Medicaid Archives - Page 5 of 39 - Florida Politics

Rick Scott administration again mishandles individuals’ personal information

The private information of nearly 1,000 individuals was mishandled by the state’s Division of Elections as it responded to a public records request last year, making it the second time in four months that a state agency has compromised the private information of Floridians.

State officials said Friday that the last four digits of the social security number of 945 individuals were sent in error to a member of the public.

The department has notified all the individuals whose confidential information was released by mistake.

While officials say there is no reason to believe their private information has been misused, they are offering those affected a year-long membership to an identity theft protection service.

Earlier this month, officials with the Agency of Health Care Administration confirmed that the medical records and personal information of up to 30,000 people enrolled in the state’s Medicaid program may have been compromised after a data breach.

The incident in that agency stemmed from a state employee opening a malicious phishing email. The data breach exposed the Social Security numbers, dates of birth, Medicaid ID numbers and private health care information of clients.

Darren Soto under fire for having urged Puerto Ricans to declare they intend to stay

U.S. Rep. Darren Soto of Orlando has come under fire for statements he made last Friday at a Puerto Rico town hall meeting in Kissimmee, when he urged evacuees to declare they intend to stay in Florida.

Soto’s comments had come during a question-and-answer period after he, Puerto Rico Gov. Ricardo Rossello, and others including Florida Gov. Rick Scott had addressed more than 500 people gathered at the Kissimmee Civic Center about issues surrounding Puerto Rico, evacuees who have fled to Florida following Hurricane Maria, and federal, state, and local assistance and recovery efforts.

Responding to a question about federal assistance, Soto noted inequities and legal quirks in the federal Medicaid and Medicare programs. He noted that when evacuees go home to the island they lose coverage, and that he and others are working on legislation to try to make benefits more seamless as people move back and forth. But that’s not the case yet, he said.

“One thing for those who recently arrived need to know is, you’re going to be asked the question, ‘Do you intend to stay?’ I urge you to say ‘yes, for now,'” Soto told the town hall. “Because otherwise you’re going to get rejected, and then you’re going to find yourself without health care. So I urge you to watch for that pitch-fall question.”

A report on WFTV-News in Orlando and posts on Facebook other social media, raised the question of whether Soto was encouraging people to make false claims about their intentions to stay in Florida or not.

In a written statement provided by his office Wednesday morning, Soto denied he made any such overture.

“I do not encourage anyone who is planning to leave our state to falsely claim otherwise. Many recently arrived Puerto Ricans have a high probability of staying in Florida. The intent of my statement was to encourage them to err on the side of caution and declare their intent to stay if they are in doubt about their future plans,” Soto said. “If they eventually leave, their Medicaid or Medicare will automatically be terminated and they will have to reapply back in Puerto Rico. Healthcare could mean the difference between life and death for eligible seniors, disabled and children evacuees, many of whom have been without healthcare for months.”

One of Soto’s Republican opponents seeking to take him on in the 2018 election, Wayne Liebnitzky of St. Cloud, said he did not think Soto said anything that would raise legal problems, but he questioned the ethics of the statement.

“There is an ethics problem here,” Liebnitzky said. “Is it a big problem? Probably not. It is an ethical problem. He shouldn’t have done it.”

Up to 30,000 state Medicaid clients warned of potential data breach

Thousands of Floridians enrolled in Florida’s Medicaid program are being notified that their medical records and personal information may have been compromised, the state’s Agency of Health Care Administration said.

The data breach occurred after a state employee opened a malicious phishing email last November. The incident may have exposed the  Social Security numbers, dates of birth, Medicaid ID numbers and private health care information of up to 30,000 Floridians, a two-month-review by the Inspector General found.

While the review is ongoing, AHCA has so far been able to confirm that the Medicaid IDs and/or Social Security numbers of approximately 1,800 clients have been potentially accessed.

In response, AHCA officials are offering those affected a free one-year membership to an identity theft protection program, even though they contend there is no reason to believe individuals’ information has been misused.

No other state systems or email accounts were targeted and AHCA is currently exploring additional security options to protect against further breaches.

For more information, including steps one may take to protect themselves from potential information, enrollees may call the Agency’s hotline at 1-844-749-8327.

