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Florida Association for Behavior Analysis Responds to Recent Moratorium on Enrollment of New Providers in Miami and Broward

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Florida Association for Behavior Analysis’ Response

The Florida Association for Behavior Analysis (FABA) today commended the state Agency for Health Care Administration (AHCA) for issuing a temporary moratorium on the enrollment of new behavior analysis providers in Miami-Dade and Broward counties. The issue of Medicaid fraud and abuse is something that board-certified behavior analysts take very seriously, and FABA is grateful that AHCA is aggressively investigating and prosecuting fraudulent providers. [Read more…] about Florida Association for Behavior Analysis Responds to Recent Moratorium on Enrollment of New Providers in Miami and Broward

Florida HIE Notification Service Delivers 7.5 Million Alerts, Expands to Include Hospital Subscribers

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The Agency for Health Care Administration (Agency) today announced that the Encounter Notification Service® (ENS®) operated by the Florida Health Information Exchange Services (Florida HIE) has delivered over 7.5 million notifications to facilitate patient care coordination since its inception in 2013. These notifications are generated by over 215 participating hospitals throughout the state and are currently being routed to 43 different subscribers, including health plans, Accountable Care Organizations (ACOs), provider practices, and now hospitals. These subscribers use ENS to facilitate post-acute care coordination, avoiding unnecessary hospital utilization.

Agency Secretary Justin Senior said, “The continued growth of ENS brings benefits to patients, providers, hospitals, and health plans by sharing information about patient hospital encounters. I commend all of the health care stakeholders participating in this valuable service for their commitment to using health information technology as a means to providing better health care.”

Adventist Health System, in partnership with the Florida HIE, is the first hospital system in Florida to subscribe to ENS. This pilot partnership with Adventist Health System will place the system at the forefront of HIE adoption in the state. Going forward, Adventist will utilize these notifications to inform their clinically integrated network of their patients’ acute care encounters.

Adventist Health System’s Senior Director of Interoperability Jason Aspinwall said, “Through the use of the ENS alerting system, Adventist Health System’s Population Health Services Organization has been able to accurately monitor out-of-network admissions, better facilitate transfers where needed, and help with timely discharge planning and follow-up for our patients.”

Subsequent to Adventist Health System, four other hospital systems have contracted with the Florida HIE to deploy ENS subscriptions and two of those have fully implemented.

The Agency governs the Florida HIE in partnership with Audacious Inquiry (Ai), which provides operational infrastructure. The Florida HIE’s ENS platform facilitates improved care coordination. The ENS system also supports state and federal health care initiatives, including Statewide Medicaid Managed Care, the Medicare Shared Savings Program, and the Medicaid Electronic Health Records Incentive Program.

To date, the ENS platform is supported by Ai in 12 states and has delivered approximately 80 million notifications, benefiting over 32 million subscribed patients across the United States.

Ai’s Managing Partner, Chris Brandt said, “Effective care coordination facilitated by the Florida HIE and ENS will increasingly benefit Florida patients. We are honored to support Florida’s dedicated hospitals, physician practices, health plans, and ACOs in the shared pursuit of higher quality and more efficient care delivery.”

For more information on this and other Florida HIE services, please visit florida-hie.net.    

For more information about the health information exchange, please visit fhin.net or florida-hie.net.

Incoming Senate Democratic Leader Audrey Gibson Sets the Record Straight

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In letter to federal government, AHCA’s false claims belie the facts

Incoming Senate Democratic Leader Audrey Gibson (D-Jacksonville) on Friday called on Governor Rick Scott’s Agency for Health Care Administration to immediately retract its misleading claims that no legislative objections or concerns were raised over its plan to gut a critical safeguard protecting Florida’s seniors and families facing catastrophic health care emergencies.

“AHCA omitted key facts in its letter to the federal government seeking to amend its Medicaid waiver, promoting the move as an efficiency tool. In reality, despite both opposition and concern raised by myself and other Democrats, the main intent was to free up $38 million for general revenue, surrendering $60 million in federal matching dollars while saddling seniors, the disabled, and their families with massive medical debt.”

