The Weekly Check Up: Working Some Medicaid Magic

Apr 30, 2018

Humana is probably very happy right about now.

The insurer emerged from negotiations with Medicaid officials as one of the winners in the contest to deliver health care to poor, elderly and disabled Floridians over the next five years.

Though Humana didn’t receive top scores from the agency's negotiation team that reviewed bids for new Medicaid contracts, Humana earned enough points for the health plan to be invited to the negotiating table.

And that's all it took.

Once it was at the table, Humana --- guided by Greenberg Traurig lobbyist Hayden Dempsey, a co-worker of former AHCA Secretary Liz Dudek --- leapfrogged its competition.

For instance, Humana was one of seven companies to offer access to a comprehensive health plan in Medicaid Region 7, which covers Brevard, Orange, Osceola and Seminole counties. Comprehensive means the plan offers long-term care services and more-traditional  managed medical care. State documents show that Humana’s response to the invitation to negotiate in Medicaid Region 7 was ranked near the bottom, coming in fifth.

The score was good enough, however, to get the company an invitation to negotiate. When the negitiations were finalized, Humana was able to edge Coventry Health Care of Florida, doing business as Aetna Healthcare, which received higher marks on the ITN but wasn't the agency's pick in awarding a plan for the area.

The same held true in Region 10,  in Broward County, where Humana's response to the ITN  was scored fourth. Again, near the bottom, but good enough to move to the negotiating table. And when negotiatons ended, Humana edged competitor Simply Healthcare Plans which was ranked No. 2 for the region before negotiations started.

Humana also replied to the Medicaid ITN In Region 2, which covers 14 counties across Northwest Florida. Again, the plan scored well enough to be invited to negotiate a deal with the state and ultimately was awarded a contract for the region. That contract for Region 2 also allows Humana to serve people in Region 1, the western-most part of the Panhandle.

To  encourage managed-care participation in the Panhandle, lawmakers agreed in 2011 to provide health plans an incentive to participate in regions 1 and 2. A law requires AHCA to award additional contracts in any other regions where plans bid if they have contracts in Region 1 or Region 2.

And it's that provision that Humana used successfully to score contracts in Region 8 and Region 9, which include 14 counties in Southwest Florida and five counties north of Broward in Southeast Florida.

Dempsey and Dudek declined to comment on the Medicaid negotiations and the agency's decison to award the five-year Medicaid contracts, which, in all, could be worth upward of $90 billion to Humana and eight other companies. 

Meanwhile, companies that don't agree with the Agency for Health Care Administration's decisions to award contracts had until 4:15 p.m. today to file notices of protest with AHCA. More here

FLU!!!!! Three outbreaks of influenza or influenza-like illnesses were reported in week 16, which ended last Saturday. Thus far, 493 outbreaks of influenza and influenza-like illnesses have been reported since the start of the 2017-2018 season. More about the flu here

RULES

The Board of Medicine is developing a rule to update and clarify language in Rule 64B8-40.003, authorizing the delegation of powers and duties of the Dietetics and Nutrition Practice Council. More here

The Board of Medicine is developing Rule 64B8-13.008, regarding disciplinary guidelines for impaired practitioners. More here

The Board of Medicine is proposing an amendment to Rule 64B8-8.001, regarding continuing-education courses required for physicians who prescribe controlled substances. More here

The Board of Osteopathic Medicine is developing Rule 64B15-13.0025, regarding continuing-education courses required for physicians who prescribe controlled substances. More here

The Board of Pharmacy is developing changes to Rule 64B16-27.8206 to update language regarding patient counseling from pharmacists. More here

The Board of Psychology is developing changes to Rule 64B19-11.010 relating to applications. More here

The Office of Insurance Regulation is developing rules to implement pharmacy benefit manager requirements passed by the Legislature this year. More here

The Division of Environmental Health has proposed changes to Rule 64E-11.002 to, in part, make it consistent with changes in state law. More here

The Board of Acupuncture has proposed development of Rules 64B1-3.009 --- licensure by endorsement through national certification ---- and 64B1-3.010 --- licensure by endorsement through another state license. More information here

The Board of Acupuncture is proposing development of Rule 64B1-9.007, relating to advertising. More here

The Board of Pharmacy has changed its proposed amendment to Rule  64B16-27.831, relating to continuing-education requirements for filling controlled-substance prescriptions and electronic prescribing. More here

The Board of Optometry has proposed amending Rule 64B13-18.002. More here

The Agency for Health Care Administration has changed plans to amend rules 59G-13.070 and 59G-13.081, regarding the Developmental Disabilities Individual Budgeting Waiver. More here