Health care spending, regulations confront lawmakers

Battles over health-care spending and regulation of Florida’s vast health-care industry are likely to command a great deal of time and attention when the Florida Legislature convenes in January for its annual Session.

Lawmakers are again expected to engage in a tug-of-war about what type of regulations should be in place for health care facilities, but a main focus will be on Florida’s strained safety-net health program at a time of tight state finances.

Florida’s Medicaid program already costs $26 billion and covers an estimated 4 million people.

A July snapshot by the Kaiser Family Foundation estimated that Medicaid along with a major children’s health-insurance program provide coverage to two out of every five low-income people in the state, half the state’s children and more than three-fifths of all nursing home residents.

The bulk of money for Medicaid comes from the federal government, but this year more than $6 billion comes from general revenue, the state’s main budget account funded primarily by sales taxes.

House Health Care Appropriations Chairman Jason Brodeur, a Sanford Republican, said hurricanes Irma and Maria put “a bit of a strain” on the budget he oversees, and as a result that could hamper any requests for new social-services spending.

“From the explicit costs of providing more health and human services to a larger than anticipated population, to the implicit costs of things like the overtime paid to our (state employees) who are in charge of registering and providing (benefits) to all those new enrollees, all of those costs must be paid for before we can start looking at new programs,” he said.

Nevertheless, Brodeur said members have filed more than 200 requests to fund local projects “which is the exact opposite of `small government.’ ”

During the 2017 Session, legislators agreed to change how the state pays nursing homes to provide care for the poor and seniors who rely on Medicaid. Lawmakers decided to scrap a longstanding system where nursing homes have been paid based on audited cost reports and agreed to implement a prospective payment system where payments are determined in advance, regardless of the intensity of the services provided.

While lawmakers agreed to change the payment methodology, they delayed implementation of the new system until 2018. Brodeur said the conversion “is our next step in efficiency.”

Senate President Joe Negron, though, wants the Legislature to do more than pull the trigger on the prospective-payment system. He wants to increase the amount of money the state directs to paying nursing homes.

“That’s a very strong priority of mine,” said Negron who, quoting Sen. Lizbeth Benacquisto, notes that the average Medicaid-funded nursing home resident in Florida is an 85-year-old woman.

“These are the women who shaped our communities. We have a responsibility to give them the highest level of care,” Negron said.

The Stuart Republican also said he would like to help the industry offset the costs of generators that Gov. Rick Scott has mandated for nursing homes after deaths at a Broward County nursing home following Hurricane Irma. Negron predicted that the generators “will ultimately be a shared endeavor between the state and the industry.”

But Negron’s push to increase reimbursement for nursing homes and offset the costs of generators also comes at a time when two state agencies are requesting funding to help plug deficits.

The Agency for Persons with Disabilities is asking for $34 million in general revenue to help cover a $89 million deficit in a Medicaid waiver program that enables developmentally disabled people to live in communities instead of institutions. Also, the Department of Health is requesting $25 million to plug a shortfall in the Children’s Medical Services program, which pays the health care costs for medically complex children covered by Medicaid.

Negron downplayed the deficits in the programs and the effects they could have on new funding requests during the 60-daysession, which starts Jan. 9.

“You have to make difficult decisions,” Negron said of crafting the state budget. “That’s why I think the budget process is fascinating.”

While the annual budget is the only bill the Legislature is required to pass when it meets, it isn’t the only piece of health-care legislation that members will focus on.

Indeed, there are hundreds of bills filed for consideration, from requiring birth centers to report adverse events to state health care regulators (SB 510 and HB 673) to authorizing new needle-exchange programs to try to prevent the spread of infectious diseases (SB 800 and 579).

The Legislature will once again consider passing a bill that would allow ambulatory surgical centers to keep patients overnight. Florida law currently requires the surgical centers to release patients the same day they are admitted and cannot keep patients overnight.

“It’s silly that people have to be discharged the `same work day’ and not 24 hours. The marketplace could open up for consumers if they could adjust their schedules for the 24-hour standard,” Brodeur said.

