News from Tallahassee for 8/21/14

Health insurers raise 2015 Fla. exchange rates posted on 8/5/14

by Kelli kennedy | ap

FORT LAUDERDALE, Fla. (AP) -- Eight insurance companies are raising the price of health plans and three are lowering them in Florida through the Affordable Care Act exchange, state insurance officials said Monday. But whether you'll pay more or less depends on a complex formula including where you live and how many companies are competing in that market.

Fourteen companies, including three new insurers, are planning to sell to Floridians through healthcare.gov in 2015. Of the 11 returning plans, eight filed average rate increases ranging from 11 to 23 percent, and three filed rate decreases ranging from 5 to 12 percent. Florida Blue, the state's largest insurer, is raising its premiums by an average of 18 percent. Humana proposed an average 14 percent increase for its HMOs, while Molina proposed a 12 percent average rate decrease, according to state officials.

Florida's increases aren't staggering as health insurance rates have risen as much as 20 or 30 percent in recent years. Critics of the health overhaul warned of huge rate increases, a signal they say shows the law isn't working. Gov. Rick Scott was quick to seize on the rate release to slam the law, while health advocates countered that the state's analysis was misleading.

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FL Prescriber Tied to Drug Maker posted on 8/5/14

by CHARLES ORNSTEIN | PROPUBLICA

Many of Medicare's top prescribers of the expensive specialty drug H.P. Acthar Gel have financial ties to the drug's maker.

Only 18 practitioners wrote 15 or more prescriptions for the drug in 2012. At least nine — and all of the top four — were promotional speakers, researchers or consultants for Questcor Pharmaceuticals, a ProPublica analysis shows.

We identified the top prescribers of Acthar by using data from Medicare's prescription drug program, known as Part D. We determined if physicians had financial relationships with Questcor by checking their names against ads for speaking events sponsored by the company, and against clinical trial databases, research articles and conference disclosures.

The amounts paid to practitioners have not been disclosed, but beginning this fall, all such payments by pharmaceutical and medical device companies will be public under the Physician Payment Sunshine Act.

The No. 1 prescriber of Acthar in Medicare in 2012, Dr. William Shaffer, said he gives speeches that draw on his experiences as both a neurologist and a patient with multiple sclerosis, a condition that Acthar treats.

"I was and still am an M.S. patient and have seen not only my personal results but other patients that have responded amazingly," Shaffer said.

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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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FL Blue Premiums Up Nearly 18 Percent posted on 8/1/14

by Phil Galewitz | Kaiser Health News

caduceusFlorida Blue, the state’s largest health insurer, is increasing premiums by an average of 17.6 percent for its Affordable Care Act exchange plans next year, company officials say.

The nonprofit Blue Cross and Blue Shield affiliate blames higher health costs as a result of attracting older adults this year who previously lacked coverage and are using more services than expected.

Florida insurance regulators plan to release rate information for all companies next week. The exchange plans cover individuals who aren’t covered by employer-based policies.

Florida Blue offers many plans. The 40 percent of its individual policyholders who chose “narrow network” plans called BlueSelect that limit coverage to fewer doctors and hospitals will see rates rise by an average of 13 percent.

Critics of the health law have predicted big rate hikes in the second year of the online marketplaces. Florida Blue CEO Patrick Geraghty noted that premiums in the individual market have been going up for years. “In the individual market, this type of average rate increase is typical,” he told Kaiser Health News. “It’s is not aberrant.”

Next year will mark the fourth consecutive year Florida Blue has increased premiums by at least 11 percent on average for people under 65 who buy coverage on their own. Florida Blue increased rates an average of 16.5 percent in 2014, 16 percent in 2013 and 11.5 percent in 2012, the company said.

Florida Blue signed up 339,000 customers through the Affordable Care Act’s federal marketplace this year— about 34 percent of the nearly 1 million who enrolled in the state, the company said. Florida does not operate its own exchange.

Nationally, 2015 rates that have been made public have varied sharply, with some insurers increasing rates, some reducing them and others keeping them stable.

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Insurers: 2015 Exchange Rates Likely to Spike posted on 7/31/14

by AP

State insurance officials are preparing to release figures next week on how much health plans will cost under the Affordable Care Act for 2015, and rate increases seem inevitable as insurers say their new consumers are older and sicker than anticipated.

Top executives at Blue Cross and Blue Shield of Florida and Cigna said rate increases are likely, but declined specifics. Humana proposed an average 14.1 percent increase for its HMOs, saying the increase was driven by factors including increased prescription drug costs and doctor and hospital reimbursements. However, Molina has proposed an 11.6 percent average rate decrease.

Critics of the health overhaul warned of huge rate increases, a signal they say shows the law isn't working. But rates have risen as much as 20 or 30 percent in recent years and early filing from insurers in other states suggest the 2015 increases won't be as dramatic.

Meanwhile, insurers say that even though the nearly 1 million Florida enrollees include many who are older with chronic conditions, the marketplace is still ripe for profits.

Brian Evanko, president of Cigna's U.S. individual market, said the company anticipates financial losses from the exchange in 2014, but "we expect over time that as things tend to shake out this could be a very attractive market for us."

Federal health officials say 91 percent of Florida's 983,775 enrollees received a tax subsidy, 55 percent were female and 45 percent were male. The government and insurance companies have not released data on how many were previously uninsured and no details on their health conditions.

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