News from Tallahassee for 3/6/15

Scott won't backfill federal LIP funding posted on 3/4/15

by KATHLEEN MCGRORY | HERALD/TIMES TALLAHASSEE BUREAU

If the state and federal government can't reach an agreement on Florida's Low Income Pool program, Gov. Rick Scott won't backfill with program with state dollars, he said Wednesday.

"Florida taxpayers fund our federal government and deserve to get a return on their investment," Scott wrote in a letter to President Barack Obama. "Moreover, we have worked hard to turn Florida's economy around and cannot afford to fund programs started by the federal government."

The Low Income Pool is key to Florida's budget.

The $2 billion program, which reimburses hospitals that treat large numbers of poor and uninsured patients, is scheduled to expire on June 30. The state Agency for Health Care Administration is hoping to reach a deal with the federal government to keep the federal portion of the funding in place.

The U.S. Centers for Medicare & Medicaid Services, or CMS, has made it clear that the program will not continue without significant changes.

Scott is open to restructuring LIP.

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No Medicaid Expansion? No Problem For Many Safety-Net Hospital Profits posted on 3/4/15

by phil galewitz | kaiser health news

Hospitals that treat many poor and uninsured patients were expected to face tough financial times in states that did not expand Medicaid under the federal law known as Obamacare.

That’s because they would get less Medicare and Medicaid funding under the Affordable Care Act, while still having to provide high levels of charity care.

But in some of the largest states that did not expand Medicaid, many safety-net hospitals fared pretty well last year — even better than in 2013 in many cases, according to their financial documents. KHN looked at the performance of about a dozen such hospitals in Florida, Texas, Georgia, Tennessee, South Carolina, Virginia and Kansas, which released their 2014 financial results.

An improving economy was the single, biggest reason shared by all of the strongly performing hospitals because it helped reduce the number of patients who couldn’t pay their bills and increased local property and sales tax revenues earmarked for publicly supported hospitals.

Another factor for some hospitals was the increase in insured patients who bought coverage through the health law’s insurance exchanges. For instance, Fort Lauderdale, Fla.-based Broward Health saw a 30 percent drop in charity care, which officials attributed to seeing more insured patients.

Still, the biggest fiscal challenges lie just ahead — with significant Medicaid funding cuts starting late next year under the Affordable Care Act. The health law’s drafters anticipated the number of uninsured Americans to decrease dramatically, in part because they expected a nationwide expansion of Medicaid. Therefore, beginning in October, 2016, the law calls for cuts to special Medicaid funding for hospitals that typically see a disproportionate share of the poor. In addition, other Medicaid funding that supports indigent care in certain states (and that predates the 2010 health law) is slated to expire in Florida in June and in Texas, next year.

“We are still very early in the Affordable Care Act, and one year does not make a trend,” cautioned Daniel Steingart, an analyst with Moody’s Investors Service. “Just because they got though this period, does not mean they do not have more financial pain to come.”

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Billions at Stake as State, Feds Negotiate Medicaid posted on 2/27/15

by Carol Gentry | Health News Florida

When the 2015 legislative session begins next week, many of the state’s decisions on health care for the poor are on hold as state and federal Medicaid officials negotiate over funding, behind closed doors. Billions of dollars are at stake.

When it comes to health-care funding, Florida’s in a funny position. The state has twice turned down billions of dollars from federal Medicaid that would have covered care for about a million poor Floridians.

This year may be no different.

"I don't believe for one moment that this is a good plan for Florida and I would certainly not change my opinion on that,," said State Representative Matt Hudson, who chairs the powerful committee in charge of health spending.

At the same time, state legislators and Governor Rick Scott want federal officials to keep a special fund for hospitals that treat those same patients. It's called the Low Income Pool.

It may seem inconsistent, but that's health-care politics in Florida.

Justin Senior, Florida’s Medicaid director, is watching the calendar as he negotiates with federal health officials over renewing the Low Income Pool. It expires June 30.

“In order for us to make any plans for expenditures on July 1 of this year we really do need agreement in principle from our federal partners sometime in late March or very early April,” he said.