The legislation (HB 23) is already ready for the House floor. While the House bill also would authorize and license so-called “recovery care centers,” to provide post-surgical and post-diagnostic care to patients for up to three days, the Senate version (SB 250) would only authorize overnight stays at ambulatory surgical centers.

Sen. Greg Steube, a Sarasota Republican sponsoring the Senate version, said he does not plan to take the House bill as it has been drafted. “It’s my intention just to get the 24-hour piece done,” he said.

The House also is poised to vote on a measure (HB 27) that would eliminate a controversial regulatory program for hospitals that’s known as certificate of need. Bill sponsor Rep. Heather Fitzenhagen, a Fort Myers Republican, said ending the regulations would remove “barriers to entry” and increase competition in the hospital industry.

“I think competition is healthy in almost all settings,” she said.

But critics have raised questions about how lifting the regulations, which require state approval of new facilities and programs, would affect older public hospitals that provide a wide array of services.

And while the legislation is touted as eliminating artificial barriers that impede competition, the bill would only eliminate so-called CONs for hospitals. New nursing home beds and facilities would still be regulated by the CON program.

The Florida Health Care Association, a statewide nursing-home group, has lobbied against legislative efforts to eliminate CONs for long-term care providers.

House Health Quality Subcommittee Chairman Rep. James Grant said he supports eliminating CONs for hospitals and nursing homes but said he won’t vote against Fitzenhagen’s bill for not including nursing homes.

“Some repeal is better than no repeal,” Grant, a Tampa Republican, said.

The Senate does not have a companion bill, though, and the potential CON elimination is opposed by much of the powerful hospital industry.

Florida Hospital Association President Bruce Rueben said certificate-of-need requirements have ensured that low-income communities and rural communities have access to inpatient, acute-care health services.

“CON deregulation would allow a proliferation of these services in affluent communities and undermine hospitals serving communities with high numbers of uninsured and underinsured Floridians,” Rueben said.

Report says loss of health care mandate would hit South, Central Florida hard

Three South Florida congressional districts represented by Republicans would be among the hardest-hit in the country according to a new report assessing how many people would lose or drop health care coverage if the final tax reform bill in Congress includes the U.S. Senate’s provision to repeal the individual coverage mandate in Obamacare.

A report “Estimates of the Increase in Uninsured by Congressional District Under the Senate GOP Tax Bill” from the Democratic-leaning Center for American Progress calculated the prospects for people dropping insurance in all 435 U.S. congressional districts, based on numbers produced by the Congressional Budget Office, if the Affordable Care Act’s individual mandate is repealed. The report, first produced earlier this week but revised late Wednesday, found the districts of U.S. Reps. Mario Diaz-Balart, Ileana Ros-Lehtinen and Carlos Curbelo all would be among the top seven in the country in the numbers of people dropping health care coverage.

Districts of Democratic U.S. Rep. Debbie Wasserman Schultz, Val DemingsAlcee HastingsDarren SotoTed Deutch, and Frederica Wilson would not be far behind.

Only one Florida member of Congress, Republican U.S. Rep. Dan Webster, could expect to see his district among the 100 in the nation that are least-affected by projected health care coverage reductions, according to the center. Florida’s 11th Congressional District in west-central Florida could expect to lose 24,100 people from health care coverage, the 18th-least among the nation’s 435 congressional districts.

The fate of the mandate is in the hands of the congressional conference committee, as the tax reform bill approved by the Senate includes the mandate repeal, while the bill approved by the House of Representatives does not.

Overall, Florida could see 873,000 people drop their health care coverage by 2025 if the mandate is eliminated the center estimated, according to the center. Nationally, state-by-state numbers pretty much rank the same as a state’s population size, and Florida would expect to have the third-highest number of people losing or dropping health care coverage, behind the only two states with higher populations, California and Texas.

With congressional districts, however, the variances range more widely, dependent on how many people in each district now are enrolled in Medicaid, or in health insurance policies purchased through the individuals’ market, or in insurance packages purchased through employer-sponsored plans.

The CBO projected that 5 million of those people dropping health care coverage would be dropping from Medicaid, another 5 million from the individuals’ market, and about 3 million from employer-sponsored health insurance.

