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Magic Johnson visits Tallahassee to talk up Medicaid managed care

Magic Johnson visited with Senate Democrats Monday to praise Medicaid managed care programs that are using town hall meetings and church outreach to steer HIV, dental, geriatric, and other health care to poor people in 60 Florida counties.

The programs have served 9,500 people with HIV during the past four years, Johnson said.

Moreover, “our providers and our doctors look like the patients they serve. That’s very important, because they can serve them better, understand their needs,” Johnson said, providing “the best health care they’ve ever received.”

Johnson, who recently rejoined the Los Angeles Lakers as president for basketball operations, later dropped in on Senate President Joe Negron, and was scheduled to meet with Senate Republicans later in the day.

He and Negron talked about health care and baseball — Johnson is a co-owner of the Los Angeles Dodgers; Negron is a notorious Atlanta Braves fan.

Lourdes Rivas, president and CEO of Simply Health Care and Amerigroup Florida, which are administering the managed care program under a contract with the state, said Florida has greatly improved access to dental care — now covering nearly half of its residents, up from a low of 28 percent.

The contract is up for renewal, Rivas said.

Johnson, a “brand ambassador” for the programs, said the importance of dental care cannot be understated. He referred to reports that a child in Washington, D.C., died of a dental abscess.

“We’ve been doing a lot of great things. I just hope that all of you are proud of the work that we’ve been doing. If we are awarded this contract again, we look forward to partnering with all of you and try to do more,” Johnson said.

Caucus members expressed skepticism of GOP plans to block grant Medicaid and cut funding for health care programs, including HIV research.

Sen. Kevin Rader suggested that when Johnson met with Senate Republicans later in the day, he tell them: “Please put it back in.”

Johnson offered no comment on the Republican plans, beyond observing that he has worked with the University of Miami on HIV issues.

There was a lot of picture taking. Lauren Book introduced Johnson to her new twins. Sen. Randolph Bracy produced a basketball for Johnson to sign.

“I told him I wanted to get a game of one-on-one,” said Bracy, who played basketball at the College William & Mary.

“We won’t have enough time today,” Johnson joked.

Pam Bondi touts $165 million recovered by state’s Medicaid fraud unit

Florida has proved to be one of the most effective states in the nation last year for recovering Medicaid fraud money.

A report issued by the U.S. Department of Health and Human Services revealed Florida recovered more than $165 million in otherwise lost funds through fraudulent Medicaid cases during fiscal year 2015-2016, the state’s attorney general said in a statement Thursday.

The report shows Attorney General Pam Bondi’s Medicaid Fraud Control Unit (MFCU) is working, according to the Office of Inspector General for Health and Human Services.

“My Medicaid Fraud Control Unit investigators work tirelessly to stop Medicaid fraud and recover stolen funds for taxpayers,” Bondi said in the statement. “This report sends the strong message that we will continue to aggressively pursue anyone trying to defraud Florida’s Medicaid program.”

According to the report, Florida ranked only second in the nation in total funds recovered for the 2015-2016 fiscal year, with New York raking in the most at nearly $229,000,000.

Since taking office in 2011, Bondi’s MFCU has obtained more than half a billion dollars in settlements and judgments in total.

The unit investigates and prosecutes providers that intentionally defraud the state’s Medicaid program through fraudulent billing practices. In addition, the MFCU investigates allegations of patient abuse, neglect and exploitation in facilities receiving payments under the Medicaid program.

Each year OIG of the HHS publishes a report of the Medicaid Fraud Control Unit statistical data from the preceding federal fiscal year.

California and Texas ranked third and fourth, respectively, with California saving more than $136,000,000 and Texas saving more than $128,000,000.

To view HHS OIG’s report, click here.

Rick Scott says ACA replacement is a work in progress

Gov. Rick Scott said Thursday that he thinks Florida would be treated unfairly under the current version of congressional Republicans’ Obamacare repeal bill.

Scott did not tell reporters he opposed the bill after meeting with House Speaker Paul Ryan in Washington, D.C., though he did say the repeal bill needs to be fair for states like Florida, which did not expand Medicaid. He also said the bill needs to give autonomy to run their own Medicaid programs.

States like Florida which didn’t expand can’t get treated unfairly,” he said. He also called the current plan “a work in progress.”

The newly unveiled proposal would allow states that expanded Medicaid to keep their extra federal funds for the next few years until the program phases out in 2020. The bill would also tie Medicaid funding to the number of enrollees in each state.

States that did not expand Medicaid would get an extra $10 billion over the next five years under the bill and would also have spending cuts for safety net hospitals lifted in 2018, 2 years ahead of Medicaid expansion states.