HOSPITALS

—The Daytona Beach News-Journal reports that a circuit judge ruled that Halifax Health cannot build a facility outside of its special taxing district.  More here

—The Ledger of Lakeland reports that Lake Wales Medical Center earned a D grade from the Leapfrog Hospital Safety Grading system, ranking it among the bottom 7 percent of approximately 2,500 hospitals nationwide. More here

... Speaking of Leapfrog here are some nuggets of information gleaned from the latest Leapfrog report. The five states with the highest percentage of "A" hospitals were Hawaii, Idaho, Rhode Island, Massachusetts and Virginia. Florida makes the list of states with hospitals with F grades, as do California , Washington, D.C., Iowa, Illinois, Maryland, Michigan, Mississippi, New Jersey and New York.

NURSING HOMES

AHCA is requesting that nursing homes submit information t regarding ventilator-dependent Medicaid recipients who received care during 2017. A section of state law requires a ventilator supplemental payment of $200 per Medicaid day within the prospective payment system that will be effective Oct. 1. To calculate the supplemental payments for the Oct. 1 rate-setting, nursing homes need to submit information no later than May 15.

REVIEW

—More than 1,800 people have been removed from the state-employee health insurance program after Gov. Rick Scott’s administration started requiring workers to fork over tax documents and their children’s birth certificates to verify that family members qualify for coverage. Nina Ashley, a spokeswoman for the state agency that oversees the health-insurance program, said decisions to terminate coverage have been made by people who were enrolled. More here

—Pointing to an arbitrary process that “ignores substance in favor of blind luck,” Administrative Law Judge  R. Bruce McKibben on Thursday rejected a state emergency rule drawn up to help license more methadone-treatment centers across Florida. In a 44-page order, McKibben hammered the process in which the Department of Children and Families accepted applications for the licenses on a first-come, first-served basis. More here

— In a case stemming from an injury to a child who was deaf and had been diagnosed with psychiatric conditions, the Florida Supreme Court on Thursday tried to resolve questions about when lawsuits deal with medical malpractice --- or ordinary negligence. The questions are important legally because state law makes it harder to pursue medical-malpractice cases than other types of negligence claims. More here

—The state Department of Financial Services announced Wednesday it intends to pay $195,000 to the Workers Compensation Research Institute to study how Florida’s workers’ compensation insurance market is performing compared to other states. The department contends the non-profit institute is the “only known entity” that published independent data for 15 to 20 other large states that participate in the study. According to the state, “stakeholders … benefit from research that assists in monitoring the effects of legislation and administrative changes and from the comparison of legislative and administrative strategies of other states to better forecast necessary policy changes.” More here 

—The St. Augustine Record reports that the University of St. Augustine for Health Sciences is being bought by new owners. More here

CALENDAR

APRIL 30

9 a.m. The Board of Occupational Therapy will meet. Capital Circle Office Center, 4042 Bald Cypress Way, Room 301, Tallahassee. A copy of the agenda may be obtained by visiting the website: www.floridasoccupationaltherapy.gov.

MAY 2

8 a.m. The Board of Podiatric Medicine Probable Cause Panel will meet to review cases in which a determination of existence of probable cause has  been made. Call-in number: 1-888-670-3525. Participant code 7342425515.

MAY 3

9 a.m. The Bureau of Emergency Medical Oversight will meet. 4042 Bald Cypress Way, 3rd Floor, Conference Room 301, Tallahassee.

5:30 p.m. The Pediatric Cardiology Technical Advisory Panel will meet to organize subcommittees and determine the next steps for panel meetings. This meeting is online via webinar and requires a telephone for audio. To join the webinar, use the following link and webinar ID: https://attendee.gotowebinar.com/register/6137668909786551298. Call-in number: 1-877-309-2071. Access code: 865-603-531.

6:30 p.m. The Board of Physical Therapy will meet. Orlando Marriott Lake Mary, 1501 International Parkway, Lake Mary. A copy of the agenda may be obtained by contacting the Board of Physical Therapy, 4052 Bald Cypress Way, Bin C05, Tallahassee, FL 32399-3255, by calling the board office at (850) 245-4373 or by visiting the website http://floridasphysicaltherapy.gov.

MAY 4 

9 a.m. The Board of Dentistry will have an orientation traning for new board members. Florida Department of Health, 4042 Bald Cypress Way, Room 310S, Tallahassee. A copy of the agenda may be obtained visiting www.floridasdentistry.gov. 

1 p.m. The Division of Community Health Promotion, Bureau of Tobacco Free Florida, will hold a meeting to discuss a Constitution Revision Commission proposal regarding electronic smoking devices. Call-in number: 1-888-670-3525. Participant code: 5720848571.