Christine Jordan Sexton, Author at Florida Politics

Christine Jordan Sexton

Humana emerges as big winner in bid for Medicaid contracts

The insurer emerged from negotiations with Medicaid officials as one of the winners in the contest to deliver health care to poor, elderly and disabled Floridians over the next five years.

Though Humana didn’t receive top scores from the agency’s negotiation team that reviewed bids for new Medicaid contracts, Humana earned enough points for the health plan to be invited to the negotiating table.

And that’s all it took.

Once it was at the table, Humana — guided by Greenberg Traurig lobbyist Hayden Dempsey, a co-worker of former AHCA Secretary Liz Dudek — leapfrogged its competition.

For instance, Humana was one of seven companies to offer access to a comprehensive health plan in Medicaid Region 7, which covers Brevard, Orange, Osceola and Seminole counties. Comprehensive means the plan offers long-term care services and more-traditional  managed medical care. State documents show that Humana’s response to the invitation to negotiate in Medicaid Region 7 was ranked near the bottom, coming in fifth.

The score was good enough, however, to get the company an invitation to negotiate. When the negitiations were finalized, Humana was able to edge Coventry Health Care of Florida, doing business as Aetna Healthcare, which received higher marks on the ITN but wasn’t the agency’s pick in awarding a plan for the area.

The same held true in Region 10,  in Broward County, where Humana’s response to the ITN  was scored fourth. Again, near the bottom, but good enough to move to the negotiating table. And when negotiatons ended, Humana edged competitor Simply Healthcare Plans which was ranked No. 2 for the region before negotiations started.

Humana also replied to the Medicaid ITN In Region 2, which covers 14 counties across Northwest Florida. Again, the plan scored well enough to be invited to negotiate a deal with the state and ultimately was awarded a contract for the region. That contract for Region 2 also allows Humana to serve people in Region 1, the western-most part of the Panhandle.

To  encourage managed-care participation in the Panhandle, lawmakers agreed in 2011 to provide health plans an incentive to participate in regions 1 and 2. A law requires AHCA to award additional contracts in any other regions where plans bid if they have contracts in Region 1 or Region 2.

And it’s that provision that Humana used successfully to score contracts in Region 8 and Region 9, which include 14 counties in Southwest Florida and five counties north of Broward in Southeast Florida.

Dempsey and Dudek declined to comment on the Medicaid negotiations and the agency’s decison to award the five-year Medicaid contracts, which, in all, could be worth upward of $90 billion to Humana and eight other companies.

AIDS foundation fights getting shut out of Medicaid

The largest nonprofit AIDS health care provider in the nation is at risk of being blocked out of South Florida’s Medicaid market.

AIDS Healthcare Foundation attorneys filed a written protest and requested a hearing after its managed-care division was not among the health plans selected to negotiate with state Medicaid officials to continue providing care in Miami-Dade, Broward and Monroe counties beginning in 2019.

As of March 1, nearly 2,000 people in South Florida with HIV or AIDS were enrolled in Positive Healthcare, the managed-care plan.

“It is inconceivable that such an experienced plan would have its proposal to continue operating as an HIV/AIDS specialty plan scored so low compared to other plans without the same experience or provider network,” Jeffrey Blend, Positive Healthcare assistant general counsel, wrote, noting that it scored well below other plans that responded to a state contracting process known as an “invitation to negotiate.”

Agency for Health Care Administration Secretary Justin Senior denied the request for a hearing this week, saying the issues weren’t ripe for challenge because the state hadn’t finalized negotiations.

The dispute comes as part of a broader process by the Agency for Health Care Administration to award new contracts in the state’s Medicaid managed-care system. Total five-year contracts could be worth up to $90 billion, with contracts awarded to health plans in different regions of the state.

The state issued its invitation to negotiate, the second under the Medicaid managed-care program, in July 2017. The winning bids are expected to be announced on April 16. The state will transition from current health plans under contract to new plans at the end of 2018, according to state documents.

In its protest, Positive Healthcare alleged that “upon information and belief” the state is negotiating with two other specialty plans for the treatment of HIV-positive people in the South Florida regions 10 and 11: Clear Health Alliance and United Healthcare of Florida Inc.

