Agency for Health Care Administration (Agency) Secretary Justin M. Senior released the following statement today recognizing National Nurses Week (May 6th– 12th):
“As we recognize National Nurses Week, I would like to thank all nurses who work throughout our state to provide passionate care for Floridians. The American Nurses Association has designated 2017 as the ‘Year of the Healthy Nurse,’ and this year’s National Nursing Week celebrates those nurses who are leading advocates for health and wellness. I also want to recognize all of the nurses who work for AHCA and help our Agency achieve its goal of Better Health Care for All Floridians. Nurses are on the frontline of caring for our vulnerable citizens, and I ask that you will please join me in celebrating all that they do for our state.”
To learn more about National Nurses Week please visit: http://www.nursingworld.org/nationalnursesweek.
AHCA
March Monthly Actions from AHCA
March Monthly Actions: Agency Took Licensure Action against Five Providers,
Eight Additional Providers Suspended from the Medicaid Program
The Agency for Health Care Administration (Agency) issued final orders to four providers for failure to meet licensure requirements in March.
There were three final orders to deny a license renewal and one to revoke an existing license. Some of these providers were enrolled in the Medicaid program and the Agency has terminated or is in the process of terminating their participation in the program.
The Agency also issued an Immediate Moratorium on Admissions to Little Friends Learning Center, Inc. dba Alpine Adult Care Center, an assisted living facility in Escambia County.
In addition, the Agency suspended eight providers from participation in the Medicaid program, prohibiting the providers from being paid for claims to the Medicaid program for furnishing, supervising a person who is furnishing, or causing a person to furnish goods or services.
Agency Medicaid terminations and suspensions typically result from failure to return funds due to the Agency within required timeframes; a charge, indictment, or guilty plea to a health care related crime; suspension, termination, or exclusion from Medicare or Medicaid in another state; or a license denial, revocation, suspension or termination by the licensing agency.
The chart below displays the Agency’s March licensure actions:
The chart below displays the Agency’s March Medicaid final order actions:
Further information about the actions and final orders can be found on the public records search page. Emergency orders, including moratoriums on admissions and suspensions, can also be found on the public records search page by searching the name of the facility.
The Agency encourages anyone who may have a concern or observes a problem in any health care facility or with any provider regulated by the Agency, to file a complaint by calling our consumer complaint line at 1-888-419-3456 or by reporting online at http://ahca.myflorida.com/Contact/call_center.shtml.
Tips about suspected fraud can be reported by calling the Attorney General’s Fraud Hotline at 1-866-966-7226 or the Agency’s Consumer Call Center at 1-888-419-3456. Anyone can report fraud online by visiting the Agency’s website at https://apps.ahca.myflorida.com/InspectorGeneral/fraud_complaintform.aspx.
Gov. Scott announces resignation of Melinda Miguel
Eric Miller to join as Chief Inspector General
Governor Rick Scott today announced Chief Inspector General Melinda Miguel’s resignation, which will be effective today. Melinda Miguel will be pursuing opportunities in the private sector. Click HERE to see her resignation letter. Eric Miller, who currently serves as Inspector General at the Agency for Health Care Administration, will serve as the Governor’s Chief Inspector General beginning Friday, April 21, 2017.
Governor Scott said, “Melinda has done a great job serving our state as Inspector General, and I’m extremely grateful for her commitment to ensuring government remains accountable to Florida taxpayers. She has been a valuable part of my team for over six years and I wish her success in her new endeavor as a business owner.”
Melinda Miguel said, “I’d like to thank Governor Scott for his leadership during my time as his Chief Inspector General for the past six years. It has been an honor to serve Florida’s families and work to make Florida even better for our future generations.”
Governor Scott continues, “Eric has dedicated his career to serving our state for more than twenty years. As Inspector General at AHCA, Eric has firsthand experience in fighting fraud and ensuring tax dollars are used efficiently and effectively. I am confident he will continue his great work as Chief Inspector General in my office.”
Eric Miller has served in his current position as Inspector General at AHCA since September, 2011. Prior to this role, Eric served as Manager of Corporate Compliance at Citizens Property Insurance Corporation from 2008 to 2011. He has also served in various leadership roles in Florida state government since 1993. Eric received his Bachelor of Arts degree in Criminal Justice from the University of West Florida and his Master of Science in Public Administration from Troy University.