“Mandate repeal has two effects on the individual market,” Emily Gee, a health economist at the Center for American Progress, explained in her report. “First, some healthy enrollees would drop out of ACA-compliant plans and become uninsured or underinsured. Second, because the remaining enrollees in the risk pool would be sicker on average, insurance companies would need to raise rates about 10 percent to cover the increased average cost. The resulting higher premiums would discourage even more people from obtaining coverage through the individual market.”

With those factors, Diaz-Balart’s district could become one of the most vulnerable in the nation to reductions in health care coverage, a phenomenon expected to not just affect individuals, but also the financial pressures on hospitals, other health care entities, and local governments, the report notes.

The center’s report says that Florida’s 25th Congressional District could expect to see 41,000 people drop or lose insurance, the fourth-highest number of any congressional district. Ros-Lehtinen’s district is projected to lose 40,800, the nation’s sixth-highest total; in Curbelo’s district, 39,900, seventh-highest among the 435 congressional districts, according to the Center for American Progress.

Diaz-Balart’s, Ros-Lehtinen’s, and Curbelo’s offices did not respond Thursday to a request from Florida Politics to comment on the center’s findings.

Several Democrats, already opposed to either version of the tax bill, responded, including Demings, whose 10th Congressional District was projected to lose 37,700 health care enrollees.

“After much debate, the facts are in: the president’s tax bill will raise your healthcare costs, putting your right to manage your own health further out of reach. Without a second thought, donors came first,” she said in a written statement. “The GOP’s proposal would mean nearly a million Floridians would lose their healthcare over the next eight years. Floridians have done their part by turning out in record numbers during the open enrollment period. However, the people seem to have been forgotten in a tax bill that was supposed to be all about the people.”

Soto, whose Florida’s 9th Congressional District in Central Florida is projected to lose about 35,400 enrollees, declared that “Florida’s hardworking families should be troubled by the current GOP Tax bill. As it stands, it is disastrous for our state’s health programs. In Central Florida alone [including his, Demings’ and Democratic U.S. Rep. Stephanie Murphy‘s districts,] approximately 103,000 people would face a reduction in health insurance coverage due to the individual mandate repeal.”

The other four Florida districts projected to be among the nation’s 50 hardest-hit nationally are Wasserman Schultz’s 23rd Congressional District in South Florida (expected to lose 37,700 health care enrollees); Hastings’ 20th Congressional District in South Florida (36,300); and Deutch’s 22nd Congressional District and Wilson’s 24th Congressional District, both in South Florida, both 35,200.

Across the country, the average congressional district would lose about 29,800 enrollees from health care plans, the center reported. Eighteen of Florida’s 27 congressional districts would exceed that average.

Stephanie Murphy CHIP reauthorization bill lining up as Democrats’ offering

With the federal Children’s Health Insurance Program and other health programs expiring, U.S. Rep. Stephanie Murphy has introduced a reauthorization bill that is becoming the Democrats’ favored vehicle facing Republican alternative measures.

On Tuesday Murphy introduced House Resolution 4541, which would reauthorize the Children’s Health Insurance Program (CHIP) community health centers funding, and other critical public health initiatives like the Special Diabetes program, the National Health Service Corps, and Family-to-Family Health Information Centers.

All of those programs had Sept. 30 reauthorization deadlines, which Congress missed.

The bill also provides funding to support the under-resourced Medicaid system in Puerto Rico and the other U.S. territories, and to support the Medicaid system in states like Florida that enroll displaced individuals from hurricane-stricken Puerto Rico and the U.S. Virgin Islands.

The cost of the bill is fully offset by modifying the timing, but not the amount, of federal payments to Medicare Advantage and Medicare Part D plans, a move supported by numerous independent experts, according to a press release issued by Murphy’s office.

“A healthy nation is a strong and resilient nation,” Murphy said in the release. “My fiscally-responsible bill provides support for children and families, invests in the prevention and treatment of serious diseases, helps our fellow U.S. citizens in Puerto Rico and other territories, and strengthens the health care systems in states like Florida that are welcoming Americans displaced by Hurricane Maria. It’s vital that we work across party lines to help the tens of millions of Americans, including millions of children, who depend on these public health initiatives.”

