News from Tallahassee for 9/2/14

Scientology-related Narconon rehab center may have violated law posted on 8/26/14

by Joe Childs | Tampa Bay Times

When the Scientology-affiliated Narconon drug treatment center in Spring Hill was told by Hernando County it could not expand its residential facility, the center didn't try to make do with existing space.

Its officers rented three properties elsewhere in Spring Hill and expanded there. That allowed the center to admit more patients. Narconon charges up to $30,000 for a three-month stay.

One site was in a commercial center. Narconon shuttled patients there for what director Tammy Strickling described as "daily therapeutic classes.'' The other two sites were houses. One slept eight, the other six. Narconon staffers, trainees and overflow patients bunked there.

"I don't like turning anyone away,'' Strickling said in court last year.

But all three rented locations may have violated state law.

Substance abuse treatment centers in Florida are required to deliver services only at licensed facilities. Since Narconon opened in 2008, it had been licensed by the state Department of Children and Families to provide services at one place, 8213 Cessna Drive.

"My mouth is hanging open,'' said Department of Children and Families licensure specialist Troy McDermott, when told of the rented sites. In his 21 years at DCF, he never has encountered a center providing services at unlicensed facilities, he said.

Penalties can range from a moratorium on patient admissions to loss of license.

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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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Court Sides With Patient On Confidentiality posted on 8/1/14

by News Service of Florida

A South Florida appeals court Wednesday ruled that a sheriff's deputy cannot testify about a conversation he heard between a patient he was guarding and a psychotherapist in a hospital emergency room...

A three-judge panel of the 4th District Court of Appeal upheld the circuit judge's decision. "Admitting this statement into evidence over objection would effectively mean that an individual in custody must forego his right against self-incrimination to obtain necessary medical diagnosis and treatment,'' said Wednesday's opinion, written by Judge Mark Klingensmith and joined by Judge Carole Taylor and Judge Spencer Levine.

"Requiring the relinquishment of this constitutional right as a condition of medical diagnosis and treatment for persons placed under arrest or otherwise in custody would be unconscionable. If the privilege were to be nullified by the mere presence of a law enforcement officer, confidential conversations between psychotherapists and their patients would surely be chilled, particularly when it is obvious that the circumstances giving rise to the need for treatment will probably result in prosecution or litigation. Given these facts, a person in (the) defendant’s position might not receive appropriate treatment, knowing they risked losing their confidentiality by answering questions posed to them by their psychotherapist."

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Court Deals Setback to Health Care Law posted on 7/22/14

by ROBERT PEAR | NY Times

Affordable Care ActWASHINGTON — In a ruling that could upend President Obama’s health care law, a federal appeals court ruled Tuesday that the government could not subsidize premiums for people in three dozen states that use the federal insurance exchange. The 2-to-1 ruling could cut off financial assistance for more than 4.5 million people who were found eligible for subsidized insurance in the federal exchange, or marketplace.

Under the Affordable Care Act, the court said, subsidies are available only to people who obtained insurance through exchanges established by states.

The law “does not authorize the Internal Revenue Service to provide tax credits for insurance purchased on federal exchanges,” said the ruling, by a three-judge panel of the United States Court of Appeals for the District of Columbia Circuit. The law, it said, “plainly makes subsidies available only on exchanges established by states.”

Their share of premiums could then increase sharply, making insurance unaffordable for many.

However, the decision is the not the last word, as other courts are weighing the same issue. And the ruling could be reviewed by the full appeals court here.

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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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