Like Positive Healthcare, Clear Health Alliance already is a contracted specialty health plan that’s available for HIV-positive people. United Healthcare has contracts for long-term care services and traditional managed care but not specialty care, such as HIV or AIDS.

Michael Rajner, an activist living with HIV in Broward County, said he wasn’t aware that Positive Healthcare was at risk of losing its Medicaid contract but said that “could be harmful for people living with HIV that have enjoyed access to that plan and particular providers because it could force them to establish a new relationship with a new physician, and that doesn’t benefit patients.”

The Legislature passed a sweeping rewrite of the state’s Medicaid program in 2011, requiring nearly all beneficiaries, from the cradle to the grave, to enroll in managed-care plans. Eleven managed-care organizations, including Positive Healthcare, were awarded contracts after the state’s first invitation to negotiate.

For contracting purposes, the state is divided into 11 regions. State law establishes a minimum and maximum number of plans that can operate in each of the 11 regions. Positive Healthcare operates only in Broward, Miami Dade and Monroe counties.

Positive Healthcare isn’t the only managed care plan currently under contract that has been snubbed in the second round of bidding. Molina Healthcare disclosed in a recent Securities and Exchange Commission filing that its Florida subsidiary, Molina Healthcare of Florida, was invited to negotiate a new contract only in the Miami-Dade region.

Molina Healthcare of Florida currently has contracts in eight regions, and Medicaid premiums from the plan accounted for 8 percent of Molina Healthcare’s projected revenues in 2018.

The filing noted that the company “intends to take all appropriate actions to both protect its rights and ensure continuity of care for its members,” according to the filing.

Republished with permission of the News Service of Florida.

Direct primary care gets Rick Scott’s approval

After years of legislative discussion about the issue, Gov. Rick Scott on Friday signed a measure (HB 37) that amends the state insurance code to make clear that “direct primary care” agreements do not run afoul of insurance laws.

Under direct primary-care agreements, doctors charge patients monthly fees in advance of providing services, with patients then able to access services at no extra cost.

The bill, sponsored by House Insurance & Banking Chairman Danny Burgess and Sen. Tom Lee does not spell out how much can be charged or what services need to be included in the agreements.

Primary care providers are defined as physicians, osteopathic physicians, chiropractors, nurses or primary-care group practices.

The bill was one of 74 that Scott signed into law Friday, including a tax-cut package.

House Speaker Richard Corcoran made a priority of the direct-primary care issue, which also received heavy backing from the small-business group National Federation of Independent Business Florida.

“It turned out a great day for Florida’s small businesses to have Gov. Scott sign both small-business rent tax cuts and direct-primary care into law,” NFIB Executive Director Bill Herrle told the News Service of Florida, referring to part of the tax package that reduced a tax on commercial rents. “We look for the direct-primary care act to transform how small businesses and their employees get their primary health care delivered. Less middlemen, more docs.”

The Senate voted unanimously to pass the bill, which was approved in a 97-10 vote by the House.

Lawmakers agree on plan to battle opioids

In the waning hours of the annual session, the Florida Legislature approved tough new restrictions Friday on prescription drugs and agreed to spend more than $53 million on treatment and prevention to battle the state’s opioid crisis.

Despite the issue being a top priority for the 2018 session, the final vote on the measure (HB 21) almost didn’t come as the Senate and House were at odds for hours over whether the bill should include dedicated funding for Vivitrol, which is a monthly shot that has been successful in helping people with opioid addictions.

The House and Senate passed a compromise that sets aside money but makes clear that it shouldn’t be used only for naltrexone, which is sold under the brand name Vivitrol. The bill passed both chambers unanimously Friday night and is headed to Gov. Rick Scott’s desk.

Lawmakers finished most of the session’s business Friday night but will return Sunday to pass a budget and a tax-cut package.

While the drama on Friday may have focused on funding for treatment, much of the attention during the session focused on preventing addiction. That strategy included trying to prevent people from getting addicted to prescription painkillers, which can lead to abusing street drugs such as heroin and fentanyl.

