Urban hospitals would lose in Senate plan
Negron seeks to shift state funding to for-profit systems.
Despite his normally cautious and reserved outlook, Senate President Joe Negron sounded confident last week that he will win support for a contentious plan to redirect $318 million in hospital funding away from large urban hospitals and toward for-profit hospitals such as those run by HCA Healthcare. “I feel a momentum in the building moving to that side,” Negron said. Senate leaders have proposed a complicated plan that includes taking $50 million in general revenue, which, when matched with federal Medicaid dollars, would total $130 million. The plan would then redirect that funding to base rates. As a result, the Senate plan would increase Medicaid base rates from $3,426 to $4,049 for each hospital admission.
Because the base rates would be increased, the Senate plan would benefit any system that owns more than one hospital, such as HCA, Tenet, Community Health Systems, BayCare and Adventist Health System. HCA, which owns 43 facilities in the state, could see nearly $40.5 million in Medicaid increases under the Senate plan. Conversely, Jackson Memorial Hospital in Miami faces more than a $59 million reduction, UF Health Shands in Gainesville faces more than a $20 million hit and Tampa General Hospital could lose nearly $14.7 million. Negron and other Senate Republicans have defended the shift as a model where the “money follows the patient.”
“I think senators are prepared to move quickly to implement a fairer model that says we are going to reimburse hospitals based on actual treatment of a patient rather than what the sign on the door says,” Negron said.
The Senate push for the funding proposal has created an unusual dynamic where advocates for public and teaching hospitals have been more complimentary of hospital funding levels included in the House budget. It’s unusual because in the past few years, top House Republicans sharply criticized hospitals, with the next House speaker, Jose Oliva, going so far as to brand them the “hospital-industrial complex.”
Challenge in the making?
Despite the Agency for Health Care Administration’s efforts to keep its Medicaid managed-care procurement negotiations under wraps, Molina Healthcare reported to the federal Securities and Exchange Commission last week that its Florida plan has been invited to negotiate for a Medicaid managed-care contract only in Region 11, which includes Miami-Dade and Monroe counties. Molina currently operates in eight counties, and it wanted to be a statewide provider for the next five years, documents posted on the Agency for Health Care Administration website show. “The Florida health plan is seeking to understand the basis for AHCA’s preliminary selection of candidates under the ITN (invitation to negotiate) and intends to take all appropriate actions to both protect its rights and ensure continuity of care for its members,” the filing said. The filing shows that Molina Healthcare premium revenue from the Florida Medicaid plan was about $1.1 billion for the nine months that ended Sept. 30, 2017, or approximately 8 percent of total premium revenue.
There are reports that Molina stock is down because of the perceived risk in South Florida, and stock analysts predict that the managed-care company will challenge the AHCA decision. Overall, the five-year contracts statewide are worth upward of $90 billion.
Flu at a record pace in state
There were 82 outbreaks of influenza and influenza-like illness reported from Jan. 28 to Feb. 3, including 37 with laboratory evidence of influenza, the Florida Department of Health reports. There have been more flu outbreaks reported this season, 319, than any previous season on record.
All-payer claims database
The AHCA on Friday published changes to its proposed rule on data submission to the new all-payer claims database rule. The changes address ERISA plans, making clear those claims aren’t required to be submitted. But the rule puts the burden on the employer to “affirmatively elect(s)” not to share the claims. The News Service of Florida in January reported on the proposed rules, which will make possible Gov. Rick Scott’s transparency vision he has championed since 2016. The Legislature passed a bill authorizing an all-payer claims database and agreed to spend more than $4 million to get it up and running. AHCA has an agreement with Health Care Cost Institute, which will analyze the data and post it to a state website. AHCA Secretary Justin Senior has said he wants the rules finalized this spring.
Certificate of need
The AHCA has accepted seven letters of intent from businesses that want to establish new hospitals. Three are for proposed projects in Marion County. Munroe Regional Medical Center wants to establish a 100bed acute care hospital, and there are proposals to build a 54-bed adult psychiatric hospital and an 18-bed children’s and adolescent psychiatric hospital. Medical Centers of Southwest Florida notified the state it wants to build a 100-bed facility in Lee County.
AHCA also announced that Shands Teaching Hospital and Clinics is adding 20 adult psychiatric beds to the UF Health Shands Psychiatric Hospital. Capital costs are projected to be about $12 million.
Lastly on the certificateof-need front this week, AHCA has proposed an exemption for a hospice program for MorseLife Health System in West Palm Beach.
Pharmacies in rural areas
“Remote dispensing site pharmacies” could pop up in rural areas of the state under bills being considered by lawmakers. Remote dispensing pharmacies would be in rural areas and at least 10 miles from community pharmacies. A licensed pharmacist would remotely supervise the registered pharmacy technicians in the remote location. Sen. Denise Grimsley, R-Sebring, told a Senate health panel last week that her bill wouldn’t change underlying relationships or oversight requirements that pharmacists must have with pharmacy technicians. It doesn’t. But the Florida Board of Pharmacy last week proposed changes to its rules that would increase from six to eight the number of pharmacy technicians a pharmacist could supervise.
Lawmakers are moving to better regulate pharmacy benefit managers, requiring them to register with the Florida Office of Insurance Regulation. More here
Meanwhile, an attempt to expand pharmacists’ scope of practice and allow them to test and treat customers for the influenza virus and streptococcal infections is finished this session after the Senate Health Policy Committee deferred action on it.
Talk about bringing work home with you
Physician Scott Loessin has filed a petition with the Florida Board of Medicine seeking a declaratory statement as to whether it is permissible to perform Level II and Level III cosmetic and plastic surgery procedures in residential homes that would serve the limited purpose of a temporary office space. He also filed a petition with the board to get a variance from a rule that patients be discharged within 24 hours of presenting themselves to the office for surgical procedures.
What’s in a name?
A lot for former AHCA Secretary Alan Levine, who last week helped unveil Ballad Health, a new health system resulting from the merger of Mountain States Health Alliance and Wellmont Health System. In a prepared release, Levine said the name was chosen following a survey of local residents asking what they wanted most in a provider. The most common response was a provider who listens. Ballad includes 21 hospitals in Northeast Tennessee and Southwest Virginia, an addiction-treatment facility, long-term care facilities, home care and hospice services and retail pharmacies. Levine will serve as executive chairman, president and chief executive officer of Ballad Health.
Here’s a quick roundup of some bills last week:
The Florida Legislature for more than a decade earmarked funding in the state budget for “pregnancy support services.”
The Senate on Thursday gave approval to a bill (HB 41) that would put into law the longstanding initiative, which encourages women to carry pregnancies to term.
The Senate is inching closer to approving a bill that would allow hospitals, clinics, medical schools and substance-abuse treatment programs to begin offering needle-and-syringe exchange programs to reduce the spread of diseases such as HIV.
Health insurers and health maintenance organizations would be banned from retroactively denying claims if they verified eligibility at the time of treatment and provided authorization numbers, under a bill the Florida Senate agreed to roll to third reading.