Gov. Scott, U.S. HHS, AHCA announce $1.5 billion commitment to LIP funding for Fla
Governor Rick Scott, U.S. Health and Human Services (HHS) Secretary Tom Price, M.D. as well as Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, and Florida’s Agency for Health Care Administration (AHCA) Secretary Justin Senior announced the federal government’s commitment to continuing funding for the Low Income Pool (LIP) in Florida in the amount of over $1.5 billion annually. This funding is nearly a billion dollars more than what the Obama Administration provided to Florida. The LIP program is a federal matching program that provides federal funds to Florida hospitals to cover costs for the state’s most vulnerable patients. State officials and the Trump Administration have had ongoing discussions regarding the LIP funding since early this year.
Governor Scott said, “Working with the Trump Administration to secure a commitment of $1.5 billion in LIP funding for our state will truly improve the quality and access to health care for our most vulnerable populations. I appreciate their quick turnaround and commitment to working with Florida to provide additional flexibility for how these funds can be used more efficiently, including allowing money to follow each patient. This will provide better healthcare for the individuals intended to be served with this funding.
“It is great to have a partner in Washington who is willing to work with us to help our state. Florida was on the frontline of fighting against federal overreach under President Obama and it is refreshing to now have a federal government that treats us fairly and does not attempt to coerce us into expanding Medicaid.”
Secretary Price, M.D., said “From day one, we have been committed to working with our state partners to ensure they have the flexibility they need to make decisions that best reflect the unique needs of their populations. Today’s announcement reflects that commitment on the part of the Trump Administration. We look forward to continuing to work with Governor Scott as well as governors across the country to make sure Americans have access to quality healthcare.”
Administrator Verma said, “Centers for Medicare and Medicaid Services is working toward a new era of state flexibility and leadership. For too long states have been sharing in the cost but have not been allowed to have a meaningful role in decision making. We want to provide states the flexibility to make health care decisions that best meet their citizens’ unique needs, and support states covering access to healthcare services.”
Secretary Senior said, “The $1.5 billion in LIP funding that the Trump Administration has committed to Florida will help to support Florida’s low income families. Our Agency has had open and direct conversations with Secretary Price and his staff and we look forward to continuing this partnership. We truly feel like our federal partners are listening to our state and our needs and we know that Florida will have the flexibility we need to run our Medicaid program as efficiently as possible while providing the highest level of care in our state’s history.”
AHCA announces continued improvements in access to health care services for children
The Agency for Health Care Administration (Agency) announced today that Florida’s Medicaid program showed significant improvement in a key national report on quality and access for children. The report showed continued improvement in children’s access to services for the second year in a row, with Florida once again showing gains in every single metric in the report. The 2016 Form 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 screening and dental services. The Agency saw improvements in children receiving blood lead screenings and the usage of dental and other oral health services, and Florida’s dental scores have improved every year since 2011.
Agency Secretary Justin M. Senior said, “The Agency has worked to improve quality and access simultaneously, and the increase in usage of Medicaid services by eligible children is a testament to the hard work that our Agency has done. Preventive services are vital for keeping Florida’s children healthy, and I am excited that we are delivering necessary health care to more eligible children than ever. Our managed care system is working as it was intended to, and we will continue to work to ensure that all Medicaid recipients have access to quality health care.”
During this reporting period, 36 percent of eligible children enrolled for 90 continuous days received a preventive dental service, such as dental cleanings and fluoride varnish, as calculated using the Child Core Set P-Dent measure. This is an increase of 3 percentage points from last year and 17 percentage points from the federal fiscal year 2012 report. In addition, this year 156,291 children received a sealant on a permanent molar, an increase of more than 16,550 children (12 percent) compared to last year. Over the reporting period, 38 percent of eligible enrollees accessed dental services provided by a dentist, an increase of 3 percentage points, and more than 41 percent of eligible enrollees accessed some form of oral health care through Medicaid. These dental scores are the highest in the history of the program. In addition, the ratio for eligible enrollees receiving an initial or periodic screening increased from 0.57 to 0.59. The Agency also achieved a 5.4 percent increase in children who were tested for lead in their blood.