At issue is a waiver to the state’s Medicaid program sought by Scott’s Administration to eliminate “Medicaid retroactive eligibility,” which allows Medicaid to cover unpaid medical bills for up to 90-days from the date of application. Florida Medicaid only covers certain low income individuals: pregnant women, children, a limited number of parents who meet stringent income limits, people with disabilities, and senior citizens. While the waiver now being sought would continue the retroactive coverage of Medicaid-eligible pregnant women and children, seniors and the disabled – including veterans – would lose this extended period, and bear the heaviest financial consequences.

In its April 27, 2018 letter to the Centers for Medicare & Medicaid Services, AHCA’s Deputy Secretary for Medicaid claimed: “We are not aware of any concern or opposition raised by any member of either party regarding this provision during extensive budget debate.”

The record refuting that statement follows. During the March 9th, 2018 Senate floor debate on HB 5001, the General Appropriations Act, Democratic Senators Audrey Gibson, Jose Javier Rodriguez, Kevin Rader, and Victor Torres all expressed concerns and raised questions about the need for the cut.

“Contrary to AHCA’s alternative facts, Senate Democrats did raise both opposition and concerns during the budget debate on the Medicaid retroactive eligibility cuts. Attempting to sell this as a bi-partisan blessing on bad policy is an untruth.”

AHCA Announces the Award of New Contracts for the Statewide Medicaid Managed Care Program

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The Agency for Health Care Administration (Agency) today announced its intent to award contracts to nine health plans as a result of the re-procurement of the Statewide Medicaid Managed Care (SMMC) program. Florida law mandates that SMMC health plans be re-procured every 5 years; this was the first re-procurement. Through a regular, established competitive procurement process, the Agency negotiated and selected health plans to provide Managed Medical Assistance (MMA) and Long-term Care (LTC) services to the more than 3 million Floridians enrolled in the SMMC program.

The Agency’s negotiation team, made up of experts in the field of Medicaid and managed care, have negotiated the broadest benefit package ever available to Florida Medicaid recipients. This includes a wide array of added benefits available to health plan enrollees at no additional cost to the State of Florida. The enhanced benefit package negotiated is the most abundant ever available to Florida Medicaid recipients and includes, for the first time, a variety of extra benefits focused on substance abuse treatment and mental health, including intensive outpatient treatment, group and individual therapy, enhanced pain management services to provide alternatives to the use of opioids, and additional medication assisted treatment options. Health plans have agreed to continue to offer adults preventative benefits such as adult dental preventative and treatment services. In all, more than 55 additional benefits will be offered.

Further benefits for participating providers were also achieved, including additional enhanced payments to pediatric providers under the Medicaid Physician Incentive Program (MPIP).

In the Invitations to Negotiate for this procurement, released in July of 2017, the Agency laid out three primarily quality related goals for the program, including reducing potentially preventable inpatient and outpatient hospital events (e.g., hospitalizations and trips to the emergency department); improving birth outcomes; and increasing the percentage of enrollees receiving long-term care services in the community instead of a nursing facility. The Agency has negotiated commitments from each of the awarded plans to aggressively pursue these goals, including plan specific reductions in the percentage of potentially preventable healthcare events and adverse birth outcomes and continued rate incentives for transition to community based services for LTC recipients even after statutory benchmarks for transition are met.

In addition, there are several enhancements which will aid in combatting the opioid epidemic, including alternative pain management, greater access to medication assisted treatment options, and additional tools to reduce the incidence of babies with neonatal abstinence syndrome (NAS).  Access to providers will be enhanced through coverage parity via telemedicine for all covered services.

For the first time in the history of the Florida Medicaid program, those diagnosed with HIV/AIDS or a serious mental illness will have the option to enroll in a specialty plan specifically designed to serve those diagnoses, in every region and every county of the state. A specialty plan focused on serving children in Florida’s child welfare system will also be available statewide.

In addition, the awards will bring two new provider-based health plans, known as Provider Service Networks, or PSNs, into the Florida Medicaid program to serve recipients receiving MMA and LTC services.

Upon posting the intended awards, the Agency will remain in a blackout period for the next 72 hours. Florida law provides an opportunity for respondents who did not receive an award the option to challenge the result.

All information regarding the Agency’s solicitations is posted via the Vendor Bid System can be found by clicking here.

