From the Florida Agency for Health Care Administration:


Medicaid is the medical assistance program that provides access to health care for low-income families and individuals. Medicaid also assists aged and disabled people with the costs of nursing facility care and other medical expenses. Eligibility for Medicaid is usually based on the family’s or individual’s income and assets.

In Florida the Agency for Health Care Administration (AHCA) is responsible for Medicaid.  It is the equivalent of the corporate head office. The Department of Children and Families acts as AHCA's agent by enrolling people in Medicaid. AHCA contracts with other state agencies and private organizations to provide the broad range of services that Medicaid offers its participants.

AHCA is also the lead agency for the Children’s Medical Insurance Programs (Title XXI–SCHIP). In Florida, this program is known as the Florida KidCare program and is the state's children health insurance program for uninsured children.

Medicaid serves approximately 2.97 million people in Florida, with over half of those being children and adolescents 20 years of age or younger. Estimated expenditures for Fiscal Year 2010-11 (July 2010 through June 2011) are approximately $20.2 billion.

To meet the needs of Medicaid participants, we have approximately 100,000 Florida Medicaid enrolled individuals and facilities offering health care services. If you are a medical provider interested in serving Medicaid recipients, an online enrollment application is available for your convenience at AHCA's Fiscal Agent Web Portal.  Medicaid's fiscal agent processes approximately 135 million claim lines every year.

At times, individuals confuse Medicaid and Medicare, but Medicare is a separate program. Medicaid is a partnership between the states and the federal government, with each paying about half the cost. Each state operates its own Medicaid program under a state plan that must be approved by the federal Centers for Medicare and Medicaid Services or CMS. The Plan outlines current Medicaid eligibility standards, policies and reimbursement methodologies to ensure the state program receives matching federal funds.

Per federal regulations, certain services must be offered by all states, but each can place some limits on the services. There are also optional services that a state may choose to offer, variations in eligibility groups, different limits on income and assets to decide eligibility, and differences in how much states pay their Medicaid providers. For more information about Medicaid covered services view the Summary of Services.

The Deputy Secretary of Medicaid oversees the Divisions of Medicaid Operations and Medicaid Finance. The Assistant Deputy Secretary for Medicaid Operations is responsible for oversight of the Bureaus of Medicaid Services, Health Systems Development, Pharmacy Services, and the eleven Medicaid area offices throughout the state that provide local management of provider networks and assist beneficiaries to navigate the health care system. The Assistant Deputy Secretary for Medicaid Finance is responsible for the oversight of the Bureaus of Program Analysis, Quality Management, and Contract Management.

To go to Florida's Medicaid Landing Page, click here.



General Medicaid Information


Eligibility for Medicaid Services
Health Insurance Portability Accountability
Medicaid Area Offices
Medicaid Fiscal Agent
Medicaid State Plan
Medicaid Summary of Services
Nursing Facility ICP Eligibility Information
Organ Transplant Advisory Council
Nursing Home Transition
Report Medicaid Fraud
Substance Abuse Services
What is Medicaid?




Medicaid Managed Care-Related Services


Enhanced Benefits Rewards
Medicaid HMOs
Medicaid Managed Care Providers
Medicaid Reform
Provider Service Network (PSN)
Quality in Managed Care




Medicaid Pharmacy-Related Services


Florida Medicaid Preferred Drug Program
Pharmacy Prior Authorization Forms
Pharmacy Services
Preferred Drug List (PDL)




Medicaid Provider Informational Publications


Provider Bulletins
Provider Fee Schedules
Provider Handbooks
Public Information for Providers



Medicaid Reimbursement Related-Information


Medicaid Encounter Data System
Medicaid Reimbursement Rates
Medicaid Third Party Liability
Payment Error Rate Measurement (PERM)




Licensing & Regulation


Background Screening
Certificate of Need
Decisions and State Agency Action Reports
Emergency Preparedness Resources
Health Quality Assurance
Regulated Providers




Data Submission/Online Reporting


Background Screening Results Web site
Data Collection and Quality Assurance
Emergency Status System
Federal Immediate & Five Day Reports
for Nursing Homes
Training and help document.
Hospital/Ambulatory Surgery Center On-line Reporting
Nursing Home and Assisted Living Facility On-line Reporting
NFQA—Nursing Home Facility Quality Assessment




Field Offices


Field Offices
Regulation Sets
Survey Protocols
CMS Survey and Certification Memorandums




Licensing/Program Offices


Health Care Clinic Unit
Home Care Unit
Hospital and Outpatient Services Unit
Laboratory Licensure Unit
Long Term Care Unit (includes nursing homes and ALFs)
Managed Health Care
Plans and Construction




Publications, Reports & Forms


Health Alerts
Health Care Facility and Provider Inspection Reports
Publications and Forms
Public Records
Recent Medicaid Presentations

To view the complete list of Florida Governor Rick Scott's line item vetoes, click here.

All Governor's budget-related documents are here.