Safety net hospital executives travel to Washington in search of money

Representatives of hospitals that provide a lot of charity care in Florida were headed to Washington Monday to urge federal health care officials and members of Congress to give them more money and freedom to spend it.

Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, said members hope the Trump administration will prove friendlier than former President Obama, who trimmed Washington’s Low Income Pool financing for charity care from $2.2 billion to $608 million during the past three years.

That harmed “hospitals’ ability to care for all residents, not just those that cannot pay for their care. Now is the time to correct that injustice and ensure that Florida receives its fair share of federal funding to help cover the costs of caring for the poor and uninsured,” Carvalho said in a written statement.

Texas gets 500 percent more than Florida, he said, and California gets 20 times more.

“While we appreciate Gov. Rick Scott recommending the continuation of today’s $608 million in LIP supplemental Medicaid funding in his proposed 2017-18 budget, we urge his office to work with the Trump administration to secure at least $1.6 billion,” he said.

Scott’s proposed state budget would save $581 million by trimming Medicaid reimbursements to hospitals, and $298 million in supplemental money for for-profit hospitals that stint on charity and uncompensated Medicaid care.

They’d also like more freedom in how they spend charity dollars.

“Current LIP parameters for funding care for the poor and uninsured are too restrictive. Federal officials need to remove the allocation straight-jacket strapped on the state so Florida can direct that the precious LIP dollars be used to benefit the greatest number of patients in need,” Carvalho said.

“Federal officials need to remove the allocation straight-jacket strapped on the state so Florida can direct that the precious LIP dollars be used to benefit the greatest number of patients in need,” he said.

“Compounding Florida’s unfair charity care funding deficit is Florida’s precariously low Medicaid reimbursement rates. Today, even before the governor’s proposed $1 billion cut in reimbursements for services to Medicaid enrollees, hospitals are paid much less than the basic cost of providing the care.”

Low reimbursement for charity care forces a “hidden tax” on businesses in the form of higher insurance costs, he said. “Each year, Florida’s hospitals provide more than $3 billion in uncompensated and charity care that those with commercial insurance ultimately pay for.”

The alliance comprises teaching, public, and children’s hospitals that spend heavily on uncompensated and charity care.

Along for the Washington trip were Jonathan Ellen, chairman of the alliance board and CEO of Johns Hopkins All Children’s Hospital; Ed Jimenez, vice chairman and CEO of UF Health Shands Hospital; Carlos Migoya, president and CEO Jackson Health System; and Lindy Kennedy executive vice president and CEO of the alliance.

Executives from Halifax Health, Lee Health, Orlando Health, and Tampa General Hospital also were participating.

Federalism message echoed by Florida health subcommittee members

A day after Florida’s House Education Committee voted to send a memorial to Congress seeking fewer strings tied to federal education funding, a health policy panel made the same request for health care funding.

The House Health Innovation Subcommittee on Wednesday approved sending a memorial to Congress asking lawmakers to consider giving Medicaid funding to the states in the form of block grants.

“As you know, Medicaid is supposed to be a partnership. In reality, the federal government is in control,” said state Rep. Frank White, R-Pensacola, who introduced the memorial at the hearing.

“More than at any time in the past, states have the opportunity to have a serious, thoughtful discussion with the federal government about the nature of federal-state partnerships, like Medicaid, and what those successful block grants in Medicaid and other programs might look like,” White said.

White said effective Medicaid block grants would be based on the number of enrollees and adjusted for health risks and income levels. He argued that the states need flexibility to design programs tailored to their specific demographic and geographic needs.

In the public testimony on the memorial, speakers offered a mix of caution and enthusiastic support.

“In the redesign of health care, would you like to be in charge, as the state legislature? Or would you like a bunch of people in Washington to be in charge, dictating terms, creating more requirements, limiting your ability to manage the utilization of your own Medicaid program?” asked U.S. Rep. Matt Gaetz, a freshman Republican who previously represented the Panhandle in the state House.

Gaetz agreed that there were still details to iron out about how the block grants would work, but cited his previous experience as a state legislator and current experience in Congress as he told the subcommittee members that they were best suited to determining Florida’s needs.

“I can say with clear eyes that Washington screws everything up,” he said.

Sal Nuzzo, vice president of policy for the James Madison Institute, voiced his support for motivating Congress to move in the direction of federalism and allowing solutions for state-based health care access.

“The most efficient and effective way to guarantee access to actual care is the method of moving subsidization down to the state level where it can actually intersect with the specific needs of each state’s health population,” Nuzzo told the subcommittee.

Michael Daniels, executive director of the Florida Alliance for Assistive Services and Technology lobbying group, asked the members to proceed with caution, and to continue including the ultimate stakeholders — Florida patients — in the conversation.

