From USA Today:

A federal government website that starts July 1 takes a step in that direction. The site, for the first time, will give consumers a list of all private and government health care plans for individuals and small businesses in their areas.

The nation’s new health care law requires the site (www.healthcare.gov). Initially, it will provide just basic facts, such as the names of companies, health plans and Web links. Beginning in October, it will list detailed cost and benefits information. Consumer groups and insurers already are clashing over exactly what information should be displayed.

To read the full article, click here.

While the Agency for Persons with Disabilities is doing a better job of tracking people on its waiting list for services, it needs to develop a multi-year plan to eliminate that list altogether.

That is among the recommendations outlined in a July 2 report from the Office of Program Policy Analysis and Government Accountability (OPPAGA).

As of March 1, 2010, the agency reported having 18,862 individuals on its waiting list for waiver services.

Three-fourths have been waiting for waiver services for five years or less. The majority (67%) have a primary disability of mental retardation; others include autism (17%) and cerebral palsy (14%).

The agency currently assesses all new eligible applicants using a questionnaire and plans to reassess all clients every 36 months unless it needs to gather this information sooner, the OPPAGA report states.

The Legislature required APD to assign priority categories to individuals on the waiting list. To do that, the 2009 Legislature required the agency to place all applicants for waiver services into one of seven categories by July 1, 2010. That is underway. But due to limited waiver slots, the agency provides waiver services only to individuals in Categories 1 (individuals in crisis) and 2 (dependent children in foster care), the report states.

APD administrators report that the new system will need to be operational for two years before they can collect sufficient information to develop a plan to address the waiting list.

To read the full report, click here.

The Society for Human Resource Management and the Partnership for America’s Economic Success have published a new brochure, Meeting the Workforce Needs of the Future Means Meeting the Developmental Needs of Young Children Today.

It includes data showing that investment in early childhood education is the best way to improve our nation’s workforce and economy.

It also says that one study found that an investment of just $6,692 in pre-K for disadvantaged children yielded a lifetime return of up to $69,937—a return on investment of greater than 10:1.

Click here to read the brochure.

Candidates seeking the governor’s office will face each other in an October debate that will be broadcast live statewide on public television and radio, according to News Service Florida.

The debate will be sponsored by the Florida Hospital Association, and will center on health care issues, according to sponsors. 

The event is scheduled for Oct. 14 in Orlando, and will be produced and broadcast by Florida Public Broadcasting Stations.

Pediatric therapy providers and families have an opportunity to weigh in on the federal government’s decision to extend Florida’s Medicaid Reform pilot program.

The state of Florida will be asking the federal government by June 30 to extend the pilot program now in place in five counties (Broward, Duval, Baker, Clay and Nassau). The Centers for Medicare and Medicaid (CMS) will take into consideration comments from the public.

The Medicaid Reform pilot program is set to expire in June 2011.

The Alliance for Pediatric Therapies is concerned about the degree to which therapy services have been reduced, even denied, to children enrolled in Medicaid Reform health plans.

If you’d like to share your concerns about Medicaid Reform with the federal government, please send an email to victoria.wachino@cms.hhs.gov.

The Florida Interagency Coordinating Council for Infants and Toddlers (FICCIT) will have a quarterly meeting June 22-23 in Jacksonville.

The meeting will take place at Four Points by Sheraton, 8520 Baymeadows Road.

The role of FICCIT is to assist public and private agencies in implementing a statewide system of coordinated, comprehensive, multidisciplinary, interagency programs providing appropriate early intervention services to infants and toddlers with disabilities and risk conditions and their families, according to its website www.floridaicc.com.

For more information, contact the FICCIT liaison Tameka Davis at 850-245-4444 extension 2268.

A report from the federal government’s Office of the Inspector General shows that Medicaid children in nine states including Florida are not getting screenings required by federal law.

The report shows that 76 percent of children in those nine states did not receive the medical, vision and hearing screenings under the Early and Periodic Screening, Diagnosis and Treatment program. These screenings are required for children enrolled in Medicaid.