Below, The Florida Current reports on Agency for Health Care Administration meetings that begin on June 10 in Tallahassee on the State of Florida's transition into Medicaid managed care.  Fort Lauderdale and Miami Gardens meetings take place on June 16; the West Palm Beach meeting is June 14.  The complete schedule is below.


Christine Jordan Sexton, 05/26/2011
www.thefloridacurrent.com

The Agency for Health Care Administration has scheduled 11 meetings across the state where the public can discuss the state's latest foray into Medicaid managed care.

The meetings begin June 10 in Tallahassee and culminate June 17 in Ft. Myers. A spate of cities -- including Florida's largest like Ft. Lauderdale, Miami, Jacksonville, Orlando and Tampa -- will also be sites of public meetings.

Florida CHAIN Executive Director Laura Goodhue said she wasn't familiar with the locations AHCA had identified for the meetings except for the meeting in Palm Beach which is located at the airport. Goodhue said that wasn't an ideal location for patients to show up to testify.

"Ideal locations would be along public bus routes and centrally located within a county," she said in an email.

"Community centers, libraries and schools would be a more logical choice and each county has social service advocates that could easily point out the best location," she said, adding "these meetings (must) be accessible to Medicaid recipients and their families and that would include accommodating persons with disabilities."

The Florida Legislature this session passed a major overhaul of the existing Medicaid program. If the federal government agrees, the state will place most Medicaid patients into managed care plans by 2014, which is when the large Medicaid expansions under the Affordable Care Act also take effect. The two bills were sent to Gov. Rick Scott earlier this week. Scott is expected to sign the bills.

AHCA is directed to submit any waiver it may need for the new Medicaid program to the federal government by August 1. Before the state submits a waiver it is required to hold the meetings and obtain public input.

Goodhue said she is hopeful that AHCA gives Medicaid patients the opportunity to speak. The meetings are scheduled for three hours. Agency for Health Care Administration Communications Director Michelle Dahnke said the format for the meetings will be identical: AHCA will make a presentation and then allow for public testimony. Goodhue said when AHCA held similar meetings last year as the state prepared to submit its extension request for the Medicaid 1115 waiver the agency made an hour presentation which left little time for people to speak. "The vast majority of time should be given to ask questions and to raise concerns, because it's a public hearing and not a presentation," Goodhue said.


AGENCY FOR HEALTH CARE ADMINISTRATIONMedicaid Managed Care Transition Public Meetings

DATE AND TIME: June 13, 2011 from 1:00pm ‐ 4:00pm CT
PLACE: City Hall, Hagler/Mason Auditorium 2nd floor, 222 W. Main St., Pensacola, FL 32502
DATE AND TIME: June 14, 2011 from 9:00 am – 12:00 pm
PLACE: Department of Children and Families, 5920 Arlington Expressway, Jacksonville, Florida  32211, Main Auditorium
DATE AND TIME: June 14, 2011 from 9:00 am ‐12:00 pm
PLACE: Hilton Palm Beach Airport, 150 Australian Avenue, West Palm Beach, FL 33406
DATE AND TIME: June 14, 2011 from 2:30 pm – 5:30 pm
PLACE: Alachua Regional Service Center, 14107 US Highway 441, Conf Rm 190‐A, Alachua, FL  32615
DATE AND TIME: June 15, 2011 from 9:00 am ‐12:00 pm
PLACE: Mary Grizzle Building, Rooms 136 & 137, 11351 Ulmerton Road, Largo, FL 33778‐1629
DATE AND TIME: June 16, 2011 from 9:00 am – 12:00 pm
PLACE: Florida Department of Transportation, Auditorium, 11201 N. McKinley Dr., Tampa, FL 33612
DATE AND TIME: June 16, 2011 from 9:00 am – 12:00 pm
PLACE: Marriott Fort Lauderdale North, 6650 North Andrews Avenue, Ft Lauderdale, FL 33309
DATE AND TIME: June 16, 2011 from 2:00pm – 5:00pm
PLACE: El Palacio, 21485 NW – 27th Avenue, Miami Gardens, FL 33056
DATE AND TIME: June 16, 2011 from 2:00 pm – 5:00 pm
PLACE: Medicaid Program Office, 400 West Robinson St., Hurston Building, Conference Rooms A&D – 1st Floor Orlando, FL 32801
DATE AND TIME: June 17, 2011 from 2:00 pm – 5:00 pm
PLACE: Joseph D’Alessandro Bldg., 2295 Victoria Avenue, Rm. 165, Fort Myers, FL 33901
Florida Medicaid meetings kick off June 10 in TallahasseeDATE AND TIME: June 10, 2011 from 1:00 pm ‐ 4:00 pm
PLACE: Agency for Health Care Administration, Building 3, Conference Room A, 2727 Mahan Drive, Tallahassee, FL, 32308

Florida Governor Rick Scott officially signed the State Budget yesterday, May 26, in a highly scripted ceremony that took place in a Tea Party "stronghold" known as "The Villages."  Reports were that members of the public were turned away when they attempted to attend.  The Florida Current reports below on the health care line items that suffered from what was a record amount of vetoes by a Florida governor at $615 million. 