The solicitation numbers for Statewide Medicaid Managed Care are AHCA ITN 001-17/18 – Region 1 through AHCA ITN 011-17/18 – Region 11.

Nursing Home Quality Continues to Improve in Florida

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The Agency for Health Care Administration (Agency) today is highlighting recent national data showing Florida nursing homes, with oversight from the Agency, are delivering higher and higher quality during the course of this decade. Since 2011, Florida nursing homes have shown strong results and/or improvement in a host of quality measures, including those related to infections, falls, pressure ulcers, wandering, physical restraints and the use of anti-psychotic medicines. From information available on the CMS website, Florida nursing homes are either outperforming national averages, showing significant improvements over the last 10 years, or both, on the vast majority of core quality measures.

Agency Secretary Justin Senior said, “Our Agency’s top priority is providing the highest level of quality for patients in Florida. Florida nursing home residents today are less likely to fall, less likely to wander, less likely to suffer infections, less likely to exhibit unhealed pressure ulcers, and less likely to be chemically restrained than they were at the beginning of the decade. Florida tends to do well compared to national averages on these measures as well. This achievement is the product of high standards, consistent regulation, and the hard work of dedicated nursing home employees in the state. It is also the product of swift enforcement action whenever a nursing facility fails to meet Florida’s high standards. I am proud of the efforts that we have made with our partners, and clear expectations and strong regulatory oversight have led to vastly improved performance in our state’s nursing homes.”

The Agency is tasked with regulating the state’s nursing homes, which ensures that Florida’s most vulnerable population is safely cared for in the hands of our state’s nursing homes. The Agency is constantly taking action to ensure patient safety in Florida’s nursing homes. In late 2017, CMS implemented its Quality Assessment Performance Improvement requirements. Nursing homes are required to create quality plans to ensure that their levels of care and service maintain acceptable performance standards and are always improving. The Agency will hold nursing homes in Florida accountable for adhering to their quality plans as well as all regulatory requirements as one of many methods of safeguarding their residents.

Nursing homes in Florida are held to the highest standard. Florida has a unique and diverse population, and our nursing homes reflect that. As more people move to the Sunshine State, our Agency will remain diligent in improving the quality of care our vulnerable citizens receive. Even the best nursing homes can improve the experience for their residents, and our Agency is committed to continued work with our partners in fostering this environment of constant improvement and high levels of service and care.

AHCA Continues to Work With Federal Government On Extension of CHIP

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TALLAHASSEE, Fla. – Today, the Agency for Health Care Administration (AHCA) released a timeline of actions regarding the state of Florida’s continued work urging the federal government to reauthorize and extend the federal Children’s Health Insurance Program (CHIP). For months AHCA and the Florida Healthy Kids Corporation have been working with federal partners and conducting weekly meetings with our Florida KidCare partners which includes the Florida Healthy Kids Corporation, Florida Department of Health and Department of Children and Families to plan and implement strategies related to CHIP reauthorization.  AHCA has also participated in calls regarding CHIP arranged by the federal  Centers for Medicare and Medicaid Services (CMS), the National Academy for State Health Policy, and the National Medicaid Directors Association.

Secretary Justin Senior said, “Governor Scott has made it clear that he supports reauthorizing CHIP and the state of Florida fully expects Congress to act immediately on CHIP reauthorization. Our Agency is closely monitoring Congressional activity regarding the extension of CHIP funding. We remain hopeful that Congress will act to ensure that the many children and families that rely on this federal program have continued and uninterrupted service. Our Agency has been involved in discussions on CHIP reauthorization since August with federal CMS. Additionally, representatives from Florida Healthy Kids have been in Washington, D.C. to pursue this reauthorization since the summer of 2016. AHCA will do everything to ensure that these children have health care, and Florida has funding to continue the CHIP program through January. We will continue to reevaluate funds as this process moves forward. Ultimately, the continuation of this important federal program requires federal action.” 

CHIP Related Planning:

·         Contingency calls to discuss how Florida would ensure seamless operations following CHIP reauthorization, including short term and long term plans were held on August 23, September 19, October 13, October 27, November 3, November 11, November 17, December 1, December 8, and December 15. These calls included AHCA, Florida Healthy Kids and the Department of Health.

