News from Tallahassee for 8/30/14

Pediatricians in Florida could see relief from low Medicaid payments posted on 8/19/14

by Nick Madigan | Miami Herald

caduceusAfter years of hearings and delays, the possible resolution this fall of a class-action lawsuit against Florida health and child-welfare officials could mean that physicans will at last receive what they consider to be adequate compensation for treating children of the poor.

The lawsuit, filed in 2005 by pediatricians, dentists and nine children against the Agency for Health Care Administration, the Department of Children and Families and the Department of Health, claimed that Florida violated federal law by providing inadequate Medicaid services to children, and that their care had been hampered by low Medicaid payments to doctors. A federal judge is expected to rule on the case in October.

Medicaid payments to pediatricians — and to primary-care doctors in general — were bumped up for two years by the Affordable Care Act. But that will end Dec. 31, and the Florida Legislature’s passage of $3.4 million in increased Medicaid payments to pediatricians for the coming fiscal year doesn’t come close to achieving parity with federal Medicare levels for comparable services.

If the lawsuit goes the plaintiffs’ way, the state might have to come up with about $227 million a year, according to AHCA, to permanently increase payment rates to pediatricians and dentists — although an appeal would likely delay the change.

That leaves some physicians in Florida in a state of limbo, not knowing how much they will be paid or when.

“I can’t be playing games with the government,” said Bruce Eisenberg, a Miami Beach pediatrician who, like many doctors in Florida, reduced his Medicaid caseload over the years to less than 10 percent of his practice because of the traditionally low payments. He and other physicians say they usually operate at a loss when they treat patients under Medicaid.

“I sort of do it as a service to the community,” said Eisenberg, who has been a pediatrician for 25 years. Before the ACA hikes went into effect, he said, Medicaid rates paid to Florida doctors for most procedures were about half as much as those set by Medicare, the federal health insurance program for people aged 65 or older. Many physicians have elected to stay out of the system altogether, leaving low-income families with little option but to turn to emergency rooms or urgent-care clinics when they are ill.

If the payment rates are not permanently improved, “I definitely won’t be increasing my percentage of Medicaid patients,” Eisenberg said. “I could be seeing a lot of other patients who could be paying fairly for my time. My time is valuable.”

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Despite progress in backlog, thousands of Florida’s veterans still wait for benefits posted on 8/11/14

by MONICA DISARE | Miami Herald

While his mortgage, electric bill and child support payments fell months behind, James Pendleton, a 57-year-old U.S. Army veteran from North Lauderdale, waited years for disability compensation benefits.

Some 37,000 veterans in Florida are like Pendleton, waiting for a letter from the Veterans Benefits Administration and wondering how they will pay bills in the meantime.

While the number of pending disability claims has decreased significantly since 2013, when the nation became outraged by the number of backlogged claims, the regional benefits office in Florida still had the highest number of pending claims in the country in early August. Of those claims, 59.7 percent are backlogged — meaning the claims have been pending for more than 125 days — which is above the national average of 48.7 percent.

“There was nothing I could do which is why I began to write,” said Pendleton, who sent a series of letters to politicians and government administrators.

“If I lose my house, where will I live? If I can’t keep the lights on or water on, how will I survive?” he wrote in a letter to the Department of Veterans Affairs in March 2013.

The VBA says it is working to ensure that veterans like Pendleton won’t have to spend years worrying about whether they will qualify for benefits and, if so, when.

Allison Hickey, the undersecretary for benefits at the VBA, told a congressional committee on veterans’ affairs in July that her organization has made “tremendous progress” in reducing the disability claims backlog. She also reaffirmed the organization’s commitment to eliminating the backlog by 2015.

Nationally, she said, the number of backlogged disability claims, which are given for service-connected injuries, has decreased by over 55 percent from the peak of 611,000 in March of 2013 to 275,000 in July of 2014.

The number of backlogged claims has dropped in Florida too. In spring 2013, the number was 34,609 and by August this year, it was approximately 22,134.

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Shands among safety net hospitals saying state underpaid them posted on 8/11/14

by christopher curry | gainesville sun

UF Health Shands Hospital and several other safety net hospital systems in Florida say the state has underpaid them a combined $73.3 million for Medicaid patient care over a 13-year period.

Shands and UF Health Jacksonville each say the Florida Agency for Health Care Administration owes them $10 million for the period stretching from July 2000 through June 2013, according to complaints filed with the Department of Administrative Hearings.

Jackson Memorial Hospital, Orlando Health Inc., the South Broward Hospital District and North Broward Hospital also have filed cases saying they were underpaid.

All the hospitals involved are members of the Safety Net Hospital Alliance of Florida, a group representing facilities that handle a large amount of charity care and Medicaid patients.

Their claims against the state also challenge the Florida Administrative Code rule that sets out the complicated formula for determining reimbursement amounts for Medicaid care. The hospitals all say that, in determining those amounts, ACHA treated some hospital expenses that should have been variable costs as fixed costs.

As a result, instead of being inflated in the reimbursement formula, those costs were subject to depreciation, leading to the reduced payments to the hospitals.

“They are not paying us the full cost of providing services as it is through Medicaid and then less than what the state plan dictates,” UF Health Shands Senior Vice President and Chief Financial Officer Bill Robinson said. “It's an important number to us, but it's a fraction of the Medicaid business going back and forth between us and the state.”

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Feds OK continuing Medicaid managed care, give hospitals reprieve on money issue posted on 8/4/14

by Tia Mitchell | Times/Herald Tallahassee Bureau

It was an issue that threatened the bottom lines of Florida's safety net hospitals, who are now breathing a sigh of relief.

The federal government had accused them of receiving $267 million in Medicaid payments erroneously over the past eight years and wanted to recoup the dollars immediately. Hospitals asked for a compromise that would have spread the penalty over three years to soften the blow and give them time to finalize audits and possibly dispute the charges.

The hospitals got even better news Thursday. In a letter granting a three-year renewal of the state's Medicaid managed care program, the U.S. Department of Health and Human Services said it will slow down on the repayment issue and focus only on part of the disputed funds.

For now, the federal government will only go after hospitals for $104 million that audits show was overpaid through the Low Income Pool (LIP) fund for the first three years of the program. Hospitals will also be allowed to file appeals and challenge the amounts before any money is recouped.

The remaining $163 million is off the table for now, although HHS said it will continue to review LIP payments for the other five years of the program that have already passed to determine if additional money has been overpaid.

The difference for individual hospitals is significant. Tampa General Hospital now faces a maximum penalty of $5.2 million instead of $13.3 million. The stakes were even higher at Jackson Memorial Hospital in Miami that initially was told it would be out $47 million but now is only facing an $18.3 million penalty.

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State corrects errors in its lawsuit against VA posted on 7/23/14

by staff | tampa bay times

The state has filed an amended lawsuit against the Department of Veterans Affairs that deletes several significant errors about a patient offered as an example of the poor care veterans receive in agency hospitals.

The Tampa Bay Times reported earlier this month that the suit made several errors in the case of veteran Roland "Dale" Dickerson, a Largo resident who believes the VA failed to treat his serious coronary blockages in a timely manner.

The suit said Dickerson tried to get care at St. Petersburg General Hospital and had a procedure showing he had a minimal narrowing of his coronary arteries when, in fact, he had a 69 percent blockage. It noted Dickerson had to get pricey private health insurance to pay for heart surgery at a non-VA hospital.

None of these assertions are true, though a Times review of Dickerson's medical file appeared to support the veteran's belief that the VA delayed critical heart tests for more than two years.

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