To view the complete list of Governor Scott's line item vetoes, click here.

Notably, however, much of the "vetoes" actually represented false accounting and non-existent funds (as reported by Sunshine State News here) in relation to the Florida Forever State land buying program.  Another "veto" was $3.2 million set aside for the Governor's pet charity, the "Wounded Warrior" program.  The day before the veto, the charity officially returned the money set aside for it by the Legislature, claiming that they do not accept government funding (which leads us to wonder why it was set aside in the first place?).

The Florida Current report on health care-related veto items is below:

Scott doesn't spare health care in his budget vetoes
Christine Jordan Sexton,
Above:  Gov. Rick Scott signs the budget Thursday in the Villages and students from Four Corners Charter School look on. Scott slashed $615 million from the budget before signing it. | Photo: Gray Rohrer


State lawmakers cut spending in health care as part of their overall plan to eliminate a nearly $4 billion budget shortfall.

But that didn't stop Gov. Rick Scott from using his veto pen to eliminate even more health care spending from the state's now $69 billion budget.

The governor eliminated a long list of funding for health care and safety net programs, ranging from millions for a Brevard County program that works with homeless veterans to money for programs designed to help the health of minorities. He also whacked $750,000 for the Farm Share program, a food bank program based in South Florida.

Scott eliminated $5 million to Mount Sinai Medical Center, which would have been used to help fund graduate medical education programs for 120 resident physicians. Mount Sinai lobbyist Ron Book called the cut disappointing. "He was looking to focus on new jobs, we think [funding graduate medical education] provides new jobs.

"It is what it is. At the end of the day he reached a pretty big [veto] number and we'll see where it all goes," Book said.

Mt. Sinai is a 1,171 bed tertiary care teaching hospital. The Mt. Sinai School of Medicine was founded in 1968 and in 2010 ranked 22nd out of 126 medical schools nationwide in a U.S. News & World Report best graduate schools issue.

Book said the GME funding for Mt. Sinai was new and that Scott targeted many new initiatives. Lee Memorial, which wants to build a new children's hospital, also felt the sting of Scott's veto. Although it was included in both chambers' budgets from the start, Scott eliminated $1.5 million that was supposed to help the hospital plan for a new children's facility.

Lee Memorial also had recurring funding for its regional perinatal intensive care center -- or a RPICC -- eliminated. That funding has been recurring for more than a decade.

While Scott in his veto letter said there is "merit to the study," he eliminated from the budget $150,000 for the Neurological Injury Compensation Association to study birth related brachial plexus injuries. Scott said he believed NICA -- the state's no fault group which provides care for certain brain-damaged children as a result of oxygen deprivation -- had the authority to conduct the study without legislative authority.

NICA Executive Director Kenney Shipley said NICA's general counsel was researching whether the study could be conducted as Scott suggested in his veto letter. The study was to focus on birth related brachial plexus injuries, including the causes and treatments as well as their impact on malpractice premiums, and was slated to be given to the Senate President and House Speaker no later than Dec. 1.

Shipley said the brachial plexus injuries don't involve the brain and therefore aren't covered by NICA. Shipley attributed the veto to the governor not wanting to spend money on "anything that is not essential and obviously he viewed this as non-essential."

While HB 479, the "medical malpractice" bill remains on the desk of Florida Governor Rick Scott pending his action, FPIC Insurance Group, the state’s largest medical malpractice insurer announced yesterday, May 24, 2011, that it has been sold for $362 million, which amounts to a 31 percent increase over the stock price of the company before the sale.  The Florida Current reports below and details of HB 479 are explained below that:

Republican State Representative Mike Horner's bill, HB 479, will makes numerous changes to affect medical malpractice litigation and protect physicians from liability in Florida.

State's largest medical malpractice carrier reaps big windfall in sale

Christine Jordan Sexton, 05/24/2011 - 02:03 PMwww.thefloridacurrent.com

The state’s largest medical malpractice insurance company announced Tuesday that it has been sold for $362 million, representing a 31 percent increase over the stock price of the company before the sale.

The transaction comes shortly after state lawmakers enacted changes to medical malpractice laws that had been sought by Florida’s doctors for years. Legislators also passed separate measures that will help doctors affiliated with institutions such as the University of Miami to be shielded from lawsuits.

The main malpractice bill -- HB 479 -- requires that doctors who testify in medical malpractice cases will be required to obtain expert witness certificates. Gov. Rick Scott has not yet acted on the bill but he has been an outspoken advocate of the need for additional lawsuit limits in Florida to help the state’s business climate.

FPIC Insurance Group is being acquired by The Doctors Company, the nation’s largest professional medical liability insurance company.

“This transaction will deliver significant value to our shareholders and place our organization with one of the largest and most respected medical professional liability insurance organizations in the nation," said John Byers, president and chief executive officer of FPIC.