To that end, the bill would impose a three-day limit on prescriptions for treatment of acute pain. Physicians could prescribe up to seven-day supplies of controlled substances if deemed medically necessary. Cancer patients, people who are terminally ill, palliative care patients and those who suffer from major trauma would be exempt from the limits.

The bill also would require physicians or their staff members to check with a statewide database before prescribing or dispensing drugs. The goal is for the database, known as the prescription drug monitoring program, to interface with physicians’ offices and electronic health records used by doctors. To help make that a reality, lawmakers agreed to spend $991,000 for improvements.

The bill also would require physicians to take a two-hour, board-approved continuing education course on prescribing controlled substances.

With the prescription limits, education requirements and funding for treatment, House sponsor Jim Boyd said the bill will go a long way in helping curb a growing opioid crisis.

“In the big picture, I think it’s a great initiative, and I think it will definitely save lives,” Boyd said.

In 2016, heroin caused 952 deaths in Florida, fentanyl caused 1,390 deaths, oxycodone caused 723 deaths, and hydrocodone caused 245 deaths. Those statistics led Scott in May 2017 to declare a state of emergency.

The House and Senate had differences about funding for medication-assisted treatment and whether insurance companies should be required to provide it.

The Senate, in part, wanted to direct money to be spent on Vivitrol.

Alkermes, the manufacturer of Vivitrol, spent more than $156,000 on campaign contributions in Florida during 2016 and directed $50,000 to Senate President Joe Negron and political committees he controlled.

House Appropriations Chairman Carlos Trujillo grew frustrated Friday evening, issuing s terse statement that the Senate holding “up the passage of vital addiction services legislation while demanding one company receive … taxpayer money every year puts profits before people.”

Ultimately, though, the chambers agreed to spend $53.5 million in opioid funding.

The bill targets $14.6 million in recurring funds to the Department of Children and Families to take steps to increase access to treatment and reduce waitlists. It also allows funding to be directed to case management, residential services, outpatient services, aftercare services, and medication-assisted treatment, which includes a number of options including Vivitrol.

The bill earmarks another $6 million to the Office of State Court Administrator for medication-assisted treatment but again allows for a variety of options. The bill also would direct $5 million to the Florida Department of Health for emergency opioid antagonists to be made available to emergency responders.

The Senate also wanted to make medication-assisted treatment easily accessible and proposed preventing Medicaid managed-care plans and commercial insurance companies from requiring patients to obtain prior authorization before getting medication-assisted treatment.

Health care is sticking point in budget talks

With just hours before a deadline to finalize a state budget, a stalemate over health-care spending could push this year’s legislative session into overtime.

Senate Health and Human Services Appropriations Chairwoman Anitere Flores confirmed that health care is the hold-up but did not get into details. However, one key difference between the House and Senate has been how they would spread Medicaid funding to hospitals.

Another key difference has been money for nursing homes — the Senate wants to increase Medicaid spending for nursing homes by $130 million.

Flores said the “House and Senate are working together to come up with hospital funding that takes into account the concerns of each chamber,” and that the House and Senate are “working together.”

As of Tuesday morning, legislative leaders had not held a public meeting for two days to discuss the budget, but lobbyists say nearly all spending items have been worked out. The budget needs to be available for review for 72 hours before lawmakers may take a vote. That means if lawmakers are to end the session as scheduled Friday, the budget needs to be finalized sometime Tuesday.

Health-care lobbyist Bill Rubin remained optimistic that will occur. “My gut tells me they will both move toward the other for a final solution,” said Rubin, whose health care clients include HCA Healthcare, among others.

Senate Appropriations Chairman Rob Bradley also expressed optimism.

“We’ve made incredible progress over the past several days,” Bradley said in a text message. “The finish line is in sight. All areas of the budget are essentially completed, with the exception of hospital funding.”

ALF generators issue bumped to budget chairs

Finding it difficult to convince the House to ratify emergency generator rules for assisted living facilities, Gov. Rick Scott’s administration looked to the Florida Senate for help this week.

Sen. Anitere Flores on Friday offered to include $350,000 in next year’s budget to help small ALFs that have not had regulatory violations pay for generators. She proposed reimbursements up to $1,000 for ALFs with six or fewer beds to help offset costs of purchasing and installing emergency power. The House did not immediately agree, and the issue will be bumped to House and Senate budget chairmen for further consideration.

