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Diagnosis For 6.20.22: Checking The Pulse Of Florida Health Care News And Policy

Florida Medicaid agency officials have scheduled a two-hour public meeting to discuss a proposed ban on Medicaid coverage of gender dysphoria in Florida.

Anticipating that the proposed changes could draw a crowd, the Agency for Health Care Administration opted to hold what could be the only public meeting in the auditorium of the Florida Department of Transportation building instead of its headquarters.

The proposed amendment published by the Ron DeSantis administration last week would add language to an existing Medicaid rule that bans Medicaid from providing coverage for gender dysphoria. It excludes coverage of puberty blockers, hormones and hormone antagonists, sex reassignment surgeries, and other procedures that alter primary or secondary sexual characteristics.

Ron DeSantis gives a hard no on Medicaid coverage of gender dysphoria.

Moreover, the proposed language bans physicians from considering dysphoria and gender-affirming treatment when determining what’s “medically necessary” for their patients.

The administration is moving to alter the state policy by amending a rule that applies to all Medicaid-participating providers. The underlying rule allows providers to limit the number of Florida Medicaid recipients they treat but makes clear that hospitals cannot refuse to provide emergency care, and providers are precluded from denying services based solely on “race, creed, color, national origin, disabling condition or disability, in accordance with federal anti-discrimination laws.”

If successful, gender dysphoria would be the only diagnosis in the rule for which treatment is banned. But Florida does limit other Medicaid coverage in the rule. For instance, the regulation prohibits Medicaid from providing coverage for people in prison. The rule also makes clear that “aliens” qualify for “emergency” Medicaid services, but once the emergency no longer exists, Medicaid stops providing coverage.

The meeting starts at 3 p.m. and ends at 5 p.m.

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— Medicaid procurement heats up 

There are signs that work on the state’s Medicaid managed care procurement is beginning.

Three medical care advisory subcommittees are scheduled to meet this week — two of the committees address children’s health care issues, and the third committee will discuss mental health and substance abuse issues. A long-term care committee met last week. The subcommittees are part of a larger medical Care advisory Committee that is required to meet by federal law.

Everyone has an opinion on revamping the state’s Medicaid system.

AHCA also made available this week the responses to its request for Information soliciting input on ways the state’s Medicaid managed care program could be improved before the state issues its next solicitation.

The responses are available herewith a summary of responses below ….

— Managed care plans say 

Florida Association of Health Plans wants the state to streamline the collection of quality metrics like how Medicare measures quality metrics and explore “alternatives to liquidated damages for quality metrics.”

Aetna Better Health of Florida, Inc. asked the state to work with managed care plans to identify opportunities to reinvest any savings into the Florida communities.

AmeriHealth Caritas Florida identified several opportunities for AHCA to reduce the administrative burden for the plans, providers, and the state by eliminating the mandatory site visits for every primary care physician every three years. “Other states have removed this requirement from their Medicaid program, as it creates an undue administrative burden on the provider offices (that) must accommodate this request from every plan with whom they contract,” the plan wrote in its response. Additionally, the plan said the accuracy of enrollee information needs to be improved: “There is significant waste of financial resources and time as well as lost opportunity associated with failed attempts to contact enrollees that is caused by inaccurate enrollee contact information.”

Florida Medicaid managed plans offer suggestions to make the system better.

Community Care Plan suggested that the state alter the current auto-assignment algorithm to reward plans with higher HEDIS quality scores to receive preferential auto-assignment. It also recommends requiring enrollees to provide their preferred communication method (by phone, text, email, or postal mail) at the time of application. The health plan also recommended allowing plans to ask members for a preferred method of communication in addition to the contact information.

Humana Medical Plan was the only plan to submit a redacted response. In its response, the health plan recommended that the state allow contracted health plans to telehealth to address network adequacy issues and “to provide critical support services to low-risk recipients or those needing follow up.”

FloridaPolitics, excerpt posted on  SouthFloridaReporter.comJune 20, 2022

Republished with permission 

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