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Welcome again to Prognosis, a vertical that focuses on the crossroads of well being care coverage and politics.
The Company for Well being Care Administration’s resolution late final week to award six-year Medicaid managed care contracts to 5 incumbent well being plans might be challenged.
Aetna Higher Well being of Florida Inc. AmeriHealth Caritas Florida, Inc. Florida Neighborhood Care, ImagineCare, Molina Healthcare of Florida, Sentara Care Alliance, South Florida Neighborhood Care Community (d/b/a Neighborhood Care Plan) and UnitedHealthcare of Florida. filed a discover of intent to problem the choice with the Company for Well being Care Administration by the Wednesday deadline, based on the Workplace of Public Data.
AHCA’s printed resolution final week reveals the state’s intent to stay with five incumbent plans and reject 4 others: Aetna Higher Well being of Florida, AmeriHealth Caritas Florida, Molina HealthCare of Florida and United Healthcare, all of that are at the moment below contract, weren’t among the many checklist of successful bidders.
All of the rejected plans are at the moment below contract to offer care to Medicaid beneficiaries within the closely populated Medicaid Area 11, which consists of Miami-Dade and Monroe counties.
Aetna Higher Well being of Florida additionally has contracts to offer complete care in Medicaid Areas 6, a five-county swath of Southwest Florida composed of Hillsborough, Manatee, Polk, Hardee, and Highlands counties, and Area 7, which consists of Seminole, Orange, Osceola, and Brevard counties.
AmeriHealth Caritas additionally has a contract to offer care in Medicaid Area 8, which incorporates Sarasota, Desoto, Charlotte, Glades, Lee, Hendry, and Collier counties.
Molina is contracted for Medicaid Area 9, composed of Indian River, St. Lucie, Martin, Palm Seashore and Okeechobee counties.
Moreover, United Healthcare at the moment has contracts in Medicaid Areas 3, 4, and 6.
Area 4 consists of Baker and Clay counties and the stretch of coastal northeast Florida from Nassau to Volusia counties.
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— A better look —
Nevertheless it wasn’t simply the rejected plans that filed challenges.
ImagineCare LLC and Sentara Care Alliance had been new managed care plans hoping to enter Florida’s Medicaid managed care market.
Florida Neighborhood Care and South Florida Neighborhood Care Community are PSNs, or provider-sponsored networks, and had been every chosen to offer care in 5 Medicaid Areas.
That’s a major enlargement for the South Florida Neighborhood Care Community, the PSN plan owned by Broward Health (North Broward Hospital District) and Memorial Healthcare System (South Broward Hospital District). Former DeSantis Chief of Workers Shane Strum heads Broward Well being.
The identical just isn’t true, although, for Florida Neighborhood Care. The PSN that focuses on offering care to frail and getting old adults and adults with disabilities at the moment has contracts statewide.
Final week’s announcement decreases the PSN’s footprint to simply 5 Medicaid Areas. It’s price noting, although, that Florida Neighborhood Care was chosen as the only supplier for the Complete Mental and Developmental Disabilities (CIDD) Managed Care Pilot Program.
In the meantime, the state has sanctioned two of the incumbent plans that had been awarded statewide contracts — Sunshine Well being Plan and Merely Healthcare Plans.
Sunshine State Well being Plan, which was awarded contracts statewide for its complete long-term care plus, HIV/AIDS, severe psychological sickness plans, and youngster welfare plans, has been sanctioned twice. It was sanctioned and hit within the 3Q of state fiscal yr 2018-19. AHCA’s information don’t point out the plan was fined on the time. The second sanction was within the 3Q of FY 2021-22. The plan paid a $9 million superb.
In accordance with a compliance dashboard maintained by AHCA, Merely Healthcare Plans was sanctioned $2,500 in Q1 of state fiscal yr 2023-24.
Humana Medical Plan, which additionally was awarded contracts statewide for complete long-term care plus, HIV/AIDS and severe psychological sickness specialty plans, has not been sanctioned.