States are required by CMS to inform all Medicaid-eligible individuals under the age of 21 of the availability of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, provide or arrange for the provision of screening services, arrange for necessary corrective treatment and annually report EPSDT performance information via Form CMS-416. For more information on the Agency’s Medicaid program, visit the Medicaid website at: http://ahca.myflorida.com/Medicaid/index.shtml
AHCA Releases Statewide Medicaid Managed Care Re-Procurement Data Book
The Agency for Health Care Administration (Agency) announced today the release of the Statewide Medicaid Managed Care (SMMC) data book in preparation for the program’s competitive re-procurement. The data book provides relevant background information that prospective plans will find useful in the development of their response to the Invitation to Negotiate (ITN), which the Agency will release in the summer of 2017.
Agency Secretary Justin M. Senior said, “Releasing the data book is an important step in the re-procurement process of the SMMC program. We hope this will provide prospective plans with valuable information as they prepare their responses to the ITN. The Agency looks forward to working with the plans to provide the best possible health care for Medicaid recipients as we move through the first re-procurement of the program.”
The Agency is hosting a public meeting to address questions about the Statewide Medicaid Managed Care data book released on March 30, 2017. The public meeting will be held on Wednesday, April 12, 2017, 8:30am – 11:30am Eastern Time at the Agency for Health Care Administration, 2727 Mahan Drive, Bldg. 3, Conference Room A, Tallahassee, Fla. 32308. A conference number will be available for those unable to attend in person.
Dial In Number: 1-(877)-218-8845
Conference Code: 497-971-21#
Anyone interested in the data book can download it from the SMMC re-procurement website. For additional information about the public meeting and the SMMC program, click here.
February Monthly Actions from AHCA
February Monthly Actions: Agency Took Licensure Action against Nine Providers,
25 Additional Providers Suspended or Terminated from the Medicaid Program
The Agency for Health Care Administration (Agency) issued final orders to six providers for failure to meet licensure requirements in February.
There were two final orders to revoke an existing license and four final orders to deny a license renewal. Some of these providers were enrolled in the Medicaid program and the Agency has terminated or is in the process of terminating their participation in the program.
The Agency also issued an Immediate Moratorium on Admissions and Emergency Restriction Order to E2 Emerson and Emerson, LLC d/b/a Brightstar, a home health agency in Lake County; an Immediate Moratorium on Admissions and Emergency Suspension Order to Fairway Park Retirement Facility, Corp., an assisted living facility in Miami-Dade County; and an Immediate Moratorium on Admissions to Senior Living Properties II LLC dba Savannah Court of Orange City, an assisted living facility in Volusia County.
In addition, eight providers were issued final orders terminating them from participation in the Medicaid program and have been reported to the federal government for placement on the federal exclusion list, which prohibits them from participating in Medicaid and Medicare nationwide. The Agency also suspended 17 providers from participation in the Medicaid program, prohibiting the providers from being paid for claims to the Medicaid program for furnishing, supervising a person who is furnishing, or causing a person to furnish goods or services.
Agency Medicaid terminations and suspensions typically result from failure to return funds due to the Agency within required timeframes; a charge, indictment, or guilty plea to a health care related crime; suspension, termination, or exclusion from Medicare or Medicaid in another state; or a license denial, revocation, suspension or termination by the licensing agency.
Further information about the actions and final orders can be found on the public records search page here. Emergency orders, including moratoriums on admissions and suspensions, can also be found on the public records search page by searching the name of the facility.
The Agency encourages anyone who may have a concern or observes a problem in any health care facility or with any provider regulated by the Agency, to file a complaint by calling our consumer complaint line at 1-888-419-3456 or by reporting online at http://ahca.myflorida.com/Contact/call_center.shtml.
Tips about suspected fraud can be reported by calling the Attorney General’s Fraud Hotline at 1-866-966-7226 or the Agency’s Consumer Call Center at 1-888-419-3456. Anyone can report fraud online by visiting the Agency’s website here.
