An administrative law judge recommended Tuesday that the state Agency for Health Care Administration toss aside agreements it signed for treatment of Medicaid beneficiaries with HIV and AIDS in three South Florida counties.
In an 80-page ruling, Judge John Newton said the Agency for Health Care Administration did not follow rules it included in an initial request for vendors in the Medicaid managed-care program. As a result, Newton said the state should reject all responses submitted by managed-care plans for HIV and AIDS treatment in the counties and renew the contracting process.
The ruling came just weeks before Medicaid beneficiaries in South Florida are expected to transition from old managed-care plans to new plans that are a result of a lengthy contracting process. The Agency for Health Care Administration had hoped to finalize the transition by Dec. 1, according to its website.
Agency spokeswoman Mallory McManus told the News Service of Florida that the state was reviewing the judge’s recommended order and had no further comment. Under administrative law, the recommended order has to go back to the agency for final action.
The ruling was a victory for the AIDS Health Care Foundation and its managed-care subsidiary, Positive Healthcare, and a loss for Simply Healthcare Plans, which was picked by the agency to provide the care for HIV and AIDS patients.
“We applaud Judge Newton for making a decision that is not just a decision that is right for AIDS Healthcare Foundation and Positive Healthcare but a decision that is right and has a positive impact on the thousands of HIV patients that rely on this care,” AIDS Healthcare Foundation official Imara Canady told The News Service of Florida.
Canady said the health plan has been in communications with its patients throughout the legal challenge. He said there had been some “murmurs” in the community that the health plan was dissolving.
Canady said the foundation is going to “make sure patients are clear we are very much here.”
Florida lawmakers in 2011 required that almost all Medicaid beneficiaries enroll in managed-care plans, with contracts divvied up in 11 regions of the state. An initial set of contracts is expiring, which led the Agency for Health Care Administration to go through a procurement process that ended in awarding the HIV and AIDS contracts to Simply Healthcare in two regions made up of Broward, Miami-Dade and Monroe counties.
The AIDS Healthcare Foundation challenged the contract awards in administrative court, with the state unsuccessfully trying to get the cases dismissed. The state argued that Positive Healthcare violated what is known as a “cone of silence,” which precludes vendors from making contact during certain timeframes with anyone in government regarding bids.
AHCA alleged, in part, that Positive Healthcare violated the cone of silence by sending letters to the governor’s office criticizing the agency’s decisions. AHCA said during a hearing that if it were ordered to reissue the contracts, it wouldn’t award them to Positive Healthcare because of the alleged violation.
But Newton said the agency didn’t initially reject the AIDS Healthcare Foundation bid because of the alleged cone of silence violations.
The Agency for Health Care Administration’s contracting process included seeking health plans to provide long-term care and “managed medical assistance” — the types of care needed by the bulk of Medicaid beneficiaries. It also sought “specialty plans,” which deal with specific populations such as patients with HIV and AIDs.
While the AIDS Healthcare Foundation challenge may have gotten the most public attention, Newton also considered challenges filed by Community Care Plan, a type of managed-care plan known as a “provider sponsored network” that is owned by two Broward County hospital districts.
In addition to submitting a bid to provide managed medical assistance in Broward County, Community Care Plan submitted bids to provide care to people with serious mental illness, children with special health care needs, children in the child welfare program and people living with HIV and AIDS.
While AHCA chose Community Care Plan as a managed medical-assistance provider for Broward County it didn’t invite the health plan to negotiations for specialty-plan contracts.
Community Care Plan filed a challenge to the agency’s decision to award a Broward contract for people with serious mental illness to a subsidiary of WellCare of Florida. It also challenged an agency decision to deny Community Care Plan contracts for other types of special plans.
Along with recommending that the agency reject all responses submitted by managed-care plans for HIV and AIDS treatment, Newton recommended that it should invite Community Care Plan to negotiate to provide care in Broward for patients with serious mental illness and for child-welfare specialty services. He also recommended that the agency award a contract to the WellCare subsidiary, Staywell Health Plan of Florida, to provide services for patients with serious mental illness.