • Authorizes regulation of discount medical plans.

  • Requires small group carriers to develop a high-deductible plan that meets the federal requirements for a health savings account (HSA) or a health reimbursement arrangement (HRA).

  • Authorizes insurance rebate for healthy lifestyles.

  • Adds insurance advisors as a type of agent and defines duties and responsibilities of the advisor.

  • Provisions related to “transparency”:

  • Requires all policies and rates to be submitted to OIR.

  • Requires AHCA to place on web site information regarding “age specific, disease specific and community specific health promotion, preventative care and wellness programs”.

  • Requires each licensed facility to place performance out-come and financial data on a website.

  • Requires pharmacies to report retail prices for the 50 most frequently prescribed medicines and the Agency to make available data on website.

  • Requires health care facilities to make available on a website patient charge, volumes, length of stay, and performance outcome indicators collected from health care facilities for no less than 50 inpatient and 50 outpatient procedures.

  • Contains an extensive section for AHCA in conjunction with a: “State Comprehensive Health Information System Advisory Council” to implement a long-range plan for making performance outcome and financial data available that will allow consumers to compare health care services.

  • Establishes a Healthy Communities, Healthy People Program.

  • Establishes a Patient Safety Corporation.


November 2004

  • OIR drafted rules to amend regulations and rate filing requirements concerning discount medical plans. Rule workshop held October 7 and hearing held November 22. Informational memorandum issued October 21 regarding implementation of new requirements.

  • All small employer carriers have complied with requirements to file an HSA or HRA compatible benefit plan. 16 carriers are offering HSAs and five HRAs.

  • OIR has drafted rules enabling carriers to offer a healthy lifestyles rebate and a workshop was held by OIR in August concerning the draft rules. Proposed rules were published in September and a hearing held October 21.

  • The State Comprehensive Health Information System (CHIS) Advisory Council was established by statute to advise the Agency regarding data collection and public reporting, especially the publication of comparative health data for consumers. The CHIS Advisory Council meets four or more times each year at the AHCA offices in Tallahassee or various locations in the state. Meetings are noticed in the Florida Administrative Weekly and are open to the public.

May 2005

  • Health Savings Accounts:

  • OIR reports carriers responding to survey have issued policies covering 24,072.

  • All small employer carriers complied with requirement to file.

  • Sixteen carriers are offering HSAs and five offering HRAs.

  • 2005 Legislation extends requirement for small group carriers to issue HSA or HRA plans to one-person group.

  • Discount Medical plans: Plans filing applications per rules; Florida appointed lead in NAIC for development of model legislation.

  • 2005 Legislature modified existing authority.

Agency on data reporting requirements in HB 1629, and publishes its work on the Florida Health Statistics web site. Two technical workgroups were recommended at the October 20, 2004 meeting of the CHIS Advisory Council; the Hospital Acquired Infections Technical Work Group and the Health Care Facility Web Site Technical Workgroup.

“The purpose of the Hospital Acquired Infections work group is to advise the Agency on issues concerning hospital acquired infections. Specific topics to be examined by the Hospital Acquired Infections Technical Workgroup include:

    • Reporting of Surgical Infection Prevention (SIP) measures

    • Reviewing current systems of reporting infection rates

    • Determining the appropriate infection measures to report”.

  • On October 15, 2004, AHCA activated a “Consumer Health Data” feature on the website: This site contains the information on hospital inpatient, outpatient and ambulatory surgical centers. Information on number of hospitalizations for particular conditions/procedures is available. Case mix adjusted average charges and average length of stay also can be found.

  • Consumer Data for Pharmacy: AHCA is working on the requirements and scope of work for reporting of the 50 generic and brand name drugs on the web site. Completion of this effort is scheduled for October 1, 2005.

March 2006

  • OIR: “All small employer carriers have complied with the requirement to file an HSA or HRA compatible benefit plan. Sixteen carriers are offering HSAs and five are offering HRAs.

  • 2005 legislation extends the requirement for small group carriers to issue HSA or HRA plans to one-person groups.”

  • OIR: Lifestyles Rebates:

  • “Rules have been developed to implement the Healthy Lifestyle Rebate. Carriers have complied with rebate requirement.

  • Rules 69O-149.0055 and 69O-191.0545 were adopted effective March 24, 2005.

  • 2005 legislation has made offering a rebate to individual policy holders optional and allowed group rebates to be either calendar or policy year. The subsequent rules were adopted effective January 12, 2006.”

  • OIR reports as of 2/1/2006 that carriers have reported issuing 10,682 HSA policies covering 46,369 lives.

Evidence-based Medicine: HB 1629


Health Care Cost Drivers

Summary of Legislation

  • Establishes the Patient Safety Corporation and advisory committees. The Corporation and committee tasks include:

  • Provisions for accumulation of literature specific to the use of evidence-based medicine;

  • Analysis of the feasibility of joining or supporting evidence-based efforts already underway;

  • Assessment of methods that could be used to encourage use of such practices; and

  • An implementation plan that includes key components of the Comprehensive Health Information System and Patient Safety Corporation [evidence-based medicine being one component].


  • The Florida Patient Safety Corporation is currently in its initial start-up phase.

March 2006

  • Florida Patient Safety Corporation as been established and has assembled resources on its web site:

Medicaid Coverage issues:

Authorized study for Medicaid Buy-In: “The Office of Program analysis and Governmental Accountability shall conduct a study of state programs that allow non-Medicaid eligible persons under a certain income level to buy into the Medicaid program as if it was private insurance. The study shall examine Medicaid buy-in programs in other states to determine if there are any models that can be implemented in Florida which would provide access to uninsured Floridians and what effect this program would have on Medicaid expenditures based on the experience of similar states. The study must also examine whether the Medically Needy program could be redesigned to be a Medicaid buy-in program. The study must be submitted to the Legislature by January 1, 2006.”

CS for CS for SB 404:

Repeals language that would have changed the Medically Needy program to pharmacy benefits only on July 1, 2005;

Repeals language that would have reduced eligibility for Medicaid for pregnant women with incomes between 185% and 150% of the Federal Poverty level beginning on July 1, 2005;

Repeals language that would have eliminated the adult dental coverage in the Medicaid program effective July 1, 2005.


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