Senate Appropriations Chairman Rob Bradley said Friday he hopes the funding helps make ratification of the rule more palatable to the House, which has not ratified the rule because of the steep fiscal impact. An agency estimate put the cost of compliance with the rules at about $243 million for the nearly 3,000 licensed ALFs in the state.

Justin Senior, secretary of the Agency for Health Care Administration, told The News Service of Florida on Friday that the money, if approved by lawmakers, should help the smallest ALFs in the state, the same group of providers that House members have worried about. “For the small ALFs, probably what you need is a Honda (generator) unit from Home Depot as well as a window AC unit that plugs in,” Senior said. “That should cool enough square footage and keep it at 80 degrees for them to get their four, five residents into a cool room and give them a respite from the heat.”

In addition to offering the funding, the Senate this week introduced a bill (SB 7028) to ratify the ALF rule.

The Senate could approve the bill as soon as Monday.

Rick Scott’s office pulls IRS filings, makes public records requests to get hospital executives salaries

Gov. Rick Scott‘s blue-ribbon commission on health care and hospital spending asked Florida hospitals in May to provide the state with information about the salaries and compensation packages of their top executives.

Two months later, only four facilities have voluntarily provided that information, Agency for Health Care Administration Deputy Secretary Molly McKinstry told members of the Commission on Healthcare and Hospital Funding on Wednesday in Jacksonville.

Commission Chairman Carlos Beruff acknowledged there still is “a lot of missing information” but said the state won’t be deterred.

“We are going to get the data no matter what it takes to get it,” he said.

To that end, McKinstry said that the agency is making public records requests at government-owned facilities and noted that staff in the governor’s office has been combing through Internal Revenue Service tax filings to glean salary information.

McKinstry told the commission, though, that they won’t be able to find the information for for-profit facilities in IRS tax filings.

The largest for-profit hospital chain in the state is Hospital Corporation of America, which owns 45 Florida facilities. None of those facilities has provided information to the commission, according to information the agency has compiled on hospital responses.

Meanwhile, the information that staff has been able to gather is included in a 15-page chart that was briefly touched on by the commission at the meeting in Jacksonville on Wednesday.

Data collected to date shows that Isaac Mallah, president South Florida Baptist, a 147-bed facility, was the highest-paid executive in 2013 with a total compensation package of $3.3 million in 2013.

Stephen R. Mason, chief executive officer of the not-for-profit BayCare system, had a total compensation package of nearly $2.44 million in 2013. Sacred Heart Health System’s Susan Davis had a total compensation package of $2.4 million in 2013.

The governor created the commission in May via an executive order. He appointed nine members to the commission, most of them contributors to Scott’s campaign for governor or to his political committee, Let’s Get to Work.

Before the Jacksonville meeting adjourned, commission members Sam Seevers asked that another round of correspondence be sent to the hospitals requesting the salary and compensation information. Commission member Marili Cancio Johnson agreed and asked that the hospitals be told if they don’t provide the information that funding will be withheld from the facilities.

If there is no transparency, Johnson said, there should be no tax assistance.


Health care agency closes three Medicaid offices

 Three Medicaid field offices  are closing June 30.

The Agency for Health Care Administration is closing regional offices in Panama City, Alachua and West Palm. Combined, they have been processing fee for service claims, among other things, for 37 counties across the state.

Medicaid providers who normally send fee for service claims to those field offices will use on of two other existing offices. Claims that are sent sent to the  Panama City office must be sent to the Pensacola office, instead. Claims that normally are sent to Alachua or West Palm now must be sent to the office in Tampa.

The offices are being closed as part of staff reductions under the new budget that goes into effect July 1. The Legislature reduced 81 positions from the agency, leaving it with 1,563 positions for the upcoming year.

Twenty-six people, earning a combined $1.12 million in salary and benefits, will lose their jobs with the closure of two field offices, budget documents show. The agency closed three offices. The reductions are being made because of restructuring under the statewide Medicaid mandatory managed care program.

