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Diagnosis For 6.13.22: Checking The Pulse Of Florida Health Care News And Policy

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.


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— 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.

What’s up with Florida’s Medicaid overhaul? Your guess is as good as ours.

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.

AHCA finalized 31 actions against managed care plans — to the tune of nearly $10M.

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.

FloridaPolitics, excerpt posted on  SouthFloridaReporter.comJune 13, 2022

Republished with permission 


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