News from Tallahassee for 4/17/14

Health Bill 'Train' on Its Way posted on 4/11/14

by Carol Gentry | Health News Florida

The Florida House Health & Human Services Committee passed a megabill Thursday morning that combines three prickly issues, in the hope that packaging them will make it harder for the Senate to kill or maim any of them.

HB 7113 would protect private for-profit trauma centers, allow for independent practice for nurse practitioners and allow out-of-state doctors to participate in telehealth without a Florida license. The Florida Medical Association opposes the latter two.

Such a package is sometimes called a "train" in legislative parlance. The idea of a train is that it's a bunch of connected railcars, and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers have to accept a proposal they don't like in order to get one they really want. One of the creators of the telehealth legislation acknowledged as much.

"It was not my choice for all these things to be in the same bill," said Rep. Mia Jones, D-Jacksonville. "We're going to take some good and some bad and move forward."

A few minutes later, the process was replayed as another combo bill rolled out of the committee. HB 573 heightens oversight of assisted-living centers, allows visitation for grandparents, and enables outpatient surgery centers to expand their services as "recovery care" centers.

The first two parts of that combo brought no opposition to speak of. Disagreement was saved for the third, as both hospitals and nursing homes foresee the loss of some paying patients.

But their lobbyists didn't get to say much. HHS Committee Chairman Richard Corcoran, R-Land O'Lakes, limited public testimony to one minute per speaker, saying the committee had a lot to cover during this, its last meeting.

» Read more

Obama Administration Retreats On Private Medicare Rate Cuts posted on 4/8/14

by Jay Hancock | Kaiser Health News

Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.

After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent.

America's Health Insurance Plans, the main industry lobby, said it was still studying the announcement. While it acknowledged that Monday's action leaves payments higher than what HHS had originally proposed, it disputed the agency's statement that 2015 rates would rise. AHIP had calculated the originally proposed cuts to be nearly 6 percent, not 1.9 percent.

Adjustments to the February proposals "will help mitigate the impact on seniors," AHIP CEO Karen Ignagni said in a statement. "But the Medicare Advantage program is still facing a reduction in payment rates next year..."

Ana Gupte, an industry analyst for Leerink Partners, agreed, saying the rates disclosed Monday will cut Medicare Advantage payments by about 3 percent. Still, that's a smaller reduction than what she calculated to be 5.5 percent in HHS's first proposal, she said in a note to clients.

The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought...

The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought.

"The industry asked us to use whatever means we could to keep the rates close to parity, to where they are today," Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, told reporters. The rates set Monday are "a little higher than what the industry had recommended," Blum said.

Among other alterations, HHS dropped a plan to abandon the use of home-visit diagnoses for assigning member risk scores that affect payments. That proposal alone would have shaved 2 percentage points off what Medicare Advantage plans get from the government, according to a study commissioned by AHIP.

"There's a little bit for everybody" in the final policy for 2015, said Anne Hance, a lawyer with McDermott Will & Emery who represents insurers. The administration "tried to work with Medicare Advantage organizations and recognize their concerns," she said.

Medicare Advantage costs taxpayers about 6 percent more per beneficiary than traditional Medicare, according to the Medicare Advisory Commission. Reducing or eliminating that gap could save the program billions of dollars, proponents say.

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As lawmakers pass session’s halfway point, here’s where big issues stand posted on 4/7/14

by News Service of Florida

FL Capitol BldgTHE CAPITAL, TALLAHASSEE -- Florida lawmakers have crossed the mid-point in their 60-day march to craft new laws, amend existing ones and agree on a roughly $75 billion budget for the next fiscal year.

And they've done so mostly without controversy.

A day at the Capitol was blown out to honor the Florida State University football team for winning the national championship, and another day was seemingly devoted to lawmakers taking "selfies" with retired British soccer star David Beckham, who wants to build a soccer stadium in Miami.