There are several Republican and Democratic alternatives addressing CHIP and the other health programs. Murphy’s office said her bill has become the favorite among Democrats, drawing 30 co-sponsors already, including U.S. Rep. Darren Soto of Orlando.

Murphy’s bill provides a five-year extension for CHIP, a two-year extension for community health centers funding and other expiring health care programs. It also offers equity in the Medicaid programs for Puerto Rico, the U.S. Virgin Islands and other American territories, increases the Medicaid caps for those territories, and provides increased Medicaid reimbursement funding to Florida states for providing care to individuals from Puerto Rico and the U.S. Virgin Islands who were displaced by Hurricanes Irma and Maria.

Darren Soto, Bernie Sanders pushing Puerto Rico, Virgin Islands rebuild bill

U.S. Rep. Darren Soto plans to help introduce a bill in the U.S. House of Representatives that would seek to provide comprehensive rebuilding money and resources for Puerto Rico and the U.S. Virgin Islands beyond what is needed to address just the devastation from Hurricanes Maria and Irma.

Soto, an Orlando Democrat, announced he would be joining Democratic U.S. Reps. Stacy Plaskett from the Virgin Islands, and Nydia Velázquez from New York in sponsoring the House version of a U.S. Senate bill announced late Tuesday by independent U.S. Sen. Bernie Sanders of Vermont and cosponsored by several other Democrats.

The Puerto Rico and Virgin Islands Equitable Rebuild Act, unveiled in Washington D.C. Tuesday by Sanders, Soto and the others, goes beyond just providing immediate humanitarian relief from the storms, which left the island U.S. territories in tatters, still largely without electricity and potable water more than two months later. The bill addresses longterm rebuilding of infrastructure including the schools and power systems, and equity in how the islanders are eligible for federal benefits, including Medicaid and Medicare.

It also calls for more equitable resolution of the Puerto Rico government’s $75 billion debt, now being addressed in bankruptcy proceedings, and seeks seeks to provide the additional aid without forcing the territories to take on more debt.

First, though, it calls for the federal government to immediately address the humanitarian crises by “mobilizing all necessary resources and assets to restore power, provide clean drinking water and food, safe shelter and access to health care,” according to a press release issued by Soto’s office.

“The people of Puerto Rico have been living in a nightmare for far too long,” Soto said. “We talk about power to the people. The people of Puerto Rico and Virgin Islands need power! I am proud to support this legislation that will help the islands get the lights back on and their economies going again. As we look to rebuild the islands, we have an opportunity to become an energy model for the 21st century if we invest right.”

“We will stand with the American citizens of Puerto Rico and the Virgin Islands,” Sanders said in introducing his bill Tuesday. “We will rebuild those islands better than before the disasters devastated them.”

In addition to stepped-up immediate relief, the bill calls for:

– Puerto Rico’s debt to be addressed in a way to ensure the territory can recover “with dignity” and that the recovery effort should not add additional debt.

– Replacing the “antiquated, centralized and inefficient”power systems with new grids incorporating renewable energies, including solar.

– Parity with states in benefits from Medicaid and Medicare, and equity in the amount of money available.

– Rebuilding and improving the U.S. Department of Veterans Affairs hospital and clinics.

– Improvements to public schools, colleges and childcare facilities, which the sponsors contend were “inadequate before the storms hit,” noting that hundreds of public schools were closed in Puerto Rico because of Austerity measures before the storms, and the Virgin Island schools struggled.

– Investments in infrastructure to spur economic development.

– And environmental cleanup, not just from the storms, but from prior pollution and military bombing exercises on the island of Vieques.

Florida Hospital Association lauds Stephanie Murphy’s ‘Disaster Displacement Act’

The Florida Hospital Association is expressing strong support and “deep appreciation” for a bill by U.S. Rep. Stephanie Murphy that would make Puerto Rican evacuees almost immediately eligible for full Medicaid coverage by the federal government if they have to evacuate to Florida.

The hospital association praised Murphy’s “Disaster Displacement Act of 2017,” House Resolution 4249, introduced last Friday by Murphy, a Winter Park Democrat, and co-sponsored by U.S. Rep. Darren Soto, an Orlando Democrat, and which is an identical companion to legislation introduced in the Senate by U.S. Sen. Bill Nelson, a Florida Democrat.

