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Florida Medicaid Managed Care Receives Green Light From HHS
From Akerman’s Health Law Rx Blog:
POSTED BY SHERYL D. ROSEN AND BRUCE D. PLATT ON FEBRUARY 6, 2013
Florida has been working on a plan to shift the state’s Medicaid population into managed care for nearly two years – ever since the Florida Legislature directed the change in 2011. On Monday the state received the approval it needed from the federal government.
By letter dated February 1, 2013, the U.S. Department of Health and Human Services granted Florida’s request to waive certain provisions of the Social Security Act, allowing the state to transfer some Medicaid recipients from the traditional fee-for-service program into a Medicaid managed care plan for individuals needing long-term care.
The federal waiver is limited to the state’s Medicaid Long-Term Care Managed Care recipients. It will allow up to 36,795 Medicaid recipients to receive long-term care services from health maintenance organizations (“HMOs”) or provider services networks (“PSNs”) in the recipient’s local area. Such a transition would include access to services including adult day health care and case management, instead of more costly nursing home care. The waiver goes into effect on July 1, 2013, ahead of the state implementation deadline of October 1, 2013. On January 15, the Florida Agency for Health Care Administration (“AHCA”) posted notices of intent to award Medicaid Long-Term Care Managed Care contracts to PSN American Eldercare and HMOs including UnitedHealthcare of Florida and Sunshine State Health Plan.
A second waiver request is pending with HHS. If granted, it will allow Florida to shift the majority of remaining fee-for-service Medicaid recipients into the Managed Medical Assistance program via an HMO or PSN in the recipient’s area. On December 28, 2012, AHCA issued the invitations to negotiate seeking managed care organizations to provide Mandatory Managed Medical Assistance to Medicaid recipients in Florida. It is anticipated that AHCA will post the notice of intent to award these contracts on September 16, 2013. If the second waiver request has been granted by this time, the anticipated contract execution date is December 31, 2013.
Health Care Reform – Should Employers Reduce Expected Health Costs in 2014 by Transitioning Some Full Time Employees to Part Time Status Now?
From Akerman’s Health Law Rx Blog:
POSTED BY BETH ALCALDE ON FEBRUARY 1, 2013
2013 is shaping up to be a very busy year for employers in all industries, with the continued implementation of the Patient Protection and Affordable Care Act (“ACA”). Recognizing that in 2014, applicable large employers will avoid ACA-related penalty taxes by offering required affordable group health plan coverage just to full-time employees (i.e., those working an average of 30 hours or more per week, as calculated in a number of permitted ways), some applicable large employers have already begun examining whether to cut their employees’ hours.
Considerations in the reduction of hours decision will vary by industry and by employer, and there is no one-size-fits-all approach. Some of the factors to weigh should include the following:
- How much will the costs of health coverage continue to rise for this employer? What portion of those costs are expected to be specifically attributable to these employees?
- What tax savings are currently available for the employer-sponsored coverage for these employees?
- Are there employee morale, recruitment, productivity, and/or retention issues to consider?
- Are there public relations or government relations issues to consider?
- How many part-time employees does the company currently have? Does the company’s business model permit a shift away from full time employment?
- Will salary increases be needed if no insurance is offered to these employees?
- How many of these employees are expected to be eligible for subsidized health insurance coverage in a state or federal exchange? (Note that employers are not advised to solicit pledges from employees to not seek a subsidy in exchange for continued full time employment.)
11th Circuit Upholds Florida’s Patient Self-Referral Act
From Akerman’s Health Law Rx Blog:
POSTED BY JOSEPH W. N. RUGG ON FEBRUARY 4, 2013
Last month, in the case Fresenius Medical Care Holdings, Inc. et al. vs. DVA Renal Healthcare, Inc., the 11th Circuit Court of Appeals upheld the constitutionality of the Florida Patient Self-Referral Act of 1992.
The Florida Legislature modeled the Florida Act after the federal Physician Self-Referral Prohibitions, or Stark law, that was passed in 1989. The Stark law has gone through a number of revisions and clarifications over the last 23 years, but the Florida Legislature has not kept the Florida Act up to date with the many changes in the Stark law. The result is that the Florida Act contains provisions that are either inconsistent with, or in some instances more burdensome than, the Stark law. This makes it difficult for healthcare businesses to operate in Florida, as Fresenius discovered.
Fresenius and the related appellants are out-of-state corporations that provide renal dialysis services in Florida, both directly and through subsidiary corporations, to patients suffering from end stage renal disease. Fresenius wanted to use a vertically integrated business model in Florida and refer all the patients’ blood work to associated laboratories. Fresenius stated that such a business model would be more efficient and better for patients. However, because the employee-physicians of Fresenius had a financial interest in the associated laboratories, they were prohibited by the Florida Act from referring their patients there for blood work.
Fresenius sued the Secretary of the Florida Department of Health and the members of the Florida Boards of Medicine and Osteopathic Medicine, arguing that the Florida Act is unconstitutional because it is (1) preempted by federal law, (2) violative of the dormant U.S. Constitution’s Commerce Clause, and (3) violative of substantive due process.
The Court of Appeals was not persuaded by any of the legal arguments made by Fresenius and upheld the constitutionality of the Florida Act.
The important take away from this case is that in Florida, as in many states, there are legal restrictions on a physician’s ability to refer patients to entities in which the physician may have an investment interest. Compliance with the Stark law is not enough. The Florida Act is much more restrictive. Moreover, Florida has its own versions of the anti-kickback and the false claims statutes. When physicians do business transactions in Florida, it is critical that all of the relevant statutes are carefully considered.
