News from Tallahassee for 8/1/14

Medicare plans cutting doctors posted on 7/21/14

by diane c. lade | Sun Sentinel

Unexpected breakups can be painful, as South Florida seniors have been finding out lately.

Some Medicare Advantage plans have retooled or shrunk their provider networks in the past year, forcing patients to find new physicians or facilities for treatment.

Simply Healthcare is the latest Medicare Advantage insurer to shuffle its provider network. The Coral Gables-based company is cutting some doctors in Broward County this summer and reassigning new physicians to affected members, said Betsy Henao, senior director of corporate marketing.

The plan has 4,842 members in Broward. Those who don't want their assigned doctor can choose another from the company's updated network, she said.

Network rejiggering "is a common practice in the Medicare Advantage system. It sustains us and maintains good quality," Henao said. She declined to say how many doctors were cut.

Officials with the Centers for Medicare and Medicaid Services (CMS) said they can't release details on Medicare Advantage plan changes because the companies are private entities.

Companies have the right to terminate their contracts with physicians, therapists and hospitals at any point, but almost all enrollees are stuck with their plan choices until the end of the calendar year.

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FL Mosquitoes Spreading Virus posted on 7/18/14

by Mary Shedden | Health News Florida

Health officials say a mosquito-borne illness that had afflicted Floridians who traveled to the Caribbean has now been transmitted within the state.

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$4.8B in FL Subsidies at Stake posted on 7/18/14

by Carol Gentry | Health News Florida

A court case challenging the Affordable Care Act's subsidies for plans sold on the federal marketplace could have an outsize effect on Florida, according to a new analysis. 

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Enroll America making health insurance pitches wherever uninsured are posted on 7/14/14

by Lawrence Mower | Palm Beach Post

RIVIERA BEACH — Roughly 30 million Americans still don’t have health insurance.

That means Florence French has her work cut out for her.

French is an organizer with Enroll America, a nonprofit devoted to finding people eligible for for insurance through the Affordable Care Act and showing them where and how to enroll.

That means a lot of one-on-one pitches, wherever there are people: the Department of Motor Vehicles, homes, Home Depot parking lots.

On Sunday, French was at the Valley of Life Ministries, a small Haitian church in a strip center on Broadway near Blue Heron Boulevard. The church’s president, Marie Antoinette Jean Pierre, takes care of and feeds people who walk through the church’s door. Many are homeless.

French’s job lately has been to find people who qualify for a special enrollment period.

The first enrollment period for the Affordable Care Act, also known as Obamacare, ended in March. The next enrollment period is in November, but will carry a $95 fine for adults who missed the first enrollment. The penalty escalates to $300 and $700 in subsequent years.

But if someone has a qualifying life event recently — including a marriage or divorce, a move or a new job, a 26th birthday or a new child — they can use the federal exchange right now to buy health insurance without a penalty. They have 60 days from the date of the event to enroll.

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State Blasts Insurers for Hiding Rates posted on 7/11/14

by Carol Gentry | Health News Florida

Florida health plans were wrong to use a state "trade secrets" law to hide their rate proposals from the public, the Office of Insurance Regulation says in letters to 15 insurers.

In what became a nationwide embarrassment for Florida, insurers falsely placed a "zero" on the public rate-filing form for 2015 in the run-up to the June 27 reporting deadline. OIR officials say their intention was apparently to hide their actual rate proposals from one another, but it backfired when Health News Florida reported on the unusual phenomenon.

The trade-secrets law was never intended for that purpose, and its use is blocking the state's goal of making rate proposals "transparent," OIR Assistant General Counsel Virginia Christy wrote in a July 3 letter to plans participating in the 2015 federal Health Insurance Marketplace.

Because of the way the trade-secrets law is written, OIR says, it cannot just release the information to the public. It must wait for someone to request the document and then give the companies 30 days' notice that it intends to release it, so that they can try to block it through court action. The July 3 letters provided that official notice.

The first public records request was filed June 30 by Bryan Trochessett of Chandeleur Investment Consulting, LLC, according to Christy's letter. Later, other requests were filed by reporters and the consumer group Florida CHAIN.

CHAIN's Policy Director Greg Mellowe said in a July 8 letter to OIR that the agency should release the rate proposals right away because the trade-secrets claim is phony.

Mellowe wrote that the insurers and HMOs "are intentionally misleading the public" and added a zinger for state officials "For its part, if OIR has knowingly allowed such false information to be reported and then defended such reporting, it may have facilitated insurance fraud."

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