Peter Schorsch
An amendment put forward by Sen. Bill Galvano would turn over the state’s budget for medically complex children to one company: Miami-based Caregiver Services, Inc.
The proviso language would allow the Agency for Health Care Administration to contract with a provider service network offering specialty plans that cover children who are eligible for the state’s Medicaid program.
Though seemingly innocent, the amendment relies on Florida statutes that lack the competitive procurement, accountability and quality of care requirements that Florida’s current Medicaid managed care plans are held to, effectively allowing Caregiver Services and its affiliate, Children First Specialty Plan, LLC, to get a sole-sourced contract without a competitive bidding process.
The lack of a competitive bidding process has turned into a major sticking point with top-ranking lawmakers in the House, who have offered language to add back in the bidding and standards statutes, but Caregiver Services ignored it and pushed ahead with the sole-source language on the Senate side.
Under the current Medicaid MMA plan, medically complex children are referred by a physician to a prescribed pediatric extended care center, a type of part-time nursing home intended for only the most fragile and sickly children, who are among the most expensive patients to the state.
Caregiver Services owns multiple PPECs in the state and, if given a sole-sourced contract for their specialty, plan,could refer children who wouldn’t be otherwise eligible to their own facilities, boosting overall enrollment and greatly increasing costs for Florida.
Caregiver Services’ ultimate goal is to sell this creation – a money printing machine fueled by Florida’s most fragile children – and has been presenting both the company and the plan in prospectus fashion to any interested buyer as if the language had already been adopted.
This isn’t the first time the company has tried get its sole-source language passed. Galvano put a nearly identical amendment into last year’s budget, and advocates claimed at the time that Florida PPECs supported the move, though the PPEC community ended up deriding the changes as a grave threat to healthcare for the state’s most vulnerable children.
This monopoly-granting amendment was never heard in a public committee this session or last session, and has the potential to put Florida taxpayers on the hook for millions in increased Medicaid costs. All through the quiet adoption of a late-filed amendment on the Senate floor three weeks ago.
