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AHCA Announces Panel Members of Pediatric Cardiology Technical Advisory Panel

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Panel will establish standards for pediatric cardiac procedures

The Agency for Health Care Administration today announced the cardiology specialists and cardiac surgeons who will serve on the new Pediatric Cardiology Technical Advisory Panel (Panel). The Panel will fulfill the responsibilities outlined in Chapter 2017-151, Laws of Florida, signed by Governor Scott earlier this year. The Panel will develop procedures and standards for measuring the quality and outcomes of pediatric cardiac surgery programs in the state and make recommendations to the Agency on specific regulatory guidelines. Panel members include representatives from each of the state’s ten existing pediatric cardiology surgery programs, as nominated by the Chief Executive Officers of those hospitals, and three additional at-large members appointed by the Agency’s Secretary Justin Senior.
The Panel members are:
William Blanchard, MD – Retired. Formerly Sacred Heart and Nemours Children’s Clinic – Pensacola
Mark Bleiweis, MD – University of Florida Health Shands Hospital – Gainesville
Eric Ceithaml, MD – Wolfson Children’s Hospital – Jacksonville
Eric Eason, MD – Golisano Children’s Hospital SWFL – Fort Myers
Kristine Gulesreian, MD – Nicklaus Children’s Hospital – Miami
Jeffrey P. Jacobs, MD – Johns Hopkins All Children’s Hospital – St. Petersburg
Stephen Langley, MD – St. Joseph’s Children’s Hospital – Tampa
Jorge McCormack, MD MBA – Mednax Medical Group / Pediatric Cardiology Associates – St. Petersburg
David Nykanen, MD – Arnold Palmer Hospital for Children – Orlando
Frank Pigula, MD – Florida Hospital for Children – Orlando
Eliot Rosenkranz, MD – University of Miami Holtz Children’s Hospital – Miami
Frank Scholl, MD – Joe DiMaggio Children’s Hospital – Hollywood
Peter Wearden, MD – Nemours Children’s Hospital – Orlando
The Panel will convene in the fall and meet as needed to form their recommendations. The Agency has launched a dedicated webpage to make available information about the Panel’s work, member appointments, and meeting information. Under Florida’s Sunshine Laws, all Panel meetings will be open to the public. Members of the public may also send questions and information to the Panel through the website.
 

AHCA Suspends the License of the Rehabilitation Center of Hollywood Hills

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Tallahassee, FLA. – Today, the Agency for Health Care Administration issued an emergency suspension order on the license of the Rehabilitation Center of Hollywood Hills. On September 13, the Agency issued a temporary moratorium on admissions for the facility, which stopped new patients from being admitted. On September 13, the Agency also initiated an investigation of the facility and the preliminary results have shown that a permanent emergency suspension of licensure is warranted and necessary. Today’s action will suspend their ability to operate a nursing home, and prohibit the facility from admitting any patients.

Per the AHCA investigation’s initial findings, residents of the facility did not receive timely medical care because the trained medical professionals at the facility overwhelmingly delayed calling 911. Also, these patients were not timely evacuated to the air-conditioned hospital located across the street. These patients ended up at the hospital with body temperatures of, for example, 109.9 degrees Fahrenheit, 108.5 degrees Fahrenheit, 108.3 degrees Fahrenheit, and 107 degrees Fahrenheit – far too late to be saved. The facility also made many late entries into patients’ medical records. The “late entries” were recorded hours after a nurse visited the patients, and therefore, portray an inaccurate depiction of the situation at the facility.

Agency Secretary Justin Senior said, “As more information has come to light on this egregious situation, this facility absolutely cannot continue to have access to patients. This facility failed its residents multiple times throughout this horrifying ordeal. It is unfathomable that a medical professional would not know to call 911 immediately in an emergency situation. The facility also entered late entries into medical records claiming safe temperatures for patients while those same patients were across the street dying in the emergency room with temperatures of over 108 degrees Fahrenheit. No amount of emergency preparedness could have prevented the gross medical and criminal recklessness that occurred at this facility. For that reason we will suspend their license and completely terminate them from the Medicaid program. We will continue to do everything in our power to protect patients in Florida – especially those who are frail and can’t take care of themselves.”

