To update the rule by adding a definition of Health Maintenance Organization (HMO) Region.

 

DEPARTMENT OF MANAGEMENT SERVICES

Division of State Employees' Insurance

RULE NO.:RULE TITLE:

60P-1.003Definitions

PURPOSE AND EFFECT: To update the rule by adding a definition of Health Maintenance Organization (HMO) Region.

SUMMARY: The amendment establishes a definition for HMO Region, consistent with section 110.123(3)(h)2.d, F.S., which requires the department to establish regions throughout the state within which an HMO is authorized by contract to provide services to State Group Insurance Program enrollees.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Pursuant to section 110.123(3)(h)2.d, F.S., the rule is required to be submitted for ratification by the Legislature.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 110.123(3)(h)2.d, 110.123(5), F.S.

LAW IMPLEMENTED: 110.123, F.S.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Greg Mauldin, Manager of Policy & Contracts, Department of Management Services, Division of State Group Insurance, 4050 Esplanade Way, Tallahassee, FL 32399, or [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

60P-1.003 Definitions.  

For the purpose of administering the State Group Insurance Program, the following words and terms shall have the meaning indicated:  

(1) through (11) No change.

(12) “Health maintenance organization (HMO) Region service area” is a county or designated geographical means the geographic area composed of a county or contiguous counties within which an HMO is authorized by contract with the Department to provide covered services to Subscribers which the HMO has received a Certificate of Authority issued by the Florida Department of Insurance to provide or arrange for comprehensive health services and for which the HMO has received approval to offer such services to state employees residing in the area. The Department has established the designated geographical areas for use in procurements of HMO services as set forth below:  

(a) Region 1 consists of Bay, Calhoun, Escambia, Gulf,­ Holmes, Jackson, Okaloosa, Santa Rosa, Walton, and Washington Counties.

(b) Region 2 consists of Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla Counties.

(c) Region 3 consists of Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Marion, Suwannee, and Union Counties.

(d) Region 4 consists of Baker, Clay, Duval, Flagler, Nassau, Putnam, St. Johns, and Volusia Counties.

(e) Region 5 consists of Brevard, Indian River, Lake, Orange, Osceola, and Seminole Counties.

(f) Region 6 consists of Citrus, DeSoto, Hardee, Hernando, Highlands, Hillsborough, Manatee, Pasco, Pinellas, Polk, Sarasota, and Sumter Counties.

(g) Region 7 consists of Martin, Okeechobee, Palm Beach, and St. Lucie Counties.

(h) Region 8 consists of Charlotte, Collier, Glades, Hendry, and Lee Counties.

(i) Region 9 consists of Broward, Miami-Dade, and Monroe Counties.

(13) through (24) No change.  

Specific Authority 110.123(3)(h)2.d, 110.123(5) FS. Law Implemented 110.123 FS. History–New 11-2-76, Amended 2-3-77, 6-30-77, 7-1-80, Formerly 22K-1.03, Amended 7-16-86, 9-25-86, 4-11-88, Formerly 22K-1.103, Amended 8-22-96, Repromulgated as Amended 1-31-02, Amended ___________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Greg Mauldin, Manager of Policy & Contracts, Department of Management Services, Division of State Group Insurance

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: J. Todd Inman, Secretary, Department of Management Services

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: October 29, 2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: November 3, 2021