Tuesday, June 21, 2011

Health insurance laws enacted in 2011 - Florida (updated)

(Status updated through 6/21/2011)

Florida’s Legislature did little to change private health insurance in 2011, but enacted several controversial bills impacting health insurance from a public policy perspective.  The enacted bills are:
  • Anti-federal purchase mandate - SJR 2 and HB 1193.
  • Abortion insurance - HB 97
  • Wellness - HB 445
  • Florida Health Choices Program - HB 1125
  • Medicaid Managed Care - HB 7107
  • Medicaid - HB 7109
On June 21, 2011, the Governor signed the last of these bills into law.  Additional information is provided below:

Anti-federal purchase mandate.  SJR 2 and HB 1193 prohibit persons from being compelled to purchase health insurance, with exceptions. SJR 2 is in the form of a Florida constitutional amendment that requires approved by 60% of Florida's voters in November 2012.  Both bills conflict with the insurance purchase mandate contained in the 2010 federal health insurance reform, Patient Protection and Affordable Care Act (PPACA).  Status: HB 1193 (Ch. No. 2011-126) became law 6/2/2011; effective upon becoming law.

Abortion insurance.  HB 97 prohibits any individual, group, or out-of-state group health insurance policy or health maintenance contract from providing coverage for an abortion (with exceptions) -- but only if purchased with state or federal funds through an exchange created under the federal PPACA.  Status:  Ch. No. 2011-111 became law 6/2/2011; effective July 1, 2011.

Wellness.  HB 445 authorizes health insurers (group and individual) and HMOs to offer voluntary health or wellness improvement programs to their insureds. The bill permits rewards and incentives to be offered for participation in the programs, including merchandise, premium discounts, copayments, and deductibles.  Status:  Ch. No. 2011-167 became law 6/17/2011; effective July 1, 2011.

Florida Health Choices Program.  HB 1125 removes the statutory limitation to participation in the Program for employers with more than 50 employees; eliminates some oversight by the Florida Office of Insurance Regulation over policies offered through the Program; and expands participation in the Program by health maintenance organizations, prepaid limited health service organizations, and discount medical plans.  Status:  Became law 6/21/2011; effective July 1, 2011.

Medicaid.  The most comprehensive health insurance bills enacted this session related to Medicaid reform.  HB 7107 (Medicaid Managed Care) establishes the Medicaid program as a statewide, integrated managed care program for all covered services.  The new program consists of two components:
  • Managed Medical Assistance will provide medically-necessary primary and acute health care services such as doctor’s visits, hospitalization, pregnancy care, and prescription drugs.  Implementation begins January 1, 2013, with full implemention by October 1, 2014.
  • Managed Long-Term Care will provide certain aged and/or disabled persons with services beyond routine health care, such as adult day care, home delivered meals, personal care, case management.  Long term care will be transformed into a managed care program effective July 1, 2012, with full implementation by October 1, 2013.
Among other key provisions of the bill:
  • Plan variety.  Medicaid recipients may choose from among a variety of plans providers, including insurers, exclusive provider organizations (EPOs), health maintenance organizations (HMOs), hospital-owned provider service networks (PSNs), and accountable care organizations (ACOs).
  • Developmentally disabled.  Enrollment of developmentally disabled into the managed care program is deferred until after 2015.
  • Intergovernmental Transfers (ITGs).  Authorizes ITGs from local funding sources that can enhance the quality and accessibility of services for Medicaid and uncompensated care patients.  IGTs consist of qualified revenue from counties, municipalities, tax districts and public hospitals.
  • Profit limits.  Places limits on how much profit can be earned by managed care plans to ensure that plans are not overspending on administration or earning profit at the expense of patient care (using “achieved savings rebates” instead of medical loss ratios).
StatusHB 7107 (Ch. No. 2011-134) became law 6/2/2011; effective July 1, 2011, subject to other implementation dates therein.  For further information, see Senate Summary.

HB 7109 (Medicaid) is designed to conform certain provisions of existing Medicaid law to HB 7107 (Medicaid Managed Care).  The bill also makes various changes to the Medicaid program not directly related to managed care, including:
  • Torts Reform.  Lawsuit protections for doctors and hospitals that treat Medicaid patients, limiting non-economic damages to $300,000 per claimant and $200,000 per provider.
  • Nursing home CONs.  The bill extends the moratorium on certificates of need (CONs) for additional nursing home beds until the Medicaid managed care is implemented statewide or October 1, 2016, whichever is earlier.
  • Rates.  AHCA is directed to implement a methodology for establishing Medicaid reimbursement rates for hospitals. The payment requirements applicable to provider service networks (PSNs) in the five Medicaid Reform pilot counties are applied to all PSNs statewide; specific requirements are established for PSN fee-for-service. 
StatusHB 7109 (Ch. No. 2011-135) became law 6/2/2011; effective July 1, 2011, subject to other implementation dates therein.  For further information, see Senate Summary.

“Ordered enrolled” means that a bill has been passed by both the House and Senate; the next step is to “enroll” (ER) the bill and send it to the Governor for action. After receipt, the Governor has 15 days to act on a bill (sign it, veto it, or allow it to become law without signature).

This summary was prepared by Perry Cone and posted at www.tallyinslaw.com/

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