- Bob Herman
- Caroline Catherman
- Cindy Krischer Goodman
- CMS Health Plan
- Commission on Mental Health and Substance Abuse
- Denis McDonough
- Florida Children and Youth Cabinet
- Florida Community Care
- Florida Medical Association
- Florida Voices for Health
- Health Care for Florida Coalition
- Humana Medical Plan
- Javon L. Harris
- John Henderson
- Jupiter Medical Center
- Justice Clarence Thomas
- Kat Cammack
- Liberty HealthShare
- lorida Medical Association
- Magellan Complete
- Magellan Complete Care
- Marco Rubio
- Medicaid Medical Care Advisory Committee
- Melanie Brown-Woofter
- Molina Healthcare
- Rick Scott
- Simply Health Care Plans
- Staywell Health Plan
- Sunshine Health Plan
- Traci Koster
- UF Health
- Vickie Chachere
- Vivida Health
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Florida’s two Senators joined with other Senate Republicans in demanding answers to an extensive line of questions surrounding the ongoing COVID-19 public health emergency declared by federal authorities.
On Friday, Sen. Marco Rubio and Sen. Rick Scott signed a letter led by Wyoming Sen. John Barrasso to Health and Human Services Secretary Xavier Becerra.
In the letter, Senators insist on knowing more about the federal government’s plan to transition out of the more than two-year-long emergency, which funneled billions in added federal Medicaid funds into the state but has precluded the state from disenrolling anyone from the safety net program.
“As the American people return to normalcy,” the letter states, “workers, families, front-line health care providers, and a range of other stakeholders need transparency and certainty regarding the path forward.”
The signatories added that they need this information; without it, they say, “Congress will lack the clarity and information needed to inform any productive discussion on potential phase-outs, extensions, terminations, or modifications for temporary flexibility and relief measures.”
The letter is part of an ongoing push by Republicans to bring an end to the declared emergency first put in place in late January 2020. HHS has renewed the 90-day emergency declaration nine times — and it looks like the 10th time will be in July.
Federal officials have previously promised to give a 60-day notice if they plan to lift the declaration, but the federal government’s mid-May deadline came with no action.
A lengthy line of health organizations, including the American Hospital Association and American Medical Association, sent a letter to HHS on May 10 that urged the “administration to maintain” the public health emergency “until we experience a period of greater stability.”
The GOP Senators’ letter asks for information about any waivers put in place for Medicare, Medicaid, and the Children’s Health Insurance program and whether those waivers are contingent on continuing a public health emergency.
Senators also want to know what “concrete” steps will be taken on waivers once the emergency is terminated.
Children in Florida have been at considerable risk of losing health care coverage when the public health emergency expires.
I welcome your feedback, questions, and especially your tips. You can email me at [email protected] or call me at 850-251-2317.
— Opaque —
So precisely what was the Agency of Health Care Administration told about its upcoming Medicaid overhaul?
Well, as of right now, it’s a bit of a mystery.
Despite earlier promises to make public the responses received, AHCA still has released answers to its Medicaid request for information on its managed care procurement.
More than 50 responses were submitted to the state by the June 3 deadline. An array of stakeholders interested in Florida’s mandatory Medicaid managed care program, from NCQA to the Florida Medical Association to Sunshine Health Plan, submitted responses to the state.
Vendors had to send two responses, one to be seen internally by AHCA staff and the other for the public. Vendors could redact information from the public submission that is exempt from public records.
Before responding to the RFI, potential vendors had the opportunity to ask the agency questions.
Simply Health Care Plans, Inc. asked AHCA whether it would make the RFI responses available for public review and, if so, whether the release would be before the procurement or after its conclusion.
AHCA replied: “All RFI responses will be subject to (a) public records request, in accordance with Chapter 119, Florida Statutes.”
Florida requires most Medicaid beneficiaries to enroll in a managed care plan. The plans get monthly premiums to manage the care the person receives, whether delivered in an office or a hospital. The plans manage most covered Medicaid benefits except for dental care and applied behavior analysis.
Last month, the state released an RFI on the upcoming Medicaid managed care procurement. It was the first step in what can be a long journey before Florida’s multi-year Medicaid managed care contracts expire in 2023. The state must start work before the end of the year to have new competitively bid contracts in place by Jan. 1, 2024.
— Busy 4Q —
Medicaid officials have assessed nearly $10 million in liquidated damages against health plans in the final quarter of the fiscal year 2021-2022 for breaching their contracts.
As of June 10, AHCA had finalized 31 actions against managed care plans for the fourth quarter of the fiscal year that will end on June 30 and levied $9,964,187 in liquidated damages.
StayWell Health Plan, Sunshine Health Plan, and Magellan Complete Care were hit with the largest liquidated damages for the quarter, totaling $4,378,690, $2,401,785, and $729,360, respectively, for breaching the “quality” requirements in their contracts.
The Medicaid Compliance Action dashboard did not provide further details on the quality violations.
Of the 31 complaints completed in the 4Q of 2022, 11 involved “quality” issues. Other plans hit with liquidated damages for the quarter for quality violations were Florida Community Care, Vivida Health, Molina Healthcare, Magellan Complete Care, Humana Medical Plan, and CMS Health Plan.