FPIC Insurance Group covers 18,000 policyholders and is the largest provider of medical malpractice insurance in Florida, and is a leading provider in several other Southern states. The Doctors Company offered $42 per share -- which was a sizable increase over the $32.10 FPIC was trading at before the announcement.

FPIC was a major player in last year’s election cycle as campaign records show the company donated nearly $200,000 to candidates, political parties and other political organizations. While FPIC did donate to some Democrats, campaign records show that last year the company donated $100,000 to The Committee for Florida Justice Reform, a committee of continuous existence that donated heavily to the Republican Party of Florida and to GOP candidates.

Filed in: Health Care, Insurance

About HB 479

If enacted, HB 479, originally sponsored by State Representative Mike Horner, would make numerous changes to affect medical malpractice litigation in Florida.

The bill would allow a prospective defendant to interview a claimant's health care providers without the presence of the claimant if the prospective defendant provides 10 days notice of the intent to interview.

It also requires the claimant to execute an authorization for release of health information.

Further, it creates an "expert witness certificate" that an expert witness who is licensed in another jurisdiction must obtain before testifying in a medical negligence case or providing an affidavit in the presuit portion of a medical negligence case.

Under HB 479, discipline against the license of a physician, osteopathic physician or dentist that provides misleading, deceptive, or fraudulent expert witness testimony related to the practice of medicine or the practice of dentistry is provided.

An "informed consent" form related to cataract surgery would be created. Such a form is admissible in evidence and its use creates a rebuttable presumption that the physician properly disclosed the risks of cataract surgery.

Medical malpractice insurance contracts would be required to contain a clause stating whether the physician or dentist has a right to "veto" any admission of liability or offer of judgment made within policy limits by the insurer. Current law prohibits such provisions in medical malpractice insurance contracts.

If enacted, HB 479 would provide that records, policies or testimony of an insurer's reimbursement policies or reimbursement decisions relating to the care provided to the plaintiff are not admissible in any civil action and provides that a health care provider's failure to comply with, or breach of, any federal requirement is not admissible in any medical negligence case.

A plaintiff in a medical negligence action would be required to prove by clear and convincing evidence that the failure of a health care provider to order, perform, or administer supplemental diagnostic tests is a breach of the standard of care.

HB 479 would provide that a hospital is not liable for the negligence of a health care provider with whom the hospital has entered into a contract unless the hospital expressly directs or exercises actual control over the specific conduct which caused the injury.

It also would provide additional immunity from civil liability for volunteer team physicians.


For information about quality, certified, accredited and affordable quality home health care in South Florida, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or http://www.afamilymemberhomecare.com/.

The Sun-Sentinel reported on a new Web site that allows patients to stay at home until emergency room doctors are ready to receive them:


New reservation system lets you stay home until emergency room doctors are ready

By Lois K. Solomon, Sun Sentinel
May 23, 2011

For $9.99, nine South Florida hospitals are guaranteeing immediate entry into their emergency rooms. Or your money back.

Patients with non-life-threatening conditions such as a sprained ankle or urinary-tract infection can make reservations at InQuickER.com or on the hospitals' websites, which post the next available appointments.

InQuickER returns the money if a patient isn't evaluated by a health care professional within 15 minutes of the reservation time.

The Tenet hospitals, seeking to make money through their potentially profitable ERs, are betting that patients will prefer to rest at home instead of waiting in their crowded lobbies, filled with sick people and emotional family members.

Emergency room wait times have become a point of contention, or pride, with hospitals using their websites, text messages and billboards on Interstate 95 and others throughout the state to display, in real time, how many minutes patients must wait.

Susan Flanagan, of Boca Raton, recently made an emergency room reservation at West Boca Medical Center, a participating hospital, when she had severe abdominal pain.

"There is nothing worse than sitting and being miserable in an ER for hours," said Flanagan, 50, a production manager for a catalog company. "When I got there, they knew what was wrong with me and I was in a bed in five minutes."

Surveys have shown that the average wait time in an American emergency room is four hours. Some South Florida hospitals appear to get their patients in quicker. The wait time at Delray Medical Center last week was 16 minutes; at North Shore Medical Center in Fort Lauderdale, it was nine minutes, according to the hospitals' websites.

The system has safeguards that officials say will ensure that a patient with a serious emergency, such as a heart attack, does not have to wait for an appointment. Patients enter their symptoms into the website, which forwards the information to nurses and paramedics at the emergency room front desks.

"We would call them on the phone and say, 'Tell me more about your pain,' " said Margaret Neddo, West Boca Medical Center's emergency room director. "If they have a history of aneurysms, we would say, 'Come in now.'"

Still, some doctors say the system could make some patients who want a reservation delay treatment when there's a true emergency.

Dr. Ryan Stanton, spokesman for the American College of Emergency Physicians, said he has seen many patients try to "sleep off" a stroke or a heart attack, and says they may do the same if they go online and see they can't make a reservation for a few hours.