Between 1:30AM and 5:00AM on September 13, several residents suffered respiratory or cardiac distress, and at least eight of those patients ultimately died as a result of not receiving the medical attention they deserved. On September 13, the Rehabilitation Center at Hollywood Hills added many late entries to patients’ medical records. This includes a facility nurse recording a patient’s temperature at 101.6 degrees, but the patient was actually no longer at the facility, and had a recorded temperature 108.3 by the hospital. In a second, and very egregious case a late entry was added that stated the patient was resting in bed with respirations even and unlabored, however, this resident had already died before this entry was made.

Governor Rick Scott said, “The action AHCA took today to close the Hollywood Hills Rehabilitation Center sends a clear message – if you do not protect the patients that are entrusted in your care, you will be held accountable. The more we learn about this facility’s reckless behavior, the more concerning it becomes that the Hollywood Hills Rehabilitation Center made the decision not to immediately call 911 or evacuate to one of the state’s largest hospitals located across the street – which never lost power. We will not stop demanding answers to these questions on behalf of every family who lost a loved one.”

This facility’s license to operate a nursing home in Florida is immediately suspended based upon the facts presented to the Agency. Their Medicaid participation has been terminated. A copy of the facility’s suspension order is attached. AHCA is currently conducting an investigation. The Hollywood Police Department and FDLE are also conducting a criminal investigation.

Gov. Scott Directs AHCA to Terminate the Rehabilitation Center at Hollywood Hills from Medicaid Program

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After the loss of eight lives at the Rehabilitation Center at Hollywood Hills, Governor Scott directed the Agency for Health Care Administration to terminate the facility as a Medicaid provider.
This facility was responsible to provide their patients a safe environment and they failed to do so. The state has had multiple points of contact with this facility prior to the tragedy, and at no time did the facility communicate any imminent threats to their patients’ life or safety.
This facility is currently undergoing a criminal investigation from the local authorities, and open investigations from both AHCA and DCF.  It is clear that this facility cannot be responsible for Florida’s vulnerable patients, and therefore the State will stop them from providing care.
Anyone found to not be acting in the best interests of their patients will be held accountable to the fullest extent of the law.
All patients have been evacuated from the Rehabilitation Center at Hollywood Hills.
Click HERE to see the Governor’s statement from yesterday.

AHCA Issues Emergency Moratorium for the Rehabilitation Center at Hollywood Hills

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Governor Rick Scott directed the Agency for Health Care Administration to issue an emergency moratorium for the Rehabilitation Center at Hollywood Hills.

All patients have been evacuated from the Rehabilitation Center at Hollywood Hills. This moratorium immediately prevents this facility from admitting any patients until it is lifted, and it is necessary to protect the lives and the safety of frail elders. Governor Scott made it clear today that he is demanding answers on and had ordered the Agency for Health Care Administration and the Department of Children and Families to immediately investigate this facility. Click HERE to see the Governor’s statement from earlier today. A copy of the moratorium can be found HERE.

AHCA Announces Call for Nominations to Pediatric Cardiology Technical Advisory Panel

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The Agency for Health Care Administration (Agency) is issuing a call for nominations for cardiology specialists and cardiac surgeons to serve on a new Pediatric Cardiology Technical Advisory Panel (Panel). The Panel will fulfill the responsibilities outlined in a new law, Chapter 2017-151, Laws of Florida, signed by Governor Rick Scott earlier this year. The Panel is charged to develop procedures and standards for measuring the quality and outcomes of pediatric cardiac surgery programs in the state. The panel will make recommendations to the Agency on specific regulatory guidelines.
Panel members will include representatives from each of the state’s ten existing pediatric cardiology surgery programs, as nominated by the Chief Executive Officers of those hospitals and three additional at-large members to be appointed by the Agency’s Secretary Justin Senior. Additional eligibility information is outlined in the legislation. The Agency will accept nominations through the end of August and appointees will be announced in September.
The Panel will convene in the fall and meet as needed to form their recommendations. The Agency has launched a dedicated webpage at: www.AHCA.myflorida.com/PCTAP to make available information about the Panel’s work, member appointments, and meeting information. Under Florida’s Sunshine Laws, all Panel meetings will be open to the public. Members of the public may also send questions and information to the Panel through the website.