Provider complaints (13) account for more than one-third of the finalized actions for the quarter and about 5% of the amount of liquidated damages assessed or the quarter to date. AHCA data show that 10 provider complaints were about network adequacy issues, and the other three stemmed from claims payments.
Seven final agency actions were for breaching contractual requirements about the treatment of enrollees. Data show the issues all stemmed from admissions or discharges from nursing facilities. Liquidated damages for those contract breaches totaled $56,000.
The $9,962,847 in 4Q liquidated damages accounts for more than 80% of the $12,441,077 million in damages the state levied against the plans during the current fiscal year involving 193 finalized agency actions.
AHCA assesses liquidated damages when plans breach their contracts. Liquidated damages are not meant to be punitive. Instead, according to AHCA, they are levied to cover the agency’s projected loss and damage.
Sanctions are levied when the agency finds health plans violated their contracts. In February, AHCA levied a record-setting $9,092,025 sanction against Sunshine Health Plan.
— You go, girl —
Florida Behavioral Health Association President and CEO Melanie Brown-Woofter has been recognized by her peers as the 2022 leading advocate of mental health and substantive expansion.
Brown-Woofter, in 2022, worked to pass legislation that streamlines medical decisions and addresses stigma. Brown-Woofter worked tirelessly to help secure an added $126 million to increase payments to community mental health and substance abuse providers and expand access and capacity. Before 2022, community mental health and substance abuse service providers had seen rate increases since 2001.
Brown-Woofter isn’t a run-of-the-mill association executive or health care lobbyist. She’s a rare mix of someone who understands Medicaid policy and has a clinical background. She is a former Florida Medicaid Bureau Chief with a BSN from the University of Florida.
Melissa Larkin-Skinner, CEO of Centerstone in Florida and the board chair of FBHA, lauded her executive’s skillset. “I have witnessed firsthand Melanie’s advocacy efforts and their positive impact on Florida’s mental health and substance use policies and funding. Under her guidance and leadership, community mental health and substance use providers received $126 million to the base budget this past legislative session. This is unprecedented and would not have been possible without Melanie’s knowledge, perseverance and advocacy.”
While she was bestowed with the 2022 Award for Individual Achievement in Advocacy, Brown-Woofter said it was a group award.
None of this would be possible without the tireless effort, experience, and expertise of the entire FBHA staff. This is a true group award that I am proudly accepting on behalf of Florida’s community mental health and substance use providers who tirelessly work to help Floridians in need,” she said.
— RULES —
—The Board of Psychology published a change to its proposed amendment for Rule 64B19-18.004 regarding the administration of psychological tests via telemedicine. More here.
—The Board of Psychology proposes amending Rule 64B19-11.012 about a Division of Medical Quality Assurance application form. More here.
—The Board of Orthotists and Prosthetists proposes amending Rule 64B14-5.002 to update the language to clarify the continuing education requirement and mandatory courses. More here.
—The Board of Orthotists and Prosthetists proposes amending Rule 64B14-7.001 to remove the word “intern” from the standards of practice rule. More here.
—The Board of Osteopathic Medicine proposes amending Rule 64B15-14.004 on the standards of practice for the prescribing of medication for the treatment of obesity in children and adults to allow for the use of telemedicine. More here.
— ROSTER —
— Tampa General Hospital Executive Vice President and Chief Medical Officer Peggy Duggan M.D. was named to the Hall of Fame Health Medical Advisory Board. Hall of Fame Health is dedicated to bringing health care solutions and services to former professional football players and their families. Duggan was one of five physicians named to the panel last week but the only Florida-practicing doctor. Hall of Fame Health was launched in 2020.
— Andrea Gary and Jason Weida were appointed to the Florida Healthy Kids Board of Directors by the Governor last week. Gary is the Bureau Chief of the Florida Department of Health and the chief administrator for the Children’s Medical Services Health Plan. Weida is the Assistant Deputy Secretary for Medicaid policy and quality at the Florida Agency for Health Care Administration.
— DeSantis also appointed Matthew Eaton and Samantha Ferrin to the Alzheimer’s Disease Advisory Committee Eaton is the vice president of communications for the Florida region at the Alzheimer’s Association. Ferrin is the government law and policy practice director for Greenberg Traurig in Tallahassee.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— Details in two Medicaid IT bids emerge: Five vendors submitted responses to the ITN for the provider service module, a seven-year contract worth an estimated $33 million. They are Gainwell Technologies, Optum; HHS Tech Group; FEI Systems; and Digital Harbor Inc.
Six vendors submitted bids for the unified operations center. They are Conduent State Healthcare, Gainwell Technologies; Deloitte; Automated Health Systems TTEC; Cognosante; and Maximus. The seven-year contract is worth an estimated $139 million.
— Headed south: University of Florida (UF) Health and Jupiter Medical Center announced Tuesday plans to build new clinical facilities that will be jointly owned and operated. It is not clear when the new clinical facilities will be operational. In addition to developing jointly owned clinical facilities, the release notes that UF Health and Jupiter Medical Center are also set to begin discussions on developing “novel clinical and hospital programs and service lines.”