"It needs to come with a lot of teaching about what an emergency is," said Stanton, an emergency room physician in Lexington, Ky. "With a heart attack, every minute you delay at home is another minute you lose heart muscle and can have permanent damage."

A 2009 General Accounting Office study found it was taking 37 minutes to see emergency room patients who had conditions that required care within 14 minutes. The reasons are complex, said Dr. Andrew Bern, attending emergency physician at Delray Medical Center, and include a shortage of beds for psychiatric patients; the closing of nearby hospitals in recent years, which has increased visits to remaining emergency rooms; and an insufficient number of beds for ER patients who need to be admitted to the hospital.

Only about 8 percent of emergency room visits are non-urgent, according to the Centers for Disease Control and Prevention. The primary reasons for going to the ER: chest pain and abdominal pain. Emergency rooms are most crowded on weekends and at night, when doctors' offices are closed, according to ACEP.

Chris Song, marketing director for InQuickER, based in Nashville, said company founders noticed overcrowded emergency rooms were inefficient, with personnel communicating poorly and having trouble managing patient surges. The company started in 2006 and now has 37 participating hospitals, with 95 percent of registrants seen within 15 minutes, he said.

Flanagan said she sent her information to West Boca at 9 a.m. and got a 9:30 a.m. appointment, which the hospital changed to 11 a.m. Her diagnosis: a gall bladder stone and other complications, which landed her in the hospital for a week.

"When I got there, they knew my name, they had my paperwork and they were ready for me," Flanagan said. "The only downside is you have to pay 10 bucks."Lsolomon@tribune.com or 561-243-6536

Copyright © 2011, South Florida Sun-Sentinel

After a bruising battle during the 2011 Florida Legislative Session over whether to require the any sale or lease of a public hospital that is owned by a county, district or municipality to be approved by a majority vote of the registered voters or by a circuit court, the public versus private fight continues into the funding arena, as reported last week by The Miami Herald:




HCA, Baptist gain state funds while Jackson Health System loses
By John Dorschnerjdorschner@MiamiHerald.com

Posted on Fri, May. 20, 2011

In a major shift on how the state funds hospitals, the Florida Legislature has decided to spread more money among for-profit and nonprofit hospitals to compensate for their care of the poor and uninsured — and give less to the state’s public hospitals.

The money comes from the Lower Income Pool, a billion-dollar pot of state-federal dollars that has traditionally been allocated by the LIP Council, a group dominated by the state’s public hospitals. For-profit hospitals have long complained that they too have to treat the uninsured in their emergency rooms and should be reimbursed more for their care.

New calculations

The Legislature generally follows the LIP Council recommendations — but not this year. With Gov. Rick Scott and legislative leaders questioning the need for government-run hospitals, the Legislature applied new calculations to give more reimbursement money to nongovernment hospitals that provide some care for the poor.

The Legislature generally follows the LIP Council recommendations — but not this year. With Gov. Rick Scott and legislative leaders questioning the need for government-run hospitals, the Legislature applied new calculations to give more reimbursement money to nongovernment hospitals that provide some care for the poor.

The biggest loser: Jackson Health System, usually the largest recipient of LIP funds. It saw a $20 million drop — 8 percent — from the amount recommended by the LIP Council, according to an analysis by the Florida Hospital Association.

The biggest winners are the for-profit HCA hospitals, which gained $23.3 million — or 83 percent more than the LIP Council recommendation, according to the FHA. Baptist Health South Florida gained $12.8 million — 94 percent more than recommended by the council.

Alan Levine, a healthcare policy advisor to Scott and earlier to Gov. Jeb Bush, says the reallocation makes sense. “There are many hospitals … both not-for-profit and investor owned that provide significant amounts of care for the poor.”

Levine and Scott are strong proponents of “tax dollars following the patient,” rather than all healthcare tax money going to government hospitals.

Jackson executives had no comment but Martha Baker, president of SEIU local that includes Jackson healthcare professionals, called the legislative action “outrageous…. This disrespects both taxpayers and those who use Jackson’s lifesaving services. HCA and Baptist had record profits and yet our politicians are diverting taxpayer money away from our neediest citizens.”

Baptist Health spokeswoman Roymi Membiela said the system’s costs for the poor have continued climbing and it was “very appreciative” of the Legislature’s action. HCA did not respond to a request for comment.

Carlos Migoya, Jackson’s new chief executive, has said that he endorses the theory of healthcare tax dollars following patients, but he hopes that legislators delay full implementation of the move until Jackson is back on its feet financially. Jackson lost $337 million the last two years and is projected to lose about $80 million this fiscal year.

According to the FHA analysis, Jackson saw its LIP funding drop to $221.3 million in the Legislature, although the LIP Council had recommended $241.3 million. Between LIP and Medicaid reductions, Jackson expects to see a reduction of about $130 million in state funding next year.