Prudential Productivity Awards Recognize Five Teams from AHCA

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The Agency for Health Care Administration (Agency) today announced that five teams of Agency staff members have been selected as winners in the annual Prudential Productivity Awards.
Agency Secretary Justin M. Senior, “I am honored to congratulate this year’s Prudential Productivity Award winners on their contributions to the Agency and the state. These employees found innovative solutions to complex issues in an effort to help Florida government operate more efficiently and reduce costs to taxpayers. Thank you for all that you continue to do for our state.”
Since the program’s inception in 1989, the Prudential Productivity Awards committee has received more than 16,000 nominations. The committee has given awards to state employees who have cumulatively saved or maximized more than $9.2 billion in taxpayer dollars.
The following Agency employees were selected as winners:
Business Analytics Team
Winners: Kimberly Noble, Emily Kinman, Bryan Cook, Barbara Fincher
The Agency saved thousands of dollars by organizing an Agency and Inter-Agency Tableau User Group. These groups train users on the fundamentals of Tableau, Tableau best practices, and serve as ongoing resources for help and trouble-shooting.
The Tableau User Groups fill the need of training new and experienced Tableau users. Training by Tableau is approximately $700/day per participant if the trainee travels to the training site (not including travel costs). Bringing a certified trainer to Tallahassee costs $1000/day per participant with a 12-15/person minimum.
Multiple agencies participate in the Tableau User Group and benefit from the cost savings. The Inter-agency group averages 25 attendees monthly (1.5 hours) from at least 10 different State agencies. The Agency group averages 15 attendees twice a month.
Estimated Yearly Savings: $101,250.00

Medicaid Provider Enrollment Streamlined Credentialing Team
Winners: Shawn McCauley, David Powers, Tamara Strayer, Nicholas Constantino, Ross Hart, Terry Schmidt, Pamela Hall
The team designed, developed, and implemented a streamlined Medicaid provider enrollment application, called Limited Enrollment, for providers seeking to participate in Medicaid health plan networks that eliminated an administrative burden on the plans, as well as providers who participate in multiple health plan networks.
The implementation of Statewide Medicaid Managed Care (SMMC) presented the Agency with two concerns raised by the health plans that this project addressed. Providers who did not want to fully enroll in Medicaid and were contracted with more than one health plan had to be fully credentialed individually by each health plan, providing the same documentation or variations for each. For providers who wished to fully enroll with the Medicaid program, the health plans had to wait until the enrollment process was completed before a Medicaid provider ID could be assigned.
The new process provides relief to the Medicaid health plans and providers from the administrative burden through a simplified process. The Limited Enrollment application serves as a single point of submission for provider data and eliminates duplicative submissions of data by providers to multiple sources.
Estimated Yearly Savings: $300,000.00

FLAIR Automation Team
Winners: Katrina Derico Harris, Sharon Dixon, Patricia Williams, Verionica Bishop, Cassandra Gainer
The automation of the Medicaid Accounts Receivables (MAR) to FLAIR upload has been implemented to eliminate the MAR revenue holding account and reduce the length of time to update the MAR and FLAIR accounts, to make recouped funds available sooner.
The automation eliminated the MAR holding account and reduced the time it takes to update the MAR revenue accounts in FLAIR. In the past, the money was deposited into the MAR holding account until it was determined where to allocate the funds.
The implementation of the automated process reduced the upload period from one week to a day, eliminated the manual process of preparing the spreadsheet, reduced the chance for manual entry errors, and made the fiscal year-end accounting process more efficient and accurate.
The implementation of the MAR FLAIR upload automation eliminated steps in the original process by eliminating the need for a revenue holding account. It also significantly improved year-end performance by allowing staff to work on other critical efforts related to closing out the Agency financials before June 30, 2017. This improvement has reduced processing time by 80% for all related transactions and reduce the amount of manual keystroke errors.
Estimated Yearly Savings: $7,341.55