The present Medicaid contracts have been in impact since state FY 18-19 and expire on the finish of the yr. In that point there have been 1,130 closing actions taken in opposition to the contracted managed care plans for violations and $70.5 million in complete greenback quantities related to these closing actions. Most of these actions (1,123) and financial penalties ($61.4 million)
—What about DeSantis? —
A number of states, led by Republican Governors, are warning that the brand new federal Medicaid tips launched by the Facilities for Medicare and Medicaid Providers (CMS) would “devastate the Medicaid security internet” if they’re applied.
Gov. Ron DeSantis didn’t signal on to the letter despatched late final week by eight GOP Governors, together with Texas Gov. Greg Abbott and Georgia Gov. Brian Kemp.
The letter straight cites Florida as a state that would ultimately lose out on $2.6 billion in funding however Gov Ron DeSantis just isn’t one of many signatories.
The proposed rule facilities on how states give you matching {dollars} to herald federal Medicaid funds. This subject is especially acute in Florida, the place the state depends closely on cash collected by suppliers, reminiscent of hospitals and nursing houses, to fund its share of Medicaid, which is funded collectively by the state and federal governments.
“If CMS however forges forward and implements these insurance policies, Medicaid funding might be lowered by $48 billion every year, impacting 49 states that depend on supplier taxes to bolster their Medicaid applications,” states the letter despatched to President Joe Biden.
“Struggling most could be states like Louisiana, Missouri, Texas, and Florida. Texas and Florida alone depend on supplier taxes to assist greater than $8 billion and $2.6 billion, respectively, in crucial Medicaid funding every year. Such reductions would hurt crucial well being care techniques serving our most weak residents, exacerbating disparities in care.”
The letter provides that “your administration’s actions represent a direct menace to Medicaid funding and to our most weak residents. We urge you to right away abandon these misguided insurance policies.”
DeSantis’ workplace didn’t reply to a request for remark concerning the letter despatched to Biden and declined to touch upon why the Governor didn’t signal onto the letter, as an alternative deferring remark to AHCA.
—Q/A BioFlorida —
BioFlorida’s new President and CEO Mark A. Glickman is a New York native, former New Jersey entrepreneur and Florida enterprise capitalist transplant. He’s been on the helm of BioFlorida for lower than 5 months and says he’s obtained massive plans for the group that, based on its web site, represents 8,600 entities and analysis organizations within the life sciences trade that make use of 107,000 Floridians.
Glickman will probably be in Alachua County April 25 on the nineteenth annual BioFlorida Celebration of Know-how, an outside occasion that pulls greater than 500 trade, life science, and neighborhood professionals to the house county of the College of Florida and a burgeoning hub for innovation in biotechnology and life sciences.
Glickman spoke with Florida Politics’ Prognosis to debate his plans for the group. An edited model of that dialog is under:
Prognosis: Are you able to talk about your imaginative and prescient for BioFlorida
I’m right here to attach the dots on this ecosystem. You understand, if you go to New Jersey, otherwise you go to Massachusetts or California, it’s not that arduous to attach the dots, you already know, who the banks are, you already know who the businesses are, you already know, who the representatives are, who’re going to assist you and who aren’t, it’s sort of, you don’t even want a map.
In Florida, you want that. You don’t even know. Let’s say I’m standing in Miami or I’m standing in Alachua. Is that the correct place to be? Six months in the past, I didn’t know there was an Alachua County in Florida.
However in New Jersey, in the event you go to Princeton, you might have a 90% probability that you simply’re in the correct place. You’re going to search out every little thing. So, I’ve taken it critically. We have to join the dots, and what I discovered in a brief interval is that we have now an excellent product at BioFlorida.
It’s beginning to come collectively actually quick, which means the dots. And now the Tallahassee piece is coming collectively.
Prognosis: Are you able to clarify what you imply by the Tallahassee piece?
So to me, the Tallahassee piece has a few totally different angles to it. For those who take a look at our constituents, it’s most likely one-third tutorial, one-third, let’s name it an funding, and one-third business section two of the three. However all three of the constituents actually don’t know find out how to navigate or develop into conscious of what the state may even supply them, whether or not it’s the roles, Alternative Fund, discovering find out how to entry these funds, or discovering out what’s accessible. There’s a gap. And possibly this falls into the lobbying piece however is Florida open to the life sciences trade? For our 450 members, I’m undecided all of them are totally conscious that Florida values, the life sciences.