The Medicaid budget that Governor Scott recently sent to the Legislature includes more than $1 billion for the Low Income Pool. But federal Medicaid chief Eliot Fishman told business leaders in Orlando recently that the Low Income Pool – which he calls LIP -- will not be renewed in its present form.

“We extended the LIP for a year with the explicit purpose of moving to a significantly reformed payment system," Fishman said at the Associated Industries of Florida's Health Care Affordability Summit.

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10 big issues to watch during the 2015 Session posted on 2/24/15

by JIM SAUNDERS | NEWS SERVICE OF FLORIDA

FL Capitol Bldg RotundaTHE CAPITAL, TALLAHASSEE, February 23, 2015— Florida lawmakers will gather March 3 in the Capitol for the pomp-filled start of the 2015 legislative session. Then the real work begins. For 60 days, the House and Senate will grapple with hot-button issues ranging from standardized testing in public schools to reforming the troubled prison system. And that doesn't even touch on the one must-pass bill of the session: a roughly $77 billion state budget.

Here are 10 big issues to watch during the upcoming session:

BUDGET: Banking on a nearly $1 billion surplus, Gov. Rick Scott offered a budget proposal in January that included record per-student spending in public schools and $673 million in tax cuts. But a major question looms for the Republican-dominated Legislature as it prepares to negotiate a final spending plan this spring. A program that has funneled about $1 billion a year to hospitals and other health providers is set to expire June 30, and it is unclear whether state and federal officials can agree on an extension. If they can't agree, that would leave a huge hole in the budget. The program, known as the Low Income Pool, helps subsidize care for low-income and uninsured Floridians...

HEALTH CARE: The noisiest health-care issue during the upcoming session likely will focus on whether the state should accept tens of billions of dollars in federal money to expand Medicaid or to provide coverage through a similar private health-insurance program. But like the past two years, the idea appears dead on arrival in the Florida House. Health-care lobbyists, however, are working on a variety of other issues, including proposals to bolster the use of telemedicine in the state. The House and Senate could not reach agreement on a telemedicine bill last year but appear to be close to a compromise heading into this spring's session.

LAND AND WATER: Voters sent a strong message in November when they overwhelmingly approved a constitutional amendment requiring the state to set aside hundreds of millions of dollars a year for land and water projects. But one of the most closely watched issues of the session will be how the Legislature carries that out. House Speaker Steve Crisafulli, R-Merritt Island, and Senate President Andy Gardiner, R-Orlando, have made clear that water issues will be a priority of their two years leading the Legislature. But at least part of the debate will focus on how to divvy up money between proposed water projects, which range from cleaning up natural springs and the Everglades to helping with local-government stormwater systems.

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‘Exorbitant’ hospital charges rob Florida drivers, suit claims posted on 2/16/15

by charles elmore | palm beach post

HCA logoPALM BEACH GARDENS — After a car wreck, Penny Wollmen said she had no idea a hospital’s scans to check for injuries would use up her $10,000 in Personal Injury Protection benefits in a single day. A chiropractor told her there were no benefits left to pay for his services under Florida’s car insurance system, she said.

“I was crying,” said Wollmen, who said she has four kids and has to drive her husband to work in their one remaining car. “I couldn’t get the proper treatment.”

A lawsuit scheduled for a hearing Tuesday names Gov. Rick Scott’s former company and alleges HCA hospitals including JFK Medical Center in Atlantis are exhausting consumers’ PIP benefits by grossly overcharging for services — at up to 65 times what Medicare pays.

Hospital attorneys have asked a federal judge in Tampa to dismiss the suit.

“We believe the case lacks merit, and we intend to defend it vigorously,” a statement from JFK Medical Center said.

With one motorist in Palm Beach County, JFK charged nearly $18,000 for scans for which Medicare pays a total of less than $500, the suit claims. The lawsuit seeks class-action certification to represent others affected at some 80 HCA hospitals around the state.

Win or lose, it’s a very different narrative than the debate about bad guys faking accidents or providing phony care that preceded 2012 PIP reforms. Scott personally lobbied for and signed a bill that helped focus payments on hospitals and other emergency providers by reducing nonemergency benefits to $2,500.

This lawsuit claims hospitals are the ones ripping off consumers and exploiting the system.

» Read more

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