Karen Woodall, policy director for the Florida Center for Fiscal and Economic Policy, argued that in the context of block grants, flexibility equaled an erosion of the protections afforded by federal benefit mandates.

Several Democratic lawmakers offered similar concerns.

The subcommittee approved the memorial on an 8-5 vote along party lines.

Via FloridaWatchdog.org.

VIDEO: Matt Gaetz in Tallahassee to promote Medicaid block grants

Congressman Matt Gaetz was in the Capitol Wednesday to discuss health care reform, including his support for a block grant funding method for Medicaid, the joint state-federal health care program for the poor.

After a structured media availability, the former state representative elected to Congress last year held a more informal gaggle with members of the Capitol Press Corps.

Gaetz, a Fort Walton Beach Republican, served in the Florida House for six years.

Below is a Periscope video of his Q&A in the House media room.

Nursing homes fighting plan to eliminate certificate of need program

The top legislative priority for Florida’s nursing homes this year is to kill a proposal, backed by Gov. Rick Scott, to repeal a requirement that they demonstrate a demand for new beds before they can expand or build new facilities.

SB 676, by Rob Bradley, and CS/HB 7 by Alex Miller, and would eliminate the certificate of need program at the Agency for Health Care Administration for all health care facilities.

Eliminating the requirement for nursing homes “would be extremely disruptive,” Florida Health Care Association chief lobbyist Bob Asztalos told reporters during a briefing Monday.

The association, which represents 82 percent of the skilled nursing facilities in Florida, fears competition from newer, shinier “Taj Mahal” facilities would drive down occupancy rates.

That’s what happened in Texas, where the occupancy rate hit 70 percent after the state scrapped its certificate of occupancy requirement, Asztalos said.

In Indiana, eliminating the requirement led to the construction of “so many buildings that they were looking at taxpayer money to buy buildings to take them off line,” he said.

“We don’t want to see Florida make the same mistakes,” Asztalos said.

Staffing levels would be “watered down,” said Rob Greene, CEO of Palm Garden Healthcare, which operates a network of facilities.

The association would like to see expansion limited to about 3,750 beds through July 2017, targeted to areas where they’re needed.

Free-market advocates, including Scott, argue an open marketplace would lower costs and increase quality.

“The government sets our rates. If there were a true free market, we would set our rates that the state would pay us for our care. But how do you have a free market where they set our rates?” Asztalos said.

The existing system is in the best interests of nursing homes, he conceded, but it also serves the state’s policy of placing patients in home- or community-based care.

“It’s not like nursing home A is going to steal beds from nursing home B. You’re going to look for people with high acuity who are in assisted living facilities, who are eligible for nursing home care or in home- or community-based care.”

“It’s really a bad idea,” said Emmett Reed, executive director of the association.

“I understand the free-market concept. But this is a public-private partnership. This is not a true free-market business we’re in.

He added: “I think that, philosophically, the governor wants to get it all on the table, to have the discussion. At the end of day, I think, he may have a reasonable ear for nursing homes when we discuss it with him.”

In other priorities, the association supports a proposed prospective payment reimbursement system — paying facilities on a per diem basis tied to factors including patient care and quality.

But it would like a three-year phase-in and more incentives to increase room size and build other improvements.

Additionally, representatives of the organization said, the state could save $68.2 million by exempting long-stay nursing home residents from Florida’s managed care system when it is demonstrated they can’t be moved to less intensive care settings.

Florida seniors, be careful what you wish for with Donald Trump, Medicare

Florida’s estimated 3.8 million senior citizens wanted change. They wanted to, how you say, drain the swamp? They voted overwhelmingly for Donald Trump in November.

With voters age 65 and over, Trump won Florida by 17 percent. That likely was the difference in a statewide race he won over Hillary Clinton by about 119,000 votes.

Here is part of the change they voted for. His name is Tom Price, just confirmed in the Senate as Trump’s secretary of Health and Human Services by a party-line vote of 52-47. Seniors may become better acquainted with him the next few years. He is the guy who The Washington Post says wants to privatize Medicare and Medicaid.

“Under his vision, both programs would cease to be entitlements that require them to provide coverage to every person who qualifies,” the Post reported. “Instead, like many House Republicans, he wants to convert Medicaid into block grants to states — which would give them more latitude from federal requirements about eligibility rules and the medical services that must be covered for low-income Americans.

“This plan would also require ‘able-bodied’ applicants to meet work requirements to receive health care benefits — an idea that the Obama administration has consistently rebuffed.”

I wonder how that will go over with the good folks in Charlotte, Sumter, Sarasota and Citrus counties. They are among the 11 “grayest” counties in the country.

Sumter, with nearly 53 percent of residents age 65 or older, ranks No. 1 on that list compiled by Pew Research. It is the only county in the nation to have that distinction.

