SECTION 110.12301. Competitive procurement of postpayment claims review services and dependent eligibility verification services; public records exemption.

• (1) The Division of State Group Insurance is directed to competitively procure postpayment claims review services for the state group health insurance plans established pursuant to s. 110.123. Compensation under the contract shall be paid from amounts identified as claim overpayments that are made by or on behalf of the health plans and that are recovered by the vendor. The vendor may retain that portion of the amount recovered as provided in the contract. The contract must require the vendor to maintain all necessary documentation supporting the amounts recovered, retained, and remitted to the division; and
  (2) The Division of State Group Insurance is directed to competitively procure a contract for dependent eligibility verification services for the state group insurance program; however, compensation under the contract may not exceed historical claim costs for the prior 12 months for the dependent populations disenrolled as a result of the contractor’s services.

  (a)1. By September 1, 2017, the division shall notify all subscribers regarding the eligibility rules for dependents. Through November 30, 2017, the division must hold subscribers harmless for past claims of ineligible dependents if such dependents are removed from plan membership before December 1, 2017.

  2. Subparagraph 1. does not apply to any dependent identified as ineligible before July 1, 2017, for which the department has notified the state agency employing the associated subscriber.

  (b) The contractor providing dependent eligibility verification services may request the following information from subscribers:

  1. To prove a spouse’s eligibility:

  a. If married less than 12 months and the subscriber and his or her spouse have not filed a joint federal income tax return, a government-issued marriage certificate; or

  b. If married for 12 or more months, a transcript of the most recently filed federal income tax return.

  2. To prove a biological child’s or a newborn grandchild’s eligibility, a government-issued birth certificate.

  3. To prove an adopted child’s eligibility:

  a. An adoption certificate; or

  b. An adoption placement agreement and a petition for adoption.

  4. To prove a stepchild’s eligibility:

  a. A government-issued birth certificate for the stepchild; and

  b. The transcript of the subscriber’s most recently filed federal income tax return.

  5. Any other information necessary to verify the dependent’s eligibility for enrollment in the state group insurance program.

  (c) If a document requested from a subscriber is not confidential or exempt from public records requirements, the division and the contractor shall disclose to all subscribers that such information submitted to verify the eligibility of dependents may be subject to disclosure and inspection under chapter 119.

  (d) A government-issued marriage license or marriage certificate submitted for dependent eligibility verification must include the date of the marriage between the subscriber and the spouse.

  (e) A government-issued birth certificate submitted for dependent eligibility verification must list the parents’ names.

  (f) Foreign-born subscribers unable to obtain the necessary documentation within the specified time period of producing verification documentation may execute a signed affidavit attesting to eligibility requirements.

  (g) Documentation submitted to verify eligibility may be an original or a photocopy of an original document. Before submitting a document, the subscriber may redact any information on a document which is not necessary to verify the eligibility of the dependent.

  (h) All documentation obtained by the contractor to conduct the dependent eligibility verification services must be retained until June 30, 2019. The department or the contractor is not required to retain such documentation after June 30, 2019, and shall destroy such documentation as soon as practicable after such date.
  (3) Records collected for purposes of dependent eligibility verification services conducted for the state group insurance program, as authorized under subsection (2), and held by the department are confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution. This subsection does not apply to records that are otherwise open for inspection and copying which are held by the department for purposes other than for the performance of dependent eligibility verification services. This subsection is subject to the Open Government Sunset Review Act in accordance with s. 119.15 and shall stand repealed on October 2, 2022, unless reviewed and saved from repeal through reenactment by the Legislature.

History.-s. 1, ch. 2010-150; s. 33, ch. 2012-116; s. 1, ch. 2017-127; s. 1, ch. 2017-128.

History.-s. 1, ch. 2010-150; s. 33, ch. 2012-116; s. 1, ch. 2017-127; s. 1, ch. 2017-128.