Medicaid Exceptional Claims Processing Re-Design and Consolidation Team
Winners: Deborah Warfel, David Powers, Gayle Ninis, Catherine Eichenlaub, Catherine Nowotny, Don Fuller, Aaron Lounsberry, Sheila Gonzalez, Ondria Bacon, Teresita Fitzgerald 
The Medicaid Exception Claims Processing Re-Design Team developed and implemented a process that allows Medicaid providers to submit exceptional Medicaid claims directly to the Medicaid Fiscal Agent, bypassing the manual screening and tracking process previously performed by the Medicaid Field Offices, and allowing the Field Office staff to work the claims on-line.
An exceptional claim is a claim that would deny system edits of submitted directly to the Medicaid Fiscal Agent for processing, but the provider thinks that there should be an exception given due to special circumstances. In the past, providers submitted these claims in paper form, and each office scanned and entered them into the Claims Tracking System (CTS).
The original plan was for all field offices to work exceptional claims using the new process. The new system allowed the Agency to reorganize this process into a single Claims Hub office. Now all claims processors are working out of one centralized location, which has led to less quicker processing times.
Estimated Yearly Savings: $1.675 million

Florida Encounter Exchange and Expanded Benefits Project(s)
Winners: David Powers, Ross Hart, Michael Boston, Debbie Warfel, Teri Arnoldy, Mary McCullough, Erica Floyd-Thomas, Arlene Elliott, Kelly Rubin
To improve the Agency’s business need for receiving timely and accurate health plan encounter data that supports both capitation rate setting and monitoring of the health plan recipient services, the Encounter Exchange and Expanded Benefit Project Tteam developed and implemented new Florida Medicaid Management Information System (FLMMIS) encounter processing technical architecture.
The Agency needed a robust and informative encounter processing system to provide enhanced tracking and reporting of encounter receipts, processing, and operational functions, as a result of the implementation of the SMMC program and the new contractual health plan requirements. The encounter system redesign addressed the Agency’s business requirements to support the SMMC program, which serves over 3 million individuals enrolled in Medicaid at a cost of approximately $14 billion annually.
Estimated Yearly Savings: $0-24,999

AHCA Announces Release Date of the Invitation to Negotiate for SMMC Re-Procurement

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The Agency for Health Care Administration (Agency) today announced the upcoming date that the Invitation to Negotiate (ITN) for the re-procurement of the Statewide Medicaid Managed Care (SMMC) program will be posted, on or around July 14, 2017.  The ITN will be posted to the Florida Department of Management Services’ Vendor Bid System website.
As stated in s.287.057(23), F.S., “Respondents to this solicitation or persons acting on their behalf may not contact, between the release of the solicitation and the end of the 72-hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the procurement officer or as provided in the solicitation documents. Violation of this provision may be grounds for rejecting a response.”
While we have not yet entered the statutory blackout period as described in s. 287.057(23), F.S., due to the upcoming re-procurement, we will not have any discussions relating to the scope, evaluation or negotiation of those procurements.
All health plans and potential bidders must direct their questions related to the SMMC procurement to the Agency’s Procurement Officer: Jennifer Barrett, [email protected].
For more information about the SMMC program, or to sign up to receive SMMC related alerts, click here.