With the two chambers working in tandem on most issues, Gov. Rick Scott was able to sign a series of bills into law this week. They included a bill, dubbed the "Florida GI Bill," aimed at making the state more military friendly; a package of bills aimed at keeping sexually violent predators locked up; and a bill that will roll back motor-vehicle registration fees.

Meanwhile, the vast majority of the 1,826 bills, resolutions and memorials filed by members and committees as of Friday morning had already died with barely a murmur.

Here's a look at where a dozen major issues stand as lawmakers head toward the homestretch of the 2014 session:

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Health Items in Senate, House Budgets posted on 4/4/14

by staff | Health News Florida

The Florida Senate and the Florida House have passed their budgets for the 2014 legislative session.

From a Florida Senate news release, here is a look at the health funding in the Senate’s $74.9 billion budget:

Health and Human Services

The budget includes funding to transition wait list individuals to the home and community-based services waiver (approximately 1,400 individuals) through $8.1 million GR (general revenue), $11.9 million TF (trust funds) and funding to serve additional clients in the long-term care managed care program (approximately 1,136 individuals), $6.6 million GR; $9.7 million TF...

The budget will provide substance abuse services for pregnant women, $10 million GR; children’s mental health Community Action Teams, $8.1 million GR; adult community mental health funding, $4 million GR; domestic violence services, $4 million GR; and adult/children community substance abuse funding, $3.6 million GR.

The budget also doubles the personal needs allowance (currently $35 per month) for Medicaid patients living in nursing homes, $9.1 million GR; $10.9 million TF; provides for the phase one construction of new state veterans’ nursing home, $11 million TF; and funds ongoing maintenance and repair of state veterans’ nursing homes and other domiciliary, $7.8 million TF.

From a Florida House news release, here is a look at the health funding in the House’s $75.3 billion budget:


The Health Care Appropriations Subcommittee overall proposed budget totals $30.7 Billion ($8.2 billion from General Revenue and $22.5 billion from Trust Funds). This total includes funding for 32,943 authorized positions.


• Medicaid Price Level and Workload Adjustment - ($600.4) M, $260.0 M GR - Funding for Medicaid caseloads and price level adjustments as agreed upon by the February 2014 Social Service Estimating Conference for an anticipated 3.7 million Medicaid beneficiaries. No category of Medicaid eligibility is eliminated or reduced. No provider rates are reduced.

• Long Term Care Waitlist Reductions - $19.8 M, $8.0 M GR - Funding to reduce waitlist clients for the Elderly Long Term Care Medicaid Waiver to serve approximately 1,295 additional individuals.

• Florida Kid Care Enrollment - ($36.3) M, ($12.7) M GR – Fully funds the KidCare program for the 2014-15 Fiscal Year to serve approximately 269,778 children.

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As final budget talks near, Scott administration meets with feds over 1b holding up health care budget posted on 4/2/14

by MATT DIXON | Scripps/Tribune Capital Bureau

With the clock ticking on this year’s legislative session, top officials from Gov. Rick Scott’s administration met Tuesday with federal regulators in Baltimore to discuss a $1 billion pot of money holding lawmaker’s proposed health care budget hostage.

In 2005, the Centers for Medicare and Medicaid Services (CMS) approved a waiver allowing Florida to implement a “Low Income Pool.” That money can be used for things like uncompensated care, care for those without insurance and Medicaid services.

The current waiver, which has a $1 billion cap in place, is set to expire June 30. Officials with the Agency for Health Care Administration, which Scott oversees, were initially seeking $4.5 billion for LIP and related programs designed to supplement hospital payments. That’s roughly $1.2 billion over current levels.

After it became clear that additional federal officials would not green-light the increase, AHCA turned its focus to consolidating the handful of programs related to LIP into one roughly $3.3 billion fund.  If CMS does not approve that plan, another option is to sign-off on a one-year extension at the current $1 billion cap.

The issue has forced heartburn for health-care budget writers because it’s unclear what direction is going to come down from federal officials.

» Read more

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