Among the laws that was on the market through the 2024 Session, whether or not it got here from, you already know, Rep. Randy Advantageous relating to worldwide reference drug pricing, Canadian import drug pricing, or hospital 340 B, all these items, give the recommendation, give the looks, that Florida just isn’t within the life sciences trade. However that’s not true. So now I must work with Company for Well being Care Administration Secretary Jason Weida and FloridaCommerce Secretary Alex Kelly to assist inform the story if the funds are there and the heat is there, and the state desires to draw these corporations.
That is what we don’t have. However it’s a must to discuss to folks, it’s a must to perceive the place they stand. So, I can construct that, and I’ll assist them construct the product, to say, ‘Hey corporations who’re right here, we wish you to remain right here. Firms who’re on the fence, we wish you to maneuver right here, and corporations that don’t consider that they may develop right here, we have now the sources that can assist you develop. None of that’s apparent to the constituents. The bigger pharmaceutical corporations like Medtronic, the Pfizers, and Bristol Myers Squibb, they’re right here. They should know that BioFlorida is vocal of their points.
Prognosis: What can BioFlorida do for the trade?
We’re beginning to model BioFlorida, and what I imply by branding it’s. I’m placing this model on from idea to shopper. And what I imply by that’s, who can we be? From idea, I imply, that discovery stage spin spun out of a college, or it has a molecule from some other place from idea to impression in human lives. We really feel like we have to tie this ecosystem collectively. That is the present want. We’ve college discovery stage corporations, we have now medical machine corporations, pre-clinical stage corporations, medical stage, and business stage, corporations. The businesses sort of come to the Florida ecosystem, and say, ‘Hey, I need assistance. ’I would like to search out distributors, whether or not it’s CROs we want coverage assist administration, mentorship, capital, and human sources, is an enormous a part of this.
And I did this once I turned a CEO of a Florida-based firm, I got here to Florida, however I stayed centered on the folks I knew in New Jersey. I went again to my sources to New Jersey.
So that is our imaginative and prescient right here. We wish to be the centralized mannequin the place all these totally different constituents come to BioFlorida and develop into the supply. So, you don’t need to be a brand new firm determining what coverage is, find out how to navigate Tallahassee, and the place to go for human sources. We wish to create the supply for all of the wants of Florida Life Sciences.
In order that’s, that’s my three-minute overview of what we’re making an attempt to perform in a really brief interval right here. So, what I’m doing is I’m prioritizing. That’s what’s so thrilling it’s taking place rapidly.
— New partnership —
Florida’s youngster and household direct service suppliers have joined collectively in a brand new partnership known as the Companions for Florida’s Youngsters & Households to assist form a greater future for Florida’s kids, households, and communities.
By means of this collective voice, the Companions for Florida’s Youngsters & Households advocate for options to empower Florida’s kids and households, strengthen communities, and create generational change. A key focus is working for a community-based care system in Florida that retains kids and households on the forefront and finest serves the wants of our state’s communities.
The Companions for Florida’s Youngsters & Households collectively supply providers to all Florida kids and households with applications and attain in Florida’s 67 counties and collectively convey unmatched on-the-ground expertise in offering these providers. These accomplice organizations and suppliers work to maintain kids protected and supported, create stronger households, and construct bridges to success by way of prevention, intervention and ongoing therapy and assist providers.
Companions for Florida’s Youngsters & Households stated In a joint assertion, “All kids should develop up in sturdy households and supportive communities and have each alternative to achieve their full potential.
“As Florida’s youngster and household service suppliers, the Companions for Florida’s Youngsters and Households are on the entrance strains working to fulfill the best wants dealing with our youngsters, households, and communities. We’re there earlier than the hotline name, through the disaster, and within the years of life to observe. By means of this continuum of care, we offer Florida’s kids and households, together with those that want us most, with security, safety, hope, and the alternatives to assist them attain their full potential.
“Our collective on-the-ground expertise provides us an unparalleled understanding of find out how to assist the absolute best outcomes for Florida’s kids and households. We’re devoted to working with our state’s leaders, policymakers, and communities to make Florida a state the place households can thrive collectively.”