Sumter, by the way, voted 69 percent for Trump. Charlotte, the second-grayest county in the land, delivered 62 percent in favor of Trump. Citrus was 68 percent. Sarasota was 54 percent.

To be fair, some of the angst over Price is about what he “might” do versus what he “can” do. He can’t just wave a calculator and do away with traditional Medicare and Medicaid, and for the time being his focus likely will be on reconfiguring the Affordable Care Act into something that will suit conservatives.

Congress would have to approve any major changes to Medicare and Medicaid, and although Republicans control both chambers President Trump has said he wants to keep things the way they are.

PunditFact rated claims by a Democratic website that Price wants to “phase out” Medicare as false.

Phase out? No.

Change? You betcha.

In case Price gets any funny ideas, though, AARP — the advocacy group for seniors — sent a letter Jan. 30 to a House committee holding Medicaid hearings warning block grants are something that could “endanger the health, safety, and care of millions of individuals who depend on the essential services provided through Medicaid.”

Shifting these programs to block grants would have a huge impact on Florida’s budget, given the high percentage of seniors living here. Imagine how long it would take for state representatives to run those budget numbers and decide nope, we can’t afford that.

This is just the first inning of what promises to be a long game in the contentious debate over these social safety nets for seniors. It’s also true, though, that House Republicans have had this issue in their crosshairs for decades and now they have a shot at reform — whatever that means.

If that happens, it will be too late for Sumter, Charlotte, Citrus and Sarasota counties to demand a recount. Those voters wanted change. Careful what you wish for.

Rick Scott: Obamacare expanded the welfare state

Florida Gov. Rick Scott, who has asserted that he is helping President Donald Trump work on a replacement for “Obamacare,” made his feelings known about the Affordable Care Act again on Friday.

In an editorial on CNN‘s website, Scott made a number of points.

Among them, that the Affordable Care Act was nothing more than an expansion of the welfare state, and an usurpation of state’s rights when it comes to handling Medicaid.

“With Obamacare,” Scott writes, “President Obama enacted a massive expansion of the welfare state. And, not surprisingly, Obamacare has resulted in widespread increases in premiums and costs are expected to continue increasing.”

Scott’s preferred option — and likely the one the Trump administration will land on — block grants to the states for low-income health care.

“States can do a far better job administering the Medicaid program than the federal government can. If Florida is given the flexibility to run our own Medicaid program, we will be more efficient and less wasteful than the federal government,” Scott notes.

“Liberal Democrats,” asserts Gov. Scott, “have a game plan for America: everything for free, provided by the government, paid for with your tax dollars. There is a name for this approach, and it is called socialism. President Obama gave it a try, and in the process he proved what we already knew — it does not work.”

“Government assistance must be the last resort,” Scott adds, “not the first stop. This is no time for Republicans to go wobbly or get weak in the knees about repealing Obamacare. If we refuse to roll back the welfare state, what real purpose do we serve?”

With many people expecting Scott, termed out next year, to challenge Democrat Bill Nelson for his Senate seat, an oped like this serves multiple purposes.

It reminds national conservatives that, when it came to Medicaid expansion, the governor fought Washington and won.

It allows the governor to frame the current debate around what he has accomplished in Florida.

And, most importantly, it provides a framework for what might come out of Washington this year regarding reform of the current health care schematic.

Expect more op-eds like this in the weeks ahead.

State asks feds to extend Medicaid managed-care waiver

Florida has asked the federal government for a five-year extension of a waiver that allows it to provide Medicaid services through a managed care program.

Gov. Rick Scott filed the state’s application on Friday, seeking to extend the program through June 30, 2022. The program would remain essentially the same.

“The demonstration objectives and the financial eligibility criteria for waiver recipients remain unchanged since the Managed Medical Assistance Program extension request was approved June 31, 2014,” Scott wrote in a cover letter to Department of Health and Human Services Secretary Sylvia Burwell.

“The program is designed to provide primary and acute care to the majority of Florida Medicaid recipients without increasing costs,” Scott wrote.

The federal Centers for Medicare and Medicaid Services first gave Florida permission to treat recipients through managed care, rather than fees for service, in 2013.

“The MMA program improves health outcomes for Florida Medicaid recipients while maintaining fiscal responsibility,” the Florida Agency for Health Care Administration wrote in the application.

“This is achieved through care coordination, patient engagement in their own health care, enhancing fiscal predictability and financial management, improving access to coordinated care and improving overall program performance,” the agency said.

The move comes as Republicans in Congress prepare to act on their vow to dismantle the Affordable Care Act.

Meanwhile, Florida Senate President Joe Negron has called for shifting Medicaid to block grant funding that would allow the state “to build a program that looks like Florida and addresses our issues.”

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