AHCA releases statement on conclusion of Bayou Shores case

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The Agency for Health Care Administration (Agency) today announced that on June 5, 2017, the U.S. Supreme Court ended a Florida nursing facility’s three-year quest to avoid the jurisdiction of federal and state healthcare authorities. In 2014, Bayou Shores, a St. Petersburg nursing facility with a history of serious health and safety violations, attempted to avoid the termination of its Medicare and Medicaid provider agreements by seeking the protection of the bankruptcy court. The bankruptcy court obliged, forbidding the Agency and the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) from taking action against the Medicaid and Medicare payments. The Agency and CMS appealed the injunction, prevailing first in the U.S. District Court for the Middle District of Florida and again in the Eleventh Circuit Court of Appeals. The court of appeals issued an important page opinion last year supporting each of the Agency’s arguments regarding the federal government’s exclusive jurisdiction over this issue. The Supreme Court’s decision not to take up the case preserves this critical victory and ensures that the Agency and CMS can continue to cooperatively administer Medicaid and Medicare in Florida.
Agency Secretary Justin M. Senior said, “This is positive news for our Agency, and a vindication of all of the efforts our staff have invested to ensure that this facility was held responsible for the deplorable level of care provided. We have worked for over three years with our federal partners at CMS to defend this case. While bankruptcy courts tried to guarantee that this facility could continue receiving Medicaid payments, our Agency fought to have them removed from the Medicaid program, and all residents relocated because of the dire situation at the facility. Our Agency will continue to ensure that the facilities we regulate and participate in Medicaid are maintaining proper standards and providing the best care possible to patients.”
The Agency for Health Care Administration is committed to better health care for all Floridians. The Agency administers Florida’s Medicaid program, licenses and regulates more than 49,000 health care facilities and 43 health plans, and publishes health care data and statistics at www.FloridaHealthFinder.gov. Additional information about Agency initiatives is available via Facebook, Twitter and YouTube.

AHCA Announces Increase in Access to Health Care Services for Previously Uninsured Children

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The Agency for Health Care Administration (Agency) today announced that based on the Urban Institute’s report on Medicaid/CHIP Participation Rates, Florida’s Medicaid program showed significant improvement in the percentage of eligible children enrolled in the Medicaid and Children’s Health Insurance (CHIP) programs. Florida saw a 7.1 percentage point increase in eligible children enrolled in the Florida Medicaid and CHIP between 2013 and 2015. This represents the sixth highest state increase in the nation, and is well above the national average increase.  To access the full report click here.
Agency Secretary Justin M. Senior said, “With the implementation of Statewide Medicaid Managed Care our state has revolutionized the way we administer the Medicaid program. This report highlights that more children than ever are receiving health care services and have access to the highest quality of care in our program’s history. With the increased percentage of eligible children enrolled in the Medicaid program, and the improvement in access to services announced this spring as part of the CMS-416 report, the numbers are proving that our program is a success and that children are receiving necessary health care.  We know we have more work to do, but our managed care system continues to improve each year — the proof is in the numbers, and our Agency will remain committed to our goal of better health care for all Floridians.”
The CMS-416 report announced last month showed that Florida Medicaid continues to improve in children’s access to health care services. For the second year in a row, Florida showed gains in every single metric in the 416 report. The 2016 CMS-416 data reported to the Centers for Medicare & Medicaid Services (CMS) is a nationally recognized quality and access measure in the Medicaid program, and includes a yearly report that tracks the number of children who received preventive medical screening and dental services. The Agency also saw improvements in children receiving blood lead screenings and the usage of dental and other oral health services.  Florida’s dental scores have improved every year since 2011.

AHCA Secretary Recognizes National Nursing Home Week

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Agency for Health Care Administration (Agency) Secretary Justin M. Senior released the following statement today recognizing the beginning of National Nursing Home Week (May 14-20):

“This week, nursing homes across Florida will host events in honor of National Nursing Home Week. Nursing homes care for many of our state’s most vulnerable residents, and I am thankful for their commitment to improving the quality of life for Floridians. When our staff visit facilities around the state, we are often amazed at the level of care and service that nursing home staff and administrators provide for their residents. Please join me in recognizing the hard work and dedication shown by these facilities.”

To find more information about National Nursing Home Week, click here.

To utilize our nursing home comparison tool, view inspection reports and learn more about nursing homes in your community please visit our Nursing Home Guide.