The Companions for Florida’s Youngsters & Households embody 4 Sisters Options; A Child’s Place; Boys City of Florida; Champions for Youngsters; Youngsters’s Harbor; Youngsters’s House Community; Youngsters’s House Society; Florida Sheriffs Youth Ranches; Associates of Youngsters & Households; IMPOWER; Children In Misery; Residing Hope; St. Augustine Youth Providers; and Thompson Little one & Household Focus.
— RULES —
The Division of Well being Entry and Tobacco proposes new Guidelines 64I-7.001, 64I-7.002, and 64I-7.003 to ascertain the standards for purchasers, dentists, and suppliers to take part in a voluntary dental providers program. Extra here.
— LOBBYISTS —
David Daniel, Jeff Hartley, Lisa Hurley, Smith Bryan & Myers: Residing Hope
Kelly Mallette, Gabriela Navarro, Ronald L. E book P.A.: Florida Smoke-Free Affiliation
— ETC —
There’s a brand new group on the town and it’s known as the Companions for Florida’s Youngsters & Households. The group represents youngster and household direct service suppliers and can advocate for a community-based care system in Florida that, based on a information launch, “retains kids and households on the forefront and finest serves the wants of our state’s communities.”
The group consists of representatives from 4 Sisters Options; A Child’s Place; Boys City of Florida; Champions for Youngsters; Youngsters’s Harbor; Youngsters’s House Community; Youngsters’s House Society; Florida Sheriffs Youth Ranches; Associates of Youngsters & Households; IMPOWER; Children In Misery; Residing Hope (previously often called Florida United Methodist Youngsters’s House); St. Augustine Youth Providers; and Thompson Little one & Household Focus.
— ROSTER —
— Alecia Collins is the brand new Deputy Chief of Workers Communications and Exterior Affairs on the state Company for Well being Care Administration. She has labored at a number of state businesses, most just lately on the Division of Emergency Administration.
— Precision Healthcare Specialists employed Todd Lindquist, M.D., who focuses on circumstances involving the ears, nostril and throat.
— Jessica Reimers has been named Government Director of the World AIDS Museum and Instructional Middle in Fort Lauderdale, Florida. The museum is a nonprofit with the mission of accelerating consciousness and reducing the stigma of HIV/AIDS.
— ICYMI —
In case you missed them, here’s a recap of different crucial well being care coverage tales lined in Florida Politics this previous week.
“More than 22K children dropped from Florida KidCare in 2024 as state challenges federal eligibility protections” through Christine Jordan Sexton of Florida Politics — In a transfer that some have known as “egregious,” Florida since January has dropped greater than 22,000 kids from a sponsored medical insurance program for failing to pay premiums regardless of the federal authorities saying it can not. State knowledge reveals that 6,780 kids had been disenrolled from the Florida KidCare program Jan. 1, which, based on the federal authorities, is when a 12-month eligibility requirement went into impact for youngsters enrolled within the Medicaid or the state kids’s medical insurance program (CHIP), which in Florida is known as Florida KidCare.
“FDACS inspectors find nearly 200,000 hemp products targeting kids in search” through Gabrielle Russon of Florida Politics — State inspectors found practically 200,000 hemp merchandise illegally being marketed to kids, with the state intervening to maintain them off the cabinets, stated Florida Division of Agriculture and Client Providers (FDACS) Commissioner Wilton Simpson.
“State announces intent to ink multibillion-dollar contracts with five managed care plans” through Christine Jordan Sexton of Florida Politics — The Company for Well being Care Administration on Friday introduced the names of the successful bids for the Medicaid managed care program. The contracts are large in scope for the reason that managed care corporations which can be picked will get six-year contracts to manage a well being care program that yearly prices tens of billions of {dollars}. The newest knowledge from AHCA reveals that there are 3.45 million Floridians receiving Medicaid by way of managed care plans.
“Rick Scott backs 15-week abortion ban with exceptions, distancing from law DeSantis signed” through A.G. Gancarski of Florida Politics — U.S. Sen. Rick Scott’s place on abortion continues to get scrutiny as he runs for a second time period, with the previous Governor distancing himself on the report from a regulation DeSantis signed in 2023. And feedback he made to The Hill possible received’t take the warmth off the Republican Senator from Democrats who wish to take away him from workplace.