— Future costs recoverable: Florida can recover money from a settlement award won by an injured Medicaid patient, the U.S. The Supreme Court ruled Monday. The 7-2 decision written by Justice Clarence Thomas ruled the federal Medicaid Act allows states to recover settlement awards for future medical expenses. Although the federal law prohibits states from placing a lien on a patient’s “property,” there is an exemption for settlements involving awards for medical expenses. Thomas refuted arguments that the exemption only applies to damages for past medical expenses, not future medical expenses.
— CanineCare: Canine veterans can have their health care needs covered under a new Florida law. At least $300,000 will be set aside annually to take care of the medical needs of these retired dogs. The dogs would have had to serve at least five years in a crime-fighting capacity to qualify for a $1,500 annual benefit.
— Change is in the air: The U.S. Census Bureau is requesting millions of dollars to study how best to ask about sexual orientation and gender identity. The results could supply much better data about the LGBTQ population nationwide when views about sexual orientation and gender identity are evolving.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worthy of your time.
“Hospitals unable to meet undocumented patient data demand from Gov. DeSantis“ via Javon L. Harris of the Gainesville Sun — In September 2021, Gov. Ron DeSantis signed an executive order requiring the Florida Agency for Health Care Administration to begin collecting data from hospitals on the amount of money spent on caring for undocumented immigrants. The problem? Most health care facilities don’t question patients about their immigration status before treating those in need.
“Shock, anger, guilt: What Parkland can teach Uvalde about mental health struggles ahead” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — Four years after her daughter watched a friend get shot in a Marjory Stoneman Douglas High School classroom, Nicole Cook is angry that another community faces the same magnitude of mental health recovery without a roadmap. “There still is no trauma research on something like this,” Cook says. “No guidelines for what to say or what should happen. No evidence-based manual. No protocol. By now, we know it’s going to happen again, and so there should be.”
“Feds withhold $1.2M as Florida refuses to enforce COVID-19 vaccine rule for health care workers” via Caroline Catherman of the Orlando Sentinel — The Centers for Medicare & Medicaid Services is enforcing a federal vaccine requirement for health care staff that offers only medical or religious exemptions. The rule, which the U.S. Supreme Court confirmed in January, contradicts a state law that requires employers to offer broad exemptions that are not allowed by CMS. Though the Florida Agency for Health Care Administration has vowed not to monitor or report whether Florida health care facilities are following the requirement, that isn’t stopping the federal government from checking. CMS required 100% of eligible Florida health care workers to be fully vaccinated or receive an exemption by Feb. 28. CMS has reduced Florida’s federal allocation of survey and certification funding by $1.2 million and will pay contractors to check if health care facilities are following the law, which would typically be the state’s responsibility, a CMS representative said.
“Lawmakers demand answers for ER care at VA hospitals after death in Gainesville facility” via John Henderson of The Gainesville Sun — Lawmakers are demanding answers from the U.S. Department of Veterans Affairs about emergency room care at some of its largest hospitals after an investigation found that Malcom Randall VA Medical Center Emergency Department in Gainesville was negligent in its care of a patient who died. Rubio, Scott and U.S. Rep. Kat Cammack, all Republicans, sent a letter to U.S. Department of Veterans Affairs Secretary Denis McDonough, saying they were “appalled” at the findings of an Office of Inspector General (OIG) investigation into the June 2020 incident.
“Florida hospital system sues religious sharing ministry over unpaid medical claims” via Bob Herman of STAT — Orlando Health is suing Liberty HealthShare, alleging the Christian health care sharing ministry owes the hospital system at least $1.1 million and that it told members not to say to Orlando Health that Liberty was their source of coverage. Health care sharing ministries — which do not provide comprehensive health insurance coverage but often mislead people into thinking they do — have faced criticism for exposing their members to large, unexpected medical bills. This lawsuit suggests hospitals and other providers are now willing to take these organizations to court to get their side of the bills paid.
— PENCIL IT IN —
10:30 a.m.: Medicaid Medical Care Advisory Committee (MCAC) Subcommittee Meeting for Managed Long-Term Care. Meeting link here. Email [email protected] for a copy of the agenda.
2 p.m.: The Florida Children and Youth Cabinet meets. Cabinet meeting room, The Capitol.
Happy birthday to Rep. Traci Koster.
9 a.m.: The state Commission on Mental Health and Substance Abuse meets. More here.
10 a.m.: The FX Executive Steering Committee meets, Agency for Health Care, 2727 Mahan Drive, Building 3, Tallahassee. More here.
8:30 a.m.: The Florida Board of Pharmacy meets. Rosen Plaza Hotel, 9700 International Drive, Orlando.
4 p.m.: The Florida Voices for Health and the Health Care for Florida Coalition hosts an online seminar on expanding Medicaid eligibility. Register here.
Happy birthday to Vickie Chachere, Florida Trend executive editor.
9 a.m.: The Florida Board of Acupuncture meets. Call- (877)-309-2073; participant code: 650133477.