Senate health panel OKs bills to continue pill mill regs, nix $30 million in hospital legal challenges

medicaid healthcare

The Senate Health Policy Committee plowed through a number of bills Tuesday, including a measure that continues regulation of pain management clinics as well as a bills relating to the Children’s Health Insurance Program and diabetes.

Perhaps the most controversial bill the committee passed was one that it had to defer action on when it last met: SB 322 by Sen. Kelli Stargel, R-Lakeland. See related story.

The bill is retroactive and would affect legal challenges by five hospitals that, combined, are challenging $30 million in disputed costs.

Safety Net Hospital Alliance of Florida President Tony Carvalho made clear that his group — which represents 23 hospitals across the state — supports a five-year statute of limitations to challenge a final agency action on a hospital’s final audited cost report.

“That is something we can agree to and work with the sponsor and the committee on,” he said, adding that he wants to make sure the bill does not apply to what he called the front end, or when the agency sets the rates it will use to reimburse hospitals.

There are times when there is disagreement between the agency and hospitals on the front end of the rate-setting process, Carvalho said, adding that “99 percent of the time we work with the agency and we work it out. There is no litigation, but that’s on the front end of the process.”

The state in 2013 changed how hospitals are paid for providing inpatient services, shifting from cost reports to diagnostic related groups or DRGs. However, rates are still used for hospital outpatient services, though the governor’s proposed budget moves to use a DRG-like systems for outpatient services as well.

There is no companion bill in the House. The measure heads to the Senate Fiscal Policy Committee next.

The committee also gave the nod to:

  • SB 450 — The bill keeps intact regulatory requirements for pain clinics that are set to expire Jan. 1, 2016. See related story.
  • SB 296 — The bill directs the Diabetes Advisory Council to prepare a report on the affect of diabetes on state-funded or -operated programs, including Medicaid and the state group health insurance plan and then submit a report to the governor and Legislature by Jan. 10 of each odd-numbered year. It also adds to the 26-member council representatives from the American Association of Diabetes Educators.
  • SB 294 — The bill allows lawfully residing immigrant children to participate in KidCare program and not have to wait five years for coverage.

“I think this bill is long overdue,” said bill sponsor Sen. Rene Garcia, R-Hialeah. He noted that when the Agency for Health Care Administration first “scored” the fiscal impact of the measure it was “tens of millions of dollars.” The estimated impact this year, Garcia said, is $4.8 million. “It’s still significant but it will go a long way to make sure these kids have access to health coverage.”

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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