— FOR YOUR RADAR —
Other than protection by Florida Politics, these tales are price your time.
“Born to die: Florida’s infant mortality crisis” through Cindy Krischer Goodman of the South Florida Solar-Sentinel — Throughout Florida, many dad and mom spend their days and nights watching screens, adjusting tubes and struggling to maintain their untimely infants alive. Preemie kids, many with undeveloped organs, face unbelievable odds to outlive and thrive and infrequently require years of monitoring and medical interventions that drain household and authorities funds. Untimely births in Florida — these sooner than 37 weeks gestation — rose 4% over the past decade, even because the state’s total birthrate declined by practically 10% in the identical time interval. Florida docs see a well being disaster unfolding: Toddler mortality charges within the state persist at ranges greater than the nationwide common, however equally regarding is the rising variety of untimely births. Extra superior know-how permits docs to carry out lifesaving measures on newborns the dimensions of a shoe; untimely infants are likely to die inside 28 days, leaving households grieving; fragile kids are despatched house from hospitals with respiration machines, feeding tubes and different medical units to maintain them alive.
“New surgical tower at TGH will bear a familiar name in Tampa health care circles” through Ashley Gurbal Kritzer of the Tampa Bay Enterprise Journal — Tampa Basic Hospital’s new 13-story surgical tower will bear the identify of Tampa’s Taneja household after a “historic present” towards the mission. TGH celebrated the groundbreaking of the tower, which can home surgical, neuroscience, and transplant providers when it opens in 2027. Jugal and Manju Taneja based Belcher Prescription drugs collectively in 2010. The tower is known as in honor of the Taneja Household Basis’s undisclosed present to the TGH Basis. In complete, TGH says it has raised $120 million towards the surgical tower. “We’ve lived the American dream, and now we wish others to have that very same probability at life,” Jugal Taneja stated in a press release on behalf of himself, Manju and the household. “What higher option to pay it ahead than to offer larger entry to world-class care for many who want it most?”
“COVID-19 death toll nears 2,300 in 2024; experts urge updated vaccines” through Caroline Catherman of the Orlando Sentinel — Though COVID-19 instances are at the moment low, practically 2,300 folks have died in Florida this yr from a virus that refuses to vanish totally. That has well being care consultants reminding Floridians once more that it’s time for an additional booster shot of vaccines designed to stop severe sickness and loss of life. The most important danger is for folks ages 65 and up. They account for 91% of Florida’s COVID-19 deaths. Throughout preliminary vaccine rollouts, aged folks had been extremely vaccinated. Now solely 43% of U.S. residents over 65 are up-to-date on their photographs. This has led consultants to induce this group particularly to get immunized.
“Florida conspiracy theorists are making a bid to commandeer a prestigious hospital” through Ja’han Jones of NBC Information — There’s a brand new Every day Beast report on makes an attempt by conservative anti-vaxxers to win management of the medical Board that oversees the celebrated Sarasota Memorial Hospital in Florida. Because the Beast stories, the group of contenders seeking to win seats on the Board contains Mary Flynn O’Neill, sister of former Trump adviser and conspiracy theorist Michael Flynn. A victory for the conspiracy theorists would permit them to set requirements for what qualifies as efficient and moral well being care — a horrifying prospect. Florida is already providing a crash course within the risks of permitting pseudoscience to drive well being coverage, within the insurance policies of its Surgeon Basic, Dr. Joseph Ladapo. And but Florida alone doesn’t paint the total image of the conservative motion’s assault on public well being.
— PENCIL IT IN —
Friday
Joyful birthday to Sen. Colleen Burton.
3 p.m. — AHCA holds a gathering on proposed modifications to Rule 59G-4.002 relating to supplier reimbursement charges. Company for Well being Care Administration, 2727 Mahan Dr. Bldg. 3, Tallahassee, 32308-5407.
Saturday
Joyful birthday to Rep. Randy Advantageous.
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Prognosis is written by Christine Jordan Sexton and edited by Drew Wilson.
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