·         Calls with CMS to discuss Florida’s availability of CHIP funding were held on August 17, September 23, October 4, December 19, and December 21.

·         Florida Healthy Kids continues to have internal discussions and partner calls scheduled on October 6, November 3, and December 1, where congressional action around CHIP reauthorization was discussed.  

·         Florida submitted the CHIP funding template to the Centers for Medicare and Medicaid Services (CMS) with estimated need for November and December of 2017 on October 4, 2017.

AHCA Announces Launch of FloridaHealthPriceFinder

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The Agency for Health Care Administration (Agency) today launched FloridaHealthPriceFinder, a new health care transparency tool for consumers. The new website allows consumers and caregivers to look up the average amounts paid by insurance plans for a specific service, giving them a better estimate of what their total out-of-pocket expenses will be. The average payments are based on billions of lines of claims data from three Florida health plans, and claims data from additional plans will be added in early 2018. Further updates to the website will be available in the upcoming months.

Agency Secretary Justin Senior said, “Florida continues to lead the way in providing health care transparency for our residents. Floridians have already had the ability to use FloridaHealthFinder to access health plan report cards, locate the best facilities for their families, and access educational resources. FloridaHealthPriceFinder takes these resources a step further, and gives consumers a more realistic cost estimate than was previously available. I look forward to continued innovations in health care transparency as we pursue our mission of Better Health Care for All Floridians.”

The website lists the services as “care bundles” in order to factor in all aspects that account for the final price. For example, the care bundle for a knee replacement includes consultation, surgery, physical therapy and a follow-up visit. Since 2007, Floridians have been able to use FloridaHealthFinder.gov to look at undiscounted hospital charges, but this is rarely the amount that individuals or insurance companies are expected to pay. This tool can be used in conjunction with contacting your health insurance company to find out-of-pocket costs.

FloridaHealthFinder and FloridaHealthPriceFinder will operate together to continue to provide Floridians with transparent health care resources. To compare health care facilities in Florida please click here. All of the new resources provider by FloridaHealthPriceFinder can be found by visiting pricing.floridahealthfinder.gov.

AHCA Begins Process to Impose Fines to Facilities in Non-compliance with Emergency Generator Rule

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The Agency for Health Care Administration (AHCA) today announced that the Agency will begin fining assisted living facilities and nursing homes that have failed to comply with the Governor’s Emergency Generator Rule. The Agency will issue orders of non-compliance and fines of $1,000 a day for each facility not in compliance with the life-saving rule. The penalty for non-compliance with the rule includes possible license revocation. AHCA has been clear in communicating the cost of non-compliance, and facilities choosing to not enact these life-saving measures must do so immediately.
Secretary Justin Senior said, “The deadline for compliance with the Emergency Power Rule has passed. From day one we have stressed the importance of compliance and we will hold those facilities who failed to come into compliance fully accountable. This rule was written with one goal in mind, and that is to ensure the safety of patients and residents in nursing homes and assisted living facilities. It is a shame that some facilities have ignored these life-saving measures, and we will work with the local emergency management agencies and State Fire Marshal to ensure that nursing homes and assisted living facilities are in compliance.”
If a facility has submitted a statement of compliance to AHCA and the local emergency management agency, AHCA will confirm approval of the emergency power plan by the local emergency management officials and a confirmation of compliance by the State Fire Marshal whose review will be completed within 15 days after implementation.
If a facility has not responded to the Governor’s Emergency Rule in any form, AHCA will issue a notice of non-compliance informing the facility of the fines and possible license revocation. The notice of non-compliance will demand a certified response in 10 days. During this time, each facility not in compliance is being fined $1,000 per day.
The variance process is outlined in Florida law. If a facility has been granted a variance, or is awaiting approval of a variance, it is expected that these facilities will be in compliance by the date granted in the variance. All variances will be granted solely for construction and permitting timelines, and no facility will receive a variance due to cost. If at the end of the variance period a facility has not come into compliance, they will be subjected to fines and possible license revocation. If facilities meet the stringent threshold to obtain a variance, the state is required to grant the variance under Florida law, F.S. 120.542.
AHCA is the regulatory agency that will enforce the fines for both nursing homes and assisted living facilities.

