News By Industry
News from Tallahassee for 2/5/16
Univita Health Losing Medicaid Contracts posted on 7/30/15
by carol gentry | health news florida
Univita Health, which gained control of the entire Florida Medicaid home-care market a year ago, has suddenly lost all of its HMO contracts.
The Florida Agency for Health Care Administration made the announcement in an e-mail blast late Tuesday afternoon.
Univita, based in Miramar, stopped processing requests for home health-care services, durable medical equipment such as wheelchairs, and intravenous therapy “effective immediately,” AHCA said.
AHCA provided no reasons for its announcement, but released a statement this morning.
“We will continue to focus on ensuring Floridians have access to quality health care – this includes working to prevent any lapses in service for MMA health plan enrollees,” a spokeswoman said.
AHCA released a list of phone numbers for Medicaid providers, physician offices and health plan members to call in order to get authorization for equipment and services.
Earlier, United Healthcare of Florida and Sunshine Health had already announced their contracts with Univita were ending as of Aug. 1.
Several owners of mom-and-pop suppliers, who had regarded Univita as their nemesis, began celebrating as early as Monday, when rumors about what was happening began to leak.
As sole authorizer of home services for most Medicaid plan members, several suppliers said, Univita cut their Medicaid payments in half and redirected some of their business to its own home-care affiliate. Many said they had trouble getting paid at all.
44% of HMOs in Florida report 2014 losses - database posted on 7/7/15
by Nina Lincoff | South Florida Business Journal
Of the 34 HMOs in Florida listed in a report from the Florida Office of Insurance Regulation, 15 reported losses in 2014.
Losses ranged from $14.6 million to $165.1 million, while profits ranged from $138,555 to $333 million. In total, the combined 34 HMOs reported net income of $66.5 million in 2014, which is a 90 percent decrease from the collective $648 million profit reported by 39 HMOs in 2013.
The 15 HMOs reporting losses in 2014 account for 44 percent of the HMOs in Florida.
The Business Journal combined 2014 net incomes, 2013 net incomes, and the change in 2014/2013 net incomes in a searchable database. Click here to see which HMOs reported the highest profits, the biggest losses, and who saw the greatest change year-over-year.
Sunshine State Health Plan and UnitedHealthcare of Florida reported the biggest negative changes in net income between 2013 and 2014 at over $125 million for each HMO. Medica Healthcare Plans and Health Palm Beaches reported the largest positive change in net income between 2013 and 2014, at $14.3 million and $13.6 million, respectively.
HMOs in Florida has a tumultuous year in 2014 partly due to an influx of new members, Minn.-based insurance analyst Allan Baumgarten previously told the Business Journal. “That can be tied to problems in adding new providers to the network when the HMO is under a time crunch to get hospitals and physicians under contract,” he said. “Sometimes the providers sense weakness and try to boost their prices.”
Supreme Court Allows Nationwide Health Care Subsidies posted on 6/25/15
by ADAM LIPTAK | ny times
WASHINGTON — The Supreme Court ruled on Thursday that President Obama’s health care law may provide nationwide tax subsidies to help poor and middle-class people buy health insurance.
Chief Justice John G. Roberts Jr. wrote the majority opinion in the 6-to-3 decision. The court’s three most conservative members — Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — dissented.
The case concerned a central part of the Affordable Care Act, Mr. Obama’s signature legislative achievement. The law created marketplaces, known as exchanges, to allow people who lack insurance to shop for individual health plans.
Some states set up their own exchanges, but about three dozen allowed the federal government to step in to run them. Across the nation, about 85 percent of customers using the exchanges qualify for subsidies to help pay for coverage, based on their income.
The question in the case, King v. Burwell, No. 14-114, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.”
Chief Justice Roberts wrote that the words must be understood as part of a larger statutory plan.
“In this instance,” he wrote, “the context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he added. “If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”
Four plaintiffs, all from Virginia, sued the Obama administration, saying the phrase meant that the law forbids the federal government to provide subsidies in states that do not have their own exchanges. Congress made the distinction, they said, to encourage states to create their own exchanges.
Winners and losers of the Florida Legislature’s special session posted on 6/22/15
by palm beach post
Working into June on a state budget for the first time in 23 years, Florida lawmakers avoided a government shutdown by approving a $78.7 billion spending plan Friday evening.
But the long battle left a few bruises.
Gov. Rick Scott and legislative leaders didn’t get all they wanted. Talk back in March of almost $700 million in tax breaks got downsized amid a long fight over the Senate’s unsuccessful push to expand health coverage for the uninsured.
And the special session that started June 1 after the regular 60-day legislative session ended without a budget will cost taxpayers.
The cost of the extra 19 days of legislating? It’s still being calculated. But history shows taxpayers will pony up anywhere from $24,000- to $87,000-a-day, or in other words probably somewhere in the $500,000-$1.5 million range.
Scott is now reviewing the budget. He’s expected to sign it, while issuing a round of line-item vetoes before this year’s budget expires July 1.
How did some of the top players, and special interests, fare? Take a look inside.
Study: 19 Million Uninsured If Law Repealed posted on 6/22/15
by phil galewitz | kaiser health news
Repealing the federal health law would add an additional 19 million to the ranks of the uninsured in 2016 and increase the federal deficit over the next decade, the Congressional Budget Office said Friday.
The report is the first time CBO has analyzed the costs of the health law using a format favored by congressional Republicans that factors in the effects on the overall economy. It is also the agency’s first analysis on the law under Keith Hall, the new CBO director appointed by Republicans earlier this year.
CBO projected that a repeal would increase the federal deficit by $353 billion over 10 years because of higher direct federal spending on health programs such as Medicare and lower revenues.
But when including the broader effects of a repeal on the economy, including slightly higher employment, it estimated that the federal deficit would increase by $137 billion instead.
Both estimates are higher than in 2012, the last time that the CBO scored the cost of a repeal.
The latest report from the nonpartisan congressional watchdog and the Congressional Joint Committee on Taxation comes just days before the Supreme Court is expected to rule on the health law’s premium subsidies in the nearly three dozen states that rely on the federal marketplace.
Such a ruling would cut off subsides to more than 6 million people and be a major blow to the Affordable Care Act. It could also boost Republican efforts to repeal the entire 2010 law, which would likely face a presidential veto.
Last week, President Barack Obama said nearly one in three uninsured Americans have been covered by the law—more than 16 million people.
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