Forty-one percent of children never received medical screenings. And when children did receive a medical screening, they were often incomplete, according to the study (click here to read it). The study was based on reviews of 2007 medical records.

Why wouldn’t states want to screen youngsters?

Under EPSDT, Medicaid children are entitled to health care screenings and access to all Medicaid-covered services they are found to need, regardless of any Medicaid benefit restrictions imposed on adult beneficiaries by their state, according to a 2006 issue brief released by the national Health Policy Forum (click here to read it).

Florida’s track record of providing ESPDT screenings is currently under scrutiny in a Miami courtroom.

A group of families, pediatric dentists and pediatricians are suing the state Medicaid program for providing inadequate care for children. One of their claims in the class-action lawsuit is that Florida is falling short in its duty to provide EPSDT screenings to children enrolled in Medicaid program.

According to an article by the Associated Press, doctors say regular checkups are especially important for low-income children who are at higher risk for chronic problems including obesity, depression and poor cognitive development.

“Missing checkups means problems aren’t spotted early and increases the chance they will develop into something more significant, Dr. Louis St. Petery, a Florida pediatric cardiologist, told the AP.

“Checkups aren’t just made up,” said St. Petery, who is part of the class-action lawsuit. “They are essential.”

The Florida Cabinet for Children and Youth commissioned a special project last year to determine which state agencies conduct screening, and how effective they are in carrying out those screenings. The results mirror what the federal Office of Inspector General found. 

The Florida report states: “Not all children receive a screening that addresses the full range of developmental
capacities, and often the individual administering the screening lacks sufficient knowledge of child
development and skill in screening. In too many instances, screening information for children with
findings is not referred to a qualified provider for further assessment and diagnosis .”

The report recommends that Florida create a system of standardized screenings tools, processes and procedures. The read the full report, click here.

The state Agency for Health Care Administration (AHCA) is holding several hearings across the state about the future of the five-county Medicaid Reform pilot program.

The first hearing was held in Tallahassee on May 14 (read about it here). The next one is scheduled for June 8 in Jacksonville. Click here to see the full schedule.

The Medicaid Reform pilot program has been underway since 2006 in Broward, Duval, Baker, Clay and Nassau counties. It was an initiative of former Gov. Jeb Bush and was approved by the federal Centers for Medicare and Medicaid Services (CMS) under the administration of his brother, President George Bush.

CMS gave Florida permission, in the form of a federal “waiver,” to move forward with its Medicaid Reform experiment through June 30, 2011.

Under the waiver, Florida must tell CMS by June 30 what it plans to do with the pilot program.

The Florida Legislature voted, in SB 1484, to ask the federal government to extend the waiver beyond 2011. In preparation, AHCA is seeking public comment on how the program has worked.

Results have been inconclusive as to whether it has saved money. Studies have certainly shown that the program has not improved access to health care.

Medicaid Reform is different than the traditional Medicaid program. It allows HMOs and provider service networks to enroll Medicaid-eligible Floridians and offer their own package of benefits. That means that the Reform health plans do not have to abide by state Medicaid guidelines in terms of the amount, duration and scope of services, including pediatric therapies.

By JOHN KENNEDY
THE NEWS SERVICE OF FLORIDA

THE CAPITOL, May 14, 2010 — A new state audit criticizing Florida’s Medicaid program for shoddy oversight is raising heightened concerns about the role state officials play in fueling the runaway costs that have prompted calls to overhaul the health plan covering 2.7 million Floridians.

Medicaid payments from the state to hospitals, nursing homes, hospices and rural health clinics frequently relied on inaccurate rates and unsubstantiated claims, resulting in potentially millions of dollars in overpayments during the 2007-09 period reviewed by state auditors.

Even the state Agency for Health Care Administration’s attempts to ride herd on these payments was flawed. A $1.8 million annual contract with a Jacksonville-based health-care auditing firm, First Coast Service Options, was issued without recommended competitive bidding, auditors found.