Gov. Scott’s Securing Florida’s Future Budget Makes Investments to Increase Protections and Transparency for Patients and Families

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The Agency for Health Care Administration (AHCA) today highlighted Governor Rick Scott’s Securing Florida’s Future budget, which invests $28.7 billion in the agency. The Governor’s proposed budget includes important initiatives to improve transparency and protect patients at Florida health care facilities, and invests funding to reduce administrative burdens on health care providers and the Floridians they serve.
Governor Scott said, “Since I have taken office, we have worked to fight price gouging and make Florida’s health care system more transparent so families have the tools they need to make informed health care decisions. The investments I am proposing this year build on that commitment by increasing protections and transparency for patients and families across the state.”
AHCA Secretary Justin Senior said, “Governor Scott’s proposed Securing Florida’s Future budget helps our Agency exemplify our priority of better health care for all Floridians. Our Agency has worked to streamline processes and create efficiencies allowing staff to focus on areas of health care, such as access, cost and quality, ensuring that Medicaid recipients and those on private-pay insurance are receiving high quality care. These investments will allow health care facilities to spend more time focused on patients and less time dealing with burdensome regulations, and allow our Agency to offer more transparency while increasing the accuracy and dependability of reporting.”
The Securing Florida’s Future budget includes:
$925,000 for the Claims Data Analytics tool that will allow AHCA to enhance analysis and transparency of health care claims data. This supports Governor Scott and AHCA’s ongoing mission for transparency in health care pricing. It also continues the fight against price gouging and helps Floridians make informed health care decisions about providers, quality and pricing.
$500,000 for a Health Facility Inspection Scheduling system to streamline the scheduling process for the facilities AHCA licenses, allowing the Agency to streamline health facility inspections by consolidating visit and staff schedules. This investment from the Securing Florida’s Future budget will reduce travel costs and increase staff productivity and reduce possible burdens by duplicative visits on facilities so they can spend more time on the health and safety of the patients that they serve.
Florida Hospital Association President Bruce Rueben said, “FHA commends the Scott administration for its commitment to transparency and protections for patients and families. These investments will have a real impact on the patients we serve. FHA is proud to be a partner in the mission of better health care for all Floridians.”
Samira Beckwith, President and CEO of Hope Hospice & Palliative Care, “Ensuring the health and safety of our patients is the number one priority. The investments Governor Scott’s budget is proposing will create efficiencies in the health care field that will allow facilities like ours to spend less time handling on paperwork and more time with the patients we serve.”
Lourdes Rivas, President, Florida Medicaid, Simply Healthcare Plans, “As a Medicaid provider we have worked with the Agency for years to utilize data collection in order to improve the experience for our Medicaid members and increase cost effectiveness. The data analytics tools in the Governor’s recommended budget will improve practice and referral data thus further enhancing access to quality healthcare for all Florida Medicaid members.”
Chris Paterson, CEO of Sunshine Health said, “Sunshine Health is committed to transforming the communities we serve, and with Governor Scott’s investments in a claims database there will be improved transparency in health care and more access to information leading to better health outcomes.”

AHCA Statement on Florida Healthy Kids Board Meeting

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The Agency for Health Care Administration Secretary Justin Senior today released the following statement on the upcoming Florida Healthy Kids Board meeting.
Secretary Senior said, “Our Agency remains steadfastly committed to ensuring that no children lose their insurance coverage due to Hurricane Irma. During tomorrow’s Board meeting, the Board will hear and discuss the facts and the options Florida may have. We look forward to learning the facts, and discussing strategies that ensure that no child loses insurance as a result of Hurricane Irma.”
Ensuring that children have access to health care has always been a priority of our Agency. Under Governor Scott’s leadership, Florida has had much success in lowering the rate of uninsured children. According to a Georgetown University study, in 2009 Florida’s uninsured rate among children was 14.8 percent, and by 2016 had dropped to 6.2 percent. This is the second best improvement of any state in the U.S. this decade.
To qualify for CHIP, families can have incomes between 133 percent and 200 percent of the poverty level. This means the children in a family of four would qualify with an annual income between $33,000 and $49,000. Children included in the full-pay population are families living over 200 percent of the federal poverty line.