New cancer center director wants to increase University of Florida’s research efforts

Anticipating a bigger role in the fight against cancer in the coming years as Baby Boomers age, the University of Florida has hired a new director for its cancer center.

Jonathan D. Licht, M.D.,  takes the reins at the University of Florida Health Cancer Center Oct. 1.  An expert in blood cancers, Litcht brings with him a $2 million research portfolio that includes funding from the National Institutes of Health, the National Cancer Institute and the Leukemia and Lymphoma Society.

Litcht identified expanding the National Cancer Institute-funded research portfolio and extending investigator-initiated clinical trials to as many people as possible to improve treatment outcomes for patients as his priorities in a university press release.

There were 106,166 new cancer cases in Florida in 2012, according to information from the Department of Health. The majority of those cases, or 63,340, were reported in people aged 65 and older.

Licht currently serves as the associate director for clinical sciences at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. His research focuses on aberrant gene regulation as a cause of blood cancers and ways to reverse the effect of the gene.

Paul Okunieff, M.D. announced in January that would be stepping down from the UF Health Cancer Center to focus his efforts on research and academics; he chairs the University of Florida department of radiation oncology.

In all, 16 people applied for the director position said Lindy Brounley, communications director UF Health Cancer Center. Of those, the university interviewed four candidates.

Tom Lee says early LIP talk is good for state

After six months of political jockeying, litigation, and one-upsmanship Florida and the federal government have agreed in principle to $1.6 billion in supplemental Medicaid funds over the next two years.

Most of those funds, $1 billion, have been allocated in the budget Rick Scott signed into law on Tuesday. A little more than $600 million, though, still needs to be negotiated between Florida and the federal government.

Which means, just because the special session is over, discussions over who gets what aren’t. And that’s just fine for Sen. Tom Lee, the chief budget writer in the Florida Senate.

“We really ned to get out in front of this, ” Lee told Florida Politics, saying that discovering LIP was  not going to be renewed at the $2 billion level in March, was too late in the process.

“It was disappointing for me to learn in March that our budget might have been built upon a fiction of federal dollars that wasn’t going to be available,” Lee said.  “Now that we know, I think it’s great that we can begin working on a model in the fall. And if it’s put to be early, we can build our budget based on reality and avoid these conflicts based on allocations.”

In her letter to Florida Deputy Secretary for Medicaid Justin Senior, Centers for Mediare and Medicaid Services Director Vikki Wachino said Florida needs to submit a new distribution formula for the Low Income Pool program by October 31, 2015. The goal is to have the formula approved by the federal government by December 31, 2015.

That’s just before the start of the 2016 session, where lawmakers will meet from January 12 through March 11. They will work in a 2016-17 state fiscal year budget.

“Florida may not claim federal financial participation for LIP payments [in 2016-17] until a new methodology is approved by the federal government,” the letter notes.

The Florida Legislature could not pass the 2015-16 budget because the stat did not know how much Low Income Pool money to expect. Though the federal government had advised Florida in writing in April 2014 that the $2 billion LIP program would not exist in its present form  beyond this summer, Gov. Rick Scott built his proposed budget assuming the $2 billion would be available.

And while Senior hoped to secure an agreement in principle on the future of LIP  by April so the Legislature could pass a budget, they two sides weren’t able to agree on the amount of supplemental funds. Florida continued to push for the $2 billion limit and the federal government advised Florida the dollar amount was too large.

The governor sued the federal government in court in an attempt to require the federal government to continue funding at that level. Scott withdrew the lawsuit Thursday.

To prepare for the 2016 session the Legislature will begin meeting in September. Sen. Aaron Bean has asked for the creation of a joint legislative task force, so the chambers can examine some of the more controversial health care issues, including the elimination of certificate of need for new hospitals, giving the green light to longer stays at ambulatory surgical centers, and approving recovery care centers, which could care for patients who are rehabbing from surgery.

Legislative leadership were on board with the joint legislative committee. It’s not clear whether a new LIP distribution formula would be part of the task force’s conversations.

Ballard Partners Tampa office manager Jan Gorrie, who represents some large urban hospitals, said  “there’s no rest for the weary.”

6_23_15 Lettter to Florida



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