The bills are in response to the influx of Hurricane Maria victims evacuating the island because their homes and communities remain unlivable, and in many cases their jobs are gone. Estimates run as high as 120,000 who already have arrived in Florida, and estimates go as high as 300,000 who might eventually arrive. Many are arriving with little documentation and no insurance, relying on Medicaid for health care issues that include cancer treatment and chronic illnesses.

Murphy’s and Nelson’s bills would enroll evacuees arriving in Florida in Medicaid through an expedited process, and have federal government cover the full costs of their care for at least 24 months. In the absence of this legislation, the state of Florida would be required to pay nearly 40 percent of the cost of care, straining the state’s budget.

Nelson’s Senate Bill 2066, which, like Murphy’s was filed late last week, has already received endorsements from several local officials, including: Orlando Mayor Buddy Dyer, Osceola County Commissioner Fred Hawkins and Miami-Dade County Commissioner Daniella Levine Cava. The measure now heads to the Senate Finance Committee for consideration.

Murphy’s bill has been assigned to the House Energy and Commerce Committee, and the House Financial Services Committee.

“On behalf of the Florida Hospital Association’s over 200 organizational members, I am writing to express our strong support and deep appreciation,” FHA President Bruce Rueben wrote.

“In all cases, Florida’s hospitals will help everyone and anyone in need. The displaced residents of Puerto Rico are not exceptions. Our mission is to care for everyone and we will gladly meet this new challenge just as we stepped up to help our own communities during and after Hurricane Irma. This vital legislation will go far to help ensure that Florida’s hospitals continue to have the necessary funding to fulfill our mission to care.”

Murphy said the bill is modeled after a similar law passed to assist states such as Texas that took huge influxes of migrants displaced by Hurricane Katrina in 2005.

Her and Nelson’s bills also would allow local housing authorities to access additional federal funding to help provide housing for Puerto Rico evacuees.

“Florida is doing the right thing by taking in thousands of our fellow American citizens whose lives were uprooted as a result of Hurricane Maria, and the federal government should have our state’s back,” Murphy stated in a news release . “Just as we did after Hurricane Katrina, we should give states who receive hurricane victims the resources they need to provide for their current and new residents. Central Florida has received a significant percentage of the Americans leaving Puerto Rico, creating greater demand for health care services and quality, affordable housing

Senate moves again on health insurance changes

Physicians would have greater leeway in prescribing medications to patients, and insurance companies would have less time to approve prior-authorization requests under a bill unanimously approved by a Senate panel Tuesday.

But bill sponsor Greg Steube, a Sarasota Republican, told senators that if they would like to see the proposal (SB 98) make it into law, they need to press the House of Representatives – which, he said, killed a similar measure last year.

The bill would amend current law to require health insurers, HMOs, Medicaid managed-care plans and pharmacy benefit managers to approve or deny prior-authorization requests in urgent circumstances within 24 hours of receiving the requests. In non-urgent situations, companies would have three days.

The timelines are shorter, for example, than what’s currently allowed in the state-employee health insurance program and in the Medicaid program.

HMOs and insurance companies that participate in the state group program are contractually required to review urgent or emergency prior-authorization requests within 24 hours after receipt and within 14 calendar days after receiving routine requests.

Meanwhile, according to a staff analysis, Medicaid officials said they would have to amend managed-care contracts to change prior-authorization requirements and utilization-review timeframes.

Currently, Medicaid managed-care contracts require health plans to authorize or deny standard requests for prior authorization for services other than prescribed drugs within seven days and authorize or deny expedited requests within 48 hours.

Prior authorizations for prescription drugs must be handled more swiftly; the plans must deny, approve or seek additional information within 24 hours after receiving requests for prior authorization for prescription drugs.

According to the staff analysis, the bill would “significantly affect the business (staffing, systems, etc.) and clinical operations of the Medicaid managed care plans. The bill requires the plans to shorten the time to review authorizations, which will increase the administrative costs.”