Studies by Rand Corp., a think tank, have found that a hospital’s location may have more effect on the amount of uninsured care it ends up providing than its status as a for-profit or nonprofit hospital. One example: Plantation General, a for-profit HCA facility near Broward Boulevard and Highway 441, had uncompensated care costs amounting to 7.6 percent of its total billings, according to state data — more than twice the amount provided by Holy Cross, a nonprofit Catholic hospital in affluent northeastern Fort Lauderdale.

Under the new calculations this year, the Legislature approved $5 million in LIP funding for Plantation General — more than twice the $2.8 million recommended by the council. Homestead Hospital, which cares for many uninsured migrants as part of Baptist Health, received $7.5 million in LIP money, 58 percent more than the council recommendation. Baptist Hospital in Kendall was given $18.1 million in LIP funds, more than twice the council recommendation. The nonprofit Baptist system reported an audited surplus — the equivalent of profit for a for-profit company — of $272 million for fiscal 2010.

Reform act

Long a target of business lobbyists such as Associated Industries of Florida, the LIP Council is set to die in 2014 as part of the just-passed Medicaid Reform Act. It will be replaced by a formula to determine how much each hospital should receive in LIP funding.

Long a target of business lobbyists such as Associated Industries of Florida, the LIP Council is set to die in 2014 as part of the just-passed Medicaid Reform Act. It will be replaced by a formula to determine how much each hospital should receive in LIP funding.

“Nobody understands what would be the impact of the new formula,” said Anthony Carvalho, head of the Safety Net Hospital Alliance of Florida, which represents Jackson and other public/teaching hospitals. “I am very concerned about what has been put into the statutes.”



© 2011 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

Read more: http://www.miamiherald.com/2011/05/20/v-print/2226085/hca-baptist-gain-state-funds-while.html#ixzz1NKBzdob5

The Florida Hospital Association recently released a report on Florida HMO trends during the final quarter of 2010, as reported by The Florida Current below.  To view the complete report, click here.


HMO profits up in Florida even as enrollment is down

Christine Jordan Sexton, 5/20/2011

http://www.thefloridacurrent.com/

Commercial enrollment was down but Medicare and Medicaid enrollment was up -- as were profits -- at Florida HMOs in the last quarter of 2010, a data brief released by the Florida Hospital Association this week shows.

The health maintenance organization with the largest enrollment as of Dec. 31 was Humana Medical Plan which had 493,768 members. Aetna Health Plan of Florida was second in membership with 364,282 lives.

Net income for the plans in the fourth quarter of 2010 was $675.8 million, up from $573.8 million from the fourth quarter of 2009.

The plan with the highest profit margin in the fourth quarter of 2010 was Cigna Healthcare which, according to the FHA report, had a 27.1 percent profit margin. Health Options -- a Leon County based HMO -- had the second highest profit margin for the fourth quarter of 2010 with 10.7 percent profit, according to the FHA.

Florida Association of Health Plans President and Chief Executive Officer Michael Garner said that the data brief was somewhat limited because it’s only one quarter’s worth of information. “One quarter does not make a trend,'' he said.

He also noted that the publicly available brief does not differentiate among lines of businesses and that plans that sell commercial-only policies are being compared to plans that sell Medicaid-only benefits.

“You’ve got to be careful that you’re not talking about apples and oranges,” Garner said.

There is no dispute with the enrollment, though. Overall, HMO enrollment was at 3.6 million Floridians and was slightly lower in the fourth quarter of 2010 than it was for the same period of 2009.

Specifically, commercial enrollment in 2010 was down 6 percent from the previous year to 1.6 million Floridians. But Medicare enrollment jumped 3.2 percent from the previous year’s time to 773,712 members.

Medicaid enrollment -- which will swell under the Medicaid overhaul the Legislature passed this year -- increased by 2.9 percent over the fourth quarter of 2009 to 1.1 million people.

:

As turmoil continues in the face of new Florida laws that curtail litigation against nursing homes, the federal Administration on Aging has launched an investigation into former Florida Nursing Home Ombudsman Brian Lee's dismissal  . . . the Associated Press reports below (reprinted from the Bradenton Herald).

Fla. nursing home watchdogs see turmoil in agency



By MATT SEDENSKY
Associated Press
Updated: Sunday, May. 22, 2011


Florida, long one of America's most revered retirement spots, has launched what critics call an unprecedented assault on watchdogs for its oldest and sickest they believe amounts to political kowtowing to the powerful nursing home industry.


Since Gov. Rick Scott assumed office, the state's top nursing home watchdog has been replaced with someone seen as far more favorable to the industry, the watchdog's subordinates have been muzzled from speaking to the press and its outspoken head volunteer have been fired, cumulatively triggering two whistleblower complaints and a federal investigation.


"The state is succumbing to the demands of the nursing home industry," said Janet Wells, director of public policy at The National Consumer Voice for Quality Long-Term Care, a nonprofit that advocates for long-term care residents.