The firm has held the contract for at least three years and continued to raise its hourly rates while reducing the number of audits performed for the state, the report by the state’s Auditor General’s office said.

“It’s pretty shocking,” said Sen. Durell Peaden, R-Crestview, chairman of the Senate’s Health and Human Services budget committee. “When you look at this, you don’t know if you need Medicaid reform as much as a reform of the business practices that let this go on.”

In the agency’s response, AHCA officials acknowledged past payment problems and difficulties with getting health care providers to submit rates in a timely fashion. AHCA said it is also looking to impose fines on those that fail to submit the proper paperwork before seeking payments.

“The agency does not believe that the report concludes that oversight of billing is lax,” said Tiffany Vause, an AHCA spokeswoman. “The agency makes every effort to collect the cost reports in a timely manner, diligently review and audit the reports and establish the rates. Late filed or amended cost reports may be necessary due to circumstances beyond the provider’s control.”

The report by Auditor General David Martin was released in late April, about the same time state lawmakers were considering a sweeping rewrite of the $19 billion Medicaid program.

The Senate wanted to expand a five-county Medicaid pilot program to 19 counties, drawing 250,000 low-income Floridians into managed care. The House would have expanded Medicaid managed care statewide over the next five years in a bid to rein-in program costs that now absorb a quarter of all state spending.

While the House and Senate failed to reach a consensus on revamping Medicaid, the effort proved an enduring subplot in the session and is expected to re-emerge next year when an even tougher budget prods lawmakers to rein-in state spending across many areas.

Fallout from the state’s troubled efforts to combat Medicaid fraud also nearly cost AHCA Secretary Tom Arnold his job, with the Senate waiting until the session’s final day to confirm his appointment last fall by Gov. Charlie Crist.

During the period reviewed by auditors, Arnold was AHCA chief-of-staff under then-AHCA chief Holly Benson, now a Republican candidate for attorney general. As part of her campaign, Benson has touted her Medicaid fraud-fighting and ability to “reduce the regulatory burden for providers and consumers.”

Benson said the billing problems cited by auditors were relatively small — and occurred during a time period when Medicaid switched fiscal agents. Technology giant Electronic Data Systems (EDS) took over the state contract from Affiliated Computer Services, Inc., (ACS) and the state upgraded a 20-year-old computer system.

“We were going through a transition,” Benson said. “If you put this in context, I think the department did pretty well.”

Vause, the AHCA spokeswoman, added, “Many of the issues identified have been resolved and others are being addressed.”

The AHCA audit, anchored on procedural failings within the Medicaid program, does not calculate the amount of dollars that may have been misspent. But in examining a small sample of hospitals, hospices and rural health clinics, auditors pointed out that bills were often paid using inaccurate rates and “resulted in overpayments for some claims.”

Nineteen nursing homes were paid $40.6 million during the 2008-09 year without the facilities submitting actual cost data, auditors found, prompting AHCA to make payments based on its own estimates. “The agency is unable to ensure that nursing homes were paid the amounts legally authorized by law,” according to the audit.

House Health Care budget chair Denise Grimsley, R-Lake Placid, who helped craft the House’s Medicaid overhaul, acknowledged that the small sample size of health care providers used for the audit made it difficult to make “generalizations about the program.” There are more than 80,000 Medicaid service providers statewide.

But Grimsley added the audit, “supports what I have said many times and that is: Florida’s Medicaid program is complex and largely unmanageable; AHCA’s resources for operating a program of this size and complexity are very limited; and legislatively-authorized policies for buy-backs and other adjustments to rates further complicate the rate setting process.”

She said the findings, “support a fundamental redesign of the system.”

The second annual meeting of the Alliance for Pediatric Therapies will be held June 4 at Arnold Palmer Children’s Hospital in Orlando.

We’re looking forward to setting our goals for 2010-11.

For membership information, please contact Alisa Snow at alisa@allianceforpediatrictherapies.com.