Trauma, Medicaid Changes Move Forward In House

Apr 18, 2017

With House Republican leaders looking to make major health-care changes, a key panel Monday approved proposals that would erase limits on the numbers of trauma centers in the state and revamp parts of the Medicaid program.

The bills, approved by the House Health Care Appropriations Subcommittee, are particularly drawing interest from the hospital and nursing-home industries.

The bill (HB 1077) that would eliminate limits on the numbers of trauma centers comes after years of legal battles in the hospital industry about whether the Florida Department of Health should approve proposals to open new trauma facilities. State law caps the number of trauma centers at 44 statewide and, within that, also includes limits in 19 different geographic regions.

Echoing a theme that is part of House leaders' push for changes in the health-care system, bill sponsor Jay Trumbull, R-Panama City, pointed to taking more of a free-market approach. He said more trauma centers could meet the needs of a growing population and increasing numbers of tourists.

"What we're saying is that we're going to allow the free market the ability to be able to open up other trauma centers across the state," Trumbull said.

But many major hospitals that have long operated trauma centers oppose the proposal. They argue, in part, that trauma centers need a steady flow of patients for the specialized types of care and that allowing new facilities would "dilute" quality.

"The dilution and proliferation of trauma centers is going to create a substandard level of care, in our view, in the state," said Mark Delegal, a lobbyist for the Safety Net Hospital Alliance of Florida, which represents public, teaching and children's hospitals.

Gov. Rick Scott has also backed eliminating the limits on trauma centers, but a Senate version of the bill (SB 746) has not been heard in committees as the annual legislative session enters its final three weeks.

House Republican leaders have pushed a series of bills during the session to revamp parts of the health-care system, though many of the ideas have received little support in the Senate. As an example, the full House on Tuesday could take up a bill (HB 7) that would eliminate what is known as the "certificate of need" regulatory process for building hospitals --- an idea that has not moved forward in the Senate.

The House Health Care Appropriations Subcommittee on Monday also moved forward with a bill (HB 7117) that seeks a series of major changes in the Medicaid program. As an example, the bill, spearheaded by Health & Human Services Chairman Travis Cummings, R-Orange Park, would direct the state Agency for Health Care Administration to seek federal approval to require Medicaid beneficiaries to make premium payments of $10 or $15 a month, depending on their income levels.

But perhaps the part of the bill drawing the heaviest lobbying deals with payments to nursing homes that care for Medicaid beneficiaries enrolled in managed-care plans.

Under current law, the Agency for Health Care Administration sets rates for payments to each nursing home. The bill would lead to nursing homes negotiating rates with managed-care plans, similar to how other Medicaid providers negotiate rates.

The Florida Health Care Association, a nursing-home industry group, is fighting the idea.

"Giving managed-care companies the ability to reduce those rates further without a floor in place would jeopardize the care of our state's seniors, and centers would have to make difficult decisions to cut services that our residents have come to rely on to enhance their quality of life," said Tom Parker, director of reimbursement for the association.

But Health Care Appropriations Chairman Jason Brodeur, R-Sanford, said the current system leads to payments ranging from $165 to $300 a night "basically for the same patient." He said the state needs to look at changes in the way nursing homes are paid.

"That's just too big of a spread for the state to continue to support," he said.