The long-term care ombudsman program, as the watchdog agency is known, costs about $3 million annually, with most of that coming from the federal government. Most of its work is done by volunteers who go out to facilities to investigate the complaints of residents and advocate on their behalf. All states have such agencies, which are mandated by the Older Americans Act, though they're largely invisible to the general public.


Unless a personnel change implodes into a high-visibility tussle.


It started in February, a month after Scott took office, when program leader Brian Lee says he was told to resign or he'd be fired. He left, saying he felt he was forced out because he sometimes butted heads with the nursing home industry, but the dismissal prompted a wave of complaints from volunteers in the program.


Chief among them was Lynn Dos Santos, a volunteer and state chairwoman of the ombudsman program who helped oversee its roughly 300 other volunteers and repeatedly called Lee's firing unjust to anyone who would listen.


The state responded by issuing an order to volunteers and other ombudsman workers that they were no longer allowed to talk to the press. It replaced Lee with Jim Crochet, who had been suggested for the job by the nursing home lobby. And it notified Dos Santos she was fired.


The federal Administration on Aging has, in turn, launched an investigation into Lee's dismissal. And Lee and Dos Santos have each filed whistleblower complaints with the Florida Commission on Human Relations that have not yet been resolved.


"The program is in serious trouble," said Lee, who says he doesn't want his ombudsman job back. Lee now heads Families for Better Care, a nonprofit advocate for nursing home residents.


Scott spokesman Lane Wright said the importance of the ombudsman program has not been diminished.


"It is vital we have someone in that role committed to the agency's core mission of caring for some of Florida's most vulnerable while also protecting Florida tax payers," Lane said.


Ashley Marshall, a spokeswoman for the state Department of Elder Affairs, which oversees the ombudsman program, said personnel change such as the replacement of Lee is normal in a government transition.


She said Dos Santos was dismissed for repeated Sunshine Law violations, claiming her e-mail conversations on ombudsman business amounted to breaking the freedom of information law. And she says Crochet's friendliness with the industry is a benefit, not a liability.


"The secretary of the Department of Elder Affairs has nothing but confidence in our new ombudsman and the missions and goals that he has set forth for the program, which includes a focus on the resident which has been lost in all this," Marshall said.


Still, as if the turmoil within the program weren't enough, it also became a magnet for legislation seeking to curtail its power.


State lawmakers proposed bills that, among other things, would have removed the requirement for ombudsmen to conduct on-site assessments of nursing homes; repealed a law requiring the collection and analysis of data related to complaints in long-term care facilities; remove a requirement to disseminate a list of facilities that have been fined; and make it more difficult to sue nursing homes and place a lower cap on damages that could be awarded.


All of those measures ultimately failed, though another legislative change, to lower the staff-to-resident ratio requirements for nursing homes, did pass, seen as a cost-cutting measure in the face of reductions to Medicaid reimbursements. It reduces the average amount of direct care provided residents by 18 minutes each day.


"Eighteen minutes can be the difference between someone coming in and putting food on the tray and not having time to feed someone," said Jeff Johnson, AARP's interim state director. "Or it's another 18 minutes that someone has to sit in a soiled diaper."


AARP did not take a position on the changes within the ombudsman program in Florida, which has a higher percentage of seniors than any other state. But Johnson said he found the sheer number of bills focusing on it and other aspects of nursing home care troubling.


"In terms of the amount of attention that was placed on the overarching theme of eroding the rights of nursing home residents and eroding the nursing home quality standards that we've had in place for over a decade and then reducing oversight of the ombudsman program," he said, "You put those things together and that's a very disturbing trend."


Lee said he expects the legislative measures that failed this session to emerge again next year.


"They didn't get some of the stuff they wanted done but it does lay a foundation for what direction they're headed next session," he said.


"And now that they have their people in place - their man as governor and their man as ombudsman - they don't have anything in their way."


The turmoil has eclipsed politics. Lee was appointed by former Gov. Jeb Bush, a Republican, and served under his successor, former Gov. Charlie Crist. Both Lee and Dos Santos are registered Republicans who say they voted for Scott.


That has prompted many to question the loyalties of Scott, who made billions running the Columbia/HCA hospital chain, and who founded Solantic, a chain of urgent care centers.


Marshall said Crochet, who was recommended for his job by the Florida Assisted Living Association, was traveling and unable to be interviewed. She said his good relationship with the industry will be helpful in advocating for residents.


"You have to be able to maintain a cooperative relationship with those in the industry to be able to affect the change you seek," she said.


Dos Santos was notified of her dismissal just before she was set to deliver a state chair report at a gathering of ombudsmen. Her speech, which criticized "troubling and unthinkable actions" and "the systematic dismantling of our program," was never delivered.


A former special education teacher, Dos Santos retired to Florida nine years ago. If nothing else, the experience has triggered her to make some long-term care plans of her own.


"I've already instructed my entire family if I ever need a nursing home, get me out of this state," she said.