Akerman’s Health Law Rx Blog
I am pleased to announce my firm’s new health law blog, Health Law Rx Blog.
Akerman’s Health Law Rx Blog provides timely updates on the latest health law issues, keeping the firm’s clients, friends, and readers up to date on pertinent legal developments. Akerman attorneys regularly update the blog with changes in the law and other relevant news. As this is meant to be an interactive site, your comments and contributions are appreciated. I am one of the contributors, so I hope you will visit the blog often and participate in any discussions that interest you. I plan to shadow post articles from the blog that I think you will find interesting.
Content on Akerman’s Health Law Rx Blog is intended to inform you about legal developments, including recent decisions of various courts and administrative bodies. It should not be construed as legal advice or a legal opinion, and you should not act upon the information without seeking the advice of legal counsel.
With more than 550 lawyers and government affairs professionals and a network of 19 offices, Akerman is ranked among the top 100 law firms in the U.S. by The National Law Journal NLJ 250 (2012). The firm’s Healthcare Practice Group includes over twenty attorneys and professionals representing health systems, physicians, health insurers, and other clients in all aspects of healthcare law across Florida and throughout the United States.
Immigration reform could add millions of people under Obama health law – The Hill’s Healthwatch
Comprehensive immigration reform could make millions of people suddenly eligible for assistance under President Obama’s healthcare law, assuming a final deal paves the way for undocumented immigrants to receive papers.
Illegal aliens are now prohibited from purchasing coverage through the Affordable Care Act’s insurance exchanges, which will launch next year.
They are also ineligible for Medicaid under most circumstances, making the law’s expansion of the program fruitless for people without documents.
The landscape could change completely if Hispanic lawmakers get their wish — an overhaul of U. S. immigration policy that includes a path to legalization.
Helping people get and stay healthy, illegal immigrants or not, has to be cheaper in the long run. Sort of like Stephen Covey’s “sharpening the saw” — it takes time and resources to sharpen the saw, but once done, the work goes easier.
See on thehill.com
Is Concierge Medicine Finally Ready for Takeoff? – HealthLeaders Media
For years observers have been predicting the impending migration of physicians into direct pay or concierge medicine, where no longer will they have to accept low Medicare and Medicaid reimbursements or haggle with private payers.
Has that time finally arrived?
A recent survey of more than 13,500 physicians found that 6.8% of them would “embrace” direct pay or concierge medicine within the next three years. That includes 9.6% of practice owners, 7.7% of primary care physicians, and 6.4% of specialists, according to the survey conducted by physician recruiters Merritt Hawkins for The Physicians Foundation.
See on www.healthleadersmedia.com
Physicians have limited choices in front of them for how they will provide care in the future (and the future is now) — (1) maintain the status quo, (2) combine, merge, or consolidate with, or sell to, with other physicians, (3) sell to, or affiliate with, hospital systems or managed care companies, or (4) become independent of other physicians, of hospitals, and of managed care companies by doing concierge medicine.
Telehealth to Expand in Rural Communities with FCC $400 Million Fund
The FCC has announced $400 million will be made available through a healthcare connect fund to create and expand telehealth networks and services.
See on www.hitechanswers.net
Mining Electronic Records for Revealing Health Data
The New York Times reported last week (www.nytimes.com) another value of electronic health records — to supplement or even replace clinical research to improve patient care:
Over the past decade, nudged by new federal regulations, hospitals and medical offices around the country have been converting scribbled doctors’ notes to electronic records. Although the chief goal has been to improve efficiency and cut costs, a disappointing report published last week by the RAND Corp. found that electronic health records actually may be raising the nation’s medical bills.
But the report neglected one powerful incentive for the switch to electronic records: the resulting databases of clinical information are gold mines for medical research. The monitoring and analysis of electronic medical records, some scientists say, have the potential to make every patient a participant in a vast, ongoing clinical trial, pinpointing treatments and side effects that would be hard to discern from anecdotal case reports or expensive clinical trials.
Beth Kassab: Patients lose when hospitals take over doctors
When a big hospital chain buys an independent doctor’s office, we often hear the move will “enhance care”, “integrate care” or “improve health-care efficiency.”
Spare us the euphemisms.
Patients are the losers in these deals.
We pay higher costs. We get fewer choices because doctors are pressured to refer patients only to providers who also work for the hospital. And, because these acquisitions are so common today, an independent doctor’s office is becoming as quaint as the house call.
Unfortunately, this is the entire article and is much too short to discuss a topic full of so many nuances. Tough issues need far more analysis and thought than this. The question to study is, if the goal of physician practice acquisitions is integration of healthcare to enhance and improve the patient experience while reducing costs, then where are the disconnects? Why are hospitals and physicians failing (assuming this “reporter” is correct in her bottom line conclusion)?
See on articles.orlandosentinel.com
Physician groups eye mergers but blindsided by legal fights – amednews.com
Declining payments and increasing financial pressures have led more physicians to become employees of large medical groups and hospitals. At the same time, the Affordable Care Act is prompting smaller practices to consolidate as a way to more easily participate in new health system delivery models such as accountable care organizations.
But as physicians attempt to escape administrative burdens and financial stress, they are encountering another hurdle — legal disputes brought about by mergers.
See on www.ama-assn.org
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