Budget vetoes: No transparency on health care transparency? 

partial view of group of medical workers with equipment in labor
AHCA would have been required to submit studies to the Legislature and Governor by the end of the year

Florida has invested millions of dollars to promote health care prices and transparency. 

However, Gov. Ron DeSantis vetoed $750,000 lawmakers included in the state Agency for Health Care Administration’s budget to competitively procure an independent study to evaluate the utility of the data now being collected.

Specifically, the Legislature directed that the study must include, at minimum, all costs incurred for such tools for each of the last three state fiscal years and review current development and redesign efforts, including contract compliance.

The proviso language attached to the spending item had a long set of requirements for the study, including looking at the state’s claims database and evaluating how it compares to what’s happening in the health insurance market and how the information collected inform health care decisions by consumers, the public sector, employers and researchers; and provide a trend analysis of the website engagement metrics including top data comparisons and searches.

The proviso language would have required AHCA to submit the study to the chair of the Senate Committee on Appropriations, the chair of the House of Representatives Appropriations Committee, and the Executive Office of the Governor’s Office of Policy and Budget by Dec. 31. 

Gov. DeSantis also vetoed from AHCA’s budget $1 million lawmakers agreed to spend to competitively procure an assessment of payment transactions in the Medicaid program for medical benefit and administrative costs as reported for purposes of the 2020, 2021, and 2022 Achieved Savings Rebate (ASR) Program.

The ASR program is part of the statewide Medicaid managed care program and was included in the law to ensure that Medicaid managed care plans don’t earn excessive profits. 

The ASR is established by determining pretax income as a percentage of revenues. Under Florida law, the plan retains all profits up to 5% of revenue. Half the profit above 5% and up to 10% of revenue is retained by the plan, and the other half is refunded to the state. All profit above 10% is refunded to the state.

Plans may retain an additional 1% of revenue if they meet or exceed quality measures defined by the AHCA, including plan performance for managing complex, chronic conditions associated with an elevated likelihood of recurring high-cost medical treatments.

The vetoed budget proviso language would have required the study, at minimum, to include a comparison of the amount and associated percentage of payments to contracted Medicaid managed care plans within the medical loss ratio to the standard health care procedure code level for other Medicaid providers.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.

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