However, the staff analysis stopped short of putting a price tag on the changes, noting that the increased costs in the Medicaid program and the state group health plan are “indeterminate.”

Groups supporting the bill include the Florida Medical Association, the Florida Osteopathic Medical Association and AARP Florida. It has widespread support in the Senate, which unanimously passed a similar proposal last year.

Senate Banking and Insurance Committee member Doug Broxson, a Gulf Breeze Republican, said he has seen similar legislation over the last several years and asked Steube: “Why didn’t it pass last year, and what would we have to do to make sure this gets on the governor’s desk this year. Where’s the hang up?”

Steube said the bill died last year in the House Health and Human Services Committee and half-jokingly told members, “I encourage you to talk to Chair (Travis) Cummings,” who leads the House committee.

Broxson, though, pressed Steube, asking him if the Senate was “positioning itself to do this every year, to vote on something that is not going to be heard in the House or be seriously considered?”

Steube then struck a serious tone, saying he’s been told Cummings, in Orange Park Republican, may be “more open to looking at it this year” but said he hadn’t had the opportunity to speak with the House chairman about the bill. The bill is filed for the 2018 legislative session, which starts in January.

In addition to addressing prior authorization requirements, the bill also would create a new section in insurance law to address “step therapy” or “fail first” protocols used by insurance companies, HMOs and pharmacy benefit managers. The protocols prescribe certain medical procedures, prescription drugs or courses of treatments that must be used to treat conditions.

Natalie Blake, director of program services for the Multiple Sclerosis Foundation, told senators that “it’s unconscionable for somebody with a disease like multiple sclerosis to have to fail a drug first. They should be allowed to take any drug that their physician approves for them that is approved,” by the Food and Drug Administration.

“In MS, if you fail a drug, it results in further disability. You have more progression of your disease and in the long run, it results in a lot more costs to the health system,” she said.

But insurers said the bill would curb the effectiveness of the protocols by requiring insurance companies to approve providers’ requests for exceptions under certain criteria. Exceptions would be required, for instance, if a treatment is expected to worsen a patient’s medical condition or decrease the ability of the patient to perform daily activities.

Audrey Brown, president of the Florida Association of Health Plans, was the sole lobbyist to speak against the bill Tuesday.

She told the panel that prior authorization and step therapy requirements serve a twofold purpose: to save costs and to ensure patient safety.

“Half of over every dollar spent by the pharmaceutical industry is on direct consumer marketing, which increases a patient’s demand for high-cost brand drugs,” she told the committee. “Requiring the step of a generic equivalent is one of the only negotiating tools a health plan has over costs.”

Brown also touched on Florida’s opioid crisis in her testimony, noting that requiring patients to take non-addictive opioid alternatives before narcotics helps curb potential overprescribing.

Republished with permission of the News Service of Florida.

Nursing home providers quarrel over quality payments

A bruising battle over how to parcel out billions in Medicaid payments for nursing homes is showing little signs of ending anytime soon.

The latest skirmish happened this week at a meeting where both sides of the tug-of-war were supposed to be trying to draw up a detailed blueprint for a revamp of how nursing homes get paid under the state-federal health care program.

The meeting devolved into a tense exchange when Scott Hopes, a nursing home lobbyist, snapped at a fellow member of the workgroup for not answering what he said was a “simple, yes or no question.”

Keith Myers, president and CEO of West Palm Beach-based MorseLife Health System, was interrupted by Hopes three times as he tried to respond.

It’s not surprising that those involved in the nursing home industry are closely watching the workgroup, since long-term care remains one of the largest expenses in the Florida’s $26 billion Medicaid program.

The state set up a nursing home prospective payment workgroup earlier this year following a contentious battle during the 2017 session over a push by some nursing homes to alter how they are reimbursed.

A prospective payment system is a reimbursement system in which rates are determined in advance of payment and considered final upon payment. Currently, the state reimburses skilled nursing facilities on a cost-based rate and rates are generally retrospective in nature.

The Florida Health Care Association pushed the Legislature to approve a prospective payment system but LeadingAge Florida said the new calculation system didn’t make quality a top priority.