Read more: http://www.bradenton.com/2011/05/22/v-print/3214127/fla-nursing-home-watchdogs-see.html#ixzz1N6snch7q

Left: State Representative Kathleen Passidomo sponsored CS/CS/HB 1037 to allow continuing care at-home contracts to be offered to consumers in Florida.  As of May 22, 2010, Florida Governor Rick Scott has not yet acted on the legislation.

An article from the Naples Daily News is reprinted below, and a summary of the bill is below that:

Continuing Care Retirement Communities ("CCRCs"), also known as life-care facilities, are retirement facilities that furnish residents with shelter and health care for an entrance fee and monthly payments.

In Florida, CCRCs are regulated by the Florida Department of Financial Services, the Florida Agency for Health Care Administration and the Florida Office of Insurance Regulation ("OIR"); the latter primarily through chapter 651, F.S.

The OIR authorizes and monitors a facility’s operation as well as determines the facility’s financial status and the management capabilities of its managers and owners.  The OIR is also empowered to discipline a facility for violations of residents’ rights. Currently there are 70 CCRCs in the State, which are home to approximately 25,000 residents.

CS/HB 1037 allows continuing care at-home contracts to be offered to consumers in Florida.  Continuing care at-home contracts and programs allow seniors to receive services offered by a continuing care retirement center in their own homes while reserving the right to shelter to be provided by the retirement center at a later date.  Continuing care at-home contracts specify the exact services to be provided to an individual by a provider, in exchange for an initial fee and a recurring monthly premium.  Continuing care at-home contracts provide seniors the flexibility of receiving services in their home until they are ready to move to a traditional continuing care retirement center.
The bill creates s. 651.057, F.S., which establishes a new regulatory scheme for continuing care at-home contracts.  The provisions of the bill closely reflect the provisions regulating continuing care contracts found throughout chapter 651, F.S.

It also establishes criteria for providers seeking provisional certificates of authority and certificates of authority to offer continuing care at-home contracts. The legislation provides the OIR with authority to regulate the issuance of provisional certificates of authority and certificates of authority, and to approve continuing care at-home contracts for use in Florida.

Although it has not yet been signed by Florida Governor Rick Scott as of May 22, 2011, the bill provides an effective date of July 1, 2011.

• Full Report (PDF, 7 pages)
• Accessible Text

From The Miami Herald today, May 20, 2011:

State lawmaker’s son charged with Medicaid fraud

The son of Democratic state Rep. Daphne Campbell was charged with defrauding Medicaid of nearly $300,000.

BY JULIE K. BROWNjbrown@MiamiHerald.com

Gregory Campbell, the son of Democratic state Rep. Daphne Campbell, has been snared in a $299,000 Medicaid scheme in which he is accused of fraudulently billing the agency for clients he didn’t provide any services for.

The charges include grand theft, organized fraud, and Medicaid fraud, all first-degree felonies.

Campbell, 28, allegedly billed Medicaid for the same recipients at two separate adult family care homes in Miami-Dade, and also billed for clients who never lived at either facility, according to the arrest affidavit filed in Miami-Dade court by the Florida Attorney General’s office.

He split part of his take with Percival Wignall, the owner of Sunnyman Retirement Home, 61 NE 211 Street, Miami. The other home, Denian Adult Home, was located at 1835 NW 185th Street, Miami Gardens. It was owned by Cebert George Williams, who shut it down in 2005 and moved to Port St. Lucie but kept the nursing home license.

The two-year investigation by the state Medicaid Fraud Control unit uncovered $299,000 in fraudulent claims paid by the state Agency for Health Care Administration. Medicaid, jointly funded by the state and federal government, is a $20 billion program serving more than 3 million low-income adults and children in Florida.

Campbell was arrested May 12 and is being held in the Miami-Dade County jail.

When reached by telephone about her son’s arrest, Daphne Campbell declined comment.

A political newcomer, Daphne Campbell, a registered nurse, won the state District 108 seat last November. The district covers Northeast Miami and includes portions of North Miami, El Portal and Miami Shores.

During this year’s legislative session, she infuriated fellow Democrats with her support of bills that put further restrictions on abortion. The anger erupted on the House floor when she and Rep. Scott Randolph of Orlando got into a skirmish, with Randolph promising to find someone to unseat her in 2012.

She ran into trouble with state officials in 2005 when she was accused of running nursing homes in which clients were mistreated, neglected and, in four cases, died.

At the time, she operated a chain of nine group homes for disabled people in Miami-Dade, Broward and Lee counties called Professional Group Homes, Inc.

In response to complaints, the state Agency for Disabilities terminated Campbell’s contract in 2006, but she appealed the decision. After a series of legal actions, the decision was reversed. She was eventually given new authority to bill under the state’s Medicaid program and operate group homes for the disabled.

She did not lose her license. She is now owner and president of Florida Nurses Home Health Agency, which provides nurses and other specialists to patients in their homes.

Herald staff writers Michael Sallah and Sergio R. Bustos contributed to this story.


Read more: http://www.miamiherald.com/2011/05/19/2225075/state-lawmakers-son-charged-with.html#ixzz1MthNGjdS