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‘Medical home’ bill riding on train

By Christine Jordan Sexton
4/23/2009 © Health News Florida

Rep. Ed Homan, who dreams of solving two of the state’s most pressing problems by providing “medical homes” for Medicaid patients at expanded physician-training programs, has found a way to improve odds of making that happen.

He’s turned HB 7131 into a “train” – a massive piece of legislation that contains a number of unrelated issues, some too powerful to derail. He’s hooked his dream onto a Medicaid fraud-fighting bill and a measure that would streamline state regulation of health facilities.

The Tampa Republican, an orthopedic surgeon, met with at least 17 lobbyists for hospitals and physician groups to discuss strategy on Wednesday. He says he told them “to speak to all the (lawmakers) they know” to counter resistance from Medicaid HMOs. 

This morning, Sen. Don Gaetz, R-Fort Walton, said he will amend a version similar to Homan’s bill onto his own Medicaid fraud bill (CS/CS/SB 1986), which is scheduled for debate today. 

Gaetz said his version has a better chance of surviving than Homan’s because it took out a provision that’s anathema to Medicaid HMOs. The “any-willing-provider” provision would have prevented certain Medicaid HMOs from limiting their networks if they expanded into new counties.

That “added a little more spice to the bouillabaisse than we can handle at the moment,” Gaetz said.

Michael Garner, president and CEO of the Florida Association of Health Plans, said his group was continuing to examine Homan’s plan but has concerns that it places Medicaid HMOs at a competitive disadvantage. “Our biggest concern is an unlevel playing field,” he said. 

Homan’s plan is to provide better care for Medicaid patients, who often have trouble finding specialists who will accept the low-paid state insurance, while at the same time expanding training for physicians.

“Medicaid patients have a hard time getting specialty care. They can get primary care but they can’t get specialty care; that’s been a real problem,” Homan said. “So here we have medical schools who give specialty care and have patients who need it. So why not put those two together?” 

State surveys over several years have signaled a growing problem as doctors age and aren’t being replaced in numbers sufficient to care for Florida’s population. Last year’s survey found 31 percent of Florida’s licensed physicians don’t even live in the state. 

Originally Homan wanted to try his plan at four medical schools, but two were dropped. The bill now involves just the Gainesville and Tampa areas, home to the universities of Florida and South Florida medical schools. 

Homan, who chairs the Health and Family Services Policy Council, would require Alachua and Hillsborough MediPass patients – those who see a family doctor instead of a prepaid health plan – to enroll in a Medicaid HMO or one of his “medical homes.”

These would likely be federally qualified health centers or clinics connected to a medical school or teaching hospital. 

More than $2 million in Medicaid funds would be added to graduate medical education to accomplish the expansion. This could come from the Low Income Pool, a pot of Medicaid funds used to pay hospitals for treating the uninsured. 

In contrast to the Medicaid Reform project running in five counties, doctors in the medical home project would be paid on the traditional fee-for-service basis. 

This week, Homan convinced members of the House Policy Council to move his bill on a 15-8 vote, with no clear party-line breakdown, once he added two big amendments. 

The first mirrors the Medicaid fraud bill co-sponsored by Gaetz, R-Fort Walton, and Sen. Durell Peaden, R-Crestview, which has been touted as a multimillion-dollar cost-saver. 

The other was the substance of CS/CS/CS/HB 651, by Rep. Matt Hudson, R-Naples. The bill would remove duplication in state regulation of health facilities by the Agency for Health Care Administration. 

Rep. Bill Galvano, R-Bradenton, opposed the bill, saying that a return to fee-for-service payment is a bad idea. The state has moved more and more to a system of prepaid premiums with managed-care organizations such as HMOs; in five counties, a Medicaid Reform pilot eliminates MediPass.

Galvano, who tried unsuccessfully last year to expand the pilot into Miami-Dade, said it saves the state money, although he conceded it has “many flaws” that need addressing. Nonetheless, said Galvano, “to revert back from the very heart of where we tried to go … is not an appropriate action.” 

Galvano said he didn’t like the idea of tagging hundred page amendments onto Homan’s bill, either. 

--Contact Christine Jordan Sexton.