FHCA Executive Director Emmett Reed Statement In Response To AHCA's Bill Analysis on SB 682
Florida Health Care Association Executive Director Emmett Reed Issued The Following Statement In Response To AHCA’s Bill Analysis on SB 682
“While we respect the Agency, it has completely missed the point by failing to recognize that our proposal would apply only to those Floridians whose frail condition prevents them from using less costly home- and community-based care options. AHCA’s figures are based on an assumption of what it would cost the state IF individuals who received home- and community-based services during certain times had instead been cared for in a nursing center. But that’s not how the system works, and it’s not what Senator Stargel’s bill does.
Senate Bill 682 focuses solely on exempting long-stay nursing center residents. There are no savings to be realized in a home- and community-based setting for these individuals. Their health and medical needs can be addressed only in a nursing center, and they cannot be safely cared for in a home or a community setting. The state will save almost $68 million when these long-stay residents are exempted from the managed care system, because it will eliminate the redundancy of the managed care administrative and case management fees – which duplicate services and support that is already provided by the nursing center’s interdisciplinary team of social workers, nurses, and other clinical staff.”
January Monthly Actions from AHCA
January Monthly Actions: Agency Took Licensure Action Against Eight Providers,
Seven Additional Providers Terminated from the Medicaid Program
The Agency for Health Care Administration (Agency) issued final orders to eight providers for failure to meet licensure requirements in January.
There were two final orders to revoke an existing license, three final orders to deny a license renewal, three final orders that resulted in the providers surrendering their license, and one final order to deny a Change of Ownership (CHOW). Some of these providers were enrolled in the Medicaid program and the Agency has terminated or is in the process of terminating their participation in the program.
In addition, seven providers were issued final orders terminating them from participation in the Medicaid program and have been reported to the federal government for placement on the federal exclusion list, which prohibits them from participating in Medicaid and Medicare nationwide.
Agency Medicaid terminations and suspensions typically result from failure to return funds due to the Agency within required timeframes; a charge, indictment, or guilty plea to a health care related crime; suspension, termination, or exclusion from Medicare or Medicaid in another state; or a license denial, revocation, suspension or termination by the licensing agency.
Further information about the actions and final orders can be found on the public records search page. Emergency orders, including moratoriums on admissions and suspensions, can also be found on the public records search page by searching the name of the facility.
The Agency encourages anyone who may have a concern or observes a problem in any health care facility or with any provider regulated by the Agency, to file a complaint by calling our consumer complaint line at 1-888-419-3456 or by reporting online.
Tips about suspected fraud can be reported by calling the Attorney General’s Fraud Hotline at 1-866-966-7226 or the Agency’s Consumer Call Center at 1-888-419-3456. Anyone can report fraud online by visiting the Agency’s website.
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 (AHCAFlorida), Twitter (@AHCA_FL) and YouTube (/AHCAFlorida).
Event Notification Service covers more than two million Floridians
The Agency for Health Care Administration (Agency) announced today that the Florida Health Information Exchange’s (Florida HIE) Event Notification Service (ENS) has expanded to cover more than two million Florida residents. The ENS provides timely and secure notifications of patient hospital encounters to health care providers and health plans, who use these notifications to improve the delivery of patient care.
Agency Secretary Justin M. Senior said, “The ENS bridges a critical gap by notifying providers and health plans about their patients’ hospital visits. Reaching two million Floridians is an incredible milestone for this service, and the use of ENS and other health information technology platforms will be a key element in improving quality and reducing the cost of health care across the state.”
Together eight Florida health plans – Aetna, Florida Blue, Humana, Magellan Complete Care, Molina Healthcare, Prestige Health Choice, Sunshine Health, UnitedHealthcare and Wellcare of Florida – receive alerts on nearly half of all Florida Medicaid enrollees. This patient-authorized exchange provides information essential to improving care coordination, promoting primary care utilization and reducing health care costs.
Over 20 Accountable Care Organizations (ACOs) are also participating in ENS and together cover an additional 300,000 Florida residents. Each ACO is a group of doctors, hospitals, and other health care providers who voluntarily come together to provide high quality care to their Medicare patients. By keeping providers informed of patient hospital encounters, the ENS is making it easier to provide high quality care to Florida’s Medicare population.
The ENS was piloted in late 2013 and the dedicated service has delivered over 1.8 million notifications since its inception. For more information on this and other Florida HIE programs, please visit www.florida-hie.net.
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 (AHCAFlorida), Twitter (@AHCA_FL) and YouTube (/AHCAFlorida).