The Legislature agreed to the changes but pushed back implementation to October 2018. Lawmakers also tasked the State Agency for Health Care Administration with creating a work group to, among other things, assist in the development and refinement of quality measures that should be included in the reimbursement calculations.

Workgroup members agreed at their inaugural September meeting to use, as a starting point, quality metrics included in a 2016 report published by state-hired consultant Navigant. The report provided a roadmap for transitioning from cost-based reimbursement to a fixed-fee system.

After a lengthy discussion last month, the panel agreed to keep some of the quality metrics included in the Navigant report but left pending until Thursday’s meeting action on more than a half-dozen other recommended changes.

Some of the proposed changes include eliminating incontinence and the use of restraints as metrics in the quality payment incentive but adding weight loss for consideration.

The additional time between meetings, however, didn’t help the workgroup members to reach consensus.

After 45 minutes of debate, mostly focused on whether the proposed changes would take effect in October 2018 or in 2020, the committee voted 6-5 to delete the incontinence metric, effective next year, from consideration.

But panel member Beverly Williams subsequently said she was uncomfortable with approving any changes that would take effect in October 2018.

“I’m thinking really we should kinda stay with the way it is now until such time that we’ve gone a year or so and we know what’s going on, which ones are problematic,” she said. “I think I am changing my first vote.”

Sensing that the technical advisory panel wasn’t going to be able to come to agreement, Hopes recommended that the committee approve the quality recommendations included in the 2016 Navigant report and that a subsequent panel be appointed to further analyze the quality of care metrics.

“(Is there) such strong opposition to it (the Navigant metrics) that we cannot move this meeting forward unless we change it?” Hopes asked panel members, especially Myers.

“Some of them,” said Myers. But when Myers tried to explain his position, Hopes interrupted.

“So your problems are significant enough that you are not going to be able to live with this? We have to change it?” Hopes asked Myers.

“It’s not about the organization,” Myers said, again trying to elaborate.

But Hopes interrupted Myers for a second time, asking him again whether he would agree to submitting the Navigant report or if that made him uncomfortable.

When Myers went to answer the question, Hopes interrupted him a third time.

“It’s a simple question: yes or no,” Hopes said, quickly adding, “I’m trying to move this meeting along.”

Myers noted that he also was trying to keep the group on task. He reminded Hopes that the panel last month agreed to delay action on nine proposed changes until Thursday, which was why the items appeared on the agenda.

Myers also said that creating another committee to examine the quality metrics between now and October 2018 just adds another layer of bureaucracy to the process.

But Hope told Myers that his “sense” was that the panel wouldn’t be able to come to a consensus on the nine issues Thursday.

He reiterated his recommendation that panel members be asked whether they supported submitting the recommendations in the Navigant report.

But this time it was Myers who retorted.

“Is that an agenda item, because that’s not what I’m reading,” he said.

The back and forth ended only after Interim Assistant Deputy Secretary for Medicaid Finance and Analytics Tom Wallace suggested that the panel members submit written comments to the agency.

Wallace said he wanted the technical advisory committee’s report to be a reflection of the panel’s sentiments and, to that end, asked that each member provide written comments on the nine proposed changes. The comments would be included in the final report, Wallace said.

“We could definitely do that,” he said. “We like to do that.”

The three-hour meeting at the Agency for Health Care Administration’s Tallahassee headquarters wasn’t all controversial, though.

Nursing home technical advisory panel members agreed to temporarily defer any decision on how supplemental payments for ventilators should be applied.

The panel also agreed not to apply a 2011 law that prevents rates from being adjusted for inflation when the prospective rates are being rebased.

That recommendation was made by panelist Bob Asztalos, chief lobbyist for the Florida Health Care Association, which aggressively lobbied the Legislature to pass the prospective payment system into law.

Asztalos noted that the state retooled how it paid hospitals for inpatient and outpatient care. During that transition period, hospitals were exempt from a 2011 law restricting Medicaid rates from being annually adjusted for inflation.

After the recommendation was unanimously approved, Asztalos quipped he was beginning to feel “warm and fuzzy.”

Hopes, who had been frustrated earlier in the meeting, joined in Asztalos’ optimism.

“We went from a health debate to ending our agenda with consensus,” Hopes said.

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